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Introduction

Pakshaghat has been explained by Aacharya Charak in vaat vyadhi chikitsa.[1] According to Madhavnidan it can be considered ekangavaat in which vitiated Vaat causes, sira and snayu shosh in half side of the body leading to cheshta nivrutti, shool, vvaakatambh and hasta paad sankoch .[2] Also Charak mentions ardit in trimarmiya adhyay.[3] which can be can be corelated to facial paralysis. When shira marma gets damaged may be due to aaghaat or dosha prakop it may lead to pakshaghaat. Acharya Sushrut says that vitiated vaat dosha travels in urdhwa, adho and tiryak dhamani and causes sandhi bandha moksha which leads to loss of function in half of the body.[4] Pakshaghat can be corelated to hemiplegia due to stroke. Worldwide stroke is the second leading cause of death and third leading cause of disability.Aacharya Madhav says about sadhya asadhyatva of pakshaghat that sadhyam aneyan sanyuktam.[5] A case study of pakshaghat with non-haemorrhagic infarct and chronic ischemic changes has been presented here. This article is to highlighten that if patients with stroke comes as early as possible for ayurvedic treatment and proper chikitsa according to avastha is given we can cure this disease and prevent patient from disabilities.

Case Study

A male patient aged 57 years brought by relatives to Panchakarma OPD, R A Podar Ayurved Hospital on 26/12/2022 with C/O left upper and lower limb weakness and muscle spasms, difficulty in walking and overall weakness for one month. He also had ubhay manibandhashool, hasta parva shool, janu sandhi shool for 3 years.

History

K/C/O –              DM for 10 years (Metformin 500 mg OD)

                             Grade 1 prostatomegally

H/O –                  Pulmonary TB

N/H/O-               fall, trauma

S/H/O-                Nil

Addiction-        Alcohol, tobacco

23/12/22

MR Angiography of brain showed small focal area of acute non haemorrhagic infarct involving left corona radiata. Few focal hyperintensities on FLAIR images involving bilateral periventricular and frontal parietal white matter and basal ganglia suggestive of chronic ischemic changes. CT scan dated 26/12/22 showed small gliosis involving right parietal lobe and age-related cerebral atrophy. Blood investigations dated 24/12/22 BSL- Fasting -246 mg /dl PP-434 mg /dl

WBC court 11200/cu mm Neutrophil- 69%

Patient was under following medicines for 1 month

Tab. Aspirin 150 mg OD

Tab. Clopitab 75 mg OD

Tab. Atorvas 40 mg OD

Tab. Glyciphage BD

Tab. Glimestar OD

Tab. Gabator NT OD

On Examination

Gait- spastic gait

Table 1-muscle power grade

Table 2– Deep tendon reflex

 SLRT-rt -60

          Lf-60

          B/L-20

Mala-asamyak, grathit

Mutra-Samyak-pit varni

Kshudha-samyak

Jivha-niram

Nidra-samyak

Sweda-adhikya

Hetu-mansahaar,alcohol,tobacco,

 krodhadhikya, katu rasa sevan

Dosha-vaat – pitta

Dushya-rakta, mans, snayu, shiromarma

Samprapti- madyapaan, krodhaadhikya, katu rasa sevan, mansahaar - vaat and pitta dosha vruddhi- malaavashtambh- hetu sevan continued- aapan and vyaan vayu prakop - shiromarma ghaat-pakshaghaat.

Internal medicine-

On his first follow up on 3 rd jan patient was adviced admission and admitted on 6 th jan 2023      

On admission-treatment planned

Bahya chikitsa

1)sarvang snehan swedan

2)shirodhara

3)first anuvasan with mahanaryan tel then shodhan basti

 Followed by baladiyapan basti

4)pratimarsha nasya with shadbindu tel 4 drops in each nostril

Abhyantar chikitsa-

Table 4

Pt was told to continue his antidiabetic medicine and ecosprin

All blood routine was done

BSL-     fasting-212

               PP- 420

Urine-  protein- + 3

Sugar- +3

Blood urea-      45

Sr.creat – 1.6

After completion of anuvasan basti- shodhan (dashamool-erandmool-guduchi) Niruha basti baladiyapan b. [6] was started.

Discussion

In this case though the patient was diabetic he was not having any symptoms of prameha or prameha poorvaropa. It was diagnosed as vaat pittaj pakshawadh. It has been told by aacharyaas that if in pakshaaghat vaat is associated with kaph or pitta are curable/sadhya than pakshaghaat caused due to vaat dosha alone. It has been told to give virechan in pakshaghaat. [7] According to Sushrut after snehan,swedan and mrudu sanshodhan , anuvasan and niruha basti should be given along with shirobasti,abhyanga,upanaha.[8]

But considering the samprapti of vyadhi , bala and avastha of patient he was given shirodhara, pratimarsha nasya and yapan basti. Internal medicines and karma chikitsa were selected for vaatanuloman, rakta prasadan and giving strength to snayu and kanadara.

Conclusion

Ayurvedic treatment is based on person to person.Not one single protocol is applicable for any disease in every individual.Considering the hetu, hetu bala, rugna bala,samprapti of disease treatment is to be given without any delay otherwise the samprapti becomes deep rooted and Sadhya vyadhi will become asadhya.Ayurvedic treatment is based on  swabhavoparam vaad which explains that  when Vaidya  cures a disease there is no any reason for destruction the abnormal dosha and dhatu because it happens on its own.

What we are doing while giving treatment is just forming new normal gunas – dosha and dhatu.[9] This principle really helps us in giving proper Chikitsa to any patient. Abhyantar chikitsa along with karma chikitsa like snehan, swedan, vaman, virechana, basti, nasya, shirodhara,pindasweda, lepa, upanaha is a boon given by Ayurveda which when used in proper way helps us to cure any Sadhya vyadhi.