E-ISSN:2456-3110

Case Report

Bell's Palsy

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 10 October
Publisherwww.maharshicharaka.in

Management of Ardita through Nasya with special reference to Bell's Palsy : A Single Case Study

Jaswani J1*, Kodwani G2
DOI:10.21760/jaims.8.10.45

1* Jaya Ashok Jaswani, Post Graduate Scholar, Department Of Rog Nidan Avum Vikruti Vigyan, Govt Ayurveda College, Nagpur, Maharashtra, India.

2 GH Kodwani, Head of Department, Department of Rog Nidan Avum Vikruti Vigyan, Govt Ayurveda College, Nagpur, Maharashtra, India.

In modern era, prevalence of neurological disorders are rising due to fast-paced and stressful lifestyle. Ayurveda categorizes neurological disorder as Vata Vyadhi. Of the 80 Nanatmaj Vatavyadhi, Ardita is the one. Ardita is the disease characterized by Mukhardha Vakrata & results in Facial asymmetry & dysfunction. Ardita can be correlated to Bell's Palsy. Bell's Palsy is a neurological condition that involves the 7th cranial nerve & results in facial drooping and weakness. As per Acharya Charaka, Nasya is the specific treatment for Ardita. Nasya is one of the Panchakarma procedure in which the drug (medicated oil / ghee / decoction / powder, etc.) is administered through Nasa, essentially to eliminate the vitiated Dosha present in Shira. The present case deals with the 50 years old man diagnosed with Ardita and treated with Ayurvedic Shaman Aushadh along with Nasya. Patient got complete relief in all symptoms with appreciable changes. Criteria of assessment was based on House-Brackmann facial paralysis scale. To explore and elaborate the role of Nasya in Ardita with special reference to Bell's Palsy, various Samhitas along with contemporary books, research articles available on Nasya and Ardita are studied. Panchakarma procedure like Nasya proves to be the promising Ayurvedic management in Ardita.

Keywords: Nasya, Ardita, Panchakarma, Bell's Palsy

Corresponding Author How to Cite this Article To Browse
Jaya Ashok Jaswani, Post Graduate Scholar, Department Of Rog Nidan Avum Vikruti Vigyan, Govt Ayurveda College, Nagpur, Maharashtra, India.
Email: 		Jaswani J, Kodwani G, Management of Ardita through Nasya with special reference to Bell's Palsy : A Single Case Study. J Ayu Int Med Sci. 2023;8(10):279-284.
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https://jaims.in/jaims/article/view/2835

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-08-09 2023-08-11 2023-08-16 2023-08-21 2023-09-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.89%

© 2023by Jaswani J, Kodwani Gand 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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Jaya Ashok Jaswani et al. Ardita through Nasya with special reference to Bell's Palsy

Introduction

The face is regarded as the "window of the soul" and can reflect joy, sorrow, anger, fear and excitement. Facial expression plays an important role in communication in our daily life. The ability of facial expression and speech both are hampered in Ardita, a Vata Vyadhi,[1] which is more common in present day scenario due to exposure to cold and wind. Ardita is defined as Vakrata of Mukhardha meaning deviation of half of the face.[2] Acharya Charaka states that Ardita is localized to half of the face with or without involvement of body.[3] But the reference and explanation given by Acharya Sushruta points out only the involvement of face only which can be correlated to Bell's palsy in modern science.

Bell’s palsy is an acute, idiopathic LMN / Infra-nuclear type of facial Paralysis.[4] It is characterized by weakness of muscles to one side of the face which is caused due to lesion on the seventh cranial nerve i.e., facial nerve. It leads to partial or total loss of movement of unilateral face. Both Acharya Charaka[5] and Acharya Sushruta[6] described Nasya (Navana) as the prime treatment modality for Ardita. Nasa is an Indriya which works not only to perceive the smell but also to provide the main breathing pathway along with this, Nasa is one of the drug administration pathways.

Nasya is one of the Panchakarma procedure in which drug is administered through Nasa for the expulsion of Doshas present in supra clavicular region (Urdhwajatrugat)[7] and Ardita is mainly a disease of Urdhwajatrugat.

Aim and Objective

To study the role of Nasya in Ardita with special reference to Bell’s Palsy.

Case Report

A 50 year old man came to Rog Nidan OPD in Government Ayurveda College, Nagpur with the following complaints from 5 days.

  • Deviation of mouth towards right side
  • Incomplete closure of left eye
  • Watering from left eye
  • Dribbling of saliva
  • Slurred speech

History of present illness

A detailed medical history of the patient revealed that the patient had been drenched in rain two days before the onset of Bell’s palsy. During those two days, he suffered from fever, pain around his left ear and headache. When he suddenly came home from work, he noticed deviation of face and watering from left eye, he also realized that he was unable to close his left eye. For this he consulted near by physician and took steroids for 5 days. The complaints persisted even after allopathic treatment so for further treatment and management, patient came to Rognidan OPD, Govt Ayurved College, Nagpur.

Past medical history

  • Patient is K/C/O DM since 1 year (Irregular medications)
  • Do not have significant family history.

Personal history

  • Diet - Mixed diet (Non-veg - once a week)
  • Addiction - Tobacco and Kharra 2-3 times daily since 10 - 15 years, Alcohol - 90 ml twice or thrice a week since 10-15 years
  • Sleep - Regular sound sleep
  • Occupation - Labour

Ashtavidha Pariksha

  • Nadi - 80/Min
  • Mutra - Niyamit
  • Mala - Niyamit
  • Jivha - Alpa Saam
  • Shabda - Alpa Aspashta
  • Sparsha - Samsheetoshna
  • Druka - Prakruta
  • Aakruti - Krusha
  • Pulse - 80/Min
  • BP - 130/80mmhg

Systemic examination

Patient was conscious and well oriented to time, place and person. Higher function like intelligence, memory, behavior, emotions are normal. Superficial and deep reflexes were normal. Speech was slightly


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slurred. All the cranial nerves are intact except VII nerve i.e., facial nerve.

Facial nerve examination

Forehead FrowningAffected on Left Side
Eye ClosureIncomplete Closure of Left Eyelid
Teeth ShowingNot Possible on Left Side
Blowing of CheekNot Possible on Left Side
Nasolabial FoldLoss on Left Side
Taste PerceptionNot Affected
Dribbling of Saliva Present
Bell’s PhenomenonPresent on Left Side
Deviation Of MouthTowards Right Side

Materials and Methods

Clinical assessment was made from subjective symptoms and House- Brackmann’s Facial Nerve Grading Scale.[8]

Following Internal medicines were prescribed during the course of treatment -

1. Dashamool Kwatha 20ml BD for 15 days
2. Ekangveer Rasa 10 gm + Roupya Bhasma 1 gm + Gudvel Satwa 10 gm + Chopchinyadi Churna 50 gm - 42 chits prepared - 1 BD with milk
3. Nasya 4 - 4 drops in the morning

Panchakarma Procedures

  • Nasya with Panchendriya Vardhan Tail 4- 4 drops in the morning.
  • Sthanik Snehan-Swedan was prescribed prior to Nasya.
  • Gandusha with Til Taila improves voice and speech and strengthens the facial muscles which are weakened by Prakupit Vata Dosha.

Mode of action of Nasya

Acharya Charaka described Nasa as the “Gateway” to Shira.[7] The drug given through the nose as Nasya enters the deeper tissues of the brain and pacifies Doshas responsible for the disease. The drug administered in Nasya is mainly Sneha (oil). Sneha is considered to be the best Vatashamaka. Viscocity of Sneha increases the absorption of the drug by increasing the contact time to the nasal mucosa and lipophilic drugs have better absorptive capacity (Transcellular passive diffusion).[9] Nasya drug acts on Shringataka Marma which is a congruence of the nerve fibres for smell, taste, speech, vision and hearing sensation.[10] Anatomically Shringataka Marma has been taken as cavernous sinus. This sinus drains into the facial vein through superior opthalmic veins.

Result

After 15 days of treatment with internal medications, patient showed marked improvement in signs and symptoms of Ardita. This was assessed by House Brackmann facial nerve grading scale which was reduced from grade IV to grade II. Nasya provided highly significant results in complete closing of left eye and in deviation of mouth.

Parameter Before treatment After treatment
Deviation of mouth towards right sideGrade IVGrade II
Incomplete closure of left eyeGrade IVGrade II
Lacrimation from left eyePresentAbsent
Dribbling of salivaPresentAbsent
Nasolabial foldLoss from left side of the mouthNormal
Slurred speechMild difficulty in pronouncingNormal speech

Table 1: Subjective parameters

 Before treatment After treatment
Left side of faceGrade IV (Weakness with asymmetry of mouth, forehead frowning loss, incomplete closure of eyes with efforts)Grade II (slight weakness, noticeable on close observation, normal symmetry at rest, forehead - moderate to good function, eye - complete closure with minimal effort, mouth slightly asymmetry)
Right side of faceGrade I (normal facial function in all areas)Grade I (normal facial function in all areas)

Table 2: House Brackmann Facial Nerve Grading Scale[8]

SNGrade Defined by
1.NormalNormal facial function in all areas
2.Mild dysfunctionSlight weakness noticeable only on close inspection. At rest: normal symmetry of forehead, ability to close eye with minimal effort and slight asymmetry, ability to move corners of mouth with maximal effort and slight asymmetry. No synkinesis, contracture, or hemifacial spasm
3.Moderate dysfunctionObvious, but not disfiguring difference between two sides, no functional impairment: noticeable, but not severe synkinesis, contracture, and/or hemifacial spasm. At rest: normal symmetry and tone. Motion: slight to no movement of forehead, ability to close eye with maximal effort and obvious asymmetry, ability to move corners of mouth with maximal effort and obvious asymmetry. Patients who have obvious, but no disfiguring synkinesis, contracture, and/or hemifacial spasm are grade III regardless of degree of motor activity
4.Moderately severe dysfunctionObvious weakness and/or disfiguring asymmetry. At rest: normal symmetry and tone. Motion: no movement of forehead. Inability to close eye completely with maximal effort. Patients with synkinesis, mass function. action, and/or hemifacial spasm severe enough to interfere with function are grade IV regardless of motor Only barely perceptible motion. At rest possible asymmetry with droop of comer of mouth and decreased activity.
5.Severe dysfunctionOnly barely perceptible motion. At rest possible asymmetry with droop of comer of mouth and decreased absence of nasal labial fold. Motion: no movement of forehead, incomplete closure of eye and only slight movement of lid with maximal effort, slight movement of corner of mouth. Synkinesis, contracture, and hemifacial spasm usually absent.
6.Total paralysisLoss of tone: asymmetry; no motion; no synkinesis, contracture, or hemifacial spasm.



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Before treatment

After 8 days
not found

After 15 days
not found

Before treatment
not found

After 8 days
not found

Discussion

Ardita is a disease belonging to the group of Vata Nanatamaja Vyadhis.[1] Ardita is also included in Samanya Shiroroga[11] and Acharya Charaka described that Nasa is gateway to the Shira. Nasya is considered best to control the Urdhwajatrugat Rogas (disease above the neck). Panchendriya Vardhan Tail Nasya provides nourishment to Shiro-Indriyas. Here in this case, patient was given Sthanik Snehan and Swedan prior to Nasya therapy. This Poorvakarma promotes microcirculation by dilating blood vessels. An improved blood supply to face nourishes the facial muscles, increases their strength and allows them to function properly. It also speeds up drug absorption and speeds up recovery.

Conclusion

From this study, it can be concluded that Ardita can be successfully treated according to Ayurvedic principles if the patient arrives at the right time. With oral medication and Nasya therapy, the patient experienced significant relief from all symptoms. However, as this is a single case study, similar large-scale studies should be performed to determine the statistical significance of present line of treatment.

References

1. Tripathi B. Caraka Samhita Vol-2, Caraka Chandrika Hindi Commentary. Varanasi: Chaukhambha Surabharati Prakashan; 2017. Sutrasthana Adhyay 20, verse no. 11, p. 390.

2. Shastri A. Sushruta Samhita, part 1, Ayurveda Tatva Sandipika Commentary.


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Varanasi: Chaukhambha Sanskrit Sansthan; 2018. Nidanasthana Adhyay 1, verse no. 70, p. 304.

3. Tripathi B. Caraka Samhita Vol-2, Caraka Chandrika Hindi Commentary. Varanasi: Chaukhambha Surabharati Prakashan; 2017. Chikitsasthana Adhyay 28, verse no. 42, p. 943.

4. Kamath S. API Textbook of Medicine, Vol 2, Bell’s Palsy. 11th edition. CBS Publications; 2019. p. 1934.

5. Tripathi B. Caraka Samhita Vol-2, Caraka Chandrika Hindi Commentary. Varanasi: Chaukhambha Surabharati Prakashan; 2017. Chikitsasthana Adhyaya 28, verse no. 99, p. 956.

6. Shastri A. Sushruta Samhita, part 1, Ayurveda Tatva Sandipika Commentary. Varanasi: Chaukhambha Sanskrit Sansthan; 2018. Chikitsasthana Adhyaya 5, verse no. 22, p. 43.

7. Tripathi B. Ashtang Hridayam Nirmala Hindi Commentary. Delhi: Chaukhambha Sanskrit Pratishthan; 2017. Sutrasthana Adhyay 20, verse no. 1, p. 244.

8. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985 Apr;93(2):146-7.

9. Shamkuwar M. Panchakarma Sangraha. Varanasi: Chaukhamba Prakashak; 2016. p. 362.

10. Shastri A. Sushruta Samhita, part 1, Ayurveda Tatva Sandipika Commentary. Varanasi: Chaukhambha Sanskrit Sansthan; 2018. Sharirasthana Adhyay 6, verse no. 27, p. 75.


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