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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 68-73

Customized Ayurveda approaches in modulating brain injury: A case report


1 Rajeev Ayurveda Hospital, Hassan, Karnataka, India
2 Department of Kayachikitsa and Manasaroga, Rajeev Ayurveda Hospital, A Unit of Rajeev Institute of Ayurvedic Medical Science and Research Centre, Hassan, Karnataka, India
3 Department of Kaumarabrithya, Rajeev Ayurveda Hospital, A Unit of Rajeev Institute of Ayurvedic Medical Science and Research Centre, Hassan, Karnataka, India

Date of Submission25-Aug-2021
Date of Acceptance13-May-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Dr. Govardhan Belaguli
Department of Kayachikitsa and Manasaroga, Rajeev Ayurveda Hospital, A Unit of Rajeev Institute of Ayurvedic Medical Science and Research Centre, Hassan, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_71_21

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  Abstract 


Cerebrovascular stroke is the most common source of neurological debility in the present adult population worldwide. Its manifestation, symptoms, and pathogenesis can be understood with Pakshaghata (~cerebrovascular stroke) in Ayurvedic parlance. This can be managed through Ayurveda principles with appropriate Panchakarma procedures and oral medications. A case of 23-year-old male who was diagnosed with sudden severe stroke of totally dependent and severe disability with intracranial acute hematoma and hemorrhagic abnormalities was successfully treated with planned Ayurveda interventions. Significant improvement in the degree of disability was found and the interventions modulated him into partially dependent and moderate disability. The minimal strategic intervention used resulted in the significant recovery in overall quality of life. Consequently, the study validates that the treatment planned with Ayurveda principles along with suitable Panchakarma therapies and oral medications has a potential role in the management of Pakshaghata.

Keywords: Cerebrovascular stroke, Pakshaghata, Panchakarma


How to cite this article:
Nithin S A, Belaguli G, Mohan K. Customized Ayurveda approaches in modulating brain injury: A case report. J Ayurveda Case Rep 2022;5:68-73

How to cite this URL:
Nithin S A, Belaguli G, Mohan K. Customized Ayurveda approaches in modulating brain injury: A case report. J Ayurveda Case Rep [serial online] 2022 [cited 2022 Oct 4];5:68-73. Available from: http://www.ayucare.org/text.asp?2022/5/2/68/348701




  Introduction Top


Cerebrovascular stroke is the most common source of neurological debility in the present adult population worldwide.[1] Its frequency increases with age, and is higher in men than women.[2] The portrayal of the clinical signs and symptoms of cerebrovascular stroke can be understood with the Pakshaghata (~cerebrovascular stroke) in Ayurveda science. The disease Pakshaghata has been registered among the eighty forms of Vata vyadhi (~disorders of Vata).[3] The manifestations of Pakshaghata can be managed through appropriate Panchakarma (~five intensive treatment modalities) procedures along with suitable internal medicines as described in the classics,[4] and rehabilitation therapies through Ayurveda are reported to be credible options in the rehabilitating stroke survivors holistically.[5] Majority of the patients were found to benefit not only in self-efficacy domains but also in the domains of positive health behaviors and emotional well-being. Inpatient rehabilitation facilities have been reported to foster patient abilities to cope with such disabilities. It was also noted that the follow-up cases after three months of composite treatment plan of Ayurvedic oral medications and Panchakarma procedures significantly improved existing neurological deficits and quality of life.[6]

A case of traumatic brain injury due to a road traffic accident, managed with Ayurveda after initially been kept under modern neurological care, showed encouraging outcomes. The whole course of Ayurvedic therapy began two weeks after the initial trauma, continued for about three months, and resulted in coma reversal with near-complete recovery.[7]

Studies have also established the importance of Panchakarma procedures along with Ayurvedic internal medications improving quality of life of individual suffered with stroke.[3]

Adopting Ayurveda procedures like Abhyanga was well tolerated in self-selected patients who were one month post stroke. These self-selected patients improved faster in standing and had better locomotion at discharge. Various medicated oils used here restored internal homeostasis, promoting recovery. It promoted faster gains possibly by either modulating interneuron activity promoting spasticity or improving selective voluntary motor control. It was believed that the Abhyanga modulated the unregulated alpha moto-neuron overactivity that caused spasticity, yielding better outcomes.[8] All these studies infer about the importance of Ayurveda procedures in the management of stroke and related manifestations.


  Patient Information Top


A 23-year-old male was brought to hospital on May 4, 2021, with fresh complaints of loss of fine movements and cold extremities, excessive sweating of right upper and lower limb, associated with unclear speech for 10 days. Previously, on April 25, 2021, he was diagnosed with cerebrovascular stroke with midbrain and pontine bleed with intraventricular extension. After primary treatments, he was referred to a higher center from there on April 30, 2021. At higher center, he was intubated and was treated with the support of mechanical ventilation in Intensive Care Unit (ICU) for nearly four days. He underwent and was treated symptomatically for multiple uncertain events such as fall in blood pressure, heart rate, impaired oxygen saturation level, and altered sensorium during his stay in ICU, and eventually, he was referred back to home stating high risk of mortality. The worried family members shifted him to hospital on May 4, 2021, for a try with Ayurveda intervention. On his arrival, he was on stature, on Ryle's tube feed, and with Foley's catheter.


  Clinical Findings Top


On noticing, he was severely dehydrated, drowsy, but oriented, cooperative, and was obeying oral commands. His vitals were stable. His central nervous system examination marked right-sided hemiplegia with severe motor and sensory deficits with Glasgow Coma Scale of 13/15 (E3V4M6) and hemiplegic gait. The tone and muscular bulk in the right upper and lower limb was declined and rigid. With the power of 1–2, the reflexes were nil at the right upper limb and extensor plantar reflexes were present at the right lower limb.


  Diagnostic Assessment Top


The degree of disability was measured following Scandinavian Stroke Score,[9] Barthel Index Score,[10] and Modified Rankin Scale.[11] It measured 13 (severe stroke), 0 (total dependence), and 5 (severe disability), respectively. [Table 1] represents the impression of multiple Computed Tomography (CT) brain imaging done.
Table 1: Impressions of brain imaging (CT brain)

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  Timeline and Therapeutic Intervention Top


The advised oral medications (third-generation cephalosporin and racetam anticonvulsant) were continued for five days. Ayurvedic interventions were started from the 6th day (May 8, 2021). The whole treatment schedule opted was based on classical description consisting of topical treatments and oral medications. [Table 2] depicts the external treatment plan, and [Table 3] represents the oral medications. [Figure 1] represents the schematic classification of the intervention.
Figure 1: Schematic representation of the interventions

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Table 2: The external treatment schedule

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Table 3: Oral medications

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  Follow-Up and Outcome Top


The assessments through Scandinavian Stroke Scale, Barthel Index Scale, Modified Rankin Scale and CT imaging of brain were documented as before treatment (on the 0th day – May 8, 2021) and after treatment (on the 45th day – June 21, 2021). The observations and results are provided in [Table 4],[Table 5],[Table 6],[Table 7].
Table 4: Assessment of the intervention with Scandinavian Stroke Score

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Table 5: Assessment of the intervention with Barthel Index Scale

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Table 6: Assessment of the intervention with Modified Rankin Scale

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Table 7: Assessment of the intervention with brain imaging (CT brain)

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  Discussion Top


From an Ayurveda perspective, cerebrovascular stroke is considered Pakshaghata. It is a disease attributed to an aberration of Vatadosha. The diverse treatments advocated in Ayurveda for this disease are to primarily harmonize the aberrant physiology.[12] Acharya Charaka, describes that morbid Vata beholds either side of the body, dries up Sira (~any tubular vessel of the body) and Snayu (~sinew) of that part rendering it lifeless and producing a loss of motor activity with pain and Vakstambha (~impediment of speech/dysphagia).[13] In addition, its pathogenesis can include Margaavarna (~obstruction of channels), Dhatukshaya (~diminution of Dhatu/emaciation), and Vama or Dakshinachestanivritti (~deficit of motor functions in any side of the body).[14] With these, the cardinal features of Pakshaghata can include Chestahani (~deficits in sensory and motor functions), Hasta-padasankocha (~increased muscular tone or rigidity of limbs), Ruja (~pain), Vakstambha, Sandhibandha vimoksha (~weakness of joints), and Sira-snayu-shosha (~wasting of veins and tendons).[15]

There is also a similar theory which states that the disease Pakshaghata is due to vitiation of Vata dosha and Sthanasamshraya (~stage of localization) in the Khavaigunya (~vacant spaces), leading to the formation of the Lakshanas (~symptoms). The treatment plan is mainly to control the aggravated Vatadosha, based on the Dosha-doshya (~combination of vitiated Doshas with weak and prone tissues), Vriddi-kshaya (~increased or decreased Dosha), Sama-nirama (~association or dissociation of Ama with Vatadosha), and Avarana-lakshana (~symptoms occurred due to enveloping Dosha on other) of the Dosha expressed by Sthanadusti (~vitiation of the entire system).[16]

The above two discussions are the most acceptable hypothetical reviews of Pakshaghata. Based on these theories, interventions were planned for the present case. First, in the external therapies, the Agnilepa (~application of special paste made up of medicinal herbs) and Sthanikalepa (~local application of paste of medicines) were used on the dearth right side of the body and on the forehead, respectively. As his aggravated Vatadosha had Avrita (~enveloped) by other two Doshas (Pitta and Kapha), drugs of Agnideepana (~appetizers of metabolic fire), Amapachana (~digestives of undigested toxins), and Srotoshodhana (~cleansers of channels) were selected for the action of neutralizing and scraping out the Avrita dosha. This action created a targeting pathway to treat the single aggravated Vata dosha.

Once this pathway was cleared, a set of Panchakarma therapies were induced to desolate the aggravated Vata dosha. The Snehana (~oleation therapy), Nasya (~medications through nasal route), Basti karma (~medicated enema therapy), Swedana (~sudation therapy), and Mruduvirechana (~elimination therapy) were induced. The drugs that had Brihmana (~restorative measures) and Rasayana (~rejuvenation) properties were selected for the first two therapies. Langhana (~eliminators of excess toxins), Amahara (~scrapers of undigested Ama and Kapha dosha), and Vatahara (~normalizers of the aggravated Vata dosha) properties were selected for the last three sets of treatments. Snehana therapies such as Shiropichu (~a procedure of applying oil on the head using cotton pad), Sarvanga abhyanga (~synchronized whole body massage with medicated oil), and Mukhabhyanga (~facial massage with medicated oil) Swedana therapies like Shashtika shali pinda (~pouch of Oryza sativa L.), Panasa patra (~leaf of Artocarpus heterophyllus Lam.), Sarvanga utsadana (~synchronized whole body massage with medicated powder of Macrotyloma uniflorum (Lam.) Verdc., Hordeum vulgare L., Vigna radiata (L.) R.Wilczek, Cyperus rotundus L., Emblica officinalis L., Terminalia chebula (Gaertn.) Retz, Terminalia bellirica (Gaertn.) Roxb., Trigonella foenumgraecum L., Curcuma longa L. and Brassica juncea (L.) Czern.) with Nadisweda (~sudation using pipe-like instrument) were used. The selection of suitable medicines and the above stipulated sets of treatment [Table 2] and [Table 3] might have resulted in the lubrication, reduction of stiffness, dryness, and rejuvenation to the deficient nerves and muscles.[17] The same set of interventions, mainly Pratimarsha nasya (~low-dose medication through nasal route) and Mukhabhyanga, might have restored his intracranial abnormality. The Pratimarsha nasya helps to expel the vitiated Dosha from the vital center from the body.[18] Thus, it might have uprooted the intracranial abnormality. In the present study, Ksheerabala taila might have acted as Vatahara, Brihmana, Rasayana, and Snehana. At the time of discharge, he was partially dependent with moderate disability. He is currently on regular follow-up with Shamanoushadi (~discharge medicines).


  Conclusion Top


The uncommon nature of the disease in a young adult; the minimal strategic intervention used that resulted in the significant recovery in his overall quality of life was believed to be worth documenting. A 23-year-old young male adult of severe stroke of totally dependent and severe disability with intracranial acute hematoma and hemorrhagic abnormalities was successfully treated with Ayurvedic intervention for 45 days. The peripheral external and internal treatments that had Agnideepana, Amapachana, and Srotoshodana might have helped in scraping out the enveloped Pitta and Kapha dosha from vitiated Vata dosha. Once vitiated Vata dosha was left alone, the sets of Panchakarma treatments and oral medications might have helped as Brihmana, Rasayana, Langhana, Amahara, and Vatahara. This action might have resulted in lubrication, reduction of stiffness, dryness, and rejuvenation to the dearth nerves and muscles, resolving the intracranial hemorrhage. There was a significant improvement in his degree of disability as per the Scandinavian Stroke Score, Barthel Index Score, and Modified Rankin Scale; it measured 51, 55, and 4, respectively, after the intervention. His concluding CT brain notified the normal intracranium. At the time of discharge, he was honored with refurbished nervous system, normal brain, and increased quality of life.

Recommendations

Subsequent to the conclusion, the study certifies that the planned treatment of suitable Panchakarma therapies and oral medications based on Ayurveda principles has a nontoxic and proficient role in managing Pakshaghata. Although the evidence obtained here is derived from a single sample, a robust design for large samples can be drawn to guide the practitioners, scholars, and the patients from the present study. The prerequisite for considering the efficacy of this type of study is still vital and is recommended for suitable advanced researches.

Acknowledgment

The authors are obliged to the patient and his family members for their prized consent, endurance, and kind support. The authors also extend their salutation to the entire hospital staff that directly or indirectly revitalized the willpower of the patient.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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