E-ISSN:2456-3110

Case Report

Study on Pakshaghata

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

A Case Study on Pakshaghata - A Successful Story

Mural P1*, Prashanth AS2, Kulkarni M3
DOI:10.21760/jaims.9.4.40

1* Pooja Mural, First Year Post Graduate Scholar, Dept of Pg Studies in Kayachikitsa, Ayurveda Mahavidyalaya Hospital, Hubbali, Karnataka, India.

2 Prashanth AS, Professor HOD, Dept of PG Studies in Kayachikitsa, Ayurveda Mahavidyalaya, Hubbali, Karnataka, India.

3 Madhusudhan Kulkarni, Assistant Professor, Dept of PG Studies in Kayachikitsa, Ayurveda Mahavidyalaya Hospital, Hubbali, Karnataka, India.

Pakshaghata (hemiplegia) is a condition that affects half side of the body. Vata Dosha regulates all the functions of the body. Vata Prakopa acts as a main cause for Pakshaghata. Vata Prakopa happens due to Marghavarodha and Dhatukshaya. According to the contemporary science, all the sensory and motor activities are controlled by the brain. Cerebrovascular accidents are mainly responsible for loss of function in the body and due to its similarity, it can be correlated to Pakshaghata as explained in Ayurveda. Pakshaghata can be treated in Ayurveda, with Panchakarma procedures like Mridu Samshodhana and Basti. In the present case, the patient presented with the weakness in the right side of the body. Patient was bed ridden and treated with Panchakarma therapy for 4 months with Udwartana, Basti, Nasya, Abhayanga. After treatment patient was able to walk without any support and other complaints got relived by 80%.

Keywords: Pakshaghata, Vata Vyadhi, hemiplegia, Udwartana, Basti

Corresponding Author How to Cite this Article To Browse
Pooja Mural, First Year Post Graduate Scholar, Dept of Pg Studies in Kayachikitsa, Ayurveda Mahavidyalaya Hospital, Hubbali, Karnataka, India.
Email: 		Mural P, Prashanth AS, Kulkarni M, A Case Study on Pakshaghata - A Successful Story. J Ayu Int Med Sci. 2024;9(4):254-260.
Available From
https://jaims.in/jaims/article/view/3263

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-18 2024-02-28 2024-03-08 2024-03-18 2024-03-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 19.52

© 2024by Mural P, Prashanth AS, Kulkarni 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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Introduction

Pakshaghata is one among the Vataja Nanatmaja Vyadhi,[1] where Sira and Snayu get Vishoshana[2] by the Vata Dosha. Paksha denotes half of the body. Aghata is loss of voluntary muscle functions. Pakshaghata is Akarmanya Vata Vyadhi. Acharya Charaka explains that it is mainly produced due to Dhatukshaya and Margavarodhajanya Vata Prakopa, where Avarana of Vata Dosha by other Dosha and Dhatu takes place and leads to Karma Kshaya of half of the body associate along with Gouravata. Acharya Vagbhata describes this phenomenon as Sira Snayu Vishoshana in one side of the body leads to Sandi Bandha[3] Vimokshana, Hasta Pada Sankocha and Vaak Sanga. If the patient presents with the symptoms of Achetana, that is, numbness he may become bed ridden and ultimately attain to death. According to Acharya Sushruta the Kevala Vata is Krichra Sadhya,[4] Vata with other Dosha-Anubandha is Sadhya. When Dhatukshaya leads to Pakshaghata it is Asadhya. Chikitsa-Sutra of Pakshaghata includes Virechana, Basti, Nasya, Mrudusamshodana and Bahirparimarjana Chikitsa like Abhayanga, Ksheeradhooma and Shirodhara.

Hemiplegia[5] is most common manifestation of the stroke, which is one among the leading cause of death and disability in India. Hemiplegia is a paralysis that affects one side of the body. It’s often diagnosed as either the right or left hemiplegia, depending on which side of the body is affected. According to the National Stroke Association, as many as “9 out of 10 stroke survivors have some degree of paralysis immediately following a stroke”. Hemiplegia is caused by an injury to the parts of the brain that control movement, resulting in the inability to control the voluntary movement of a muscle or a group of muscles. It’s often accompanied by these Muscle spasticity (weakness in the muscles), Muscle atrophy (loss of muscle strength) and pain. Subacute infarcts in the left basal ganglia, Right frontal and left fronto - parietal regions lead to Occlusion in the middle cerebral artery. Obesity, RHD (Rheumatoid heart disease) is leading cause of the stroke. Hemiplegia, Dysarthria are the usual clinical manifestations. Vitals should be managed first followed by symptomatic treatment.

Case Study

The present case study deals with 48-year-old female patient presented with the complaints of weakness in the right side of the body associated with difficulty in speech and locomotion, generalized weakness and constipation in the past 1 week.

History of present illness

Patient was apparently normal 1 week ago. One evening she suddenly fell to the ground and had frothing in the mouth, loss of conscious, not oriented to time and place. Inability to move right upper limb and lower limb and difficulty in speech. She was treated conservatively at modern hospital after getting discharge from there she got admitted in Ayurvedic hospital.

History of past illness

Patient was Known case of type 2 DM, HTN and RHD on treatment with Allopathy medicine. She underwent percutaneous ballon mitral valvuloplasty. History of paralysis attack 2 times. Patient is on regular medication. No history of any food allergy.

Drug history: Allopathic medications

Tab. Atorva 20 mg (1-0-1)

Tab. Aten 25 (0-0-1) after food

Tab. Deplatt 75 (1-0-0)

Vital examination

TemperatureAfebrile
Pulse rate90/m
Blood pressure140/80 mmHg
Respiratory systemB/L clear
CVSS1, S2 normal

Central nervous system

Consciousness, oriented - conscious to time, place, person

Dasha Vidha Pareeksha

DoshaVata Pradhana Tridosha
DushyaRakta,Mamsa, Meda, Snayu, Sira
PrakrutiKapha-Vata
DeshaJanghala
KalaSharata
BalaMadyama
SaraAvara
SamhananaAvara
PramanaAvara
SatmyaVyamishra
SatwaAvara
Ahara ShaktiMadyama
VayaMadhyama

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O/E

Eye closure normal, blowing normal, whistling not present.

Gait: She is unable to walk.

Motor system

Table 1: Muscle power (Before Treatment)

RightLeft
Upper limb0/55/5
Lower limb1/53/5

Table 2: Muscle tone (Before Treatment)

RightLeft
Upper limbRigidityNormal
Lower limbRigidityNormal

Table 3: Reflexes

RightLeft
BicepsExaggeratedN
TricepsExaggeratedN
BrachioradialExaggeratedN
KneeExaggeratedN
Achilli’s tendonExaggeratedN
PlantarAbsent + ve Babinski signN

MRI - Brain Screening

Subacute infarcts in the left basal ganglia, Right frontal and left fronto-Parietal regions.

Old infarcts in the left middle cerebral artery territory.

Small old infarcts in the right cerebellar hemisphere.

No evidence of intracranial space occupying lesion.

Materials and Methods

Manjishtadi Kwath Niruha Basti[6]

  • Saindava Lavana - 5 gm
  • Madhu - 30 ml
  • Kalka - Ashwagandha Kalka - 15 gm
  • Taila - Ketaki Muladi Taila - 30 ml
  • Kashaya - Rasna Saptaka Kwath - 80 ml, Manjishtadi Kwath - 80 ml
  • Jala - 250 ml
  • Total - 500 ml

Shamana Aushadhi

  • Brihat Vata Chintamani with gold 0-1-0 after food
  • Yogaraj Guggulu 1-0-1 after food
  • Shephalika Patra Kashaya 2tsf -0- 2tsf before food
  • Unmada Gajakesari Rasa 1-0-0 before food
  • Ekanga Veera Rasa 1-0-1 after food
  • Kalyanaka Avaleha Churna with Nimbu Swarasa and Madhu

All the above medicines were given for the period of 3 months

And continue Allopathic medications

Tab. Atorva 20 mg (1-0-1)

Tab. Aten 25 (0-0-1) after food

Tab. deplatt 75 (1-0-0)

DateProcedureAoushadaDaysObservation
15/08/23 to 30/08/23Sarvanga UdwartanaKolakulathhadi Churna10 daysSlight bluish discolouration on the rt. thigh region
31/08/23 to 29/9/23Sarvanga Abhyanga f/b KsheeradhoomaKayatirumeni Taila + Prabanjana Vimardana Taila24 daysSlight movement of the rt. side of body, reddish rashes
1/10/23VirechanaNimba Amruta Eranda Taila1 day 20 ml with Ksheera morning4 Vegas
6/10/23 to 28/10/23Kukkutanda Swedana f/b KsheeradhoomaBala Moola Churna + Ksheera20 daysAble to lift right upper extremities
22/10/23 to 28/10/23Matra BastiMahamasha Taila7 daysAble to lift right upper extremities
30/10/23 to 10/11/23Karma BastiManjishtadi Kwath, Rasna Saptak KwathNiruha Basti - 12Able to walk without support 2 steps
30/11/23Karma BastiKarpasaasthyadi Taila and Ketaki Mooladi TailaAnuvasana Basti - 18Able to walk without support 2 steps

Table 4: Muscle power (after treatment)

RightLeft
Upper limb4/55/5
Lower limb5/54/5

Table 5: Muscle tone (after treatment)

RightLeft
Upper limbNormalNormal
Lower limbNormalNormal

Gait: During treatment she developed circumduction gate, after treatment attained normal gait.


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Anthropometry before and after treatment

SiteBefore TreatmentAfter Treatment
Right upper limb
Mid arm
Mid forearm		37 cm
27cm		37 cm
25 cm
Right Lower limb
Mid-thigh
Mid foreleg		65 cm
36 cm		64 cm
34 cm
Left Upper limb
Mid arm
Mid forearm		36 cm
27.1/2 cm		36 cm
25.5 cm
Left Lower limb
Mid-thigh
Mid foreleg		56 cm
36 cm		60 cm
35.5 cm

Discussion

Ayurvedic management of Pakshaghata includes Snehana, Swedana, Snigda Virechana, Vatasya Upakrama and Vyayama. Acharya Charaka mentions Udvartana for Medoroga in Sutrasthana. Acharya Sushruta and Acharya Vagbhata also describes about Udvartana that it dissolves Kapha and Meda. Udvartana is indicated in Vataja and Kaphaja disorders, as it does ‘Kaphavilayana’ and ‘Srotoshodhana’ and also helps to dissolve the vitiated Meda Dhatu and promotes Agni. Udvartana is generally administered in Gauravata (heaviness of body), Shula (pain all over body) and Aamaja conditions. Kolakulatthadi Churna contains Kola, Kulattha, Suradaru, Rasna, Masha, Atasi, Kustha, Vacha, Shatavha, Yava Churna which all are Medohara.

Sira Snayu Vishoshana mainly occurs in Pakshaghata hence Snehana is very essential for such condition. Abhyanga[7] helps in nourishing and strengthening the muscles of upper limb and lower limb. Therapeutically, Abhyanga also acts on vitiated Vata Dosha, it also nourishes the Dhatu of the body. Kayatirumeni Enna contains Tila Taila, Tambula (Piper beetle), Nimbuka (Citrus limon), Bala (Sida retusa), Kalonji (Nigella sativa), Swarna Patri (Cassia angutifolia), all are Kapha, Vata Hara, Shoolagna property. Prabhanjana Vimardana Taila contains Tila Taila, Ksheera Bala, Shatavari, Eranda, Vajigandha, Bilva, Syonaka, Patala which acts as Vatahara and Shula-Hara. Abhyanga allows free movement of toxins through the skin, makes skin soft, reduces spasticity, rigidity of joints and muscles, giving it a soothing effect and relieves pain.

Ksheeradhooma[8]: Ksheera and Balachurna are used in the procedure. Rukshata will decrease by Snigdha Guna, Sthanika Srotovivarana

decreases by Ushna Guna and, Mridutva and Balya effects are accomplished by steam of a mixture of Ksheera and Balamoola Kwatha. Ksheera Dhuma with milk decoction vapours causes the body part to sweat, which opens the pores. This aids in the relief of inflammation and stiffness in the afflicted areas. Ksheera Dhooma is a Snigdha variant of Nadi Sweda.

The Kukkutanda in itself has Brumhana and Snigdha Guna which further assists in the process of Snehana. These Guna are opposite to the vitiated Vata Dosha and hence improve the strength of the fibrous tissue and, increase movement and flexibility of the joints by relieving the pain and stiffness caused mainly due to Vata Dosha. The Snehana action also strengthens the nerves through Balya Karma and relieves nerve compression by providing Snigdhata (lubrication).

Virechana[9]- Virechana is the procedure which expels out the Doshas through Adhomarga i.e., Guda. This Karma mainly aims to eliminate Pitta Dosha. In Pakshaghata, Samprapti presents through Sira, Kandhara Shoshana. They are Upadhatu of Rakta. Pitta is Mala of Rakta, hence Virechana is useful. After Virechana therapy, purification of body channels takes place along with clarity of the sense organs, lightness of the body, increase in energy, promoting the power of digestion and metabolism and expulsion of faeces. Acharya Charaka has the view that the physician should use Mridu Virechana drugs in weak patients having more Doshas because repeated elimination of Doshas in small quantity will give good prognosis in the disease. The patient who has not taken Virechana drugs in past and whose Koshta is unknown, in such patients Acharya Sushruta has recommended the use of Mridu Virechana drugs in the beginning and after knowing the Koshta, the required drug may be prescribed. As per Acharya Vagbhata, Nimbaamritadi Eranda Taila Nitya Virechana is one among the line of treatment advocated to treat Kupitavata and Sanchita Mala.

There is involvement of Suddha Vata Prakopa, Anya-Dosha Samshrista Vata Prakopa and Dhatu-Kshaya-Janya Vata Prakopa in Pakshaghata. As per contemporary medical science, any stroke or shock associated with ischemia and haemorrhage resulting in the destruction of brain tissue and disturbed blood supply. Thus, with the help of Virechana Karma, vitiated doshas can be expelled out from the


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body which helps in maintenance of the equilibrium of the body and reduce the symptoms of the disease.

Nasya[10] is potent Vata Shamaka procedure as it directly acts on the Urdhava Jatrugata Vikara. Shira Pradesha is the main Adhishthana of Indriya and, Nasa is considered way to reach it. Drug administered through Nasa, goes to Shiras and causes Dosha Nirharana and Vata Shamana simultaneously. Karpasasthyadi Taila contains Karpasa Asthi which acts as Vata-Kaphahara and Bruhmana. It is a formulation mentioned in Sahasrayoga and is indicated in the form of Nasya in Pakshghata and Ardita like conditions.

Due to diet and lifestyle of the present era, Rakta (blood) gets vitiated and which in turn does the Avarana (covering) of Vata. Vata Prakopa (aggravation) takes place and it gets localized in different parts of the body manifesting the signs and symptoms of aggravated Vata like Toda, Pani-Pada Karmakshaya, Achetana like Lakshanas. Manjishtadi Niruha Basti, In Niruha Basti, Madhu possesses Yogavahi and Sukshma Marga Anusarita Guna, functions as a catalyst, penetrating the Sukshma Srotas. The Laghu and Tridosha Shamaka Gunas were introduced through the Saindhava Lavana. The Snigdha Guna of Sneha Dravya (Ketaki Muladi Taila, Karpasa Asthyadi Taila) combats the Ruksha and Laghu Gunas of Vata, resulting in Vata Shamana. Kalka (Ashwaganda) Balya, Ksharabasti[11] is mentioned by Chakradatta and decoction of Rubia cordifolia (Manjisthadi Kwatha) is mentioned by Sarangadhara. Rubia cordifolia (Manjistha) is renowned blood purifier (Rakta Sodhaka), channel cleanser (Sroto-Sodhaka) and the Ksharabasti removes the Avarana of Vata.

Tablet Yogaraja Guggulu[12] contains Guggulu, Ghrita, Triphala, Trikatu are Ushna Virya, Katu Vipaka, Laghu, Srotodushtihara, Deepaniya, Pachaniya, Marghavarodha Hara helps in Pakshaghata.

Shephalika Patra Kashaya[13] here Shephalika refers to Nirgundi Patra acts as Vatahara and it is indicated in Vataroga, Bhaisajya Ratnavali. Katu, Tikta Rasa, Ushna Virya Vata-Kapha Hara.

Tab Unmada Gajakesari Rasa[14] - contains Suta, Gandhaka, Manashila, Datura, Vasa, Rasna indicated in Unmada, to prevent epilepsy, Vata-Kapha Hara.

Kalyanaka Avaleha Churna[15] - contains Haridra, Vacha, Kushta, Ajaji, Ajamoda, Shunti, Pippali, Yashtimadu, Saindava, indicated in Swarabheda Adhikara. It improves memory, makes voice clear, cures hoarseness of voice, Aphasia.

Tab Bruhat-Vata Chintamani[16] with gold-contains Swarna, Roupya, Louha, Abraka Bhasma, Pravala,Mukta,Abraka ,Rasa Sindura, Kumari Swarasa, given once in day along with Ushna Jala acts as Rasayana, Pittasrita Vata Hara, according to Bhaisajya Ratnavali Vataroga Adhikara.

A medicine prepared by combination of Ekangaveera Rasa, Mahavatavidhvamsa Rasa, Sameer Pannaga Rasa and Sutasekhara Rasa, and all these Yogas are directly indicated in Vataja Roga. This specific type of combination was administered to patient to tackle symptoms like weakness and stiffness in the muscle.

Conclusion

Pakshaghata is Akarmanya Vata Pradhana Vyadhi which causes loss of function of one half of body and may be co-related to hemiplegia of any origin. Vata Pradhana Vyadhis are best treated with Basti and Nasya, as main Adhishthana of Dosha is Shiras. Symptomatic relief given by Sthanika Abhyanaga and Swedana. Thus, it can be concluded that Panchakarma procedure are very effective in Pakshaghata Chikitsa and should be given vigorously in the patients suffering from stroke and similar ailments. Pakshaghata is a difficult disease to manage, Acharya Sushruta mentions Pakshaghata associated with Pitta and Kapha is Sadhya, Vataja Pakshaghata is Krichra Sadhya. But by adopting a proper logical Panchakarma treatment protocol, one can get good prognosis in Pakshaghata. Panchakarma helps in muscle restoration and boost motor system and thus, overall relief in impairment occurs in patient of Pakshaghata. The success of this case helped to gain trust of the patients towards Ayurveda and Panchakarma.

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