E-ISSN:2456-3110

Case Report

Cerebro-Vascular Stroke

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 7 July
Publisherwww.maharshicharaka.in

A successful Ayurvedic Intervention of Pakshaghata (Cerebro-Vascular Stroke) - A Case Report

Srivastava S.1*, Gupta S.2
DOI: http://dx.doi.org/10.21760/jaims.8.7.36

1* Sanjay Srivastava, Professor & HOD, Department of Rog Nidan Evum Vikriti Vigyan, Pt. Khushi Lal Sharma Government Ayurveda Institute, Bhopal, Madhya Pradesh, India.

2 Sakshi Gupta, Post Graduate Scholar, Department of Rog Nidan Evum Vikriti Vigyan, Pt. Khushi Lal Sharma Government Ayurveda Institute, Bhopal, Madhya Pradesh, India.

Pakshaghata (Stroke) is one of the most common causes of death especially in the elderly. Vataja Nanatmaja Vyadhi, Pakshaghata is a Mahavatavyadhi. Pakshaghata has been linked to hemiplegia, a type of paralysis caused by a cerebrovascular accident or stroke. Paksha refers to a man's flank or side, while Ghata, Aghata, and Vadha refer to killing, destruction, and paralysis. Pakshaghata mainly occurs due to the obstruction of cerebral blood vessels, ischemia, and lack of glucose metabolism and weakness of nerve cells. Ayurveda offers various treatment modalities for the management of Pakshaghata such as; use of herbs & formulation, Yoga and Shodhana Chikitsa. Present article described various approaches of Ayurveda for the management of Pakshaghata including natural herbs and Shodhana Chikitsa. Treatment protocol was Snehana, Mridu Swedana, Basti Karma, Murdhani Taila (Shirodhara) along with internal medication which is mentioned by Acharyas. Utilizing the basic concept of Ayurveda (Nidanpanchaka), drugs with potent properties such as Vataghna, Bruhana, Ushna Veerya were utilized to manage this condition which showed promising results. This reveals that Ayurveda treatment modalities can play a significant role in treatment of Stroke (Pakshaghata).

Keywords: Pakshaghata, Vatavyadhi, Shaman, Shodhan Chikitsa

Corresponding Author How to Cite this Article To Browse
Sanjay Srivastava, Professor & HOD, Department of Rog Nidan Evum Vikriti Vigyan, Pt. Khushi Lal Sharma Government Ayurveda Institute, Bhopal, Madhya Pradesh, India.
Email: 		Sanjay Srivastava, Sakshi Gupta, A successful Ayurvedic Intervention of Pakshaghata (Cerebro-Vascular Stroke) - A Case Report. J Ayu Int Med Sci. 2023;8(7):188-192.
Available From
https://jaims.in/jaims/article/view/2503

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-05-29 2023-05-31 2023-06-07 2023-06-14 2023-06-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes

© 2023by Sanjay Srivastava, Sakshi Guptaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Srivastava S et al: A successful Ayurvedic intervention of Pakshaghata

Introduction

Pakshaghata is a Vatavyadhi and a large number of the population is affected by disease globally and elderly people are more susceptible than younger one. Various etiological factors such as; Virudha Aahara, Atijagarana, Ati Vyavaya, Asruk Srava, Vichesta, Dhatu Kshya, Shoka, Chinta, Diwaswapna, Marmabhighata and Vegasandharana initiates pathogenesis of Pakshaghata.[1-3] Pakshaghata can be correlated with the disease Stroke. Stroke is the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is lost by blockage or rupture of an artery to the brain.[4] Modern science described age, arteriosclerosis, injury, hemorrhage, nutrition imbalance and anxiety as causative factors of disease. These factors vitiated Doshas especially Vata, causes nerve degeneration further resulting obstruction in nerve impulse which leads to altered functioning of cerebral vessels and finally hemorrhagic strokes.[5,6] The most common symptom of a stroke is sudden weakness or numbness of the face, arm or leg, most often on one side of the body. Other symptoms include: confusion, difficulty in speaking, difficulty in seeing with one or both eyes; difficulty in walking, dizziness, loss of balance or coordination; severe headache with no known cause; fainting or unconsciousness. Cerebrovascular accidents, sometimes known as strokes, are divided into two categories: A blockage causes an ischemic stroke, while a blood vessel rupture causes a hemorrhagic stroke. Both types of strokes deprive a section of the brain of blood and oxygen, resulting in the death of brain cells. A blood clot in the brain blocks or clogs a blood vessel, resulting in an ischemic stroke.[7] Ischemic strokes are the most prevalent form, accounting for around 80% of all strokes. A blood vessel breaks and bleeds into the brain, resulting in a hemorrhagic stroke. About one-fifth of patients with an acute stroke die within a month of the event and at least half of those who survive are left with physical disability.[8]

Case Report

A 67 years old male patient was clinically diagnosed as a case of Pakshaghata (stroke) presented with the chief complaints mentioned below for three months. It was associated with deviation of angle of mouth to right side, salivation from right side, unable to move (right side), loss of sensation of the right side of the body.

Past History: Hypertension from 10 years and taking Tab Telmisarton and Tab Ecospirin for this.

Chief complaints of the patient

  • Weakness in the both upper and lower limb
  • Unable to stand and walk
  • Slurred speech
  • Loss of function in right side of the body
  • Deviation of the angle of mouth to the right side
  • Dribbling of Saliva from the right angle of the mouth

Associated Complaints

  • Loss of appetite
  • Insomnia

History of Present Illness: The patient was well before three months, then gradually started complaining of deviation of angle of mouth to right side, salivation from right side, difficulty in walking from right side and then unable to walk and loss of sensation of the right side of the body. The patient received modern allopathic treatment for three months but got temporary relief. However, the rate of recovery was so slow that's why the patient approached Pt. Khushilal Sharma Government Ayurveda Institute, Bhopal for further management.

Clinical Findings

Asthavidh Pariksha

Nadi Vata-Pittaj
Mala Niram
Mutra Samyak
Jivha Niram
Shabdha Aspashta
Sparsha Samsheetoshna
Drik Vikrut
Akriti Madhyam

Physical Examination

  • Blood pressure - 130/70 mmHg
  • Pulse - 76 /min.
  • Pallor - Absent
  • Icterus - Absent
  • Temperature - Afebrile

Radiological Findings

MRI - Non-haemorrhagic patchy acute infarct left centrum semi ovale and fronto-parietal lobe effacing sulci due to oedema.


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Srivastava S et al: A successful Ayurvedic intervention of Pakshaghata

Intervention

a. Shaman Aushad

SN Medicine Dose Duration
1. Aaragwadh Kashay 20 ml BD 39 Days
2. Cap. Ksheerbala 101 Avarti 1 BD 39 Days
3. Kaishor Guggulu 2 BD 39 Days
4. Balarishta 15 ml BD 39 Days
Ashwagandharista 15 ml BD with 30 ml of water
5. Gandharvhastadi Kwatha 30 ml BD 39 Days
6. Giloy Churna 3gm For 4 days & on every 5th day the dose of Vacha Churna was 1.5 gm. Total duration 39 days and at the time of discharge the dose of Vacha Churna was 500mg
Yashtimadhu Churna 3gm BD
Vacha Churna 1gm
8. Rheumasyl Maxx Liniment Local application  -

b. Panchakarma

SN Procedure Drug Used Date
1. Sarvang Mridu Abhyang Ksheerbala Taila 17/03/23 - 24/04/23
2. Sarvang Mridu Nadi Sweda Dashmool Kwatha 17/03/23 - 24/04/23
3. Nasya Shadbindu Tail 17/03/23 - 27/03/23 (8 drops) & 13/04/23 - 15/04/23 (6 drops)
4. Shiropichu Ksheerbala Tail 17/03/23 - 27/03/23 & 03/04/23 - 12/04/23
5. Shirodhara Ksheerbala Taila 28/03/23 - 31/03/23
6. Shirodhara Jatamansi Kwatha 13/04/23 - 24/04/23
7. Matra Basti Ksheerbala Taila - 60ml Satpushpa - 2gm Saindhav - 1gm 28/03/23 - 24/04/23

c. Physiotherapy: Along with Shaman Aushad and Panchakarma therapy, physiotherapy was also given to the patient which shows remarkable results.

Assessment Before and After Treatment

SN Examination BT AT
1. Higher function test    
  Memory Past memory – Normal Past memory – Normal
Present memory- Lost Present memory – Improved
  Intelligence Decreased Improved
  Concentration Disturbed Improved
  Behaviour Confused Precise
  Speech Slurred Improved
  Consciousness Conscious Conscious
  Orientation Disturbed Improved
2. 2-point discrimination Absent Present
3. Cognition Disturbed Improved
4. Power    
  Biceps Right 0 Right 3
Left 3 Left 4
  Triceps Right 0 Right 2
Left 2 Left 4
5. Babinski Sign Right Positive Right Negative
Left Negative Left Negative
6. Reflexes        
  Knee jerk Right Absent Right ↑
Left Present Left Present
  Ankle jerk Right Present Right Present
Left Present Left Present
  Biceps Right Absent Right ↑
Left Present Left Present
  Triceps Right Absent Right ↑
Left Present Left Present


*MRC Grading of Power

Grade 0: No power

Grade 1: Flicker of contraction only

Grade 2: Movement with gravity eliminated

Grade 3: Movements against gravity

Grade 4: Movements against gravity & some resistance

Grade 5: Normal power

Discussion

Acharya Charak has described Pakshaghata in Vata Nanatmaj Vyadhi[9] and Acharya Sushrut has mention in Mahavatvyadhi[10] and also Acharya Charak & Sushrut has given treatment protocol of Pakshaghata[11] which is Snehana, Swedana, Mridu Virechana, Basti Karma, Murdhani Taila. Abhyanga (local massage) is acting on the channels which are carrying muscle nutrients and waste products in it. It has the property to nourish the superficial and deep muscle tissue and make the joint strong. Skin is one of the sense organs and sites of Vayu. Thus, Snehan straight away treats the Vata Dosha.[12]

In present study Ksheerbala Tail is used for Sarvang Mrudu Snehan which has great Vatahar property. Nadi Swedana (sudation) removes the stiffness of the body parts, facilitates joint mobility, clearing the microchannels that increase the blood circulation, and removes the blockage (excess Vata & Kapha) in-between the channels. Nasya with Shadbindu Taila stimulates the peripheral olfactory nerve and acts as chemoreceptors, which identifies the particles and stimulates olfactory bulbs, hypothalamus, and limbic systems. It also works on higher centers at the anterior & posterior pituitary gland and endocrine system as a whole and nervous system. It is also helpful to prevent the recurrence of signs and symptoms. Matra Basti was given with Ksheerbala Taila because it is Vata-Pittashamak. The drug Bala (Sida cardifolia) a well-known Rasayana drug, because of it Pichila, Snigdha, Laghu property and Sheeta Virya subsides Vata and Pitta. As a result of this nutrients/essence reach the Dhatus transferring through the minute Srotas. Thus, it helps in subsiding Vata dominant in old age causing Vayasthapan enabling the essence to reach all Dhatus.



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Srivastava S et al: A successful Ayurvedic intervention of Pakshaghata

Conclusion

In the treatment of Pakshaghata, Sarvang Mridu Abhyang and Sarvang Mridu Vaspa Sweda, Nasya, Shirodhara, Shiropichu, Matra Basti and Shaman (palliative) treatment play a vital role in relieving all signs and symptoms and associated complaints. Before treatment the patient was unable to stand, his right side of the body lost sensation and reflexes, but after taking treatment the patient was able to stand and took some steps with support and felt sensation and seen improvement in the reflexes. As this is a single case study, there is a need for a large number of patients in a randomized clinical trial to establish the effectiveness of the above treatment protocol in the management of Pakshaghata.

Reference

1. YT Acharya, Editor, Caraka, Caraka Samhita Chikitsasthana 26/77-103 Choukhambha Krishnadas Academy, Reprint 2006. 602-605

2. YT Acharya Editor, Caraka, Caraka Samhita Sutrasthana 26/4 Choukhambha Krishnadas Academy, Reprint 2006. 144.

3. Pandit Parasuram Sastri Editor, Sarngadhara, Sarngadharasamhita Pradhamakhanda 4/9-10 Choukhambha Surabharati Prakashan, Varanasi, 2006. 36-37.

4. Walter Johnson, Oyere Onuma, Mayowa Owolabi & Sonal Sachdev. Bulletin of the World Health Organization 2016.

5. K. Nishteswar, Ayurvedic Management of Stroke (Hemiplegia), Choukhambha Krishnadas Academy Varanasi, 2nd Edition, 2009. 61.

6. G.S Pandey Editor, Bhavamisra, Bhavaprakasa Nighantu, 1/196. Chowkambha Bharathi Academy, Varanasi, 2010. 111.

7. Ehrlich ME, Liang L, Xu H, et al. Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients with History of Stroke Plus Diabetes Mellitus. Stroke. 2019;50(6):1497-1503. doi:10.1161/STROKEAHA.118.024172

8. Nicki R. Colledge, Brian. R. Walker, Stuart H. Ralston Ian D. Penman, editors. Davidsonʼs principles & practice of medicine. 22nd edition. Churchil livingstone elsevier. p-1237.

9. Agnivesha. CharakaSamhita. Panday Kashinnath & Chaturvedi Gorakhnath, editor. Sutra Sthana, 20/11. Varanasi: Chaukhambha Sanskrit Series Office; 2013.p-399.

10. Susruta. Susruta Samhita. Shri Dalhanacharya, editor. Chikitsa Sthana, 5/19, Varanasi: Chaukhambha Surbharti publisher; 2018. p-43.

11. Agnivesha. Charaka Samhita. Panday kashinnath & Chaturvedi Gorakhnath, editor. Chikitsa Sthana, Vatavyadhichikitsa 28/100. Varanasi: Chaukhambha Sanskrit Series Office; 2013. p-795.

12. Mohan M, Sawarkar P. Ayurvedic management of Gridhrasi with special respect to sciatica: a case report. J Indian Sys Medicine 2019;7:131-8.


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