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Introduction

Guillain Barre Syndrome is one of the most common severe acute paralytic neuropathies. It is heterogeneous rapidly progressive disease. Around 20-30% of patient may be associated with life threatening respiratory failures. Prevalence of Guillain Barre Syndrome is 2.7 per 1,00,000 per year. Prevalence is more in men than women and has seasonal fluctuations.1 It is rapidly evolving reflexes motor paralysis with or without sensory disturbance. The usual patterns are an ascending paralysis that may be first noticed as rubbery legs. Weakness typically evolves over hours to a few days and is frequently accompanied by tingling diathesis in the extremities. The legs are usually more affected than the arm and facial diaparesis is present 50% of affected individuals.2 Rapidly progressive ascending muscle weakness, poorly delimited distal sensory disorder in the limbs, Absent or reduced deep tendon reflexes.3 The disease is usually triggered by an infection. In modern science Intubation, plasmapheresis, intravenous immunoglobulin & Glucocorticoid are line of treatment for Guillain Barre Syndrome.4 The treatment is expensive and effective only when given within 4 weeks. Administration of IVIG had adverse effect like liver inflammation and kidney failure may occure.5 Many diseases in this era not clearly mentioned in Ayurveda Samhitas but managed by Ayurveda through basic principles given in our classical text. Acharya Charak stated that nomenclature is not necessary to treat the disease. Disease can be managed by its dosha, dushya, samprapti vighatana, vyadhi awastha, etc.6 Guillain Barre Syndrome is one of them. Guillain Barre Syndrome not clearly stated in classical text but symptoms of sarvangagata vata.7 vyadhi closely co related with Guillain Barre Syndrome. Cheshta nivruti (Absent or reduced deep tendon reflexes.) Ruja (Rapidally progressive ascending muscle weakness) Vakasthambha. So, all above fact of Guillain Barre Syndrome consider as sarvangagata vata vyadhi and managed with the help of its chikitsa sutra and samanya chikitsa siddhanta of vata vyadhi chikitsa and found better result.

Case Report

A 47year old female patient (OPD no. 21172) 8/3/23 presented with complete generalized weaknesses, tingling sensation in both hands and legs, backache for 4 years. She was admitted in hospital for 1 months. Nerve conduction study was done in which e/o generalized symmetrical pure motor, axonal lower limb + upper limb peripheral neuropathy. Diagnosed with Axonal variant of Guillain Barre Syndrome.

Treatment taken: Inj. IVIG 5 ml QID for 4 days.

Tab. Neurobian forte 1-1 and Tab. Pan 40 1 OD. For 1 month.

She has no previous history of Diabetes, Hypertension, Asthma, Tuberculosis, any major surgical procedure.

Past History:

Tubal ligation 25 years ago

Pelvic inflammatory disease 6 year ago

Deviated Nasal Septum (left) 5 year ago for this homeopathic treatment taken.

Patience had tingling sensation and muscle weakness in both hands for which she had treatment in private hospital Nanded. In civil hospital after nerve conduction study the Guillain Barre Syndrome was diagnosed for which she taken treatment for 12 days. And an internal medication for 1 month. For reoccurring problems, the patient visited our facility.

Examination on Admissions:

GENERAL EXAMINATION 

The patient was afebrile

Pulse -76/ min

BP -130/90 mm of hg

Weight- 55 kg

General condition –moderate

PHYSICAL EXAMINATION

There was diffuse weakness of all four extremities distal greater than proximal and involving lower limb more than upper limb. Muscle tone was normal and vibration sensation was normal, muscle reflexes (biceps and triceps was exaggerated in B/L) other was normal.

SYSTEMIC EXAMINATION

In s/e findings of respiratory and cardiovascular system were within normal limits. abdomen was mildly distended; non-tender and bowel sounds were present. Patient was concious and well oriented and pupillary reaction to light was normal.

VIKRATASROTAS PARIKSHA:

Mamsavahasrotovikriti was presented as ubhayahastapada daubalya (weakness over all four limbs) Rasavahasrotovikriti was presented as panduta, Gaurav,tandra,aruchi, tama.

HETU: atiasana (continuos setting position), parushit ahara   katurasaadhikya, ratri jagrana,atichinta,ativichar

DOSHA: vata,kapha Pradhan tridosha

DUSHYA:  Rasa,rakta ,mamnsa,meda

DESHA: sadharana

BALA: madhyam

KAALA: Vasant

PRAKRITI: vatakapha

NIDANA PANCHAKA:

Nidana: atiasana (continuos setting position), parushit ahara, katurasaadhikya, ratri jagrana,atichinta,ativichar

Purvroopa: generalised weakness, muscle weakness

Roopa:  tingling sensation in both hands and legs,backache

Samprapti: On considering above references we plan this case as a sarvangagata vata through Ayurveda.

NERVE CONDUCTION STUDY:

There is e/o generalised symmetrical pure motor, axonal lower limb, upper limb peripheral neuropathy. (Axonal variant of GBS)

HbA1C 4.9 (abnormal hb variant)

ANA /DNA negative

HIV / HBsAg negative

Discussion

In the demyelinating forms of GBS, the basis for flaccid paralysis and sensory disturbance is conduction block. First attack on Schwann cell surface, widespread myelin damage, macrophage activation, and lymphocytic infiltration. If the axonal connections remain intact the recovery will be faster as rapidly as remyelination occurs.9 Circumstantial evidences suggests that all GBS results from immune responses to nonself antigens (infectious agents /vaccines). By analysing the vyadhivrutanta (history of illness), nidana (etiology), lakshana (symptoms) presented here we have taken in consideration of Avaranajanya vatavyadhisamprapti and finally arrived a final diagnosis as sarvangavata and started treating this particular condition. GB syndrome done at Government Ayurvedic Hospital, Nanded where managed with vatahara as well as sarvangata vata for which medicine selected was shashtikashalipindasweda with balamula,ashwagandha churna and shatavarichurna. Yogabasti krama along with niruha with dashmool kwath, anuvasana with tilataila. Nasya with anutaila also with panchendriya vardhana tail. Manyabasti along with tilataila.

Bruhatvatchintamani 10 gm with Ashwagandha churna 50 gm with Guduchi satva 10 gm combination given for 14 days in BID.

Agastiprash 5 gm in bid for 15 days

Haritaki churna 5 gm hs for 15 days given

DISCUSSION ON TREATMENT:

SHODHANA

Considering the vata vyadhi and balakshyaya shastiksshalipindasweda with all the ingredients of the shashtikashalipindasweda such as kshira (milk), shashtikashali (type of red rice with 60 days old), and bala moola possess santarpana (nourishing) qualities with pritwi and apamahabhuta and is indicated for balya, bruhmna, and strengthening dhatus and vata pacification Vata disease is cause due to the reduction in its chalaguna causing inability to transmit nerve impulses, this helps in opening up of blocks in nerve conduction and facilitates remyelinating of nerves; thereby helps to transmit nerve impulses. Taking pakwashya as moola sthana 10 for the vatavyadhi we have selected yogabasti along with niruha basti   contents dashmool kwath and anuvasna content tilataila for 8 days, which played a major role in improving the condition. The active principals of drugs used in basti gets absorbed in systemic circulation by passing hepatic circulation. The organ is inter connected at molecular level, each molecule of the body is connected with another molecule of the body by direct or indirect way. “Nasa hi shirsodwara “11Shodhna Nasya along with anutaila for 7 days, followed by bruhana nasya with panchendriya vardhana taila for 7 days. shows marked improvement in disease condition.

SHAMANA:

Bruhatvatchintamani 15 which balances vata dosha, it has excellent rejuvenating properties used with ashwagandha which is balya ,bruhana and it normalise the cortisol level help to reduce the stress and anxiety .with guduchi satva16 having agnideepana (improves digestion),dahahara( relieve burning sensation ),rasayani( rejunivate the whole body), balya (improve the muscle strength), amahara (treate digestion). properties give significant result in generalised weakness and improves muscle power, tone. Agastipras 17 is laghu (light to digest), ruksha(dry), tikta rasa (bitter taste) it balances kapha and pitta dosha, it is antitoxic and used to trate fatigness. Haritaki 18 is having properties of virechnanopaga (reduce purgation), grahi (treats diarrhoea), shulahara (reduce pain), deepana (enhance stomach fire), Pachanga (helps in digestion), rochana (stimulates appetite). It is tridoshaj and hence balances body. By taking shodhana karma, there were marked improvement in muscle power up to 5/5. Muscle tone was improved, associated symptoms like generalised weakness and loss of appetite was improved with the help of agstiprash and bruhatvatchintamani yoga. Hughes score were improved from 2 to 0. After complete 1 month of treatment patient was able to perform all daily activities normally.

Conclusion

The analysis of GBS in terms of Ayurveda concludes that the GBS is a symptom complex where we can’t correlate particular ayurvedic term, but based on the symptoms here we have taken as sarvangavata. In this patient recovery was seen in one months, which is suggestive of quicker beneficial effects of ayurvedic treatments. along with this ayurvedic panchkarma chikitsa as well as shamana chikitsa plays major role in improving muscle tone, muscle strength and reflexes.

Following Ayurveda model of treatment step wise and customized approach have beneficial effect.Outcome showed significant role of Ayurveda in GBS.Ayurveda management can decrease the disability and improve quality of life. It is concluded that Guillain Barre Syndrome with special reference to sarvangagata vata treated through Ayurveda found better results in this case.Further reasearch should be done with large sample size for results.