Introduction

Hemiplegia (hemi = half; plegia = paralysis), as the name suggests, literally means paralysis of half of the body. If there is muscle weakness without paralysis, it is termed hemiparesis. Therefore, hemiplegia affects only one side of the body. Hemiplegia can occur suddenly, or develop slowly. Main causes of hemiplegia are cerebrovascular accident (CVA), Brain injury, Infections, Haemorrhage etc. [1] There are over one billion people with disabilities in the world, of whom between 110-190 million experience very significant difficulties.[2] From all the disabilities, hemiplegia is one of the crippling disorders in our society. .[3] Having disabilities, people may face difficulties in their daily lives, such as dependence on others in self-care and work. They may feel angry, depressed, and guilty when facing these challenges. .[4]

    Hemiplegia can be correlated with Pakshaghata in Ayurveda if compared according to symptoms. The cardinal features of Pakshaghata include Chesta nivrutti (impaired motor activity), Ruja (Pain), Vakstambha (slurred speech) which is explained in Charak under the heading of Pakshavadha. .[5] Pakshaghata is explained as an important Vatavyadhi described under Vataja nanatmaja vyadhi [6]and Mahavatavyadhi [7] can manifest either due to dhatukshaya and margavarana. In this Paksha denotes half of the body and Aghata denotes impairement in Indriya leads to karmahani of Indriya. Main cause of this disease is vitiated Vatadosha takes shelter in half side of the body. According to Ayurvedic literature, it is evident that no specific etiological factors described separately for Pakshaghata. So, common factors causing Vataprakopa considered as causes of Pakshaghata. Nidana described for Vata disorders in various Ayurvedic texts are classified systematically as below:

1. Aharajanya Factors

2. Viharajanya Factors

3. Manasika Factors

4. Abhighataja Factors

5. Anya Factors [8]

In Ayurveda treatment of pakshaghata is described which includes Panchkarma, Bahiparimarjan chikitsa like Snehana, Swedana, Pindsweda therapy used to aid in a Rapid recovery and Rehabilitation from Pakshaghata along with Shaman Aushadhi and Nidanaparivarjana. So, present study is planned to assess the efficacy of Ayurvedic intervention in Pakshaghata.

Aim & Objective: To see the effect of Ayurved intervention in management of Pakshaghata.

Methods:

Case Report

A 66yrs female patient attending Kayachikitsa outpatient department of Government Ayurved Hospital, Nagpur with complaints of unable to stand and walk, weakness in left upper limb and lower limb, slurred speech, dysphagia, constipation on and off since 3 months. She didn’t receive any treatment for 3 months. Then she was treated for left hemiplegia diagnosed on the basis of Signs and symptoms and CT Brain (Plain) which shows chronic lacunar infarcts in the Government Medical Hospital Nagpur and the she is Conscious and oriented but has no symptomatic relief.              

                She was brought by her relatives to Govt. Ayurvedic Hospital, Nagpur. Patient was admitted in Indoor Patient Department (IPD) (IPD No.542-05/08/2022). She did have history of DM type 2, Hypertension for 3 years. She had surgical history of Appendectomy 2 years back. She had history of Tobacco chewing daily for 15 years stopped from 2 months. No history of any specific medication or drug abuse.                                                                                             

Past history

Patient was healthy 3 months back but suddenly She was asymptomatic and suddenly she felt cramps and severe numbness in the left side of her body; again, on the next day, her complaints became severe then she felt weakness in left upper and lower limb. For which she didn’t receive any proper treatment. She also develops symptoms like Dysphagia, slurred speech etc. She was investigated with CT brain and other investigation at GMC Nagpur. Treatment advised by to patient in GMC includes Atorvastatin (40mg 1OD) and under medication for Diabetes includes Metformin and Glimepiride combination (500mg + 2mg 1BD), and for hypertension losartan (25mg 1OD).

Examination on Admission

General examination

Blood pressure - 130/90mmhg.

• Pulse rate – 84/min.

• Respiratory rate – 20/min.

• Temperature – 97.60 F

• Edema – No

• Pallor – Present

• Icterus – No

• Clubbing – No

Ashtavidha Pariksha

• Nadi (Pulse) - Vatapradhana kapha                  

• Mala (Stool) - Vibhandata

• Mutra (Urine) - 5-6 times per day

• Jivha (Tongue) - Saama

• Shabda (Speech) - Slurred speech

• Sparsha (Tactilation) - Samashitoshna

• Druk (Eyes) - Prakruta

• Akriti (Anthropomentry) – Krusha

Systemic Examination

• Respiratory system - on auscultation, normal sounds heard and no abnormality detected.

• Cardiovascular system - S1 S2 heard and no abnormality detected.

• Gastrointestinal system - Soft, non-tender, no organomegaly detected.

Central nervous system

• Consciousness- conscious  

• Orientation - Semi oriented to time, place and person

• Memory Intact.

Cranial Nerve Examination

• Facial Nerve Examination – Asymmetry of Face (Deviation of mouth to Right Side).

Motor functions

• Gait: Unable to walk Power

• Right Upper and Lower limb- 5/5

• Left Upper and Lower limb- 2/5

Reflexes

• Deep reflexes such as biceps, triceps, supinator, and ankle jerk on affected side (left)were found to be diminished and knee jerk found Exaggerated on left side and on right side found to be normal.

Tone:

• Left upper and lower limb was found to be hypotonic (when compared to right side)

• Sensory functions are normal

Laboratory Investigations

Hematological investigations were done on 08/08/2022,

• Hb - 10.5gm%
• Total WBC count- 9,800 cells/cm
• Platelet count- 5.59 lacs/cu mm
• Total Cholesterol – 149 mg/dL
• Triglycerides – 188 mg/dL
• Serum Creatine – 0.95 mg/dL

• Blood sugar – Fasting- 116 mg/dl

                        PP – 204 mg/dl

Specific Investigation

• Computerized tomography scan of head done on 29/07/2022 shows chronic lacunar infarcts noted in pons and right thalamus

• Case was diagnosed as a Pakshaghata (Cerebrovascular Accident).

Methodology

Study setting: treatment of patient was carried out in IPD of GACH, Nagpur.

Observation and Result:

After 30 days of treatment patient gradually shows improvement in symptoms of Pakshaghata as treatment progressed. The Barthel index score changes from 25 to 65 and effect on NIH stroke scale was 12 reduces to 4, FAQ score was 16 changes to 29. The Strength and Power of both Left upper and lower limb was increased to 4/5 from 2/5, also Tone of the muscle improved, constipation is also relieved. Also shows improvement in Speech and she is able to walk herself with some support.

Discussion

Discussion:

According to Ayurved Pakshaghata is a disease with dominant Vata Dosha with Kapha or Pitta Dosha Anubandha, Charak described treatment of Pakshaghata in very brief manner and advised Swedan, Snehavirechana as main part of treatment. [10] Mode of action of treatment applied is probabaly as mentioned below.

Snehana

Snehana in Ayurveda is adopted for healing, relaxation and treating various diseases. [11] Snehana means massaging the body with oil in Anuloma gati, skin becomes Drudha and good by anointing it with oil, which acts on vitiated Vata, so, for Vata Dosha it should be treated at first with oleation therapy. [12] In Pakshaghata there is Sira Snayu Sankochana Snehana is very essential for such condition. Tila Tail possesses Tikta Rasa (bitter taste), the most effective in mitigating Pitta Dosha and Kapha Dosha in addition to Madhura Rasa. Tikta Rasa promotes memory and intellect (Medhya). Ushna Veerya (of heating virtue) of Tila Taila reduces the Vata. So, Snehana with Tila Tail helps in pacifying Vatadosha. [13]

Swedana

Swedana is usually given after Snehana and is the procedure that relieves Stambha, Gaurava, Sheeta which induces Swedana (Sweating). It plays a dual role in Poorvakarma as well as Pradhanakarma. Nadi Sweda is highly beneficial in many conditions in all diseases caused by vitiated Vata and especially in Stambha/Sankocha pradhana Vata vyadhi. [14]

Probable Mode of Action of Snehavirecahana:

Virechana is a one among the Panchkarma`s and is main Therapy for Pitta Dosha and Charaka mentioned Virechana as pradhana chikitsa in pakshaghata. [9] Mridu Virechana with Erand Tail is given to patient which helps in vata Anulomana of Pranavayu and also shows effect on Updhatu`s of Raktadhatu viz are Sira and Kandara. And as we have given Snehavirechana it avoids chances of Vata Doshaprakopa. Eranda taila is antagonistic to Vata dosha due to its innate qualities and has Pakvashaya Shodhaka (cleans the large intestines) action.

Basti

It is the most important procedure among Panchakarma procedures and the most appropriate remedial measure for Vata dosha. [15] Basti karma’s place of action is Pakwashaya which is Vata Dosha’s main site. Hence it is the major treatment modality for Vata Dosha. When Basti is administered it collects the accumulated Doshas and Shakrut from Nabhi, Kati, Parshwa and Kukshi pradesha, causes Snehana to the body and expels out the Dosha along with Pureesha. Charakacharya have explained that it is ‘amrutopamam’ for the patients having Kshina Majja, Shukra and Oja and has properties like Balya, Brimhana and Pushtikara. So, basti is very beneficial in Pakshaghata. Balaashwagandhadi Tail used for Anuvasan Basti is Bal-mansadhatu vardhak and vatashamak and Rasnadi niruh basti mentioned as vatavyadhnashak, pramehanghna [16]

Nasya:

Nasya includes administering drops of Sneha or medicine in nostrils. According to Ayurved nasal canal is a way to reach brain directly (Nasa hi Shiraso Dwaram). [17] It gives Bala to Indriya. And special treatment for Urdhwajatruvikara`s so, Nasya is effective in Pakshaghata.

ShashtikaShali Pinda Sweda

Shastika Shali Pinda Sweda is a unique Ayurveda therapy using a special variety of Indian rice in a bolus, dipped in a nourishing herbal milk decoction and massaged onto the body. Shastika means “sixty”-denoting rice that matures in sixty days; Shali means “rice”; Pinda implies a bolus or bag and Sweda is the name of a sudation therapy. Shastika Shali Pinda Sweda is performed Ekangam (on one part of the body) or Sarvangam (on the whole body) with a bolus of boiled Shastika rice dipped in Balamooladi Kwatha (a herbal decoction) and Ksheera(milk). Even though it is a Swedana, it has a Brimhana (nourishing effect) and is useful to strengthen, nourish and support bones, muscles, joints and nerves. So,it gives strength to patients muscles. [18] Shaman chikitsa acts on vitiated Vata and Pitta Dosha. According to classics, Brihan, Balya regimen given according to Avastha of patient and Vyadhibala.

Conclusion

Pakshaghata is a disease with predominant Vata Dosha and one among the Vataj Nanatmaj Vyadhi Charak explained etiopathogenesis and treatment of Pakshaghata in Charak Samhita in this case mention in above we have planned treatment of patient according to Ayurved in accordance with Doshapradhanya and Sthanadushti as well as Dhatu etc. Bahiparimarjan, Shodhana chikitsa along with Shamana dravya and Physical exercise was administered to the patient according to Vyadhi Avastha, Rogi Bala and Dosha Bala. Patient was able to walk independently with some support. The results were satisfactory and encouraging. Present case highlights potential of Ayurveda. On the basis of this case study, it can be concluded that intervention along with Panchakarma can be effective in symptomatic relief and improve functional status of patient.