|
 
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| CASE REPORT |
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| Year : 2022 | Volume
: 3
| Issue : 2 | Page : 88-93 |
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Stage-wise management of Pakshaghata (Ischemic stroke with left hemiplegia) through ayurveda - A case report
Govardhan Belaguli1, SA Nithin2
1 Department of Kayachikitsa and Manasaroga, A Unit of Rajeev Institute of Ayurvedic Medical Science and Research Centre, Hassan, Karnataka, India
2 Principal and Chief Medical Officer Rajeev Ayurveda Hospital, A Unit of Rajeev Institute of Ayurvedic Medical Science and Research Centre, Hassan, Karnataka, India
| Date of Submission | 07-Dec-2021 |
| Date of Decision | 03-Aug-2022 |
| Date of Acceptance | 07-Aug-2022 |
| Date of Web Publication | 12-Dec-2022 |
Correspondence Address:
Govardhan Belaguli
Department of Kayachikitsa and Manasaroga, Rajeev Ayurveda Hospital, A Unit of Rajeev Institute of Ayurvedic Medical Science and Research Centre, Hassan, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijaim.ijaim_25_21
In the context of Ayurveda, the condition Pakshaghata counters with hemiplegia and its variety of characteristic symptoms. The causes, pathogenesis and its management are well elucidated in Ayurveda. The following is a case report of an elderly male patient with Pakshaghata (Ischemic stroke with left hemiplegia) that was effectively treated on two different stages for nearly 56 days. His condition was divided into two stages, a) Margavaranajanya (~obstruction and adherence of other Doshas by the aggravated Dosha) stage, and b) Vatanulomana (~controlling of vitiated Vata dosha, bringing back to its normalcy) stage. The drugs that had the properties of Agnideepana (~neutralizers of the impaired metabolic fire), Amapachana (~metabolizers of undigested toxins), Srotoshodana (~evacuators of obstructed channels) and Vatanulomana were found effective in the first stage. As Vata Dosha (~one of bodily humors), is considered as the master controller of nervous system, and in order to bring it back to normal from the vitiated state, a set of drugs that had the property of Vatanulomana, Balya (~strength promoters) and Rasayana (~rejuvenators) were induced in the second stage. There was a significant improvement in his degree of disability as per Scandinavian stroke score, Barthel Index score and Modified Rankin Scale; it measured 51, 65 and 3 respectively after the intervention (from 16, 0 and 5 prior to intervention). Through this study, it can be planned that, the treatment protocol of Pakshaghata can be judged by the acute and chronic phase of the condition based on its association with Vata dosha. The wise selection of the appropriate drugs and therapies in the present case secured the optimistic outcome of the intervention. Although his concluding magnetic resonance imaging of brain notified “no” modifications, at the time of discharge he was privileged with refurbished gait; sensory and motor deficits with increased quality of life, which prompted us to document it.
Keywords: Ayurveda, hemiplegia, ischemic stroke, pakshaghata, paralysis
How to cite this article:
Belaguli G, Nithin S A. Stage-wise management of Pakshaghata (Ischemic stroke with left hemiplegia) through ayurveda - A case report. Indian J Ayurveda lntegr Med 2022;3:88-93 |
How to cite this URL:
Belaguli G, Nithin S A. Stage-wise management of Pakshaghata (Ischemic stroke with left hemiplegia) through ayurveda - A case report. Indian J Ayurveda lntegr Med [serial online] 2022 [cited 2023 Mar 23];3:88-93. Available from: http://www.ijaim.in/text.asp?2022/3/2/88/363111 |
| Introduction | |  |
In the Ayurveda background, the condition Pakshaghata matches with the hemiplegia and its range of symptomatic representation.[1]Acharya Charaka mentions Pakshaghata under Nanatmajavata Vikara (~diseases caused only by the vitiation of Vatadosha).[2]Acharya Sushruta describes it as one of the Asta Mahagada (~eight grave diseases).[3] Conferring to Ayurveda viewpoint, Pakshaghata occurs mainly due to vitiation of Vatadosha alone or in association with Pitta or Kaphadosha.[4] Acharya Vagbhata empirically elaborates its Samprapti (~pathogenesis) and proposes that the vitiated Vatadosha affects one half of the body causing dryness of Sira (~veins) and Snayu (~tendons), resulting in Pakshaghata.[5] In addition, its pathogenesis can include, Margaavarna (~obstruction of channels), Dhatukshaya (~depletion of tissues), and Vama or Dakshinachesta-nivritti (~deficit of motor functions in any side of the body).[6] With these, the cardinal features of Pakshaghata can include chesta-hani (~deficits in sensory and motor functions), Hasta padasankocha (~decreased muscular tone or rigidity of limbs), Ruja (~pain), Vakstambha (~dysarthria or aphasia), Sandhi-bandhavimoksha (~weakness of joints), and Sira-snayuvishosha (~spasticity of veins and tendons).[7] Although the above descriptions state, the analogous basics between the Ayurvedic and modern concept of Pakshaghata, the need of detail considerate of the ancient concepts with present empirical perceptive is still lacking and the present article may fulfill the need.
Following is a case report of an elderly male patient with Pakshaghata (ischemic stroke with left hemiplegia). The treatment schedule was adopted at stage wise, as per the classical description.[8] At the time of discharge, the patient and his sensory and motor deficits were restored.
| Case Report | | |
Patient information
A 65-year-old male patient was brought to our hospital on November 12, 2020, with the history of sudden onset of weakness of the left upper and lower limb and its gradual loss of movement. Since 15 days, he was diagnosed with hypertension, Type 2 diabetes, and was on its regular medications. He had one episode of vomiting, slurred speech, and headache 5 days back followed with convulsion and facial twitching toward the right side. On examining, he was conscious (bit drowsy), oriented, cooperative, dehydrated, and bit agitated. His vitals were stable. His central nervous systemic examination marked left hemiplegia with severe sensory deficits. The tone and muscular bulk in the left upper and lower limb was decreased and rigid. With the power of 1–2, reflexes were nil at the left upper limb and extensor plantar reflexes were present at the left lower limb. He was admitted on the same day and was sent for magnetic resonance imaging (MRI) brain. It confirmed, the “large subacute infarct with hemorrhagic transformation at the right frontotemporoparietal region of middle cerebral artery territory involving the basal ganglia and around 3.2 cm × 4.5 cm sized parenchymal hemotoma at the right frontal lobe.” Carotid Doppler study revealed the “atherosclerotic soft plaques of about 50% lodged at the right proximal inferior carotid artery.” His 2D echo noticed “Left ventricular diastolic dysfunction with ejection fraction of 58% and early CorPulmonale.” We diagnosed him with Pakshaghata (~ischemic stroke with left hemiplegia). By the request of family members, the patient was referred to a neurological center of a corporate city for advance medical management. Due to the COVID-19 pandemic situation, the patient was referred back from there with the advice of rehabilitation and conservative management for 15 days (till November 26, 2020). The conservative treatment [Table 1] was administered under the supervision of an allopathic physician. Along with their advices, the first stage of Ayurvedic treatments was started from the 6th day (November 17, 2020).
Diagnostic assessment
The degree of his disability was assessed with Scandinavian stroke score,[9] Barthel Index score,[10] and Modified Rankin scale.[11] It measured 16 (severe stroke), 0 (total dependence), and 5 (severe disability) out of its total index of 58, 79, and 6, respectively.
Therapeutic intervention
The treatment schedule in the present case was divided into two stages. These two stages were opted for acute and chronic phase of his illness, respectively. [Table 2] represents those stages of treatment schedule with details.
Timeline, outcome, and follow-up during the course of treatment
[Table 3] represents the subjective and objective remarks observed during the course of whole treatment. On the basis of assessments of Scandinavian Stroke Scale, Barthel Index scale, Modified Rankin Scale, and magnetic resonance imaging of the brain between before the treatment (on 0th day–November 17, 2021) and after the treatment (on 56th day– January 15, 2021), the observations and results were noted and they are plotted in the [Table 4], [Table 5], [Table 6], [Table 7], respectively. At present, patient is on 6 months regular follow-up and is neurologically getting better. | Table 7: Assessment of MRI brain imaging before and after the intervention
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| Discussion | | |
From an Ayurveda perspective, stroke or hemiplegia is recognized as Pakshaghata attributed to an aberration of mainly Vatadosha. The diverse treatments advocated in Ayurveda for this disease is to primarily harmonize the aberrant physiology.[9] The disease Pakshaghata is explained and well explored by all the Bruhatrayee's (~great trios of Ayurveda-Charaka, Sushrutha and Vagbhata). Due to vitiation of Vatadosha, Sthanasamshraya (~localization of vitiated Dosha leading to pathogenesis) of Vata dosha takes place in the Khavaigunya (~weak or malfunctioning part of the body). This process leads to the formation of the Lakshana (~symptoms) expressed by Sthanadusti (~vitiation of the entire system). The treatment is mainly to control the aggravated dosha, based on the Dosha-doshya (~combination of vitiated doshas with weak and prone tissues), Vriddi-kshaya (~increased or decreased Dosha), Sama-nirama (~association or dissociation of Ama with Vatadosha), and Avarana-lakshana (~symptoms occurred due to enveloping Dosha on other) of the Dosha.[10]
Stages of treatment followed and their probable mode of action
The treatment protocol of Pakshaghata followed here is based on its associated Dosha status. In acute phase, it was considered as Vata-kaphajaor Vata-pittaja; and in chronic phase, it was considered as pure Vata condition.[11] In the present case, both phases were given equal importance and the acute phase was treated first as the first stage and the latter as second. [Table 8] represents the treatment principle[8] followed in two stages and two phases. | Table 8: Representation of the treatment principle Vis a Vis two stages and two phases
Click here to view |
First stage: In the present case, the aggravated Vata dosha had Margavaranajanya (~adherence with the aggravation of the other) Medhasdhatu, Pitta, and Kapha dosha. This adherence is said to obstruct the Rasa and Rakta Dhatu, which play a vital role in the metabolism and circulation. In contemporary verse, this process can be called as “Infarction” at channels like blood vessels. To bring them back to normalcy, Agnideepana (~neutralizers of the impaired metabolic fire) and Amapachana (~metabolizers of undigested toxins) were selected as the first line of treatment. The oral medications (Amavatari Rasa, Acidinol, Anuloma DS, Manjistadikashaya, Tab. Bhruhat vata chintamani rasa (plain), Ekangaveera Rasa, and Stresscom), Nasya with Ksheerabalataila and Agnilepa (~special compound of paste made for external application), had the properties of Deepana (~appetizers), Pachana (~digestives) and Srotoshodhana (~evacuators of obstructed channels). These classes of drugs might have helped in the correction of Agnidusti (~digestive and metabolic functioning of aggravated Medhas and Pitta dosha). The probable mode of action of these drugs and their treatment also resided in digestion of the Ama (~scraping out of the undigested Medhas, Kapha dosha).[12] The Agnideepana followed with Amapachana here might have acted on bringing back the infuriated Medhas, Pitta, and Kapha dosha giving way to Vatanulomana (~controlling of vitiated Vata dosha).[13]
Second stage: Once his aggravated Doshas were bought to normal, a set of Snehana (~oleation therapy), Basti Karma (~medicated enema therapy), Swedana (~sudation therapy), Mruduvirechana (~elimination therapy), and Nasya (~administration of drugs through nasal cavity) were induced, to bring Balya (~strength) to affected Vata dosha. Vata dosha is considered as controller of the whole nervous system. The drugs (Ksheerabala, Ashwagandha, Limiron granules, and Rasarajeswara Rasa) that had the drugs of Brihmana (~strength promoters), Langana (~eliminators of excess toxins), and Rasayana (~rejuvenators) properties were selected for the treatment. The selection of suitable drugs and stipulated sets of treatment [Table 2] might have helped in lubricating, reduced stiffness and dryness, improved tone, power, and health of muscles. The probable mode of action at this stage of treatment may have acted on the affected Vata dosha and on dearth nerve cells that were rejuvenated at the end.
| Conclusion | | |
In the present case study, on the basis of observation, result and discussion, the following conclusions were drawn.
The need of detail considerate of the Ayurveda concepts of Pakshaghata with present empirical perceptive is still lacking and the present study may fulfill such need. From the present study, it was understood that in Pakshaghata, the treatment plan should be divided on the basis of Dosha involvement. The intervention should be identifying and targeting the vitiated Dosha and its involvement on the chronicity of the disease. In Margavaranajanya stage, the drugs that has the properties of Agnideepana, Amapachana, Srotoshodana, and Vatanulomana are found effective. After the clearance of Margavaranajanya stage, a set of drugs that has the property of Balya, Rasayana, and Vatanulomana can be induced, to bring back the physiological action of Vata dosha. The wise selection of the appropriate drugs [Supplementary Table 1] and therapies [Table 2] that has the above properties assures the optimistic outcome of the intervention on Pakshaghata. In the present case report, such intervention brought a significant improvement in his degree of disability as per Scandinavian stroke score, Barthel Index score, and Modified Rankin Scale; it measured 51, 65, and 3, respectively, after the intervention. Although his concluding MRI brain notified “no” modifications, at the time of discharge, he was privileged with refurbished gait; sensory and motor deficits with increased quality of life.
Declaration of patient consent
The authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.
Acknowledgment
The authors are thankful to the patient and their family members for their valuable patience and kind support for the treatment. The authors also extend their credit to the whole hospital staff that directly or indirectly invigorated the willpower of the patient.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]
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