|Year : 2020 | Volume
| Issue : 4 | Page : 308-312
Management of Ardita through Ayurveda: A case series
Swarnakant Jena, Manish Dhiman, Santosh Kumar Bhatted, Prasanth Dharmarajan
Department of Panchakarma, All India Institute of Ayurveda, Sarita Vihar, New Delhi, India
|Date of Submission||20-Nov-2020|
|Date of Decision||19-Sep-2020|
|Date of Acceptance||21-Nov-2020|
|Date of Web Publication||11-Feb-2021|
Dr. Swarnakant Jena
Department of Panchakarma, All India Institute of Ayurveda, Sarita Vihar, New Delhi.
Source of Support: None, Conflict of Interest: None
The prevalence of Vatavyadhis (neurological diseases) such as Pakshaghata (hemiplegia), Gidhrasi (Sciatica), Ardita (Facial palsy) has increased. Arditavata can be correlated in contemporary medicine with Bell’s palsy, affecting the unilateral side of the face. This is the most common unilateral lower motor neuron facial palsy that usually develops suddenly or spontaneously. Ardita was successfully managed with Ayurveda treatment such as Snehana (oleition), Svedana (fomentation) followed by Nasya (nasal medication) and intake of other Ayurveda medicines. The aim of the study is to evaluate the efficacy of Navaneeta (butter) used for Abhynaga along with Ksheerbala oil for Nasya and Talam in the management of patients suffering from Ardita. The study was a consecutive case series done on an OPD basis to study the pre- and post-effect of the treatment regime mentioned earlier on patients suffering from Ardita. This study was conducted on four patients of Ardita, in whom Abhynaga with Navaneeta (butter), Nasya with Ksheerbala oil was done for seven days followed by an intake of Shamana medicines for the next 14 days. Use of Navaneeta (butter) for Abhyanga (massage), Ksheerabala oil for Nasya and Talam (medicinal application in scalp) showed significant improvement in the symptoms of patients with Ardita without any adverse effects in seven days, and most of the symptoms disappeared within 14 days of treatment. For pre- and post-assessment of the patients, House-Brackmann facial nerve grading system was used. Hence, the use of Navaneeta for Abhyanga, Ksheerbala Taila for Nasya and Talam helps is alleviating the symptoms of patients with Ardita.
Keywords: Ardita, Ayurveda, Bell’s palsy, Nasya, Navaneeta
|How to cite this article:|
Jena S, Dhiman M, Bhatted SK, Dharmarajan P. Management of Ardita through Ayurveda: A case series. J Indian Sys Medicine 2020;8:308-12
| Introduction|| |
An idiopathic facial paralysis, which has an acute-onset, isolated, unilateral, lower motor neuron facial weakness, can be called Bell’s palsy. Annual incidence varies in different parts of the world, with estimates varying between 11 and 40 per 100,000 people being reported. Bell’s palsy is considered as the most common cause for unilateral peripheral facial weakness with acute onset. It may occur at any age and both sexes may be affected equally; the average age where cases are found is 40 years. People who are younger than 10 years have a lower chance of being affected and those older than 70 years have highest incidence to be affected. Both sides of faces are equal chance to be affected. Diabetic patients are more prone to be affected by this disease.
Starting with an acute stage can develop severe symptoms. Symptoms may include muscle twitching and weakness, and they can develop to a total loss of ability to move one or rarely both sides of the face. Other symptoms include dropping of the eyelid, a change in taste, otalgia, or pain around the ears, and they increase sensitivity to sound. The House-Brackmann nerve grading scale is used as a tool to asses the disease severity in Bell’s palsy. Treatment of Bell’s palsy in acute stage aims at speeding recovery and avoiding any corneal complications. Frequent lubrication for eye and use of eye patch, lubricating drops should be applied frequently during the day and eye ointment should be used at night. Symptoms may be relieved if the nerve pressure is released. Research suggests that this can be archived by using a steroid or a steroid plus antiviral.
In Ayurveda literature, the symptoms can be compared with Arditavata, which is described as one among the Vatavyadhi. Acharya Charak describes it with Vatananatmakavyadhi among the 80 Vatavyadhis. Sushruta Samhita says that the mouth and other regions of the head are affected. According to Acharya Vagbhatta, half of the face is involved with or without body parts.
| Case Report|| |
This case series included participants who visited the Panchakarma OPD of AIIA, New Delhi, with a primary history of the weakness of one half of the face. Cases that were evaluated initially included the history and physical examination and grading based on the House-Brackmann scale. Demographic data collected included age, gender, and personal and medical history with duration since the onset of the condition. Pre- and post-assessment was done by the House-Brackmann facial nerve grading scale.
All demographic data that include age, gender, occupation, affected site of face, and durations of all patients are described in [Table 1].
| Case Presentation|| |
A 37-year-old male patient came with a complaint of incomplete closure of left eyelid and right deviation of lips while talking, which started after a brief period of earache and toothache. Symptoms appeared 10 days before he visited AIIA. The patient received medical management, which included steroid and antiviral drugs on the same day of the onset of signs and symptoms without any relief.
Angle of mouth deviated to the right. Inability to lift the left eyebrow and minimal eye closure were observed. Both the nasal crease and frontal furrow were absent. Air also passed while blowing.
A 36-year-old male patient who reported with right-sided facial weakness visited AIIA hospital after seven days when the first symptom appeared. No diagnostic imaging was performed. Symptoms started after right eye incomplete closure with continuous tearing, for which he took eyedrops and oral medication for two days, without any relief.
Angle of mouth deviated to the left side with continuous tearing from the right eye. Frontal ridges disappeared on both sides with the nasolabial fold. Also, it was impossible to perform a pursing of lips.
A 35-year-old male patient reported with right-sided facial weakness. He visited AIIA after 10 days of onset of symptoms. The first symptoms appeared after he woke up from bed with an inability to close his right eye.
Patient was unable to close his right eyelid and frontal ridges disappeared also. Release of air while pursing of lips and deviated mouth towards left side also observed.
A 22-year-old male patient presented with left-sided facial weakness since two days. Onset of symptoms appeared during traveling toward work. The patient used to ride a bike daily for hours.
On examination, sagging of the left eyelid was noticed. The patient was unable to lift the left eyebrow and unable to close the left eye. Bell’s phenomenon was present. The nasal crease was absent. He had more severe symptoms than others.
| Treatment|| |
After observing all the signs and symptoms, the following treatments were advised for 14 days, as mentioned in [Table 2].
| Assessment|| |
By facial nerve examination:
House-Brackmann score is shown in [Graph 1].
| Observation and Results|| |
The current case series was assessed after administering seven days of Abhyanga with Navaneeta and localosed Nadisvedana given to patients. Significant relief was observed in closure of the eyelids, and improvement was noticed in weakness of different facial muscles [Figure 1] and [Figure 2]. There was no passing of air from the mouth without any deviation of angle of mouth [Figure 3] and [Figure 4]. For Shaman of Doshas, the same medications were continued for two more weeks. Among these four cases, three patients recovered completely and one patient showed improvement in the grade but did not return to normal symmetry. Research suggests that the prognosis is better if the patient is young. Four patients in the current case series were middle age. Studies suggest that the outcome is significantly good if medical management is commenced within three days after the palsy. In the current study, patient 4 showed significant changes, improving from grade 5 to grade 2 as he was treated after two days of the onset of disease. Ayurveda describes that continuous exposure to cold food, wind, and the environment may aggravate Vatadoshas, which is the prime cause for Ardita. Here, it was observed that all patients developed their symptoms after continuous exposure to cold. Patient 1 spent a long duration in an air-conditioned room; patient 3 was a construction worker, so he was exposed to excessive wind and dust; and patient 4 spent 1hr riding daily on his motorcycle. During treatment, all patients avoided cold exposure, except patient 3 so this may be the reason for improvement as compared with others.
|Figure 1: Changes in the eye closure: Before treatment, After seven days and after fourteen days|
Click here to view
|Figure 2: Changes in the forehead furrows: Before treatment, After seven days and after fourteen days|
Click here to view
|Figure 3: Changes in the deviation of lips: Before treatment, After seven days and after fourteen days|
Click here to view
|Figure 4: Changes in the air blowing capacity: Before treatment, After seven days and after fourteen days|
Click here to view
| Discussion|| |
Bell’s palsy can be correlated with Arditavata in Ayurveda as compared with the signs and symptoms and needs proper administration of therapy to prevent irreversible changes; hence, in conventional therapy, the administration of corticosteroid with some antiviral treatment as early as possible is the first line of management. Here, without any steroid and other conventional drugs, we use the Navaneeta Abhyanga and Nasya with Ksheerabalataila, which alleviates the main causative factors for Ardita.
Probable Mode of Action
The treatment for Aridtavata described by different Ayurveda scholars are Nasya, Murdhnitaila (application of different oil treatments on head), Tarpana (retention of oil in eye), Karnapurana (retention of oil in ear), and Upanaha (herbal poultice) with internal medications, which pacifies Vatadosha. Prior to Nasya, Abyanga and svedana are essential. Here, Navaneeta was used for Sthanik Mukha Abhyanga (Local Massage of Face) followed by Mridu Svedana, as snehana and svedana pacify Vatadosha, which is the main pathological factor involved in the development of ArditaVata. Navaneeta is said to be an Agryadravya (main drug) for Arditavata by Acharya Vagbhatta. It is Snigdha and Madhura Rasa and has Vatapittahara properties.Ksheerabalataila, which is used for Nasya, is known for its Brimhanakarma, which pacifies Vata dosha; it gives strength to the facial muscle and reduces any type of irritation of nerves. The constituents of Ksheerabalataila, that is Bala (Sida cordifolia Linn.), milk, and sesame oil, are well demonstrated to be antioxidants that prevent the possible damage of neurons. Ksheerbalataila has been established to emolliate oxidative stress in rat brain., For Moordhnitaila we used Rasnadichoorna with Ksheerabalataila as Talam, which has Vatahara properties, thereby improving the motor functions of the facial nerve. Astavargakashaya is used as a Shamana medication; it has all the ingredients, such as ushna and Brihmanaguna, which are used to pacify Vata. Avipattikarchoorna has Trivrit as its main ingredient, which is used as sukhavirechana, which is essential treatment for Vatavyadhi.,Vatagajankush Ras in combination with Trikatu works as Deepan, and Pachana improves digestion. Visha or Vastanabha has properties such as Vikasi, Vyavayi, and Yogavahi, which help in opening all the microchanels. Vatagajankush works as Valya, Rasayan, and Vata Pradhana Tridosha.
| Conclusion|| |
The current case is based on the management of patients on an OPD basis who are diagnosed with Bell’s palsy on the line of treatment of Ardita Vata. Facial massage of Navaneeta, which was easy to use and cost-effective, is described as Agryadravya in Ayurveda texts along with Nasyakarma; internal medications possessing Vatahara drugs were found to be very useful in the management of Arditavata. No other conventional medicines were given during the course of treatment. The current study provides a way for more clinical trials to evaluate the effect of Navaneeta, and also shows a good effect of OPD basis management of Ayurveda therapies for Arditavata with Navaneeta Abhyanga and Nasya is helpful in alleviating the sign and symptoms found in Bell’s palsy (Arditavata) without any side effects
Declaration of patient 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.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
De Diego-Sastre JI, Prim-Espada MP, Fernandez-Gracia F [The epidemiology of Bell’s palsy]. Rev Neurol 2005;41:287-90.
Adour K, Wingerd J, Doty HE Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bell’s palsy). Diabetes 1975;24:449-51.
National Institute of Neurological Disorders and Stroke (NINDS).Bell’s Palsy Fact Sheet. NINDS; 2016. Available from: ninds.nih.gov. [Last accessed on 2021 Jan 27].
Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, et al
. Early treatment with prednisolone or acyclovir in Bell’s palsy. N Engl J Med 2007;357:1598-607.
de Almeida JR, Al Khabori M, Guyatt GH, Witterick IJ, Lin VY, Nedzelski JM, et al
. Combined corticosteroid and antiviral treatment for bell palsy: A systematic review and meta-analysis. JAMA 2009;302:985-93.
Kashinath SP, Gorakhnath C, editors. Sutra Sthana; Chapter 20, Verse no. 11. In: CharakSamhita of Agnivesha with Vidyotini Hindi Commentry. Varanasi, India: ChaukhambaSurabharatiPrakashana; 2008. p. 399.
Ambikadatt SK, editor. NidanaSthana; Chapter 1, Verse no. 68–73. In: SushrutaSamhita of Sushruta with Ayurveda TatvaSandipika Hindi commentry, part1. Varanasi, India: ChaukhambaPrakashan; 2009. p. 303.
Bramhananda Tripathi , editor. NidanaSthana; Chapter 15, Verse no. 32–36. In: AstangaHridaya of Vagbhatta with Nirmala Hindi commentary. Varanasi, India: Chaukhamba Sanskrit Pratisthana; 2013. p. 541.
Finsterer J Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngol 2008;265:743-52.
Kashinath SP, Gorakhnath C, editors. ChikitsaSthana; Chapter 28, verse no. 15. In: CharakSamhita of Agnivesha with Vidyotini Hindi Commentry. Varanasi, India: ChaukhambaSurabharatiPrakashana; 2008. p. 779.
Kashinath SP, Chaturvedi Gorakhnath C, editors. ChikitsaSthana; Chapter 28, verse no. 99. In: CharakSamhita of Agnivesha with Vidyotini Hindi Commentry. Varanasi, India: ChaukhambaSurabharatiPrakashana; 2008. p. 795.
Bramhananda T, editor. Sutra Sthana; Chapter 20, verse no. 17. In: AstangaHridaya of Vagbhatta with Nirmala Hindi Commentary. Varanasi, India: Chaukhamba Sanskrit Pratisthana; 2013. p. 247.
Bramhananda T, editor. UttaraTantra; Chapter 40, verse no. 15. In: AstangaHridaya of Vagbhatta with Nirmala Hindi Commentary. Varanasi, India: Chaukhamba Sanskrit Pratisthana; 2013. p. 1212.
Kashinath SP, Gorakhnath C, editors. Sutra Sthana; Chapter 27, verse no. 230. In: CharakSamhita of Agnivesha with Vidyotini Hindi Commentary. Varanasi, India: ChaukhambaSurabharatiPrakashana; 2008. p. 552.
Bramhananda T, editor. ChikitsaSthana; Chapter 22, verse no. 45. In: AstangaHridaya of Vagbhatta with Nirmala Hindi Commentary. Varanasi, India: Chaukhamba Sanskrit Pratisthana; 2013. p. 821.
Swathy SS, Indira M The ayurvedic drug, ksheerabala, ameliorates quinolinic acid-induced oxidative stress in rat brain. Int J Ayurveda Res 2010;1:4-9.
Rejitha S, Prathibha P, Madambath I The ayurvedic drug ksheerabala (101) ameliorates alcohol-induced neurotoxicity by down-regulating the expression of transcription factor (nfkb) in rat brain. Ayu 2015;36:323-8.
The Ayurveda Formulation of India, part 1, second revised English ed, Govt of India, Bhaishajyaratnavali, Amlapittadhikar, p. 106.
Bramhananda T, editor. Sutra Sthana; Chapter 13, verse no. 1. In: AstangaHridaya of Vagbhatta with Nirmala Hindi Commentary. Varanasi, India: Chaukhamba Sanskrit Pratisthana; 2013. p. 185.
Ambikadatta S, editor. ChikitsaPrakaran: Chapter 26, verse no. 116–120. In: Bhaisajyaratnavaliof Govindassen with Vidyotini Hindi Commentary. Varanasi, India: Chaukhamba Sanskrit Pratisthana; 2017. p. 541.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]