Journal of Ayurveda and Integrated Medical Sciences

Introduction

Hemiplegia refers to paralysis affecting the muscles of the face, arm, and leg on one side of the body. Alongside motor impairments, individuals may experience other deficits, such as changes in sensation, memory, and cognition. Stroke is a major cause of disability and death in India. The prevalence of stroke in the country ranges from 40 to 270 cases per 100,000 people. Stroke is the most frequent cause of hemiplegia, typically damaging the corticospinal tracts in one hemisphere of the brain. Other potential causes include trauma, such as spinal cord injuries, brain tumors, and brain infections. Based on morbidity rates, 45% of stroke patients are able to live independently, while 22% become dependent on others, and 20% require hospitalization. There are primarily two types of strokes: ischemic and hemorrhagic. Ischemic strokes are more prevalent and occur due to a disruption in blood supply, whereas hemorrhagic strokes result from the rupture of blood vessels or abnormal vascular structures.^[1,2,31]

Pakshaghata is a condition in Ayurvedic medicine characterized by sudden paralysis or weakness on one side of the body, often linked to Vata dosha imbalances. It is similar to hemiplegia and may be associated with strokes or neurological disturbances. According to acharya charaka हत्वैकं मारुतः पक्षं दक्षिणं वाममेव वा|| This verse suggests that in the context of treatment, one should address an imbalance or blockage in a single part of the body, particularly referring to the “Marutaḥ” (vata or vital force) which might be affecting one side - either the right (Dakṣiṇa) or left (Vāma) side of the body. कुर्याच्चेष्टानिवृत्तिं हि रुजं वाक्स्तम्भमेव च| गृहीत्वाऽर्धं शरीरस्य सिराः स्नायूर्विशोष्य च||५४|| This verse elaborates on a therapeutic practice involving the cessation of abnormal movements or symptoms (Cheṣṭā Nivṛutti) that can help alleviate conditions like pain (Ruja) or speech impediments (Vāk-stambha).पादं सङ्कोचयत्येकं हस्तं वा तोदशूलकृत् | एकाङ्गरोगं तं विद्यात् सर्वाङ्गं सर्वदेहजम्|| This verse deals with the specific practice of constricting (Sankocayati) one foot or hand to alleviate localized pain or symptoms (Todaśūla-kṛt). The approach is indicative of treating single-limb ailments or localized issues (Ekāṅga-roga). This shloka, likely from an Ayurvedic or traditional medical text, describes a particular condition affecting the body and its treatment.^[3]

Pakshaghata and Hemiplegia both refer to conditions characterized by paralysis or weakness on one side of body, though they originate from different medical viewpoints. Pakshaghata is an Ayurvedic term that describes a condition similar to hemiplegia, involving weakness or paralysis on one side of body. In Ayurveda, this condition is attributed to imbalances in Vata dosha, affecting nervous and muscular systems. It is often associated with sudden onset and may be linked to disorders like stroke or neurodegenerative diseases, reflecting disruptions in body’s channels or vital energies. Hemiplegia is a term from contemporary medicine that denotes partial or complete paralysis on one side of body. Paralysis treatment focuses on managing symptoms and maximizing function. Physical therapy is crucial for maintaining muscle strength and flexibility. Medications and surgery may address underlying causes or complications. Ongoing research explores emerging therapies like stem cells and periprosthetic for potential recovery. Both conditions involve unilateral paralysis, but Pakshaghata is viewed through lens of Ayurvedic principles focusing on Dosha imbalances and traditional therapies, whereas Hemiplegia is examined through a modern medical approach that emphasizes neurological damage and rehabilitation.

Case Report

A 60 years old male patient came to the OPD. The patient reported being healthy until six months ago, when he abruptly developed spastic paralysis and associated pain affecting the left side of his body. He sought evaluation and treatment at our hospital.

Table 1: Personal History

Family History - NAD

Table 2: Dashavidhapareeksha

Table 6: Reflexes

Treatment

स्वेदनं स्नेहसंयुक्तं पक्षाघाते विरेचनम् || Ch.Chi.28/100 स्वेदनं This refers to the process of sweating or inducing perspiration. In Ayurveda, Swedana is a therapeutic technique used to help open the channels in the body, loosen toxins, and promote circulation. It can be performed using steam or other heating methods. स्नेहसंयुक्तं This means combined with oil or other lubricating substances. In this context, it suggests that the sweating therapy is done in conjunction with the application of oils. This combination helps to nourish the tissues, enhance the effect of sweating, and facilitate the removal of toxins. पक्षाघाते विरेचन (Virechana) This is a purgation therapy used in Ayurveda to cleanse the digestive system and eliminate toxins from the body. It involves the administration of Mridu Virechaka drug to induce a controlled, therapeutic purge.^[5] पक्षाघातोपद्रुतमम्लानगात्रं सरुजमात्मवन्तमुपकरणवन्तं चोपक्रमेत् | This describes a person suffering from paralysis, with symptoms including a weakened body, pain (Sarujam), and an impaired condition, implying the person is either unable to use or has diminished function in the affected parts. तत्र प्रागेव स्नेहस्वेदोपपन्नं मृदुना शोधनेन संशोध्यानुवास्यास्थाप्य च यथाकालमाक्षेपकविधानेनोपचरेत् | It suggests a treatment regimen for such a person. Initially, one should begin with gentle methods such as oil application (Sneha) and sweating therapies (Swedopapanna) to cleanse and purify the body. After the initial cleansing, one should use a mild treatment (Mriduna Shodhana) and apply medicinal oils (Anuvasya) as prescribed, ensuring the treatment is adapted according to the timing and progress (Yathakalam). वैशेषिकश्चात्र मस्तिष्क्यः शिरोबस्तिः, अणुतैलमभ्यङ्गार्थे, साल्वणमुपनाहार्थे, बलातैलमनुवासनार्थे | Mastishkya refers to treatments related to the head, indicating the importance of head and brain therapies. Shirobasti and shiropichu refers to a specific therapy where medicated oil is retained on the head for a period, used in conditions related to the head and nervous system.

Table 9: Observation^[7]

Discussion

Spastic paralysis, marked by increased muscle tone and stiffness, can be effectively managed through Ayurvedic treatment and Panchakarma therapies. By addressing underlying Dosha imbalances and employing techniques such as Mridu Virechana, Basti, and Abhyanga, these treatments help reduce spasticity in the affected right upper and lower limbs. Patients often experience improved muscle relaxation, enhanced flexibility, and overall better motor function.

Snehana

Sarwang Snehana with Vata Shamaka Taila used in Pakshaghata where Abhyanga, a form of oil massage, is crucial for treating Pakshaghata (hemiplegia) as it nourishes and strengthens the muscles of the upper and lower limbs. Swedana, which involves inducing sweating, helps alleviate symptoms like stiffness and heaviness while providing pain relief.^[8] Abhyanga is essential for managing Pakshaghata, a condition characterized by muscle contraction. This oil massage helps nourish and strengthen both the upper and lower limbs, addressing imbalances in Vata Dosha and supporting overall tissue health.^[9,10]

Shashtika Shali Swedana

Shashtika Shali Swedana is known for its nourishing, strength-enhancing, and pain-relieving properties. When used with Bala and Godugdha, it provides significant benefits due to its warm, oil-infused nature. This treatment improves blood circulation, reduces muscle stiffness, enhances tendon flexibility, and alleviates pain. By preventing muscle wasting through local absorption, it aids in reducing spasticity and facilitates joint movement. Combined with Abhyanga and physiotherapy, Shashtika Shali helps prevent the progression of disabilities and contractures.^[19]

Shiro Pichu

Shiro Pichu is an Ayurvedic procedure that involves placing a sterile cotton pad soaked in medicated oils on the top of the head, specifically at the Brahmrandhra (anterior fontanelle), and securing it with a bandage. This treatment often uses a combination of Jatamamsi, Amalaki powder, and Ksheerabala Taila. Shiropichu is highly effective for alleviating stress and nervous tension by targeting Tarpaka Kapha, Sadhaka Pitta, and Prana Vayu. The oil’s properties, such as its sharpness and penetration, help address mental imbalances and improve brain circulation, which is crucial for managing Vata Dosha.^[20]

Yograj Guggulu

Yograj Guggulu, with its properties of Tikta, Kashaya, Katu Ras, and Ushna, Ruksha Guna, is effective in balancing Kapha and Vata. It also offers pain relief, strengthens the nervous system, and reduces inflammation, making it essential for symptomatic relief in Vata disorders.^[21] Palsineuron Capsule is designed to address neuro-muscular disorders affecting both the central nervous system (CNS) and peripheral nervous system (PNS). It contains a blend of Mahavatvidhwans Rasa, Sameerpannaga Rasa, Sootshekhara Rasa, Ekangveer Rasa, Khurasani Owa (Hyoscyamus niger), and Lajari (Mimosa pudica). Mahavatvidhwans Rasa enhances CNS and PNS metabolism and coordinates neuro-muscular activities. Sameerpannaga Rasa improves tissue oxidation, combats anoxia, and normalizes neuro-muscular metabolism. Ekangveer Rasa supports nerve and blood vessel repair, facilitates blood vessel recanalization, and stimulates sensory and motor functions.

and calcium nanoparticles manage calcium channels and synaptic plasticity. Rasa Sindura also contributes to reducing neurodegeneration by supporting protein clearance.^[24-28]

Rasaraj Rasa

Rasaraj Rasa was chosen for this study to manage post-stroke depression due to its blend of Vatashamaka (Vata-balancing) drugs and its antidepressant properties. It is specifically recommended in the Bhaishajya Ratnavali for treating Vata-related disorders. In the other trial group, Vajigandhadi Basti was administered, as Pakshaghata and Vishada are associated with Vata Dosha imbalances, and Basti is considered an effective treatment for Vata disorders. Additionally, Acharya Charak noted that physical and mental conditions can significantly affect one another.^[29]

Erand Tail

Ayurvedic Erand Tail, or Castor Oil, alleviates pain through various mechanisms. It contains ricinoleic acid, which has strong anti-inflammatory properties that reduce inflammation in tissues, joints, and muscles, helping to ease pain from conditions like arthritis and muscle strains. When applied topically or used in massages, Erand Tail acts as a natural pain reliever by blocking pain signals locally. It also helps relax muscles, improves blood circulation, and reduces muscle tension and spasms, further alleviating pain. Enhanced circulation aids in removing metabolic waste from tissues, supporting healing and reducing discomfort. Additionally, Erand Tail’s detoxifying effects assist in removing toxins from joints and muscles, contributing to reduced pain and inflammation.^[30]

Conclusion

In conclusion, this case report highlights the complex presentation and management of a 60-year-old male patient who developed spastic paralysis and associated pain affecting the left side of his body. Despite a sudden onset of symptoms and an initial lack of a clear aetiology, the patient demonstrated notable improvement following 62 days of Ayurvedic treatment. This case underscores the potential of integrating traditional Ayurvedic approaches in the management of neurological conditions and suggests that further research is warranted to evaluate their efficacy and mechanisms in treating spastic paralysis.

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