*Dr. Shilpa Patle * Dr. J.H. Mhaisekar- Assistant Professor
*Govt. Ayurved College, Nagpur
Hemiplegia is the third most common cause of death after cancer and ischemic heart disease. Hemiplegia due to stroke is mainly due to obstruction of cerebral blood vessels, ischemia and depletion in glucose metabolism and finally death of nerve cell. Symptoms produced are loss of power and movement affecting any one side of body, minor sensory deficit, dysarthria, atrophy due to disease, stiffness.
Though for confirm diagnosis neuro-imaging and for treatment modern medicine available, due to limitations in the degree of improvement in the recovery of damaged cell, so many adverse effects of use of steroids, unable to increase blood flow through damaged area by thrombolytics, anticoagulants and vasodilators, no drug availability to improve mental functions, cost effectiveness of vascular surgery and rare chances of fitness in surgery, there is no standard satisfactory treatment so far. Ayurveda is gaining popularity for effectiveness because almost all patients of Pakshaghata becoming victim of physical disability. After taking modern medicines, so many patients preferring to go to Ayurveda after acute phase of stroke. The knowledge of Hemiplegia as history reveal, existed with India since pre-historic age describing this condition under Vatavyadhi (Pakshaghata).
According to Ayurveda, causes forPakshaghata or any other vatavyadhi are Ruksha, Sheeta,Alpa, Laghu Aahara, AtiVyavaya, Atijagarana,Asruk srava, Ativyayama, Vichesta, Dhatu kshya, Shoka, Chinta, Marmabhighata, Diwaswapna, Vegasandharana, Atibhojana,According to modern science, age, Arteriosclerosis, hemorrhage, injury to head, nutrition imbalance are causative factors for disease.
SAMPRAPTI (PATHOPHYSIOLOGY) –
The above factors cause vitiation of Doshas i.e. Vata as singly or Vata with Anubandhi of Pitta or Vata with Anubandhi of Kapha. The factors responsible only for Vata vitiation cause successive changes in the structure of nerve leading to their degeneration. The Vata with Anubandhi of Pitta leads to obstruction in passage of nerve impulse causes enhancement of Drava and Rakta due to which Cerebral vessels get dilated and ruptures which results into hemorrhagic strokes. The factors responsible for vitiation of Vata with Anubandhi of Kapha leads to obstruction in passage of nerve impulse due to which Upleptva of Kapha in Strotas occurs which increases viscosity of blood leading to dyslipidemic condition causing myocardial infarction or stroke (ischemic) The above ailments causes Sira Snayu Shoshatva (Atropy), Shithiltva of Sandhibandhana (stiffness), loss of power and movement affecting any one side of body, dysarthria, sensory deficit duo to vitiation of Prana Vayu of which Mastishkya is the main Sthana.
CORRELATION OF VAYU WITH CENTRAL NERVOUS SYSTEM
Without Vata Doshas other two Doshas cease to operate. Acharya Charak quoted that “Vayus tantra yantra dharaha”. It clears that maintenance of body’s activities should be normal. Tantra correlates with physic and Yantra correlates with somatic activities. CNS does the same function. Out of 5 Prakaras of Vayu, Prana Vayu and CNS both located in Mastishkya hence both are one as the same thing. It is such a force, which is self-generating, self-propagating and integration of all vital functions and structure of body. It is said to be “Avyakta Vyakta Karma cha” means it is that biophysical force which is not seen but recognized by its function and performance. Vayu described as “Va GatiGandhanyoh” means it performs Gati (Motor function) and Gandhanyoh (sensory function), it is responsible for growth and origin in Prakrut condition and for destruction in Vikrut condition, Pakshaghata is due to such Dusti of Vayu.
TREATMENT OF PAKSHAGHATA (HEMIPLEGIA DUE TO STROKE)
Ayurvedic principles of Hemiplegia namely- 1) Nidan Parivarjana 2) Shaman & 3) Shodhana Chikitsa
The causes responsible for Pakshaghata should be avoided. It stops the further progression of the disease by restricting vitiation of Doshas hence main objective of treatment is to improve metabolic activities at Dhatu level by preventing further Strotasavrodha and to provide nourishment to depleted Dhatus.
- Shamana Chikitsa
To normalize vitiated Vata Doshas, Gandharvhastyadi kashayam, Rasnadi churna, Yogaraja Guggulu, Baladi ghrita, Nirgundadi taila, Sahacharadi taila, Shwadanstra taila,Rasna taila used. The tailas and ghrutas are used as pana, Abhyanga, Anuvasana Basti etc. because they give nourishment to body. Ekangveer Ras ,Rajat Bhasma are neurostimulant. To normalize vitiated Vata Dosha with Anubandhi of Pitta, Mahamanjishtadi kashayam, Kumariasavam, Abhayaamalaki Rasayana and other vatashamana yogas used. To normalize vitiated Vata Dosha with Anubandhi of Kapha, Dashmooayam, Dashmoolarishta, Lavangarista, Dashmooladi ghruta, Chitrakadi ghruta, Rasna taila and other vatashamana yogas used.
- Shodhana Chikitsa (Panchakarma Therapy)
Shodhana means purification of body by eliminating vitiated Doshas and Dushyas from body through panchakarma. Swedana, Snehana, Anuvasana Basti, Nasya, Shirobasti ,Shirodhara etc. are the line of treatment for Pakshaghata.’ Snehana includes both external as well as internal application. Internaly Snehan lubricates the body reduces dryness (Rukshatva) and aid in remaining impurities. By external massage (Snehan), power of muscles inceases, stiffness remove and muscle tone also improves.
Snehan oil is medicated with Doshahara herbs. Snehan mainly responsible for protein and fat metabolism of body and Nervous tissue closely connected with this. As they themselves contain high level of lipoprotein, myelin sheath around the axon of myelinated nerve fibre consists myelin lipids with protein, so in such condition we are administering snehan with pre-asumption that snehan due to its Similarity of constitution with nerve fibre (vata) may help in repairing structural degeneration and restore the lost function. Due to snehan, damaged tissue repair within some limit. Bruhana property of snehan normalize Vata Dosha (CNS), relieves pain in body, soothens and enables nerve to function properly.
Virechan- Pakshaghata occurring mainly due to cerebrovascular accidents which has major role in Pitta, Rakta, Kapha and Meda in association with Vata. Virechana removes Aavarana of Vata so that Vayu performs its function normaly.Virechan used for diseases of Raktavaha Strotas working like Mannitol. Pakshaghata, Sira Snayu Vishoshan is there which are Updhatus of Rakta Dhatu.
Basti- When Basti is given by Vatahara and Bruhana drugs, the nutritive substances of drugs absorb from mucosa layer of Gut and toxic material of body flush out from rectal or intestinal mucosal layer.
Shirodhara and Shiropichu- It causes neuromuscular relaxation and nourishment because it directly strike site of lesion of Mastishkya. It eliminates toxins and mental exhaustion as well as relieves stress, any ill effect of CNS and pacify aggrevated Vata Dosha in Shira which help in relaxing CNS and balancing Pranavayu around head. When Snehayukta liquid touches head, it produces wave leading to state of concentration enhancing releasing of serotonin, which is responsible for relieving stress of mind and body. Due to continuity of this process, acetylcholine secretes which causes fall of blood pressure.
Nasya- It nourishes brain as Nasa is a portal gateway of shira. Drug administrated through Nose reaches the Drain. Drug stimulate high centre of brain and show action on regulation of endocrine and nervous system function, If we notice in Ayurvedic treatment we pacify obstruction, promote normal Dhatu (Majja) production which are main factor for pathogenesis. Physical disability after attack can also be regained, In Pakshaghata, prevention as WQII as treatment both are easily possible by this pathy.