Ayurvedic management of Pakshaghat (Cerebrovascular Accident): A Case Study

About Author

Correspondence Address

Shri Ayurved Mahavidyalaya, Nagpur
Contact No. : 9403294868, Email : sohammadankar22@gmail.com

Date of Acceptance : 02 Sep 2024

Date of Publication : 27 Sep 2024

Article ID : SD-IJAY_099

How to cite this article : http://doi.org/10.55552/SDNJAY.2024.2302

Abstract

Stroke is one of the leading causes of death and disability in India. Stroke is a heterogeneous group of disorders. The medical field has faced significant challenges in treating this disease. There is an abundance of information available regarding the cause, prevention, risk, and treatment of stroke. Even so, our understanding of stroke treatment remains limited; there is currently no satisfactory and widely accepted treatment for stroke. Researchers in both Ayurveda and modern fields are conducting numerous studies to improve the management of cerebrovascular accidents (CVA). Ayurveda describes stroke (CVA) as Pakshaghata. Pakshaghata, also known as Nanatmaja vatavyadhi, arises due to vataprakopa. It affects the sira and snayus of half the body parts, as well as the face. In hemorrhagic conditions, vitiated vatadosha, pitta, and raktdushti are the main causes of pakshaghata. The study's goal was to assess the effects of ayurvedic treatment on pakshaghata. Sharia regards Vata as the controller of all the Tridoshas. Vatavyadhi is the influence of vitiated Vata on the Dushyas, which penetrates the entire body or a part of it and causes various ailments.

Material and Methods: A case study of CVA was admitted, with the patient presenting with complaints of drowsiness, difficulty walking, slurred speech, heaviness of the affected side of the body, pain, stiffness, bladder incontinence, and slurred speech. Upon examination, the Glasgow Coma Scale was 14/15 (E -3, M-5, V-6), and a CT scan of the brain revealed an intraparenchymal haemorrhage in the left gangliocapsular region, measuring 3.3 x 5.1 x3.5 cm. The case was diagnosed as Pakshaghata with Pittavatavruta, in conjunction with laboratory investigations. Various stages of the disease were treated with oral medications, including Snehan, Swedan, Shirodhara, Nasya, Yapan basti, Shashtikshali pindswed, Mruduvirechana, and Jivhanirlekhana. Additionally, physiotherapy sessions were implemented on a consistent basis. Observation and Result: After successfully combining shaman treatment and Panchakarma treatment for consecutive times, the patient got complete relief in all complaints. Before treatment NIH-Stroke Scale was 17 & Barthel index scale was 15 and after the treatment NIH-Stroke Scale was 4 & Barthel index scale was 70 providing symptomatic relief too.

KEY WORDS:- Stroke, Cerebrovascular Accident, Ayurveda, Pakshaghata, Snehana, Swedana

Introduction

The name "Visha" comes from the combination of the words "Vish" and "ka," which indicate to quickly disseminate or absorb. Visha quickly spreads throughout Rasadi Dhatus and takes up residence there. Visha1 which meaning poison, comes from the word vishada, which can also indicate sad spirits or dukha. When the world saw this, it lost all hope or turned into Vishanna; Charaka called it Visha2 The root dusha, which meaning "impure" and "having the property or nature to vitiate," is the source of the word dushi Visha3 According to Susruta and Vagbhata, Dushi Visha: Latent poison (Dushi Visha) is any form of poison that comes from inanimate (sthavara) or animate (jangama) sources, or any artificial poison (kritrim Visha) that is retained in the body after partial expulsion or that has temporarily undergone detoxification by anti-poisonous drugs, forest fire, wind, or sun. Any poison that lacks the ten inherent qualities of Visha and is unable to cause severe poisoning symptoms can also be referred to as Dushi Visha. Delay in effect and cumulative toxicity on the body are attributed to low potency of all 10 attributes. The poison's low potency means that it won't be fatal. These low potency poisons are kept in the body for extended periods of time without causing lethal symptoms, much like the encircling action of Dosha Kappa (Avarana)4, 5

Discussion

Acharya Charak has described Pakshaghata in vata nanatmaj vyadhi [8] and Acharya Sushrut has mention in mahavatvyadhi [9] and also Acharya Charak & Sushrut has given treatment protocol of Pakshaghata [10] which is Snehana, Swedana, Basti karma, murdhani taila, Nasya, Shashtikshali Pindsweda, Mruduvirechana, Jivhanirlekhana and oral medication accordingly treatment was in this patient. The case taken for study was diagnosed as Pittavatavrutta Pakshaghata (CVA). Considering the involvement of doshas i.e. pradhanyata of Pitta, Vata and Rakta dhatu dushti assessed on basis of laxanas. The treatment was planned according to the Dosha, Dushya and Sthana dushti. The Prakupita Pitta dosha got ashraya in the Raktavaha srothas because of Sanga and Atipravrutti type of Strothodusti. The pathological consequences are seen all over the body, involving rakta, mamsa, majja dhatu and the Uttamanga Shir Marma. Hence below mentioned treatment plan was done in keeping interest of Dosha, Dushya and Sthana dushti.

Patient was admitted on 10/07/2024 at 2:20 pm in IPD Pakwasa Samanvaya Rugnalaya. Shaman Chikitsa was started Bruhatvatachintamani Rasa [11] having properties such as medhya, rasayana, lekhana, balya, kshayagna, ojovardhana & yogavahi which has targeted effect for the management of Pakshaghata.  Hemgarbha Pottali [12] contains Parada, Gandhak, Suvarna, Tamra bhasma. It had Rasayana property. It is prepared which is potent medicine in emergency aspect They shows fast action towards mastiksha [13].  Nagkeshar Churna [14] is kashay rasatmak, sheet viryatmaka, ruksha, shoshak, laghu aampachak, therefore it is raktprasadak property. Hence used in combination with Hemgarbha Pottali. Kakolyadi kwatha [15] used as vatapittapradhan-shonitdushti, bhruhana, vrushya and jivaniya perspective. Mansyadi Kashaya [16] used when marmaghata is due to mansik hetu, which reflects in this case. Mashaatmaguptadi Kashaya [17], Gandharva Haritaki Vati [18] helps to control Vata and Pitta with the Anulomana activity, which helps to break the disease's pathophysiology and corrects the body's metabolism [19].   

After 5 days of shaman chikitsa started, Panchakarma treatment started, Sarvanga Snehan [20] was done with Ksheerbala taila [21] because it is snehana vata-pittashamak & balya and Sarvang Swedana[22]  (Nadi Swed) with Dashmoola kwatha [23] together Snehana & Swedana liquefies the dosha and brings them to koshtha [24] . Anuvasan basti [25] as a Matra basti [26] was given with Sahacharadi taila because it is vatashamak. Mustadi Yapana basti [27] was given in after 7 days of anuvasan basti.  Mustadi Yapana basti as it is indicated in Vata vyadi acts as Bruhana, Balya, Mamsabalapradha and Vrushya. Shirodhara [28] started with Tila taila & Bramhi taila [29] as mentioned above proportion because of vata shamak & Sangyasthapan. Shirodhara was planned to treat the Shiro-Marmabhighata. Nasya [30] given as Sangyaprabhodhanartha. As the samprapthi is involved from the Sangyavaha Srothas, the Sangyaprabhodhana Nasya [31] has been done with the Narayan taila [32] which stimulates the Sangya and act as Srothoshodhana too. Shashtikshali pindsweda [33] also started as dhatu Bruhana & Balya perspective. It provides bala to the affected siraa and kandara. Jivhanirlekhana was done as a Sangyaprabhodhanartha with ushna, tikshna dravyas which produces laghavata in tounge by kaphachhedana; those dravyas like Pippali, Vacha, Shunthi, Marich, Madhu.

Glasgow Coma Scale (GCS – Eye opening response was 4, Verbal response was 5 and Motor response was 6; therefore, Total score 15/15.

Conclusion

Several reports suggest that in about 20% of non-cardio-embolic strokes in young (<45 years), the commonly believed risk-factors (e.g. hypertension diabetes mellitus, tobacco use, etc.) are absent [34]. On the basis of results observed in this case; it can be said that, Ayurvedic management with Panchakarma procedure like Abhyanga, Shashtikshali pindswed, Nasya, Matrabasti, Shirodharav, Snehapana, Virechana and Jivhanirlekhan along with oral ayurveda medication are effective in the management of Pakshaghata. These approaches are safe, cost effective and easy to follow. The patient was followed up for two months and there was no any deterioration. As this is a single case study, there is a need for large number of patients randomized clinical trial to establish the effectiveness of the above treatment protocol in the management of Pakshaghata. This case report serves as a lead for further researches in the management of Stroke (Pakshaghata).

References

1. Cerebrovascular Accident Medically reviewed by Seunggu Han, M.D. — Written by Mary Ellen Ellis — Updated on September 29, 2018.
2. Drugs and Cell Therapies in Hematology (ISSN: 2281-4876)
   Volume 10 Issue 1 (2021) 3433 Management of Cerebro-Vascular Stroke (Pakshaghata) with the Successful Intervention of Ayurveda: A Case Report 1. Shumaila Mirza, 2. Dr. Gaurav Sawarkar, 3. Dr. Punam Sawarkar Article Received: 9/04/2021Article Revised 10/05/2021 Article Accepted: 15/06/2021.
3. Jones SP, Baqai K, Clegg A, Georgiou R, Harris C, Holland EJ, Kalkonde Y, Lightbody CE, Maulik PK, Srivastava PM, Pandian JD, Kulsum P, Sylaja PN, Watkins CL, Hackett ML. Stroke in India: A systematic review of the incidence, prevalence, and case fatality. Int J Stroke. 2022 Feb;17(2):132-140. doi: 10.1177/17474930211027834. Epub 2021 Jul 2. PMID: 34114912; PMCID: PMC8821978.
4. Incidence & prevalence of stroke in India: A systematic review Sureshkumar Kamalakannan, 1. Aashrai S. V. Gudlavalleti, 2. Venkata S. Murthy Gudlavalleti, 3. Shifalika Goenka, and Hannah Kuper1Indian J Med Res. 2017 Aug; 146(2): 175–185. doi: 10.4103/ijmr.IJMR_516_15.
5. Dr. Akshay Santosh Gandhi, and Dr. Bhojraj A Chaudhari. (2018). “ROLE OF AYURVEDA IN THE MANAGEMENT OF PAKSHAGHAT VYADHI W.S.R TO HAEMORRHAGIC HEMIPLEGIA.” International Journal of Research - Granthaalayah, 6(11), 23-26. https://doi.org/10.29121/granthaalayah.v6.i11.2018.1101.
6. General consideration of Pakshaghata and its management using natural medicine
   and Ayurveda principles Vd. Shankar Lahuraj Mane 1. Amol S. Patil, 2. Vd. Shital Shankar Mane, 3. Jagdish P. Patil, 4. Ajit U. Dahatonde.
7. The George Washington University Hospital 900 23rd Street, NW, Washington, DC20037202-715-400.
8. Agnivesha. CharakaSamhita. Panday kashinnath & Chaturvedi Gorakhnath, editor. SutraSthana, 20/11. Varanasi: Cukhambha Sanhaskrit Series Office; 2013.p-399.
9. Susruta. SusrutaSamhita. Shri Dalhanacharya, editor. ChikitsaSthana, 5/19, Varanasi: Chaukhambha Surbharti publisher; 2018. p-43.
10. Agnivesha. CharakaSamhita. Panday kashinnath & Chaturvedi Gorakhnath, editor. ChikitsaSthana, Vatavyadhichikitsa 28/100. Varanasi: Cukhambha Sanhaskrit Series Office; 2013. p-795.
11. Review of Bruhat Vata Chintam,ani Rasa in The Management of Pakshaghata (Stroke), IAMJ; 1. Navami L. R., 2. Aniruddha S., 3. Shrilatha T., doi:10.46607/iamj3210022022, ISSN: 2320-5091, Feb. 2022.
12. Pottali Rasayana – The Emergency Medicine of Ayurveda W.S.R. To Hemgagarbha Pottali. 1. Ved Bhushan Sharma, 2. Parul Sharma, Asian Journal of Multidiciplinary Studies. ISSN: 2321-8819, Vol. 3, Issue 3, March 2015.
13. Acharya Vagbhatta. Astangahridaya. Shri Arunadatta & Hemadri, editor. SutraSthana, 7/27; Varanasi: Chaukhambha surbharti prakashan; 2017. p-26.
14. Dr. A. P. Deshpande. Dr. Subhash Ranade. Dr P. R. Javlekar. Dravyagun Vigyana, editor. Pune: Proficient Publishing House; p-677.
15. Susruta. SusrutaSamhita, Dr. Ambikadatta Shastri, editor. SutraSthan 38/36, Varanasi: Cukhambha Sansakrit Sansthan; 2015. p-186.
16. Ayurved Sarsangraha. Shri Baidyanatha Ayurveda Bhavana, editor. Nagpur:Shri Baidyanatha Ayurveda Bhavana Pvt. Ltd.; 2017. p-814.
17. Shri Govind Dasa Sena & Vaidya Ambikadatta Shastri, editor. VatavyahiChikitsaAdhyaya 26/31, Varanasi: Chaukhamba Prakashana; 2022. p-531.
18. Kuchewar VV. Management of Avascular necrosis through Ayurveda–A case study. Journal of Ayurveda and Holistic Medicine (JAHM). 2015 May 15;3(2):41-4.
19. Vaidya HD, Sawarkar P. Ayurvedic remedies for COVID-19-A conceptual study. International Journal of Research in Pharmaceutical Sciences. 2020 Mar 11;11(Special Issue 1).
20. Acharya Vagbhatta. Astangahridaya. Shri Arunadatta & Hemadri, editor. SutraSthana, 2/8. Varanasi: Chaukhambha surbharti prakashan; 2017. p-26.
21. Dr. D.B.Panditrao & Dr. Sharda Nayar, editor. Sahasrayoga. purvardha, 5th prakranam. published from central council for research in Ayurvedic science, ministry of ayush; 2011.p-292.
22. Susruta. SusrutaSamhita. Shri Dalhanacharya, editor. ChikitsaSthana, 37/4, Varanasi: ChaukhambhaSurbharti publisher; 2018. p-531.
23. Susruta. SusrutaSamhita. Shri Dalhanacharya, editor. SutraSthana, 38/71, Varanasi: ChaukhambhaSurbharti publisher; 2018. p-189.
24. Agnivesha. CharakaSamhita. Panday kashinnath & Chaturvedi Gorakhnath, editor. VimanSthana, 11/48. Varanasi: CukhambhaSanhaskrit SeriesOffice; 2013. p-235.
25. Susruta. SusrutaSamhita. Shri Dalhanacharya, editor. ChikitsaSthana, 37/4, Varanasi: Chaukhambha Surbharti publisher; 2018. p-531.
26. Agnivesha. CharakaSamhita. Panday kashinnath & Chaturvedi Gorakhnath, editor. SiddhiSthana, 4/52-54. Varanasi: Cukhambha Sanhaskrit SeriesOffice; 2013.p-1013.
27. Charaka. CharakSamhita. Acharya viddyadhar Shukla & Prof. Ravidatta Tripathi, editor. SiddhiSthan, 12/15(1). Delhi: Chaukhamba SanskrutPratitshthan; 2014. p-961.
28. Susruta. SusrutaSamhita. Shri Dalhanacharya, editor. Uttartantra, 18/46. Varanasi: Chaukhambha Surbharti publisher; 2018. p-636.
29. Ayurved Sarsangraha. Shri Baidyanatha Ayurveda Bhavana, editor. Elahabad:Shri Baidyanatha Ayurveda Bhavana Pvt. Ltd.; 2021. p-787.
30. Paradakara HSS, Ashtanga Hrudayam with Sarvanga Sundaram commentary of Arunadatta and Ayurveda Rasayana of Hemadri. ChikitsaSthana 21. 10th ed. Varanasi (India): Chaukambha Orientalia; 2011. P.726.
31. Paradakara HSS, Ashtanga Hrudayam with SarvangaSundaram commentary of Arunadatta and Ayurveda Rasayana of Hemadri. ChikitsaSthana 21. 10th ed. Varanasi: Chaukambha Orientalia; 2011. P.726.
32. Ayurved Sarsangraha. Shri Baidyanatha Ayurveda Bhavana, editor. Elahabad:Shri Baidyanatha Ayurveda Bhavana Pvt. Ltd.; 2021. p-783.
33. Nisha Singh, Sriyash Dubey. Evaluate the Efficacy of ShashtikShali Pindasweda & Abhyanga in Management of Pakshaghata Along with Virechana w.s.r. To hemiplegia. International Journal of Ayurveda and Pharma Research. 2020;8(7):1-12.
34. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bulletin of the World Health Organisation. 1976;54(5):541–553.