E-ISSN:2456-3110

Research Article

Facial Paralysis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 9 SEPTEMBER
Publisherwww.maharshicharaka.in

Etiopathological study of Ardita w.s.r. to Facial Paralysis - An observational study

Sinha R1*, Nayak NR2, Kande A3
DOI:10.21760/jaims.9.9.6

1* Roshani Sinha, Post Graduate Scholar, Dept of Roga Nidana Evum Vikriti Vigyana, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India.

2 Nikhila Ranjan Nayak, HOD and Professor, Dept of Roga Nidana Evum Vikriti Vigyana, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India.

3 Aradhana Kande, Lecturer, Dept of Roga Nidana Evum Vikriti Vigyana, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India.

Ardita is one of the Vata Vyadhis which is caused by aggravation of Vata. Ardita has been enlisted amongst the eighty types of Nanatmaja Vata Vyadhis. The vitiation of Vata especially aggravation of Vata causes ‘Ardita’ as mentioned in almost all Ayurvedic classics. Acharya Charaka has included Sharirardha in Ardita while Sushruta has considered only face or upper part of the body is affected in Ardita. Ardita can be co-related with facial paralysis on the basis of its signs and symptoms mentioned in texts. Here, temporary suspension or permanent loss of function, especially loss of sensation or voluntary motion of unilateral side of face is considered. It occurs due to any injury or inflammation to facial-VIIth cranial nerve, which leads to partial or total loss of movement of unilateral face. Actually, facial paralysis leads to a disability of interaction by loss of facial expression, which is a major part of human communication. It may reoccur or leave synkinesis. Modern science found drugs like steroid and Antivirals etc. for it, also surgical and other treatments are available for facial paralysis. Yet, its recurrence and synkinesis also reported. Facial function plays an integral part in everyday lives disability of both verbal communication and facial expressions are hampered in Ardita. It is a condition that causes temporary weakness or paralysis of muscles in face.

Keywords: Ardita, Vata Nanatamaja, Facial Paralysis, Vata

Corresponding Author How to Cite this Article To Browse
Roshani Sinha, Post Graduate Scholar, Dept of Roga Nidana Evum Vikriti Vigyana, Shri NPA Govt Ayurveda College, Raipur, Chhattisgarh, India.
Email: 		Sinha R, Nayak NR, Kande A, Etiopathological study of Ardita w.s.r. to Facial Paralysis - An observational study. J Ayu Int Med Sci. 2024;9(9):42-48.
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https://jaims.in/jaims/article/view/3825

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-08-12 2024-08-22 2024-09-02 2024-09-12 2024-09-25
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.48

© 2024by Sinha R, Nayak NR, Kande 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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Roshani S et al. Etiopathological study of Ardita w.s.r. to Facial Paralysis

Introduction

Ayurveda considers unwholesome interaction of man with his environment through Ayoga - Atiyoga-Mithya Yoga of Kala-Buddhi Indriyartha as the main cause of disease. Equilibrium state of Doshas, Dhatus, and Agni is dependent on Vata. It also receives the sense objects & induces actions related to to physical, speech and mind. Acharya Charaka has considered Ardita as one among the 80 Vataja Nanatmaja Vyadhi in Sutrasthana. Ardita can be result of long-term suppression of natural urges like sneezing and yawning.

The features of Ardita mostly resembles with palsy of 7th nerve such as deviation of face, less or decreased function of affected muscles and numbness of particular area. Vata is the control factor for the mechanism of mind and body. Moreover the fast life style, irregular food habits and lack of rest also aggravate ‘Vata” Dosha, thus the ratio of Vatavyadhi is increasing day by day.

In Ayurveda, Ardita is a disease with functional disturbance affecting Uttamanga. The disease has been elaborated by Ayurveda Acharya Charak, Sushruta and Vagbhatta in their respective Samhitas.

Objectives

  • Etiopathological study of Ardita described in classical texts from the point of theoretical view.
  • Study on etiological factors, symptoms and pathogenesis of Ardita based on the Research proforma.

Methodology

Pattern of Research Work: To fulfil the above objectives, the entire research work was studied by dividing into two parts -

  • Conceptual study
  • Observational study

Conceptual study:Ardita was discussed in detail after studying various Ayurvedic classical texts, modern textbooks, various magazines, journals and research papers.

Observational study:A special research proforma was prepared on the basis of classical Nidana and modern diagnosis of Ardita.

Selection of the patient:40 patients were selected from Shri Khudadad Dungaji Ayurveda Hospital, Raipur (C.G.).

Diagnostic criteria: Blood routine investigations, Urine test (Routine and microscopic), HbA1C, RBS, MRI & CT Scan reporting is done.

Inclusion Criteria

  • Patients who were willing for study. Either sex between the age group of 18 years to 70 years.
  • Patients presenting the clinical features of Ardita as mentioned in Ayurveda texts.

Exclusion Criteria: Patients who were not willing for study. Pregnant or lactating women, Any others neuropathy (except Bells Palsy), Unstable cardiovascular disease, Severe immune deficiency.

Assessment Criteria : the assessment was done by the Lakshanas of Ardita as per in Ayurvedic texts.

Subjective Criteria : The lesion area having following symptoms will be included-

Gradation of symptoms of Ardita - Facial Paralysis

  • Watering from the Affected Eye
  • Widening of Palpebral Aperture
  • The Absence of Nasolabial Fold
  • Smiling Sign
  • Slurring of Speech
  • Dribbling of Saliva
  • Trapping of food between gums and teeth

Methods of data collection:

General examination and research proforma which includes Nidana Panchaka Patraka, consent form, sphygmanometer.

Procedure of data collection: Interview

A structured interview was conducted, which included information on socio demographic variables like age, gender, education, occupation, religion, domicile, marital status, behavioral factors like diet and habits, Nidana Panchaka questionnaire.

Statistical Analysis: The continuous data were calculated using descriptive statistics and others were calculated in frequency and percentage.


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Roshani S et al. Etiopathological study of Ardita w.s.r. to Facial Paralysis

Study design: Observational study was conducted during April 2023 – April 2024 after selecting subjects as per inclusion criteria, an interview was conducted to assess the quality of life and Prakriti.

Discussion

Discussions on observations


  • Observational study of 40 patients according to Age with Ardita found maximum 70% patients in the age group of 36-60years. In accordance to the general Ayurvedic principle, every disease gets more severe during the Vriddhawastha of Rogi which is kala of ‘Vata’ Prakopa and beginning of the ageing process and degenerative change. The cause of Ardita in patients aged above 36years might be disordered lifestyle, Viruddhahara such as consumption of canned products, bakery products, samosa, kachori, burger, pizza etc. and mental stress also.
  • Observation according to Gender, maximum 80% male patients and 20% male patients were found. The reason for getting the highest percentage of male category might be that males are not aware of their health. Also, males are busier with their job and more active in daily work activities. Males are more addicted to these unhealthy lifestyles, consuming junk foods, smoking, Alcohol, gutakha etc.
  • Observation according to Religion, maximum 95% Hindu patients, 2.5% Muslim patients, 2.5% Sikh patients and 3.3%patients were found. Ardita can afflict a person of any religion. According to religion, in the description of 40 patients of Ardita, the reason for getting the maximum number of patients of Hindu religion group is that the area of the observational study is dominated by Hindus.
  • Observation according to residence, the study was carried out at a hospital located in an urban area. Therefore, as many as 70% of patients were from urban areas. The urban lifestyle, fast and stressful schedules, irregular dietary patterns, etc. may be supporting to the pathogenesis of the disease. Distribution of almost all patients (100%) among Sadharana Desha can be due to geographic location of the institute.
  • Observation according to the Occupation, maximum 32% of patients were found to be Serviceman. The busy lifestyle produced by activity is the most likely cause of Ardita in service profile. Mentally strenuous activity lead to Ardita due to Mansika Hetu, excessive consumption of Viruddhahara, Adhyasana, etc. Labour/daily wages constitute 30% which may be the result of physical strenous activity leading to Vata Prakopa. The incidence among these two are may be due to constrains of household, financial tension, irregular diet habits and Vegavidharana, Ratrijagarana, Kriyatigyog, etc.
  • Observation according to Education, the maximum 38% patients with secondary education, 30% patients with higher education, 12% patients with primary education and 20% patients were found uneducated. No association of Ardita with education can be established.
  • Observation according to Marital status, 100% patients found in married category. Since a married person has a family and social responsibility who remains busy and consumes Mithya Ahara Vihara. Also because of the age group was found more primarily between 30yrs-60yrs, where in India which is a common age range of marriage.
  • Observation according to Socio-economic status, the distribution of patients in which the majority of them about 47% patients were from the middle class. This majority is the result of a study done in a government hospital where most of the patients belong to middle-class families.
  • Observation according to Food habit, maximum 65% patients were found in mixed group (vegetarian & non-vegetarian) and 35% were found in vegetarian group.
  • Observation according to Bowel habit, maximum of 70% patients were found to have irregular bowel habit. The reason may be that due to busy lifestyle and mental stress, the person is not able to pay attention to proper eating habits, due to which the condition of Agnimandya arises, as a result of which there is improper excretion of Mala, Mutra and Sweda Pravritti and accumulation of Mala pollutes the body.

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  • Observation To Addiction wise distribution of study shows that maximum 55% patients were addicted to tea, 15% to coffee, 18.3% to pan masala, 8.3% each to alcohol and smoking. There may be vitiation of Vata due to tea as it may cause Mangadni. Other all addictions also effect the Agni making it Vishama. The immunomodulatory mechanism may be suppressed due to it and may support to aggravate Vata, Long history of such addiction like alcohol and smoking may hamper the normalcy of Doshas which may lead to Ojakshaya and neurological disorders too.
  • Observation acc. to Sharirika Prakriti wise distribution of study shows that maximum 50% had Vata-Kaphaja Prakriti. The possible reason could be that a person who consumes Ahara which are of same Doshika predominance as his Prakriti, his Doshas automatically get aggravated. As per Acharya Charaka, Ardita is Vata predominant Tridoshaja Vyadhi. Vata Dosha are aggravated by consumption of Vata dominant Ahara-Vihara and consuming Kapha dominant Ahara-Vihara causes Agnimandya, due to which Amarasa is produced and Kapha Dosha are vitiated. Both Dosha get aggravated. That’s why probably, people with Vata-Kapha predominance were found to have Ardita.
  • Observation acc. to Mansika Prakriti wise distribution of study shows that maximum 65% were found to be of Tamasika Prakriti Rajasika Prakriti and 35% were of Rajasika Prakriti.
  • Observation according to Sara Pariksha, maximum 87% with Madhyama Sara and 13% with Avara Sara.
  • Observation according to Samhanan Pariksha, maximum 91% with Madhyama Samhanan, 5% with Pravara Samhanan and 4% with Avara Samhanan.
  • Observation according to Pramana Pariksha, maximum 87% with Madhyama Pramana, 5% with Pravara Pramana and 8% with Avara Pramana.
  • Observation according to Satmya Pariksha, 34% patients were of Mishrarasa Satmya, 6% patients were of Ekarasa Satmya and none of the patients were of Sarvarasa Satmya.
  • Observation according to Satva Pariksha, maximum 77% with Madhyama Satva, 23% with Avara Satva.
  • Observation according to Ahara Shakti Pariksha, maximum 72% were found with Madhyama Ahara Shakti.Observation According to Vyayama shakti pariksha, 52% patients were of Madhyam vyayama shakti were found.

Observation on the basis of Nidana Panchaka

The following result were obtained after conducting an observational study of 40 Ardita patients on the basis of Aharaja Nidana / Viharaja Nidana and Anya Nidana. In this particular study, Maximum of patients were accustomed to

  • Ruksha, Sheeta, Laghu Ahara Sevana like Chanaka, Kalaya, Yava etc. And Vatakaraka Aahara Vihara Sevana like Kathina Padarth Sevana, Atipravaat Sevana, Ati Sheeta Sevana (90%).
  • Katu, Tikta, Kshaya Rasa Pradhana Ahara like Maricha, Karela, Patola (87.5%)

In present era due to sedentary life style and the food habits, consumption of these are so common nowadays.


  • It has been observed that Vega Sandharan (82.5%) has been commonly found, this maybe due to sedentary life style, prolonged sitting jobs or working on computers, and avoidance of public washrooms, By holding Mala-Mutra Vega, due to which being lack of proper Pravritti of Mala-Mutra, it pollutes the body, Apana Vayu got aggravated which got Vimarga Gamana and can affect Urdhva Sharira.

Where as particularly in Ardita, By holding Vega of Kshavthu, Jrimbha, Udgaar, the remnants Doshas are not removed properly, and eventually Vata get aggravated and produce Ardita.


  • It is found that Adhyashan / Vishmashan / Anshana / Virruddhashan has 80% contribution for the disease. This could be probably due to late night lifestyles which may be the possible reason that exercises after eating leads to the generation of Ama through Agnimandya, due to which Kapha Dosha get aggravated and causes Ardita.
  • Where as in Adhyasana - The undigested Rasa (Amarasa) were develop from the Adhyasana. This Amarasa mixes with Rasadi Dhatu and flows via Tiryakvaha Siras and develops Srotorodha which leads to Ardita.

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Roshani S et al. Etiopathological study of Ardita w.s.r. to Facial Paralysis
  • Manasika Hetu like Chinta, Shoka, Bhaya, Krodha (72.5%) were also registered. High levels of stress, anxiety, and emotional instabilitycan profoundly affect Vata Dosha.
  • 60% of patients who had Ratri Jaagrana/Diwaswapna (sleep in day) were found. The probable reason for which could be that there is an outbreak of Vata and Kapha Prakopa, as a result Ardita develops.
  • Some specific Hetue., Kashta Dayak Shayya Shyana (65%), Atipravata Sevana, Abhighata, Ati Prabhasana, Ati Ucchairbhasana, Rakta Kshaya may directly involved in provocation of Vata.

Thus, it was observed that many of patients were having multiple type of Nidana. These observations were in favour of Ayurvedic description of disease and it confirmed Nidana of Ardita. Observational study of 40 Ardita patients on basis of Purvarupa - Among 40 patients in this study, 85% patients experienced Toda, 82% patients experienced Aavila Netrata, 80% patients experienced Manya-Hanugraha.

  • Toda is described as a typical Vatika symptom in Ayurvedic classics, which is also one of Vata Nanatmaja Vyadhi, may be due to aggravation of Vata, Toda found in maximum patients.
  • Hanugraha or we can say Lock jaw is one of complications of Bell's palsy which is damage to fourth and fifth branches of Cranial Nerve VII i.e., Facial Nerve and, consequently dysfunction of jaw-opening muscles. Thus, it is validated through modern science.
  • Other Purvarupa also been observed in patients such as Twacha me sunnata, Vayu ka urdhvavega, Romaharsha, Vepathu in very small proportions which directly or indirectly leads to Vata Prakopa.

The following result were obtained after conducting an observational study of 40 Ardita patients on basis of Lakshana -
The study of Symptomatology reveals that maximum numbers of patients were presented with Vaktrardh Vakra (100%), Prabhavit bhaga se nishthiva, anna evum jala ka girna (lalastrava) (100%), Netravikriti was observed in 100%, Griva Chibuk Dantanum Parsve Vedana in 95%, Shruti Haani (52.5%), Kshava Graha (52.5%). Shirakampa and Vaksanga contributes 27.5%, Gandha Agyaanta also found in some of patients.

It mostly resembles to the cardinal signs and symptoms of Ardita as well as facial palsy, i.e., inability to close eyes, facial asymmetry, loss of forehead and nasolabial fold, drooping of corner of mouth, dribbling of saliva, stasis of food, oedema on lips, etc. The results obtained in this way confirm the fact that the classical symptoms of Ardita are effective at present.

Grade wise distribution

50% patients were found Grade IV facial paralysis, 30% of them were found Grade III, 15% of them were with Grade V while 5% of them were found with Grade II Facial paralysis. The degree of voluntary movement was assessed as per House Brackmann’s classification system for Facial paralysis.

  • Observation on the basis of affected side : In this study, 60% of the patients were found with affection of right side and 40% of then with affection of the left side of the face. According to National Institute of Neurological Disorders and Stroke (US Govt.), Bell's palsy can affect both sides of the face. This observation may be due to small sample size.
  • Observation according to Haemoglobin test, 32 patients of male group with Ardita, maximum 63% male patients with haemoglobin less than 13gm, 37% were found. This might be due to Srotorodha and Raktadushti in Ardita.
  • Observation according to Haemoglobin test, 8 patients of female group with Ardita, maximum 75% female patients with haemoglobin less than 11.5gm% were found. This is due to vitiation of Rakta Dhatu and Margavarodha in Ardita. In modern aspect, Hb has a direct relation with blood supply and the delivery of oxygen to the central nervous system.
  • Observation According to ESR test, in 32 patients of male group, maximum 72% male patients with raised ESR (more than 15 mm/1hr found) & in 8 patients of female group, maximum 63% female patients with raised ESR (more than 20 mm/1hr) were found. Due to deregulation of inflammatory process and hyper activation of Auto-immune factors, ESR has been raised.
  • Observation According to Blood Pressure, 45% patients are found to have Blood Pressure more than 130/90mmHg.

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Roshani S et al. Etiopathological study of Ardita w.s.r. to Facial Paralysis
  • The association of Hypertension may lead to embolism or infarct and atherodegenerative changes, which may be a supportive factor for the disease also.
  • Observation According to Hb1Ac, 50% patients with higher than 6 value. Diabetics are more than 4 times more likely to develop Bell's palsy then general population.

Conclusion

From the survey study done it is concluded that the Nidana and Lakshana of Ardita Roga are described in ancient Samhitas were also found in the present context in the patients selected for the survey. In order to stay healthy in this modern era, it is necessary to follow Matravata and Samyaka Ahara Vidhi Vidhana, Nidra, Niymita Dincharya, Ratricharya and Ritucharya. The Pathya-Apathya described in ancient Samhitas are still beneficial for health in this present Era too.

In this study, in Aharaja Nidana maximum patients were having the history of mainly Vata Pradhana Dravya. In Viharaja Nidana, maximum patients were having the history of Ucchaibhashan, Atipravaata Sevana, followed by Vegadharana, Atiprabhasana, Divaswapana, Vishamasana, Atyambupana, Atiprajagrana and Vishamasana (wrong posture).

In Manasika Hetu maximum patients were having the history of Chinta followed by Krodha, Shoka, and Bhaya. In Anya Nidana maximum patients were having the history of Ama formation. The history of Margavarodha, Dhatukshaya and Rogatikarshana were also found in some patients.

In the Samprapti, Vata Prakopak Ahara Vihara gives rise to aggravation of Vata and at the same time, Ruksha, Laghu, Sheeta Guna of Vata get vitiated and get localized in the regions of head, neck, nose, chin, forehead, eyes resulting in the Rakta Dhatu Shoshana in turn result into aggravation of Vata. This way, Vata located in Urdhva Jatrugata and produces the symptoms of Ardita. Some of observations obtained during the study that max 60% of patients had Right sided Bell’s palsy. But according to modern science, left and right side of face are equally affected in Bell’s palsy. Maximum patients were 36-60 years of age group, Hindu, Married, Higher educated, Service class, and middle-income group.

On the basis of history of Hypertension and diabetes, we found that maximum of them were chronic HTN and DMII patients, The relationship between facial paralysis and hypertension has been reported in a maximum number of cases, including several reports of recurrence of paralysis during acute exacerbations of hypertension. On the other hand, we found that the maximum patients have an acute onset (idiopathic) of facial paralysis.

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