“Ayurvedic Management of Pakshaghata(Cerebrovascular Accident) : A Case Study”

Stroke, or CVA, is characterised by the sudden localised neurological deficit caused by illnesses affecting the cerebral vasculature and its components. It is the third leading cause of death in developing countries. This disease has posed a great problem to the medical field as far as its treatment is concerned. There is currently no satisfactory and widely accepted treatment for stroke. Researchers in both Ayurveda and modern fields are conducting numerous studies to improve the management of CVA. Pakshaghata, known as paralysis or hemiplegia, is a disorder that typically affects one side of the body and is defined by the abrupt loss of motor function. Pakshaghata is a condition where the Vata dosha is vitiated, causing problems with the nervous system and muscles. The study's goal was to assess the effects of ayurvedic treatment on Pakshaghata. Material and Methods: A case study of CVA was admitted, with the patient presenting complaints of difficulty in standing and walking, slurred speech, heaviness of the affected side of the body, and pain. A CT scan of the brain revealed a hypodense area in the thalamocapsular region s/o infarct. The case was diagnosed as Pakshaghata in conjunction with laboratory investigations. Various stages of the disease were treated with oral medications, including Snehan, Swedan, Nasya, Basti, and Mruduvirechana. Additionally, physiotherapy sessions were implemented on a consistent basis. Observation and Result: After successfully combining shaman treatment and Panchakarma treatment for consecutive times, the patient got complete relief from all complaints. Before treatment the Barthel index scale was 15, and after the treatment the Barthel index scale was 75, providing symptomatic relief too.

KEY WORDS:-  Stroke, Cerebrovascular Accident, Ayurveda, Pakshaghata, Snehana,

CVA is defined as a focal neurological deficit due to a vascular lesion lasting longer than 24 hours^[1]. Of patients presenting with stroke, 85% have a cerebral infarction due to inadequate blood flow to some part of the brain. It is one of the leading causes of death in India. It is a heterogeneous group of disorders. Stroke presents with symptoms of sudden weakness of face, arm or leg, difficulty in speaking, dizziness, loss of coordination, headache and unconsciousness^[2]. Three major types of stroke are ischaemic, haemorrhagic and lacunar strokes. Ischaemic strokes with infarction result from atherothrombosis or embolism of cerebral vessels. Haemorrhagic stroke refers to bleeding from central nervous tissue occurring due to ruptured cerebral aneurysm in the young and hypertensive intracerebral bleeding in the elderly. Lacunar infarcts are deep, small cerebral infarcts located in the basal ganglia or deep white matter^[3].

Ayurveda describes stroke (CVA) as Pakshaghata. It is a condition where vata dosha is vitiated. It is a Nanatmaja vatavyadhi^[4]. It affects the sira, snayu and kandara of the half side of the body, including the face. The term 'Pakshaghata' refers to 'Paksha', which means either half of the body, and 'Aghta', which means impairment of karmendriya and gyanendriyas.^[5] Karmendriya is considered as the part of the motor system, whereas gyanendriya is considered as the part of the sensory system.

Ayurveda is a discipline that cures diseases by treating their causes as well as their symptoms. which eventually results in Samprapti Vighatana. Vata is the primary cause of Pakshghata.

illness and ought to be addressed first. When it comes to the muscles, they first exhibit flaccidity before becoming firm. If Snehana⁶ and Swedana are done early, they avoid this stage. There is muscular hypertrophy, which Abhyanga can also prevent since it enhances the blood supply. Swedana⁷ is the process that alleviates Sthambha, Gauravta, and Sheetata. Swedana gives relief from stiffness, heaviness and coldness. Virechana is viewed as the best treatment for Pakshaghata. Virechana⁸ is recommended in Pakshaghata, as both Pitta and Vata Doshas are disturbed, and to eliminate the disturbed Vata and Pitta, Virechana has a significant function.

Basti⁹ was given with Sahacharadi taila because it is vatashamak. Dashooladi niruha basti as it is indicated in Vata vyadhi. Murdhataila pichu started with Bramhi taila⁹, as mentioned above, as a vata shamak & Sangyasthapan. Nasya¹⁰ is a potent Vata Shamaka procedure, as it directly acts on Urdhava Jatrugata Vikar. Shira Pradesh is the main Adhishthana of Indriya, and Nasa is considered the way to it. The drug administered through NASA goes to Shira and causes Dosha Nirahana and Vata Shaman simultaneously. In this case the patient was given Shaman Nasya with Panchendriya Vardhan Tail. Panchendriya Vardhan Tail has Vata Shamaka properties. Bruhatvatachintamani Rasa¹¹ has properties such as medhya, rasayana, lekhana, balya, kshayagna, ojovardhana & yogavahi, which have a targeted effect for the management of Pakshaghata. Capsule Palsinueron¹² was given during the whole course of treatment. It is a proprietary medicine prepared by a combination of Ekangaveera Rasa, Mahavatavidhvamsa Rasa, Sameer Pannag Rasa and Sutasekhara Rasa, and all these Yogas are directly indicated in Vataja Roga. Due to this specific type of combination, it was administered to the patient to

tackle symptoms like weakness and stiffness in the muscle. Jivha Pratisaran is performed with Vacha Choorna¹³, Chitrak Choorna and Pippali Choorna in the treatment of speech disorders. It holds a special place in Ayurveda because it is a key Medhya medicine that has the ability to improve memory and cognition. Rasnadi guggulu is given as an analgesic, as it balances the aggravated vata dosha and calms neurological disturbance. Gandharva Haritaki choorna vati¹⁴ and eranda taila¹⁵ are given at night, which gives a virechan effect and does Vatanulomana.

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