E-ISSN:2456-3110

Case Report

Integrated management of Ardita

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 11 November
Publisherwww.maharshicharaka.in

Integrated management of Ardita in 32 years old patient

Katna D1*, Patil N2, Ghosh A3
DOI:10.21760/jaims.8.11.34

1* Deeksha Katna, Post Graduate Scholar, Dr Dy Patil College Of Ayurved Research Centre Dr Dy Patil Vidyapeeth Deemed To Be University, Pimpri Pune, Maharashtra, India.

2 Neelesh Patil, Associate Professor, Dr DY Patil College of Ayurved Research Centre Dr DY Patil Vidyapeeth Deemed to be University, Pimpri Pune, Maharashtra, India.

3 Atri Ghosh, Post Graduate Scholar, Dr DY Patil College of Ayurved Research Centre Dr DY Patil Vidyapeeth Deemed to be University, Pimpri Pune, Maharashtra, India.

Bell's palsy accounts for sixty to seventy-five percent of facial paralysis. It is described as acutely onset paresis. Either gender experiences it equally frequently. Although the incidence rises with age, it can affect any age group. In 6-8% of cases, a positive family history is present. Pregnant women and diabetics (angiopathy) are more at risk for Bell's palsy. In contemporary science, treatment options include vitamins, mast cell inhibitors, and steroids. It is associated with Ardita, Vataja Nanatmaja Roga, according to Ayurveda. In this study, a 32-year-old male patient presented with mouth deviation to the left, difficulty closing his right eye, ear pain, and headaches that had persisted for ten days at the Shalakya OPD of Dr. D.Y. Patil College of Ayurveda and Research Center in Pimpri, Pune. After a history and examination, Bell's palsy was the diagnosis. The patient received local treatment with Netra Tarpana therapy, Swastika Sali Pinda Sweda, Nasya, and Shamana Chikitsa, utilizing a variety of Ayurvedic formulations. The patient was also administered vitamins and allopathic steroids. All of the disease's symptoms and indicators improved, which was a remarkable outcome. Therefore, we are using an integrative approach in this study to manage Bell's palsy as soon as possible.

Keywords: Netra Tarpana therapy, Pinda Sweda, Shamana Chikitsa, Nasya, Ayurvedic formulations, Bell's palsy

Corresponding Author How to Cite this Article To Browse
Deeksha Katna, Post Graduate Scholar, , Dr Dy Patil College Of Ayurved Research Centre Dr Dy Patil Vidyapeeth Deemed To Be University, Pimpri Pune, Maharashtra, India.
Email: 		Katna D, Patil N, Ghosh A, Integrated management of Ardita in 32 years old patient. J Ayu Int Med Sci. 2023;8(11):211-215.
Available From
https://jaims.in/jaims/article/view/2797

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-09-16 2023-09-26 2023-10-06 2023-10-16 2023-10-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 22.66

© 2023by Katna D, Patil N, Ghosh Aand 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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Deeksha Katna et al. Integrated management of Ardita in 32 years old patient

Introduction

Ayurveda is one of the world's oldest medical sciences. Ayurveda is a combination of two words: "Veda" (knowledge) and "Ayu" (life). Ayurveda is a person's entire way of life, not just a method of treatment. Eight specialty branches make up Ayurveda. Thus, "Ashtanga Ayurveda" is another name for Ayurveda. Among them is the Shalakya Tantra. Urdha Jatrugata Roga is the subject of Shalakya Tantra. "Ardita" is the word for someone who is troubled. As reported by Shabdakalpdruma.[1] While the Vagbhatta states that half of the face is affected, either with or without involvement of half of the body, the Sushruta states that the mouth and head are affected. Vataj Nanatmaj Vyadhi is described by Acharya Charaka, and Ardita is one of them[2] In Charak, Susruta and Vagbhatta we don’t find types of Ardita. But Acharya Bhavmishra[3] mentioned the three types of Ardita that is Vataja, Pittaja, Kaphaja. Symptoms of Ardita are-

  • Facial Weakness
  • Impairment of taste
  • Muscle twitching
  • Ringing in one or both ears
  • Difficulty in speech
  • Pain and discomfort in jaw and behind the ears
  • Tremors in head
  • And so on.

The majority of Bell's palsy symptoms and Ardita symptoms are extremely similar. Bell's palsy accounts for sixty to seventy-five percent of facial paralysis. It is described as acutely onset paresis. Either gender experiences it equally frequently. Although the incidence rises with age, it can affect any age group. In 6-8% of cases, a positive family history is present. Pregnant women and diabetics (angiopathy) are more at risk for Bell's palsy.

Clinical features of bell’s palsy: Start is abrupt. The patient can't shut his eye. The eyeball turns up and out when you try to close it (Bell's phenomenon). The face starts to sag. From the eye, tears flow downward (epiphora). Ear pain may occur either before or after nerve paralysis. Some claim they have stapedial paralysis (noise intolerance) or chorda tympani involvement (taste loss). A person may be completely paralyzed or not. Ardita

and Bell's palsy are related in relation to the symptom. Approximately 1 in 65 people will experience it in their lifetime. Global data suggest that approximately 0.02% of the population experiences this phenomenon. Thus, Ardita is a common illness in today's world. A suitable integration treatment must be found. Furthermore, there are numerous adverse effects connected to modern medicine. Therefore, it is necessary to find a treatment that works in both allopathy and Ayurveda. Therefore, the current study will be used to determine how best to control Ardita.

Etiology

a) Infection by virus the majority of the data points to the viral etiology of herpes simplex and herpes zoster. Bell's palsy is regarded as a component of the overall picture of polyneuropathy because it may also involve other cranial nerves.

b) Vascular ishaemia: It could be secondary or primary. Both emotional stress and the cold can cause primary ishaemia. Primary ischaemia results in increased capillary permeability, which causes fluid to exude, edema to develop, and compression of the nerve's microcirculation. Secondary ischaemia is the outcome of this.

c) Hereditary: Due to a genetic predisposition, the fallopian canal is narrow, which puts the nerve at risk of early compression with even the smallest amount of oedema.

d) Auto immune disorder

Aims and Objectives

To evaluate the efficacy of Integrative approach in the management of Ardita.

Materials and Methods

On 28th December 2022, a Hindu male of 32 years old, visited to Shalakya OPD of Dr. D.Y Patil College of Ayurved and Research Centre, Pimpri, Pune with the complaints as cited below.

Case History

Patient, 32 years old, has been experiencing headaches and earaches for the past 10 days. She also has mouth deviation to the left and difficulty closing her right eye.



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History of Present Illness:

Prior to two weeks, the patient appeared to be in good health. He gradually noticed a tilt to the left, heaviness in that area, trouble closing his right eye, and trouble raising his left eyebrow. The patient did not have hypertension or diabetes. The patient received treatment at another hospital and was given allopathic medication, but she did not get better. And subsequently, for the same reason, he went to the Shalakya OPD of the ‘Dr. D.Y. Patil College of Ayurveda and Research Center in Pimpri, Pune’ and began treatment there.

General Examination

Measuring 61 kg, 169 cm of height, 80 beats per minute-pulse, and 120/80 mm of mercury-BP

Personal History

Constipated bowel movement, irregular appetite, regular bowel movements, and sound sleep.

Previous History

No history of previous illness.

Family History: Father has a troubled past with DM Type 2.

Central Nervous System Examination

1. Unaffected Higher Motor Functions
2. Consciousness - Awareness
3. Orientation to an intact time, place, and person
4. Recent memory - unaffected
5. Complete Intelligence
6. Absent Hallucinations and Delusions
7. Muffled speech words

Cranial Nerve Examination

Except for the facial nerve, all other cranial nerves exhibit normal neurological and cerebellar examination function.

a) Raising the eyebrows cannot be done on the right side.

b) Eye closure: When the patient tries to close their right eyelid, their eyeball moves inward and upward and their eyelid closes partially. The Bell phenomenon

c) Teeth exposing - the right side denture cannot accommodate this

d) Right-side blowing of the cheek is not possible

e) Nasolabial fold: Loss of the right side's Nasolabial fold.

f) Dribbling of saliva: When eating from the right side, saliva dribbles on the right angle of the mouth and spills food.

g) There is a bell phenomenon on the right side of the

h) Mouth’s departure to the left Deep reflexes like the plantar reflex, biceps, triceps, supinator, and knee jerk are all typical. All limbs' muscle tone and power are also normal.

Ashta Sthana Pariksha

  • Nadi: 90 bpm
  • Mala: Baddha Koshta
  • Mutra: 5-6 times /day
  • Jihwa: Alpa Liptata
  • Shabda: Prakruta
  • Sparsha: Twak Parishata and Krishnata over both arm and leg
  • Drik: Prakruta
  • Akruti: Madhyam

Treatment Protocol

1) Inj. Dexa 2 mg BD for day
2) Inj. Vitcofol
3) Tab free nerve
4) Triphla Ghrit Netra Tarpan for 14 days
5) Shirbala Tail Nasya 2 drops in each nostril daily for 14 days
6) Shashti Shali Svedan - Mukh Pradesh
7) Cap Palsineuron 1 cap BD for 14 days
8) Ekangveer Ras 125 mg 1 tab bd for 14 days

Assessment Criteria: Assessment was done on the basis of gradation system.

House-Brackmann facial paralysis scale

GradeImpairment
INormal
IIMild dysfunction: normal symmetry when at rest, slight weakness
IIIModerate dysfunction: normal symmetry when at rest, noticeable but unidentifiable weakness with synkinesis Full eye closure with maximum effort and good movement of the forehead
IVa dysfunction that is moderately severe (notable and disfiguring asymmetry, significant synkinesis) Not quite finished
Vsevere dysfunction (movement hardly noticeable)
VIcomplete paralysis, unable to move

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Result

Based on the scoring of observed symptoms and cardinal associated signs, an assessment was conducted. The results were evaluated using the House-Brookman grading measures for facial nerve function.

ParameterBeforeAfter 7 daysAfter 14 days
Deviation of mouth towards left sideGrade- 3 Grade- 2 75 percent less in value. Raising the eyebrows and furrowing the forehead were possible when the face reverted to its normal symmetry.
Meal getting stuck between the gums and cheeks and being unable to chew from the right sideGrade- 3Grade- 2 Chew easily from the right side
Improper blinking of right eyeGrade- 4Grade 2 – occasionally blinks controlled Right eyelid easily blinked, then closed complete
Slurred speech Complete slurringGrade-3Pronouncing with less efforts Normal speech
Nasolabial foldAbsence of Nasolabial fold Nasolabial fold seen while attempting to smile. There is no nasolabial fold on the left side. Normally present nasolabial fold

Mode of Action

1. Swedana eliminates Gaurava, Sheeta, and Stambha. Swedana produces perspiration, widens the Srotas (microchannels), aids in thorough cleansing of the Srotasas, and transfers the adhering Ama Dosha to Kostha. Khara, Ruksha, and Vishada are characteristics of Vayu. Additionally, the attributes of Sashtik Shali are the opposite of Vayu, which are Mridu/Manday, Shlakshna, Snigdha, Pichhila, and Shita.

2. Vyana Vayu closes her eyes. Snehana is one method of treating Vata. One of Bahya Snehana's methods is Akshi Tarpana. Snigdha Guna of Ghruta calms Ruksha Guna of Vata. Triphala Ghruta is also beneficial to the eyes. The Triphala Ghruta's contents, including Snigdha, Vatashamaka, Balya, Bruhana, Tarpana, and Rasayana, are all beneficial for the eyes. Aalochaka Pitta's sheet is Netraindriya. Ghruta is good in Vatapitta Shamana because it has Madhur Rasa, Madhur Vipaka, and Sheeta Virya.

3. Ksheerbala Tail strengthens the facial muscles and feeds the Shleshaka Kapha, which in turn stimulates the sensory nerve endings. The Nasya Dravya remedy cures the vitiated Dosha by traveling to Sringataka Marma and spreading into different Strotas (vessels and nerves).

4. When taken orally, Ekangaveera Rasa functions as Brinhana, Rasayana, and Vishaghna, aiding in the patients' faster rate of recuperation.

5. The results of the study demonstrated that Bell's palsy patients' paralyzed side of the face can move more freely thanks to steroid treatment. Its anti-inflammatory mechanism of action lessens facial nerve inflammation and oedema in cases of acute Bell's palsy.

6. Vitcofol gives the body the resources it needs to repair damage to the facial nerve and myelin sheath.

Conclusion

Although this is only one case study, it may offer some hope for developing an integrated standard protocol for the management of Ardita. However, more in-depth research with a bigger sample size is required to create the standard operating procedure for the illness. Based on this clinical case study, future researchers may investigate integrative line-up treatment.

References

1. Shankar U. Textbook of Shalakya Tantra, Vol. 1. Chaukhambha Visvabharati, Varanasi. 2019. Reprint.

2. Shankar U. Textbook of Shalakya Tantra, Vol. 1. Chaukhambha Visvabharati, Varanasi. 2019. Reprint.

3. Shankar U. Textbook of Shalakya Tantra, Vol. 1. Chaukhambha Visvabharati, Varanasi. 2019. Reprint.

4. Shankar U. Textbook of Shalakya Tantra, Vol. 1. Chaukhambha Visvabharati, Varanasi. 2019. Reprint.

5. Susruta. Susruta Samhita with Nibandh Sangraha commentary of Dalhana Acharya, edited by Jadavji Trikamji. Chaukhaba Surbharti Prakashan; 2014.

6. Shankar U. Textbook of Shalakya Tantra Illustrated. Chaukambha Visvabharati, Varanasi. 2018. Vol 1, Chapter 33.

7. Bhavaprakasha Purva Khanda, 6/43. English Translation by Srikantha Murthy K R. Vol I. Chaukhamha Krishnadas Academy, Varanasi. 2011. p. 164.


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8. Bhavaprakasha Purva Khanda, 6/146. English Translation by Srikantha Murthy K R. Vol I. Chaukhamha Krishnadas Academy, Varanasi. 2011.


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