A STUDY OF THE EFFECT OF VATA RAKSHASA RAS WITH BHRINGADI TAILA NASYA IN THE MANAGEMENT OF PAKSHAGHATA DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT FOR THE DEGREE OF DOCTOR OF MEDICNE (AYURVEDA) IN KAYACHIKITSA BY DR.G.RANGA NADH CO-GUIDE GUIDE Dr. VIJAYA LAKSHMI Dr. V.VIJAYA BABU M.D (Ayu) M.D (Ayu) /LECTURER READER POST GRADUATE TRAINING AND RESEARCH UNIT DEPARTMENT OF KAYA CHIKITSA DR. B.R.K.R.Govt. AYURVEDIC COLLEGE AND HOSPITAL HYDERABAD FACULTY OF AYURVEDA N.T.R. UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA, A.P., INDIA 2007-2008. created by technoayurveda.wordpress.com of Dr.KSRPrasad
A STUDY OF THE EFFECT OF VATA RAKSHASA RASWITH BHRINGADI TAILA NASYA IN THE MANAGEMENT OF PAKSHAGHATA, G.RANGA NADH, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD
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A STUDY OF THE EFFECT OF VATA RAKSHASA RAS WITH
BHRINGADI TAILA NASYA IN THE MANAGEMENT OF
PAKSHAGHATA
DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT FOR THE
DEGREE OF
DOCTOR OF MEDICNE (AYURVEDA)
IN KAYACHIKITSA
BY
DR.G.RANGA NADH
CO-GUIDE GUIDE
Dr. VIJAYA LAKSHMI Dr. V.VIJAYA BABU
M.D (Ayu) M.D (Ayu)
/LECTURER READER
POST GRADUATE TRAINING AND RESEARCH UNIT
DEPARTMENT OF KAYA CHIKITSA
DR. B.R.K.R.Govt. AYURVEDIC COLLEGE AND HOSPITAL
HYDERABAD
FACULTY OF AYURVEDA
N.T.R. UNIVERSITY OF HEALTH SCIENCES
VIJAYAWADA, A.P., INDIA
2007-2008.
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Ayurmitra
TAyComprehended
DR.N.T.R.UNIVERSITY OF HEALTH SCIENCES
VIJAYAWADA, A.P.
DEPARTMENT OF KAYACHITIKSA
POST GRADUATE UNIT
DR. B.R.K.R. Govt.Ayurvedic College/Hospital
Erragadda, Hyderabad, Andhra Pradesh
INDIA.
Date:
Place: Hyderabad
CERTIFICATE
This is to certify that the present study titled “A STUDY OF
THE EFFECT OF VATARAKSHASA RAS WITH BHRINGADI TAILA
NASYA IN THE MANAGEMENT OF PAKSHAGHATA” was carried out by
Dr.G.Ranga Nadh under our direct supervision and guidance for the award of
Doctor of Medicine in Ayurveda in the speciality of kaya chikitsa.
A continuous effort has been done not only in compiling the
relevant information and also in conducting the clinical study sincerely and
carefully.
Hence we recommend this work for accept
CO - GUIDE GUIDE
Dr. VIJAYA LAKSHMI, Dr. V.VIJAYA BABU
M.D. (Ay) M.D. (Ay)
LECTURER READER
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DR.N.T.R UNIVERSITY OF HEALTH SCIENCES
VIJAYAWADA, A.P
DEPARTMENT OF KAYACHIKITSA
POST GRADUATE UNIT
DR. B.R.K.R.Govt. Ayurvedic College / Hospital
Erragadda, Hyderabad, Andhra Pradesh.
INDIA
Place : Hyderabad
Date :
C E R T I F I C A T E
This is to certify that Dr. G.Ranga Nadh a student of
M.D.(Ayu) Kayachikitsa, has worked for his thesis on the topic ‘A STUDY OF
THE EFFECT OF VATARAKSHASA RAS WITH BHIRNGADI TAILA
NASYA IN THE MANAGEMENT OF PAKSHAGHATA’ as per requirements
of the ordinance laid down by NTR university of health sciences, Vijayawada
for the purpose. The Hypothesis submitted by him in the first year M.D. is one
and the same to that of the dissertation submitted.
I am fully satisfied with this original work and here by
forward the thesis for the evaluation of the adjudicators.
DR.PRAKASH CHANDER
M.D.(Kayachikista)
PROFESSOR &
Head of the Department of K.C.
Post graduate unit
Dr.B.R.K.R.Govt.AyurvedicCollege/ Hospital
Hyderabad.
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ACKNOWLEDGEMENTS
I convey my heartful gratitude and respect towards my beloved
parents
It gives me great pleasure to express my profound sense of
gratitude and deep respect to my guide Dr. V.Vijaya Babu, Reader K.C.Department,
P.G.Unit, Dr. B.R.K.R. Govt. Ayurvedic Medical College / Hospital, Erragadda,
Hyderabad, for his valuable guidance constructive advises and whole hearted co-
operation which enabled me to present this thesis in its present form.
I am very highly indebted to my co-guide Dr. Vijaya Lakshmi
Gaxetted Lecturer, K.C. Department, P.G. Unit, Dr.B.R.K.R. Govt. Ayurvedic
Medical College / Hospital. It is only due to his constant encouragement, wise
advises, stimulating discussions and admirable affection inspired me to bring out
this heavy work.
It is pleasure to convey my thanks to former co-guide Dr.
Ramalingeshwara Rao, Gaz. Lecturer, Dept. of K.C., P.G.Unit, for his suggestions.
My sincere regards to Dr. Prakash Chander Reader, Professor,
Head of the department, K.C., P.G.Unit, Dr. B.R.K.R. Govt. Ayurvedic Medical
College / Hospital, Erragada, Hyderabad, for his valuable suggestions during my
couse of study.
I am highly thankful to the College principal Dr. Sadashiva Rao
for providing my necessary equipment.
I am thankful to the hospital Superintendent Dr. L.R.K.Murthy
for his cooperation for allowing me to do work on his patients and providing
necessary requirements.
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I acknowledge sincere gratitude to Dr. Anantha Sena Chary,
Professor, Head of the Department of Shalya, Dr. V.L.N.Sastry, Dr. Philip Anand,
Dr. Jeevaratnam for their valuable suggestions.
I am thankful to Dr. Ramakrishna, adviser of Annapurna Herbal
Industry for his contribution towards preparing the Thesis Drugs.
The assistance received from Dr. P.Yoshada, Lecturer of Govt.
Ayuverdic College, Hyderabad, Dr. Parumallu, Dr. Priya, Dr.Vinod Singh, Dr.
Sivannaryana, Dr. Lavanya for their valuable suggestions and co-operation.
I am thankful to my friends Dr. Ravi, Dr. Padmaja, Dr.
Venkateshwarulu, Dr. Nagaraju, Dr. Kavitha, Dr. Nageshwara Rao, Dr. Samba
Shiva Rao, Dr. Sirisha, Dr. Karnate, Dr. Jha, Dr. Shivarama Krishna, Dr. Namratha,
Dr. Kandagadla, Dr. Rajalakshmi and all of my classmates for their wholehearted
co-operation during my education.
It becomes impossible to complete Thesis work without the co-
operation of my Sister K.Rama Devi, Brother In-law K.Raghavendra Rao. Wife
G.Tulasi Devi, my Parents G.Sanjeeva Rao & G.Bhagya Lakshmi and my father in-
law M.V.V.Kumar Babu.
.
My thanks are also due to college library and P.G.Dept, Libraray
staff for providing necessary books for the literary work of this thesis.
I am highly thankful to my patients and their attendars for
allowing me to conduct clinical trails and their co-operation through out my clinical
studies.
My respects to all those who helped me directly and indirectly in
completing the present thesis work smoothly.
Date :
Place : Hyderabad DR.G.Ranganadh
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Out of these Ashtangas Kaya chikitsa occupies prominent place in
Ayurveda. Kaya chikitssa deals with numerous internal diseases. Vataja vikaras
outnumber other doshic vikaras. Pakshaghata is one such Vataja nanatmaja vyadhi,
where in Ayurvedic line of treatment gives encouraging results. Rasoushadhas will
give more encouraging results, because no need of panchakarmas (shodhana). It was
fast acting therapy and has been found effective in smaller doses. It is said to be
more of Rasayana in nature, which in practice prevents Jara (old age or the ageing
process) and vyadhis (disease), rejuvenates body and prolongs life span.
We know that 50% of Indian population is above the age group of 50
years and one out of 10 suffer from vata vikaras and a majority of them suffer from
Pakshaghata The incidence of pakshaghata is alarming. It occurs mostly as a
complication of Diabetes mellitus and Hypertension. If a study on Rasoushadhis like
Vatarakshasa Ras is made, which is said to be useful, it will be more helpful in the
present day.
Along with vatarakshasa ras Bhringadi taila nasya is taken for the
Treatment.
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HISTORICAL ASPECT
Ithihasa is an essential aspect ot know about the diseases, drugs, the
mode of treatment and the life style of the people starting from the prevedic period.
VEDAKALA:
Atharvana veda(4.13.4) is considered as the main source of Ayurvedic
knowledge among the four Vedas the four Vedas but the first and the fore most veda
i.e. Rigveda(8.20.23-26) also contributed much for Ayurvedic therapeutics.
In Rigveda(11.7.6) there are some references which directly or
indirectly indicate the existence of a disease like pakshaghata. The derailment of
‘panchavidha vatas’ takes place in the disease pakshaghata. Yajurveda mentions
about the different types of vatas.
Ayurveda is considered as the Upa veda of Atharvana Veda((s.s.su.1.6)
because of the existence of many pharmacological, anatomical, physiological and
therapeutic aspects, The word ‘vata vyadhi’ is noted first in Atharvana veda.
According to Atharvana veda there are hundreds of ‘Hirah’ (sira) and thousands of
‘Dhamanis’ in which the blood flows like river. The vessels are of different colours
ranging from ‘aruna’, ‘dhoomra’ directed upwards and downwards. These words are
simulating the Susruta’s pakshathata samprapti.
SAMHITA KALA:
Atreya samhita : called as Charaka samhita, the first samhita grantha
explains the nidana, samprapti, chikitsa and sadhyaaasadhyata of pakshaghata. The
other synonyms used in this are pakshagraha and pakshavadha.
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Susruta samhita: Mentioned the detailed description of the samprapti,
types, sadhyaasadhyata, chikitsa and the duration of chikitsa. The treatment
procedures like mastishkya, sirovasti, abhyanga, parisheka and anuvasana vasti with
specific dravyas is described.
But the contemporars and co-scholars of Agnivesa i.e. Bhela and
Hareetha have not used the word Pakshaghata. They mentioned vatavyadhi prakopa
nidana and lakshanas. Kasyapa is the only authority who mentioned pakshaghata
among the ‘Asheethi Vata Vikaras’. Other information is not seen regarding the
disease but vata prakopa nidanas etc. are described.
SANGRAHA KALA :
Vagbhata mentioned the samprapti of Susruta and the chikitsa of
Charaka Samhita.
Shamana Chitisa : formulae are newly added in :-
Chakradatta (11th Century)
Sarangadhara samhita (13th century)
Basava Rajeeyam (15th century)
Vaidya chintamani (16th century)
Bhava prakasha (16th century)
Yoga Ratnakaram (17th century)
Bahishajya Ratnavali (18th century)
The contribution of Madhavakara is the parakopa lakshanas of vata
in association with pitta and kapha. In this way he explained the “Samsarga doshas”
given by Susrutha while explaining the sadhyasadhyata of pakshaghata.
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The sources of information are mainly Charaka Samhita, Susruta
Samhita and its commentaries – Nibandha snagraha, Nyaya Chandrika, Madhava
nidana and its madhukosa commentary.
Based on the information available in different snagraha granthas, it
can be stated that there is gradual development in chikitsa.
History of Pakshaghataa in Allopathic system of medicine :
The word “stroke’ is synonym to pakshaghata. Stroke indicates
cerebrovascular disease which came into existence in 19th century. Till then the
word “Apoplexy” is used.
Hippocrates : He used the term “Apoplexy” and described the features of sudden
loss of consciousness.
Galen (130 – 200 A.D.) : he concluded that apoplexy involved brain matter. It was
he who first proved that arteries contain and carry blood. He was the first to describe
the cranial nerves and the sympathetic system. He made the first experimental
bisection of the spinal cord and proved that it caused paraplegia.
Gabriel Falopius (1523 – 1562 A.D.) : He was the first to describe the trigeminal,
auditory and glossopharyngeal nerves.
Romberg M.M. (1795 – 1873) observed paralysis of the body in the opposite side of
the hemispheric lesion
Virchow R.L.K (1821 – 1902 A.D.) : Proposed the concept of ‘thrombosis’ and
‘embolism’, which lead to infarction.
J.M.Charcot (1825 – 1893 A.D.) : He acquainted with the ankle clonus.
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The world Health Organization has introduced a clinical and research
classification of stroke which is as follows:
1. Transient Cerebral ischemic attack
2. Completed stroke
3. Minor stroke
4. Major stroke
5. Progressing stroke or stroke in evolution.
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SHAREERA
INTRODUCTION
The Importance of Vata is explicit by the fact that charaka
has allotted one seperate chapter (Chraka Sutra 12) for discussion on this dosha.
A few references from the Ayurvedic classes will indicate the
vata is the most important and powerful of the three doshas.
So long as vata lasts in the body as long as thus life exists.
Bhe.sam. su.16.2
It is indicative of the continuity of the life.
Vata is powerful and important because of:
Its control over the functions of the body its capacity to spread
throughout the body.
There it is capable of swift action
Powerful and
Capable to Vitiate other factors.
Independent movements and
Its vitation causes a large number of diseases.
The term ‘VATA’ is derived from the root ‘VAA GATHI
GANDHANA YOH1’ means to move, to enthuse, to make known, to
become aware of, induction, effort and to enlighten.Co-incidence of all these
factors is called ‘VATA’.
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According to Vyakarana shastra the dhatu which gives the ‘GATI’
and jaanartha bodhana is called vata2.
GATHI – To move
GANDHANA- To make known, to enthuse
VAA GATHI – presence of movement, knowledge and enthusiasm.
The movements in the body are manifested by the action of all the muscles,
i.e., the motor functions of the cognitive organs; i.e. the sensory functions.
Therefore for a humour or a factor which is capable of conducting both
motor and sensory functions is called vata.
Vata is the combination of AKAASHA MAHA BHUTA and VAYU
MAHABHUTA.
The properties of Akaasha bhuta are Shabda, sense of hearing
(Sravanendriya – KARANA), porosity, power of differentiation. According
to Dalhana VIVIKTATHA means individualization of srothases also; and
the properties of Vayu bhuta are Sparsha, sparshanendriya (the sense of
perception – TWACHA). All functional activities of organism, and all
vibrations (spandana) and lightness.
Vata will have both the properties as it is the combination of akaasa
and vayu mahabhutas with the predominance of vayu mahabhuta.
Moolam shareeram is dosha dhatu and malas. We find elaborate
description about them in Ayurveda3. They are,
1) DOSHAS : VATA, PITTA AND KAPHA
2) DHATUS : RASA, RAKTA, MAMSA, MEDAS, ASTHI &
SHUKRA.
3) MALA : SWEDA, MOOTRA AND PUREESHA.
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Doshas in normal state also said as dhatus in which condition they
bear the body. ‘DOSHA’ means the factor which is capable of vitiating certain other
factors or (tissues) dushyas of the body is known as DOSHA. Since tridoshas are
capable of getting vitiated due to the respective causes and modify and disturb the
physiological functions of the doshas to initiate the process of onset of disease. They
are known as Doshas. In chetana shareera above three doshas are there .
Vata, Pitta and Kapha pervade the whole body, but special seats in
the normal state are lower, middle and upper portion of the body respectively4. Thus
as three pillars can support and maintain the building, these three doshas support
and maintain the body. That’s why they are called as “TRISTHUNA” or three
pillars5.
Doshas in our body are of two varieties, namely sukshma and sthoola
doshas. Vata is sukshma dosha; by its performance only we will infer its existence.
It shows vata is invisible6 and this is produced in kostha itself7.
Tridoshas in their state of equilibrium working as complementary to
each other perform and control all physiological processes of the body and mind
maintaining the health, therefore these three doshas are also known as “Tridhatus”.
The word dhatu is defined as a factor which supports the body, here with reference
to the Tridhatus, the physiological processesof the body. In Rigveda we will find
‘Tridhatus’. Shayana the commentrator of Vedas explains the term ‘Tridhatu’ as a
synonym of vata, pitta and Kapha8.
SWAROOPA:
Vata is termed as Bhagavan. Because as it is Swayambhu, Swatantra
and Nitya. Some people worship it as God, due to its presence in Pranis as Prana
swaroopa, the complete human machinery is controlled by Vata, because it is
‘TANTRA YANTRA DHARA’9, means the upholder of both structures and the
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functions of the body, the Vata maintains this machinery and keeps it in good order
as it is swayambhu performs the srushti karya but it never is visible, that’s why Vata
swaroopa is not visible but it’s actions and functions only are experienced by the
sensory organs10.
The Roukshya, Shaitya, Laghava, Vaishadya, Gati, Amoortatva and
Anavasthitha are all swaroopas described by Acharyas in Ayurvedic treatises11.
GUNAS:
According to Charaka Vata is Anavasthita, Asanghata and
Amoortatva (incorporeal). This word has been explained by Chakrapani as
Adrishyata i.e. invisibility and Rooksha (dryness), Laghu (lightness), Daruna, Khara
(roughness), Vishada (clearness) and Sookshma (penetrative) and Chalatva
(mobility)12. Chakrapani the commentator interprets Daruna as Chalatva but
according to others darunatva is ‘Kathinaya’ meaning the vata can make a substance
hard by drying it up. Which means to be a better interpretation. The sookshmatva
quality is the capacity to penetrate through the smallest orifices of the body. 13 The
Chalatva or mobility has been qualified to be very swift.14
Susrutha said it is also Asukari, Neta or commander of dosha. Roga
samrat or emperor of diseases and will have Achintya veerya.
Therefore the earlier stated qualities of vata appeared to be based on
inferential reasoning. Both Shareera vata and loka vayu are invisible. Therefore the
description of the physical attributor of these two can only be used on Anumana
Pramana which is relied on the facts of observation the presence of both can be
recognized by the functions they perform.
Another important observation for the inference of the qualities of
vata is related to the influence of AHARA, OUSHADHA and VIHARA. The
constant use of the Abharaoushadhas possessing the Rookshadi guans is associated
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with the abnormal states of functioning of vata and the use of Aharaoushadhas
possessing opposite gunas like snigdhadis is associated with the alleviation of the
signs and symptoms of the vitiated vata and restoration to its normal states of
functioning these observation leads to conclusion that the qualities of the shareera
vata must comprise of the former group of qualities viz. Rookshadi gunas, the main
principle on which this conclusion is based is the application of the postulate
‘Samanya’ is the cause of an increase in all things at all times.15
It also stated that Vata is ‘YOGAVAHI’ that is a medium which
when associated with other substances projects their qualities also without losing its
own qualities when vata induces the other pitta, kapha doshas into activity. It
identifies itself with the; when associated with pitta produces a feeling of Ushna,
Daha and Daha and when with Kapha produces a feeling of Sheeta.16
Susrutha states thata vata will have Rooksha, Sheeta, Laghu, Khara.
Has movement in all directions is possessed of the two qualities of Shabda, Sparsha
and has the Rajo guna in predominant degree.17
SITES OF VATA:
Vata, Pitta and Kapha pervade the whole body, their general seats
being the lower, middle and upper portions of the body respectively. But particular
parts of the body where the normal doshas are generally located are mentioned
below.
According to Charaka the seats of vata are Vasthi, Pureeshadhanam,
Kati, Uru, Pada, Asthi and Pakwashaya. The Pureeshadhana has been interpreted by
Chakrapani as Pakwashaya but Pureeshadhanam, should be taken as that portion of
the intestines where it is located the Pureeshadhara Kala of these, the Pakwasaya is
the special seat of the Vata.18
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In addition, locations of vata as stated by Vagbhata are the ears and
skin.19 It is a fact that the perception by those two sensory organs is mediated
through changes in the air.20
GENERAL FUNCTIONS OF VATA:
Functions related to Emotions and Mind:
1. Utsaha
2. Harsha
3. Control of the mind from indulging in undesirable
arthas and Direct it towards desireable arthas.
Vata capable of actually shutting down the pathways
connecting the Manas with undesirable Arthas and open up the pathways towards
desirables.
I. Motor Functions:
1. Activity of Skeletal muscles.
2. Action of Involuntary muscles like Heart, Intestines,
muscle fibres present in blood vessels and also respiratory
muscles (both voluntary and involuntary).
3. Secretory functions.
II. Sensory Functions:
1. Vata Stimulatory all sensations.
2. The information about the Artha from sense organ is
carried to the Mangas and Buddhi (Cortical centers) for
Nischyatmkajnana.
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The receptive impression of the Artha on the sense organ is
transformed in to the nerve impulse in the organ and carried through the
Samjnavaha srotas via the Manas to Indriya Buddhi ( Respective Cortical centers) .
III. Integration of Motor and sensory Functions:
The “Tantra – Yantra Dharah’ Function of vata signifies this
integration. This function incorporates the maintenance of equilibrium of the body
and also the kinesthetic sense (perception of One’s own body parts, weight and
movement). This integration of gate and gandhana is executed in the Manas which
is ubhayatmaka, to make the movements co-ordinated and purposeful. Therefore an
emphasis is given on relation of vata with the srota and spanyanandnya.
IV. Biochemical Functions:
Even though the chemical relations in the body are conducted by the
respective pitas the planning is managed by vata.
1. Dhatuvyuhakana sign thesis of the dhatus from the nutrients present
in the Rejadhatu / Ahevarafa in to definite structures according to the
plan of requirement of the body.
2. Regulation of the functions of the dhatas.
V. Division and Differentiation of the Cells:
1. Vata is the main force for the union and division of the Para manus.
“Samyoga Vilshaga Paramanunam karanam vayuh” Here the
“paramanus “are to be understood as cells (or) Jeevapanamanus.
2. Development of the Garbhakfi is through the differentiation of cells
during the development according to the requisite specialized
functions.
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3. The first four of the above stated functions are related to the
Mastishka and Vatavaha Srotasas (CNS) and the last two to the
genetic material, affected by the stimulation by vata present in each
cell.
TYPES OF VATA:
Vata has been classified into five types according to sites and
functions viz. Prana, udana, Samana and Apana.21In Vedic treatises aiso we will
find five types of vata, NAGA, KURMA, KRUKARA, DEVA DATTA
ANDDHANUNJAYA VATAS.22
Charaka has given complete description of five types of vata and left
other two doshas. In tridoshas only vata is swatantra as other two are dependents of
it.23
PRANA VATA:
Shiras is stated to be the seat of Prana vata by Charaka and Vagbhata.24, and this is stated to be the transverse in the region of the oral cavity, ears, neck
and chest for the proper control and the discharge of its functions.
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INVESTIGATION:
Radiological: Biochemistry: a) CBP: Others
CT Scan brain b) CUE: Carotid Doppler
MRI – BRAIN c) Lipid Profile 2D ECHO
d) Renal Profile:
Serum creatinine
Blood urea
e) FBS:
RBS:
PLBS:
Urilne sugar:
NIDANA PANCHAKA:
Nidana :
Poorva Rupas :
Rupas :
Upashaya / Anupashaya :
VYADHI VINISCHAYA:
Vyadhibala – Balavattara / Madhyama / Alpabal
RESPONSE TO THE TREATMENT:
Duration Changes Observed Remarks
After 20 days
After 40 days
After 60 days
Response Observed After 30 Days of Treatment – Pravara / Madhyama / Avara
Signature of the Co-guide
Signature of the Guide Signature of the patient
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A CLINICAL STUDY OF THE EFFECT OF VATA RAKSHASA RAS WITHBHRINGADI TAILA NASYA IN THE MANAGEMENT OF
PAKSHAGHATA
ByDr. G. RANGA NADH
B.A.M.S
GuideDr. V.VIJAYA BABU
M.D (Ayu)
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INTRODUCTIONINTRODUCTION
AyurvedaAyurveda is a science of life. AYUis a science of life. AYU –– LIFE, VEDALIFE, VEDA –– SCIENCE, covering theSCIENCE, covering theinterrelation of body. It is said that this science is a part ofinterrelation of body. It is said that this science is a part of Vedas mainlyVedas mainlyAtharvanaAtharvana vedaveda. In ancient India it developed and advanced and was divided int. In ancient India it developed and advanced and was divided intoo8 main branches i.e. (1)8 main branches i.e. (1) KayaKaya chikitsachikitsa, (2), (2) SalakyaSalakya, (3), (3) SalyaSalya (4)(4) VishaVisha ChikitsaChikitsa,,(5)(5) BhutaBhuta vidyavidya, (6), (6) KowmaraKowmara bhrityabhritya, (7), (7) RasayanaRasayana chikitsachikitsa and (8)and (8) VajeekaranaVajeekaranachikitsachikitsa..
Out of theseOut of these AshtangasAshtangas KayaKaya chikitsachikitsa occupies prominent place inoccupies prominent place in AyurvedaAyurveda.. KayaKayachikitssachikitssa deals with numerous internal diseases.deals with numerous internal diseases. VatajaVataja vikarasvikaras outnumber otheroutnumber otherdoshicdoshic vikarasvikaras.. PakshaghataPakshaghata is one suchis one such VatajaVataja nanatmajananatmaja vyadhivyadhi, where in, where inAyurvedicAyurvedic line of treatment gives encouraging results.line of treatment gives encouraging results. RasoushadhasRasoushadhas will givewill givemore encouraging results, because no need ofmore encouraging results, because no need of panchakarmaspanchakarmas ((shodhanashodhana). It was). It wasfast acting therapy and has been found effective in smaller dosefast acting therapy and has been found effective in smaller doses. It is said to bes. It is said to bemore ofmore of RasayanaRasayana in nature, which in practice preventsin nature, which in practice prevents JaraJara (old age or the ageing(old age or the ageingprocess) andprocess) and vyadhisvyadhis (disease), rejuvenates body and prolongs life span.(disease), rejuvenates body and prolongs life span.
We know that 50% of Indian population is above the age group ofWe know that 50% of Indian population is above the age group of 50 years and50 years andone out of 10 suffer fromone out of 10 suffer from vatavata vikarasvikaras and a majority of them suffer fromand a majority of them suffer fromPakshaghataPakshaghata The incidence ofThe incidence of pakshaghatapakshaghata is alarming. It occurs mostly as ais alarming. It occurs mostly as acomplication of Diabetes mellitus and Hypertension. If a study ocomplication of Diabetes mellitus and Hypertension. If a study onn RasoushadhisRasoushadhislikelike VatarakshasaVatarakshasa RasRas is made, which is said to be useful, it will be more helpful inis made, which is said to be useful, it will be more helpful inthe present day.the present day.
Along withAlong with vatarakshasavatarakshasa rasras BhringadiBhringadi tailataila nasyanasya is taken for the Treatment.is taken for the Treatment.
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HISTORICAL ASPECTHISTORICAL ASPECT
ItihasaItihasa is an essential aspectis an essential aspect otot know about the diseases, drugs, the modeknow about the diseases, drugs, the modeof treatment and the life style of the people starting from theof treatment and the life style of the people starting from the prevedicprevedic period.period.
VEDAKALA:VEDAKALA:
AtharvanaAtharvana veda(4.13.4) is considered as the main source ofveda(4.13.4) is considered as the main source of AyurvedicAyurvedic knowledgeknowledgeamong the four Vedas the four Vedas but the first and the fore mamong the four Vedas the four Vedas but the first and the fore mostost vedaveda i.e.i.e.Rigveda(8.20.23Rigveda(8.20.23--26) also contributed much for26) also contributed much for AyurvedicAyurvedic therapeutics.therapeutics.
SAMHITA KALA:SAMHITA KALA:
AtreyaAtreya SamhitaSamhita :: called ascalled as CharakaCharaka samhitasamhita, the first, the first samhitasamhita granthagrantha explainsexplainsthethe nidananidana,, sampraptisamprapti,, chikitsachikitsa andand sadhyaaasadhyatasadhyaaasadhyata ofof pakshaghatapakshaghata. The other. The othersynonyms used in this aresynonyms used in this are pakshagrahapakshagraha andand pakshavadhapakshavadha..
SusrutaSusruta SamhitaSamhita:: Mentioned the detailed description of theMentioned the detailed description of the sampraptisamprapti, types,, types,sadhyaasadhyatasadhyaasadhyata,, chikitsachikitsa and the duration ofand the duration of chikitsachikitsa. The treatment procedures. The treatment procedureslikelike mastishkyamastishkya,, sirovastisirovasti,, abhyangaabhyanga,, parishekaparisheka andand anuvasanaanuvasana vastivasti with specificwith specificdravyasdravyas is described.is described.
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SANGRAHA KALASANGRAHA KALA::
VagbhataVagbhata mentioned thementioned the sampraptisamprapti ofof SusrutaSusruta and theand the chikitsachikitsa ofof CharakaCharaka SamhitaSamhita..
ShamanaShamana ChitisaChitisa:: formulae are newly added in :formulae are newly added in :--
History ofHistory of PakshaghataPakshaghata in Allopathic system of medicinein Allopathic system of medicine ::
The wordThe word ““strokestroke’’ is synonym tois synonym to pakshaghatapakshaghata. Stroke indicates. Stroke indicates cerebrovascularcerebrovascular diseasediseasewhich came into existence in 19th century. Till then the wordwhich came into existence in 19th century. Till then the word ““ApoplexyApoplexy”” is used.is used.
Hippocrates :Hippocrates : He used the termHe used the term ““ApoplexyApoplexy”” and described the features of sudden loss ofand described the features of sudden loss ofconsciousness.consciousness.
The world Health Organization has introduced a clinical and reseThe world Health Organization has introduced a clinical and research classification of strokearch classification of strokewhich is as follows:which is as follows:
Transient Cerebral ischemic attackTransient Cerebral ischemic attack Completed strokeCompleted stroke Minor strokeMinor stroke Major strokeMajor stroke Progressing stroke or stroke in evolution.Progressing stroke or stroke in evolution.
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SHARRERASHARRERA
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The Importance ofThe Importance of VataVata is explicit by the fact thatis explicit by the fact that charakacharaka has allotted onehas allotted one seperateseperatechapter (chapter (ChrakaChraka Sutra 12) for discussion on thisSutra 12) for discussion on this doshadosha..
A few references from theA few references from the AyurvedicAyurvedic classes will indicate theclasses will indicate the vatavata is the mostis the mostimportant and powerful of the threeimportant and powerful of the three doshasdoshas..
So long asSo long as vatavata lasts in the body as long as thus life exists.lasts in the body as long as thus life exists.Bhe.samBhe.sam. su.16.2. su.16.2
It is indicative of the continuity of the life.It is indicative of the continuity of the life. VataVata is powerful and important because of:is powerful and important because of:
Its control over the functions of the body its capacity to spreaIts control over the functions of the body its capacity to spread throughout the body.d throughout the body.
There it is capable of swift action Powerful and Capable to VitiThere it is capable of swift action Powerful and Capable to Vitiate other factors.ate other factors.Independent movements and ItsIndependent movements and Its vitationvitation causes a large number of diseases.causes a large number of diseases.
The termThe term ‘‘VATAVATA’’ is derived from the rootis derived from the root ‘‘VAA GATHI GANDHANA YOHVAA GATHI GANDHANA YOH’’ means tomeans tomove, to enthuse, to make known, to become aware of, induction,move, to enthuse, to make known, to become aware of, induction, effort and toeffort and to enlighten.Coenlighten.Co--incidence of all these factors is calledincidence of all these factors is called ‘‘VATAVATA’’..
According toAccording to VyakaranaVyakarana shastrashastra thethe dhatudhatu which gives thewhich gives the ‘‘GATIGATI’’ andand jaanarthajaanartha bodhanabodhana isiscalledcalled vatavata..GATHIGATHI –– To moveTo moveGANDHANAGANDHANA –– To make known, to enthuseTo make known, to enthuseVAA GATHIVAA GATHI –– presence of movement, knowledge and enthusiasm. The movements ipresence of movement, knowledge and enthusiasm. The movements in then thebody are manifested by the action of all the muscles, i.e., thebody are manifested by the action of all the muscles, i.e., the motor functions of the cognitivemotor functions of the cognitiveorgans; i.e. the sensory functions. Therefore for aorgans; i.e. the sensory functions. Therefore for a humourhumour or a factor which is capable ofor a factor which is capable ofconducting both motor and sensory functions is calledconducting both motor and sensory functions is called vatavata..
VataVata is the combination of AKAASHA MAHA BHUTA and VAYU MAHABHUTA.is the combination of AKAASHA MAHA BHUTA and VAYU MAHABHUTA.
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GENERAL FUNCTIONS OF VATA:GENERAL FUNCTIONS OF VATA:
Functions related to Emotions and Mind:Functions related to Emotions and Mind:
1.1. UtsahaUtsaha2.2. HarshaHarsha3. Control of the mind from indulging in undesirable3. Control of the mind from indulging in undesirable arthasarthas and Direct it towardsand Direct it towards
desireabledesireable arthasarthas..
VataVata capable of actually shutting down the pathways connecting thecapable of actually shutting down the pathways connecting the ManasManas withwithundesirableundesirable ArthasArthas and open up the pathways towards desirables.and open up the pathways towards desirables.
I.I. Motor Functions:Motor Functions:
1. Activity of Skeletal muscles.1. Activity of Skeletal muscles.2. Action of Involuntary muscles like Heart, Intestines, mus2. Action of Involuntary muscles like Heart, Intestines, musclecle fibresfibres present in bloodpresent in blood
vessels and also respiratory muscles (both voluntvessels and also respiratory muscles (both voluntary and involuntary).ary and involuntary).3.3. SecretorySecretory functions.functions.
II.II. Sensory Functions:Sensory Functions:
1.1. VataVata Stimulatory all sensations.Stimulatory all sensations.2. The information about the2. The information about the ArthaArtha from sense organ is carried to thefrom sense organ is carried to the MangasMangas andand
BuddhiBuddhi (Cortical centers) for(Cortical centers) for NischyatmkajnanaNischyatmkajnana..
The receptive impression of theThe receptive impression of the ArthaArtha on the sense organ is transformed in to the nerveon the sense organ is transformed in to the nerveimpulse in the organ and carried through theimpulse in the organ and carried through the SamjnavahaSamjnavaha srotassrotas via thevia the ManasManas toto IndriyaIndriyaBuddhiBuddhi (Respective Cortical centers) .(Respective Cortical centers) .
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III.III. Integration of Motor and sensory Functions:Integration of Motor and sensory Functions:
TheThe ““TantraTantra –– YantraYantra DharahDharah’’ Function ofFunction of vatavata signifies this integration. This functionsignifies this integration. This functionincorporates the maintenance of equilibrium of the body and alsoincorporates the maintenance of equilibrium of the body and also the kinesthetic sensethe kinesthetic sense(perception of One(perception of One’’s own body parts, weight and movement). This integration of gates own body parts, weight and movement). This integration of gate andandgandhanagandhana is executed in theis executed in the ManasManas which iswhich is ubhayatmakaubhayatmaka, to make the movements co, to make the movements co--ordinatedordinated and purposeful. Therefore an emphasis is given on relation ofand purposeful. Therefore an emphasis is given on relation of vatavata with thewith the srotasrota andandspanyanandnyaspanyanandnya..
Even though the chemical relations in the body are conducted byEven though the chemical relations in the body are conducted by the respective pitas thethe respective pitas theplanning is managed byplanning is managed by vatavata..
1.1. DhatuvyuhakaraDhatuvyuhakara sign thesis of thesign thesis of the dhatusdhatus from the nutrients present in thefrom the nutrients present in theRasadhatu/AhararasaRasadhatu/Ahararasa in to definite structures according to the plan of requirementin to definite structures according to the plan of requirementof the body.of the body.
2. Regulation of the functions of the2. Regulation of the functions of the dhatusdhatus..
V.V. Division and Differentiation of the Cells:Division and Differentiation of the Cells:
1.1. VataVata is the main force for the union and division of the Para manus.is the main force for the union and division of the Para manus. ““SamyogaSamyoga VilshagaVilshagaParamanunamParamanunam karanamkaranam vayuhvayuh”” Here theHere the ““paramanusparamanus ““are to be understood as cells (or)are to be understood as cells (or)JeevapanamanusJeevapanamanus..
2.2. Development of theDevelopment of the GarbhakrutiGarbhakruti is through the differentiation of cells during theis through the differentiation of cells during thedevelopment according to the requisite specialized functions.development according to the requisite specialized functions.
3.3. The first four of the above stated functions are related to theThe first four of the above stated functions are related to the MastishkaMastishka andand VatavahaVatavahaSrotasasSrotasas (CNS) and the last two to the genetic material, affected by the(CNS) and the last two to the genetic material, affected by the stimulation bystimulation by vatavatapresent in each cell.present in each cell.
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ShariravataShariravata and Nerveand NervePhenomenon:Phenomenon:
It has often been asked ifIt has often been asked if vatavata asasindeed theindeed the tridoshastridoshas can becan bequantitatively determined andquantitatively determined andexperimentally demonstrated theexperimentally demonstrated theavailable descriptions ofavailable descriptions of tridoshastridoshasmentioned in the books are essentiallymentioned in the books are essentiallyqualitative and functional.qualitative and functional. ThilsThils isisparticularly so in the case ofparticularly so in the case of vatavata. It. Itmay however;may however; vatavata that is very closelythat is very closelyresembles that of the nerve impulse,resembles that of the nerve impulse,which has been described as a selfwhich has been described as a self ––prorogated disturbance in the nerveprorogated disturbance in the nervefibrefibre. In other words, the energy for. In other words, the energy forthe transmission of the impulse isthe transmission of the impulse isstated to be derived from the nervestated to be derived from the nervefibrefibre over which it passes.over which it passes.
The Similarities between theThe Similarities between thePhenomenon ofPhenomenon of vatavata and nerveand nerveimpulse can be noticed from theimpulse can be noticed from thefollowing table.following table.
7.Motor and sensory7.Motor and sensoryfunctions.functions.
7.Functions of7.Functions of gatigati andandgandhanagandhana
6.Obstruction in its6.Obstruction in itsmovement leads tomovement leads toPathalogicalPathalogical condition.condition.
6.6. AvyahatagataAvyahatagata
5. Moves in a nerve5. Moves in a nerve fibrefibresome times at a velocitysome times at a velocityof 100of 100 mtsmts / second/ second
4. Pass through a nerve4. Pass through a nervefibrefibre of even of oneof even of onemicron in diametermicron in diameter
4.Sukshma capable of4.Sukshma capable ofpassing through smallpassing through smallchannelschannels
3.Self originated in the3.Self originated in theneurons of cells and selfneurons of cells and selfpropagated in nervepropagated in nerve fibrefibre
3.Swamyambhu self3.Swamyambhu selforiginate and selforiginate and selfpropagatedpropagated
2. It is conducted in one2. It is conducted in onedirection from thedirection from theneuron through axon toneuron through axon toits termination.its termination.
2.Anavasthita/Chalaswabha2.Anavasthita/ChalaswabhaIt is mobileIt is mobile
1. Invisible not perceived1. Invisible not perceivedby Sense organs.by Sense organs.
1.1. AmurtaAmurta –– invisible noinvisible nocorporeal form . It iscorporeal form . It isenergyenergy
NERVE IMPULSENERVE IMPULSEVATAVATA
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The nervous system is the bodyThe nervous system is the body’’s control centre and communicationss control centre and communicationsnet work. In human being the nervous system serves three broad fnet work. In human being the nervous system serves three broad functions.unctions.First it senses changes within the body and in the outside envirFirst it senses changes within the body and in the outside environment,onment,second it interprets the changes, third it responds to the intersecond it interprets the changes, third it responds to the interpretation bypretation byinitiating action in the form of a muscular contractions or glaninitiating action in the form of a muscular contractions or glandular secretions.dular secretions.
Through sensation, integration and response, the nervous systemThrough sensation, integration and response, the nervous systemrepresents the bodyrepresents the body’’s most rapid means of maintaining homeostasis.s most rapid means of maintaining homeostasis.
ORGANISATION:ORGANISATION: The nervous system may been divided into two principalThe nervous system may been divided into two principaldivisions. The Central Nervous System (C.N.S) and the Peripheraldivisions. The Central Nervous System (C.N.S) and the Peripheral NervouaNervouaSystem (P.N.S) and several subdivisions.System (P.N.S) and several subdivisions.
HISTOLOGY:HISTOLOGY: Despite the organizational complexity of the nervous system itDespite the organizational complexity of the nervous system itconsists of only two principal kinds of cells NEURONS & NEUROGLIconsists of only two principal kinds of cells NEURONS & NEUROGLIA.A.
NEUROGLIA:NEUROGLIA: The cells of the nervous system that perform the functions ofThe cells of the nervous system that perform the functions ofsupport and protection are calledsupport and protection are called neuroglianeuroglia ((NeuroNeuro = Nerve,= Nerve, GliaGlia = Glue) or= Glue) orglialglial cells. About 50% of the all brain cells arecells. About 50% of the all brain cells are neuroglialneuroglial cells. See table No.1cells. See table No.1for description and functions offor description and functions of neuroglianeuroglia of central nervous system.of central nervous system.
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NEUROGLIA OF CENTRAL NERVOUS SYSTEMNEUROGLIA OF CENTRAL NERVOUS SYSTEM
TYPETYPE DESCRIPTIONDESCRIPTION FUNCTIONFUNCTION
AstrocytesAstrocytes Star shaped cells with numerousStar shaped cells with numerousprocesses. Protoprocesses. Proto plasmicplasmic astrocytesastrocytes arearefound in the gray matter of the C.N.S.found in the gray matter of the C.N.S.and fibrousand fibrous astrocytesastrocytes are found in theare found in thewhite matter of the C.N.Swhite matter of the C.N.S
Twine around nerve cells to formTwine around nerve cells to formsupporting net work in brain, andsupporting net work in brain, andspinal cord, attach neurons to theirspinal cord, attach neurons to theirblood vessels.blood vessels.
OligoOligo dendroytesdendroytes ResembleResemble astrocytesastrocytes in some way butin some way butprocesses are fewer and shorterprocesses are fewer and shorter
Give support by forming semi rigidGive support by forming semi rigidconnective tissue rows betweenconnective tissue rows betweenneurons in brain and spinal cord;neurons in brain and spinal cord;produce a myelin sheath around axonsproduce a myelin sheath around axonsof neurons on central nervous system.of neurons on central nervous system.
MicrogliaMicroglia Small cells with few processes, derivedSmall cells with few processes, derivedfromfrom monocytesmonocytes; normally; normally stationaystationay jbutjbutmay migrate to site of injury; also calledmay migrate to site of injury; also calledbrain macro phages.brain macro phages.
Engulf and destroy microbes andEngulf and destroy microbes andcellular debris; may migrate to areacellular debris; may migrate to areaof injured nervous tissue and functionof injured nervous tissue and functionas small macrophages.as small macrophages.
EpendymaEpendyma Epithelial cells arranged in single layerEpithelial cells arranged in single layerand ranging in shape fromand ranging in shape from squamussquamus totocolumnar; many are ciliated.columnar; many are ciliated.
Form a continuous epithelial liningForm a continuous epithelial liningfor the ventricles of the brain (spacesfor the ventricles of the brain (spacesthat form and circulatethat form and circulate cerebrocerebro spinalspinalfluid) and the central canal of thefluid) and the central canal of thespinal cord.spinal cord.
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FUNCTIONS OF THE NERVOUS SYSTEMFUNCTIONS OF THE NERVOUS SYSTEM
The nervous system carries out a complexThe nervous system carries out a complex araara of tasks such as sensing various smells,of tasks such as sensing various smells,producing speech, remembering signals that control bodyproducing speech, remembering signals that control body –– movements and regulating the operationmovements and regulating the operationof internal organs. These diverse activities can be grouped in tof internal organs. These diverse activities can be grouped in to three basic functions. Sensoryo three basic functions. Sensoryintegrative and motor.integrative and motor.
Sensory Function:Sensory Function:
Sensory receptors detect internal stimuli such as increase in blSensory receptors detect internal stimuli such as increase in blood acidity and external stimuli landingood acidity and external stimuli landingon your arm. The nervous that carry sensory information from spion your arm. The nervous that carry sensory information from spinal and cranial nerves in to thenal and cranial nerves in to thebrain and spinal card or from a lower to higher level in the spibrain and spinal card or from a lower to higher level in the spinal card and brain are sensory (or0nal card and brain are sensory (or0afferent nervous.afferent nervous.
Integrative Function:Integrative Function:
The Nervous system integrates (process), sensory information byThe Nervous system integrates (process), sensory information by analyzing and storing someanalyzing and storing someof it and by making decisions for appropriate response. Many ofof it and by making decisions for appropriate response. Many of the neurons that participate inthe neurons that participate inintegration are interring neurons, who axons extend only for a sintegration are interring neurons, who axons extend only for a short distance and contact near byhort distance and contact near byneurons in the brain spinal cord or ganglion. Inter neurons compneurons in the brain spinal cord or ganglion. Inter neurons comprise the vast variety of neurons inrise the vast variety of neurons inthe brain.the brain.
Motor Function:Motor Function:
The nervous systemThe nervous system’’s motor function involves responding to integration decisions. Ts motor function involves responding to integration decisions. Theheneurons that serve this function are motor or different neurons.neurons that serve this function are motor or different neurons. Motor neurons carry information fromMotor neurons carry information fromto brain towards the spinal card (or) out of the brain and spinato brain towards the spinal card (or) out of the brain and spinal card in to cranial (or) spinal nerves.l card in to cranial (or) spinal nerves.The cells and organs contacted y motorThe cells and organs contacted y motor –– neurons in cranial and spinal nerves are termed effectorsneurons in cranial and spinal nerves are termed effectorsmusclemuscle –– fibers and glandular cells are examples of effectors.fibers and glandular cells are examples of effectors.
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VYADHI SAMEEKSHAVYADHI SAMEEKSHA
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DefinitionDefinition
PakshagataPakshagata comprises of two wordscomprises of two words pakshapaksha andand agathamagatham
1.1. PakshaPaksha meansmeans-- a part of bird or any thinga part of bird or any thing2.2. AgahatamAgahatam meansmeans-- injuryinjury
According toAccording to charakacharaka thethe vatavata disorder which willdisorder which will paralyseparalyse one side of the totalone side of the totalbody i.e.,body i.e., pakshampaksham is denoted asis denoted as pakshaghatapakshaghata.. AcharyaAcharya SusrutaSusruta quotatedquotated PakshavadhaPakshavadhaandand pakshaghatapakshaghata synonymously.synonymously.
However its description about clinical pictures appears to be moHowever its description about clinical pictures appears to be morere relaventrelavent intermsintermsof theof the contralateralcontralateral hemiplegiahemiplegia..
The chief complaints being complete loss of motor and sensoryThe chief complaints being complete loss of motor and sensory functions of eitherfunctions of eitherone side of the body i.e.,one side of the body i.e., HemiplegiaHemiplegia. In general terms. In general terms PakshagrahaPakshagraha,, PakshaghataPakshaghata andandPakshavadhaPakshavadha are in practice for theare in practice for the comparisioncomparision ofof hemiparesishemiparesis,, hemiplegiahemiplegia and absoluteand absoluteparalysis respectively.paralysis respectively.
From the modern perspectives it appears that the entity ofFrom the modern perspectives it appears that the entity of vatavata disorder containingdisorder containingekangaekanga vatavata,, sarwangasarwanga vatavata andand pakshaghatapakshaghata etc will come under eitheretc will come under either cerebrocerebro vascularvascularaccident (CVA) or other degenerative changes of central nervousaccident (CVA) or other degenerative changes of central nervous system. Mere loss ofsystem. Mere loss offunction of one limb, both limbs or all four limbs may occurredfunction of one limb, both limbs or all four limbs may occurred due todue to vatavata dushtidushti whichwhichcan be explained in the following terms. Loss of function of onecan be explained in the following terms. Loss of function of one limblimb monoplegiamonoplegia, loss of, loss offunction of two limbs (either upper or lower limbs) Paraplegia,function of two limbs (either upper or lower limbs) Paraplegia, all four limbs quadriplegia.all four limbs quadriplegia.Loss of function of upper andLoss of function of upper and lowelowe limbs ( either right or left) islimbs ( either right or left) is hemiplegiahemiplegia..
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Classification :Classification :
InIn madhavamadhava nidanamnidanam pakshaghatapakshaghata is classified into three groups:is classified into three groups:
When the above clinical conditions are compared with the modernWhen the above clinical conditions are compared with the modernmedicine they are upper motor neuron lesions, thalamic, hypothalmedicine they are upper motor neuron lesions, thalamic, hypothalamic lesionsamic lesionsand lower motor neuron lesions respectively.and lower motor neuron lesions respectively.
InIn AyurvedicAyurvedic system of medicine the disease aspect in general andsystem of medicine the disease aspect in general andparticularlyparticularly pakshaghatapakshaghata was mentioned under the following headings i.e.was mentioned under the following headings i.e.
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NIDANANIDANA
TheThe aetiologicalaetiological factors offactors of vatavyadhivatavyadhi in general have been described inin general have been described inCharakaCharaka,, SusrataSusrata andand VagbhataVagbhata SamhitasSamhitas, but there is no separate description, but there is no separate descriptionofof NidanicNidanic factors for thefactors for the pakshagatapakshagata..
PakshagataPakshagata is one of the varieties ofis one of the varieties of vatavata vyadhisvyadhis
AllAll NidanicNidanic factors offactors of VataVata vyadhisvyadhis can be taken ascan be taken as nidanasnidanas ofof PakshagataPakshagatahence thehence the NidanasNidanas ofof VataVata vyadhisvyadhis are discussed below.are discussed below.
Generally the termGenerally the term NidanaNidana explains the causative factors of a disease.explains the causative factors of a disease.
Therefore theTherefore the NidanasNidanas of any disease can be studied under the followingof any disease can be studied under the followingheadings:headings:
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ETIOLOGY OF EREBROVASCULAR DISEASESETIOLOGY OF EREBROVASCULAR DISEASES
The termThe term ‘‘strokestroke’’ is defined as rapidly developed clinical signs of a focal distuis defined as rapidly developed clinical signs of a focal disturbancerbanceof cerebral function of presumed vascular origin and of more thaof cerebral function of presumed vascular origin and of more than 24 hours duration.n 24 hours duration.Stroke is not a diagnosis, but a clinical syndrome with numerousStroke is not a diagnosis, but a clinical syndrome with numerous causes mainly.causes mainly.
A.A. Cerebral ischemic disease of arterial originCerebral ischemic disease of arterial origina)a) TIATIA’’S with total recovery.S with total recovery.b)b) Progressive stroke (or) stroke in evaluation.Progressive stroke (or) stroke in evaluation.c)c) Completed strokeCompleted stroke -- established cerebral infarct fromestablished cerebral infarct from
a.a. ThrombosisThrombosis b. Embolismb. EmbolismB.B. Venous infarctVenous infarctC.C. SubarachnoidSubarachnoid haemorrhagehaemorrhage..
Main risk factors for strokeMain risk factors for stroke:: HypertensionHypertension Cardiac diseaseCardiac disease –– ischemic heart diseaseischemic heart disease atrialatrial fibrillationfibrillation Transient ischemic attacksTransient ischemic attacks Cigarette smokingCigarette smoking AlcoholAlcohol
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CAUSESCAUSES::A.A. Ischemic strokeIschemic stroke
1.1.Transient Ischemic attack (Transient Ischemic attack (TIAsTIAs):):Episodes of focal neurological symptoms of less than 24 hrs duraEpisodes of focal neurological symptoms of less than 24 hrs duration occurring as ation occurring as a
result of reduced flow to a vessel from fall in perfusion pressuresult of reduced flow to a vessel from fall in perfusion pressure (e.g. Cardiacre (e.g. Cardiac arrythmiaarrythmia isisassociated with localized strokeassociated with localized stroke cerebrovascularcerebrovascular disease). (or) blockage of flow bydisease). (or) blockage of flow byembolism arising from plaques inembolism arising from plaques in aorticarchaorticarch oror extracranialextracranial vessels or from heart. If flowvessels or from heart. If flowis restored within the critical period, ischemic symptoms reversis restored within the critical period, ischemic symptoms reverse themselves, otherwisee themselves, otherwiseinfarction may occur.infarction may occur.
2.2.Developing (Progressive) Stroke:Developing (Progressive) Stroke:Sometimes paralysis progresses. Slowly comSometimes paralysis progresses. Slowly commensurate with increasingmensurate with increasing
deprivation of blood due to successive emboli (or) extension ofdeprivation of blood due to successive emboli (or) extension of thrombus further occludingthrombus further occludingthe lumen. It evolves gradually over several hours.the lumen. It evolves gradually over several hours.
3.3.Completed strokeCompleted stroke::Caused by infarction of the cerebral hemisphere is the most commCaused by infarction of the cerebral hemisphere is the most common cause of anon cause of an
acuteacute cerebrovascularcerebrovascular disease. A completed stroke reaches its peak in less than onedisease. A completed stroke reaches its peak in less than one hourhourleaving considerable residual deficit.leaving considerable residual deficit.
B.B. Venous Infarction:Venous Infarction:Thrombosis of cortical veins and / orThrombosis of cortical veins and / or duraldural sinuses is less common than centralsinuses is less common than central
arterial occlusion.arterial occlusion.
C.C. SubSub arachnoidarachnoid haemorrhagehaemorrhage::1.1. HaemorrhageHaemorrhage from intra cranial aneurysm.from intra cranial aneurysm.2.2. HaemorrhaeHaemorrhae fromfrom arterioarterio venous malformation.venous malformation.3.3. Cerebral orCerebral or cerebellarcerebellar haemorrhagehaemorrhage leading in to the ventricles of subleading in to the ventricles of sub--arachnoidarachnoid
space.space.
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Differential diagnosis of vascular causes ofDifferential diagnosis of vascular causes of HemiplegiaHemiplegia
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POORVAPOORVA -- ROOPAROOPA
TheThe LakshanasLakshanas ofof PoorvaPoorva -- rooparoopa are not mentioned specially not only forare not mentioned specially not only forPakshaghataPakshaghata but also forbut also for VataVata VyadhisVyadhis.. PoorvarupavasthaPoorvarupavastha is an investigation of a diseaseis an investigation of a diseasenext tonext to nidananidana. These. These ProdromalProdromal features occur before the beginning of the Clearfeatures occur before the beginning of the ClearManifestation of a disease.Manifestation of a disease.
TheThe UnmanifestedUnmanifested Symptoms of theSymptoms of the VataVata Disorders are known asDisorders are known as PoorvaPoorva rooparoopa((ProdromalProdromal Symptoms). When the same are manifested they represent the ownSymptoms). When the same are manifested they represent the own entity ofentity ofdisorders. So, thedisorders. So, the AlpalakshanasAlpalakshanas ofof VatavyadhessVatavyadhess are:are:
ChestaChesta -- Unwanted Works (Pain Movement)Unwanted Works (Pain Movement)15. Kara15. Kara -- CoarsenessCoarseness
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ROOPAROOPA““PradhurbhutaPradhurbhuta LakshanamLakshanam PunarlingamPunarlingam””. In the. In the RoopavasthaRoopavastha CompleteComplete
Establishment of Disease Process appears. The TotalEstablishment of Disease Process appears. The Total SymptomatologySymptomatology will be observed inwill be observed inthis stage. Thethis stage. The PakshaghataPakshaghata included inincluded in aseethiaseethi vatavata vyadhisvyadhis..
Therefore some of theTherefore some of the SamnyaSamnya LakshanasLakshanas ofof VataVata vyadhisvyadhis are also observed in mostare also observed in mostof the cases ofof the cases of PalshaghataPalshaghata, apart from the, apart from the impairementimpairement of the half of the body. The mostof the half of the body. The mostfrequently associatedfrequently associated SamanyaSamanya LakshanasLakshanas ofof VataVata VyadhisVyadhis inin PakshagataPakshagata are described asare described asfollows.follows.
SankochaSankocha –– ContracturesContractures ParwaParwa SthambhaSthambha –– Stiffness in jointsStiffness in joints AsthiAsthi BhudhaBhudha –– Tearing in bonesTearing in bones ParvaParva BhudhaBhudha –– Tearing in jointsTearing in joints PralapaPralapa –– DeleriumDelerium PanigrahamPanigraham –– StiftnessStiftness in Handsin Hands PristagrahamPristagraham –– Stiffness in BackStiffness in Back SirograhaSirograha –– Stiffness in Head.Stiffness in Head. LomaharshaLomaharsha -- HorripilationHorripilation KhanjatwaKhanjatwa –– LimpingLimping
The signs and symptoms which are manifested specially can be conThe signs and symptoms which are manifested specially can be considered assidered as rooparoopa..
1.1. ChestanrivuthiChestanrivuthi of aof a PakshaPaksha -- This may beThis may be dakshinadakshina oror VamaVama2.2. VaksthambhaVaksthambha3.3. SandhiSandhi BhandhaBhandha VimokshonaVimokshona4.4. SirasnayuSirasnayu VishoshnaVishoshna5.5. DivaDiva ratraratra ShiraShira PadaPada ArdhangaArdhanga ShoolaShoola6.6. AkarmanyaAkarmanya VichestanamVichestanam7.7. RujamRujam
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CLINICAL PICTURE OF HEMIPLEGIACLINICAL PICTURE OF HEMIPLEGIA
CLINICAL FEATURESCLINICAL FEATURES
HeadacheHeadache VariableVariable Slight or absentSlight or absent SeveareSeveare
VomintingVominting on onseton onset RareRare RareRare CommonCommon
Usually bloody pressure isUsually bloody pressure isincreased.increased.
C.T.ScanC.T.Scan Infarction may not appearInfarction may not appearfor 2 to 4 daysfor 2 to 4 days
May not appear for 2 to 4May not appear for 2 to 4daysdays
Can be confirmed with inCan be confirmed with inminutes of onset.minutes of onset.
TerminationTermination Recovery usualRecovery usual Recovery oftenRecovery often High mortalityHigh mortality
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SAMPRAPTHISAMPRAPTHITheThe SamprapthiSamprapthi of a disease explains the Process by which the alteredof a disease explains the Process by which the altered doshasdoshas reachreach
the body elements (the body elements (DushyasDushyas) and produces the anatomical and physiological variations in) and produces the anatomical and physiological variations inthe targetthe target avayavasavayavas leading to the expression as a disease.leading to the expression as a disease.
TheThe SamprapthiSamprapthi (or) Pathogenesis of(or) Pathogenesis of PakshagataPakshagata under theunder the vatavyadhivatavyadhi has beenhas beendescribed in all thedescribed in all the samhitassamhitas ofof AyurvedaAyurveda. The different views explained by. The different views explained by BrihattrayeesBrihattrayeesregarding theregarding the samprapthisamprapthi ofof PakshahataPakshahata is as follows.is as follows.
According toAccording to CharakaCharaka thatha Pathogenesis orPathogenesis or SamprapthiSamprapthi ofof pakshaghatapakshaghata is asis asexplained: theexplained: the vatavata which is vitiated (or) provoked by its ownwhich is vitiated (or) provoked by its own nidanicnidanic factors leads to thefactors leads to theseizing ofseizing of dhamanisdhamanis controlling the functions of the side of the body and constrictcontrolling the functions of the side of the body and constricting theing thesirassiras afflictsafflicts dakshinadakshina oror vamavama ardhaardha bhagasbhagas of the body resulting in theof the body resulting in the impairementimpairement ofofmovements ofmovements of urdhwaurdhwa (or)(or) adhobhagaadhobhaga (or) both. It also causes loss of sensation, pain and(or) both. It also causes loss of sensation, pain andSome times loss of Speech.Some times loss of Speech.
In view ofIn view of SusruthaSusrutha the Disease in which the vitiatedthe Disease in which the vitiated vatavata affects theaffects the dhamanisdhamanis,,which spreads either in thewhich spreads either in the vamabhagavamabhaga (or) in the(or) in the dakshinabhagadakshinabhaga of the body in otherof the body in otherterms it may affect theterms it may affect the urdhwabhagaurdhwabhaga,, adhobhagaadhobhaga andand thiryakthiryak dishadisha and making them,and making them,resulting in abnormal state (or) condition known asresulting in abnormal state (or) condition known as pakshagatapakshagata, Further he stressed lax, Further he stressed laxandand vigourlessvigourless in which thein which the sandhissandhis of either side of the body become useless andof either side of the body become useless andinoperatureinoperature both in motor and sensory functions.both in motor and sensory functions.
The Views ofThe Views of BhavamisraBhavamisra inin MadhyamaMadhyama Kanda andKanda and MadhavakaraMadhavakara inin VataVata VyadhiVyadhiNidanaNidana CahptersCahpters appear to coincide with above mentioned options ofappear to coincide with above mentioned options of AcharyasAcharyas..
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AmayaAmaya –– PakshagataPakshagata {{hemiplegiahemiplegia}}UdbahavaUdbahava SthanaSthana –– MasthiskaMasthiskaSancharaSanchara –– DhamaneesDhamaneesAdhistanaAdhistana –– DhamanessDhamaness ofof MasthiskaMasthiska,, SiraSira andandSnayusSnayusVyaktiVyakti –– ArdhaArdha SareeraSareera (Half of the body)(Half of the body)SrotasSrotas–– RasavahaRasavaha,, RaktavahaRaktavaha,, ChestavahaChestavaha andandSanjnavahaSanjnavaha SrotasesSrotasesAvayavaAvayava –– hastahasta,, Pada,MukaPada,Muka,, NetraNetra andand SwaraSwaraYantraYantraDoshaDosha DustiDusti –– VataVataDushyasDushyas –– Rasa,Rasa, RaktaRakta,, mamsamamsa,, MedaMeda,, AsthiAsthi ,,MajjaMajja,,DhamaniDhamani ,,SiraSira andand SnayuSnayu..VyadhiVyadhi SwabhavaSwabhava –– AsukariAsukari in most of the cases,in most of the cases,ChirakariChirakari in some cases.in some cases.
CharakaCharaka Stated that theStated that the dhatukshayadhatukshaya andandobstruction of theobstruction of the vatavata channels due tochannels due to kaphakapha andand pittapitta is theis themain cause inmain cause in vatavata PrakopaPrakopa..
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UPADRAVAS AND ARISTA LAKSHANASUPADRAVAS AND ARISTA LAKSHANAS
There is no specific description ofThere is no specific description of upadravasupadravas ofof PakshagataPakshagata, hence the, hence the upadravasupadravas ofof VatavyadheesVatavyadheesmay be taken be taken for this context. According tomay be taken be taken for this context. According to MadhavakaraMadhavakara the following are thethe following are the upadravasupadravas ofofVatavyadhisVatavyadhis..→→ VisarpaVisarpa→→ DahaDaha→→ ShoolaShoola→→ MoorchaMoorcha→→ AruchiAruchi→→ AgnimandhyaAgnimandhya→→ BalaBala MamsaMamsa KshayaKshaya→→ ShodhaShodha→→ SparsaSparsa SunyathaSunyatha
UpadrvasUpadrvas ofof VatavyadhiVatavyadhi according toaccording to SusruthaSusrutha
1.1. BalaBala KshayaKshaya2.2. MamsaMamsa KshayaKshaya3.3. SoshaSosha4.4. TrishanaTrishana5.5. ChardiChardi6.6. JwaraJwara7.7. AtisaraAtisara8.8. SwasaSwasa9.9. MoorchaMoorcha10.10. HikkaHikka11.11. BhagnaBhagna12.12. KampaKampa13.13. AdhmanaAdhmana14.14. SramaSrama due to disease.due to disease.
The body which hasThe body which has kshayakshaya ofof balamamsabalamamsa andand pakshagatapakshagata Like diseases along with the aboveLike diseases along with the abovesaidsaid upadravasupadravas wills troubles the patient.wills troubles the patient.
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ARISTAARISTA
AristaArista LakshanaLakshana is pioneering indication of Predictable death which occur bothis pioneering indication of Predictable death which occur both in thein theailing and nonailing and non –– ailing persons.ailing persons.
This should be carefully observed by the physicians in case of tThis should be carefully observed by the physicians in case of treating the patientsreating the patientsotherwise he is giving up his credit and profit.otherwise he is giving up his credit and profit.
CharakaCharaka says that just as the blossom is thesays that just as the blossom is the harbinarharbinar of the coming fruit so is theof the coming fruit so is theexit of the symptoms known as fatal prognosis theexit of the symptoms known as fatal prognosis the herbiniranherbiniran of death of patients.of death of patients.
According toAccording to susruthasusrutha ArishtasArishtas can be divided intocan be divided into
1.1. NiyataNiyata –– can be cured withcan be cured with RasayanaRasayana,, JapaJapa etcetc2.2. AniyataAniyata -- which cannot be cured.which cannot be cured.
VagbhataVagbhata divided thedivided the arishtasarishtas in to 2 types.in to 2 types.
1.1. TheThe AsthayeeAsthayee –– which occur due to the predominance ofwhich occur due to the predominance of doshasdoshas..2.2. TheThe SthayeeSthayee AristhtesAristhtes –– Certainly kill the patientsCertainly kill the patients
According toAccording to SusrutaSusruta in a person if the following conditions arise it is said to bein a person if the following conditions arise it is said to bedefinite death of a patient.definite death of a patient.
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SADHYA SADHYATHASADHYA SADHYATHASadhyasadhyathaSadhyasadhyatha of the disease is generally depends on three factors. They areof the disease is generally depends on three factors. They are
Duration of the onset of the disease.Duration of the onset of the disease. Place of originPlace of origin SevieretySevierety ofof LakshanasLakshanas..
CharakaCharaka says thatsays that PakshagataPakshagata isis KashtasadhyaKashtasadhya (or)(or) asadhyaasadhya because it is deep seated inbecause it is deep seated inthe body.the body. CharakaCharaka also mentionedalso mentioned ““NavanNavan BalavarthastrostanBalavarthastrostan SadhayennirupadravanSadhayennirupadravan””. It. Itdenotes the good prognosis of the disease, provided the diseasedenotes the good prognosis of the disease, provided the disease is free ofis free of upadravasupadravas. The onset. The onsetof disease is recent and more over the victim is strong enough iof disease is recent and more over the victim is strong enough i.e.,.e., BalavanBalavan rogirogi..
According toAccording to SusruthaSusrutha thethe PakshaghataPakshaghata caused due tocaused due to SuddhaSuddha VataVata isis KashtaKashta SadhyaSadhya butbutif it is associated with eitherif it is associated with either KaphaKapha oror PittaPitta it can be taken asit can be taken as SadhyaSadhya andand PakshagataPakshagata developeddevelopeddue todue to DathuDathu KshyaKshya is taken asis taken as AsadhyaAsadhya..
AcharyaAcharya SusruthaSusrutha says insays in SootrasthanaSootrasthana that thethat the VatavyadhiVatavyadhi in general isin general is ““MAHA ROGAMAHA ROGA””having incurable nature and suggest that the physicians not to thaving incurable nature and suggest that the physicians not to treat when the patient is afflictsreat when the patient is afflictswith seriouswith serious upadravasupadravas..
AstangaAstanga HridyakaraHridyakara Says that theSays that the PakshaghataPakshaghata is due tois due to SuddhaSuddha VataVata JanyaJanya can becan beconsidered asconsidered as AsadhyaAsadhya and if the disease is associated withand if the disease is associated with PittaPitta oror KaphaKapha is said to beis said to be KricchraKricchraSadhyaSadhya andand PakshaghataPakshaghata due todue to DhatuDhatu KshayaKshaya isis AsadhyaAsadhya..
According toAccording to SusruthaSusrutha if theif the PakshaghataPakshaghata patient ispatient is unwareunware ofof SparsaSparsa (Sensation & loss of(Sensation & loss ofFunctions) that can be treated asFunctions) that can be treated as asadhyaasadhya. Sometimes the patient may fall in death.. Sometimes the patient may fall in death.
PakshaghataPakshaghata caused tocaused to GarbhiniGarbhini,, perpeurialperpeurial woman, children and senile objects iswoman, children and senile objects isasadhyaasadhya.. PakshaghataPakshaghata cause due tocause due to AdhikaAdhika RaktasravaRaktasrava isis AsadhyaAsadhya..
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CHIKITSA YOJANACHIKITSA YOJANA
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CHIKITSACHIKITSA
AsAs PakshagathaPakshagatha is mainly asis mainly as ““NanatmajaNanatmaja VataVata VyadhiVyadhi”” mostly themostly the samnyasamnya vatavata harahara chitiksachitiksawill be suitable to it along with the specific line of treatmentwill be suitable to it along with the specific line of treatment. Hence it will be appropriate to discuss. Hence it will be appropriate to discusssamnyasamnya vatavata harahara chikitsachikitsa (General) line of treatment for(General) line of treatment for vatavata in the beginning and then to proceed toin the beginning and then to proceed tospecific line of treatment.specific line of treatment.
1.1. Diets and Drugs:Diets and Drugs:The Diets and drugs possessingThe Diets and drugs possessing MadhuraMadhura,, AmlaAmla ,,LavanaLavana,, UshnaUshna VrishyaVrishya andand BalyaBalya propertiesproperties
be adopted. Liquid diet processed withbe adopted. Liquid diet processed with vataharavatahara drugs anddrugs and mamsayushasmamsayushas be given.be given.
2.2. SnehaSneha Karmas:Karmas:SnehasSnehas obtained from different sources which includeobtained from different sources which include ghritaghrita (ghee),(ghee), TailaTaila (oils),(oils), VasaVasa
((MusclelfatMusclelfat) and) and MajjaMajja (bone marrow) should be processed with drugs possessing(bone marrow) should be processed with drugs possessing deepanadeepana,, pachanapachana,,vataharavatahara andand virechaneeyavirechaneeya properties should be administered in different routes i.e., oraproperties should be administered in different routes i.e., orally,lly, nasyanasya,,abhyangaabhyanga andand vasthivasthi etc.etc.
3.3. SwedaSweda Karma:Karma:SwedanaSwedana karma may be adopted along withkarma may be adopted along with swedhanaswedhana,, nadinadi-- swedasweda,, prasthraprasthra swedasweda,,
sankarasankara,, pindapinda etc. are to be adopted to suit individual cases.etc. are to be adopted to suit individual cases.
4.4. SamsodhanaSamsodhana::MridhuMridhu ShodhanaShodhana Karmas particularlyKarmas particularly virechanavirechana should be adoptedshould be adopted procededproceded by appropriateby appropriate
snehasneha,, swedasswedas. The. The virechanavirechana drugs also should be mixed withdrugs also should be mixed with snehassnehas possessingpossessing ushnaushna,, madhuramadhura,,amlaamla,, lavanalavana properties,properties, virechanavirechana will causewill cause annulomanaannulomana ofof vatavata, there by relieves obstruction in the, there by relieves obstruction in thesrotosessrotoses..
5.5. External measures:External measures:unmardhanaunmardhana,, SamvahanaSamvahana, (pressing and massaging)., (pressing and massaging). PeedanaPeedana ((Pressing),ParishekaPressing),Parisheka ((affusionaffusion))
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LINE OF THE TREATMENT OF PAKSHAGHATALINE OF THE TREATMENT OF PAKSHAGHATA
The specific therapies described forThe specific therapies described for pakshagatapakshagata by variousby various acharayasacharayas are as follows.are as follows.
According toAccording to CharakaCharaka::““SwedanamSwedanam SnehaSneha SamyuktamSamyuktam PakshagatePakshagate VirecainamVirecainam””. The line of treatment is. The line of treatment is
VagbhabataVagbhabata in he stated same as that ofin he stated same as that of charakacharaka.. ““SwedanamSwedanam SnehaSneha SamyukutamSamyukutamPakshagataPakshagata VirechenemVirechenem””
Here we can see anHere we can see an eleberateeleberate description of different aspects of treatment alongdescription of different aspects of treatment alongwith the routine type of treatment likewith the routine type of treatment like snehasneha,, swedasweda,, mriduvirechavamriduvirechava.. AnuvasanaAnuvasana, as, astherefore andtherefore and sirovasthisirovasthi.. AnutailaAnutaila abhyangamabhyangam,, SalvanaswedanamSalvanaswedanam, as special treatment and, as special treatment andshould to have continue the intense treatment up to 3 to 4 monthshould to have continue the intense treatment up to 3 to 4 months.s.
DalhanaDalhana States that vomiting should be performed first it necessary. ThStates that vomiting should be performed first it necessary. Thenen virechanavirechana,,AnuvasyanaAnuvasyana vasthivasthi should beshould be given.Aftergiven.After appearance ofappearance of SnehaSneha LakshanasLakshanas as thereforeas therefore vastivastican be given. Immediate aftercan be given. Immediate after asthapanaasthapana,, anuvasanamanuvasanam should be adopted.should be adopted.
AstangaAstanga SangrahakaraSangrahakara describeddescribed PkshagataPkshagata in similar manner toin similar manner to susrutasusruta. He also. He alsoindicated the therapies ofindicated the therapies of akshepakaakshepaka inin pakshagatapakshagata..
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NASYA KARMANASYA KARMA
The administration of either medicine (drug) or medicated oil thThe administration of either medicine (drug) or medicated oil through the nose isrough the nose isknown asknown as nasyakarmanasyakarma..
NasyakarmaNasyakarma is also known asis also known as sirorechanasirorechana,, SiroSiro –– VirekaVireka andand moordhavirechanamoordhavirechana..CharakaCharaka has also used the wordhas also used the word ““NastahNastah PrachardenamPrachardenam”” for the same.for the same.
SimilarySimilary the wordsthe words ““NavanNavan”” andand ““NasthahNasthah KarmaKarma”” also are found indicating thealso are found indicating thesamesame kriyaskriyas..
Utility ofUtility of NasyaNasya Karma:Karma:TheThe NasyaNasya Karma is essentially useful in the diseases of the neck and heaKarma is essentially useful in the diseases of the neck and head. Thed. The
conditions in which theconditions in which the nasyakarmanasyakarma is contrais contra –– indicated are given below.indicated are given below.
ContraContra –– Indications:Indications: IndigestionIndigestion Person who have just taken their meals (or) anPerson who have just taken their meals (or) an oleaciousoleacious portion.portion. Those who are thirsty for waterThose who are thirsty for water Who have bathed their head.Who have bathed their head. Those who are going to take their bath.Those who are going to take their bath. Hungry.Hungry. FatiguedFatigued FaintedFainted InjuredInjured Exhausted by SexExhausted by Sex –– act, Exercise (or) drinkact, Exercise (or) drink
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The conditions in which theThe conditions in which the NasyakarmaNasyakarma is indicated:is indicated:Except in the conditions in which theExcept in the conditions in which the NasyaNasya Karma is Contra indicated in all otherKarma is Contra indicated in all other
conditions it may be administered and more so in the following:conditions it may be administered and more so in the following: SiraSira SthambaSthamba ManyaManya SthambaSthamba DantaDanta SthambaSthamba –– SoolaSoola GalagrahaGalagraha HanugrahaHanugraha PeenasaPeenasa GalasundikaGalasundika GalasalukaGalasaluka NetragataSukrarogaNetragataSukraroga TimiraTimira
NasyaNasya VidhiVidhi::The actual method ofThe actual method of NasyaNasya Karma may be divided in to 3 parts:Karma may be divided in to 3 parts:
PoorvaPoorva Karma:Karma:There should be separate room for conducting theThere should be separate room for conducting the nasyakarmanasyakarma, and it should have good and concealed, and it should have good and concealed
ventilation andventilation and impereableimpereable to smoke, dust and sunlight but good lighting should be availabto smoke, dust and sunlight but good lighting should be available.le.PradhanaPradhana Karma:Karma:
The Patient should be made to take the correct posture, and theThe Patient should be made to take the correct posture, and the nasal administration of the medicine. In thenasal administration of the medicine. In theposture the head will be in a slightly hanging position but restposture the head will be in a slightly hanging position but resting on the head rest attached to the seat or bed. So thating on the head rest attached to the seat or bed. So thatthethe naresnares are directed upwards for easy administration of the medicine. Tare directed upwards for easy administration of the medicine. The eyes and brows are covered with a cleanhe eyes and brows are covered with a cleancloth to avoid the medicine accidentally falling in the eyes.cloth to avoid the medicine accidentally falling in the eyes.
PaschatPaschat Karma:Karma:Just after the administration of the medicine. The patient shoulJust after the administration of the medicine. The patient should lay down for about 5 minutes. Thend lay down for about 5 minutes. Then tapaswedatapasweda
is done on the forehead, cheeks and throat, and light message onis done on the forehead, cheeks and throat, and light message on the neck and shoulder region and soles of the feet.the neck and shoulder region and soles of the feet.The medicine that has flown in to the throat and mucus which isThe medicine that has flown in to the throat and mucus which is seevetingseeveting should be spit out.should be spit out. GorglingGorgling with hot water iswith hot water isessential.essential.
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PATHYA APATHYAPATHYA APATHYA
““PathonaPathona ApetamApetam PathyamPathyam”” The drugs and diets which are useful toThe drugs and diets which are useful to SrotasSrotas arearecalledcalled Pathyas.ThePathyas.The PathyaPathya andand ApathyasApathyas ofof VatavyadhisVatavyadhis i.e.,i.e., PakshaghataPakshaghata are as follows:are as follows:
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DRUG REVIEWDRUG REVIEW
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VATA RAKSHASA RASVATA RAKSHASA RAS
The drugThe drug VatarakshasaVatarakshasa RasRas is indicated inis indicated in vatavata disorders along withdisorders along with PakshaghataPakshaghata ininbooks like Yogabooks like Yoga TaranginiTarangini.. VaidyaVaidya ChintaChinta ManiMani BasavaBasava RajeeyamRajeeyam..
At firstAt first RasabhasmaRasabhasma && SuddhaSuddha GandhakamGandhakam was finely grounded & mixed and all thewas finely grounded & mixed and all theremainingremaining bhasmasbhasmas andand churnaschurnas are added one by one and madeare added one by one and made bhavanabhavana andand mardhanamardhanafor 3 days withfor 3 days with PunarnavamoolaPunarnavamoola SwarasaSwarasa.. GuduchiGuduchi KashayaKashaya,, ChitramoolaChitramoola swarasaswarasa,,TulsipatraTulsipatra SwarasaSwarasa and withand with TrikatuTrikatu KashayaKashaya then dried and put inthen dried and put in SaravamSaravam andand seelseel ititmademade swangaseetaleswangaseetale take it out and paste it with water and made pills.take it out and paste it with water and made pills.
VatarakshasaVatarakshasa rasras isis vataharavatahara,, srotosodhanasrotosodhana andand deepanadeepana, along with, along with pakshaghatapakshaghata ititis indicated inis indicated in UrusthambaUrusthamba,, VatarakataVatarakata,, AmavataAmavata,, DhanurvataDhanurvata and inand in SandhivataSandhivata..
The above mentionedThe above mentioned bhasmasbhasmas are to be madeare to be made bhavanabhavana in thein the swarasswaras // quathasquathas ofofthe followingthe following dravyasdravyas, one by one for 3 days:, one by one for 3 days: PunarnavaPunarnava QuathaQuatha GuduchiGuduchi KashayaKashaya ChitramoolaChitramoola SwarasaSwarasa TulasiTulasi PatraPatra SwarasaSwarasa andand TrikatuTrikatu KashayaKashaya
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BhringadiBhringadi TailaTaila NasyaNasya
BhringadiBhringadi TailaTaila NasyaNasya is indicated inis indicated in PakshagataPakshagata along withalong with AarditaAardita VataVata inin VaidyaVaidyaChintamaniChintamani
It containsIt containsBringarajaBringarajaErrandaErrandaNirgundiNirgundiMastchyakshiMastchyakshiArkapatramArkapatramMarichaMaricha ChurnamChurnamTilaTila TailamTailam
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CLINICAL STUDYCLINICAL STUDY
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CRITERIACRITERIA
Criteria selection and admission of patientsCriteria selection and admission of patients--
Thirty patients suffering fromThirty patients suffering from pakshaghatapakshaghata are selected randomly for theare selected randomly for thepresent Study from the bulk of patients coming for the treatmentpresent Study from the bulk of patients coming for the treatment at theat theKayachikitsaKayachikitsa Department of PostDepartment of Post--graduate Training and research Centre atgraduate Training and research Centre atGovt.Govt. AyurvedicAyurvedic Hospital,Hospital, ErragaddaErragadda, Hyderabad (A.P) during 2006, Hyderabad (A.P) during 2006--2008.2008.
The patients were selected after conducting a screening test toThe patients were selected after conducting a screening test to excludeexcludethe following type of patients.the following type of patients.
1.1. Patients with CerebralPatients with Cerebral HaemorrhageHaemorrhage2.2. Patients below the age of 20 years and above the age of 70 yeaPatients below the age of 20 years and above the age of 70 years.rs.3.3. Pregnant womenPregnant women4.4. PakshaghataPakshaghata patients with dislocation of jointspatients with dislocation of joints5.5. Comatose patientsComatose patients6.6. PakshaghataPakshaghata caused due to the mechanical injury. Known causes ofcaused due to the mechanical injury. Known causes of GranthiGranthi andand
ArbudaArbuda..
These points are excluded from the present study. After excludinThese points are excluded from the present study. After excluding allg alltheses types of patients, finally 30 patients were selected to stheses types of patients, finally 30 patients were selected to study thetudy thetreatment withtreatment with vatarakshasarasvatarakshasaras andand bhringadibhringadi tailataila nasyanasya..
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PARAMETERS-Subjective and objective parameters are taken into consideration.
The clinical improvement in the relief of symptoms of like-Impaired walkingImpaired movements of upper limbsDysphagia / dysarthria (Vakgraham / Vakstambha)Loss of appetite and digestionSleeplessness (Nidra nasha)Anxiety (Krodha / soka)Objective parameters-Blood pressureTendon reflexes : Grading
3. Muscle power grading –0 – No contractions1 – Flicker or trace of contractions2 – Active movement with gravity eliminated3 - Active movement with gravity4 - Active movement with gravity and resistance5 – Normal
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MATERIALS AND METHODSMATERIALS AND METHODS
Thirty patients suffering fromThirty patients suffering from PakshaghataPakshaghata are selected randomly for the presentare selected randomly for the presentstudy. To study the treatmentstudy. To study the treatment VatarakshasaVatarakshasa RasRas and withand with BhringadiBhringadi TailaTaila Nasya.TheNasya.Thedrugs and their quantity are mentioneddrugs and their quantity are mentioned belowbelow’’.Vatarakshasaras.Vatarakshasaras 1BD for 60 days with1BD for 60 days withhot water andhot water and BhringadiBhringadi tailataila nasyanasya 8 drops in each nostril for 58 drops in each nostril for 5--7 days.7 days.
OBSERVATIONOBSERVATION
The patients are studied based on theThe patients are studied based on the DarsanaDarsana,, SparsanaSparsana, and, and PrasnaPrasna parikshasparikshas..
These includeThese include DasavidhaDasavidha ParikshaPariksha andand AstasthanaAstasthana ParikshaPariksha. Every day the. Every day thecondition of the patients is observed and the treatment procedurcondition of the patients is observed and the treatment procedure is adopted. The totale is adopted. The totalobservations of every day are summed up after twenty days of durobservations of every day are summed up after twenty days of duration of treatment.ation of treatment.
The patients are classified based on different categoriesThe patients are classified based on different categories
LingaLinga NidanaNidana LakshanaLakshana TheThe ‘‘PakshaPaksha’’ affectedaffected DoshaDosha involvementinvolvement Hypertension andHypertension and MadhumehaMadhumeha AgeAge Muscle PowerMuscle Power Tendon reflexTendon reflex
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ClasssificationClasssification of patients according to sexof patients according to sex
LINGA (SEX)LINGA (SEX) NO. OF PATIENTSNO. OF PATIENTS PERCENTAGEPERCENTAGE
MALEMALE 2222 73%73%
FEMALEFEMALE 88 27%27%
22 (73.3%)
8 (26.7%)
0
5
10
15
20
25
No
.ofp
atin
ets
(%)
Male Female
Showing Sex wise classifcation of patients
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Affected side ofAffected side of pakshaghatapakshaghata on patienton patient’’s bodys body
S.NoS.No.. AFFECTEDAFFECTEDSIDESIDE
NUMBER OF PATIENTSNUMBER OF PATIENTS
TOTAL MALE FEMALETOTAL MALE FEMALE
PERCENTAGEPERCENTAGE
11 RIGHT SIDERIGHT SIDE 15 14 115 14 1 50%50%
22 LEFT SIDELEFT SIDE 15 8 715 8 7 50%50%
14 (46.7%)
1 (3.3%)
8 (26.7%)
7 (23.3%)
0
2
4
6
8
10
12
14
No.
ofp
atie
nts
(%)
Right side Left side
Showing Affected Attacked side of the patients
MaleFemale
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Age wise classification of patientsAge wise classification of patients
S.NoS.No.. AGE GROUPAGE GROUP MALEMALE FEMALEFEMALE TOTALTOTAL PERCENTAGEPERCENTAGE
11 2020--3030 22 11 33 10.0%10.0%
22 3030--4040 44 22 66 20.0%20.0%
33 4040--5050 66 11 77 23.4%23.4%
44 5050--6060 55 33 88 27.6%27.6%
55 6060--7070 55 11 66 20.0%20.0%
2
1
4
2
6
1
5
3
5
1
0
1
2
3
4
5
6
7
8
No.
ofp
atie
nts
(%)
20--30 30--40 40--50 50--60 60--70Age (in yrs.)
Showing Age wise classification of patients
FemaleMale
3 (10%)
6 (20%)
7 (23.4%)
8 (27.6%)
6 (20%)
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DictaryDictary classification of the total number of patientsclassification of the total number of patients
S.NoS.No.. DIETDIET NUMBER OF PATIENTSNUMBER OF PATIENTS PERCENTAGEPERCENTAGE
11 VegVeg 44 13.3%13.3%
22 NonNon--vegveg 2626 86.7%86.7%
4 (13.3%)
26 (86.7%)
0
5
10
15
20
25
30
No
.ofp
atie
nts
(%)
Vegetarian Nonvegetarian
Showing Dietary habits of the patients
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Classification ofClassification of NidanasNidanas (Male Patients)(Male Patients)
Among the thirty patients, who are indulged inMadyapana ------------------- 16Dhoomapana ------------------- 14Adhika Katu Rasa ------------------- 27Adhika Tikta Rasa ------------------- 23Adhika Kashaya Rasa ------------------- 27Adhika Amal Rasa ------------------- 28Adhika Lavana Rasa ------------------- 29Adhika Ruksha ------------------- 23Ahika Deha Parisrama ------------------- 23
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Clinical features of Male PatientsClinical features of Male Patients
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ShowingShowing DoshaDosha predominance of patientspredominance of patients
S.NoS.No.. SexSex VataVata VataVataPittaPitta
VataVataKaphaKapha
VataVata PittaPitta KaphaKapha
11 MaleMale 66 77 33 33
22 FemaleFemale 44 22 22 33
6
4
7
2
3
2
3 3
0
1
2
3
4
5
6
7
No
.ofp
atie
nts
(%)
Vata Vata Pitta Vata Kapha Vata Pitta Kapha
Showing Dosha predominance of patients
MaleFemale
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RESULTSRESULTS
The difference in the condition of the patients after the completion of durationof 60 days was observed. The results are categoriezed based on theimprovement they got as good, moderate, and mild. Subjective and objectiveparameters were followed while assessing the results. The results are consideredthe linga (sex), Vayah (Age), Paksha involved (affected side), Dosha, Musclepower, Tendon reflexes, Hypertension and Madhumeha.
Clinical Features:
1. Movements of the limbs improved actively in 11 patients in 60 daystreatment and they have started walking.
2. 12 Patients started walking with some support and 5 patients were startedwalking with great difficulity and two of them not able to walk.
3. Gripping power, Holding power improved in 23 of the patients and 7 patientsshowing mild improvement.
4. Speech is improved to good extent in almost all vakvikruti patients.5. There are no noticeable changes observed in hypertension and
madhumeha.6. The patients suffering with Malabaddaka (Constipation) are relived. Chinta,
Soka are decreased and patients manasika avastha improved.
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Muscle power Grading (Male)
BEFORE TREATMENTBEFORE TREATMENT
GradingGrading 00 11 22 33 44 55
Total NumberTotal Numberof Patientsof Patients
11 55 1010 55 11 00
AFTER 20 DAYS OF TREATMENTAFTER 20 DAYS OF TREATMENT
GradingGrading 00 11 22 33 44 55
Total Number ofTotal Number ofPatientsPatients
11 44 99 44 33 11
AFTER 40 DAYS OF TREATMENTAFTER 40 DAYS OF TREATMENT
GradingGrading 00 11 22 33 44 55
Total Number ofTotal Number ofPatientsPatients
11 22 55 55 44 55
After 20 days of Treatment
AFTER 60 DAYS OF TREATMENTAFTER 60 DAYS OF TREATMENT
GradingGrading 00 11 22 33 44 55
Total Number ofTotal Number ofPatientsPatients
00 00 55 1010 66 99
After 60 days of TreatmentAfter 40 days of Treatment
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1
0
5
0
10
5 5
10
1
6
0
9
0
1
2
3
4
5
6
7
8
9
10
No.
ofp
atie
nts
Grade-0 Grade-1 Grade-2 Grade-3 Grade-4 Grade-5
Showing Power grading before and after treatment in male
B.T.
A.T.
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BEFORE TREATMENTBEFORE TREATMENT
GradingGrading 00 11 22 33 44 55
Total Number ofTotal Number ofPatientsPatients
00 00 55 33 00 00
AFTER 20 DAYS OF TREATMENTAFTER 20 DAYS OF TREATMENT
GradingGrading 00 11 22 33 44 55
Total Number ofTotal Number ofPatientsPatients
00 00 33 22 11 22
AFTER 40 DAYS OF TREATMENTAFTER 40 DAYS OF TREATMENT
GradingGrading 00 11 22 33 44 55
Total Number ofTotal Number ofPatientsPatients
00 00 22 22 22 22
AFTER 60 DAYS OF TREATMENTAFTER 60 DAYS OF TREATMENT
GradingGrading 00 11 22 33 44 55
Total Number ofTotal Number ofPatientsPatients
00 00 11 33 11 33
Muscle power Grading (Female) After 20 days of Treatment
After 40 days of Treatment After 60 days of Treatment
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0 0 0 0
5
1
3 3
0
1
0
3
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5N
o.o
fp
atie
nts
Grade-0 Grade-1 Grade-2 Grade-3 Grade-4 Grade-5
Showing Power grading before and after treatment in female
B.T.A.T.
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Tendon Reflexes Grading (Male)
Before TreatmentBefore Treatment
GradingGrading 00 11 22 33 44
Total Number ofTotal Number ofPatientsPatients
11 22 22 55 1212
After 20 days of TreatmentAfter 20 days of Treatment
GradingGrading 00 11 22 33 44
Total Number ofTotal Number ofPatientsPatients
11 66 66 55 44
After 40 days of TreatmentAfter 40 days of Treatment
GradingGrading 00 11 22 33 44
Total Number ofTotal Number ofPatientsPatients
11 88 66 33 33
After 60 days of TreatmentAfter 60 days of Treatment
GradingGrading 00 11 22 33 44
Total Number ofTotal Number ofPatientsPatients
11 1111 77 22 22
After 20 days of Treatment
After 40 days of Treatment After 60 days of Treatment
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1
0
2
11
2
7
5
2
12
2
0
2
4
6
8
10
12
No
.of
pa
tien
ts
Grade-0 Grade-1 Grade-2 Grade-3 Grade-4
Showing Tendon reflexes grading before and after treatment in male
B.T.A.T.
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Before TreatmentBefore Treatment
GradingGrading 00 11 22 33 44
Total Number ofTotal Number ofPatientsPatients
00 22 00 44 11
After 20 days of TreatmentAfter 20 days of Treatment
GradingGrading 00 11 22 33 44
Total Number ofTotal Number ofPatientsPatients
11 33 11 22 11
After 40 days of TreatmentAfter 40 days of Treatment
GradingGrading 00 11 22 33 44
Total Number ofTotal Number ofPatientsPatients
11 33 22 22 00
After 60 days of TreatmentAfter 60 days of Treatment
GradingGrading 00 11 22 33 44
Total Number ofTotal Number ofPatientsPatients
00 55 22 11 00
Tendon Reflexes Grading (Female) After 20 days of Treatment
After 40 days of Treatment After 60 days of Treatment
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0 0
2
5
0
2
4
1 1
0
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
No
.o
fp
ati
en
ts
Grade-0 Grade-1 Grade-2 Grade-3 Grade-4
Showing Tendon reflexes grading before and after treatment infemale
B.T.A.T.
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TABLE SHOWING SUBTABLE SHOWING SUB--SIDE OF SYMPTOMSSIDE OF SYMPTOMSAFTER TREATMENTAFTER TREATMENT
28/12/0728/12/07 1 year1 year 60 days60 days55--77--daysdays
++ -- 33 33 33 22 modmod
Showing the therapeutic response
Mild response7 (24.3%)
Moderate response12 (40%)
Good response11 (36.7%)
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1.1. In this present clinical study the mean percent response of theIn this present clinical study the mean percent response of thepatients is 56 + orpatients is 56 + or –– 22.22.
2.2. The mean of this is 56.5% and standard deviation is 22%The mean of this is 56.5% and standard deviation is 22%3.3. The t test of this present study is 17.9%The t test of this present study is 17.9%4.4. The p value of this clinical trial is p<0.01 which is significanThe p value of this clinical trial is p<0.01 which is significant.t.
56.5 + 22.0
0
10
20
30
40
50
60
Me
an%
resp
onse
Mean response
Showing Mean percent response of patients
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DISCUSSIONDISCUSSION
VataVata VyadhiVyadhi is one of theis one of the ““MahaMaha rogasrogas”” described out of thedescribed out of the AstaAsta MaharogasMaharogas described bydescribed bysusrutasusruta.. PakshaghataPakshaghata is a variety ofis a variety of VataVata VyadhiVyadhi and inand in PakshaghataPakshaghata the main clinical feature isthe main clinical feature isAkarmanyataAkarmanyata ofof HastaHasta && PadaPada. Its Separate entity was observed by the ancient. Its Separate entity was observed by the ancient acharyasacharyas and itsand itsdescription is explained indescription is explained in vatavyadhivatavyadhi chapters in the classics.chapters in the classics.
VataVata disorders are caused to thedisorders are caused to the dhatudhatu kshayakshaya andand avarantwaavarantwa,, PakshaghataPakshaghata also caused due toalso caused due tothe above said two factors in generalthe above said two factors in general vatavata disorders are difficult to cure and when it is associated withdisorders are difficult to cure and when it is associated withUpadravasUpadravas andand aristalakshanasaristalakshanas they arethey are asadhyaasadhya.. PakshagataPakshagata caused predominantly bycaused predominantly by vatavata doshadoshaeven though all the threeeven though all the three doshasdoshas also take part besides itsalso take part besides its dushyasdushyas namelynamely sirassiras,, snayussnayus,, dhamanisdhamanis..SandhisSandhis andand mamsamamsa resulting in to this disease.resulting in to this disease.
Present clinical study comprises of the effect ofPresent clinical study comprises of the effect of vatavata rakshasarasrakshasaras along thealong the bhrungadibhrungadi tailatailanasya.Thenasya.The drugdrug vatarakshasavatarakshasa RasRas is indicated inis indicated in vatavata disorders along withdisorders along with PakshagataPakshagata in books likein books likeyogayoga taranginitarangini,, vaidyavaidya chintamanichintamani,, BasavaBasava RajeeyamRajeeyam..
It containsIt contains AbhrakaAbhraka BhasmaBhasma,, RasabhasmaRasabhasma,, TamrabhasmaTamrabhasma,, KantalohaKantaloha andand SuddhaSuddha GandhakamGandhakam..AbharakamAbharakam has the properties likehas the properties like tridoshaharatridoshahara andand dhatuvriddhidhatuvriddhi,, RasabhasmaRasabhasma hashas TridoshaharaTridoshahara,,RasayanaRasayana,, YogavahiYogavahi,, BalapradeBalaprade,, TamraTamra hashas RasayanaRasayana, and, and LekhanaLekhana..
RasaoushadasRasaoushadas has properties likehas properties like AlpamatraAlpamatra (Smaller dose)(Smaller dose) ArucheraprasangathaArucheraprasangatha (Palatable)(Palatable) KshipramarogyaKshipramarogya DayitwaDayitwa (Fast Acting)(Fast Acting)
VataVata rakshasarakshasa RasRas isis RasaousadhaRasaousadha posses the above said 3 qualities and having the drugs thatposses the above said 3 qualities and having the drugs thatareare vataharavatahara andand RasayanaRasayana properties. So,properties. So, VatarakshasaVatarakshasa RasRas is the drug of choice foris the drug of choice for PakshaghataPakshaghata..
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BhringadiBhringadi TailamTailam::ItIt continscontins BhringarajaBhringaraja, which is the one of the best, which is the one of the best rasayanarasayana drugdrug –– PakshaghataPakshaghata is caused dueis caused due
toto dhatukhasayadhatukhasaya, so, so rasayanarasayana is indicated along with it containsis indicated along with it contains errandaerranda which iswhich is vatanlumonavatanlumona, which is, which isindicated because inindicated because in PakshagataPakshagata avarantwaavarantwa is another cause.is another cause. BhringaditailaBhringaditaila also containsalso contains nirungdinirungdi andandother drugs which areother drugs which are vataharavatahara properties.properties.
Dose:Dose:-- VatarakshasaVatarakshasa rasras –– 125 mg125 mg --2 X BD2 X BD –– 60 days60 days-- BhringadiBhringadi TailaTaila NasyaNasya –– 8 drops in each nostril8 drops in each nostril --5 to 7 days.5 to 7 days.
30 patients are selected from the hospital out of 30, 15 are suf30 patients are selected from the hospital out of 30, 15 are suffered fromfered from DakshinaDakshina PakshaghataPakshaghata and other 15and other 15are fromare from VamaVama PakshaghataPakshaghata. Hypertension and. Hypertension and MahdumehaMahdumeha are observed in 8 patients. Only Hypertension in 15are observed in 8 patients. Only Hypertension in 15patients onlypatients only MadhumehaMadhumeha in 2 patients, without HTN &in 2 patients, without HTN & MadhumehaMadhumeha in 5 patients.in 5 patients.
CarotidCarotid atheromaatheroma and transient cerebraland transient cerebral ischaemicischaemic are more common in hypertensive patients. The next riskare more common in hypertensive patients. The next riskafter hypertension isafter hypertension is MadhumehaMadhumeha. In this clinical study cerebral. In this clinical study cerebral haemorrhagichaemorrhagic patients are excluded, because sometimespatients are excluded, because sometimesNasyaNasya maymay futherfuther provokes the bleeding tendency. 14 Patients are habituated toprovokes the bleeding tendency. 14 Patients are habituated to madhyapanamadhyapana andand dhoomapanadhoomapana and 2and 2are habituated toare habituated to MadhyapanaMadhyapana and 14 are not habituated.and 14 are not habituated.
No, Female patient is habituated toNo, Female patient is habituated to dhoomapanadhoomapana (or)(or) MadhyapanaMadhyapana in this trial. Madhya possessin this trial. Madhya possess KashyaKashya,, TiktaTikta,,KatuKatu,, AmlarasasAmlarasas,, AmlavipakaAmlavipaka andand LaghuLaghu,, ushnaushna gunasgunas.. DhoomapanaDhoomapana GunasGunas areare ushnaushna,, TeekshnaTeekshna,, RookshaRooksha andandlaghugunaslaghugunas.. AdhikaAdhika KashayaKashaya RasaRasa SevanaSevana,, LaghuLaghu,, RukshaRuksha gunasgunas vitiatesvitiates vatavata which are causative factors for theirwhich are causative factors for theirdisease.disease.
According to the modern system of medicine high alcohol intake iAccording to the modern system of medicine high alcohol intake is the risk factor for stroke. Cerebrals the risk factor for stroke. Cerebralhaemorrhagehaemorrhage, dementia,, dementia, cerebellarcerebellar degeneration etc., are the physical effects of alcohol abuse. Sdegeneration etc., are the physical effects of alcohol abuse. Smoking is the riskmoking is the riskfactor in stroke. It is responsible for hypertension, myocardialfactor in stroke. It is responsible for hypertension, myocardial infexetioninfexetion,, ischaemicischaemic heart disease,heart disease, peripherialperipherial arterialarterialdisease etc. These are thedisease etc. These are the aetiologicalaetiological factors for stroke.factors for stroke.
Interestingly, the patients withInterestingly, the patients with dysarthriadysarthria, dysphasia and also with Aphasia are responding well to the tre, dysphasia and also with Aphasia are responding well to the treatmentatmentafterafter nasyanasya speech improvement is very good in almost all of thespeech improvement is very good in almost all of the vakvak -- vikrutivikruti patients. Patients which are nonpatients. Patients which are non--diabeticdiabeticyoung and posseyoung and posse’’s good strengths good strength respondesrespondes well to the treatment compared to diabetic and older patients.well to the treatment compared to diabetic and older patients. Out of 30Out of 30patients 11 patients responds well to the treatment, 12 patientspatients 11 patients responds well to the treatment, 12 patients show moderate response and 7 patients show minimalshow moderate response and 7 patients show minimalresponse.response.
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CONCLUSIONCONCLUSION
An attempt has been made to study the effect ofAn attempt has been made to study the effect of VatarakshasaVatarakshasa RasRas withwith BhringadiBhringadi TailaTaila NasyaNasya ininthe management ofthe management of PakshaghataPakshaghata. A clinical trail has been conducted on 30 patients selected fr. A clinical trail has been conducted on 30 patients selected from IPD ofom IPD ofGovt.AyurvedicGovt.Ayurvedic Hospital,Hospital, ErragaddaErragadda, Hyderabad. Approximately about 11 patients were recovered, Hyderabad. Approximately about 11 patients were recoveredcompletely, 12 patients were left with some disability or deformcompletely, 12 patients were left with some disability or deformity, 7 patients left with persistentity, 7 patients left with persistentdeformity, eitherdeformity, either chestachesta vahavaha (motor) or(motor) or SanganaSangana vahavaha (Sensory) through out the life.(Sensory) through out the life.
InIn AyurvedaAyurveda CharakaCharaka maharshimaharshi said that the history ofsaid that the history of PakshaghataPakshaghata with short duration of onsetwith short duration of onsetand without complications and moreover if theand without complications and moreover if the pakshaghatapakshaghata patient ispatient is balavanbalavan (strong enough) such(strong enough) suchtype of cases can be easilytype of cases can be easily caurablecaurable and it has been proved in the present clinical study. Patientsand it has been proved in the present clinical study. Patients withwithdiabetisdiabetis,, oldageoldage having other complications are not responding well to the treathaving other complications are not responding well to the treatment which confirms thement which confirms theApathaApatha vachanavachana..
Now a dayNow a day’’s the present life is very fast and competitive. So the patientss the present life is very fast and competitive. So the patients are also seeing forare also seeing forimmediate cure .Though number of techniques and remedies are avaimmediate cure .Though number of techniques and remedies are available most of the people areilable most of the people arepreferringpreferring ayurvedicayurvedic treatment mainly fortreatment mainly for pakshaghatapakshaghata. So taking all these observations and views of. So taking all these observations and views ofthe people inspired me to prepare this fast actingthe people inspired me to prepare this fast acting RasaoushadaRasaoushada likelike VatarakshasaVatarakshasa RasRas along withalong withrasayanarasayana nasyanasya likelike BhringadiBhringadi TailaTaila NasyaNasya..
VatarakshasaVatarakshasa RasRas is a drug which acts very fast and showed the curative resultsis a drug which acts very fast and showed the curative results to the patientsto the patientswith in short period. After givingwith in short period. After giving nasyanasya there is a good improvement in speech in almost all of thethere is a good improvement in speech in almost all of thevakvikrutivakvikruti patients.patients.
During the period of treatment no complications are unwanted effDuring the period of treatment no complications are unwanted effects were observed. Thisects were observed. Thisshows the non toxic effect ofshows the non toxic effect of vatarakshasavatarakshasa rasras.. VatarakshasaVatarakshasa RasRas can be used incan be used in krichrakrichra sadhyasadhya andandAsdhyaAsdhya vyadhisvyadhis because of presence ofbecause of presence of RasaoushadhisRasaoushadhis likelike RasabhasmaRasabhasma,, TamraTamra BhasmaBhasma etc.etc.
RasaoushadhiRasaoushadhi is comparatively best than theis comparatively best than the KashthoushadhisKashthoushadhis because as mentioned in the textbecause as mentioned in the textthatthat RasaoushadhisRasaoushadhis will not lose there potency forever. So,will not lose there potency forever. So, vatarakshasavatarakshasa RasRas along withalong with rasayanarasayanaBhringadiBhringadi TailaTaila NasyaNasya is selected for this clinical trail in the management ofis selected for this clinical trail in the management of pakshaghatapakshaghata..
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SUMMARYSUMMARYThe present dissertation entitledThe present dissertation entitled ““A STUDY OF THE EFFECT OF VATARAKSHASA RAS WITH BHRINGADIA STUDY OF THE EFFECT OF VATARAKSHASA RAS WITH BHRINGADI
TAILA NASYA IN THE MANAGEMENT OF PAKSHAGHATATAILA NASYA IN THE MANAGEMENT OF PAKSHAGHATA”” is summarized as below:is summarized as below:The entire thesis is mainly divided in to eight sections.The entire thesis is mainly divided in to eight sections.
Section ISection I : Introduction & Historical aspect: Introduction & Historical aspectSection IISection II :: SareeraSareeraSection IIISection III :: VyadhiVyadhi SameekshaSameekshaSection IVSection IV :: ChikitsaChikitsa YojanaYojanaSection VSection V :: OushadhaOushadha SameekshaSameekshaSection VISection VI : Clinical Study: Clinical StudySection VIISection VII : Discussion, Conclusion & Summary: Discussion, Conclusion & SummarySection VIISection VII : Bibliography: Bibliography
INTRODUCTIONINTRODUCTION Definition ofDefinition of AyurvedaAyurveda and concept of disease has been discussed.and concept of disease has been discussed. Causes ofCauses of vyadhivyadhi and its consequences have been discussed.and its consequences have been discussed. TheThe RasoushadhaRasoushadha action and its importance have been discussed.action and its importance have been discussed. ItihasaItihasa tells that there is gradual evolution in the treatment patterntells that there is gradual evolution in the treatment pattern fromfrom prevedicprevedic period toperiod to sangrahasangraha kalakala. It also. It also
states thatstates that AyurvedicAyurvedic system was much advanced than thesystem was much advanced than the AllpothicAllpothic system of medicine in diagnosis andsystem of medicine in diagnosis andtreatment aspects.treatment aspects.
SHAREERAMSHAREERAM Definition ofDefinition of vatavata and its importance has been discussed.and its importance has been discussed. UtpatthiUtpatthi ofof vatavata and its relationship toand its relationship to panchamahabhutaspanchamahabhutas, and properties of, and properties of akashaakasha andand vayuvayu mahabhutasmahabhutas havehave
been explained.been explained. DoshaDosha dhatudhatu sambandhasambandha and their functions when they are in normal state have been disand their functions when they are in normal state have been discussed.cussed. SwaroopaSwaroopa ofof vatavata has been stated.has been stated. GunasGunas ofof vatavata according to differentaccording to different AcharyasAcharyas have been explained.have been explained. Sites ofSites of vatavata and types ofand types of vatavata according toaccording to BrihattrayeeBrihattrayee ,, sthanassthanas and karmas of five suband karmas of five sub--divisions ofdivisions of vatavata havehave
been tabulated.been tabulated. The cerebral blood flow is an essential aspect in the disease prThe cerebral blood flow is an essential aspect in the disease process. Carbon dioxide, hydrogen, oxygenocess. Carbon dioxide, hydrogen, oxygen
concentrations have potent effected in controlling the cerebralconcentrations have potent effected in controlling the cerebral blood flow.blood flow. The human brain normal functions are dependent on constant supplThe human brain normal functions are dependent on constant supply of oxygen and other nutrients derived fromy of oxygen and other nutrients derived from
bloodblood perfusingperfusing it. Two internal carotids, twoit. Two internal carotids, two vertebralsvertebrals and their branches perfuse the brain tissue.and their branches perfuse the brain tissue.
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VYADHI SAMEEKSHAVYADHI SAMEEKSHA TheThe NidanaNidana has been classified and types have been discussed.has been classified and types have been discussed. The basicThe basic aetiologyaetiology involved in the disease has been summarized.involved in the disease has been summarized. AetiologyAetiology ofof VataVata vyadhisvyadhis have been discussed because of a fact thathave been discussed because of a fact that pakashaghatapakashaghata is one amongis one among
thethe vatavata vyadhisvyadhis.. The expression ofThe expression of poorvaroopapoorvaroopa and meaning ofand meaning of poorvaroopapoorvaroopa are discussed in detail.are discussed in detail. The generalizedThe generalized lakshanaslakshanas of the disease has been stated according to differentof the disease has been stated according to different AyurvedicAyurvedic
AcharyasAcharyas.. The role ofThe role of nidananidana,, doshasdoshas andand dushyasdushyas in the process ofin the process of sampraptisamprapti were explained in detail.were explained in detail. The meaning ofThe meaning of sampraptisamprapti in general with special references toin general with special references to kriyakriya kalaskalas has been discussed.has been discussed. TheThe sampraptisamprapti of the diseaseof the disease pakshaghatapakshaghata has been discussed in detail according tohas been discussed in detail according to BrihattrayeesBrihattrayees.. TheThe sampraptisamprapti ofof pakshaghatapakshaghata has been made elaborately in terms ofhas been made elaborately in terms of utbhavautbhava sthanasthana,, sancharasanchara,,
explained clearly.explained clearly. PathyaPathya apathyaapathya ofof pakshaghatapakshaghata have been discussed.have been discussed.
AUSHADHA SAMEEKSHAAUSHADHA SAMEEKSHA Composition ofComposition of VatarakshasVatarakshas RasRas andand BhringadhiBhringadhi TailaTaila NasyaNasya explained in detail.explained in detail.
CLINICAL STUDYCLINICAL STUDY Parameters, criteria and method and materials have been explaineParameters, criteria and method and materials have been explained.d. ObsevationsObsevations and Results:and Results: DakshinaDakshina part of the body is affected same as that ofpart of the body is affected same as that of vamavama bhagabhaga. Hypertension is. Hypertension is
commonly associated with the disease than thecommonly associated with the disease than the madhumehamadhumeha.. The results of clinical trial are tabulated.The results of clinical trial are tabulated. The results are tabulated as goodThe results are tabulated as good–– 11 patients, moderate11 patients, moderate –– 12 patients and mild12 patients and mild –– 7 patients.7 patients. Discussion. The observations and results are discussed.Discussion. The observations and results are discussed. Total study on the diseaseTotal study on the disease pakshaghatapakshaghata. The drug and the clinical work have been revived in a brief di. The drug and the clinical work have been revived in a brief discussion.scussion. Conclusion.Conclusion. VataVata RakshasaRakshasa RasRas andand BhringadiBhringadi TailaTaila NasyaNasya have been adopted for treatment in the present study. Ashave been adopted for treatment in the present study. As
anticipated the results were encouraging. This once again provesanticipated the results were encouraging. This once again proves the validity ofthe validity of aptavachanaaptavachana
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Thank QThank Q
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