EFFECT OF MULTIMODALITY AYURVEDA TREATMENT IN PAKSHAGHATA

M.P Athira Assistant Professor,Department of Panchakarma, K.J institute of Ayurveda and Research Savli, Vadodara. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 20 April 2020 Final Accepted: 25 May 2020 Published: June 2020


Presenting Complaints:
Patient came with reduced strength in the left upper and lower limbs associated with drowsiness, difficulty in walking, slurred speech, heaviness of affected side of the body with pain, stiffness and bladder incontinence since 2weeks.

History of Present Illness:
By the statement of bystander he was apparently healthy before 8 weeks. While working he suddenly fell down and complained of reduced strength in the left upper & lower limbs along with difficulty in walking, slurred speech, heaviness of the left side with pain, stiffness and bladder incontinence since 2 week. For the same complaints they consulted an allopathic physician, took treatment for 7 days. But did not get any relief. So for further treatment they came to our hospital and admitted for treatment from 17/1/2020 to 06/2/2020.

Systemic examination:
Respiratory system-O/A-normal bronchi vascular sounds heard and no abnormality detected CVS-S1-S2 heard Central nervous system-Higher mental functions found to be normal Eye opening response was-4 Verbal response-3

Reflexes:
Deep reflex such as Biceps, Triceps, Supinator, Kneejerk, and Ankle jerk on affected side (left) were found to be 2/5 Sensory functions: Normal Babinskis sign: positive on left side Tone: Left lower limb was found to be hypotonic

Laboratory investigations:
Hematological investigations was done and found to be normal

Specific investigation:
Computerized tomography scan of head done showed acute Hemorrhage in Thalamus

Diagnosis:
Case was diagnosed as a PittakaphavruttaPakshaghata (cerebro vascular accident).as per the classics, the treatment was planned according to the Dosha and Sthana(site)as following

Results:-
The condition of the patient was improved gradually along with the course of the treatment. The strength and power of both upper and lower limb was increased to +4/5,also tone of the muscle improved, deep tendon reflex was exaggerated(g3) and was normal (g2) after the course of treatment, gait before treatment was hemiplegic and at the time of discharge he can able to walk alone over all condition was improved. Glasgow coma scale-Eye opening response was 4, Verbal response -5 and motor response -6 therefore total score 15/15.

Motor function:
Power: Hemiplegia also get manifested as a consequence of a wide variety of pathological condition involving brain like vascular disorders of brain, infective disorder, tumor, trauma, degenerative disorder of brain. As the pathological processes in hemiplegia, due to the above diseases are different, the treatment of hemiplegia also varies in each condition (etalDrsahu..) 3 . Cerebrovascular accident is the most frequent disease manifesting as Pakshaghata in course of time.
In the present study an effort had been made to establish a standard Samprapti(acquisition) for the Pakshaghata due to cerebrovascular accident with its Treatment Protocol. The risk factors associated with the stroke includes Charakacharya mentioned Swedana (Sudation), Snehana (Oleation) and Virechana (Purgation) as treatment modality for Pakshaghata (Hemiplegia). ErandaBhrishtaHaritaki was administered daily due to irregular bowel habit. It is a combination of two ingredients namely ErandaTaila(Castor Oil) and another is Haritaki(Terminalia chebula) having properties of MriduVirechaka (Laxative)and helps to relieve constipation 12 . MruduVirechana(mild purgation) helps to correct the root pathogenesis of Pakshaghata(Hemiplegia) leading to the proper Anulomanaof Vata, correction of Agni and reduces Prakupita Pitta. Externally Sarvanga Abhyanga 13 (Full Body Massage) for 7 days, Shirovasti 14 for 7 days and Matravasti 15 for 14 days along with physiotherapy were administered. In KevalaVataAvastha, SarvangaAbhyangawith Mahanarayana Taila 16 and Nadisweda were adopted. Abhyanga makes body sturdy and resistant to Vataja disorders 17. It brings smoothness (Mardava) in the body. It depletes morbid Vata and Kaphaand replenishes all Dhatus. After 300 Matras 18 from massage commenced oil reaches up to Romakupa(hair follicles) and then progressively reaches into the most deeply situated tissues. By the time of 500, 600, 700, and 800 Matras 19 Snehapenetrates Rakta, Mamsa,Meda and Asthi-Majjarespectively.After all these treatment, the patient got improvements in Coordination, Consciousness and Regaining the Motor Function of the Body. The patient was able to walk independently without any type of support. Also MahanarayanaTaila acts as Vatahara and Ayushyam. After Abhyanga 20 , started with Shirovasti for 7 days with KsheerabalaTaila and BalaashwagandhadiTaila. BalaashwagandhaTaila is Tridhosaharaand Raktaprasadanaand Ksheerabala is best in Pittanubandhaavatacondition because of its Sheeta-Ushna property. Charakamentioned it as Sahasrapaka Balataila 21 . Matravasti 22 was given with Balataila to restore the Prasaranaof Vata and BastiChikitsa is the prime treatment modality of Ayurveda. Sneha or Matravasti promote Bala of person who is emaciated and debilitated. This BalaTaila is best in all types of Vatavyadhi 23. .

Conclusion:-
In most of the times Pakshaghata due to CVA present as sudden onset without prodormal symptoms. The chief pathological phenomena taking place in the manifestation of Pakshaghatadue to CVA is Aavaranaof Vata with Pitta, Kapha, Rakta and Meda. At first stage of treatment, should be done at the level of Jataragni with adoption of BahiparimarjanaChikitsa(external therapy)and oral medicines and in second stage Amapachanawas attend with the Moordhinichikitsa and vastiall this done for 1month.virechana that is Mriduvirechana was adopted to restore the function of Agni, Srotas and Vatadosha. Physiotherapy also continued upto 1 and half month. All treatment significantly improves the signs & symptoms of Pakshaghata as well as the activities of daily livings there by making better the quality of life of the patients.