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Introduction

Pakshaghata is one of the major and one among the 80 vataja nanatmaja vikaras. It is mainly caused by occlusion of blood vessels of brain by different factors. It is characterized by sudden loss of motor functions of mainly one half of the body, often associated with speech disturbances and sensory impairment. It can be correlated with hemiplegia, commonly resulting from cerebrovascular accidents. Pakshaghata predominantly occurs due to vitiation of mainly Vata dosha. It is madhyammarga gat vyadhi. The treatment included Shodhan and Shaman Chikitsa.In brihatrayi Shodhan chikitsa is explained for upasthambhit pakshaghat. It helps to cleanse our body from all the toxic elements present in our Body. Basti is one of the Main shodhan chikitsa mentioned in the treatment for vata dosha. Charaka also mentions basti as ardha chikitsaa. Sarvang snehan and swedan help in decreasing stiffness and strengthen muscles then after snehan and swedan, Panchatiktakshir basti was given to increase dhatvagni thus increases bala of dhatu. Pakshaghsat is mentioned in asthi-majjagata vikara by Acharya charaka. This treatment helps in removing strotasavrodha and probably increases perfusion which leads to restoration of neurological functions. All the above treatment is helpful in reducing post stroke residual effect.

Materials And Methods

Case Presentation:

A 60 year old male patient was registered at IPD and OPD with UHID no. 394977 at our hospital. The patient had chief complaints of

• Right upper limb weakness
• Heaviness in right lower limb
• Stricted movement and generalized weakness since 2 months.

Past History :

• No history of any trauma .
• K/C/O- HTN On Rx Tab. Telma 40 mg OD
• DM On Rx Glimeperide 0.5mg and Metformin 500 mg OD

Examination:

• General examination:   BP – 130/80 mmHg, P- 74/min, RR- 18/min
• RS-B/L
• CVS - S1S2 Normal
• CNS-Concious oriented
• Asthavidha Pariksha:

  Nadi – Vata – kaphaj                   Jivha – Nirama

  Mutra – Prakrut                             Drik - Prakrut

  Mala- Prakrut                           Akriti - Madhyam

  Shabda –slurred speech         Sparsha –Anushnasheeta   Motor system

1.Muscle power

2.Muscle Tone[1]

3.Reflexes [2]

Investigations:

The results of the conducted haematological and biochemical analyses were determined to be within the physiological range.

MRI of brain-Acute to Subacute multifocal Cluster moderate size non haemorraghic infract in the frontal-Praeital-Occipital lobe on left side.

The Shoulder joint X-Ray appeared to be normal.

Samprapti Ghatak of Pakshaghat:

1. Dosha- Pradhana Dosha: Vata
2.  Anubandhi Dosha: Pitta / Kapha
3. Dushya - Rasa Rakta Mamsa Snayu Sira Majja
4. Srotas- Rasavaha Raktavaha Mamsavaha Majjavaha Pranavaha
5. Srotodushti Prakara- Sanga (obstruction), Vimargagamana (abnormal movement of Vata)
6. Agni- Jatharagni Mandya Dhatvagni Mandya
7. Ama- Ama present
8. Sanchara Sthana -Sira and Snayu of Urdhva and Adho Sharira
9. Adhisthana -Ardha Sharira (one half of the body)
10. Vyakti Sthana- Hasta, Pada, Vak, Mukha, Greeva
11. Roga Marga -Madhyama Roga Marga
12. Swabhava -Chirakari (chronic)
13. Sadhya-Asadhyata -Krichchhra-Sadhya / Yapya

Treatment Plan

Observation

After following the above treatment plan, the patient experienced significant relief in the signs and symptoms, pain and stiffness gradually decreased and there was a significant increase in the range of motions of the right upper and lower limb.

Result

Reflexes Grade[3]

Discussion

Pakshaghat is a type of vat vyadhi. Vat dosha get vitiated due to kaphavrodha anoccupies rikt srotas in body.[1]

[2]Panchakarma plays vital role in the preservation, maintenance & conversation of health & promotion of longevity.

Importance of panchakarma in prevention of diseases:

Regular practice of it will prevent the achaya purvaka vata prakopa, dhatu kshaya and also does mala shodhana.

Practice of panchakarma in ritucharya will prevent the diseases by expelling the chaya poorvaka prakupita doshas and sthana samshraya avastha of shat kriyakala.

Maharshi charaka advocated shodhana followed by rasayana as prophylactic measures for the prevention of epidemics and pandemics.

Employing panchakarma followed by rasayana & vajikarana chikitsa for parents can effectively prevents the occurrence of autoimmune disorders and genetic diseases in the progeny.

The dosha that are nullified by shodhana never recurs but those pacified by langhana, pachana etc. may recur.

If the plant is destroyed except root, then it grows again, in the same way, if dosha are not destroyed from the root, they again cause diseases.

[3]Shodhana therapy acts on the root sites of dosha and remove them from the body    so thatthere is no further nutrition to the other dosha sthana leading to a healthy condition, thuspanchakarma is a radical treatment.

Abhyantra Snehan-Mitigates vata & kapha, increases pitta, bala, varna, Mardavata, tvachya, krimighna, garbhashaya shodhaka, bhagna sandhanakara, it subsides yoni – sira – karna sula.

Svedana is the procedure which relieves stiffness, heaviness and coldness of them body and produces sweating.[4]Panchtikta kshir niruha basti is a specialized ayurvedic treatment that involve the administration of medicated enema containing a combination ofbfive bitter herbs (panch tikta) and milk. this therapy is used primarily to treat condition related to vata disturbance such as pakshaghat (paralysis), by balancing doshas, rejuvenating the nervous system and symptoms like muscle stiffness, spascity, and loss of motor function.

Conclusion

This case report presents the significant improvement in the patient condition.In  Ayurveda Panchakarma play very important role in management of any disease.Acharya Charaka describe basti as ardha chikitsa. Snehana, Swedan mrudu shodhan and internal medicines play very special role in vat vyadhi chikitsa. After giving this combine treatment patient show significant improvement and symptoms get reduce upto effective remark.