E-ISSN:2456-3110

Review Article

Facial Paralysis

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 9 September
Publisherwww.maharshicharaka.in

A conceptual study of Arditam and its Chikitsa mentioned in Brihatrayis along with its modern correlation (Facial Paralysis)

Anjini M1*, Jaiswal R2, Ram M3
DOI:10.21760/jaims.8.9.20

1* Anjini M, Post Graduate Scholar, Department Of Samhita Evum Siddhant, Government Ayurvedic Pg College And Hospital, Varanasi, Uttar Pradesh, India.

2 Ramnihor Tapsi Jaiswal, Reader, Department of Samhita Evum Siddhant, Government Ayurvedic PG College and Hospital, Varanasi, Uttar Pradesh, India.

3 Manohar Ram, Reader and HOD, Department of Samhita Evum Siddhant, Government Ayurvedic PG College and Hospital, Varanasi, Uttar Pradesh, India.

Ardita is considered as one among the 80 types of Vata Nanatmaja Vyadhi described in our Ayurvedic classics. Ardita with special reference to facial palsy is a disease affecting all ages and more common in the present day scenario which causes distortion of face and associated with the impairment of motor and sensory functions of the affected side of the face, Effective treatment has been highlighted by contemporary science for this crippling disease, by the virtue of targeting the Dosha involved and there by curing the disease through Ayurveda is successful key in the treatment of facial palsy. Various Ayurvedic herbal formulations and Panchakarma procedures have been so far found effective in reversing the condition.

Keywords: Arditam, Facial Palsy, Facial Nerve, Bell’s Palsy, UMN, LMN

Corresponding Author How to Cite this Article To Browse
Anjini M, Post Graduate Scholar, Department Of Samhita Evum Siddhant, Government Ayurvedic Pg College And Hospital, Varanasi, Uttar Pradesh, India.
Email: 		Anjini M, Jaiswal R, Ram M, A conceptual study of Arditam and its Chikitsa mentioned in Brihatrayis along with its modern correlation (Facial Paralysis). J Ayu Int Med Sci. 2023;8(9):125-131.
Available From
https://jaims.in/jaims/article/view/2633

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-07-08 2023-07-17 2023-07-25 2023-08-04 2023-08-13
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 20.25

© 2023by M A, Jaiswal R, Ram Mand 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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Anjini M. et al. A conceptual study of Arditam and its Chikitsa mentioned in Brihatrayis

Introduction

Vata is responsible for controlling all the functions as well as formation of body structures. It is the only motivating force in the body, having propulsive action, through which it moves things and expels waste products from the body. It controls central nervous functions, neuro-muscular activities and mind. It is responsible for all the movements in the body hence under the term Nanatmaja Vyadhi of Vata, 80 diseases have been included which covers wide range of symptoms, one such disease is Arditam. The word Ardita usually indicates ‘a person afflicted or troubled’ according to Shabda Kalpadruma. According to Ayurveda it is explained as a specific disease afflicting the Urdhavanga (parts above the neck, particularly the face). Arditam according to Brihattrayi’s are as follows:

According to Charaka

अतिवृद्धः शरीरार्धमेकं वायुः प्रपद्यते |

यदा तदोपशोष्यासृग्बाहुं पादं च जानु च ||३८||

तस्मिन् सङ्कोचयत्यर्धे मुखं जिह्मं करोति च |

Vayu affects one half of the face dries up the blood, hand, leg and knee produces contracture in that Half

वक्रीकरोति नासाभ्रूललाटाक्षिहनूस्तथा ||३९||

Consequently Nose, Eyebrows, Forehead, Eyes and Jaws get crooked.

ततो वक्रं व्रजत्यास्ये भोजनं वक्रनासिकम् [1]|

स्तब्धं नेत्रं कथयतः क्षवथुश्च निगृह्यते ||४०||

The Bolus of food goes in mouth in the crooked way, crooked nose, Eyes stiffened and sneezing is suppressed in spite of impulse .

भुग्ना जिह्मा समुत्क्षिप्ता कला सज्जति चास्य वाक् |[2]

दन्ताश्चलन्ति बाध्येते श्रवणौ भिद्यते स्वरः ||४१||

Tongue when raised becomes curved, Voice becomes feeble and impeded, Teeth becomes loose, Hearing is deficient and Voice is hoarse.

पादहस्ताक्षिजङ्घोरुशङ्खश्रवणगण्डरुक् |[3]

अर्धे तस्मिन्मुखार्धे वा केवले स्यात्तदर्दितम् ||४२||

There is pain in Foot, Hand, Eye, Shank, Thigh, Temple, Ear and cheek. This disease is localised in one-half of the face.

According to Susrutha Samhita

Nidana of Ardita

गर्भिणीसूतिकाबालवृद्धक्षीणेष्वसृक्क्षये |

उच्चैर्व्याहरतोऽत्यर्थं खादतः कठिनानि वा |

हसतो जृम्भतो भाराद्विषमाच्छयनादपि ||(Su.Ni 1/68)

Pregnant women, Post delivery period, Children, Aged persons, Weak & Emaciated persons, Anemia & Bleeding conditions, Excessive yawning, laughing carrying heavy loads on head, Sleeping in uncomfortable postures, Excessive travelling, Continuous exposure to cold winds.

शिरोनासौष्ठचिबुकललाटेक्षणसन्धिगः |

अर्दयित्वाऽनिलो वक्त्रमर्दितं जनयत्यतः ||(Su.Ni 1/69)

The aggravated Vata localise in places such as Head, Nose, Lips, Chin, Forehead and eyes, produces pain in these parts and gives rise to Ardita.

Lakshana of Ardita

वक्रीभवति वक्त्रार्धं ग्रीवा चाप्यपवर्तते |

शिरश्चलति वाक्सङ्गो नेत्रादीनां च वैकृतम् ||

ग्रीवाचिबुकदन्तानां तस्मिन् पार्श्वे तु वेदना |(Su.Ni 1/70)

Mukha Vakrata, Greeva Vakrata, Sira Kampa, Vak Sanga, Netra & Bhru Stabdha, Greeva, Chibuka & Danta Vedana, Mukha Parswa Peeda.

Purva Rupa

यस्याग्रजो रोमहर्षो वेपथुर्नेत्रमाविलम् ||

वायुरूर्ध्वं त्वचि स्वापस्तोदो मन्याहनुग्रहः |

तमर्दितमिति प्राहुर्व्याधिं व्याधिविशारदाः || (Su.Ni 1/71-72)

Appearance of Horripilation’s, tremors localized or generalized, excessive lacrimation & turbidity of eyes, upward movement of Vata numbness, pricking pain, stiffness in the sides of the neck, stiffness in the lower jaw.

क्षीणस्यानिमिषाक्षस्य प्रसक्तं सक्तभाषिणः |

न सिध्यत्यर्दितं बाढं त्रिवर्षं वेपनस्य च ||७३||

Ardita is incurable in persons who are weak, who do not wink their eye, whose speaking is obstructed constantly, which has persisted for more than 3 years and is accompanied with shaking of the head.



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According to Vagbhata: (Ashtanga Hrdaya)

शिरसा भारहरणादतिहास्यप्रभाषणात् |

उत्त्रासवक्त्रक्षवथोः खरकार्मुककर्षणात् ||३२||

विषमादुपधानाच्च कठिनानां च चर्वणात् |

वायुर्विवृद्धस्तैस्तैश्च वातलैरूर्ध्वमास्थितः ||३३||

वक्रीकरोति वक्त्रार्धमुक्तं हसितमीक्षितम् |

Carrying heavy loads on the head, over indulgence in laughing, exertion of the face sneezing bending very head bows (iron bars, spring etc.) use of uneven / hard pillow while sleeping, chewing very hard materials causes aggravation of Vata.

Gets localised in the upper part of the body and produces irregularities of half of the face found specially during laughing and seeing.

ततोऽस्य कम्पते मूर्द्धा वाक्सङ्गः स्तब्धनेत्रता ||३४||

दन्तचालः स्वरभ्रंशः श्रुतिहानिः क्षवग्रहः |

गन्धाज्ञानं स्मृतेर्मोहस्त्रासः सुप्तस्य जायते ||३५||

निष्ठीवः पार्श्वतो यायादेकस्याक्ष्णो निमीलनम् |

जत्रोरूर्ध्वं रुजा तीव्रा शरीरार्धेऽधरेऽपि वा ||३६||

तमाहुरर्दितं केचिदेकायाममथापरे ||३७|

Kampa Murdha (Shaking oh head), Vak Sangam (Obstruction of Speech), Stabdha Netratha (loss of movements of the eyes), Danta Chalanam (shaking of teeth), Swarbramsha (Hoarseness of Voice), Sruthihani (Deafness), Kshva Graha (obstruction of sneezing), Gandha Ajnana (loss of sense of smell), Smriti Bramsha (loss of memory), Moha (delusion), Suptha Thrasa (exhaustion during sleep), Nishteevana, Eka Akshi Nimeelanam (one eye is closed), Parsva, Jatrurdhva Theevra Shoolam/Ardha Shareera/Adho Shareeram (severe pain in the parts above the shoulders, half /lower part of the body).

This disease is called Ardita or Ekayama.

Facial Paralysis

  • An inability to move the muscles of the face on one or both sides is known as Facial Paralysis
  • Paralysis of any structures innervated by facial nerve is known as facial paralysis.
  • Facial paralysis is due to the lesion of the pyramidal tract between the cortex and the middle of the pons (UMN facial palsy), the nucleus and the 7th cranial nerve (LMN facial palsy)

Facial Nerve

  • 7th cranial nerve is mixed nerve (Both sensory & motor functions)
  • Its course is divided into two parts:

    i) Intra cranial (Pons to Stylo-mastoid foramen)
    ii) Extra cranial (After exit from the skull)

Branches of Facial Nerve

  • Temporal Nerve: Supplies to frontalis & orbicularis oculi
  • Zygomatic Nerve: Supplies to orbicularis oculi
  • Buccal Branch: Supplies to upper lip & cheek
  • Mandibular Branch: Supplies to lower lip.
  • Cervical Branch: Supplies to neck muscles

Functions of Facial Nerve

Each nerve controls:

  • Eye blinking and closing
  • Facial expressions
  • Smiling and frowning
  • Tear glands
  • Salivary glands
  • Taste sensations

Causes of Facial Palsy

CausesExamples
CongenitalMoebius syndrome, Vascular anomaly, Hemifacial microsomia, Goldenhar syndrome
TraumaTemporal bone fracture, Blunt force to cheek, Laceration & Swelling involving facial nerve
InfectionsEar infections, Lyme disease, Mastoiditis, HSV
NeoplasmParotid tumours, Acoustic tumours, Cholesteatoma
IschaemiaLoss of blood supply to the nerve or muscle
NeurogenicGBS
HemotogicalLeukemia, Hemophilia, HTN, Diabetes Mellitus

Symptoms of Facial Palsy

  • Unilateral facial weakness
  • Loss of taste
  • Hyperacusis
  • Pain or discomfort in jaw and ear
  • Ringing in ears
  • Head ache
  • Impaired speech
  • Difficult eating & drinking

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  • Excessive tears in one eye

UMN and LMN

Facial paralysis can be manifested by two kinds of lesions:

1. Supra nuclear lesion (Central / UMN palsy)
2. Infra nuclear lesion (Peripheral/ LMN palsy)

Jaims_2633_01.jpg

Difference between UMN & LMN Lesions

UMN LesionsLMN Lesions
Deviation of face contra-lateral to lesionDeviation ipsilateral to lesion
Lower 2/3rd of the face is mainly affectedOne side of the face is only affected
Hemiplegia on side of facial palsy may be associatedNo hemiplegia
Fore-head looks intact bilaterally but unable to wrinkle the foreheadUnable to wrinkle the forehead & Total facial palsy
Reflexes & tone maintainedFlaccid

Symptoms based on effected lesion

  • Lesion in pons - Facial sensation loss & drooping may be present hearing.
  • Lesion of chorda tympani - No salivary secretions
  • Lesion of Stapedius - Sense of hearing is lost
  • Lesion in corona radiata - Weakness of face & limbs
  • Lesion in Cerebral cortex - Weakness of limbs & face, Cognitive dysfunction, Sensory problems, Aphasia

Bell’s Palsy

  • Commonest type of facial palsy
  • Major cause of the acute facial nerve paralysis
  • It affects totally half side of the face due to the LMN lesion
  • Here, the palsy is due to the inflammation of the facial nerve
  • The inflammation prevents nerve from sending correct signals to brain & Facial muscles.

Difference between Facial Palsy & Bell’s Palsy

Facial PalsyBell’s Palsy
Causes can be known (Infection, Trauma, Tumor, Infarct)Idiopathic & may develop suddenly
Permanent (Lasts for years to life)Temporary (Permanent cure within 3 months in 90% cases)
Need Surgical treatmentWithout treatment or surgery regains facial function
Site of affection depends on UMN & LMN lesionMainly due to LMN lesions Half side of face is totally affected.

Tests for Facial Palsy

  • Ask the patient to show her teeth
  • Ask the patient to puff her cheeks
  • Ask the patient to show her eyes against resistance
  • Ask the patient to lift her eyebrows

Diagnosis

  • There are no specific lab tests to confirm the diagnosis.
  • ESR for inflammation
  • Blood sugar level for diabetes
  • Electromyography for nerve damage & determine its severity
  • MRI & CT scan

Treatment

  • Medical Treatmen
    a) Physical therapy
    b) Pharmacological therapy
    c) Psychotherapy
  • Surgical Treatment
    a) Nerve decompression

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  • b) Nerve anastomosis
    c) Nerve grafting

  • Physiotherapy

Treatment

  • Steroids & anti-viral drugs are quite effective in Bell’s palsy
  • Prednisolone & acyclovir is the drug of choice
  • Prednisolone (1 mg/kg/d) for 10-14 days recommended.
  • Vit- B1, B6, B12 may be administered which helps in nerve conduction & regeneration.
  • If patient is seen after 4-weeks, then steroid therapy is of no use.
  • Eye protection

Treatment according to Charak

अर्दिते नावनं मूर्ध्नि तैलं तर्पणमेव च ||९९||

नाडीस्वेदोपनाहाश्चाप्यानूपपिशितैर्हिताः|

In Ardita, Nasya, head oil, Saturation, Tubular Fomentation and Poultices with meat of marshy animals are beneficial.

Treatment according to Susrutha Samhita

अर्दितातुरं बलवन्तमात्मवन्तमुपकरणवन्तं च वातव्याधि विधानेनोपचरेत्, वैशेषिकैश्च मस्तिष्क्यशिरोबस्ति नस्य धूमोपनाह स्नेहनाडीस्वेदादिभिः|

The patient of Ardita, who is strong, self-controlled, having all equipments should be treated with the same therapies indicated for Vatavyadhi. Special treatments for this disease is: Sirobasti Nasya (nasal drops) Dhuma (smoke inhalation) Upanaha (warm poultice) Snehana (oleation) Nadi Swedana (sudation by steam through tubes)

Ksira Taila

ततः सतृणं महापञ्चमूलं काकोल्यादिं विदारिगन्धादिमौदकानूपमांसं तथैवौदककन्दांश्चाहृत्य द्विगुणोदके क्षीरद्रोणे निःक्वाथ्य क्षीरावशिष्टमवतार्य परिस्राव्य तैलप्रस्थेनोन्मिश्र्य पुनरग्नावधिश्रयेत्,

Trna Panchamoola Dviguna Udaka 1 drone boiled until Mahat Panchamoola (double quantity of kshira only milk remains Kakolyadi Gana of water) Vidarigandhadi Gana Anoopa Auduka Mamsam. It is the filtered, added with Taila (Tila Taila) one Prastha (640 gm) and cooked again on fire.

ततस्तैलं क्षीरानुगतमवतार्य शीतीभूतमभिमथ्नीयात्,

when the oil gets well mixed with milk, it is churned well after it cools

 तत्र यः स्नेह उत्तिष्ठेत्तमादाय मधुरौषधसहाक्षीरयुक्तं विपचेत्,

Then the oil that emerges is taken out separately and cooked again along with drugs of Madhura Rasa (eg: Kakolyadi Gana ) and milk

एतत् क्षीरतैलमर्दितातुराणां पानाभ्यङ्गादिषूपयोज्यं,

This is known as Kshira Tailam should be made use for : Pana (drinking), Abhyanga (anointing)

तैलहीनं वा क्षीरसर्पिरक्षितर्पणमिति ||२२||

In persons of Ardita Kshira Sarpi maybe prepared using Ghee instead of Oil.

According to Vagbhata : (Treatment)

अर्दिते नावनं मूर्ध्नि तैलं श्रोत्राक्षितर्पणम् |

सशोफे वमनं, दाहरागयुक्ते सिराव्यधः||४३||

Navanam (nasal medication), Murdha Tailam (anointing oil on the head), Srotra, Akshi Tarpanam (filling oil to the Ears and Eyes), Vamanam (emesis) - if there is swelling, Siravyadhnam (venesection) - if there is burning sensation and redness.

Treatment principle

  • Vata Vriddhi in Kapha Sthanam
  • Kapha & Vata Samanam
  • Ushna Virya drugs are selected

Treatment

Thalam

  • Rasnadi Choornam with Nimbamrta Eranda Tailam

Abhyangam for face

  • Karpasastyadi Tailam
  • Kshirabaala Tailam
  • Dhanwantara Tailam
  • Prabanjana Vimardana Tailam
  • Mahamasha Tailam

Lepam

Masha / Godhuma is ground in paste and applied over the affected side in the face.

Nadi Swedanam

1. Erandamoola Kashayam / Dasamoola Kashayam /


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Nirgundi Kashayam
2. Kshira Dhoomam with Bala Siddha Kshira

Kavalam and Karnapuranam

Karpasastyadi Tailam

Internal medications

Kashayam

  • Dhanadanayanadi Kashayam
  • Astavarga Kashayam
  • Guggulu Tiktaka Kashayam
  • Rasonadi Kashayam
  • Maharasnadi Kashayam
  • Masabalaatmaguptadi Kashayam
  • Suntibaladi Kashayam
  • Rasnadasamoola kashayam
  • Lasuna Kshira Kashayam

Siro-Pichu and Siro-Vasti

  • Karpasastyadi Tailam
  • Dhanwantara Tailam

Nasyam

  • Karpasastyadi Tailam
  • Mahamasha Tailam
  • Kshirabala Tailam
  • Anu Tailam
  • Maharaja Prasarini Tailam

Choornam

  • Vacha Choorna (2 gms)
  • Ashwagandha Choornam - 10 gms HS with milk after food
  • Narasimha Choornam - 5 gms hs with milk after food (Cakradatta)
  • Svalparasona Pindam - 3 gms with Eranda Kashayam after food

Vati

  • Rasonadi Vati (2 bd after food)
  • Ekangavira Ras (1 bd after food)
  • Brhat Vata Cintamani Ras (125 mg bd after food)
  • Vata Gajankusa Ras (125 mg bd after food)
  • Samira Pannaga Ras (1 bd after food)
  • Vatari Guggulu (1 bd after food)
  • Trayodasanga Guggulu (1 bd after food)

Lehyam

  • Kalyanaka Avaleham (5 gms bd after food with honey / warm milk)
  • Ashwagandha Lehyam (10 gms bd after food)

Aristam (15 ml bd with water after food)

  • Balaristam
  • Ashwagandharistam
  • Devadarvyaristam
  • Saraswatharistam

Tailam (Internally 10ml HS with milk after food)

  • Karpasastyadi Tailam
  • Masha Tailam
  • Mahamasha Tailam
  • Bhunaga Tailam - 5 ml with milk at night after food
  • Rasa Tailam - 5 ml with milk at night after food

Single drugs

  • Lasuna
  • Nirgundi
  • Eranda
  • Lavanga
  • Sarsapa
  • Rasna
  • Bala
  • Ashwagandha
  • Vacha
  • Guggulu
  • Brahmi
  • Hingu

Pathya

Ahara

  • Milk boiled with Dasamoola
  • Ghee & butter milk
  • Juice of sour fruits
  • Navanita with Lasuna
  • Mamsa Rasa

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Vihara

  • Residing in places with mild breeze and sunlight
  • Chewing bubble gums and blow baloon
  • Facial exercises like opening the mouth and eyes as wide as possible & ask them to smile and frown alternatively for 10 -15 mins.

 Apathya

  • Grams, Peas, Tubers.
  • Cold water
  • Worrying
  • Remaining waked upto late night
  • Fasting
  • Exposure to cold wind
  • Travelling
  • Suppression of urges

Ideal prescription

  • Dhanadanayanadi Kashayam (15 ml with 30 ml water before food bid)
  • Ashwagandha Choornam(10 gms HS with milk after food)
  • Kalyanaka Avaleham (5 gms bd after food with honey / warm milk)
  • Vacha Choornam (locally on tongue)
  • Palsinuron cap (1-1-1) after food
  • Kshira Bala Tailam for External application

References

1. Ashtanga hrdayam – Translated by Prof K.R. Srikantha murthy

2. Caraka Samhita – P.V. Sharma

3. Susruta Samhita- By Srikantha Murthy

4. A Text book of Kaya Chikitsa by Dr.P.S.Byadgi

5. Davidson’s Principles & Text Book of Medicine

6. Macleods Clinical Examination


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