E-ISSN:2456-3110

Case Report

Avaranjanya Pakshaghata

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

Unveiling Holistic Healing: A comprehensive case study on the integrated management of Avaranjanya Pakshaghata

Vijaykumar Darak V1*, Jitendra Shimpi A2
DOI:10.21760/jaims.9.4.41

1* Vikhil Vijaykumar Darak, Post Graduate Scholar, Department of Kayachikitsa, Tilak Ayurved Mahavidyalaya Rastapeth, Pune, Maharashtra, India.

2 Anupama Jitendra Shimpi, Associate Professor, Department of Kayachikitsa, Tilak Ayurved Mahavidyalaya Rastapeth, Pune, Maharashtra, India.

Pakshaghata is a condition where exacerbated Vata disrupts the vessels governing bodily functions, leading to constriction of sinews and affecting either the right or left side of the body. This results in symptoms such as loss of movement, pain, and speech impairment. Specific triggers can aggravate Vata, causing dryness in the Siras and Snayus, leading to hemiplegia or paralysis of one side of the body. Manifestations of Vata disorders can vary, including individual Vata aggravation, associated Vata aggravation, accumulation in bodily tissues or waste, and obstruction. Avarana, a complex concept in Ayurveda, plays a significant role in these conditions. In a case study discussed here, involving a 40-year-old male patient exhibiting loss of movement in the right upper and lower limbs and aphasia, the diagnosis was Kaphavrutta Udana Vyanjanita Pakkshaghata. Initially managed in an intensive care unit during the acute phase, the patient subsequently underwent Shamana treatment before undergoing Panchakarma and Vidhhakarma therapies.

Keywords: Acute Ischemic Stroke, Pakshaghata, Integrated allied sciences, Avarana

Corresponding Author How to Cite this Article To Browse
Vikhil Vijaykumar Darak, Post Graduate Scholar, Department of Kayachikitsa, Tilak Ayurved Mahavidyalaya Rastapeth, Pune, Maharashtra, India.
Email: 		Vijaykumar Darak V, Jitendra Shimpi A, Unveiling Holistic Healing: A comprehensive case study on the integrated management of Avaranjanya Pakshaghata. J Ayu Int Med Sci. 2024;9(4):261-266.
Available From
https://jaims.in/jaims/article/view/3087

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-11 2024-02-21 2024-03-01 2024-03-11 2024-03-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 19.33

© 2024by Vijaykumar Darak V, Jitendra Shimpi 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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Vikhil Vijaykumar Darak et al. Study on the management of Avaranjanya Pakshaghata

Introduction

Cerebrovascular diseases include some of the most common and devastating disorders: ischemic stroke and hemorrhagic stroke. Stroke is the second leading cause of death worldwide. The incidence of cerebrovascular diseases increases with age, and the number of strokes is projected to increase as the elderly population grows, but with current lifestyle trends it can be commonly seen in the younger population as in our subject. The clinical manifestations of stroke are highly variable because of the complex anatomy of the brain and its vasculature. Cerebral ischemia is caused by a reduction in blood flow that lasts longer than several seconds. In case of ischemic stroke loss of sensory and motor function on one side of the body nearly 85% of patients have hemiparesis change in vision, gait, or ability to speak or understand or a sudden, severe headache. When ischemic stroke occurs, the immediate goal is to optimize cerebral perfusion in the surrounding ischemic penumbra with the help of endovascular revascularization. Ischemic stroke from large-vessel intracranial occlusion results in high rates of mortality and morbidity. But in countries with poor socio-economic status and unawareness with acute stroke often do not seek medical assistance on their own in the window period which leads to irreparable damage to the motor functions. To overcome this limitation, an integrated approach with allied sciences is beneficial. The prevalence of stroke in our country ranges from 40-270 out of all cases 45% of stroke patients can live per 100000 population. On the basis of morbidity independently, 22% patients become dependent on others and 20% patients' needs admission in hospitals.[1]

In Ayurveda hemiplegia is correlated with Pakshaghata where the provoked Vata seizing the vessels controlling the function of the body and constricting the sinews, afflicts the right or the left half of the body. Producing loss of movement, pain and loss of speech. Vata Prakopa caused by specific causes provoked Vata causing dryness of the Siras and Snayus. Affection of Karmendriyas on one side of the body Arm and leg are affected.[2]

That condition is called hemiplegia or paralysis of one side of the body, where the morbid Vata seizing the vessels. controlling the function of the side of the body and constricting the sinuses, afflicts

the right or the left half of the body producing loss of movement, pain and loss of speech. That condition is to be known as the lesion of one limb Monoplegia where a single foot or a single hand gets contracted and afflicted with aching and pricking pain. (And that condition is called the lesion of the whole body where the entire body is affected. (Sarvang Roga).[3]

Materials and Methods

The Bruhattrayi, modern medicine textbooks, journals and online database like Google Scholar, PubMed, etc. were reviewed for this purpose.

Methodology

Patient Introduction

A 40yrs male patient, delivery boy by occupation, presented in the emergency department with loss of movement of right side upper and lower limbs and aphasia. On examination his blood pressure was 210/140 mm of Hg pulse 100/min, MPG of 0/5 on the affected side, unconscious. Hence the patient was taken to ICU for further management. There he was given a loading dose and antihypertensive medication. After stabilizing the patient in the ICU, the patient was shifted to the general ward where the patient was given reference for Ayurvedic treatment.

Patient was K/C/O - HTN in the last 1 year, IHD. S/H/O- PTCA (2021), Previous medications- Tab. Stamlo 5mg, Tab. Aspirin 75mg (Patient was taking the medicine irregularly). On detailed history it was found that patient had Hetu Sevana of Prajagara, Chinta, Shoka, Ati Pravasa (excessive bike riding), Akala, Paryushita, Mansahara Sevana, Alcohol, outside eatables, for 2-3 years.

Patient was assessed on a daily basis on the following criteria like CNS examination, CVS examination, RS examination along with Ayurvedic parameters like Trividha, Astavidha and Dashavidha Pariksha.

O/E

Pulse - 100/min

BP - 210/140mmHg

SPO2 - 98%

RR - 22/min

T- Afebrile


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S/E

CNS - Consciousness - fully conscious of time, place and person. Memory Intact

Behaviour friendly Orientation fully oriented to time, place and person.

Eye closure normal,

Motor system - Nutrition- no wasting, no hypertrophy, MPG of Right limbs were 1/5, Reflexes were exaggerated, sensation WNL, Deep sensation WNL,

Tone - hypotonic (affected side)

CVS - S1S2 normal

RS - AEBE, clear

P/A - soft, non-tender

Investigations: CBC, LFT, RFT, Sr. Electrolytes were within normal limits.

CT scan Of Brain- [Dated-03/Sep/2022]

1. This plain CT is remarkable for moderately sized areas in the left caudate nucleus and the left gangliocapsular regions.

2. Mild mass effects are noted on the ipsilateral ventricle.

3. This likely suggests non-hemorrhagic infarcts in the left LSA and ACA territories.

4. These are no significance midline shift or hemorrhagic transformation.

5. Age related cerebellar and cerebral cortical atrophy.

6. There is no intracranial/extra cerebral hematoma.

MRI brain plain and MRI brain and neck in angiography- [Dated-05/Sep/2022]

Acute non hemorrhagic infarct in the left capsuloganglionic and corona radiata regions causing mass effect seen over the ipsilateral left lateral ventricle body and third ventricle with no midline shifts.

On admission in the ICU, the patient was given Tab. Ecosprin 300mg, tab. Clopitab 300mg, tab. Atorvastatin 80mg stat along with tab. Stamlo 5mg. Vitals monitoring was kept for the following 3 days where he was continued on the dual antiplatelet

and antihypertensive therapy. After stabilizing he was shifted to the general ward for further management.

Vyadhivyavacheda

Kaphavrutta VyanaKaphavrutta UdanaPittavrutta SamanaPranavrutta Samana
Gurutasarvagatrana +
Sarvasandhiruja +
Asthiruja
Gatisanga+		Vaivarnya
Vakswargraha +
Daurbalya
Gurugatra +
Aruchi		Atisweda +
Daha
Murcha
Aruchi
Agnimandya		Jada, Gadagada Mukata

Vyadinidana

The patient was diagnosed to be a case of Kaphavrutta Udana Vyanjanita Pakshaghata.

Timeline Frame:

DayShaman ChikitsaShodhan Chikitsa (Panchakarma)OtherComments
4thYavanyadi Choorna 2gm with Ardrak Swaras + Madha TDS
Dashamoolarishta 40 ml + 80 ml water TDS
Jivhapradeshi Pratisaran - Vacha Choorna BD		Nasya
Vacha Tailam 8 drops
Pradhaman Nasya (Purva)
Udara Pradesh -
Arka Patra Bandhan + Eranda Sneha
Nabhipuran - Aradrak Swaras BD
Vaidya Patankar Kadha 20 ml BD
Pathyakshi Dhatri Kashay 20ml BD		Nasya -
Vacha Tailam 8 drops
Pradhaman Nasya (Purva)
Udara Pradeshi -
Arka Patra Bandhan + Eranda Sneha
Nabhipuran - Aradrak Swaras BD		Viddha Karma Daily
Physiotherapy
20thMakardhwaj 1 tab
with Ashwagandharishta 20ml + 40ml TDS
Vicharana Sneha - Saraswat Ghrita (BB) OD with Peya		Sarvang Abhyanga-
Dhanvantar Tail
Sthanik Pinda Sweda-
Devdar + Ashwagandha
Anuvasan Basti -
Vajigandhadhi Tail 180ml
Avagaha Sweda -Shatavaryadi Kashayam
Nasya BD
Anu Tailam		Vidhha Karma 3/WeekNiram Avastha
hence
Bruhana
60thRaupyasindur 5mg
Vidari 1gm
Sitopaladi 2gm
with Vidarayadi Kashay 20ml + 40ml water (TDS)
Gandharva Hastyadi Eranda Sneha 20ml HS		Sarvang Abhyanga -
Dhanvantar Tail
Sthanik Pinda Sweda -
Devdar + Ashwagandha
Nasya BD
Anu Tailam		Vidhha Karma 3/Week

The Samprapti Ghataka involved were-

  • Dosha - Vata; Vyanvayu, udanavayu and Kapha
  • Dushya - Rakta, Sira, Snayu, Kandara
  • Strotovaigunya - Rasavaha Srotas
  • Aama Samchiti +

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Vikhil Vijaykumar Darak et al. Study on the management of Avaranjanya Pakshaghata
  • Agnimandya +
  • Roga - Apatarpanjanya
  • Vyadi - Svatantra Vyadhi
  • Marmasandhigata Roga

Observation

A) Scandinavian Stroke Scale[23]

SNScandinavian scoreRange of scoreBefore treatmentAfter treatment
1.Consciousness6-246
2.Eye movement4-044
3.Arm motor power (Right)6-005
4.Hand motor power (Right)6-004
5.Leg motor power6-005
6.Orientation6-066
7.Speech10-0010
8.Facial palsy2-022
9.Gait12-0012
Total1653

B) Hamiltons Score[24]

SNHamilton scoreRange of scoreBefore TreatmentAfter Treatment
1.Depressed mood0 to 441
2.Feelings of guilt0 to 441
3.Suicide0 to 410
4.Initial insomnia0 to 210
5.Insomnia during the night0 to 200
6.Delayed insomnia0 to 200
7.Work & interests0 to 440
8.Retardation0 to 440
9.Agitation0 to 430
10.Psychiatric anxiety0 to 430
11.Somatic anxiety0 to 420
12.Gastrointestinal somatic symptoms0 to 220
13.General somatic symptoms0 to 210
14.Genital symptoms0 to 210
15.Hypochondriasis0 to 430
16.Weight loss0 to 202
17.Insight0 to 201
Total353

C) Samanya Parikshana

SNCriteriaBeforeAfter
1.NadiKapha Vrutta UadanavayaVata Pradhan
2.UdarGauravMardava, Laghava
3.SparshaUshnaAnushna
4.MalaMalasanga, AamaSamyaka
5.GaitAtaxiaHaemiplegic Gait
6.GatraMlanaAmlana
7.BalaHeenaMadhyama
8.VarnaNisteja, KrushnavarniyaVarna Prasadan, Tejavana

Discussion

A number of medical and surgical interventions, as well as lifestyle modifications, are available for preventing stroke. Some of these

can be widely applied because of their low cost and minimal risk but may be valuable for selected high-risk patients. Identification and control of modifiable risk factors, and especially hypertension, is the best strategy to reduce the burden of stroke, and the total number of strokes could be reduced substantially by these means.

Such symptom complexes can also be diagnosed as Avarana Vyadhi instead of plain Pakshaghata. As seen in this case it can be concluded that pathophysiology of Pakshaghata can also be induced by Avarana as the primary cause of the disease. Hence when a specific treatment is given, results found are more profound.

Study reveals that, while treating an Avarana modality, not only the dominant Dosha (Avaraka) is taken in consideration but also the secondary cause (Avrutta Dosha). Meaning, in treating Kaphavrutta Udana-Vyana leading disease of Udana and Vyana Vata Dosha vitiation are taken into account.

Conclusion

This case study demonstrates the successful management of a case of Avarana-Janya Pakshaghata (Acute Ischemic Stroke) by integrated approach with Allopathy protocols & Ayurveda principles. There was significant improvement in Hamilton D scale, Scandinavian Stroke Scale, muscle nourishment, power and reflexes, difficulty in walking without support, slurred speech, and weakness with increased quality of life. Hence, it proves that treatment with Ayurveda principles including Panchakarma therapies along with allopathy protocols have a safe and efficient role in managing hemiplegia (Pakshaghata). Due to the uncommon nature of the presentation of the disease, significant recovery and improvement in the quality of life over the span of time in this case was believed to be value documenting.

Informed Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal.

The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.


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