Vegadhāraṇa and Hṛdroga: A Critical Evidence-Mapping Review of Classical Ayurvedic Descriptions and Contemporary Cardiovascular Correlates

Background: Cardiovascular disease (CVD) is the leading global cause of morbidity and mortality, yet the cardiovascular consequences of habitually suppressing natural physiological urges remain largely uninvestigated in contemporary medicine. Classical Ayurveda identifies Vegadhāraṇa (voluntary suppression of natural urges) as a foundational Nidāna, linking several non-suppressible urges (Adhāraṇīya Vegas) to cardiac and precordial symptoms (Hṛdaya involvement) across the Bṛhat-Trayī. Objective: To critically evaluate contemporary physiological, clinical, and occupational literature relevant to classical Vegadhāraṇa-Hṛdroga correlations, distinguishing direct evidence from indirect analogy and avoiding unwarranted claims of causation or nosological equivalence. Methods: A narrative evidence-mapping review was conducted across PubMed/MEDLINE, ScienceDirect, Scopus, Google Scholar, the AYUSH Research Portal, and DHARA (inception to 15 August 2026), cross-referenced against primary classical texts and commentaries. Evidence was classified using a five-tier hierarchy (direct, moderately direct behavioural, indirect physiological analogy, disease-model extrapolation, evidence gap) across two tiers distinguishing general suppression harm from cardiovascular-specific evidence. Results: Classical texts describe three precordial manifestations — Hṛdroga, Hṛdi Vyathā, and Vibandha Hṛdaya-Urasi — across five Adhāraṇīya Vegas. Situational syncope offers an indirect, Valsalva-mediated parallel for excretory/breath-related urges; suppressed sneezing yields direct mechanical-injury evidence, though non-cardiac; emotional-expression inhibition and sleep-restriction data provide indirect sympathovagal parallels; restrictive eating disorders offer disease-model extrapolation for hunger suppression; and Śukra Vega remains an evidence gap. Conclusion: Contemporary literature is compatible with selected elements of the classical Vegadhāraṇa framework, but direct evidence for habitual urge suppression as an independent cardiovascular risk factor remains insufficient. A hypothesis-generating sympathovagal model and 4-phase translational pathway are proposed for future validation. Keywords: Vegadhāraṇa, Adhāraṇīya Vega, Hṛdroga, Hṛdi Vyathā, Udāvarta, Caraka Saṃhitā, Suśruta Saṃhitā, Aṣṭāṅga Hṛdaya, Situational syncope, Autonomic nervous system, Cardiovascular physiology, Evidence mapping