Journal of Ayurveda Physicians & Surgeons (JAPS)

(www.japs.co.in) EISSN 2394-6350

CASE REPORT
Ayurvedic Management of Pakshaghata (Cerebrovascular Accident):
A Case Study
1
Megha G 2Chauhan Vikas 3Joshi Diwakar Papurao
1
Internee, Postgraduate scholar,3Associate Professor, Department of Kayachikitsa, Sri Dharmasthala
2

Manjunatheshwara College of Ayurveda & Hospita, BM Road, Thanniruhalla, Hassan-573201

1-2
Corresponding authors: Megha G, Email address: drmeghagopi@gmail.com
Dr.Vikas Chauhan, Email address: chauhanvikas2808@gmail.com

Abstract
Stroke is one of the leading causes of death and disability in India. Stroke is heterogeneous group of disorders.
This disease has posed a great problem to the medical field as far as its treatment is concerned. There is a wealth
of information available on the cause, prevention, risk, and treatment of stroke. Even then much, less is known
about the treatment of the stroke, there is no any satisfactory and widely acceptable measure for the stroke.
Many studies were being conducted in the field of Ayurveda as well as in contemporary fields for achieving the
better line of management for Cerebro Vascular accident (CVA).
A case study of CVA was admitted, with the complaints of loss of strength in the right side of the body,
associated with drowsiness, difficulty in walking , slurred speech, heaviness of affected side of the body with
pain, stiffness, and bladder incontinence slurred speech and on examination found Glasgow coma scale was
14/15 (E -3, M-5, V-6) and CT scan suggested- Acute hemorrhage in left thalamus and corona radiata and along
with laboratory investigations, case was diagnosed as Pakshaghata with Pittakaphaavruta. Various treatment
procedures like Shirodhara, Shirosthalam, Kayaseka, Nasya, Basti etc. with oral medicines were adopted at
various stages of the disease. There was a remarkable improvement in the subjective and objective clinical
features. Result are encouraging for the further advance research in CVA.
Keywords: Stroke, Ayurveda, Pakshaghata, Cerebro Vascular Accident

Introduction: Case Report

The disease Pakshaghata is explained and well
explored by all the Bruhatrayee’s. The disease is due
to vitiation of Vata Dosha and Sthana Samshraya in
the Khavaigunya, leading to the formation of the
Laxana.i The Chikitsa is mainly to control the Vata
Dosha and it’s based on the Dosha Doshya Vriddi
Kshya, Sama Nirama and Avarana Laxana of the
Dosha and sthana dusti.
The burden of lifestyle disorders are increasing day-
by-day, and stroke is the one among them. It is the 3rd
most cause of death and disability world-wide. In
developing country like India ratio is increasing due
to increase in the ratio of lifestyle disorders. The
world wide incidence has been quoted as 2/1000
population/annum; about 4/1000 in people aged 45-
84 years.ii
A WHO study, in 1990 quoted incidence of mortality
due to stroke in India to be 73/100,000 per Year. In
India the incidence of cerebrovascular disease was
found to be 13/100,000 population/year.6 In stroke
cases 85% of patients suffer from cerebral infraction
and 15% from cerebral hemorrhage and 1.5 times
more often in male than female.iii
Here is a case study of CVA, which has shown a
remarkable improvement with Ayurvedic treatment
and the aim of the treatment was to manage the
disease without further worsening and to provide
better quality of life to the patient with medication.
A patient of 60 years aged, Hindu married male, from
Ckikkamangaluru, Karnataka, having following
complaints was brought to Kaya Chikitsa (General)
Outpatient department of Sri Dharmasthala
Manjunatheshwara College of Ayurveda & Hospital,
Hassan on 6/2/and got admitted on the same day at
4.15pm.
Presenting Complaints:
Patient came with reduced strength in the right upper
and lower limbs, associated with drowsiness,
difficulty in walking, slurred speech, heaviness of
affected side of the body with pain, stiffness and
bladder incontinence since 1 week
History of Present Illness:
As per the statement of the by-stander, he was
healthy before a week and he suddenly fell down
during the bath on 29/1/2016, and complaints of
reduced strength in the right upper and lower limbs
and difficulty in walking associated with drowsiness,
slurred speech, and heaviness of affected side with
pain, stiffness, and bladder incontinence since 1week.
For the same complaints they consulted
multispecialty hospital, took treatment for 5days
(tablet phenytoin sodium 100mg 1 thrice in a day,
tablet telmisartan 40mg 1once in a day, tablet
prazosin 2.5mg 1hs and tablet. clonidine 100mcg 1
thrice in a day) Also, he is a known case of
hypertension since 3 years and he is under
medication for it (tablet. amlodipine 5mg 1bd). So

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 Megha, Vikas and Diwakar: Ayurvedic Management of Pakshaghata (CVA): A Case Study

for the further treatment they came to our hospital  Tone : right lower limb was found to be hypotonic
and got admitted on 6/2/16. (when compared to left lower limb)
Physical examination: Sensory functions are normal
Built, nutritional status, hair, nail of the patient are Gait was hemiplegic.
normal, pallor, clubbing, cyanosis, ictrus,
lymphadenopathy were absent. Blood pressure was Laboratory Investigations:
140/90mm/hg and pulse rate was 80 beats /minute. Hematological investigations was done and found to
Systemic Examination: be normal (within the limits).
Respiratory system-on auscultation, normal bronchio- i.e. Hb was13.2gm% ,Total WBC count was10,500
vasicular sounds heard and no abnormality detected. cells/cmm, ESR was 20mm/hr, neutrophils was
Cardiovascular system- S1 S2 heard and no 60%,monocytes was 02%,eosinophils was
abnormality detected. 07%,platelet count was 2.50 lakhs/cmm, RBC count
Per abdomen was soft, non tender, no organomegally was 5.18 millions /cmm, FBS was 108.8mg/dl and
detected. blood urea was 0.6mg/dl. Urine micrological report
Central nervous system- Higher mental functions shows: pus cells7-8 hpf, epithelial cells 2-3 hpf and
found to be normal. Glasgow coma scale – few bacilli
Eye opening response was 3, verbal response-5 and
motor response, total score - 14/15 Specific investigation-
Motor functions: Computerized tomography scan of head done on
 Power 05/2/16 showed acute hemorrhage in left thalamus
Right Upper and Lower limb- 2/5 and corona radiate, measuring 3.2*2.6 cm
Left Upper and Lower limb- 5/5
 Reflexes Diagnosis and treatment
Deep reflexes such as biceps, triceps, supinator, Case was diagnosed as a Pittakhapavrutta
knee jerk and ankle jerk on affected side (right) Pakshaghata (Cerebrovascular Accident). As per the
were found to be 3/5 and on normal side (left) classics, the treatment was planned according to the
found to be 2/5. Babinski’s sign was positive on Dosha and Sthana dusti as following.
right side.
Table 1: Showing details of treatment given to patient Previous medications were continued along with
our course of treatment
Date Treatment given Observation
6/2/16 1. Shirodhara -
2. Nasya with pinch of Vacha, Pipalli, Maricha, Saindhava,
Hingu, Shunti with warm water.
7/2/16 & 1. Shirodhara . No changes
8/2/16 2. Nasya with pinch of Vacha, Pipalli, Maricha, Saindhava, Appetite- decreased
Hingu, Shunti with warm water. Bowel-not passed
3. Shunti jala 20ml tid, Tongue-coated
Tablet Haritaki 2hs
4. Chandra prabha vati 2tid
5. Laja tarpana 50ml tid,
9/2/16 & Continue 1 to 6 Bowel-not passed
10/2/16 7. Ananda bhairava rasa 1tid 10/2/16
8. Shirostalam with Manjista churna and Shatadhouta appetite –improved
ghrita bowel-passed at evening
9. Physiotherapy
11/2/16 1. Sarvanga Kayaseka with Dashamoola kashaya and Gomootra. Felt lightness of the body on
(revised 2. Shirostalam with Manjista churna and Shatadhouta ghrita 12/2/16
treatment) 3. Matra basthi with Nimbamruta eranda taila-60ml
to 4. Shirodhara with Dashamoola kashaya c/o fever since 13/2/16 night,
13/2/16 5. AB rasa 1tid due to UTI.
6. CP vati 2tid
7. Tablet Haritaki 2hs
8. Laja tarpana 50ml tid,
9. Physiotherapy
14/2/16 Stopped all the treatment (consulted allopathic physician) c/o, Fever and weakness, it
(revised 1. Injection Gramocef 1.5gm iv bd(att) gradually reduced
treatment) to 2. Injection rantadin iv bd
16/2/16 3. Tablet dolo 650mg 1tid (a/f)

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 Megha, Vikas and Diwakar: Ayurvedic Management of Pakshaghata (CVA): A Case Study

17/2/16 1. Tab zifi 200mg 1bd (a/f) Stopped kayaseka

(revised 2. Tab rantac 15mg 1bd (b/f) Bowel – not passed
treatment) and 3. Sarvanga kayaseka with Dashamoola kashaya and
18/2/16 4. Shirostalam with Manjista churna and Shatadhouta
ghrita
5. AB rasa 1tid
6. CP vati 2tid
7. Tab Haritaki 2hs
8. Laja tarpana 50ml tid,
19/2/16 & Continue 1,2,4-8 Bowel –not passed
20/2/16 3. Sarvanga abhyanga with Maha Narayana taila and nadi Catheter was clamped
sweda.
10. Matra basti with Nimbamruta eranda taila.
21/2/16 1. Sarvanga abhyanga with MN taila and nadi sweda. Bowel-passed (after enema)
(Revised 2. Shirostalam with Manjista churna and Shatadhouta ghrita Feels better
treatment) 3. Nimbamruta eranda taila 10ml hs with hot water Strength increasing in right
4. Sukumara kashaya 3tsf tid limbs.
5. Physiotherapy Power – (right upper and
Lower limb) -4/5
22/2/16 Continue 1 to 5 Strength increased gradually.
To 27/2/16 able to stand for 2min
got controlled over the
bladder and catheter was
removed.
28/2/16 Continue 1 to 5 on 29/2/16, able to walk with
To 6.Basti- Anuvasa basti with Amritha prasha ghrita -30ml + support ,able to stand with
8/3/16 Ksheera bala taila -30ml support.
Niruha basti with Mustadi mamsarasa yapana basti.
Hand grip improved. Able to
28 29 1 2 3 4 5 6 7 8 walk with the support.
A N N N N N N N N A Power (right upper and
A A A A A A A A lower limb) +4/5.

tid – thrice in a day, bd- bice a day, CP vati- Chandraprabha vati, AB rasa- Anandabhairava rasa. Contents of Mustadi mamsarasa yapana
basti are Makshika -60ml, Lavana–5grams, Sneha- Amritaprasha ghrita– 40ml, Kalka- Mustadi yapana kalka- 30grams, Kwatha- Mustadi
yapana ksheera paka- 300ml and Mamsa rasa- 100ml.

Results:
The condition of the patient was improved gradually Motor functions:
along with the course of the treatment. Power
Table 2: comparision of power grade
The strength and power of both right upper and lower before and after treatment
limb was increased to +4/5, also tone of the muscle Right (B T) (A T) Left
improved, deep tendon reflex was exaggerated Upper limbs 2/5 +4/5 5/5
(grade-3) and was normal (grade-2) after the course Lower limbs 2/5 +4/5 5/5
of treatment, gait before treatment was hemiplegic
Reflexes
and at the time of discharge it was waddling gait and Table3: comparison of reflexes grade
was able to walk alone with the help of cane. Got before and after treatment
control over the bladder. Over all condition was Affected Side Left (normal
improved. (right) side)
Glasgow coma scale –Eye opening response was 4, BT AT
Biceps 3 2 2
Verbal response-5and Motor response-6 therefore
Triceps 3 2 2
Total score 15/15. Supinator 3 2 2
Knee jerk 3 2 2
Ankle jerk 3 2 2
Babinski’s Positive Negative Negative
sign

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 Megha, Vikas and Diwakar: Ayurvedic Management of Pakshaghata (CVA): A Case Study
Discussion:
The case taken for study was diagnosed as
Pittakhapavrutta Pakshaghata(CVA). Considering the
involvement of doshas i.e. pradhanyata of Pitta,
Kapha, and vata assessed on basis of laxanas. The
treatment was planned according to the Dosha and
Sthana dusti. The Prakupita Pitta dosha got ashraya in
the Rasa-Raktavaha srothas because of Sanga and
Atipravritti type of Srothodusti. The pathological
consequences are seen all over the body, involving
Mamsa, Majja dhatu and the Uttamanga Shiras
Marma. Hence below mentioned treatment plan was
done in keeping intrest of Dosha and Sthana dusti.
As the samprapthi is involved from the Sanjnavaha
Srothas, the Sanjnaprabhodhana Nasyaiv, Shirodhara,
Shirosthalam was planned to treat the Shiro-
Marmabhighata.
The complaints of drowsiness, disturbed sleep got
reduced by 3 days.
As samprapthi of Pakshaghata involving Pitta and
Vata Sthana – Amashaya and Pakwashaya, the
Virechana (Mrudu sneha virechana) with
Nimbhamritta Eranda Taila is practiced to correct the
root pathogenesis, as Nimbhamritta Eranda Taila
does Vata-Pittahara and causes Mrudu Virechana.
Patient got Anulomana of Vata and Shamana of
Prakupita Pitta, resulting in correction of Agni,
Rasavaha, Raktavaha, Annavaha srotodusti
The restoration of vikrita seen in Mamsa and Majja
dhatu was corrected with following treatment
modalities. I.e. Kayaseka with Dhashamoola Kashaya
and Gomutra for 7days, it acts as Vatahara and helps
to restore the function of Sparshanendriya , Deepana
Pachana for 10days and Basthi chikitsa for 10days.
As Basthi is the Ardha chikitsa and main line of
treatment for the Vata Vyadi.
At the end of management, patient got improved in
coordination, consciousness, and regaining the motor
functioning of the body. The patient was able to walk
independently without support. During management,
urinary tract infection was relapsing; hence judicious
management was sought from contemporary science
for the same.
As patient got Anulomana of Vata after virechana,
functions of ApanaVata and Sanjnavaha Srothas are
restored, leading to the relief of urinary incontinency.
Shirodara with Jala was done and Shirothalam with
Manjista choorna and Shatadhouta ghritav as to
treatment Pitta and Sanjnavaha Srothas.
Nasya- Sanjnaprabhodhanartha Nasyavi has been
done with the Sanjnaprabhodana dravyas like of
Vacha, Pipalli, Maricha, Saindhava, Hingu and
Shunti with warm water which stimulates the Sanjna
and dose the Srothoshodhana.
Journal of Ayurveda Physicians & Surgeons (JAPS) | October 2016| Volume 3| Issue 4
Matra basti was planned with the Nimbhamrita
Eranda Tailavii to restore the prasarana of Vata, as it
acts as Tridoshahara especially Vata Khapha
Shamana, Rakta prasadhana, Medohara, Asti Balya,
Srothoshodhana, Lekhana, Kledahara. Here Matra
Basti was adopted because it is is Shukha prada,
Balaya, Srishta malanulomana, as the bala of rogi
was avara.
Kayaseka with Dashamoola Kashaya and Gomutra
was done to relieve the Shoola(pain) and Stambha
(stiffness) caused by Kapha-Vata Doshaviii. It is also
considered as Deepan -Pachana of Aama and acts as
Balya. Shunti jala and Ananda bhairava rasaix was
given as they do Amapachana at the Jataragni and
Dhata level.
Orally, Nimbhamruta Eranda tailax was admistered as
Mrudu Virechana for removal of Avarana of Pitta,
Kapha, and to attain the Prakruta karma of Vata,
Srothoshodhana, Kleda hara. (As it is recommended
for Pitta Kapha mishrita Vata rogas.)xi
Sukumara kashyaxii helps in Vatanulomana and
maintaining the equilibrium of all three doshas and it
is also Apanaanulomana, Mutra marga
visheshtawam, malaanulomana, Srothoshodhana,
Balya, Pushtikara, Vrishya, Rasayana.
Chandraprabha vatixiii is tridoshahara and it also acts
as Balya, Vrushya, Rasayana and it is said to be
Sarvaroga prashamana.
Then at the Kevala Vata avasta, Sarvanga Abhyanga
with Mahanarayana Taila and Nadi Sweda was
adoptedxiv as Mahanarayana Taila acts as Vatahara,
Balya, Vrishya, Shoola prashamaan, Bala Varnakrit
and Ayushyam.xv
Treatment was followed with modified Mustadi
mamsarasa yapana basthixvi, as it is indicated in Vata
vyadi acts as Brhimana, Balya, Mamsabalapradha
and Vrishya.
Conclusion:
Understanding the CVA is done on basis of
assessment of Dosha (Pitta pradhanya Kapha Vata
dosha) and Sthana dusti(Rasa, Rakta, Majja, Mansa)
At first stage of treatment functions of Sanjnavaha
Srothas was restored and Amapachana was done at
the level of Jataragni with adaptation of Moordini
Chikitsa and Amapachana was done for 10days, at
the second stage Amapachana was attend with the
help of oral medication and Kayaseka, and was done
for 10days. Virechana was adopted to restore the
function of Agni, Srotas and Vata Dosha and at the
third stage, pathological consequences seen in
Mamsa-Majja are restored by adopting Abhyanga
and Basti Chikitsa.xvii.
95
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Cite this article as : Megha G, Vikas Chauhan, Diwakar Papurao Joshi : Ayurvedic Management of Pakshaghata
(Cerebrovascular Accident): A Case Study Journal of Ayurveda Physicians and Surgeons (JAPS), Volume 3 Issue 4: 92-96.

Conflict of interest : None, Source of fund: Not declared

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