Role of Ayurvedic management in Pakshaghata (Hemiplegia): A Case Report

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[Find the meaning and references behind the names: Sharma, Vivek, Kumar, Shrikant, Hani]

CASE REPORT March 2024 Journal of Ayurveda and Integrated Medical Sciences | March 2024 | Vol. 9 | Issue 3 204 Role of Ayurvedic management in Pakshaghata (Hemiplegia): A Case Report Shrikant Lodhi 1 , Ratnesh Kumar Shukla 2 , Vivek Sharma 3 , Shraddha Sharma 4 1,2 Post Graduate Scholar, 1 st Year, Dept. of Kayachikitsa, Pt. Khushilal Sharma Govt. (Auto.) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India. 3,4 Assistant Professor, Pt. Khushilal Sharma Govt. (Auto.) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India. I NTRODUCTION Hemiplegia is a condition with gradual weakness or loss of functions on either half of the body. (Hemiplegia is a Greek word hemi - half and plagia - loss of function. Stroke is considered the foremost cause of neural disabilities which may be hemorrhagic or due to infarctions [2] The aggravated Vaat Dosha results in Karmhani of either side of the body, resulting in immobility or loss of power of the affected half. According to WHO data published in May 2014 stroke death in India has reached 881,702 or 9.94% of total deaths. The prevalence of stroke in India is approximately 200 per 100 000 persons [3] Stroke in Address for correspondence: Dr. Ratnesh Kumar Shukla Post Graduate Scholar, 1 st Year, Dept. of Kayachikitsa, Pt. Khushilal Sharma Govt. (Auto.) Ayurveda College and Institute, Bhopal, Madhya Pradesh, India. E-mail: drratneshs@gmail.com Submission Date: 14/01/2024 Accepted Date: 23/02/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.3.32 Ayurveda can be correlated with Pakshaghata . Pakshaghata is a type of Vaat Vyadhi of the Nanatmaja variety which manifests either due to Dhatukshay or Margavarna . Considering all Samprapti Ghataka , Acharyas have advised different Shodhana and Shamana Chikitsa i.e ., Snehana, Swedana , Virechana, Basti, Nasya in its treatment. In the present case patient was having Dakshin - Paksha (Right) Chesta Hani (Loss of functions) , Vaka Stambha (speech difficulty) and Ruja (Pain) [5,6] C ASE R EPORT Patient was asymptomatic before 10/03/2023. While sleeping in night he started experiencing numbness over the right half of the body including extremities, headache and reduced strength over right hand and leg. On next morning he suddenly started experiencing slurring of speech. He was admitted to nearby allopathic hospital. He took treatment there for 15 days with no or mild improvement. Then he came to OPD of PTKLS Govt Ayurveda hospital Bhopal for ayurvedic treatment. After going through the history, the patient was diagnosed as a case of Pakshaghata. Chief complaints A 50 years old male patient was clinically diagnosed as a case of hemiplegia presented with the following chief complaints - A B S T R A C T Hemiplegia is a condition with gradual weakness or loss of functions on either half of the body. The injury to the motor centers of the brain either due to ischemia or hemorrhage, can cause poor balance, speech deficits and loss of function. The prevalence rate of hemiplegia is 9 cases per 1000 in global population [1] In Ayurveda , this condition can be compared to Pakshaghata due to similarity in clinical signs and symptoms being. According to Acharya Charaka Pakshaghata is a Vatavyadhi , where vitiated Vata Dosha is involved in its pathogenesis . Since Pakshaghata is Nanatatmaja Vaat Vyadhi hence use of oral ayurvedic drugs along with Panchakarma therapeutics is recommended. Key words: Pakshaghata, Vata Vyadhi, Hemiplegia.

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[Find the meaning and references behind the names: Bala, Netra, Mala, Anu, Min, Sama]

Shrikant Lodhi et al. Role of Ayurvedic management in Pakshaghata (Hemiplegia) ISSN: 2456-3110 CASE REPORT March 2024 Journal of Ayurveda and Integrated Medical Sciences | March 2024 | Vol. 9 | Issue 3 205 ▪ Complete loss of function of right upper and lower extremities ▪ Numbness in the above said area ▪ Vaka- Aspashtata (Slurred speech) ▪ Shirahshoola ( Headache) ▪ Daurbalya (severe weakness) Past History - Hypertension-2 yrs Family History - NA Radiologic Report CT Brain Plain [15-03-2023] Hyperdense area of hemorrhage is seen in left basal ganglia measuring 19×16 mm. Mass effect is seen in the form of effacement of left ventricle. Chronic lacunar infract is seen in right basal ganglia. Diffuse symmetric per ventricular hypodensity is seen-leukoaraiosis. On examination - Patient was conscious, well oriented to time -place and person, Recent and remote memory-intact. Ashtavidha Pariksha/Samanya Pariksha : [7] Nadi (pulse) 78/min Mala (stool) Vibandha Mutra (urine) Samyak Jivha (tongue) Sama Netra (eyes) Shwetabh Pitta Sparsh (skin) Ruksha Akriti Madhyam Bala Avara Systemic Examination Raktachaap (B.P.) 130/70 mm of Hg Gait/Decubitus Patient was unable to walk R.S. Normal C.V.S. Normal G.I.T. Constipated Neurological Examination Sensory System a Pain: Present on bilateral extremities b Touch: Present on bilateral extremities c Temperature: Present on bilateral extremities Motor System Right upper limb Right upper limb Right lower limb Right lower limb Before Treatment After Treatment Before Treatment After Treatment Tone Hypotonia ++ + Hypotonia + Hypotonia ++ + Normal Power 2 4 2 4 Reflexes Biceps: +1 Biceps: +2 Knee: +3 Knee: exaggerate d Triceps: +1 Triceps: +2 Ankle: +3 Ankle: exaggerate d Supinator: +1 Supinator: +2 Plantar: extensor (Babinskis sign +ve) Plantar: extensor (Babinskis sign -ve) Treatment Regimen Date Panchakarma Shamana Aushadhi 28-11-23 to 04-12-23 Shiro Pichu - Bala Tail Sarwang Abhayanga Swedana with Vatashamak Tail Yograj Guggulu 1 bd Ashwgandha Churn 5 gm bd Lakshadi Guggulu 1 bd Rashnaspatak Kwath 10 ml bd 05-12-23 to 19-12-23 Nasya with Anu Tail 6-6 drops each nostril Yograj Guggulu 1 bd Ashwgandha Churna 5 gm bd

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[Find the meaning and references behind the names: Guna, Guru, Rasa, Sneha]

Shrikant Lodhi et al. Role of Ayurvedic management in Pakshaghata (Hemiplegia) ISSN: 2456-3110 CASE REPORT March 2024 Journal of Ayurveda and Integrated Medical Sciences | March 2024 | Vol. 9 | Issue 3 206 Sarwang Abhayanga Swedana with Vatashamak Tail Lakshadi Guggulu 1 bd Rashnaspatak Kwath 10 ml bd 20-12-23 to 09-01-24 Matra Basti - Bala Tail 40 ml Sarvang Patra Pinda Swedana Rasraj Ras 125 mg 1 bd Yograj Guggul 1 BD Assessment of the patient after total treatment of 45 days ▪ Difficulty in walking improved now patient can walk without support for at least 15 to 20 min. ▪ Weakness of the right upper extremity reduced. ▪ No pain in the upper and lower limb. ▪ Improvement in speech difficulty. DISCUSSION A stroke is defined as the sudden death of brain cells that occurs due to a blockage of blood flow or a rupture of an artery to the brain. In Ayurveda it is correlated with Pakshaghata. Pakshaghata is Vaat Vyadhi where impairment of Vata Dosha is seen. Panchakarma is an important aspect of managing Pakshaghata in Ayurveda . Abyanga - Sira Snayu Sonkochana mainly occurs in Pakshaghata hence Snehana is very essential for the condition. Abyanga helps in nourishing and strengthening the muscle power of upper and lower extremities . Swedana is the procedure that relieves Stambha Guarav, Sheeta which induce Sweda (sweating ). Swedana has the ability to provide pain relief to patients who complain pain in the affected part [8] Nasya , is an important therapy in Shirorogas. Nose has been explained as the entrance for Shiras [9] Pakshaghata is primarily a Vaat disorder. Therefore the treatment should mainly focus on Balya and Brihana drugs which alleviate Vaat, hence Nasya Karma with Ksheerbala Tail is used. Nasya Karma has a definitive impact on central neurovascular system and likely lowers the blood brain barrier to enable certain drug absorption in the brain tissue [17] It is believed that the certain drugs administered through nose may have an impact on immediate psychological functions by acting limbic system through olfactory nerves [17] Matra Basti is a type of Sneha Basti . This therapy is indicated in all age group. It is very unique therapeutic procedure having preventive, curative as well as promotive aspect. It is used in all types of Vaat Vyadhis. [10] The drugs in Bala Taila as per Charak are ‘ Marutaghana’ . Taila is mentioned to reduce Vata without increasing Kapha . Administration of Basti in such patients promotes Bala and Varna . Sneha by its Singdha , Guru and Ushana Guna counteracts the Ruksha , Laghu and Sheeta Guna of Vayu respectively. Thus , Brihana Karma occurs by use of this type of Basti . Also, there is no other therapy better than Basti , which is useful for patients suffering from Vaataj Vikar. Yograj Guggulu [14] - mainly the drugs having property like Tikta, Kashaya, Katu Ras and Ushna, Ruksha Guna, Ushna Vriya act as Kaphavatahar and Yograj Guggulu also act as Vedana Stapak , Nadi Balya , Shulshamak , Shotohara which is most essential in promoting symptomatic relief in Vaat Vyadhi. Lakshadi Guggulu [14] works as an anti-inflammatory, analgesic which can reduce the symptoms of Pkashaghat. Rasraj Rasa - it works on all three Dosha specially Vata . It has the ability to be both a nervine and cardiac tonic. In the case of stroke, it strengthens nerve muscles and aids in the restoration of nerve and blood vessel functions [18] Aswagandha Churna - It is used for various kinds of disease processes and as specially as a nervine tonic [18] Rashnaspatak Kwath - Maximum ingredients of Rasnasapatak Kwath have Vaatkaphahar p roperty which reduces symptoms of Pakshaghata. [16] CONCLUSION Ayurveda is believed to offer beneficial effects particularly in neuromuscular disorders. Pakshaghata being a Vaat Nanatmaja Vayadhi belongs to this

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[Find the meaning and references behind the names: Shri, Ramniwas, Anand, Ravi, Lakshmi, Radheshyam, Govinda, Ray, Nil, Krishana, Med, Chaudhary, Prakashan, Gopal]

Shrikant Lodhi et al. Role of Ayurvedic management in Pakshaghata (Hemiplegia) ISSN: 2456-3110 CASE REPORT March 2024 Journal of Ayurveda and Integrated Medical Sciences | March 2024 | Vol. 9 | Issue 3 207 category thus treatment modality consisting of oral Ayurvedic formulation along with Panchakarma administration is considered to be having significant impact on the overall wellbeing of the suffer. Recommendation Since the current case study was confined to a single case of Pakshaghata a large sample size may be selected to assess the efficacy of the above-mentioned treatment regimen. REFERENCES 1 Global Health Estimates. Geneva: World Health Organization: 2012 Available from: http:/www.who.int/healthinfo/globalburdendisease/en. 2 Munjal YP API text book of medicine. Vol-2, 9 th edition, New Delhi. Jaypee brothers Medical publisher (p) Ltd.2012; P 1401 3 World health rankings - the top 20 causes of death in India. http/www.worldlifeexpectency.com /india-stroke.published by WHO may 2014. 4 Munjal YP API text book of medicine. Vol-2, 9 th edition, New Delhi. Jaypee brothers Medical publisher (p) Ltd 2012; P 1403. 5 Charak Samhita, Editior acharya vidyadhar Shukla,prof.ravi dutta Tripathi,Chaukhambha Publication Vol-2 ch.28 Sloka 53- 55,59 p.697. 6 Susruta Samhita, Editior Kaviraja ambikadutta shastri,vol-1 nidan sthan chapter-1 sloka no.60-63 p no-302. 7 Yogratnakar Vidyotini hindi commentary by Vaidya Shri Lakshmi Pati Sastri, Chaukhambha Prakashan, Varanasi, 2015 Edition, Chapter, page No-5. 8 Charak Samhita, Editior acharya vidyadhar Shukla, prof.ravi dutta Tripathi, Chaukhambha Publication Vol-1 sutra sathan- 13,14. 9 Charak Samhita, Editior acharya vidyadhar Shukla, prof.ravi dutta Tripathi, Chaukhambha Publication Vol-2 Sidhi sthan chap-9 p -958. 10 Charak Samhita, Editior acharya vidyadhar Shukla,prof.ravi dutta Tripathi,Chaukhambha Publication Vol-2 sidhi sthan chap-4 sloka no 53-54 p-915. 11 Susruta Samhita, Editior Kaviraja ambikadutta shastri, vol-1 Chiktsha sthan chapter-5 sloka no.19 p-42. 12 Ramniwas sharma, hindi translation of Sahastrayogyam, Tailaprakarama, New Delhi, Chaukhambha Sanskrit Pratishthan, 2016, Pg.No.75. 13 Vagbhattacharya, Rasaratnasamucchaya, edited by Dattatreya Anant Kulkarni, Meharchand Lachhamandas Publication, New Delhi: Reprint 2010, 21 st Chapter Verse 131140,441 pp. Shri.Govinda Das, Bhaishajya Ratnavali, edited. 14 Rastantrasaar and siddhaprayog sangharha part-1 Prakshak - krishana gopal ayurved bhavan Taila Prakarn p no-422 and Guggulu Prakaran p no-322. 15 Ray c, et.al. Evaluation of neuro-protective activity of aswagandha and vacha in combination as ayurvedic Medhya rasayana in vivo. Int ayurvedic Med J.2016;4(10);2914-22. 16 Pandey, Shruti & Chaudhary, Anand. (2017). A REVIEW ON RASNA SAPTAK KWATH: AN AYURVEDIC POLYHERBAL FORMULATION FOR ARTHRITIS. International Journal of Research in Ayurveda & Pharmacy. 8. 4-11. 10.7897/2277- 4343.08126. 17 Ayurvediya panchakarma Chiktsha by Prof. Radheshyam sharma, Dr Gopesh, Dr gunjan, p no-247. 18 Ayurvedasaar sangrha, Shri vaidhyanath ayurveda bhavan Edition 2022 p 443-444. ******************************* How to cite this article: Shrikant Lodhi, Ratnesh Kumar Shukla, Vivek Sharma, Shraddha Sharma. Role of Ayurvedic management in Pakshaghata (Hemiplegia): A Case Report. J Ayurveda Integr Med Sci 2024;3:204-207. http://dx.doi.org/10.21760/jaims.9.3.32 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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