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Review of Pakshaaghaata w.s.r. to Cerebrovascular Accidents and

its Management

Arun Gupta1 and Katara Pankaj2*

1,2
Panchkarmaka Department, Ch. BrahmPrakash Ayurved Charak Sansthan Khera Dabar Govt. of NCT Delhi
N.D.-73

Abstract
Pakshaaghaata has been classified under three types in Ayurveda i.e.,SuddhaVaataja,
Anyadosha Samsrista and Kshayahetuja. A number of disease processes in modern science
manifest as Pakshaaghaata. Cerebrovascular accident is the commonest disease manifesting as
Pakshaaghaata. Virechana, SarvaangaAbhyanga, BaaspaSweda and some herbo-miniral
formulations show better result in the disease Pakshaaghata due to CVA (cerebro-vascular
accident). In this present review manuscript alternative Ayurvedic approach in the managing of
hemiplegia is discussed in a systematic way.

Keywords
Pakshaghata, Hemiplegia, CVA (cerebro-vascular accident),Vata–SleshmaDosha.Snehana,
Swedan, MriduVirechana Karma, Basti karma

Greentree Group
Received 16/10/15 Accepted 21/11/15 Published 10/01/16
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INTRODUCTION 56.9 per 1,00,000 and the high incidence of

Pakshaaghaata is a most important hemiplegia in the young has been pointed

Vaatavyaadhi described under Vaata- out, the prevalence rate per 1,00,000

NaanaatmajaVyaadhi. There are a number of population in 68.5 in male and 44.8 in

disorders like vascular disorder, infective female3.

disorders of brain, tumors, degenerative Acharya Sushruta compared Hemiplegia

disorders in brain, trauma etc in modern with Pakshaghata due to much similarity in

science which manifest them as their symptoms, where vitiated Vata is main

Pakshaaghaata (Hemiplegia). It is a type of causative factor. Acharya Charaka clinically

paralysis which is affecting one side of the compared with Pakshawadha. The changing

body. life style, bad food habits etc leads to disturb

The common cause of hemiplegia is equilibrium of Tridosha . Vata, among

cerebro-vascular accident (stroke)1. There Tridosha is responsible for dynamic entity

are two major categories of brain damage in of life and locomotion.

stroke viz. ischemia and haemorrhage, Pakshaghata has been enlisted amongst the

which result in the destruction of brain eighty types of NanatmajaVataVyadhies4

tissue via abnormalities in the blood supply and is considered to be prominent of all

of brain2. Hemiplegia also caused by a wide VataVyadhies. The pathological phenomena

spectrum of disease processes like of Vata playing central role in the

hypertensive encephalopathy, vascular manifestation of Pakshaghata are

disorders, infective disorders of brain tissue, Suddhavataprakopa,

tumours or abscess, trauma, internal artery AnyadoshaSamsirstavataprakopa and

occlusion etc. The prevalence of completed dhatukshayajanyavataprakopa5.

stroke and hemiplegia due to any cause is

Comparison between hemiplegia and pakshaghat6
S/N Factors Hemiplegia Pakshaghata
1. Etiology Age, atherosclerosis, hemorrhage, injury Vaya, Margavarana, Dhatukshaya,
to head, nutrition imbalance. Marmabhighata, AsrukSrava,
RukshaAlpaAhara
2. Signs and Loss of power and movement in half side Chestanivriti, isat karma kshaya in
symptoms of the body, minor sensory deficit, Ardha kaya, ardhanarishwaratachesta,
dysarthria, atrophy due to disease, vaksthamba, sirasanayushosha.
stiffness

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3. Pathology Obstruction of cerebral arteries& Veins, Sanga in VatavahaSrotas

ischemia devlpos due to depletion in
glucose metabolism, it outcomes in death
of nerve cells.
Nidan of Pakshaghata: If the above mentioned morbidity pervades
Due to excessive intake of the entire body; then ailment is called as
VataPrakopakaAhara-Vihara like Shita, SarvangRoga (paralysis of the entire
Ruksh , LaghuAhara, KatuTtiktaRasaAhara, body)9,10
excessive activities, prolonged wake up at
night, stress, chronic disorder, physical TREATMENT PROTOCOL
trauma, excessive walking or exercise, According to Acharya Charka, Swedana
excessive loss of Dhatus like blood, seman (Sudation), Snehana (Oleation) and
leads to VataVriddhi ,VegaDharna, heavy Virechana (Purgation) are the treatment
weight lifting7. protocol while treating
Rupa (clinical symptoms): Pakshaghata(cerebral vascular accident)
 Ruja(Ruja), patient11. Further Sushruta explains about
 Vakstambha(blurred speech), the treatment of Pakshaghata are Abhyanga,
 andChestaNivruti( loss of MruduShodhana, AnuvasanaBasti,
movements). AsthapanaBasti and ShiroBasti12
 Half of the human body is Hemiplegia is one of the most common
8
functionless and unconscious . neurological diseases and still stands as a
Samprapti (Pathogenisis): challenge to different medical systems.
Morbid and aggravated Vata may cause Many research works have been done on
restriction of the vessels and ligaments as a hemiplegia in Ayurveda and modern
result of which there will be contracture, medical science but no drug has yet been
either of one hand or limb along with aching claimed to cure hemiplegia completelyIn
or piercing pain. This ailment is called as Ayurveda there are specific treatments for
Ekangroga (monoplegia). Paralyzing one pakshaghata. Hemiplegia can be better
side of the body, either right or left, causes managed by the Ayurvedic principles of
immobility of that side in association with management namely:
pain and loss of speech, then element is 1. NidanaParivarjana
called Pakshaghata. 2. Shodhana (Panchakarmatherapy)
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3. ShamanaChikitsa. Branghana properties , it pacify the Vataand

NidanParivarjana- Avoiding the correct impairment of functions and
aetiological & risk factors which causes movement restrictions and relieves pain and
vitiation of vatadosha as like shita, ruksh , inflammation .
laghuahara, katu ,tikta rasa ahara, excessive  Tablets (Vati)-MahaYoga Raja
activities, wake up at late night regularly , Guggulu, punarnavadi Guggulu, due to
stress, chronic disorder, physical trauma, Vatahara and Branghana property
excessive walking or exercise, excessive  Herbominiral compounds
loss of Dhatus ,Vega Dharna, heavy weight (Bhasmas)- Ras Raj
lifting etc should be avoid. Nidana Ras,VarihataVatachintamaniRas
Parivarjana stops the further progression of ,EkangveerRas, Rajatbhashma etc,as all are
the disease, by restricting vitiation of potent Vatashamaka and nerve stimulant
Doshas. Hence main objective of treatment due to their ingredients.
is to improve metabolic activities in Dhatu  Rasayana-Brahma Rasayana,
level, to rectify Srotoavrodha and to provide Chyvanaprasha and Abhyaamalaki
nourishment to depleted Dhatus. Rasayana are indicated in AvritaVata14.
Samana -The principle of Shaman therapy  Gharita&Taila(Medicated oils)-,
is to normalize and maintain the equilibrium Aswagandha Ghrita, DashamooladiGharita,
of all the Doshas. As per Ayurvedic text ChitrakadiGharita,BaladiGharita,Nirghundi
many Ayurvedic formulations have been Taila,MoolakTaila,RasnaTaila,Vrishmoolad
given to pacify the VataDoshaas like – itaila15etc.
 Kwatha/Kashayam(Decoction):-  These Ghrita&Tailas are used as
Dashamool kwath, bala-Mansyadi kwath Pana, Abhyanga, AnuvashanaBasti etc. In
(kaphavatahara,), Mahamanjishtadi kwath - all these formulations mainly Vatahara
mainly in hemorrhagic stroke because of its drugs are use and Grita and Taila have good
PittaSamaka property. Vatahara property and give nourishment to
 Choorna- Rasanadi Choorna, the body.
13
because Rasana Vatahranam Shrestham , PanchakarmaTherapy(purification
Aswagandha powder & Saraswat powder therapy) –
due to its Medhya, nuerogenic and
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Panchakarma or Sodhana therapy is a Pakshaaghaata due to cerebro-vascular

unique real pathogenesis breaker therapy accident in which there is obstruction of
which re-established homeostasis and Vaata with Kapha, Pitta, Rakta and Meda.
equilibrium of body In addition to this it also clears the intellect,
Shodhana means purification of the body by improves the strength of sense organ,
eliminating morbid Doshas and Dushyas potentiates all Dhaatu, increases body
from body through Panchakarma. Acharya strength, improves Agni & delayed old age.
Charaka described treatment protocol for SarvaangaAbhyanga: - Being Kapha-
Pakshaghata Diseases in chikitsaSthana. Vaatahara, Shramahara, Pustikara, Urjaa-
Swedana (Sweating), Snehana (Oleation), Varna-Balaprada, it proofs its effectiveness
Virechana (Purgation), Anuvasanabasti, in Pakshaaghaata due to CVA. In addition
Asthapanabasti, Shirobasti, Nasya(Nasal to this it also increases circulation,
Effusion) and Shirodhara (Pouring of Oil on especially to nerve endings and tones up
the Head) etc are the line of treatment for muscle inducing strength in weak muscles,
Pakshaghata(CVA), according to various helps in improvement in elimination of
Ayurvedic texts. impurities from the body and helps in
increasing in mental alertness
DISCUSSION Basti(herbal enema therapy) - All the

The disease caused by SuddhaVaataja Acharyas(ayurvedic stalwarts) have

condition will show gradual onset as Vaata appreciated Basti as a unique form of

has to vitiate in step by step through treatment modality for Vata and other

Sanchaya, Prakopa etc. whereas that caused Doshas too because it expels the vitiated

by Aavarana will show sudden onset. So Doshas rapidly as well as it nourishes the

having sudden onset Pakshaaghaata due to body. The main cause of hemiplegia is

CVA can be taken as Aavaranajanya. vitiated Vata and in Ayurveda text the

Probable mode of action of therapy:- choice of treatment of Vatadosha is Basti

Virechana: - It is helpful in the Vatika and on the other hand Avarana is main

disorder where the Vata is obstructed by causative factor in the pathophysiology of

Kapha, Pitta, Meda&Rakta. So it will proof Pakshaghata. Thus, breaking this process of

very useful in the management of Avarana needs foremost consideration in its

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management. Charaka has stressed on
Srotoshudhhi, Vatanulomana and Rasayana
in general management of Avarana. Basti
achieves both the goals i.e. Vatanulomana
and Srotoshudhhi. Basti is treatment of
choice for MadhyamaMarga and to protect
Marmas. The place of action of drug is
(pakvasaya) gut.
Shirodhara and Shiropichu- Shirodhara is
an important therapeutic measure in
Ayurvedic system of medicine, in this
therapy pouring any liquid on the forehead
from a specific height and for a specific
period continuously and rythmatically
allowing the liquid to run through the scalp
and into the hair. This is a subtype of
Murdhataila which means keeping the
medicated oil on the head region for
neuromuscular relaxation and nourishment.
Sushruta has specifically mentioned
ShiroBasti in Pakshaghata because he
postulated that VataharaTaila directly
strikes to the site of the lesion of
Mashtishka. Shirodhara is a purifying and
rejuvenating therapy designed to eliminate
toxins and mental exhaustion as well as
relieve stress and any ill effects on the
central nervous system and relieves mental
exhaustion as well as pacifies the aggravated
VataDosha in Shira which helps in relaxing
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the nervous system and balancing the
PranaVayu around the head.
When a stream of liquid is poured on canter
point of head then a specific sensation of
touch is produced. The feeling of this
contact is like a stone drop in a pole which
extends outwards which produces wave, this
effect lead a person to a state of
concentration. The state of concentration is
enhancing the release of serotonin which is
responsible for pleasant and relieving of
stress, and the mind and body also.
Due to continuous pouring of liquid nerve
ending of autonomic nervous system are
stimulated, the produced chemical
substances like acetylcholine. Small doses of
acetylcholine cause fall of blood pressure
and larger doses activate central nervous
system. Hemiplegia is a neurological
disorder so Shirodhara and Shiropichu with
VataSamaka drugs are very effective.
Nasya-Many types of Nasyas indicated in
Pakshaghata according to Avastha of the
disease by different types of NasyaYogas.
AvapeedanaNasya indicated in unconscious
patients and Pradhamana Nasya is indicated
repeatedly to restore the consciousness.
Sneha Dhoomapana and Nasya beneficial in
Pakshaghata to give the nourishment to the
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brain. According to Charak,Nasa is the Netra, Srotra(ear), Kantha(throat), Sira

portal gateway of Shiras. mukhas(opening of the vessels) etc and
The drug administrated through nose remove the morbid Dosha, So in hemiplegia
reaches to the brain (ShringatakaMarma) Nasya is very effective because of Samana,
by; Shodhana and Bhranghna property.
A) Diffusion –lipid soluble substance
through the lipid bilayer of plasma CONCLUSION
membrane. B)Neurological pathway – Pakshaaghaata due to CVA results from
olfactory receptor stimulated, nerve impulse Aavarana of Vaata with Pitta, Rakta, Kapha
travel through olfactory nerve to olfactory and Meda.
blubs than olfactory tract to limbic system,
olfactory cortex and also related with Virechana followed by
amygdaloidal complex, hypothalamus, SarvaangaAbhyanga and herbo-
epithalaums and other important structure of minralcompounds showed significant
the brain so the drugs administrated , improvement in Distal motor function,
stimulate the high centre of the brain and Motor function of arm, Motor function of
show action on regulation of endocrine and leg, Vaakgraha, Increased muscle tone
nervous system function. (Sankocha), Muscle power and Exaggerated
C) Vascular pathway- Nasal venous blood reflex.
drains in to the facial vein and ophthalmic It also significantly improves the activities
vein also. The facial vein has no valves so it of daily living of patients like Sitting from
freely communicates with intracranial lying down, Standing from sitting, Walking
circulation so the drug administrated down stair, Increase in walking capacity and
through Nasya absorb into the meninges and Hand grip power. The associated symptoms
intracranial organ and eliminates the morbid like Tiredness, Pain, Gaurava, Vivandha,
Dosha which responsible for the disease. Sotha, Bhrama, Shaitya and Shirashula also
When drug administrated through nostril shows significant improvement.
reaches ShringatakaMarma which is a SarvaangaAbhyanga, BaaspaSweda
SiraMarma so by Nasya drug spread in the withoutVirechana also showed significant
Murdha reaches at a junctional place of

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improvement in above mentioned symptoms

of Pakshaaghaata.
Looking to the chronicity and deep seated
nature of the disease longer duration of
therapies may be required to obtain better
results.

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