THORACIC DUCT AND LYMPHATIC CONGESTION IN CARDIOVASCULAR DISEASE: AN INTEGRATED AYURVEDIC AND BIOMEDICAL LITERATURE REVIEW

Background: Lymphatic dysfunction and thoracic duct congestion are emerging as critical yet underappreciated pathomechanisms in cardiovascular disease (CVD). Classical Ayurvedic medicine offers an elaborate conceptual framework — centered on Rasavaha Srotas, Hridaya Marma, and Medo Dhatu — that closely parallels contemporary biomedical understanding of the lymphatic-cardiac axis. This literature review synthesises the biochemical, physiological, pharmacological, and pathophysiological evidence linking thoracic duct dysfunction to coronary artery disease, heart failure, and atherosclerosis, with concurrent integration of Ayurvedic classical textual references. Methods: A systematic literature search was conducted across PubMed, Scopus, Ayush Research Portal, and classical Sanskrit textual databases (Charaka Samhita, Sushruta Samhita, Ashtanga Hridayam, Sharangadhara Samhita) for studies published up to 2024. Keywords included: lymphatic congestion, thoracic duct, cardiovascular disease, VEGF-C, LYVE-1, Rasavaha Srotas, Hridroga, Srotorodha, and cardioprotective phytochemicals. One hundred references were critically reviewed and synthesized. Results: Robust experimental and clinical evidence confirms that impaired cardiac lymphangiogenesis accelerates post-infarction inflammation, myocardial fibrosis, and pericardial pathology. Cholesterol-laden chylomicron reflux from a congested thoracic duct contributes measurably to coronary atherogenesis. The Ayurvedic construct of Rasavaha Srotorodha (channel obstruction) maps mechanistically to lymphatic congestion, while Medo Dhatu Dushti corresponds to dyslipidaemia. Eight key medicinal plants — Punarnava, Arjuna, Guggulu, Pippali, Devadaru, Haritaki, Varun, and Shilajatu — demonstrate lymphagogue, anti-atherogenic, anti-inflammatory, and cardioprotective activities at biochemical and molecular levels. Conclusion: The lymphatic-cardiac interface represents a convergence zone where classical Ayurvedic pathophysiology and modern biomedical science achieve remarkable congruence. Polyherbal Ayurvedic formulations targeting this axis hold significant therapeutic promise that warrants rigorous clinical evaluation.

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• CS = Charaka Samhita; SS = Sushruta Samhita; AH = Ashtanga Hridayam; BP = Bhavaprakasha; Sutra = Sutra Sthana; Vimana = Vimana Sthana; Nidana = Nidana Sthana; Sharira = Sharira Sthana; Chikitsa = Chikitsa Sthana; Uttara = Uttara Tantra.