|Year : 2021 | Volume
| Issue : 1 | Page : 39-44
Management of Pakshaghata (Hemiplegia due to basal ganglia bleed) through Panchakarma: A case study
Poonam Verma, Latika Kundra, Santosh Kumar Bhatted, Prasanth Dharmarajan
Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India
|Date of Submission||08-Sep-2020|
|Date of Decision||24-Sep-2020|
|Date of Acceptance||25-Feb-2021|
|Date of Web Publication||16-Apr-2021|
Dr. Poonam Verma
Department of Panchakarma, All India Institute of Ayurveda, Sarita Vihar, New Delhi.
Source of Support: None, Conflict of Interest: None
Background: Stroke is defined as the fast onset of focal neurological deficit within which poor blood flow to the brain ends up in necrobiosis. It is the second most common reason for worldwide mortality. Hemorrhagic strokes are classified based on their underlying pathology. Some common causes of bleeding are hypertensive trauma, ruptured aneurism, AV fistula, transformation of previous ischemic pathology, and drug-elicited hemorrhage. They result in tissue injury by inflicting compression of tissue from an expanding hematoma. Pakshaghata described in Ayurveda can be correlated with hemiplegia or paralysis of half of the body (either right side or left side), impairment of sensory organs, and mental function. All Acharya have emphasized that in the manifestation of Pakshaghata, Vata is predominant with the association of Pitta and Kapha Dosha.Materials and Methods: The present clinical study is a case report on the efficacy of Panchakarma procedures along with internal medication in a patient diagnosed as a case of basal ganglionic bleed resulting in right-sided hemiplegia. Assessments were done on the basis of Barthel Index, Modified Rankin Scale, Scandinavian Stroke Scale, and Hamilton Depression Rating Scale. Results and Conclusion: There was marked improvement in walking, speech, and lifting of right upper limb with an overall improvement in quality of life. Hence, this study suggests that Panchakarma procedures along with oral Ayurveda medicine show significant relief in the symptoms of disease.
Keywords: Hemorrhagic stroke, Pakshaghata, Panchakarma
|How to cite this article:|
Verma P, Kundra L, Bhatted SK, Dharmarajan P. Management of Pakshaghata (Hemiplegia due to basal ganglia bleed) through Panchakarma: A case study. J Indian Sys Medicine 2021;9:39-44
|How to cite this URL:|
Verma P, Kundra L, Bhatted SK, Dharmarajan P. Management of Pakshaghata (Hemiplegia due to basal ganglia bleed) through Panchakarma: A case study. J Indian Sys Medicine [serial online] 2021 [cited 2022 Dec 7];9:39-44. Available from: https://www.joinsysmed.com/text.asp?2021/9/1/39/313703
| Key Message:|| |
Pakshaghata is a functional disability. It produces dependent and prolonged impaired life with constant mental trauma. Combined therapy of Panchakarma and oral medicine can give better results in Pakshaghata/hemiplegia.
| Introduction|| |
Stroke is the most common cause of neurological disability in the adult population, and it is the third leading cause of death in the United States. It is responsible for 4.4 million deaths worldwide. The incidence of stroke increases with age, and it is higher in men than women. “Stroke” is a clinical term for acute loss of blood circulation to the brain tissue. Spontaneous intracerebral hemorrhage occurs mostly in patients experiencing hypertension. Rupture of diverse microaneurysm is the significant cause of cerebral hemorrhage. The common sites of hypertensive intracerebral hemorrhage are the region of basal ganglia, Pons, and the cerebellar cortex. Clinically, the onset is typically fulminant with headache and a loss of consciousness. Depending on the location of the lesion, hemispheric brain stem or cerebellar signs will be present. The explosive entry of blood into the brain parenchyma during primary intracerebral hemorrhage causes immediate cessation of function in that area, as neurons are structurally disrupted and the white matter fiber tract is split apart. A rim of cerebral edema forms around, resulting in a blood clot, which with the hematoma acts like a mass lesion. If big enough, this can cause a shift of intracranial contents, producing trans tentoria coning and 15% people die shortly after stroke. The description of the clinical signs and symptoms of stroke can be interpreted with Pakashaghata in Ayurveda science.
Pakshaghata has been enlisted among the eighty forms of purely Vaataj disease. Being prominent among all Vata, the disease has been described in almost all Ayurveda literature under Vatavyadhi. Pakshaghta is also described as the loss of voluntary functions on one side of the body. Acharya Charaka, in Chikitsa Sthana describes Pakshaghata by saying that morbid Vata beholds either side of the body, dries up ligaments and tendons of that part rendering it dead and producing a loss of motor activity with pain dysarthria/ aphasia. These manifestations can be managed through the Panchakarma procedure along with internal medicine.
| Case report|| |
A 52-year-old female patient was admitted in Panchakarma IPD of the All India Institute of Ayurveda (AIIA) in May 2019 with UHID no. 374803. She was apparently well two months ago; suddenly, she developed vertigo and weakness in her body and fell down on the ground. Due to this, she was admitted to an allopathic hospital where she was diagnosed as having left basal ganglionic bleed along with hypertension. She was managed as a case of acute stroke by allopathic medicine. She was discharged from the allopathic hospital after her vitals were brought within normal physiological limits. The consequences of stroke, such as weakness of right side of the body, inability to lift right upper limb, difficulty in walking without support, and speech defect, persisted; thus, she came to the AIIA hospital for further management of her ailment.
The patient had a history of hypertension since nine years and she was taking allopathic medicine. She had been having cholelithiasis since two years. There was no history of diabetes mellitus, tuberculosis, or any family history.
MRI Brain: March 29, 2019.
An MRI of the brain revealed a left thalamo-ganglionic hematoma with an intraventricular extension, a few small foci of microbleeds in bilateral cerebral parenchyma and thalami, and left cerebellar hemisphere.
General condition was moderate, temperature was 98.3 F, pulse was 80/min and regular rhythm, blood pressure was 130/90mm Hg, body weight was 80 kg, and tongue was coated. Pallor and icterus was absent. No lymphadenopathy and pallor was seen. Speech was slurred, and the patient walked with support (with hemiplegic gait). Cranial nerves, sensory system, and memory were intact. Tests for coordination performance such as Finger nose test and Rombergs sign were negative. An examination of motor function is shown in [Table 1].
| Materials and methods|| |
Panchakarma procedure along with oral medicine used, quantity and duration is shown in detail in [Table 2] and [Table 3].
|Table 3: Following oral medications were given along with Panchakarma procedure|
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| Observations and result|| |
The observation was done on the basis of assessment of reflexes, Scandinavian Stroke Scale, Barthel Index, Hamilton Depression Scale, and Modified Rankin Scale before treatment (on 0th day) and after treatment (on 32nd day) [Table 4][Table 5][Table 6][Table 7][Table 8] and [Chart 1].
| Discussion|| |
Pakshaghata is described as one of the Vatavyadhi. Vata is the main Dosha in the Pathology of Pakshaghata. Vitiation of Vata is caused by Avaranaor Dhatukshaya (depletion of essence of tissue). Hence, in this case treatment was first initiated with Rookshana (Udwartana, Takradhara) and Shodhana (mild laxative), which can remove the Margavarana (obstruction of channels). After that, the principle of Brimhana-specific Panchakarma procedure was adopted for recovering the depletion of tissue.
Udvartana:Udvartana was done with lukewarm Triphala Choorna for 30 min. Triphala Choorna possesses the Kapha Medohara (reducing the Kapha and fat) property for Rookshana. The metabolic waste products are carried by lymphatics to the blood and ultimately excreted through the urine. So the body becomes free of any toxins and feels devoid of heaviness. When performed vigorously, massage may emulsify fat in the superficial connective tissue cells. In the emulsified state, the fat globules may enter the lymphatic system and may be metabolized.
Nadi swedana:Swedana with Dashmoola Kwatha for 15 min opens up and cleanses the Srotasas. Moreover, Dashamoola helps to pacify the morbid Vata Dosha and soothes the nerves.
Takradhara:Takradhara was carried out for 30 min. Takra, with a combination of Amalaki Choorna and Musta, produces a coolant effect on the brain and nervous system; hence, it helps to release anxiety and improve neurological functions. It might have some reflex action on baroreceptors (which are disturbed in essential hypertension and may be held responsible for constriction of arterioles, leading to a rise in blood pressure).
Virechana:Majja is considered as a component of Pitta Dhara Kala. Srotodushti (disturbance at the level of Srotas) takes place in Pakshaghata. According to Acharya Charaka, to combat the morbidity related to Majja timely bio-purification is necessary. Hence, the management of its vitiation was done by Virechana Karma with Trivrit Avleha and Gandharva Hasitadi Eranda Taila as it is the primary mode of elimination of vitiated Pitta Dosha. It has been observed that Virechana imparts strength to the body and stabilizes all the dhatus.
Talam:Rasandi Choornaand Ksheerbala 101 helps in nourishing the Indriya (sensory organ) and pacifying the Vata Dosha. Talam was advised for 7–8 hrs. In animal studies, Rasna (Pluchea lanceolate) showed anti-inflammatory, diuretic activity and its effects were observed on CVS and CNS in mice.
Abhyanga:Lukewarm Ksheerbala Taila is used for 30 min followed by Sarvang Nadi Swedana with Dashmoola Kwatha for 15 min. Ksheerbala Taila improves the strength, and this results in the nourishment of Dhatu. It also helps in the alleviation of muscle rigidity and boosts the circulation. Ksheeerbala Taila, having contents of Bala, cow milk, and sesame oil, which pacify the Vata and Pitta Dosha, shows anti-inflammatory effects.
Basti:Brihmana Dravya is selected for medicated enema in a form of Yoga Basti schedule. From the Ayurveda prospective, Vata is seen as the main aggravating factor and Basti Chikitsa is regarded as the prime line of treatment for it. Medicated enema helps to eliminate vitiated Dosha from the body, increases the strength, and spreads the potency of the drug due to its Prabhava (specific action). The potency of Basti drug acting on Dosha brings them into normalcy and provides them with nourishment. Just as the farm gets its nourishment from water supplied through channels, the whole body gets nourishment from Virya (potency) of the enema drug carried by five types of Vata through Srotas.
Bala is a nervine tonic that balances the Tridosha, mainly Vata. It has anti-inflammatory, analgesic properties that calm nerves; it also acts on CNS and provides relief from anxiety. Bala tones the blood pressure and improves cardiac irregularities.
Kapikacchu (Mucuna Pruriens) increases nerve function and helps in reducing stress. It is also useful in muscular degeneration and in improving physiological state.
Pizhichil: In Pizhichil, the body is massaged with medicated oil and warm oil is poured down on the body for 30 min. Snehana (oiliation) and Swedana (saudation) are used to correct morbid Vata. It may stimulate the nerve cell and strengthen the muscle. It is highly effective in neurological disorders.
Shastika Shali Pinda Swedana: It improves the strength, and it pacifies the Vata. It is principally indicated in Shosha (wasting of muscle) and Stambha (stiffness). The heating impact of the Shali Pinda Swedana causes vasodilation; as a result of this, the blood circulation improves and results in increased metabolic activity with the stimulation of neural receptors within the skin or tissue and eliminates the toxins.
Nasya:Ksheerbala 101 Taila gives nourishment to nerve fibers, alleviates Vata Dosha, and promotes the clarity of senses (Shrastha Indriyanam Prasadanam). The drug administered through the nose as Nasya reaches the brain and then it either eliminates the morbid Dosha responsible for producing the disease or nourishes the area.
| Conclusion|| |
This case study demonstrates the successful management of a case of Pakshaghata (left basal ganglionic bleed) by Ayurveda principles. There was significant improvement in Hamilton D scale, Barthel Index, Scandinavian Stroke Scale, Modified Rankin Scale, muscle nourishment, power and reflexes, difficulty in walking without support, slurred speech, and weakness with increased quality of life. Hence, it proves that treatment with Ayurveda principles along with Panchakarma therapies has a safe and efficient role in managing hemiplegia (Pakshaghata). Due to the uncommon nature of the presentation of the disease, significant recovery and improvement in the quality of life over the span of time in this case was believed to be value documenting.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ipsit Brahmachari, ed. A practical guide to hemiplegia treatment. 7th ed. Delhi: JAYPEE Brothers Medical Publishers; 2015. p. 29.
Hammer GD, McPhee SJ. Pathophysiology of Disease: An Introduction to Clinical Medicine. 7th ed. New York: McGraw Hill Education; 2014. p. 179.
Ipsit Brahmachari, ed. A Practical Guide to Hemiplegia Treatment, 7th ed. Delhi: JAYPEE Brothers Medical Publishers; 2015. p. 30.
Acharya YT, editor. Vatavyadhi chikitsita: Chapter 28,verse 53–54. In: Chikitsa sthana, ed. Charaka Samhita of Agnivesha. Varanasi: Chaukhambha Sanskrit Sansthan; 2002. p. 619.
Kanti Kar P udvatana-samvahan vis-a-vis effleurage. Int Ayurvedic Med J2015;3.
Jyoti, S, Pandey, K Understanding the mode of action and efficacy of takra dhara. Eur J Biomed Pharmaceut Res2019;6:111-3.
Sharma S, Commentator. Sidha Basti kalpa Adhyaya, chapter 5, verse 24. In: Kalpasthana . Ashtanga Samgraha of Vriddha Vagbhatta. 4th ed. Varanasi: Chaukhamba Sanskrit Series Office; 2016. p. 605.
Sharma PV Commentator. Niruha krama chikitsa adhyaya, chapter 38, verse 83. In: Sthana C. Nibandha Sangraha of Dalhana on Sushruta Samhita of Sushruta. Varanasi: Chaukhambha Visvabharti; 2010. p. 169.
Patil Vasant, ed. Swedan Karma, chapter 9. In: Principle and practice of panchakarma. Varanasi: Chaukhambha publication; 2016. p. 224
Harishastri P, ed. Virechana adhyaya: chapter 2, verse 9. In: Sthana S, ed. Ashtanga Hridayam of Vagbhata. Varanasi: Chowkhambha Surbharati Prakashan; 2017. p. 743.
Sharma S, editor. Vidradhi vidhi chikitsa adhyaya: chapter 15, verse 25. In: Sthana C, ed. Ashtanga Samgraha of Vagbhata. Varanasi: Chaukhamba Sanskrit Sansthan; 2012. p. 521.
Niteshwar K, Vidyanath R English Translator: Chapter 4. In: Prakaran C, ed. Sahasrayogam. 4th ed. Varanasi: Chowkhamba Sanskrit Series; 2014. p. 201.
Niteshwar K, Vidyanath R English Translator: Chapter 3. In: Prakaran Taila. Sahasrayogam. 4th ed. Varanasi: Chowkhamba Sanskrit Series; 2014. p. 111.
Niteshwar K, Vidyanath R English Translator. Taila prakaran: Chapter 3. In: Sahasrayogam. 4th ed. Varanasi: Chowkhamba Sanskrit Series; 2014. p. 110.
Niteshwar K, Vidyanath R English Translator: Chapter4. In: Prakaran C, ed. Sahasrayogam. 4th ed. Varanasi: Chowkhamba Sanskrit Series; 2014. p. 200.
Haishastri P, ed. Shodhanadi Gana Sangraha. In: Sthan S, ed. Chapter 15, Verse 16, Astanga Hridayam of Vagbhata. Varanasi: Chaukhamba Subharati Prakashan; 2014. p. 4.
Shrivastava S, ed. Madhyam Khanda, Vati Kalpana Adhyaya Chapter 7, Verse 70–81. Varanasi: Sharangdhara Samhita, Chaukhamaba Orientaliaa; 2011.
Rao GP ed. Arsharoga chikitsa prakaran: chapater 9, verse 175–180. In: Bhaishajya Ratnavali, volume 1, 1st ed. Varanasi:Chaukhamba Orientalia; 2014, p. 406.
Srikanth Murthy KR, translator. Chapter 7, verse 70–81. Sharangadhar Samhita of Sharangadhar. Varanasi: Chaukhamba Orientalis; 2016, Second Section, p. 107.
Sharma PV, Commentator. Dravya dravya vidhi adhyaya: chapter 45, verse 114. In: Sutra sthana. Nibandha Sangraha of Dalhana on Sushruta Samhita. Varanasi: Chaukhambha Visvabharti; 2010. p. 205.
Scandinavian Stroke Study Group. Multicenter trial of hemodilution in ischemic stroke-background and study protocol. Stroke1985;16:885-90.
Granger CV, Dewis LS, Peters NC, Sherwood CC, Barrett JE Stroke rehabilitation: Analysis of repeated barthel index measures. Arch Phys Med Rehabil 1979;60:14-7.
Hamilton M A rating scale for depression. J Neurol Neurosurg Psychiatry1960:2356-62.
Wilson JH, Hareendran A, Grant M, Baird T, schulz U, Muir Kw, Bone I Improving the assessment of outcome in stroke; use of a structured interview to assign grade on the modified. Rankin scale 2002;33:2243-6.
Manas TV, Goud KM, Lolashri SJ Role of Tikshna Nasya In Pakshaghata – A case study. Int Ayurved Med J 2018;6:1316-22.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]