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“Effect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke” Dr. Mane Shankar Lahuraj, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD

“Effect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke” Dr. Mane Shankar Lahuraj, Department of Kayachikitsa, PG unit Dr.BRKR Govt. Ayurvedic College, HYDERABAD

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  • 1. EFFECT OF MᾹṢᾹTMAGUPTᾹDĪ YOGA VASTI IN PAKṢᾹGHᾹTA w.s.rTO ISCHAEMIC STROKE.Dissertation submitted as partial fulfillment for the award ofAYURVEDA VACHASPATIDOCTOR OF MEDICINE (Ayu)PAÑCAKARMABYDr. MANE SHANKAR LAHURAJ B.A.M.SGuideDr. A. SANKAR BABU M.D (Ayu)Professor & HODDEPARTMENT OF PAÑCAKARMATIRUMALA TIRUPATI DEVASTHANAMSS.V. AYURVEDIC COLLEGE, TIRUPATIDr. NTR UNIVERSITY OF HEALTH SCIENCES,VIJAYAWADA, A.POctober, 2012 Regd No. 24/88/10
  • 2. Faculty of AyurvedaDr. N.T.R. UNIVERSITY OF HEALTH SCIENCESVIJAYAWADA, ANDHRA PRADESHPOST GRADUATE DEPARTMENT OF PAÑCAKARMATTDs’ S. V. AYURVEDIC COLLEGETIRUPATICERTIFICATEThis is to certify that the dissertation entitled “Effect ofMāṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke”is a bonafide research work done by Dr. Mane Shankar Lahuraj under myguidance and supervision as partial fulfillment for the award of the degreein AYURVEDA VACHASPATI– DOCTOR OF MEDICINE (AYURVEDA) inthe specialization of Pañcakarma.I recommend that the thesis may be forwarded to the adjudicatorsfor evaluation.GuideDr. A. Sankar BabuM.D (Ayu)Professor & HODDepartment of PañcakarmaS. V. Ayurvedic College, Tirupati
  • 3. Dr. N.T.R. UNIVERSITY OF HEALTH SCIENCES,VIJAYAWADA, A. PDEPARTMENT OF POST GRADUATE STUDIES IN PAÑCAKARMATTDs’ S.V. AYURVEDIC COLLEGE, TIRUPATIDECLARATIONI hereby declare that the dissertation entitled “Effect ofMāṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke”is a bonafide and genuine research work carried out by me under theguidance and supervision of Dr. A. Sankar Babu, Professor & HOD,Department of Pañcakarma, S. V. Ayurvedic College, Tirupati.Date: Signature of the CandidatePlace: Dr. Mane Shankar Lahuraj
  • 4. IIॐ नमो वेंकटेशाय IILORD VENKATESWARATIRUMALA TIRUPATI DEVASTHANAMSTIRUPATIवेङ्कटाद्रि समं स्थानं ब्रह्माण्डे नास्स्ि द्रकञ्चन् |वेङ्कटेश् समो देवो न भूिो न भस्वष्यस्ि ||
  • 5. INDEXSr. CONTENTS PAGE No.1ACKNOWLEDGEMENT i2ABBREVIATIONS iii3LIST OF TABLES AND GRAPHS v4INTRODUCTION 15REVIEW OF LITERATURE 46DRUG REVIEW 1187MATERIALS AND METHODS 1398OBSERVATIONS & RESULTS 1459DISCUSSION 15910SUMMARY & CONCLUSION 17011BIBLIOGRAPHY 17412ANNEXURE 180
  • 6. iACKNOWLEDGEMENTI humbly bow my head on the feet of LORD DHANVANTARI and LORDVENKATESHWARA for bestowing their blessings on me.It is beyond the reach of any language to communicate my pure, warm, sweetand bright flame of gratefulness to my loving, grandfather Vithoba YashavantMane, grandmother Sonubai Vithoba Mane and parents, uncle, aunty whose love,encouragement and blessings have been the source of inspiration which directs metowards the progress and success in each and every sphere of my life.It is great pleasure for me to express my gratitude with profound respect tomy guide Dr. A. SANKAR BABU, Professor and HOD, Post GraduateDepartment of Panchakarma, S.V. Ayurvedic College, Tirupati, who was theinspiring force throughout this research work. His constant inspirations,encouragement, support and affection throughout the preparation of thisdissertation gave me considerable impulsion in achieving the milestone.I deeply owe a favor and sincerely pay gratefulness to Dr. P. MURALIKRISHNA, Reader, Post Graduate Department of Panchakarma, S.V. AyurvedicCollege, Tirupati, for pooling in his experience and co-ordinate skills to reach thedesired goal.I would like to extend my thanks Dr. V. LAKSHAMANA PRASAD,Lecturer and Dr. K. HARSHAVARDHAN APPAJI, Lecturer, Post GraduateDepartment of Panchakarma, S.V. Ayurvedic College, Tirupati for their support.I convey my sincere thanks to Dr. RAJAIAH, Principal, S.V. AyurvedicMedical College, Tirupati and Dr. PARVATHI DEVI, Superintendent, S.V.Ayurvedic Hospital, Tirupati for providing necessary facilities during my study.
  • 7. iiI express my deep sense of gratitude to my Dr. Pankaj Pathak, Dr. DeepakSwain, Dr. Nitin Srivastava and Dr. Arif for their suggestion and care is theenergetic force of my life.My heartiest gratitude extends to all the teachers of this institute whohelped me in one or the other way.I avail this opportunity to express my cordial thanks to my colleaguesDr. Abhishek, Dr. Suneetha, Dr. Himabindu, Dr.Vrushali, Dr. Reena Jaiswal,Dr. Sagar, Dr. Khushal, Dr. Praveen for their support.I am very much thankful to the staff of library, laboratory, pharmacy andhospital unit for their kind co-operation, which was very much necessary for thesuccessful completion of this work.At last I express my thanks to each & every person who are directly orindirectly associated in the smooth completion of this work.DATE: Dr. MANE SHANKAR LAHURAJ
  • 8. iiiLIST OF ABBREVIATIONABBREVIATIONAfter treatment ATAṣṭāṉga Hṛdaya, Cikitsā Sthāna AH.Ci.Aṣṭāṉga Hṛdaya, NidānaSthāna AH.Ni.Aṣṭāṉga Hṛdaya, Sutra Sthāna AH.Su.Aṣṭāṉga Saṉgraha, Cikitsā Sthāna AS.CiAṣṭāṉga Saṉgraha, Nidāna Sthāna AS.Ni.Aṣṭāṉga Saṉgraha, Sutra Sthāna AS.Su.Before treatment BTBhaisajya Ratnāvalī BR.Bhela Saṃhitā, Cikitsā Sthāna Bhel.Ci.Bhela Saṃhitā, Nidāna Sthāna Bhe.Ni.Bhela Saṃhitā, Śārīra Sthāna Bhe.Śā.Bhela Saṃhitā, Sutra Sthāna Bhe.Su.Cakradatta CD.Caraka Saṃhitā, Cikitsā Sthāna Ca.Ci.Caraka Saṃhitā, Kalpa Sthāna Ca.Kal.Caraka Saṃhitā, Nidāna Sthāna Ca.Ni.Caraka Saṃhitā, Śārīra Sthāna Ca.Śā.Caraka Saṃhitā, Siddhī Sthāna Ca.Si.Caraka Saṃhitā, Sutra Sthāna Ca.Su.Caraka Saṃhitā, Vimāna Sthāna Ca.Vi.Central Nervous System CNSCerebrovascular accident CVAEnteric Nervous System ENSGram gmHypertension HTNKāsyapa Saṃhitā, Kalpa Sthāna Kā.Kal.Kāsyapa Saṃhitā, Khila Sthāna Kā.Khi.Kāśyapa Saṃhitā, Sutra Sthāna Kā.Su.
  • 9. ivKilogram kgLower Motor Neuron LMNMādhava Nidāna MN.Rasaratnasamucchaya RRS.Śabda Kalpa Drum SKD.Śāraṉgadhara Saṃhitā, Madhyama Khaṉda Śā.M.K.Śāraṉgadhara Saṃhitā, Purva Khaṉda Śā.P.K.Standard deviation S.D.Standard error of mean S.E.M.Subarachnoid Hemorrhage SAHSuśruta Saṃhitā, Cikitsā Sthāna Su.Ci.Suśruta Saṃhitā, Nidāna Sthāna Su.Ni.Suśruta Saṃhitā, Śārīra Sthāna Su.Śā.Suśruta Saṃhitā, Sutra Sthāna Su.Su.Suśruta Saṃhitā, Uttara Taṉtra Su.U.Transient ischemic attack TIAUpper Motor Neuron UMNVaṉgasena Saṃhitā VS.Vasoactive Intestinal Peptide VIPYears YrsYogaratnākara YR.
  • 10. vLIST OF TABLESSr NAME OF TABLES PAGE NO.1 Table No. 1 – Guna vācak aetiological factors vitiating Vāta 182 Table No. 2 - Nutritional aetiological factors provoking Vāta 193 Table No. 3 - Karma vācaka aetiological factors vitiating Vāta 204 Table No. 4 - Ᾱghāta as an aetiological factor for provoking Vāta 215 Table No. 5 - Psychic (Mānasika) factors vitiating Vāta 216 Table No. 6 - Season and time (Kāla) provoking Vāta 217Table No. 7 - Nidānārthakāri diseases as aetiological factors provokingVāta228 Table No. 8 - Iatrogenic aetiological factors for vitiating Vāta 229 Table No. 9 – Rūpa of Pakshāghāta 2710 Table No. 10 - Sāmānya Cikitsā of Vātavyādhī 4111 Table No. 11 – Specific line of treatment in Pakṣāghāta 4212 Table No. 12 - Clinical picture as per the nature of lesion 5913 Table No. 13 - Causes of neurological deterioration after stroke 8314 Table No. 14 – Properties of Madhu in Ᾱyurveda and in Modern science 10015 Table No. 15 - Characteristics of nozzles complications by their use 10716 Table No. 16 – Characteristics of vasti’s and complications by their use 10817 Table No. 17 – Ingredients of Māṣātmaguptādī Taila 11918 Table No. 18 – Ingredients of Māṣātmaguptādī kwātha churna 12119 Table No. 19 – Age wise distribution 14520 Table No. 20 – Sex wise distribution 14521 Table No. 21 - Religion wise distribution 14622 Table No. 22 – Marital status wise distribution 14623 Table No. 23 – Education wise distribution 14724 Table No. 24 – Occupation wise distribution 14725 Table No. 25 – Deśa wise distribution 14826 Table No. 26 – Ᾱhāra wise distribution 148
  • 11. vi27 Table No. 27 – Built wise distribution 14928 Table No. 28 – Addiction wise distribution 14929 Table No. 29 – Stress wise distribution 15030 Table No. 30 – Śāīra prakṛtī wise distribution 15031 Table No. 31 – Satva wise distribution 15132 Table No. 32 – Vyāyāma śaktī wise distribution 15133 Table No. 33 – Affected limb wise distribution 15234 Table No. 34 – Chronicity wise distribution 15235 Table No. 35 – Past history of disease wise distribution 15336 Table No. 36 – Symptoms wise distribution 15437Table No. 37 – Effect of Māṣātmaguptādī Yoga vasti on subjectiveparameters15638Table No. 38 – Effect of Māṣātmaguptādī Yoga vasti on objectiveparameters15639 Table No. 39 - Overall effect of therapy 169
  • 12. viiLIST OF GRAPHSSr NAME OF GRAPHS PAGE NO.1 Graph No. 1 – Age wise distribution 1452 Graph No. 2 – Sex wise distribution 1453 Graph No. 3 - Religion wise distribution 1464 Graph No. 4 – Marital status wise distribution 1465 Graph No. 5 – Education wise distribution 1476 Graph No. 6 – Occupation wise distribution 1477 Graph No. 7 – Deśa wise distribution 1488 Graph No. 8 – Ᾱhāra wise distribution 1489 Graph No. 9 – Built wise distribution 14910 Graph No. 10 – Addiction wise distribution 14911 Graph No. 11 – Stress wise distribution 15012 Graph No. 12 – Śārīra prakṛtī wise distribution 15013 Graph No. 13 – Satva wise distribution 15114 Graph No. 14 – Vyāyāma śaktī wise distribution 15115 Graph No. 15 – Affected limb wise distribution 15216 Graph No. 16 – Chronicity wise distribution 15217 Graph No. 17 – Past history of disease wise distribution 15318 Graph No. 18 – Symptoms wise distribution 153
  • 13. INTRODUCTIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 1INTRODUCTIONPañcakarma is the back bone of the cikitsā aspects of vyādhī explained inᾹyurvedic classics, as it is most effective and confirmatory therapy that ensures thedisease does not recur. Out of Pañcakarma, vasti is most important as it radicallyextirpates the morbid Vāta, the sole doṣa, responsible for the movements of all doṣas,dhātu and mala within the body and removes doṣas out of all three Rog-mārgas.Caraka appropriately highlighted the glorified designation of vasti - VastiVātaharānām śreṣṭha (Ca.Su.25:40). Conclusively vasti is praised as the „Ardha-Cikitsā‟ or „Sarva-cikitsā‟ by many Ᾱcāryas.In modern world, changing life style leads to vitiation of Vāta, chief amongTridoṣa and dynamic entity of life and locomotion. One of the condition offshoots asa consequence of vitiated Vāta is Pakṣāghāta. Pakṣāghāta has been enlisted amongthe eighty types of Nānātmaja Vāta vyādhīs and is considered to be prominent of allVāta vyādhīs. Its Saṃprāptī evolves in Śiras (head), which is a Mahāmarma. Due tothis devastating and refractory nature of Pakṣāghāta a minimum course of threemonths of appropriate treatment is recommended by Suśruta. Caraka – the founder ofCikitsā scool of thoughts describes Pakṣavadha (Pakṣaghāta) by saying that morbidVāta beholds either side of body, dries up sirā and snāyū of that part rendering it deadand producing Ceṣṭā nivṛttī along with Rūjā and Vākstaṃbha.The description of Pakṣāghāta can be interpreted with Hemiplegia. The strokepatient not only suffers a bodily illness but also go through a severe mental depressionon account of inability to attend daily activities like personal hygiene andmaintenance of his own cleanliness. Such persons irrespective of religion, age, sex orsocioeconomic status, face a very miserable and dependent life. This disease notmakes the person only crippled but also makes him or her burden to the family. If heor she is the only earning member in the family, the family has to suffer with endlessproblems. In such a disease if any help is extended to the sufferer, it will be a greatadvantage to the patient, a good credit to the physician and in turn to the science itself.
  • 14. INTRODUCTIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 2Prevalence:The mortality, morbidity and economic toll of stroke are very impressive. InUnited States, stroke is the third leading cause of death, behind heart disease andcancer and every year about 700,000 people suffer a stroke, where nearly 4.5 millionpersons die from stroke each year. The world wide incidence has been quoted as2/1000 population/annum; about 4/1000 in people aged 45-84 years. The W.H.O.estimates that in 2001 there were over 20.5 million strokes worldwide. 5.5 million Ofthese were fatal.In India the incidence of cerebrovascular disease was found to be 13/100,000population/year in a study conducted at Vellore in 1969-71 and 33/100,000/ year instudy conducted at Rohtak. A WHO study, in 1990 quoted incidence of mortality dueto stroke in India to be 73/100,000 per year. The survival, recovery and ultimateoutcome in stroke patients depends on various variables, out of which important onesare demographic, underlying medical disorders and specific therapy related.Current demographic trends suggest that the Indian population will survivethrough the peak years of occurrence of stroke (age 55-65 yrs) and stroke survivors inthe elderly with varying degree of residual disability will be a major medical problem.The available data from community surveys from different regions of India forHemiplegia presumed to be of vascular origin indicate a crude prevalence rate in therange of 200 per 100,000 persons. Thus, the anticipated costs of rehabilitation ofStroke-victims will pose enormous socio-economic burden on our meager health-care resources.Modern medical science attributes this condition as damage to brain or CNSstructures caused by abnormalities in the blood supply. Hemiplegia is defined asparalysis of musculature of the face, arm and leg on one side of the body. It is themost frequent distribution of paralysis in human beings. Hemiplegia is caused by avariety of clinical conditions like cardiovascular disease, trauma, brain tumor andabscess, syphilis, meningitis, etc.Therefore, early diagnosis, intensive treatment and prevention of strokes atany age should be our main strategy in the national health planning About 80% of all
  • 15. INTRODUCTIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 3acute ischemic strokes are from cerebral infarction and 10% of them die within 30days. Among the stroke-survivors, almost 50% will experience some disability. Themain goals of therapy are to rapidly restore and maintain adequate blood supply toischemic tissue with aim to minimize brain damage, and there by minimize neurologicdeficit and disability, and to improve the quality of life after the manifestation ofstroke.Currently ample research is being carried out for alleviating the disease. Newavenues are being explored for treating early ischemic injury by NMDA receptorantagonists, glutamate antagonists, GABA agonists, Ca+channel antagonists, antioxidants, thrombolytic agents etc followed by physical rehabilitation, physiotherapyetc. yet the effect of disease has not been overcome.Taking the above points into mind, its poor prognosis and nature of inertia, thedisease was selected, to find a measure that could help in restoring quality in life ofparalyzed patients. Therefore, the Āyurvedic therapeutics has attracted considerableglamour for providing safe and effective remedies. Numerous researches have beendone time and again to reprove the worth of these medicaments. Yet there is anecessity for perusing further research to find out some safe, effective and cheapremedy.This clinical study include following line of treatment as; Snehapāna,Abhyaṉga, Swedana, Virecana karma, Saṃsarjana krama and then Yoga vasti.According to Vāgbhaṭa, Nirūha vasti has to be administered after Śodhana procedure(Vamana and Virecana). Keeping the facts in mind like prevalence of Ischemicstroke, poor results in Modern science, effective therapy and results in Ᾱurvedicmedicine and the selected line of treatment and drug has not been yet done previously,so this clinical study planned out and entitled as “Effect of Māṣātmaguptādī Yogavasti in Pakṣāghāta w.s.r to Ischemic Stroke”.
  • 16. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 4REVIEW OF LITERATUREA. ᾹYURVEDIC VIEW OF PAKṢᾹGHᾹTAa. HISTORICAL REVIEW:It is natural that knowledge and understanding of any subject progressesgradually, same in the case with Pakṣāghāta. Description of Pakṣāghāta has risensteeply from Vedic Kāla to Saṃhitā Kāla.VEDIC KĀLA (PRE-SAṂHITA PERIOD 10,000 B.C. TO 500 B.C.):Vedas are considered to be the oldest scriptures of the world. ScatteredReferences of Vāta doṣa and disorders related to Vāta are found in these scriptures.Ᾱyurveda has been considered as a offshoot of Atharvaveda as it has substantialdescription of various diseases as well as health topics.In Atharvaveda, five types of Vāta have been listed, namely; Prāna, Apāna,Vyāna, Samāna, and Udāna (A.V.10.2:13). Two drugs have been mentioned inAtharvaveda namely Pippalī (A.V.6.109:3) and Vashanaka (A.V.6.44:33) which havebeen claimed as „Vātakṛtasya Bheṣaja‟ and „Vātakṛta Nāsani‟ respectively.Blumefield interprets the word Vātakṛta, as the disorder caused by Vāta. The wordsPakṣāghāta and Pakṣavadha are not mentioned in Vedas but Aṉgabheda(A.V.9.13.1:22) mentioned in Atharvaveda and Paṉgu (R.V.2.15:7) mentioned inṚgveda indicates the knowledge regarding the Pakṣāghāta related diseases in that era.UPANISHAD:Praśnopaniṣad: In this gatī of Udāna Vāyū and importance of Vyāna Vāyū arementioned.EPIC:Rāmāyana: In this graṉtha importance of Vyāna Vāyū has been discussed in relationto health.Garūda Purāna: Various Vāta prakopa nidāna have been explained.Vishnu purāna: Various gunas of Vāyū have been mentioned.
  • 17. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 5SAṂHITᾹ KĀLA (200 B.C. – 400A.D.):Detailed description regarding Pakṣāghāta has been mentioned by the Ᾱcaryāin the Saṃhitā Graṉthas. Caraka Saṃhitā (2ndcentury B.C.):Pakṣavadha and Pakṣagraha are considered among the ailments ofMadhyama Roga Mārga, i.e., Marma-Asthi-Saṉdhi Mārga (Ca.Su.11:49).Pakṣavadha has been listed under eighty Nānātmaja Vāta Vikāras(Ca.Su.20:11). Detailed description of the disease has been given asPakṣavadha (Ca.Ci.28:53-54). “Swedanam Sneha Saṃyuktam PakṣāghāteVirecanam” is the line of treatment given by Ᾱcaryā Caraka. Jejjaṭa (9thCen.), the noted commentator clarifies that by saying, Swedana and Virecanashould be administered along with Sneha. Gaṉgādhara (19thCen.) commentsthat Snehayukta Swedana and Snehayukta Virecana should be given inPakṣāghāta. It is also described that Pakṣāghāta as one of the Upadrava ofVrana (Ca.Ci.25:29). The description of Ᾱrdita by Ᾱcaryā Caraka(Ca.Ci.28:38-42) raises doubt regarding differentiation of Ᾱrdita fromPakṣavadha or ArdhaṉgaVāta. Cakrapāṇī (11thCentury), popularcommentator of Caraka Saṃhitā clarifies that by explaining Ᾱrtida as“Vegitaya Na Sarvakāla” means episodic but not always and Ardhaṉgavāta as“Sarvakāla Vyāpya” means always maintained. Bhela Saṃhitā (600 B.C.):In Bhela Saṃhitā, Vāta roga Cikitsā is explained in Cikitsā Sthāna andthe word Pakṣagraha is mentioned as one of the Vāta roga. Hārita Saṃhitā (600 B.C.):In 20thchapater of 3rdSthāna, there is a description of Ekāṉgavāyū,Ekāṉga Pakṣāghāta Vāyū and Ekāṉgaroga. Suśruta Saṃhitā (2 A.D.):In the first chapter of Nidāna Sthāna, aetiopathogenesis, clinicalfeatures and prognosis of Pakṣāghāta have been described. The role ofUrdhvagāmī, Adhogamī, and Tiryaga Dhamanī in the pathogenesis of
  • 18. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 6Pakṣāghāta has been shown. Lakṣana anyatara Pakṣahanana, Saṉdhibaṉdhana vimokṣa has been added here. Treatment of Pakṣāghāta has beendescribed in Mahāvāta Vyādhī Adhyāya of Cikitsā Sthāna (Su.Ci.5:19).Suśruta has highlighted Vāta Vyādhī among Aṣṭa Mahāgada (Su.Su.33:4/1)Commentator Ḍalhana interprets that Akarmanyatā as Iṣatkarmakṣayaas partial loss of function, where patient is unable to maintain stance and tendsto fall. He interprets Acetanā as Alpacetanā, referring to partial loss ofsensation. The novel part is mention of specific Nidāna of Pakṣāghāta viz.excessive sexual indulgence and a totally different line of treatment ofPakṣāghāta not given anywhere else. There is also mention of specificduration of treatment viz. 3 months.SAṈGRAHA KĀLA (400 A.D. - 1500 A.D.): Aṣṭāṉga saṉgraha (6thCen.):In Aṣṭāṉga saṉgraha, the general Nidāna of Vāta Vyādhī, signs,symptoms and prognosis of Pakṣāghāta has been given in 16thchapter ofNidāna Sthāna. There is separate description of Rūpa and Sādhyatāsādhyatāalso. The treatment has been highlighted in Cikitsā Sthāna, 23rd chapter. Aṣṭāṉga Hṛdaya (7thCen.):In Aṣṭāṉga Hṛdaya, Pakṣāghāta has been described in 15thchapter ofNidāna Sthāna and 21stchapter of Cikitsā Sthāna. The term Anyatara Pakṣanāsha has been used here and interpreter Arūnadatta (11thCen.) interpretsword Anyatara as right or left side of the body. Line of treatment is same asthat given by Caraka with the only difference that Sneha is mentioned insteadof Swedana. Kāśyapa Saṃhitā (6thCen.):Pakṣāghāta has been listed among 80 types of Nānātmaja Vāta Vyādhīin this Saṃhitā (Kā.Su.27:28). It is also included in the list of persons fit forSwedana (Kā.Su.23:22). More details of Pakṣāghāta are not found in theavailable edition of this Saṃhitā.
  • 19. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 7 Mādhava Nidāna (7thCen.):Mādhava Nidāna is considered to be the most authentic text ofᾹyurvedīc diagnostics. Pakṣāghāta has been described in detail here. Generaldescription of causative factors, pathogenesis, signs and symptoms of all VātaVyādhī is found in 22ndchapter. In addition to the general symptoms ofPakṣāghāta, Pitta and Kapha anubaṉdha lakṣana have also been described.Interpreter Vijaya Rakṣita (14thCen.) has differentiated Pakṣāghāta fromAdharāṉga Vāta by giving illustration of „Ardhanārīśwaravat‟ to the formerand „Narsiṃhavat‟ to the later. Cakradatta (11thCen.):Majority portion of this graṉtha deals with the treatment of various,diseases. Vāta Vyādhī Cikitsā has been described in details in 22ndchapter.Some formulations have been indicated for the treatment of Pakṣāghāta andamong them Māṣātmaguptādī yoga has been selected for the present study. Vaṉgasena Saṃhitā (12thCen.):The 60thi.e., Vātavyādhyādhikara, chapter deals with the pathogenesis,prognosis, symptomatology of Pakṣāghāta. Prognosis is described in detail.Sneha, Swedana, Virecana is the line of treatment given here. Vasti describedfor Ᾱkṣepaka has been described to be administered in Akshīna patient ofPakṣāghāta. Śāraṉgadhara Saṃhitā (13thCen.):In this Saṃhitā, very little description is found regarding the disease.Pakṣāghāta has been enumerated among the 80-Vātik Nānātmaja disorders(Śā.P.K.7:107). Some formulations of Pakṣāghāta have been mentioned inMadhyama Khaṉda (Śā.M.K.2:92; and Śā.M.K.2:142.) Bhāvaprakāśa (16thCen.):Following the footprints of Mādhavakara, detailed description has beenpresented by Bhāvaprakāśa. (BP.M.K.24:205-207, 262-263).
  • 20. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 8 Yogaratnākara (17thCen.):Description similar to that of Mādhava Nidāna is found in the VātaVyādhī Nidāna chapter. Formulations of Pakṣāghāta are also indicated. Bhaiṣajya Ratnāvalī (18thCen.):This text deals mainly the only the treatment of various diseases.Detailed Cikitsā of Vāta Vyādhī has been described in the 26thchapter namedas Vāta Vyādhī Cikitsā. Some drug formulations have also been indicated forPakṣāghāta. In other treatises i.e. Kalyānakāraka of Ugrādītyācaryā (9thCent.),Cikitsākalikā by Tisatācaryā (10thCent.), Śodhal‟s Gada Nigraha (12thCent.),Rasa Ratna Samuccaya 21stchap. (13thCent.) etc., a synoptic description isfound as presented in the earlier classics.REVIEW OF PREVIOUS RESEARCH WORK:Govt. AKhaṉdananda Ᾱyurveda College, Ahmadabad (Dept of Kaya Cikitsā) Yagnik A K - Pakṣāghāte Snehapānam (1989). Arora (Ms) P N - A clinico-comparative study of Vasti Cikitsā and Snehapānain the management of Pakṣāghāta (1995). Goyal. D R - A clinical study of Bṛhad-Rasona Rasāyana in the managementof Pakṣāghāta (1999). Durkal Krūpali A – A comparative study of Śodhana-Pūrvaka Śamana(Virecana) and Śamana Cikitsā in the management of Pakṣāghāta (2004).S R K Toshniwal Ᾱyurveda Mahavidyalaya, Akola (Dept of Kaya Cikitsā) Bhujabale S K – Study on Pakṣāghāta and its management with Mātrā-vasti,Pratimarśa Nasya and Śiro-Pichu (2004).A V Samiti’s Ᾱyurveda Mahavidyalaya (Dept of Kaya Cikitsā) Sudhir Raj N – A clinical study on Pakṣāghāta (2003).
  • 21. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 9H G Institute of P G E & R A, Paprola (Dept of Kaya Cikitsā) Gagan Thakur - A clinical evaluation of Pañcakarma therapy in managementof Pakṣāghāta (2004).Dr. BRKR Govt. Ᾱyurveda College (Dept of Kaya Cikitsā) Shrivastava L - Pakṣāghāta par Sahacara ka Ᾱbhyaṉtara evam BāhyaPrayoga (1988). Deshmukha A - Therapeutic effect of Śuddha Viṣamuṣṭi with Śodhana Karmaand physiotherapy in selected cases of Pakṣāghāta (1982). Vivekananda - A clinical study of effect of Ṣaṣṭikaśālī Piṉda-Sweda onPakṣāghāta (1986). Sreenu G – A clinical study of effect of Yogarāja Guggulu followed byMāṣātmaguptādī kwātha along with Virecana Karma in Pakṣāghāta (1994). Shivasankara Prasad – A clinical study of the effect of Ṣaṣṭikaśālī Piṉda-Sweda with physiotherapy and Mahāyogarāja Guggulu with Rāshnadi kwāthaon Pakṣāghāta (1995). Peddinti Raghu – The effect of Yoga-vasti in Pakṣāghāta (1997). Guruprasad V – The study effect of “Swedanam Sneha SaṃyuktamPakṣāghāte Virecanam” (2000). Sudhakar Rao G – A study of effect of Gaganādi vati with Śiro-vasti in themanagement of Pakṣāghāta (2002). Rdukondalu G - A clinical evaluation of Khaṉjanikarī rasa in Pakṣāghāta(2004).I P G T & R A, G A U, Jamnagar(Dept of Rasashastra and Bhaiṣajya Kalpana) Patel V C – Rasa-Mānikya (with a study on Shvāsa and Pakṣāghāta) (1967).Dept of Kaya Cikitsā Shinde B P – Pakṣāghāta (1964). Devgan (Ms) K R - Pakṣāghāta Nidāna-Cikitsātmaka Adhyayana (1973). Sadhu V R – Pakṣāghāta (1975).
  • 22. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 10 Bhatt Bheema – “Swedanam Sneha Saṃyuktam Pakṣāghāte tu Virecanam”(the effect of treatment especially on muscle power and tone loss) (1979) Shreekanth V - Studies on some systemic effects of Vasti w.s.r. to Gṛdhrasi,Vishvāci and Pakṣāghāta (1984). Malagi K J - A comparative study on the role of Virecana & Bṛhat-Vātacintāmanī Rasa in the management of Pakṣāghāta (hemiplegia) (1985). Desai K R – Comparative study on the efficacy of Bṛhat- VātaCintāmani Rasaon the Pakṣāghāta (1987). Sivaramakrishna K - A study on Ᾱyurvedic management of SakaṃpaPakṣāghāta (paralysis agitans) (1989). Panwar K S - A clinical study on Carakokta management of Pakṣāghāta(hemiplegia). Goyal Ravikant - A clinical study on the role of Karma-vasti, Māṣādī Kwātha& Māṣādī Taila in the management of Pakṣāghāta (1994). Pandya Ashutosh R - A comparative study of Virecana Karma and Sraṉsanain the management of Pakṣāghāta (2003). Sahu Dushtidev- A clinical study on Pakṣāghāta due to cerebrovascularaccident and its Upaśayātmaka managemant Gajanan Kulkarni- Yāpana vasti & Karma vasti in Pakṣāghāta (CVA)- Kāyacikitsā (2007).Diploma in Pañcakarma Sahoo S C - A comparative study in the role of vasti & Jalaukāvacarana inthe management of Pakṣāghāta (1997).Dept of Kaya Cikitsā PH D Patel A K - Pakṣāghāta mein Cikitsā ka Prayogika Adhyayana (1983).NIA, JaipurDept of Kaya Cikitsā Gupta R S - Pakṣāghāta Roga Vimarsha Nidāna- Cikitsātmaka Adhyayana(Shatāvaryādī Guggulu Prayoga) (1975). Chandra T - Pakṣāghāta mein Ardhāṉga-Vātāri Rasa ka CikitsātmakaAdhyayana (1987).
  • 23. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 11 Narain S – “Sa Kṣaudram Grathite Rakte Lihyat Pārāvata Shakṛta”(Pakṣāghāta ke Parīprekṣya mein) (1992). Upadhyay D N - Pakṣāghāta Roga mein Vāta-Rākṣasa Rasa evamCharakokta Śaṃsodhana Karma Ka Tulanātmak Cikitsākīya Adhyayana(1993). Soni S - A Clinical Evaluation of Daśmūladi Kshīra- Vasti in the managementof Pakṣāghāta with an astrological analysis (2002).Dept of Basic Principles Yadava A – Śaṃśodhana Cikitsā Vijñanīyam “Pakṣāghāte Virecanan” keParīprekṣya mein (1988).Govt. Ᾱyurvedic Medical College, Lucknow (Dept of Kaya Cikitsā) Satyavan – Development of Ᾱyurvedic regimen for the management ofPakṣavadha (2002).Govt. Ᾱyurvedic Medical College, Mysore (Dept of Kaya Cikitsā) Cidananda - Evaluation of classical line of treatment in Pakṣāghāta (1992). Chandrakala S – Management of Pakṣāghāta – An observational study (2002).Govt. Ᾱyurveda Mahavidyalaya, NagpurDept of Kaya Cikitsā Kodwani - Pakṣāghāta ka Saiddhāṉtika Vivechana (1991).Dept of Roga Nidāna Rajiv M – Pakṣavadha Vyaādhi ka NidānᾹtmāka evam Viṛiti-VijñānātmakaAdhyayana (1993).Shree Ᾱyurveda Mahavidyalaya, NagpurDept of Rasashastra Khiyani Rajkumar – Malla-Sindūra Nirmāna evam uska Pakṣāghāta parPrayoga: Ek Adhyayana (1995).Dept of Saṉskṛta, Saṃhitā and Siddhanta
  • 24. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 12 Bedarkar R P – Virecana ki Saṃhitā Granthon mein Vivechana evam“Swedanam Snehasaṃyuktam Pakṣāghāte Virecanam” – ka VisheshaAdhyayana (1995).Dept of Kaya Cikitsā Thayaru P M – “Snehana Sweda Saṃyuktam Pakṣāghāte Virecanam” (1998).Dept of Pañcakarma Pandey A K – Māṣa Taila vasti ka Pakṣāghāta mein Prabhāva ka AturalayeinAdhyayana (2000).University of Pune Khare N B - Pakṣāghāta Vyādhī (1983). Yadaiya P - Studies on Bāla-Pakṣāghāta (poliomyelitis) & its management byPañcakarma therapy (PH D THESIS)Gopabandhu Ᾱyurveda Mahavidyalaya, Puri (Dept of Kaya Cikitsā) Mishra H P - Study on the effect of Hingu-Triguna Taila in the treatment ofPakṣāghāta (1991).Govt. Ᾱyurveda College, Raipur (Dept of Kaya Cikitsā) Vishwakarma A - Clinical study of the effect of Virecana and vasti onPakṣavadha with scientific evaluation (1985).Govt Ᾱyurveda College, Trivandrum (Dept of Kaya Cikitsā and Pañcakarma) Indirabai Amma B - Effect of Virecana in Pakṣāghāta (1979). Vinodkumar - Effect of Śiro-vasti and Nasya in Pakṣāghāta (1981). Dodamani B R - A study on the effect of Pañcasneha in Pakṣāghāta (1985). Sarala M - Clinical Observation of Pakṣāghāta and its treatment with Kāla-vasti using Sahacarādi Taila (1986). Srimilas - Clinical assessment of Vāta-Vidhvaṃsi Rasa in the management ofPakṣāghāta Soman P R - Study on Laśuna Rasāyana w.s.r. to Pakṣavadha (1992).
  • 25. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 13 Mahadevan L – Management of hemiplegia with special emphasis on aphasiawith selected treatment modalities in Ᾱyurveda (1996). Joshi J R – A critical assessment of Satva in hemiplegic Patients (1997).SDM College of Ᾱyurveda, Udupi (Dept of Kaya Cikitsā) Devgirikar VaiŚalī Pandurang – A comparative study of effect of Saṃśodhanaand Saṃśamana in Pakṣāghāta (2004).
  • 26. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 14b. ᾹYURVEDIC CONCEPT OF PAKṢĀGHĀTA:I. NIRUKTĪIn Saṉskṛt language each word is considered to be Śaktī Swarūpa and behindthe word its meaning invariably entangles. The word Pakṣāghāta also bears ameaning that is hallmark of the disease itself, as explained hereby. In the Ᾱyurvedicliterature the words, Pakṣāghāta and Pakṣavadha have been used as synonyms.Pakṣāghāta has been derived as a Śaṣṭhi Tat purūṣa samās, viz.: -„Pakṣasya Ᾱghātaḥ Iti Pakṣāghātaḥ ||.‟In the above synonyms, word Pakṣa is common but the suffixes, viz. –Ᾱghāta, Ghāta and Vadha vary. To know the exact meaning of word Pakṣāghāta it isimportant to know the meaning of these terms. This word is composed of two padai.e. „Pakṣa‟ and „Ᾱghāta‟, detailed meaning is as under.i. Pakṣa:Derivation – Pakṣa eva kāyati kai ka (Vach.) It is of masculine genderand its various meanings are as follows in different texts. Dehāṉgama - Part of the body (Shabdakalpadrum) Parśwa - Side (Vachaspatyam) Dehārdha - half of the body (Vachaspatyam) Dehāṉgabheda - different parts of the body(Vachaspatyam) Pakṣa Sharirārdham - half of the body (Ḍalhana) Pakṣa Ardha Nārīśwaravat (VijayaRakṣita) Bāhu Kakṣā Parśvādībhāgam (VijayRakṣita) The flank or side or the half of anything, a limb or member ofthe body (Monier Williams) Flank, side, half, alternative (Mcdowell). The flank or side of a man or animal; half of anything; a limbof the body. (V.S.Apte)
  • 27. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 15Ᾱcārya Caraka has used the Pada „Pakṣa‟ in different contexts. It hasbeen used for describing 15 days, wing of bird and one side of the body.Ᾱcārya Suśruta has used this „Pada‟ while describing the diseasePakṣāghāta. Ḍalhana has commented on this by rightly saying it as PakṣamSharīrārdham.Aṣṭāṉga Saṉgraha and Aṣṭāṉga Hṛdaya have also used this pada whiledescribing the disease Pakṣāghāta, the meaning of Pakṣa being taken as oneside of the body. Mādhava Nidāna has also incorporated the pada Pakṣa inPakṣāghāta. VijayaRakṣita the commentator of Mādhava Nidāna explains it asArdhanārīśwaravat giving a clear idea about terminology used.In contemporary literature like Śāraṉgadhara Saṃhitā, Bhāvaprakāśaand Yogaratnākara the word Pakṣa have been used with meaning of half ofthe body during the description of Pakṣāghāta. We can conclude doubtlesslyfrom the foregoing description that word “Pakṣa” depicts one side of the body.ii. Ghāta:It is of masculine gender and is derived as below: Han + dhaṉj (Vachaspatyam) Han + Vich + Bhave + Lyut (Halayudh Kosha)The suffix Ghāta of the word Pakṣāghāta has also been used in termslike Mutrāghāta, Marmāghāta, etc.Various meanings are:- Hanan – to kill (Halayudh kosh) Vadha – to kill (Halayudh kosh) Hanaṉti Māryati iti – killing (Halayudh kosh) Prahāre Mārne – to kill with a blow (Vach.) Prahār – a blow, stroke, an assault (Shabdakalpadrum)iii. Ᾱghāta:This is masculine gender, derived as Aa + han + dhaṉj
  • 28. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 16Various meanings:- Vadhe – to kill (Vach) Ᾱhanne – to kill (vach) Hanan – to kill (Shabdakalpadrum)iv. Ghāta & Ᾱghāta:A blow; to kill, stroke, killing, destruction (V.S. Apte, M. MonierWilliams and A. A. Macdonell). Hence it is observed that both the suffixesGhāta and Ᾱghāta bear the same meaning.v. VADHA:Term Pakṣavadha is also used as a synonym of Pakṣāghāta. It is ofmasculine gender and is derived as follows –Hananam iti, Han + Ap, Vadhadesha. (Shabdakalpadrum)Various meanings of Vadha are as follows: Prāna Viyoga Phalaka Vyāpāra - Shabdakalpadrum Killing, Destruction, Stroke, Paralysis - Monier Williams Destruction, Blow, Kililing, Stroke, Paralysis - V. S. Apte.Thus, the etymology of Pakṣāghāta goes like this; Pakṣāsya Dehārdhasya Ghātam vināśanam yasmāt yatrava(SKD.). Pakṣasya Ᾱghātaḥ iti Pakṣāghātaḥ Pakṣasya Ghātaḥ iti Pakṣāghāta Pakṣasya vadhaḥ iti Pakṣavadha Pakṣāghāta, Pakṣavadha – Palsy or paralysis of one side ofbody Hemiplegia (V. S. Apte) Pakṣavadha – Paralysis of one side (V. S. Apte)
  • 29. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 17From all the above description we can draw the bottom line that themeaning of word Pakṣāghāta is loss of function of one half of the body and itsmodern homologue is Hemiplegia.II. CLASSIFICATION OF PAKṢĀGHĀTAWhile describing the prognosis of Pakṣāghāta, Ᾱcaryā Suśruta has classifiedthe disease in three types as per their aetiopathogenesis (Su.Ni.1:63). The three typesof Pakṣāghāta are as follows;i. Śuddha Vātaja Pakṣāghāta: The Pakṣāghāta where the Vāta isaggravated on account of its own Nidāna.ii. Anyadoṣa Saṃśṛṣṭa Pakṣāghāta: Where the Vāta is associated withother doṣa to manifest the disease. Ᾱcaryā Suśrūta has used the termsSamanvita, Saṃśṛṣṭa, Anvita and Saṃyukta as synonym of Ᾱvarana inthe context of description of Ᾱvarana.iii. Kṣaya Hetuja Pakṣāghāta: Where the Vāta is aggravated as aconsequence of dhātu Kṣaya.Dhātu Kṣayajanya Pakṣāghāta has again classified as two types by ᾹcaryāGayādās as, Sonitatisṛtīkṛta dhātu Kṣayajanya Pakṣāghāta and Balvadvigrahaditadhātu Kṣayajanya Pakṣāghāta.III. NIDĀNAThe word Nidāna carries two meanings in Ᾱyurvedic classics, viz - causativefactors and diagnosis. The former one will be discussed here.Nidāna is defined as the factors, which cause the disease (Ca.Ni.1:7).Treatment becomes easier by knowing the causative factors of a disease. In this lightit has been clearly stated that „Nidāna Parīvarjanam‟ is one of the Cikitsā. Accordingto Ᾱyurveda, consideration of etiological factors is important for the diagnosis,prognosis and line of treatment.With the review of Ᾱyurvedic literature it is evident that no specificaetiological factor has been described separately for Pakṣāghāta. Disorders of Vāta,including Pakṣāghāta have been classified as Nānātmaja Vāta Vyādhīs, so all the
  • 30. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 18factors vitiating Vāta in the body are likely to be the root cause of Pakṣāghāta. Hence,the general causative factors of Vāta vyādhī or factors vitiating Vāta doṣa in the bodymay be regarded as the aetiological factors of Pakṣāghāta as well. Though thecausative factors remain same in all Vāta vyādhīs, different forms appear likePakṣāghāta, Gṛdhṛsī, etc. This is because of the Saṃprāptī viśeṣa of vitiated Vāta.As there are mainly three routes for aggravation of Vāta which are;i. Svanidānajanya Vāta prakopa: The Vāta gets provocated due to theindulgence in its own Nidāna.ii. Mārgavarajanya Vāta prakopa: The normal functions of Vāta depends onthree factors viz, Avyahata Gatī, Vāta to be seated at its own natural site, Vātato be remains in its normal quantity and quality. When there is obstruction ofpath of the Vāyū by other doṣa or Dūṣya the Avyahata Gatī of Vāta ishampered and Vāyū get provocated called as Mārgāvarajanya Vāta Prakopa.iii. Dhātu Kṣaya Janya Vāta Prakopa: When there is Dhātu Kṣaya, theredevelops some emptiness in the srotas which gets filled by Vāyū and Vāta getaggravated, called as Dhātu Kṣaya Janya Vāta Prakopa.Svanidānajanya Vāta Prakopa results in the manifestation of Śuddha VātajaPakṣāghāta. Mārgāvaranajanya Vāta Prakopa results in the manifestation of AnyaDoṣa Saṃśṛiṣṭa Pakṣāghāta and Dhātu Kṣayajanya Vāta Prakopa leads toKṣayahetuja Pakṣāghāta.The Nidāna of Vāta Vyādhī and Vāta prakopa given in Ᾱyurvedic texts havebeen classified here under eight main headings, which are tabulated below.Table No. 1 - Guna vācak aetiological factors vitiating VātaSr. NIDĀNA Ca. Su. AS. AH. BP. MN. Śā. CD. YR.1 Rukṣa + + + + + + + + +2 Śita + + + - + + + - -3 Laghu + + - - + + + - -4 Kaṭu - + + - + - - + +5 Tikta - + + + + - - + +6 Kaśāya - + + + + - - + +
  • 31. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 197 Dārūna + - - - - - - - -8 Khara + - - - - - - - -9 Viśada + - - - - - - - -Table No. 2 - Nutritional aetiological factors provoking VātaSr NIDĀNA Ca. Su. AS. AH. BP. MN. Śā. CD. YR.1 Alpa/Pramita Anna + - + + + + + - -2 Laghu Anna + - + - + + + - -3 Laṉghana + - - - - + - + +4 Abhojan/Anaśana + + - - + + - - -5 Viṣamāśana - + - - + - - + +6 Adhyaśana - + - - - - - - -7 Viṣṭaṃbhī - - - - - - - - -8 Śuṣka Śāka - + - - - - - - -9Vallur (ŚuṣkaMāṃsa)- + - - - - - - -10 Varaka(Kudhānya) - + - - - - - - -11 Uddālaka - + - - + - - - -12 Kora Dūṣa - + - - - - - - -13 Shyāmāka - + - - + - - - -14 Nivāra - + - - + - - - -15 Mudga - + - - + - - - -16 Masūra - + - - + - - - -17 Ᾱdhaki - + - - + - - - -18 Harenuka - + - - - - - - -19 Niṣpāva - + - - + - - - -20 Kalāya - + + - - - - - -21 Khesari(Triput) - - + - + - - - -22 Canaka - - + - + - - - -23 Makuṣṭha - - - - + - - - -24 Varāti - - - - + - - - -25Mangalya(MasuraBheda)- - - - + - - - -26 Satin(Kalāya - - - - + - - - -
  • 32. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 20Bheda)27Bhukte hi AjīrneAshanam- - - - + - - - -28 Bisa, Śaluka,Tinduka- - + - - - - - -29 Karīra, Kaliṉga,Jāṃbava- - + - - - - - -Table No. 3 - Karma vācaka aetiological factors vitiating VātaSr NIDĀNA Ca. Su. AS. AH. BP. MN. Śā. CD. YR.1 Ativyāyāma + + + + + + - + +2 Ati Prajāgarana + + + + + + + + +3 Laṉghana + + + - + + - - -4 Plavana + + - - - + + - -5 Pratārana - + + - + - + - -6 Atiadhva + - + - - + - - -7 Ativiceṣṭā + - - - - + - - -8 Dukhaśaiya + - - - - - - - -9 Dukha-Asana + - - - - - - - -10 Diwāswapna + - - - - - - - -11 Atiadhyayana - + + - - - - - -12 Pradhāvana + - + - - - - - -13 Bhāravahana - + - - - - - - -14 Vegasaṉdhārana + + + + + + + + +15 Uccabhāśana - - + + - - - - -16 Gajāticarya - + + - - - - - -17 Turaṉgātīcarya - + - - - - - - -18 Ratha aticarya - + - - - - - - -19 Pada aticarya - + - - - - - - -20 Ati Yāna - - - - - - - + +21 Śaityatā - - - - + - - + +22 Ati Śrama - - - - + - + - -23 Truṣita - - + - - - - - -24 Kṣudhitāmbupāna - - + - - - - - -
  • 33. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 21Table No. 4 - Ᾱghāta as an aetiological factor for provoking VātaSr.NIDĀNACa.Su.AS.AHBP.MN.Śā.CD.YR.1 Abhighāta + + + - + + + - -2 Marmāghāta + - - - - + - - -3 Balvad Vigraha - + + - - - - - -4Prapatan- Gaja, Ashwa,Atiucca Patanam+ + - - + + - - -5 Prapidana/Prahār(Dandādi)- + - - - - - - -6Damya govajigajnigraham- - + - + - - - -7Ashma/Śila/Louha/KaśṭhaUtkṣepa,Vikṣepa,Bhramana,Calana- - + - - - - - -Table No. 5 - Psychic (Mānasika) factors vitiating VātaSr. NIDĀNA Ca. Su. AS. AH. BP. MN. Śā. CD. YR.1 Cintā + - - + + + + + +2 Śoka + - + + + + + + +3 Krodha + - - - - - - - -4 Bhaya + - - + + - + + +5 Kāma + - - - + - + - -6 ApravṛttaVegodirana- - + + - - - - -Table No. 6 - Season and time (Kāla) provoking VātaSr NIDĀNA Ca. Su. AS. AH. BP. MN. Śā. CD. YR.1 Pravāta - + - - - - - - -2 Griṣma Aṉte - - + + - - - - -3 Jīrna Aṉte - + - - - - + - -4AhorātriAṉte- - + + + - - - -5 Śiśira ṛtu - - - - + - - - -6 Varṣa ṛtu - + + - + - - + +7 Pradoṣe - - - - - - - - -
  • 34. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 228 Bhukta Aṉte - - - + - - - - -9 Śita Kāla - + - - - - - - -10 Abhra - + - - - - - - -11PrabhātaKāla- + - - - - - - -12 Aparāhnam - + + - - - - - -13 Himam - - - - + - - - -14 Prāgvāta - - + - + - - - -Table No. 7 - Nidānarthakāri diseases as an aetiological factors provoking VātaSr NIDĀNA Ca. Su. AS. AH. BP. MN. Śā. CD. YR.1 Dhātu Kṣaya + - - - + + + - -2RogātīKarṣanam+ - - - - + - - -3 Ᾱma + - - - + + - - -4Gadakṛt atiMāṃsa Kṣaya- - - - + - - - -5 Mārgasyāvarana - - + + + + - - -Table No. 8 - Iatrogenic aetiological factors for vitiating VātaSr NIDĀNA Ca. Su. AS. AH. BP. MN. Śā. CD. YR.1 Viṣama Upacāra + - - - - + - - -2 Ati Doṣa Sravana + - - - - + - - -3 Ati Asṛka sravana + - + - + + - - -4Kriyāti Yoga/Vamana Virecanaatiyoga- - + + + - - - -i. Guna vachaka aetiological factors vitiating Vāta: The qualities of Vāta as described in Ᾱyurvedic texts are Rukṣa, Laghu, Śita,khara, Sukṣma, cala (AH.Su.1:11/1). According to the principles of Ᾱyurveda,Sāmānya is the cause of increase and Viśeṣa is the cause of decrease of allthings at all time. (Ca.Su.1:44). Hence excess intake of the above gunayuktaᾹhāra causes Rukṣata, Laghutā, Śitalatā, Dārūnatā, kharatā in the body and
  • 35. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 23when body gets affected by these gunas, Vāyū makes its place in the body andeventually it becomes aggravated (Ca.Su.12:7). Excess intake of Ᾱhāra having Kaṭu, Tikta and Kaśāya rasa causes vitiation ofVāta (Ca.Su.1:66). Excessive ingestion of Kaṭu rasa causes Bala Kṣaya, Bhrama and on accountof having Vāyū and Agni Mahābhuta in preponderance, it generates variouskinds of Vāta disorders in the legs, arms, sides and back along with giddiness,pain etc. (Ca.Su.26:43/4). In Pakṣāghāta also leg, arm and sometimes face ofone side of the body is affected by Vāta. Tikta rasa when taken in excess causes Śoṣa of Rasa, Rakta, Māṃsa, Meda,Asthi and Majjā dhātu and produces many Vāta disorders by virtue of Rukṣa,khara and Viśada guna (Ca.Su.26:43/5). Kaśāya rasa is khara, Viśada and Rukṣa. Its atiyoga causes various Vātadisorders like Pakṣavadha, Ᾱrdita, etc. (Ca.Su.26:43/6).ii. Nutritional aetiological factors provoking Vāta: Anaśana or Alpāśana reduces Bala, Varṇa, Upacaya and Vīrya; impaireseight Sāra, Śarīra, Mana, Buddhī, and Iṉdrīyas and is cause of Vāta vyādhī(Ca.Vi.2:7). Atimātrā bhojana leads to vitiation of all three doṣas. These doṣas reside inthe kukṣī and produce various disorders. Among them vitiated Vāta producesSira saṉkucan, staṃbha, etc. (Ca.Vi.2:7). Abhojana, Ajīrna bhojana, Atibhojana, Viṣamāśana leads to Agni dūṣyatā(Ca.Ci.15:42-44). This impairs the production of Rasa dhātu and thus resultsin Kṣaya of subsequently produced dhātus. This dhātukṣaya causes Vātaprakopa. Ᾱma is produced by Ajīrnāśana and adhyaśana (Ca.Vi.2:12). This Ᾱma doṣaobstructs the path of Vāyū (mārgāvarana) which results in vitiation of Vāta(Ca.Ci.28:59). Kordūṣa, Shyāmāka, Nivāra etc., being kudhānya varga dravyas, vitiates Vātaby their Rukṣa guna and Kaṭu Vipāka. Biḍāl varga dravyas like Mudga,Masūra, Makuṣṭha, Canaka, Kalāya etc. vitiates Vāta by their Kaśāya rasa,Kaṭu Vipāka and Śita guna. These dietary habits, from the nutrition point of
  • 36. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 24view, are less nourishing, making body weak and the nervous system moreirritable and produce various nervous disorders.iii. Karma Vācaka aetiological factors vitiating Vāta: Excessive sexual indulgence makes the body Rukṣa (Ca.Su.22:29) and this isthe cause of Vāta prakopa. Ativyavāya causes Śukra dhātu Kṣaya and thisleads to Kṣaya of all dhātus according to the theory of Pratiloma Kṣaya. Thisdhātu Kṣaya results in Vāta prakopa. Ᾱcaryā Caraka mentions Balanāsha,Ekāṉga and Sarvāṉga roga, Manoavasāda, etc. doṣas due to Ativyavāya(Ca.Si.12:14/8) and indirectly pointes towards Pakṣāghāta. Ᾱcaryā Suśrutahas clearly mentioned excessive sexual indulgence as the direct cause ofPakṣāghāta. (Su.Ni.1:62). Atijāgaran / Rātrijāgaran increase the Rukṣa guna in the body (Ca.Su.21:50)and there by vitiates Vāta. Diwāswapna causes Arūci, Avipāka, Agnināśa etc. (Ca.Si.12:14/7). This leadsto Ᾱma production and results in Ᾱvaranjanya Vāta prokopa. Suppression of natural urges produces the symptoms of Vāta prakopa andVāta vikāra, for example, suppressing the urge of Apāna Vāyū causes manyVāta vikāra. (Ca.Su.7:12).iv. Trauma (Abhighāta) provoking Vāta: Ᾱcaryā Cakrapāṇī says that Abhighāta can be of two types – Doṣābhighātaand Marmābhighāta. Head is considered as a vital part (marma), the seat ofIṉdriya and Prāna (Ca.Su.17:12). Śiromarmāghāta causes diseases likeᾹrdita, Manyāstaṃbha, Spaṉdana, Svarahānī and Ceṣṭā-Nāsha etc.(Ca.Si.9:6), which are seen in Pakṣāghāta. Injury to Lohitākṣa marma causes loss of blood and leads to Pakṣāghāta.Injury to Kakṣādhara marma also causes Pakṣāghāta (Su.Śā.6:25). Abhighāta,Balvad vigraha, Prapatana, Prapīdana, etc. cause Acaya purvak Vātaprakopa.
  • 37. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 25v. Psychic (Mānasika) factors vitiating Vāta: Emotional stress of mind, i.e., Kāma, Krodha, Bhaya, Cintā etc., leads to Vātaprakopa and production of several psychosomatic disorders. Vāta ispredominant in Rajo guna (Su.Su.21:28). Psychic causes, which arepredominant of Rajo guna, will vitiate Vāta and in turn cause Vāta Vyādhī. Mana is Ubhayeṉdriya. Both the Iṉdrīyābhigraha and Karma are governed byManas (Ca.Śā.1:21). Abnormality in Manas causes‟ disturbance in above saidfunctions and leads to Pakṣāghāta. In a person suffering from Cintā, Śoka etc., the Mātrā yukta Pathya Ᾱhāra isalso not digested properly (Ca.Vi.2:9) leading to Ᾱma formation andAgnimāṉdya. This can lead to Mārgāvarodhjanya Pakṣāghāta.vi. Season and time (Kāla) provoking Vāta: The cyclic effect of season, time, day-night, temperature produce a rhythmiceffect on human body. The doṣas of the body are also affected. Griṣma, Varṣa,Śiśira seasons and Bhuktāṉte, Jīrnāṉte, end of day and night are the Kāla forvitiation of Vāta. All Saṃhitās unanimously accepted the dominancy of Vātadoṣa in the later age of life. This concept delivers a rule that old people aremore vulnerable to the Vāta disorders.vii. Nidānarthakara diseases provoking Vāta: Disease which acts as the causative factor for other disease is known asNindānarthakara Roga. Dhātukṣhaya, Ᾱma, Rogātīkarṣana, etc., comes underthis category because they vitiate Vāta and causes various Vāta disorders. Ᾱmacauses Mārgāvaranjanya Vāta prakopa. Ᾱma when combines with Vāta (Vātasaṃśṛṣṭta Ᾱma) leads to many Vāta Vyādhīes (Ca.Ci.15:48).viii. Iatrogenic (Cikitsā apacāraja) induced Vāta prakopa: Vitiation of Vāta due to improper management may be treated as acomplication of therapies. Excessive use of Pañcakarma, Rakta Mokṣana etc.causes excessive loss of body elements, malas which leads to riktatā ofsrotasa and in turn provokes Vāta. Ᾱcaryā Caraka quotes that Vāta gets
  • 38. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 26vitiated either by dhātukṣaya or Mārgāvarana (Ca.Ci.28:59). We can see thatall the above said factors vitiate Vāta either by causing dhātukṣaya or byobstructing the normal gatī of Vāta.IV. PURVARŪPAAccording to Ᾱyurveda clinical features of a disease are divided into two parts,Purvarūpa and Rūpa. Before full-fledged manifestation of disease, the symptomswhich are developed in the initial stage with the localization of doṣas in a particulararea of the body are called Purvarūpa (Ca.Ni.1:8). These symptoms are exhibitedduring the Sthānasaṃśraya avasthā of Ṣaṭakriyākāla of the disease (Ca.Ni.1:8,Cakranpāni). Treatment of the disease at this stage may stop from the progression ofdisease. Purvarūpa of Pakṣāghāta is not described in any text. Pakṣāghāta, being aVāta vyādhī; Purvarūpa of Vāta vyādhī can be taken as that of Pakṣāghāta.Ᾱcaryā Caraka mentions Avyakta lakṣana as the Purvarūpa of any VātaVyādhī (Ca.Ci.28:19). Ᾱcaryā Cakrapāṇī has interpreted the term „Avyakta‟ as theRūpa presented in lesser degree (Ca.Ci.11:12/2, Cakrapāṇī). VijayaRakṣita gives veryclear meaning of the term Avyakta. According to him the symptoms that are notmanifested clearly are Purvarūpa and these are due to;Less severe causative factors, very less or mild symptoms, less Ᾱvarana ofdoṣas (MN.1:5-6, Madhu.)VijayRakṣita has designated Avyakta lakṣanas under viśiṣṭa Purvarūpas(MN.1:5-6, Madhu). Purvarūpa will be manifested more, when the doṣa getprovocated through usual route of Saṉcaya, Prakopa and Prasara. This type ofprovocation is found in Swanidānajanya or Śuddha Vātaja Pakṣāghāta. But in case ofᾹvaranajanya the Vāyū is not get provocated through the route of Saṉcaya, Prakopaetc. rather the Vāyū get provocated suddenly due to Ᾱvarana so Purvarūpa are notfound in Ᾱvaranajanya Pakṣāghāta.
  • 39. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 27V. RŪPAWhen the disease is fully established there is full clinical manifestation, this iscalled Rūpa of the disease (Ca.Ni.1:9). The characteristic symptoms and signs appearclearly in the 5thKriyākāla, i.e., Vyakta avasthā of the disease.Various symptoms according to different Ᾱcāryas give us detailed descriptionabout the symptomatology of Pakṣāghāta which are tabulated below:-Table No. 9 – Rūpa of PakṣāghātaSr SYMPTOMS Ca. Su. AH. MN. BP. VS. YR.1Sharīrārdha Akarmanyatā/Chesta nivṛttī+ + + + + + +2 Pakṣa Hanan + + + + - + +3Ardhakāya vicetanā/Sharīrārdha acetanā- + + + + + +4 Anyatara Pakṣa vimokṣa - + - - - - -5 Saṉdhi baṉdhan vimokṣa - + + + + + +6 Rūjā + - - - - - -7 Vākstaṃbha + - - - - - -8 Hasta Pada saṉkocha + - - - - - -9 Toda + - - - - - -10 Śūla + - - - - - -11 Kaṃpa - - - - - - -Doṣānubaṉdhita Lakṣanas12 Dāha/Saṉtāpa/Murccha - - - + + + +13 Śaitya/Ś0tha/Gurutā - - - + + + +i. Śarīrārdha Akarmanyatā / Chestā nivṛttī: Akarmanyatā i.e. Loss of function of half Part of the body is called asŚarīrārdha Akarmanyatā and Chestā Nivṛttī means incapability to do normalmovements of body parts, which is the characteristic feature of Pakṣāghāta.Aggravated Vāta gets Aśraya in the Urdhva, Adha and Tiryak Dhamanī leadsto Viśoṣa of Sirā and Snāyū, Vimokṣa of Saṉdhī/; and thus leading toPakṣāghāta. (Su.Ni.1:60-62).
  • 40. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 28 Ᾱcārya Ḍalhana interprets „Akarmanyatā‟ as „Iṣatkarmakṣayam‟ i.e. partialloss of function of half of the body. He says that when there is Akarmanyatāpatient tends to fall. VijayRakṣita specifies „Ardha‟ as Ardhanārīśwarvatmeans affection of one side of body while „Pakṣa‟ as „Bāhu, Kakṣā, PārśvādiParts‟. Anyatara means left or right half; and Akarmanya as Iṣatceṣṭākṣamaḥa.(MN.22:39-40, Madhu.) Arūnadatta while commenting gives the meaning of Akarmanya as lessstrength to perform the activities. (AH.Ni.15:39- Arūnadatta). By the above explanation Cestā Nivṛttī can be revealed in two form; IśatkarmaKṣayam (Partial loss of function - Hemiparesis) and Akarmanyatā (Total lossof function - Hemiplegia). This Akarmanyatā is mainly due to vitiation of Prāna and Vyāna Vāyū. Themain seat of Prāna Vāyū is Mastiṣka and is the controller of Buddhī, Hṛdaya,Iṉdrīya and Citta. (AH.Su.12:4). All types of movements occur due to properfunctioning of Karmeṉdrīyas, which are governed by Prāna Vāyū. Hence, inPakṣāghāta, the abnormality in the motor function (Ceṣṭānivṛttī) is due toimpaired function of Prāna Vāyū. The Vyāna Vāyū controls the circulation of Rasa and Rakta and is alsoresponsible for various types of movements, viz., Gatī, Prasarana, Ᾱkuṉcanaetc. In abnormality of Vyāna Vāyū, various movements of the body are eitherdiminished or lost completely. Hence by the vitiation of Prāna and VyānaVāyū, loss of voluntary functions of one side of the body takes place. Akarmanyatā may be ascribed to Śoṣa of Sirā and Snāyū due raised levels ofRukṣa, Śita, Khara gunas of Prāna Vāyū and a fall in the levels of cala gunaof Vyāna Vāyū. Pittāvṛtta Vyāna leads to Ceṣṭā saṉga (AH.Ni.16:44/1).Udānāvṛtta Vyāna leads to Ceṣṭā hani (Ca.Ci.28:214). Pittāvṛtta Vyāna resultsin gātravikṣepa saṉga and Kaphāvṛtta Vyāna leads to gatīsaṉga(Ca.Ci.28:227-228). Snāyūgata Vāta causes Ekāṉga or Sarvāṉga Roga(Ca.Ci.28:35).
  • 41. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 29ii. Ardhakāya vicetanā / Śarīrārdha acetanā: Cetanā means sensation or consciousness and acetanā means loss of sensationor consciousness. The term acetanā has been used by Suśruta and vicetanā byVāgbhaṭa. Ḍalhana interprets the word acetanā as alpacetanā means partial diminutionof sensation. He further says that the presence of this feature raises themortality. (Su.Ni.1:62, Ḍalhana). Gayādās interprets it to be complete loss of cetanā. Todara explains vicetanāas Iṣatsparśa jñāna, i.e., less sensation. Another commentator Caṉdratā interprets it as Vigata saṉjña which meansloss of consciousness. VijayaRakṣita opinion on Vicetanā is partial diminution of sensation, wheretactile etc. sensory functions are maintained to some extent (MN.22:40Madhu). By the sannikarṣa of Ᾱtmā, Manas, Iṉdrīya and their artha, jñana orperception of sense is produced. (Ca.Su.8:12). Hence when there is alterationin this pathway or in Mastiṣka – center of Jñaneṉdrīyas, sensory impairment isproduced. Acetanā/Vicetanā is caused by vitiation of Prāna and Vyāna Vāyū. Sensationis the function of Jṉaneṉdriya and vitiation of Prāna Vāyū leads toPañcajñaneṉdriya Upaghāta (AH.Ni.16:19-20). Vitiation of Vyāna Vāyūleads to Aṉga suptatā (loss of tactile sensation) (AH.Ni.16:23-24).iii. Saṉdhi baṉdhana vimokṣa: Suśruta and Vāgbhaṭa have described this symptom. Saṉdhi baṉdhanavimokṣa means losseness or laxation of joints. As per the description given by Suśruta, when vitiated Vāyū travels throughUrdhvagāmī, Adhogāmī and Tiryaga Dhamanī, it loosens the Saṉdhibaṉdhana. Gayādās interprets word Dhamanī as Snāyū. (Su.Ni.1:61, Gayādās). Saṉdhī baṉdhana is maintained by Snāyū and Śleṣaka Kapha in particular(AH.Ni.15:39, Toḍarmala).
  • 42. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 30 Vimokṣa is viśiṣṭa mokṣa, i.e., laxation of Snāyū. Vimokṣa meansŚlathanikarana (Hemādrī) or vimocayan (Ḍalhana), i.e., sublaxation ordislocation of joints on the affected side. This may be due to fall in the level ofSnigdha guna of Kapha due to rise in the Rukṣa guna of Vāta. In Modern science, sublaxation of shoulder is described as a complication ofstroke.iv. Vākstaṃbha: This symptom is mentioned by Ᾱcaryā Caraka only in reference toPakṣāghāta. Vak means speech and staṃbha means to stop, to arrest, to cease,etc. Hence obstruction in speech or loss of speech is Vākstaṃbha. Four typesof deformities of speech have been described in classics, viz. Mukatva,Gadagadatva, Minminatva and Vāksaṉga. According to the Saṃprāptī,anyone can occur. Vākstaṃbha results due to vitiation of Prāna and Udāna Vāyū. Vākpravṛtti isone of the important functions of Udāna Vāyū (Ca.Ci.28:7). Due toabnormality of Udāna Vāyū patient may suffer from this complaint. Kaphāvṛtta Udāna results in Vakgraha. (Ca.Ci.28:224).v. Rūjā: It is an associated symptom of Pakṣāghāta which is found on the affected sideof the body. Ᾱcārya Caraka mentions Rūjā as a symptom of Pakṣāghāta and toda and Sūlaas the symptoms of Ekāṉgaroga. Rūjā means pain and any kind of pain is always associated with Vāyū.(Su.Su.17:12). „Saṉtatā Ruk‟ has been mentioned as a symptom in Asthi-Majjā gata Vāta(Ca.Ci.28:33). In Pakṣāghāta there is involvement of Snāyū and Sirā. When Vāyū getsaggravated in Snāyū, Sūla is produced (Su.Ni.1:27) When Vāyū gets aggravated in Sirā, leads to maṉda Rūjā (Ca.Ci.28:36). Pittāvṛtta Prāna Vāyū also results in Rūjā (AH.Ni.16:42).
  • 43. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 31 Pain present is said to be a good prognostic sign. While describing theprognosis of Pakṣāghāta it has been mentioned that the patient should not betaken for the treatment if there is no pain.vi. Sirā Snāyū Viśoṣa:Ᾱcārya Caraka and Vāgbhaṭa have mentioned this symptom. When Sirā and Snāyū are affected by vitiated Vāyū, due to increased level ofŚita and Rukṣa guna of Vāyū, viśoṣa of Sirā and Snāyū takes place and theseresults in Kṣaya. Sirā Snāyū viśoṣa represents itself as staṃbha (rigidity),hasta pada saṉkocha (contraction), vakrata, etc.vii. Dāha/ Saṉtāpaa/ Murcha:These are the Pittānubaṉdhita lakṣanas of Pakṣāghāta. Ᾱcārya Caraka has stated that though Vāta Vyādhī are Vāta dominantdiseases, still they are accompanied by the association of Pitta and Kapha(Ca.Ci.28:58). Ᾱcaryā Suśruta has clearly stated that when vitiated Vāta comes in associationwith Pitta Dāha, Saṉtāpa and Murcchā are produced (Su.Ni.1:32). Bhāvaprakāśa states that „Dāho Bāhya‟ and „Saṉtāpa Abhyaṉtaraḥ‟. According to Ḍalhana, Dāha, Saṉtāpa, etc. are produced due to increase in thelevel of Uṣṇa guna of Pitta. In Pittāvṛtta Samāna Vāyū, Dāha is found (AH.Ni.16:45/1). In Pittāvṛtta Vyāna Vāyū, Dāha is produced all over the body, i.e., internal aswell as external (AH.Ni.16:43, Arūnadatta). Prāna Vāyū when obstructed by Pitta, Murcha is produced. (AH.Ni.16:42).viii. Śaitya/ Śotha/ Gurutā:These are the Kaphānubaṉdhita symptoms of Pakṣāghāta. When vitiated Vāyū comes in contact with Kapha, Śaitya, Śotha and Gurutāare produced (Su.Ni.1:33/1). Both Vāyū and Kapha have Śita guna. So when
  • 44. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 32both come in contact, the level of Śita guna is increased and Śaitya ismanifested. Vitiation of Vyāna Vāyū results in Śopha (AH.Ni.16:23-24). Gaurava is aproperty of Kapha.ix. Kaṃpa: It is a Vāta Nanātmāja Vikāra due to elevation of Cala guna in particular andalso an associant of Snāyūgata Vāta (Su.Ni.1:27). There is physiological Kṣaya of Śukra in old age persons leading to RasaKṣaya and Vāta prokopa, which manifests as Kaṃpa (AS.Su.19:6).VI. UPAŚAYASuch of the medicines, diets and regimens as bring about happiness either byacting directly against the cause of the disease, and or the disease itself or byproducing such effects indirectly are called Upaśaya (Ca.Ni.1:10). It providesdiagnostic aid for diseases which are otherwise difficult for diagnosis.The specific factors for Upaśaya of Pakṣāghāta have not been pointed out inthe classics. However the factors which are opposite to Nidāna described to be theinitiator of the disease Pakṣāghāta may be understood as Upaśaya for Pakṣāghāta.VII. SaṃprāptīThe process starting right from the vitiation of the doṣa to the completemanifestation of the disease is known as Saṃprāptī. Each and every step from ahealthy state to a diseased one is included in Saṃprāptī. Knowledge of Saṃprāptī isinevitable for Vaidya, because blockage of the pathogenesis at any of the stage willterminate the disease, thereby preventing the mortality and morbidity. Again it shouldbe kept in mind that different regimens are to be applied at different stages.Conventionally the Saṃprāptī can be of two types;i. General or Sāmānya Saṃprāptī.ii. Specific or Viśiṣṭa Saṃprāptī.
  • 45. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 33i. Sāmānya Saṃprāptī of Pakṣāghāta:This is the general Saṃprāptī of Pakṣāghāta common for allVātavyādhī. The Sāmānya Saṃprāptī of Pakṣāghāta according to Caraka Saṃhitā as;due to various etiological factors, Vāta gets vitiated and it fills up the rikta srotas ofthe body causing various kinds of Vātavyādhī, which affects the whole body or somespecific part of it (Ca.Ci.28:18). Besides self provocating Nidāna, Vāyū is alsovitiated by dhātukṣaya and Ᾱvarana in srotasa (Ca.Ci.28:59/1).ii. Viśiṣṭa Saṃprāptī: Caraka Saṃhitā: Vāyū beholds either side right or left of the body, dries upSirā and Snāyū of that part rendering it dead, along with Rūjā andVākstaṃbha. Suśruta Saṃhitā: Excessively agitated Vāta holds on Adhoga, Urdhvaga andTiryaka Dhamanīs, loosens the Saṉdhi baṉdha of either half of the body andrenders it dead (Su.Ni.1:60-62). Here, Ᾱcaryā Ḍalhana comments thatDhamanī of only affected half are involved. Here it comes to notice thatSaṃprāptī described by Suśruta differs from that of Caraka in following twoways; Involvement of Dhamanī is considered instead of Sirā Snāyū. Laxity of Saṉdhī baṉdha is considered as a part of Saṃprāptī. Aṣṭāṉga saṉgraha: Vāgbhaṭa says that Vāyū takes āśraya in half part of thebody, dries up Sirā and Snāyū, loosens Saṉdhi baṉdha and leaves either halfof the body dead (AS.Ni.15:40-42). Mādhava Nidāna and Bhāvaprakāśa:Mādhavakara and Bhāvamiśra have literally followed Vāgbhaṭa(MN.22:39-40; BP.M.K.24:205).Ᾱcārya Caraka has described six types of Saṃprāptī, which aredescribed here in context with Pakṣāghāta.1. Saṃkhyā Saṃprāptī:Various types of a disease are considered under this section. There arethree types of Pakṣāghāta as said in Mādhava Nidāna; Śuddha Vātaja,Pittānubaṉdhi and Kaphānubaṉdhi.
  • 46. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 342. Pradhānya Saṃprāptī:This Saṃprāptī is described by taking in account the Tara-tama bhavaof doṣas. Pakṣāghāta is Nānātmaja Vātavyādhī so, naturally Vāta doṣa isaffected. But even in Vāta, the subtypes chiefly affected are Prāna, Udāna andVyāna Vāyū. Also Pitta or Kapha may be associated in Pittānubaṉdhi andKaphānubaṉdhi Pakṣāghāta respectively.Pakṣāghāta which occurs due to its own causes may be taken asSvataṉtra, while that occurring due to other causal factors like tumor, may beconsidered as Parataṉtra.3. Vidhī Saṃprāptī:Vidhi means variety, but as per Gaṉgādhara, Vidhi means viśeṣana. Kārana Bhedena = Nija, Agaṉtuja. Doṣa Bhedena = Kevala Vāta, Pittānubaṉdha, Kaphānubaṉdha. Sādhyasādyatva Bhedena = Sādhya, Asādhya, Mṛdu, Dārūna. Mode of Presentation = Dhātu Kṣayajanya, Mārgāvaranajanya. Mode of Onset = Sudden, Gradual.Hemiplegia caused due to haemorrhage and embolism is examples ofsudden onset, while that occurring due to neoplasm is of gradual onset.4. Vikalpa Saṃprāptī:This can be taken as Aṃśāṃśa kalpana. Quality of Vāta like Rukṣa,Laghu are called as Aṃśa. In Pakṣāghāta, usually Rukṣa and Śīta guna areincreased while Cala guna is decreased.5. Bala Saṃprāptī:When Nidāna, Purvarūpa, doṣa and dūṣya are profound in number andstrongly involved then disease is said to be of balavāna type.
  • 47. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 356. Kāla Saṃprāptī:Kāla Saṃprāptī is understood in context of age of patient, time ofoccurrence of disease with respect to season, day and night and time ofincrease or decrease of disease.Pakṣāghāta usually occurs after 40 years i.e. during Vāta PrakopakaKāla. Hemiplegia due to embolism usually occurs in young age. Hemiplegiadue to thrombosis usually occurs in Varṣa ṛtu, last part of the day and night.All these are Vāta prakopaka Kāla.Saṃprāptī Ghātaka of Pakṣāghāta: Doṣa: Vāta doṣa (Prāna, Udāna and Vyāna). Pitta and Kapha Anubaṉdhi. Dūṣya: Rasa, Rakta, Māṃsa, Meda, Sirā, Snāyū, Dhamanī and Mala. Srotasa: Rasavaha, Raktavaha, Māṃsavaha, Medovaha srotasa. Srotoduṣṭī: Saṉga = Ischaemic stroke,Sirā graṉtīi = Stroke due to Aneurysms,Atipravṛtti and Vimārgagamana = Haemorrhagic stroke. Ᾱma:When quantum of Agni is decreased, it leads to production ofundigested or semidigested material. This is termed as Ᾱma. This Ᾱmapossesses Snigdha, Picchila guna and it causes obstruction in varioussrotas. Srotorodha further causes vitiation of doṣa. Srotorodha alsohampers nutrition of various dhātus leads to dhātukṣaya(AH.Su.13:25). Agni: Jaṭharāgni, Dhātvāgni. Udbhava Sthāna: Pakwāśaya. Saṉcār Sthāna: Urdhva, Adhah, Tiryak Dhamanī. Adhiṣṭhāna: Ardhaśarīra. Rogamārga: Madhyama.
  • 48. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 36VIII. SᾹPEKṢA NIDĀNASāpekṣa Nidāna is very much important for the diagnosis and treatment. Manydiseases share common symptoms and it is the duty of the physician to demarcatethese resembling diseases.Pakṣāghāta is primly characterized by loss of voluntary movements. Sāpekṣanidāna of Pakṣāghāta in this context with diseases having this symptom is describedas below.i. Pakṣāghāta and Ᾱrdita:All texts have described these two diseases as separate entities. As per Caraka Saṃhitā, Pakṣāghāta vitiated Vāta affecting the function ofone side of the body and constricting the Sirās, afflicts the right or left side ofthe body, producing loss of movement, pain and loss of speech.While Ᾱrdita is due to aggravated Vāta which affects half of the body,arms, knee and causes contraction of these parts. Either half of the face isdistorted or asymmetry of nose, brow, forehead, eye and jaw are produced.Bolus of food doesn‟t go straight into mouth but instead sideways, nose iscurved during speech, eyes do not blink and sneezing is suppressed. Speechbecomes indistinct, stutter. Teeth are loosened and there is pain in ears, eyes,temples, cheeks, hand, calves, thighs and feet. This condition whether it occursalong with paralysis of half of the body or alone with face is called Ᾱrdita orfacial paralysis.Here the symptoms like distortion of face, asymmetry of nose, brow,forehead and eyes are present only in Ᾱrdita and not in Pakṣāghāta. Dṛadhabala adds that after Vegāvasthā in Ᾱrdita, patient returns to normal andif this does not happen then the patient remains afflicted. From this we caninfer that unlike Pakṣāghāta, Ᾱrdita occurs in Vegāvasthā. Cakrapāṇī differentiates Ᾱrdita and Pakṣāghāta by saying that Ᾱrdita isassociated with Vegā whereas Pakṣāghāta is not. Cakrapāṇī has used the termArdhāṉga vyāpi Ᾱrdita for Ᾱrdita and Ardhāṉga Vāta for Pakṣāghāta.
  • 49. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 37 Suśruta Saṃhitā describing Ᾱrdita as neck and half of the face are distorted.Tremors are experienced in face, speech deteriorates and there is deviation ofeyeball. Affected neck, chin and teeth become painful. Commentator of Mādhava Nidāna has used Sāmānya Ardhāṉga Vāta forPakṣāghāta and Viśiṣṭa Ardhāṉga Ghāta for Ᾱrdita.ii. Pakṣāghāta and Ekāṉga Vāta:In Pakṣāghāta, any one side of body is affected whereas in Ekāṉga Vāta anyone of the four limbs is affected. Ekāṉga Vāta can be considered as monoplegia,which occurs due to less space occupying lesion in cortex, on the contrary hemiplegiaoccurs due to involvement at level of pyramidal tract, involving larger area.Vākstaṃbha is an exclusive symptom found in Pakṣāghāta, while HastapadaSaṉkoca and Sirā Snāyū viśoṣa may be present in Ekāṉga Vāta.iii. Pakṣāghāta and Sarvanga Vāta:Sarvāṉga Vāta is characterized by loss of function of whole body. Thus, it iscomparable with quadriplegia or double diplegia or cerebral diplegia. There is loss offunction of both upper and lower limbs. On the contrary in hemiplegia only one sideis affected. In most cases of Pakṣāghāta, functioning of lower limb recovers andpatient is able to walk with little improvement but in Sarvāṉga Vāta the patient iscompletely bed ridden.iv. Pakṣāghāta and Khaṉja-Paṉgu:Khaṉja is characterized by loss of function of anyone lower limb. Patientbecomes lame and walks limping. The lesion is in lumbosacral plexus and so wastingis common, which is rare in hemiplegia (if it occurs it may be due to disuse). Inhemiplegia the lesion is in pyramidal tract and involvement of upper limb usuallypresent.Paṉgu is characterized by loss of function of both lower extremities. This iscomparable with paraplegia. Here also the lesion is essentially in lower motor neuronor other local nerve plexus. There is also loss of control over defecation andmicturition, which are usually absent in hemiplegia.
  • 50. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 38v. Pittānubaṉdhi and Kaphānubaṉdhi Pakṣāghāta:In Kaphānubaṉdhi Pakṣāghāta Śotha, Śaitya and Staṃbha are presentwhereas in Pittānubaṉdhi Pakṣāghāta symptoms of Pitta like Murcchā, Dāha andSaṉtāpa are present.IX. SᾹDHYATᾹ-ASᾹDHYATᾹA physician should have clear idea regarding the prognosis of the diseasebefore starting the treatment. He should know whether the disease is sādhya, kaṣṭasādhya, yāpya or asādhya. Good results are obtained in sādhya Vyādhī, but if thephysician undertakes the treatment of asādhya Vyādhī, he will tarnish his learning andfame (Ca.Su.10:8).Suśruta and Vāgbhaṭa have included Vāta Vyādhī under Mahāgada andaccording to them all the Mahāgada are Duścikitsya by nature (Su.Su.33:4-5;AH.Ni.8:30). Pakṣāghāta being a Vāta Vyādhī is also considered as Duścikitsya. Caraka Saṃhitā: Pakṣāghāta has been classified Yatnasādhya (Kaṣṭasādhya)or Asādhya because of the Gāṃbhirya of the Sthāna involved (Ca.Ci.28:73-74). Commenting on word Gāṃbhirya, Cakrapāni says that, it meansGaṃbhira Sthāna āśraya. Suśruta Saṃhitā: Pakṣāghāta cause by Śuddha Vāta is consideredKaṣṭasādhya, one caused by Saṃśṛṭa doṣa (Pitta or Kapha) as Sādhya and thatcaused by Kṣaya as Asādhya (Su.Ni.1:63). Commenting on word Kṣaya,Gayādās says that this Kṣaya may be of two types; Kṣaya caused by excessive bleeding which is Asādhya. Kṣaya caused by excessive exercise like wrestling isKaṣṭasādhya. Aṣṭāṉga Saṉgraha: Vāgbhaṭa‟s view differs from Suśruta in this subject. Asper him, Pakṣāghāta caused by Śuddha Vāta Kṛcchrasādhyatama(Atikṛcchrasādhya-Indu), that caused by saṃśṛṭa doṣa is Kṛcchrasādhya andthat caused by Kṣaya is Asādhya (AS.Ni.15:43). Mādhava Nidāna: Mādhavakara holds same view as Suśruta but in additionhe says that Pakṣāghāta accompanied by Vedanā nāśa and those of garbhinī,
  • 51. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 39sutikā, bāla, vṛddha, kshīna should not be treated. Pakṣāghāta occurring dueto excessive bleeding should also be discarded (MN.22:43). Bhāvaprakāśa: Bhāvamiśrā has followed Suśruta Saṃhitā in this context.X. CIKITSĀThe term cikitsā is derived from the root “Kit Rogāpānayane” i.e., to adoptmeasures against the disease (Śabdastom Mahanidhī). Ruk pratīkriya, i.e.,counteraction of Rūjā is Cikitsā. Cikitsā aims not only at the radical removal of thedisease but also guides for the restoration and maintenance of normal health. Diseaseis caused by the disequilibrium of the doṣas. Hence different process carried out toachieve equilibrium is termed as Cikitsā (Ca.Su.16:34). According to Ᾱcaryā SuśrutaCikitsā is defined as the removal of the causative factors (Su.U.1/25). Vāgbhaṭadefines it as the disintegration of Saṃprāptī.On the whole all kinds of Vāta vyādhī have predominance of Vāta. So ingeneral Vātahara treatment is good for all of them including Pakṣāghāta. The wordVātahara treatment refers to the use of all kinds of drugs, food and life style, whichhelps to subside Vāta. In Ᾱyurvedic classics the general treatment of Vāta Vyādhī hasbeen discussed in detail. Pakṣāghāta being a Vāta vyādhī, this general Vāta vyādhītreatment is also applicable to it.i. General line of treatment of Vātavyādhī:Ᾱcaryā Caraka has advised Snehana, Swedana, Saṃśodhana and Saṃśamanatreatment for Vāta Vyādhī in general.1. Snehana: The main principle for Snehana is to observe whether Vāta doṣa is vitiatedalone or it is associated with other doṣas and whether it is occluded or not. If there is simple provocation of Vāta without any kind of occlusion, it shouldbe treated at first with oral administration of Snehana like ghee, fat, oil andmarrow.2. Swedana: When samyaka Snehana is done, the patient should be subjected to Swedanatherapy by means of Nadi Sweda, Prastara Sweda, Sankar Sweda, etc., mixedwith snigdha dravyas (Ca.Ci.28:78).
  • 52. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 403. Effect of Sneha Purvak Swedana: Snehana purvak Swedana relieves the symptoms such as Harṣa, Toda, Ruk,Śotha, Staṃbha, Graha, etc. It produces mṛdutā in the body. Even a dry woodis made flexible by proper Snehana and Swedana. Snehana therapy when applied quickly does dhātu poṣana and increases bala,Agni, puṣṭī and life span. The Snehana and Swedana measures should be repeatedly administered inorder that the disorders of Vāta may not stay in the koṣṭha softened bySnehana procedure. These measures are useful in hasta pada Saṉkoca, Ruk, Staṃbha, Viśoṣa,Vakrata encountered in Pakṣāghāta (Ca.Ci.28:79-82).4. Saṃśodhana: If the above measures fail to pacify the disease, then the patient should besubjected to Saṃśodhana. Mṛdu Saṃśodhana is indicated here in the form ofVirecana with medicated ghee prepared with Tilvaka or Satāla or castor oilwith milk. (Ca.Ci.28:83-84). Vātānulomana with Snigdha, Ᾱmla, Lavana, and Uṣṇa drugs is necessary forthe Vāyū which is obstructed by the mala lodged in the strotas. (Ca.Ci.28:85) In weak patients or those contraindicated for Virecana, Nirūha vasti should begiven followed by Dīpana and Pācana drugs. (Ca.Ci.28:86) Virecana has been described as a Śodhana measure by almost all the Ᾱcaryāsfor Pakṣāghāta. In case of Vāta vyādhī caused by Ᾱvarana, the Ᾱvaraka doṣa should be takeninto consideration. When Vāta has the Ᾱvarana of Pitta and Kapha, then the dominant Ᾱvarakashould be alleviated first (Ca.Ci.28:188). Śuddha Vātaj Pakṣāghāta should betreated as above but the anubaṉdhita type of Pakṣāghāta should be treatedconsidering the Ᾱvaraka doṣas.5. Pittavritta Vāta:In Pittāvṛta Vāyū, hot and cold treatment should be given alternatively.In diet he should be given flesh of Jāṉgala animals, Yava and Śalī. For
  • 53. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 41Śodhana purpose Yāpana vasti, Kśira vasti, and Virecana should be given.Jīvaniya ghṛta is recommended. (Ca.Ci.28:184)6. Kaphāvṛtta Vāta:In Kaphāvṛta Vāta, diet articles made of Yava and flesh of Jāṉgalaanimals should be given. For Snehana old ghee, Tila taila and Sarṣapa tailaare beneficial. Strong Swedana, Nirūha vasti, Vamana and Virecana are alsodescribed (Ca.Ci.8:187).Table No. 10 - Sāmānya Cikitsā of VātavyādhīSr THERAPY Ca. Su. AH.1 Snehana + + +2 Abhyaṉga + + +3 Swedana + + +4 Virecana + + +5 Nasya + + -6 Śirovasti - + -7 Tarpana + - +8 Yuṣa + - +9 Māṃsa rasa + - +10 Snigdha, Ᾱmla, Lavana + - +11 Anuvāsana + + +12 Ᾱsthāpana + + -13 Dhumapāna + + -14 Pariṣeka - + -15 Saṃvahana - + -16 Śirsneha - + -17 Gaṉdūṣa - + -ii. Specific line of treatment for Pakṣāghāta:The line of treatment of Pakṣāghāta, in particular, described in variousᾹyurvedic classics is tabulated underneath:
  • 54. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 42Table No. 11 – Specific line of treatment in PakṣāghātaSr THERAPY Ca. Su. AH. BR. VS.1 Snehana - + + - +2 Swedana + + - - +3 Virecana+Sneha+Mṛdu++Tīkṣṇa+4 Vamana - + - - -5 Vasti - + - + +6 Mastiṣkya - + - - -7 Śirovasti - + - - -8 Abhyaṉga - + - - -9 Upanāha - + - - - Ᾱcārya Caraka mentions Cikitsā sūtra as;Swedam Snehasaṃyuktam Pakṣāghāte Virecanam ||(Ca.Ci.28:100). Cakrapāṇī has not commented on this verse. Ᾱcaryā Jejjaṭa interprets this asSnehayukta Swedana and Snehayukta Virecana. Gaṉgādhara has also opinedlike Jejjaṭa. Ᾱcārya Suśruta describes the specific line of treatment of Pakṣāghāta asfollows:A patient of Pakṣāghāta is not emaciated, has pain in theaffected part, and habitually observes the rules of diet and regimen and whocan afford to pay for the necessary accessories should be taken for thetreatment. Initially, Snehana and Swedana are to be conducted followed byMṛdu Vamana and Virecana. This is to be followed by Anuvāsana andᾹsthāpana Vasti. After this the general directions and remedial measures laiddown under the treatment of Ᾱkṣepaka should be imparted at proper time.Mastiṣkya, Śirovasti, Abhyaṉga by Anu taila, Sālvana upanāha Sweda andAnuvāsana by Balā taila are the specific measures described. All these abovementioned measures should be followed carefully for a continuous period ofthree or four months (Su.Ci.5:19).
  • 55. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 43 Vāgbhaṭa’s viewSnehanam Snehasaṃyuktam Pakṣāghāte Virecanam ||(AH.Ci.21:44)He says that Snehana and Snehayukta Virecana should be adopted Cakradatta has described a number of combinations for the Śamana Cikitsā ofPakṣāghāta. One of such combination named „Māṣātmaguptādī Kwātha‟which contains Māṣa, Ᾱtmaguptā, Eraṉḍa, Balā etc., has been selected forvasti purpose in the present study. Other formulations include Māṣabalādikwātha, Swalparasonapiṉḍa. Various tailas like Māṣa Taila, MahāMāṣaTaila, etc., have been described (22ndChapter). Bhāvprakāśa has advocated the use of Māṣādi kwatha, Māṣādi Taila andGraṉthikādi Taila in the treatment of Pakṣāghāta (BP.Ci.24:209-212). In Bhaiṣajya Ratnāvalī, Śodhana measures like Tīkṣṇa Virecana and Vastihave been described (BR.26:549). Brihanmaṉjiṣṭhādī kwātha and Māṣādi Nasya described in ŚāraṉgdharaSaṃhitā for Pakṣāghāta. Yogaratnākara the treatment given is similar to that of Cakradatta(YR.Vātavyādhī Cikitsā).XI. UPADRAVADue to negligence or improper treatment, the doṣas of the main disease getaggravated and further progress in to an another disorder. Such disorders are referredto as Upadravas (complications) (M.N.1:2, Madhu). They are disease itself, either bigor small, and manifest in the later period of the main disease. By pacifying the maindisease, Upadravas are often pacified.Upadravas of Pakṣāghāta, in particular, have not been listed in any of theSaṃhitās. So the general upadravas of Vāta vyādhī can be considered as that ofPakṣāghāta. Caraka Saṃhitā:In Caraka Saṃhitā there is no independent description of Upadravasof Vāta Vyādhī or Pakṣāghāta. However, while describing theSādhyatāsādhyatā of Pakṣāghāta he mentions that Pakṣāghāta devoid of any
  • 56. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 44Upadravas should be treated. (Ca.Ci.28:72-74). Cakrapāṇī interprets thatthese Upadravas are those of Ᾱvarana, i.e., Hṛdroga, Plīha, Vidradhī, Gulmaand Atīsāra. Suśruta Saṃhitā:Ᾱcārya Suśruta has described the Upadravas of Aṣṭa Mahāgada ingeneral including Vāta Vyādhī and also that of Vāta Vyādhī in perticular.Upadravas of Aṣṭa Mahāgadas are Prāna-Māṃsa Kṣaya, Śwasa,Tṛṣṇa, Śoṣa, Chardī, Jwara, Murcchā, Hikkā. Ᾱcārya further states that Vātavyādhī which present along with these Upadravas are Ᾱvaranajanya.(Su.Su.33:5-6).Upadravas of Vāta vyādhī are Śotha, Supta Twak, Bhagna, Kaṃpa,Ᾱdhmāna, Rūjā and Arti. Patient usually dies if the Vāta Vyādhī co-exists withany of the above-mentioned Upadravas (Su.Su.33:7) Mādhavakara:He has added few more Upadravas to that mentioned by ᾹcaryāSuśruta. (MN.22:78-79). They are Visarpa, Dāha, Ruk, Saṉga, Murcchā,Aruci, Agnimārdava and Kshīna Māṃsa Bala.XII. PATHYA – APATHYADrugs and regimen that are beneficial to the body and the srotas and do notadversely affect the body and mind, are termed as Pathya (wholesome). Whereas,those, which have adverse effect on body and mind and are incompatible to health, areconsidered to be Apathya (unwholesome) (Ca.Su.25:45).Pathya and Apathya depend upon various factors such as Mātrā, Kāla, krīya,bhūmī, deha, doṣa, etc. (Ca.Su.25:46). Hence it differs from person to person. Pathyacatalyses the drug action and thus plays a major supporting role in the treatment ofdisease.In Ᾱyurvedic classics, separate Pathya-Apathya for Pakṣāghāta is not given.Hence the pathya-apathya of Vātavyādhī can be taken as that for Pakṣāghāta.
  • 57. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 45i. Pathya for Vātavyādhī:1. Ᾱhāraja: Ᾱhāra guna: Snigda, Uṣṇa, Guru, Santarpana. Catusneha: Sarpi, Taila, Vasā, Majjā. Anna Varga: Kulattha, Māṣa, Godhūma, Raktābha Śalī, Navīna Tila,one year old Ṣaṣṭīka Śalī. Phala Varga: Ᾱmla rasayukta phala, Drākṣa, Dādima, Jaṃbīra,Parūshka, Badar, Pakwa Tal, Rasāla. Śāka Varga: Vārtāka, Lashūna, Patola, Śigru. Dugdha Varga: Ghṛta, Dugdha, Kilāta, Dadhī kurcika. Taila Varga: Tila Taila, Sarṣapa Taila. Drava Varga: Yuṣa, Vasā, Majjā, Kullattha rasa, Māṃsa rasa,Dhānyāmla, Gomūtra. Māṃsa Varga: Varities of Grāmya, Ᾱnupa, Jāṉgala Māṃsa Matsya varga: Shilindhra, Nakra, Gargar, khudiṣ, Zaśa. Anya: Tāṃbūla, Matsyāndīkā, Prasārani, Gokṣūra, Nīma, Kṣīrakākolī. All dietary articles having Madhūra, Ᾱmla, Lavana rasa, Uṣṇa Vīrya,Snigdha guna and having Bṛṃhana and Vṛṣya properties arecompatible for patients ailing from Vāta vikāras. Ikṣu varga: Matsyāṉdika.2. Viharaja: Sukhoṣṇa pariṣeka, Nirvāta Sthāna, Abhyaṉga, Mardana, Vasti,Swedanam, Avgāhana, Upanāha, Agnikarma, Snāna, Taildroni,Śirovasti, Śayanam, Saṃvāhanam, Nasya, Agni-ātapa sevana,Snigdha-Uṣṇa lepa, Bramhacarya. Use of Kesara, Agaru, Tejapatra, Kūtha, Elā, Tagara along with Silkcloths, woolen cloths and soft bedding. Live in a place which has goodsunlight, but devoid of direct wind.
  • 58. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 46ii. Apathya for Vāta Vyādhī:1. Ᾱhāraja: Ras: Kaśāya, Kaṭu, Tikta. Ᾱhāra guna: Rukṣa, Laghu, Śīta, Anaśana, Pramitaśana. Śūka varga: Kordūṣa, Shyāmāka, Nivāra, Kaṉgunī, Kurūviṉda. Śamī varga: Mudga, Kalāya, Canaka, Ᾱḍhakī, Mokuṣṭa, Masūra, Tila,Khandīkā, Jala varga: Tadāga (lake), Tātani (river). Ikṣu varga: Kṣoudra. Śuṣka Māṃsa.2. Viharaja: Behavioural modification: Ativyāyāma, Vyavāya, Prathijāgara,Dīwāswapna, Puraḥ pavana, Plavana, Viceṣṭa, Dukha śayyāsana, Atihima, Abhojana, Gaja-Uṣṭra-Aśwa yāna, Vega saṉdhārana,Caṉkramana, Dwija gharṣana. Emotional factors: Cintā, Śoka, Dukha, Krodha, Bhaya, Mada. Iatrogenic: Viśamapacāra, Atirakta mokśana, Vamana, Virecana,Laṉghana. Complication: Dhātukṣaya, Rogāti karṣana, Jarā, Ᾱma, Abhighāta,Marmabādha.
  • 59. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 47B. MODERN VIEW OF HEMIPLEGIAa. HISTORICAL REVIEWHippocrates (400 B.C.)At the time of Hippocrates (Father of Medicine) stroke was called apoplexy,it‟s a Greek word, which means "struck down by violence". Hippocrates was the firstphysician who recognized stroke over 2,400 years ago. In this era a little knowledgeregarding the anatomy and function of the brain, and the cause of stroke was availableto physicians. Even the management was much more obscure at that time. He alsoobserved that there were many blood vessels connected to the brain. He notified themost significant fact regarding Hemiplegia, that “If the patient has the lesion on theleft side of the head, spasm seizes the right side of the body; if the lesion is on theright side of the head; spasm seizes the left side of the body.The 16thcentury is truly designated as the age of Anatomy. Galen (131-201 A.D.) He described the anatomy of the brain and its bloodvessels. Paracelsus (1493-1541) propounded that excess mercury caused paralysis. Andreas Vesalius (1541-1564) produced sketches of brain, nerves, etc., afterextensive experimental studies. The base of the brain Pons Varolii was described by Constanzo Varolio (1543-1575).The 17thcentury is known as century of physiology. William Harvey (1578-1657 A.D.) described the circulation of blood. Johann Jacob Wepfer (1620-1695 A.D.) demonstrated the fact that apoplexy isdue to cerebral haemorrhage. Thomas Wills (1621-1675) discovered circle of Wills, recognized TIAs andprocess of embolism.In 18thcentury the focus attention was shifted to pathology and the cause of disease. Giovanni Battista Morgagni (1682-1771) father of Pathology described onecase of Hemiplegia. He recognized that paralysis was on the side of the bodyopposite to the brain lesion.
  • 60. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 4819thcentury gave rise to many discoveries, new theories and emergence of modernmedicine. John Cheyne (1777-1836) described the morbid appearances of patient‟s brainand neurological abnormalities in detail. John Abercrombie contributed a more detailed clinical classification ofapoplexy and described the causes of haemorrhage. Richard Bright (1831) gave an account of cerebral haemorrhage and paralysis. Foix and his colleagues described the clinico-pathological methods andsyndromes of infarctions in the region of MCA, PCA, ACA andvertebrobasilar artery. Fisher termed the temporary short-lived episodes of neurological symptoms asTransient Ischaemic attacks (TIAs). Marshall Hall (1790-1857) demonstrated reflex movements and discoveredthat the spinal cord is a chain of segments whose functional units are separatereflex arcs. Franscois Magendie (1822) discovered that anterior spinal nerves are motornerves and posterior spinal nerves are sensory nerves. Emil du Bois Reymond (1818-1896) created a new science„Electrophysiology‟- the physics of muscles and nerves. Cajal et. Al (1889-1891) proposed the neuron theory – each neuron is aseparate cellular entity.In 20thcentury The work of British physiologist Charles Scott Sherrington on nervous systemled to the better understanding of nervous diseases including Hemiplegia. Heassigned the functions of co-ordination to the nervous system, studied thelevels of nervous integration, the proprioceptive system, the higher controllingcentres and central inhibitors. Noguchi (1913) developed relationship of syphilis and paretics by findingspirochaeta pallida in the brain of the paretics. Clark & Taylor (1933) narrated three cases: In first case with spastichemiplegia, gave excellent result by division of the posterior root from 6th
  • 61. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 49cervical to 3rddorsal. The second case had spastic hemiplegia with epilepticattacks; section of 4thto 7thcervical roots cured the arm spasm, with no reliefin epilepsy. The third case presented with spasm and athetosis of both arms.By dividing the 5th, 6th, and 8thcervical roots on one side and 5th, 7th, 8thon theother, spasm was cured but not the athetosis. Tizianello (1926) reported two cases of hemiplegia caused due to thrombosisfollowing typhoid arteritis. Stewart et. al. (1945) recorded the rare hemianopsia and hemianesthesia. Sparberg (1963) noted hemiplegia occurring as a side effect due to diphylhydatitoin used in the cases of epilepsy. Bickerstaf (1964) gave evidence in favor of occurrence of hemiplegia afterinjuries in the region of carotid artery. Tiwary & Patil (1980) reported 6 cases of cerebral malaria presenting as comaand hemiplegia and showed good response to parentral chloroquine. Steiner (1984) recorded that at least 85% of the patients with CVD, suffertransient ischaemic attack and mild complete stroke. Harrison (ed. 1985) notifies that the mortality and morbidity following carotidartery surgery or angioplasty must be well below 3% if procedure is to conferoverall benefit. Eljamel et al. Panisset et al. (1990) highlighted the importance of dissection ofthe carotid artery as a cause of contralateral stroke and/or transient ischaemicattacks in younger patients. Medical Research Council, European carotid surgery trial, (1991) published –The importance of high quality radiology and surgery cannot, however, beover emphasized and it must be remembered that in the first post operativemonth there is a 7.5% incidence of stroke or death.Medical treatment also changed dramatically during the middle and later portions ofthe twentieth century. Antihypertensive drugs reduced the frequency of stroke. Anticoagulant therapy with heparin and dicumarol were introduced astreatments for patients with occlusive cerebrovascular disease in 1950s.
  • 62. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 50 In 1950, Craven commented on the use of aspirin as an agent that mightprevent thrombosis. The use of aspirin became wide spread in 1970s. In 1953, Fisher and Cameron treated TIAs and basilar artery disease withheparin and anticoagulant phenylindandione. . In 1980s, Streptokinase and recombinant tissue plasminogen activators wereshown to be effective in the treatment of acute coronary artery thrombosis. Other potentially effective pharmacological agents became available after1950 and included corticosteroids, mannitol to treat brain oedema.Some other new researches in late 20thcentury and early 21stcentury Inhibiting poly (ADP-ribose) Polymerase (PARP) may spare nerve cells fromenergy loss thus preventing irreversible damage and providing protection instroke. (Oct.1997, Johns Hopkins Medical Institute) Natural estrogens may offer some protection to premenopausal womenthreatened with severe brain damage during stroke. (1998, Johns Hopkins andNational Institute of Health) An enzyme cyclo-oxygenase-2 (COX-2) notorious for making a bad situationworse when it comes to inflammation causes the brain‟s blood vessels to dilatewhen the brain becomes injured. (Jan. 1999, University of Iowa College ofMedicine) Higher levels of the naturally occurring substance called homocysteineincrease the risk of stroke among younger women. (1999, University ofMaryland) A high dose of estrogen administered soon after stroke can prevent asubstantial amount of brain damage in laboratory animals. (March, 2000American Heart Association Journal Stroke.) Stroke patients who take an amphetamine before speech language therapyregain their speech at a faster rate. (Sept. 2001, UT Southwestern MedicalCenter at Dallas) The flu vaccine may offer significant protection against stroke (Feb. 2002,Journal of American Heart Association)
  • 63. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 51 Stroke patients with high iron levels are much more likely to experience moresevere neurological symptoms and possibly increased brain damage. (May2002, Issue of Neurology – American Academy of Neurology‟s ScientificJournal) Potent strains of ulcer causing bacteria may play a key role in certain kinds ofstroke. (July 2002, Journal of American Heart Association) Using transplants of the bone marrow cells improved the recovery from strokein rat experiments. (Sep. 2002, Journal of American Academy of Neurology). Stroke patients with higher levels of Natural anti-inflammatory chemicalcalled interleukin-10 in their blood suffer less brain dᾹmage after stroke (Feb2003, Journal of American Heart Association) In experiments with mice, researchers found that the chemical prostaglandinE2 protects the brain cells from damage. (Jan. 2004 Johns Hopkins MedicalInstitute.) New thrombolytic drug Desmoteplase, based on protein extracted from thesaliva of vampire bats, appear to be able to break up the clots in the brainwithout increasing the risk of bleeding. It can make its effect even if givennine hours after stroke. (Feb. 2004, BBC News, UK Edition).“Stroke” or "cerebral vascular accident (CVA)" is now often referred to as a"brain attack" to denote the fact that it is caused by a lack of blood supply to the brain,very much like a "heart attack" is caused by a lack of blood supply to the heart. Theterm brain attack also conveys a more urgent call for immediate action and emergencytreatment by the general public. Today, there is a wealth of information available onthe cause, prevention, risk, and management of stroke. However, in spite of all thisinformation and breakthroughs there is no any confirming treatment to reduce the riskof death and disability.
  • 64. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 52b. MODERN CONCEPT OF HEMIPLEGIAI. ETYMOLOGYHemiplegia described in Modern Medicine can be correlated with Pakṣāghātadescribed in Ᾱyurveda and same is considered in the current study also.ETYMOLOGY: Hemiplegia is a compound word derived from two roots viz. Hemi = Greek word meaning half Plegia = Greek word meaning paralysis or stroke.DEFINITION:The term Hemiplegia applied to voluntary muscles signifies loss of the powerof voluntary contraction, due to interruption, whether functional or organic in anymotor part of cerebral cortex down to the muscle fibre. This excludes pathology ofmuscles or any such type.SYNONYMS: Paralysis (para = beyond, lyien = to loosen, lysis = death) Stroke, Cerebrovascular Accident, Apoplexy.Some terms related to loss of voluntary movements are as under. Hemiplegia: A unilateral brain lesion producing paralysis of contralateral sideof the body including face, trunk and limbs is known as hemiplegia (Trunkmay be less affected due to bilateral connection). Diplegia: A bilateral cerebral or a high cervical lesion produces diplegia ordouble hemiplegia, the limbs on both side being affected. Monoplegia: Paralysis of a single limb resulting from a cerebral lesion istermed cerebral monoplegia. Spinal or peripheral monoplegia is less common. Paraplegia: Paralysis of the limbs resulting from a lesion of a spinal cord iscalled paraplegia, usually affecting both legs alone. It must be distinguishedfrom cerebral diplegia in which the face is also affected. Brachial Paraplegia: In rare cases both arms may be paralyzed from a spinalregion, with little or no affection of legs.
  • 65. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 53 Cross or Alternate Hemiplegia: There is a paralysis of some parts on oneside and of others on the contra lateral side. E.g.Millard – Gubler syndrome.Clinically, the most commonly encountered type is hemiplegia. Conditionmilder in form then above is known as hemiparesis, characterized by weakness oneither side of the body.Summing up, Hemiplegia means paralysis of one half of the body affecting both armand leg and sometimes face.II. ETIOLOGYThe World Health Organization (WHO) defines stroke as “Rapidly developingclinical symptoms and/or signs of focal and at times global, loss of cerebral functionwith symptoms lasting more than 24 hours. Hemiplegia is a classical sign of stroke.Ischaemic strokes have a heterogeneous group of causes, including thrombosis,embolism, and hypo perfusion, whereas haemorrhagic strokes can be eitherintraparenchymal or subarachnoid.Ichaemic stroke results from several aetiological factors out of which three arepredominant: Thrombosis, embolism and lacunar disease.i. Causes of Atherosclerotic (Thrombotic) Stroke:Atherosclerosis is a progressive pathological state where blood vesselsdevelop fibroproliferative, fatty lesions that express as occlusive plaques in thevascular disease that contributes most frequently to thrombosis. Ischemic strokeresulting from thrombosis are often classified as having atherothrombotic. This ispredisposed by; Hypertension – Initiates and accelerates the cerebral atherosclerotic disease,probably by degeneration of the small vessel wall. Hyperlipidemia or obesity affects the large vessels. Intimal thickening bydeposition of cholesterol and often by calcification and ulceration leading tobreaching of internal elastic lamina. Diabetes hastens the atherosclerotic process in both large and small arteries. Myxodema also found to be a cause.
  • 66. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 54 Smoking aggravates the process by decreasing HDL cholesterol and reducingcerebral blood flow.ii. Causes of Cerebral Embolism:Embolism of an intracranial artery is a complication of many disorders, whichallow thrombus or other material such as cholesterol, air or fat to enter the circulationin such a way that it reaches the brain. Causes are;1. Cardiac Origin: Atrial fibrillation and other arrhythmias (with Rheumatic, Atherosclerotic,Hypertensive, Congenital or Syphilitic heart disease). Myocardial infarction with mural thrombus. Acute and subacute bacterial endocarditits. Heart disease without arrhythmia or mural thrombus (Mitral stenosis,Myocarditis, etc.) Complications of cardiac surgery. Valve prostheses. Non-bacterial thrombotic endocardial vegetations. Prolapsed mitral valve. Paradoxical embolism with congenital heart disease.2. Non Cardiac Origin: Atherosclerosis of aorta and carotid arteries (mural thrombus, atheromatusmaterial). From sites of cerebral artery thrombosis (basilo-vertebral, middle cerebral) Thrombosis in pulmonary veins. Fat, tumor or air. Complications of neck and thoracic surgery.3. Cryptogenic causes:Moyamoya disease, Fibromuscular dysplasia, Binswanger‟ssubcortical arteriosclerotic encephalopathy, leuko-araiosis, Winiwarter-Buerger disease, Aortic Arch syndrome (Non inflammatory)
  • 67. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 55RISK FACTORS OF STROKEThe American Stroke Association has identified several factors that increasethe risk of stroke. The more risk factors a person has, the greater the chance that hewill have a stroke.1. Medical conditions that increase stroke risk: Transient ischaemic attacks (TIA): TIAs are “mini strokes‟. They are strongpredictors of stroke. A person who‟s had one or more TIAs is almost 10 timesmore likely to have a stroke than someone of the same age and sex who hasn‟t. High blood pressure: Hypertension is one of the leading risks of stroke. Theeffective treatment of high blood pressure is key reason for the accelerateddecline in the death rates of stroke. Diabetes mellitus: Diabetes is an independent risk factor for stroke, aboutdoubles the risk of stroke than non diabetic. Heart disease: People with heart disease have more than twice the risk ofstroke as those whose hearts work normally. Atrial fibrillation in particularraises the risk for stroke. Recent MI is also a major cause of death amongstroke survivors. Carotid artery disease: Atherosclerosis of carotid artery can lead to stroke.Carotid bruit is an indication for carotid artery disease. High Red blood cell count: A moderate or marked increase in the red bloodcell count is a risk factor for stroke. The reason is that more RBCs thicken theblood and make clots more likely. The increased level of total plasma cholesterol and low density lipoproteincholesterol and to lesser extent decreasing level of high density lipoproteincholesterol is the risk factors for the stroke. Haemostatic variables like raised plasma factor 7 coagulant activity, raisedtissue plasminogen activator antigen, low blood fibrinolytic activity and raisedVon Willebrand factor are all risk factor for coronary heart disease andperhaps also for stroke.
  • 68. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 562. Controllable risk factors and life style choices: Smoking: Recent studies have shown cigarette smoking to be an importantrisk factor for stroke. Heavy alcohol consumption is an independent and casual risk factor forHaemorrhage than Ischaemic stroke Obesity, elevated cholesterol and elevated lipids. Physical inactivity – A sedentary lifestyle. Excessive alcohol intake. Illegal Intravenous drug abuse carries a high risk of stroke from cerebralemboli. Oral contraceptive pills: It increases the risk of venous thromboembolism.3. Uncontrollable Risk factors: Increasing age: Stroke is more common in people over 60. Sex: Latest data show that, over all, the incidence and prevalence of stroke areabout equal for men & women. However, at all age, more women than mendie of stroke. Heredity and Race: The chance of stroke is greater in people who have afamily history of stroke. African – Americans and Hispanic Americans are athigher risk than white Americans. This may be due in part to hypertension anddietary differences. (Afro-Carribbean > Asian>European).4. Other factors: Season & Climate: Stroke deaths occur more often during periods ofextremely hot or cold temperatures. Socioeconomic factors: There‟s some evidence that people of lower incomeand educational levels have a higher risk for stroke. Vit. B deficiency increases stroke risk. Air pollution may increase stroke risk (Oct. 2003 – Journal of American HeartAssociation)
  • 69. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 57 Sleeping for more than eight hours at night, snoring and daytime drowsiness isassociated with an increased risk for stroke. (Feb. 2001, American strokeAssociation‟s 26th International stroke conference). Low potassium intake may increase risk for stroke. (Aug. 13, 2002 – Journalof American Academy of Neurology).III. PRODROMAL SYMPTOMSi. Cerebral Thrombosis: Premonitory symptoms are common and exist for hours, days or monthsbefore the onset of paralysis. They are given name as TIA (Transient cerebralIschaemic attack). TIA is the episodes indicating ischemia of some part of cerebral hemisphere orthe brain stem. They are defined as episodes of temporary and focal cerebraldysfunction of vascular origin leaving no persistent neurological deficit andlasting less than 24 hours. Attacks indicating ischemia in the distribution ofone carotid artery are often referred to as episodes of carotid insufficiency,those involving the brainstem as vertebro– basilar insufficiency. In carotid artery disease the transient warning attacks consist of monocularblindness, hemiplegia, hemianesthesia, disturbances of speech and language,confusion, etc. In vertebro-basilar system the prodromata take the form ofepisodes of dizziness, diplopia, numbness and impaired vision in one or bothvisual fields, dysarthria.ii. Cerebral Embolism:Premonitory symptoms are absent in this type of CVA. Onset is instantaneous,hemiplegia developing in few seconds or minutes. However cases of less suddenonset, resembling that of „Stroke-in evolution‟, have been described. A convulsionmay occur at onset and there is sometimes headache.
  • 70. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 58IV. SYMPTOMATOLOGYThe signs and symptoms of stroke depend upon the following factors;i. Nature of vascular lesionii. Duration of ischemiaiii. Region of the brain supplied by the effected vesseliv. Status of the collaterals to that regionv. Vulnerability of neurons of that regioni. Clinical picture as per the nature of lesion:As earlier mentioned there are two basic lesion of brain, manifest ascerebrovascular accident viz. ischemia (Thrombosis and embolism) and hemorrhagestroke. Each lesion manifests its characteristic clinical presentation. The presentingfeatures of each type of lesion are tabulated below.
  • 71. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 59Table No. 12 - Clinical picture as per the nature of lesionSrDIFFERENTIATINGFEATURETHROMBOSIS EMBOLISM HAEMORRHAGE1 Age Middle or Old Young Usually above 40 years2 Sex Male or Female Female predominately males predominately3 Onset Sudden or Progressive InstantaneousCatastrophic& Progresses rapidly4 Rapidity of onset Less rapid Stormy Rapid5 Premonitory symptomsHeadache,Hemiparesis,transient aphasiaAbsent Headache, Vomiting6 Symptoms at onset Absent Convulsive seizure Vomiting7 Unconsciousness Transient Patient may be dazedGradually deepeningunconsciousness8 Convulsion Rare Common Usually absent9 Blood Pressure May or may not be high May or may not be high Always high10 Pulse No change May be irregular and rapid Slowed down11 Fundus occuliMay show some changedepending on PrevioushypertensionNot so May Hypertensive retinopathy
  • 72. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 6012 Heart May or may not be involvedMay be evidence ofauricular fibrillation,coronay thrombsis or mitralstenosisMay show evidence of leftventricularhypertrophy13 Shifting Hemiplegia Never May occur Never14 VDRL Tests May be positive in syphilis Not so Negatīve15 Leucocytosis Absent Absent Common16 Lumbar punctureC.S.F. is clear, pressurenormalC.S.F. may be clear,sometimes haemorrhagicBlood is present inC.S.F. and pressure is increased17 C.T. / M.R.I. May not detect for 2 – 4 daysMay notdetect for 2 – 4 daysCan detectWithin minute18 PrognosisUsually good but residualhemiplegia persistsResidual hemiplegiapersists, recurrence iscommonNot so
  • 73. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 61ii. Nature of vascular lesion:The following are some distinctive symptoms of lesions of the corticospinaltract at different points in its course;1. Cortical lesion: Corticospinal lesions produce monoplegia or paralysis of even smaller musclegroup, Aphasia (if dominant cortex is involved), cortical sensory loss. Jacksonian fits may occur if the lesion is in or near the cortex.2. Subcortical lesion: Weakness predominates in one limb but the whole of the opposite side isaffected, impairment of postural sensibility and tactile discrimination byinvolvement of thalamocortical sensory fibres; crossed homonymoushemianopia by damage to optic radiation.3. Internal capsule: It is the commonest site and presents with a pure motor and isolatedhemiplegia, hemianesthesia if lesion in posterior one-third part. Sometimes homonymous hemianopia on the same side may be present.4. Lesions in the midbrain: Weber‟s Syndrome: IIIrd nerve palsy with crossed hemiplegia. Benedikt‟s Syndrome: IIIrd nerve affection on the side of lesion with tremors,hypertonia and ataxia on opposite side. Facial diplegia of the supranuclear type.5. Lesions in the pons: Millard- Gubbler Syndrome: Paralysis of lateral rectus, with or without LMNtype of facial paralysis on one side with crossed hemiplegia. Foville‟s Syndrome: Similar to Millard-Gubbler syndrome except that insteadof lateral rectus paralysis, there is conjugate ocular deviation to side o thelesion.
  • 74. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 62 Horner‟s Syndrome: Paralysis of the ocular sympathetic may result from alesion in the tegmentum of the pons.6. Lesions in the medulla: Many variety of crossed hemiplegia in unilateral medullary lesion. In midline lesion: Unilateral paralysis of half of the tongue, crossedhemiplegia, loss of postural sensibility is found. Lesion in lateral part of medulla: Vocal cord paralysis, Horner‟s syndrome,trigeminal analgesia, thermo anesthesia, and some cerebellar deficiency – allon the side of the lesion with loss of appreciation of pain, heat and cold in thelimbs and trunk on the opposite side.7. Lesion in thalamus: Thalamic Syndrome:Manifests as fleeting hemiparesis or hemiplegia on the opposite side ofthe lesion and Impairment of superficial & loss of deep sensation on oppositeside with elevation of threshold to cutaneous, tactile, and painful stimuli alsointolerable, spontaneous pains and hyperpathia on the opposite side, ataxia,tremor and/or choreoathetoid movements on the opposite side.8. Lesion in the temporal lobe: Deep posterior temporal lobe: - Here the pyramidal fibers pass in closeproximity to visual fibers; hence hemiplegia is usually associated withhomonymous hemianopia. Anterior temporal lobe: - On the dominant hemisphere the pyramidal systemlies just medial to the speech fibers, hence hemiparesis associated withexcessive aphasia manifest in the lesion of this region.9. Spinal cord lesion: Unilateral lesion of the cortico-spinal tract below the medulla and 5thcervicalspine produces spinal hemiplegia without paralysis of muscles innervated bycranial nerves.
  • 75. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 63iii. Duration of ischemia: If ischemia is of short duration and circulation restored immediately then thepatient develops neurologic deficit for a short period usually less than 24hours. This is called transient ischemic attack. If the ischemia is permanent and lasts for long duration then the patient‟sneurological deficit become persistent and it is called as completed stroke. If the ischemia progresses in a stuttering manner over days then the focaldeficit continue to worsen after about 6 hours from onset. This is calledevolving stroke.iv. Region of the brain supplied by the affected vessel:Obstruction of a cerebral artery gives a clinical picture, which depends uponloss of function of the parts of the brain supplied by the vessel. This is influenced bythe point at which the obstruction occurs, since blockage at the origin of a vessel mayimpair the function of a larger region than in the case when the block lies moredistally or involves only a single branch.When an infarction lies in the territory of a carotid artery, unilateral signs predominateas hemiplegia, hemianesthesia, hemianopia, aphasia, etc. In the territory of the basilarartery the signs of infarction are frequently bilateral quadriparesis, bilateral sensoryimpairment, etc.1. Internal carotid artery:The symptoms of the blockage are extraordinarily variable varyingfrom no symptoms to a completed stroke. Progressive obliteration of lumen may cause TIAs (giving aphasia, confusionor contralateral paraesthesiae or weakness) and stuttering hemiplegia. In complete occlusion, there may be contralateral homonymous hemianopia,hemiplegia and loss of spatial and discriminative sensibility on the oppositeside, aphasia of receptive, expressive or global type when the lesion is in thedominant hemisphere. Occlusion of ophthalmic branch leads to unilateral blindness.
  • 76. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 64 Occlusion of the anterior choroidal artery may give contralateral hemiplegiaand hemianalgesia. It is often asymptomatic. Some signs of occlusion of carotid artery are recurrent loss of consciousness,fainting on arising from horizontal position, headache, neck pain, paraesthesia,dimness of vision with exercise, abnormal facial pigmentation and loss of hair.2. Anterior cerebral artery: It can be occluded at several different points with varying clinical effects: Occlusion at its origin: Causes hemiplegia on the opposite side with sensoryloss of cortical type in lower limb, expressive aphasia and apraxia on left whenlesion is on the dominant side. Occlusion of Heubner‟s artery: Leads to Paralysis of face, tongue and upperlimb on the opposite side, expressive aphasia (dominant hemisphere lesion). Occlusion distal to Heubner‟s branch: Causes contralateral hemiplegia,weakness more in lower limb. There is often forced grasping in the affectedlimb. Occlusion of the paracentral artery: The result is a spastic monoplegia on theopposite side, with or without sensory loss of cortical type in affected lowerlimb. Occlusion of both anterior cerebral arteries: Characterized by profounddementia, bilateral grasp reflexes may be present and akinetic mutism.3. Middle cerebral artery: Obstruction at the origin causes hemiplegia with sensory loss on opposite side,weakness most marked in the face, tongue and upper limb, Broca‟s aphasiaand/or Wernicke‟s aphasia if lesion in dominate hemisphere. Obstruction at frontal division causes a dense sensorimotor deficit in the faceand limbs with total aphasia. Obstruction at inferior division causes Wernicke‟s dysphasia with or withouthemiparesis and hemianopia. Above all, contralateral hemiplegia, hemianaesthasia, homonymoushemianopia and global dysphasia are the classical features of middle cerebralartery occlusion.
  • 77. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 654. The posterior cerebral artery: Its occlusion causes contralateral homonymous hemianopia. Visual agnosiamay result from ischemia of the left occipital lobe and impairment of memoryfrom damage to the medial aspect of temporal lobe. If anterior and proximal branches are occluded the transitory hemiparesisaccompanied by severe sensory loss of opposite side are produced. There may be distortion of taste. Occlusion of paramedian branches gives riseto Weber‟s syndrome.5. The basilar and vertebral arteries: Incomplete obstruction in the vertebro-basilar system leads to many transitoryor permanent disorders of brainstem function, including deafness, vertigo,drop attacks, ophthalmoplegia, ataxia, nystagmus, and bilateral dysaesthesiaover the body and bilateral cortisopinal tract signs. Complete occlusion of the main trunk of the basilar artery is usually rapidlyfatal leading to impairment of consciousness, small fixed pupils, pseudobulbarpalsy and quadriplegia. A pure motor hemiplegia is caused by occlusion in single perforating branchesof basilar. Cerebellar symptoms may occur. Paroxysmal symptoms, which may be precipitated by head movements,include vertigo, drop attacks and syncope. Symptoms of vertebro-basilar insufficiency may occur due to diversion ofblood from the vertebral artery to the brachial artery because of occlusion ofsubclavian artery. This is known as „Subclavian steal syndrome‟. Many syndromes of brainstem infarction due to occlusion of branches of thevertebral and basilar arteries have been described. These are – Weber‟ssyndrome, Claude‟s syndrome, Benedikt‟s syndrome, Millard-Gublersyndrome, Foville‟s syndrome, Lateral medullary syndrome of Wallenberg.
  • 78. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 66V. PATHOGENESIS OF CVA (STROKE)Stroke or CVA is a clinical term refers to the sudden development of a neurologicdeficit caused by abnormalities of the blood supply. The hallmark of Cerebrovascularaccident is stroke with a typical mode of development and a focal neurological deficit.The stroke is usually invariably sudden in onset. In those that survive, a stabilizedstate is reached in a few days time, later followed by some degree of recovery. Thisparticular sequence of events in relation to time is rightly emphasized to be the mostimportant feature of stroke by Fisher and is referred as the temporal profile of stroke.Following a stroke, the brain and body progress through the following series ofstages, which are discussed in detail by Cailliet:i. Transischemic attackii. Flaccidityiii. Spasticityiv. Synergy.A gradual progression from one stage to the next usually occurs, but they are notmutually exclusive of one another, and they can occur simultaneously in the affectedlimb.i. Transischemic attack:TIA already described which lasts less than 24 hours.ii. Flaccid Stage:Once the inciting injury to the brain occurs, the flaccid stage evolves with astate of areflexia. This stage of areflexia includes loss of muscle tone and volitionalmotor activity, variable sensory loss, and loss of muscle stretch reflexes.iii. Spastic Stage:Spasticity is defined as a velocity-sensitive disorder of motor function causingincreased resistance to passive stretch of muscles and hyperactive muscle stretchreflexes. Following stroke, Teasell reports that supraspinal suppressor areas(Pyramidal and Extrapyramidal motor Systems) that are normally responsible for
  • 79. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 67maintaining the delicate balance between the facilitative and inhibiting influences ofboth alpha and gamma motor neurons are decreased or eliminated, resulting inspasticity, flexor tone, and synergy.As stroke recovery evolves, flaccidity may progress to spasticity. Caillietexplains that normally, the brainstem contains upper extremity flexor patterns andlower extremity extensor patterns that are refined and coordinated by the premotorand neocortexes. Following a stroke, the connections that control these reflexes can beinterrupted, resulting in the release of these basic patterns and the evolution ofspasticity and synergy patterns. If the neurologic deficits become severe enough,primitive tonic neck reflexes may develop. When primitive tonic neck reflexes arepresent, the elbow extends when the head turns toward the affected side and the elbowflexes when the head turns away. The presence of primitive tonic neck reflexes isconsidered prognostically unfavorable for motor recovery.iv. Synergy Stage:If neurologic impairment of the completed stroke progresses, synergy patterns,which tend to worsen with initiated efforts, may emerge. Cailliet proposes that thesynergy component that usually occurs first is spastic elbow flexion; the shoulderphase is weaker and usually requires a more reflexive status to occur. The restrictionscreated by the synergy patterns create therapeutic challenges to attaining meaningfulUE function. Upper extremity flexor synergy patterns include; shoulder/scapulardepression (downward rotation and retraction), humeral adduction/internal rotation,elbow flexion, forearm pronation (rarely supination), wrist/finger flexion.When treating patients in flexion synergy, aim therapy at retraining theoverwhelmed agonists, stressing the desired components of function, and releasing theuninhibited flexion patterns by initiating opposite movements at the “key points ofcontrol.”Interruption of blood supply to the brain tissue occurs as a consequence of twomain type of brain parenchymal disease as;1. Ischemia and infarction2. Intracranial haemorrhage.
  • 80. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 681. Ischemia and infarction:The normal functions of the brain are dependent upon a relativelyconstant supply of oxygen and glucose, as well as other nutrients derived fromthe blood perfusing it (55 to 70 ml of blood per 100 gram of brain per minute).The blood circulation to the brain accounts for 15 % of the resting cardiacoutput and 20 % of the total body oxygen consumption. Cerebral blood flowremains constant over a wide range of blood pressure and intracranial pressurebecause of autoregulation of vascular resistance, although this protectivemechanism may be impaired in ischemic tissue. The brain is a highly aerobictissue, with oxygen rather than metabolic substrate serving as the limitingsubstance. Since there is no reserve of oxygen in the brain, normal cerebralfunction can continue only for 8 to 10 seconds after cerebral ischemia,irreversible damage follows after 6 to 8 minutes. Glucose store however canmaintain cerebral function for 30 to 60 minutes after reduction of blood sugarlevel to near zero. So the reduction of blood flow to the brain for a prolongedperiod results in ischemia and infarction of brain.Cerebral infarction is mostly due to thromboembolic disease secondaryto atherosclerosis in the major extracranial arteries (carotid artery and aorticarch). About 20 % of infarctions are consequent upon embolism from theheart, and further 20 % are due to occlusion of the small lenticulostriateperforating vessels by intrinsic disease (lipohyalinosis), producing so called„lacunar‟ infarction.Cerebral infraction is a process which takes some hours to complete,even though the patient‟s deficit may be maximal close to the onset of thecausative vascular occlusion. After the occlusion of a cerebral artery,perfusion of its territory may be restored by the opening of anastomoticchannel from other arterial territories. Furthermore, a reduction in perfusionpressure leads to other homeostatic changes to maintain oxygenation to thebrain. These compensatory changes can prevent even occlusion of a carotidartery from having any clinically apparent effect. When these homeostaticmechanisms fail, the process of ischemia starts; this ultimately leads to
  • 81. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 69infarction. As the cerebral blood flow descends, various neuronal functionsfail at various thresholds. Once flow falls below the threshold for themaintenance of electrical activity, neurological deficit appears.At this level of blood flow the neurons are still viable; if the flowincreases again the function returns and the patient will have had transientischemic attack. However, if the flow falls further a level is reached at whichthe process of cell death starts. Hypoxia leads to an inadequate supply of ATP,which in turns leads to loss of function of membrane pump, thereby allowinginflux of sodium and water into the cell (cytotoxic edema) and the release ofthe excitatory neurotransmitter glutamate into the extra cellular fluid.Glutamate opens membrane channels, allowing the influx of calcium and moresodium into the neurons. Calcium entering the neurons activates intracellularenzymes which complete the destructive process. The infarction process isworsened by the anaerobic production of lactic acid and consequent fall intissue pH. The final result of the occlusion of a cerebral blood vessel thereforedepends upon the competence of the circulatory homeostatic mechanism, andthe severity and duration of the reduction in blood flow. If ischaemic damagehas occurred to the vascular endothelium, restoration of blood flow may causehaemorrhage into the infracted area. This is particularly likely to occurfollowing embolic occlusion when the embolus is lysed by the bloodthrombolytic mechanisms.2. Thrombosis:Thrombosis refers to an obstruction of blood flow due to a localizedocclusive process within one or more blood vessels. The lumen of the vessel isnarrowed or occluded by alteration in the vessel wall or by superimposed clotformation. The commonest type of pathology is atherosclerosis in whichfibrous and muscular tissues overgrow in the subintima, and fatty materialsforms plaques that can encroach on the lumen. Next, platelets adhere to theplaque crevices and form clumps that serve as need for the deposition offibrin, thrombin and clot. Atherosclerosis affects chiefly the larger extracranialand intracranial vessels. Occasionally clot forms within the lumen because of
  • 82. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 70primary haematological problems. In hypertensive patients increased arterialtension leads to hypertrophy of tunica media of small arteries and arteriolesand deposition of fibrinoid material into the vessel wall, sometimes withatherosclerosis is seen. Lacunar infarcts are among the commonestcerebrovascular lesions. When small arteries or arterioles already thickened asa result of hypertension are occluded by thrombus or by embolus from largeratherosclerotic vessels, this may cause areas of micro infarction, whichultimately leads to small slit like cavities known as lacunes.Some affected vessel show lipohyalinosis. In severe hypertensionmultiple lacunes may be found in putamen, pons, thalamus, internal capsuleetc. there is tendency for atheromatous plaques to form at branching andcurves of the cerebral arteries. The most frequent sides are in the ICA at thecarotid sinus, in the cervical part of the vertebral arteries and at their junctionto form the basilar at the main bifurcation of the MCA, in the PCA as theywind around the midbrain and in the ACA as they curve over corpus callosum.3. Embolism:An embolus is the foreign body that is transported from one part of thecirculatory system to another where it becomes impacted; the process isknown as embolism. Approximately 99% of all emboli are pieces of dislodgedthrombus, hence the common term thromboembolism. Other forms of emboliare fat, air, tumor, bone marrow, atheromatous material and clumps ofbacteria. Embolic material typically originates in the heart (valves,endocardium, atrial or ventricular clots or tumors) major arteries (aorta,carotid, vertebral etc. arteries) or systemic vein. In contrast to thrombosis,embolic luminal blockage is not due to localized process originating within theblocked vessel.Brain embolism is essentially manifestation of heart disease. Anyregion of the brain may be affected; the territory of MCA, particularly theupper division is most frequently involved. The arteries of the left side of thebrain are embolized more often than those of right, chiefly the MCA. Largeembolic masses can block large vessels (sometimes the carotid in the neck);
  • 83. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 71white tiny fragments may reach vessels as smaller 0.2 mm in diameter. Theembolic material may remain arrested and plug the lumen solidly but in manycases it breaks up into fragments, which enter smaller vessels and disappearcompletely. Because of the rapidity with which embolic occlusion develops,there is not much time for collateral influx to become established. Followingimpaction of an embolus, a thrombus usually forms in the vessels and mayspread distally or less frequently proximally and the area of the brain deprivedof blood supply is infarcted. If an embolus impacts and then moves on, arterialblood may enter the infarcted area. Thus embolism is the commonest cause ofhaemorrhagic infarction.When the embolus is infected, meningitis or cerebral abcess maydevelop or when the infection is on low virulence, embolism may be followedby infective softening of vessel wall and aneurysm formation. Fat embolismmay occur as the result of fat globules being set free into the circulation afterthe fracture of one of the long bones, passing through the pulmonarycirculation and so reaching the brain. In air embolism, gas bubbles may appearin the arterial circulation of the CNS in Caisson disease or air can enter thecirculation accidently during cardiac surgery, venous catheterization etc.4. Pathogenesis of atherosclerosis:As already mentioned the two pathological phenomena manifesting asstroke are ischemia and haemorrhage. The main cause of ischemia isatherosclerotic thromboembolism. In case of haemorrhage also the main causeof intracerebral hemorrhage is formation and rupture of microaneurysms bycontinuous hypertension. The major risk factor for hypertension is also theatherosclerosis.The major cause of sub arachnoid haemorrhage is the rupture ofberry‟s aneurysm and berry‟s aneurysm forms as a consequence ofdevelopmental defect in tunica media and atherosclerotic change in the wall ofarteries. So be it the ischemia or haemorrhage the main pathological processplaying central role is atherosclerosis. Atherosclerosis is a specific form ofarteriosclerosis affecting primarily the intima of large and medium sized
  • 84. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 72muscular arteries and is characterized by fibro fatty plaques or atheromas.Atherosclerosis is not caused by a single aetiological factor but is amultifactorial disease whose exact pathogenesis is still unknown. Howeverseveral risk factors has been implicated for the atherogenesis viz; Major constitutional factor like Age 4thdecade or more, Sex – Men affectedmore than Women, Genetic factor, Familial or racial factor. Major acquired factors which includes Hyperlipidemia, Hypertension,Diabetes mellitus, cigarette smoking. Minor risk factors like Environmental influence, Obesity, Oral contraceptive,Lack of exercise, Alcohol, Viral infection.There are many theories has been postulated by different scientists toexplain the pathogenesis of atherosclerosis. The widely accepted theory ofpathogenesis of atheroma is as follows; Endothelial injury or dysfunction – It induced by hypertension, haemodynamicforce, chronic Hyperlipidemia, cigarette smoking and DM Intimate smooth muscle proliferation – Endothelial injury causes adherence,aggregation and platelet release reaction at the site of exposure ofendothelium.Proliferation of intimal smooth muscle cells is stimulated by variousmitogens, the most important of which is PDGF, epidermal growth factor,fibroblast growth factor and transforming growth factor-alpha. Proliferationcan also be facilitated by loss of growth inhibitors. Intimal proliferation ofsmooth muscle cell is followed by synthesis of matrix protein – collagen,elastic fiber proteins and proteoglycans. Role of monocytes – Though blood monocytes do not possess receptors fornormal LDL, LDL does appear in the monocyte cytoplasm to form foam cell.Due to endothelial injury plasma LDL enters to intima and undergoesoxidation. For the monocytes, oxidized LDL acts to attract, proliferate,immobilize and activate them as well as is readily taken up by scavengerreceptor on the monocyte to transform it to a lipid – laden foam cell. For
  • 85. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 73endothelium, oxidized LDL is cytotoxic death of foam cell by apoptosisreleases lipid to form lipid core of plaque. Thrombosis – Endothelial injury exposes sub endothelial connective tissueresulting in formation of small platelet aggregates at the site and causingproliferation of smooth muscle cells. This causes mild inflammatory reactionwhich together with foam cells is incorporated into the atheromatous plaque.The lesions enlarge by attaching fibrin and cells from the blood so thatthrombus becomes a part of atheromatous plaque.VI. DIFFERENTIAL DIAGNOSISThe differential diagnosis in patients suspected of having a cerebrovascularaccident is twofold. First, they must be differentiated from other lesions of thenervous system; second, an attempt should be made to determine which form ofcerebral vascular accident is present.i. Thrombotic, Embolic and Hemorrhagic stroke: The differential diagnosis between cerebral haemorrhage and cerebralthrombosis or embolus, is important chiefly in regard to the prognosis as torecovery from the “shock” and as to the degree of recovery of the focalneurological signs. It is also of importance if anticoagulants are to beadministered. The diagnosis of cerebral haemorrhage carries with it a muchgraver from the paralysis. The diagnosis of cerebral embolism is indicated whenever there is a suddenonset of neurological symptoms in a patient with an acute or chronicendocarditis, auricular fibrillation, a recent coronary thrombosis, septicemia ora septic focus. These cases often present clinical evidence of embolicphenomena elsewhere in the body. The differential diagnosis between cerebral haemorrhage and thrombosis isdifficult since both occur in patients of the same age group and in patients witharteriosclerosis and hypertension. There are several points in the history andphysical examination and laboratory tests that will make possible to makes itpossible to make this differential in the majority of the cases, which is alreadydiscussed under the heading of symptommatology.
  • 86. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 74 A hemiplegia of sudden onset together with a high degree of hypertension ispresumptive evidence of a cerebral vascular lesion. It must be remembered,however, that a transient glycosuria occurs in a definite percentage of thecases of cerebral haemorrhage or thrombosis.ii. Hemiplegia and Hysterical hemiplegia: This is differentiated by Babinski‟s combine flexion of the hip and drug,platysma sign and Tibialis phenomenon of strumpet. In the hystericalhemiplegia only platysma sign is positive while the other two are positive inhemiplegia.iii. Hemiplegia and Coma: The differential diagnosis from other lesions of the nervous system is usuallynot difficult when the complete history of the patient‟s illness is known, but isoften extremely difficult when the patient is found in a comatose state andthere is no adequate history in regard to the onset of the coma. In such cases acareful examination of the patient and the judicious use of certain laboratorytests are necessary, which are explained earlier. The patient‟s head should be examined carefully for evidence of externalinjury; the size and reactions of the pupils and the odor of the breath should benoted. The optic discs should be examined. The character of the respirations,the temperature, pulse rate and blood pressure are important. The presence ofabsence of stiffness of the neck should be noted. It is of paramount importance to determine whether a hemiplegia is present.This is not simple in a comatose patient, but can usually be done. The faceshould be carefully observed. Puffing out of one cheek with each expirationindicates a paralysis of that side of the face. Paralysis of the extremities can be determined by lifting each extremity andallowing it to fall. If the coma is not too deep, the paralyzed limb will fallheavily, while the unparalyzed limb will gradually sink to the bed. When thepatient is in deep coma, all limbs may fall heavily to the bed. Vigorousstimulation of the soles of the feet by a blunt stick of key will cause awithdrawal of the unparalyzed limb, while the paralyzed limb will remaininert.
  • 87. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 75 If there is no hemiplegia and the blood pressure is normal, coma due todiabetes, acute alcoholism, extradural or subdural haemorrhage, or drugpoisoning must be excluded. The odor of acetone on the breath and thepresence of sugar in the urine (which may have to be obtained bycharacterization) are in favor of diabetes. It must be remembered, however,that a transient glycosuria occurs in a definite percentage of the cases ofcerebral haemorrhage or thrombosis. The determination of the sugar content inthe blood will aid in establishing or excluding the diagnosis of diabetic coma,since the rise in blood sugar which occurs with cerebral vascular accidents israrely as high as that commonly seen in diabetic coma. The presence of albumin and casts in the urine is in favor of uremia, but thediagnosis cannot be definitely established without a determination of the non-protein nitrogen content of the blood. It must also be remembered that cerebralvascular lesions are a common complication of uremia. An alcoholic odor to the breath, normal blood pressure, no evidence of ahemiplegia, and normal cerebrospinal fluid are the characteristic findings incases of coma due to acute alcoholism. The cerebrospinal fluid pressure inthese cases may be slightly elevated (200 to 300 mm.). Alcoholics are prone tohead injury and the diagnosis of subdural haematoma should be entertained inany alcoholic patient admitted to a hospital in coma with a hemiplegia.iv. Extradural haemorrhage cerebral Haemorrhage or Thrombosis: This is differentiated by appearance of symptoms immediately followed byinjury to the head. If the patient is lacerations of the scalp indicative of a headinjury is important. X-ray of the skull and an examination of the cerebrospinal fluid are often ofaid. If there is a fracture of the skull and an examination of the cerebrospinalfluid are often of aid. If there is a fracture of the skull, which passes throughthe groove of the middle meningeal artery, the diagnosis of extraduralhaemorrhage should be made.
  • 88. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 76v. Subdural Haemorrhage and Ischaemic stroke: The differential diagnosis between subdural haemorrhage and cerebrovascularlesions is often difficult. It is important that the diagnosis be made promptlybecause immediate operation may be necessary to save the patient‟s life. The differential diagnosis is further complicated by the fact that the headinjury, which produced the subdural haemorrhage, may have been only aslight or moderate one, and an interval of several days or weeks may separateit from the onset of the symptoms produced by the hematoma. In addition, thecoincidence of hypertension and subdural haematoma is frequent. If there is ahistory of a recent head injury and there are fluctuations in the patient‟s stateof consciousness, the diagnosis of subdural haematoma should be considered.The frequent association of subdural haematoma with chronic alcoholismshould be kept in mind. Displacement of a calcified pineal gland in the X- ray films of the skull is afinding in favor of the diagnosis of a subdural haematoma. Examination of thecerebrospinal fluid is of value in the differential diagnosis between cerebralthrombosis and subdural hematoma. The finding of a bloody or xanthochromicfluid under increased pressure renders subdural haematoma the more likelydiagnosis. Occasionally, however, the CSF in a patient with subdural haematoma will beclear, with or without an increase in the pressure. Whenever the diagnosis ofsubdural haematoma cannot be excluded by the history and examination, anangiogram should be performed or small trephine openings made in thetemporal region of the skull on both sides. It is not uncommon to have falselocalizing signs in subdural haematoma and, in addition, it is not rare to find aclot on both sides.vi. Brain tumor or brain abscess and Ischaemic stroke: This is usually differentiated by the slow and progressive evolution of thesymptoms. The presence of “choked discs,” a normal blood pressure, anincreased cerebrospinal fluid pressure and a clear or slightly yellow
  • 89. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 77cerebrospinal fluid with a normal cell count and increased protein content arethe characteristic findings in patients with tumors of the brain. Exactly similar findings are present in patients with brain abscess, except thatthe cerebrospinal fluid usually shows a mild or moderate pleocytosis. Thefindings of an increased activity of glutamic oxalacetic transaminase in thecerebrospinal fluid are in favor of the diagnosis of a Ischaemic stroke.Progression of a focal abnormality in the electroencephalogram is in favor ofthe diagnosis of a tumor.vii. Epilepsy and Ischaemic stroke: The history of numerous previous convulsions and the occurrence of aconvulsion before the onset of the coma, together with a normal bloodpressure and abnormal cerebrospinal fluid are in favor of the diagnosis ofepilepsy.viii. Subarachnoid haemorrhage and Ischaemic stroke: Symptoms in patients with primary subarachnoid haemorrhage usually have asudden onset similar to that of other cerebral vascular accidents. Headache is aprominent symptom and signs of meningeal irritation, stiffness of the neck andKernig‟s sign, develop rapidly. The presence of hemiplegia or aphasia is infavor of the diagnosis of an intracerebral haemorrhage if the cerebrospinalfluid is bloody, but it must be remembered that an aneurysm may be so locatedthat it bleeds into both the subarachnoid space and the cerebrum when itruptures.VII. DIAGNOSISDiagnosis of a disease depends on history, clinical features and labinvestigatīons. A stroke may be defined as sudden development of neurologicaldefect, usually associated with hemiplegia and sometimes accompanied byunconsciousness. Hemiplegia is a paralysis of one side of the one half of the body andit includes upper limb, one side of the trunk and the lower limb.
  • 90. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 78There are several common causes of sudden onset of neurological symptomsthat may mimic stroke, including seizure, intra cranial tumor, migraine and metabolicencephalopathy. An adequate history from an observer, that no convulsive activityoccurred at the onset reasonably exclude seizure. Tumor may present with acuteneurological symptoms due to haemorrhage, seizure or hydrocephalous. Migraine alsocan mimic stroke even in patient without migraine history, when it develops asacephalic migraine.The proper approach to the patient with neurological illness begins with thepatient and focuses the clinical problems first in anatomical and then inpathophysiological terms, only then should specific diagnosis be entertained. Thismethod ensures that technology is judiciously applied, a correct diagnosis isestablished in an efficient manner and treatment is promptly initiated.The first priority is to identify the region of nervous system that is likely to beresponsible for symptoms. The first clue is to defining the anatomical area ofinvolvement appears in the history and the examination is then directed to confirm orrule out these impressions and to clarify uncertainties. Attention to the description ofthe symptoms experienced by the patient and substantiated by family members andothers often permit an accurate localization and determination of the probable causeof the complaints, even before the neurological examination is performed. A patientwith a right hemiparesis without language deficit likely has a lesion in internalcapsule, brain stem or spinal cord different from that of a patient with righthemiparesis and aphasia.Course of illness is important to determine the precise time of appearance andrate of progression of the symptoms experienced by the patient. The rapid onset of aneurological complaints occurring within seconds or minutes usually indicates avascular events, seizure or migraine. A more gradual onset and less well localizedsymptoms point to the possibility of TIA, transient loss of symptoms suggests TIA. Astuttering onset where symptoms appear, stabilize and then progress over hours ordays also suggests CVA. An additional history of transient remission or regressionindicates that the process is more likely due to ischemia than haemorrhage.
  • 91. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 79It is always necessary to obtain information from the family and friends.Memory loss, aphasia, loss of insight, intoxication and other factors may impairpatient‟s capacity to communicate normally with the examiner. Episodes of loss ofconsciousness necessitate that details be sought from observers to ascertain preciselywhat has happened during the event.Clinical examination begins with assessment of mini mental status examinationfollowed by the cranial nerves, motor system, sensory system, coordination and gait.The clinical data obtained from the history and examination are interpreted to arrive atan anatomical localization that best explains the clinical findings to narrow the list ofdiagnostic possibilities and to select the laboratory tests most likely to be informative.VII. INVESTIGATIONSInvestigations should be planned to test, confirm and elaborate on thehypothesis of stroke mechanism and anatomical localization generated from theclinical encounter.i. Cerebral thrombosis:Test Disease1. Hb, Haematocrit Polycythemia, anemia, infection2. Platetel count Thrombocythemia3. ESR Arteritis4. Blood glucose Glycosuria / hyperglycaemia5. VDRL (Serological tests) Syphilis6. Lipid profile studies Hyperlipidaemia7. Serum uric acid is often raised8. Serum electrolytes, blood urea nitrogen, prothrombin time, partialthromboplastin time should be evaluated.9. Urine analysis should be done to rule out renal pathology.10. CSF Test – Raised protein levels is seen. There may be pleocytosisincluding a moderate excess of polymorphonucler cells. CSF pressure is
  • 92. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 80normal. Moderate increase in serum and CSF creatine kinase, aldolase andlactic dehydrogenase occur.11. Norepinephrine and other catecholamine are also raised.12. ECG – Usually shows marked abnormalities after infarction orhaemorrhage.13. CT scan is almost certain to show the site of lesion though possibly notwithin 24 hours.14. Contrast enhanced CT Scans (CT angiograms) are useful in acute strokemanagement to reveal the presence or absence of large vessel pathology.15. Magnetic resonance imaging (MRI) can demonstrate lesions in theposterior fossa not visible by CT and demonstrates ischemic zones withinfew hours after stroke.16. MRA (Magnetic Resonance Angiography) is highly sensitive forextracranial internal carotid plaques as well as intracarnial stenosis of largevessels.17. Computerized Cranial Tomography (CCT) is the single most importantnoninvasive investigatīon to distinguish an infarction from cerebralhaematoma.18. Cerebral Angiography - Conventional x-ray cerebral Angiography isuseful for identifying and quantifying atherosclerotic stenosis of cerebralarteries and other pathologies including aneurysm, intraluminal thrombi,collateral blood flow, etc. Angiography is routinely performed in all caseswith cerebral vascular lesions by some investigators. It is the generalopinion; however, that angiography is indicated only when the diagnosis isnot clear, or when surgical therapy is contemplated. Use of cerebralangiography coupled with endovascular techniques for cerebralrevascularization may become routine in near future.19. Aortic arch catheterization, digital subtractions angiography are alsohelpful tests.20. Ultrasound Techniques: - Carotid Doppler (Duplex Ultrasound) is usefulin identifying and quantifying stenosis of carotids and blood flowing insome cerebral arteries. Transcranial Doppler (TCD) is used to detect
  • 93. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 81stenotic lesions of cerebral arteries and assesses collateral flow acrossanterior and posterior circle of Willis.21. Other techniques: - Both Xenon-CT and position emission tomography(PET) can quantify cerebral blood flow. They can be useful fordetermining the significance of arterial stenosis and planning forrevascularization surgery. Single positron emission computed tomography(SPECT), CT-Perfusion and MR-perfusion techniques report relativecerebral blood flow. In special cases it may be necessary to perform anElectroencephalogram, Echoencephalograph radio-active scan.22. Pneumoencephalogram, Ventriculogram and sometimes X- ray of skull.ii. Cerebral embolism:In general, the findings are similar to those outlined under cerebralthrombosis.1. In septic infarct the WBC count may be very high.2. CSF – In haemorrhagic cerebral infarction the CSF is often bloodstained.The protein values are elevated, but the glucose content is within normallimits.3. ECG – Atrial fibrillation, tachyarrhythmia and other ECG abnormalitiesare frequently documented.4. Echocardiography determines whether a cardiac thrombus was the sourceof embolism, by imaging the ventricular chambers.5. Arterial imaging (CT or MRA or TCD) performed is characteristic andshow migratory occlusive lesion of isolated branches in early stages. Arepeat Arteriography after a few days may be entirely normal, this suggestsvanishing emboli.6. 2D-echo helps to define intracardiac and valvular emboli.7. MRI better documents the extent and location of the embolic infarction.When coupled with MRA can help identify arterial source of emboli.8. Embolic infarction may appear as a single low-density area on CTimaging.
  • 94. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 82VIII. PROGNOSIS OF ISCHAEMIC STROKEPrognosis depends on the type of stroke, the degree and duration ofobstruction or haemorrhage, and the extent of brain tissue death. Most stroke patientsexperience some permanent disability that may interfere with walking, speech, vision,understanding, reasoning, or memory.i. Thrombosis:In subjects who survive stroke, some degree of recovery is the rule. Chancesof significant recovery are remote when no improvement is noted within first 6-8weeks. Approximately 70% of ischemic stroke patients are able to regain theirindependence and 10% recover almost completely. Approximately 25% of patientsdie as a result of the stroke patients with massive cerebral infarction and brain edema.When focal ischemic lesion is within the territory of the internal carotid artery leads tothe greater the extent of the area of cerebral dᾹmage, the worse the outlook. Old age,previous strokes, coma, association of sensory loss, recurrent infections, poorlycontrolled hypertension and diabetic states and basilar artery thrombosis are bad signsof prognosis. The longer delay in onset of recovery, the poorer the prognosis.ii. Cerebral embolism:Cerebral embolism as such is rarely, fatal, unless the embolus lodges in theinternal carotid artery. The immediate mortality of cerebral embolism is 7-10%. Herethe eventual prognosis is determined by the progress of the condition causingembolism and the gravity of the underlying illness – cardiac failure, MI, malignantgrowth, etc. In auricular fibrillation when emboli are likely to be repeated or whenembolus is infected, the prognosis is much more serious. A massive brainsteminfarction due to basilar embolism is almost always fatal.
  • 95. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 83Table No. 13 - Causes of neurological deterioration after strokeIX. MANAGEMENT OF STROKEAfter the clinical diagnosis of stroke is made, an orderly process of evaluationand treatment should follow. The first goal is to prevent or reverse brain injury.Before starting the therapy, it should be first confirmed by CT that whether the strokeis ischemic or haemorrhagic. The second goal is to know the complete mechanism forpreventing future stroke.Treatment designed to reverse or lessen the amount of tissue infarction fallwithin five categories:i. Medical supportii. Thrombolysisiii. Anticoagulationiv. Antiplatelet agentsv. Neuroprotectection.i. Medical Support: In the acute stage of cerebral ischemia, maintenance of vital signs, potency ofairway and fluid and electrolyte balance and prevention of complications likepulmonary aspiration, seizures, thrombophlebitits, bedsores, etc. areSr CAUSE1 LOCAL Extension of thrombus Recurrent embolism Recurrent haemorrhage Haemorrhagic transformation of infarct Cerebral edema Brain shift and herniation Epileptic seizures2 GENERAL Hypoxia Hypotension Infection Dehydration Depression
  • 96. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 84mandatory. Unless there are major cardio pulmonary problems, in the earlystages head-low or flat position in bed is preferred. Anoxia should be prevented by keeping the airway patent and clearing thethroat secretions by gentle suction with a sterile catheter. Elevated BP should not be lowered unless there is malignant hypertension orconcomitant MI. When faced with competing demands of myocardium andbrain, heart rate lowering with the Beta-adrenergic blocker esmolol can be afirst step to decrease cardiac work and maintain BP. If BP is low, raising it isadvisable, using intravenous fluids or vasopressor drugs to enhance perfusionwithin the ischemic penumbra. Fever if present should be treated with antipyretics. Cerebral edema should be treated by hyperosmolar solution (e.g. IV mannitol)and water restriction. Hypovolemia should be avoided. Trials are under way totest the clinical benefits of craniotomy and elevation of the skull(hemicraniectomy) for larger hemispheric infarcts with marked cerebraledema.ii. Thrombolysis:The use of thrombolytic agents in acute cerebral infarction has beenstudied extensively. Recombinant Tissue Plasminogen Activator (rt-PA): The National Institute ofNeurological Disorders and Stroke (NINDS) rt-PA stroke study showed aclear benefit for rt-PA. This is a proven thrombolytic agent for stroke patient.The eligibility criteria and instruction for administration of rt-PA is as follows; Indication: Clinical diagnosis of stroke, onset of symptoms to time of drugadministration < 3h (therapeutic window), CT scan showing nohaemorrhage or significant edema, Age > 18 years. Contraindication: Sustained BP > 185/110, Platelets < 100,000; HCI <25%; glucose < 50 or > 400, use of heparin within 48 h, prior stroke orhead injury within 3 months, prior ICH, Recent MI, coma or stupor. Administration: 0.9 mg/kg IV as 10% of total dose by bolus followed byremainder of total dose over 1 hr.
  • 97. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 85 The risk of ICH appears to rise with larger strokes, longer times from onsetof symptoms, and higher doses of rt-PA administration. More localized administration, i.e., IA thrombolysis improves resolution of theblockage. Two recent trials [PROACT & ACT II (Prolyse in acute cerebralthromboembolism)] using intra-arterial thrombolysis for acute MCA occlusionupto the sixth hour following onset of stroke showed benefit. Urokinase: This is also a thrombolytic agent administered IV within 3 hours ofsymptom onset. It is presumed to be less effective than rt–PA.iii. Anticoagulants: The role of anticoagulation in atherothrombotic cerebral ischemia is uncertain.IV and subcutaneous heparin is used for the treatment. Subcutaneous heparinat low doses is approved for use in recovering stroke patients as a means ofpreventing DVT. Haemorrhage, which occurs in 2-5% of treated patients, isthe most serious complication of this therapy. During treatment patients mustbe investigated for hematocrite, etc. Its judicious use in recurrent TIAs,thrombosis-involution, cardiogenic embolization to the brain, subjects notresponding to platelet antiaggregant therapy has been recommended. If long-term anticoagulation is chosen, warfarin is administered and heparindiscontinued.iv. Antiplatelet Agents: Antiplatelet agents are widely prescribed for the secondary prevention ofIschaemic stroke. It is also administered in the acute phase of Ischaemic stroketo facilitate clot dissolution while also reducing the risk of re-occlusion andstroke recurrence. Aspirin is the only antiplatelet agent that has been prospectively studied forthe treatment of acute ischaemic stroke. The recent large trials, Internationalstroke trial and Chinese Acute Stroke Trial found that the use of aspirin within48 h of stroke onset reduced both stroke recurrence risk and mortalityminimally. These trials demonstrate that the use of aspirin in the treatment ofacute ischaemic stroke is safe and produces a small but definite net benefit.
  • 98. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 86Agents that act at the glycoprotein 11b/111a receptor are undergoing clinicaltrials in acute stroke treatment.v. Neuroprotection: Neuroprotection is the concept of providing a treatment that prolongs thebrain‟s tolerance to ischemia long enough to allow other measures to beemployed to mitigate ischemia. Hypothermia is probably the most powerfulneuroprotectant but is only now the subject of clinical trials. Drugs that blockthe excitatory amino acid pathways have been shown to protect neurons andglia in animals but despite multiple clinical trials they have not been proven tobe beneficial in humans. There are many neuroprotectors under study. Citioline: It‟s a cholinesterase inhibitor used as IV & IM injection for thetreatment of CVD. Currently in development as an oral neuroprotectantpotentially the first one in its class, citioline could offer modest early,neuroprotection from the damaging effect of Ischaemic stroke. Estrogen as a neuroprotectant in stroke (Hurn PD, Macrae IM, Johns HopkinsUniversity, USA) (April 2000): Recent evidence suggests that reproductivesteroids are important players in shaping stroke outcome and cerebrovascularpathophysiologic features. Estrogen is considered increasingly to be anendogenous neuroprotective agent. A growing number of studies demonstratethat exogenous extradiol reduces tissue damage resulting from experimentalischaemic stroke in both sexes.Primary and Secondary Prevention: A number of medical and surgical interventions, as well as life-stylemodifications, are available for preventing stroke. Evaluation of a patient‟sclinical risk profile can help determine which preventive treatments to offer.Old age, family history of stroke, DM, HTN, hypercholesterolemia, tobaccosmoking and other factors are risk factors of for Ischaemic stroke, largely bytheir link to atherosclerosis.HTN is the most significant of the risk factors and should be treated.Treatment of hypercholesterolemia should be done. It also prevents coronary
  • 99. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 87artery disease, which is a cause of embolic infarction. Tobacco smokingshould be discouraged and DM should be controlled in hypoglycemic drugs. Antiplatelet agents can prevent atherothrombotic events including TIA andstroke. Aspirin, elopidogrel and the combination of aspirin plus extended-release dipyridamole are the antiplatelet agents used most for this purpose.Every patient who has experienced an atherothrombotic stroke and has nocontraindication should be taking an antiplatelet agent regularly to preventrecurrence. Embolic Stroke: Warfarin is more effective than aspirin in preventingischaemic stroke associated with atrial fibrillation. Anticoagulation therapy: Long-term use of anticoagulants has proved to beeffective in the prevention of embolism in cases of atrial fibrillation, MI andvalve prosthesis. Surgical therapy: Surgery for atheroscleterotic occlusive disease is largelylimited to carotid endarterectomy for plaques located at the origin of ICA inneck. It is a proven effective prophylaxis against stroke and TIA. Balloonangioplasty coupled with stenting is being used to open stenotic carotidarteries and maintain their patency. In some thromboendarterectomy thoughconsidered risky but may prove beneficial as compared to the long-term risk ofanticoagulant therapy. Valvulopasty, removal of valvular verrucous lesions in endocarditis andamputation of the atrial appendage have substantially reduced the incidence ofembolism in RHD.X. COMPLICATIONSStroke like many other serious medical illnesses can be followed by manycomplications. These complications can sometimes cause neurological deterioration,which are as follows;i. Cerebrovascular System: Cerebral edema represents the major cause of death. Cerebral edema maybegin within hours but usually doesn‟t become clinically obvious until 1 to 4days after stroke. The two main components of edema are intracellular
  • 100. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 88cytotoxic edema and extracellular vasogenic edema. Cerebral edema impairsthe neuronal function over a wide area and increases the risk of transtentorialherniation and secondary brain stem haemorrhage. Seizures may also follow stroke. While they might not be a cause of mortality,seizures complicate the care of the patient. Patient with cortical infarcts,especially large ones, with persistent hemiplegia are most susceptible to postinfarction epilepsy. Patients with subcortical slit haemorrhage are also proneto early seizures.ii. Respiratory System: Aspiration: In patients with brainstem stroke, combined cerebral and brainstem strokes and bilateral cerebral lesions are susceptible to aspiration. Dysphagia: Noted in brainstem and hemispheral stroke. Pulmonary embolism: The true frequency of pulmonary emboli is probablyunknown because many are silent. Pulmonary emboli can be a cause of deathin patients who die during the first week following stroke. Patients who havesudden shortness of breath, chest pain, hypotension, haemoptysis, change inrespiratory pattern, agitation, confusion or other worsening are suspected ofhaving a pulmonary embolism. Pneumonia.iii. Cardiovascular system: Myocardial Infarction: Patients with both ischemic and haemorrhagic strokehave been demonstrated at necropsy to have subendocardial haemorrhages andfocal regions of necrosis of cardiac muscle cells. Cardiac failure Cardiac dysfunction is another frequent accompaniment ofstroke. Cardiac arrhythmia: Stroke causes an increase in sympathetic tone, elevatinglevels of catecholamines, which in turn causes focal myocardial damage andsubsequent arrhythmias. ECG changes consistent with ischemia, elevated creatine-phosphokinase –myoglobin and various cardiac arrhythmias are found in stroke patients, evenwithout previous heart disease.
  • 101. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 89iv. Infections: Urinary tract Infections: Indwelling catheter placed to empty urinary bladderallows the introduction and growth of bacteria. Functioning of the urinarybladder and the external sphincter can be altered by stroke. Urinary symptomsare common even in uninfected bladders and they include urinary urgency,frequency and retention. Tsuchida et. al. documented these symptoms andattempted to establish their relationship to brain lesion. Frontal and internal capsular lesions: Hyperactive bladder or inhibitedsphincter relaxation, with urinary frequency and incontinence. Putaminal lesions: Hyperactive bladders, with normal sphincter functions. In few lesions: Hhypoactive or inactive bladder, urinary retention and normalsphincter. Septicemia Skin infections.v. Metabolic and Nutritional Disorders: Fluid, electrolyte and nutritional abnormalities may occur during the recoveryperiod. Post stroke hyponatremia is usually related to inappropriate secretion of ADH.(Joynt et al.). Prolonged under nutrition is an important but seldom recognizedcomplication of stroke, especially in elderly patients whose nutritional intakeis poor or marginal before their stroke. Vomiting, dehydration, hyperglycemia and renal failure are othercomplications.vi. Mechanical: Spasticity, Pseudocontractures (contractures) of muscles. Periarthritis at shoulder, elbow, wrist, knuckles, knee and ankle; Ankleswelling, Osteoporosis, Fractures, Pressure sores, sublaxation of shoulders. Reflex sympathetic dystrophy syndrome (RSDS): characterized by severeshoulder pain, swelling, burning pain, hyperaesthesia and dystrophic changes. Peripheral nerve compression: Peroneal nerve compression – foot drop;Compression of nerve at elbow – Ulnar palsy.vii. Psychological Effects: Depression, Anxiety, Apathy.
  • 102. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 90C. REVIEW OF VASTIa. HISTORICAL REVIEWVEDAS:If the history of vasti is traced, it is very well found in Vedic era. We can findreferences of vasti in Ṛgveda and Atharvaveda (RV.1:161-13). Kauśikasutra ofAtharvaveda lays down use of enema as substitute for minor operation (AtharvavedaDarila Bhatta 25:27).PURᾹNA:Agni Purāna has made direct reference to the vasti therapy, especiallydesigned for tried horses named as “Turaṉga Vasti”. The quotation states that thefatigue of the horse could be relieved by the use of vasti with taila (oil) (AgniPurāna.289:4).YOGIC LITERATURE:In Jala vasti, Yogic person are using to sit in naval deep water in Utkatāsana,and sucking water into guda to clean the rectum and lower bowel by contractionrelaxation of their guda. In Śuśka vasti the aspirant is asked to move the intestineslowly downwards then contract and dilate the guda with the help of Ashvinīmudrawhich is again instructed to make downward of vasti. This improves the Agnī andcures many diseases. Jala vasti is indicated in Prameha, Udāvarta, morbid Vāta etcand to gain handsomness (Gherenda Saṃhitā 1:40).EGYPTIAN LITERATURE:The first record mentioning a colon therapy is an Egyptian medical documentdiscovered by Ebers, dated as early as 1500 B.C. and nowadays one of the greattreasures of the Leipzig Library. For the treatment of some person suffering from painin abdomen, his body swollen, when he takes nourishment, his stomach feelsuncomfortable at its entrance, right though against it with soothing remedies. Itmoves; thereafter under the fingers give him an enema for four mornings. (BryanC.P.1930, the papyrus Ebers P, 139).
  • 103. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 91Pliny, (1940) in his great work on natural history, writing under heading ofmedicinal remedies which have been borrowed from animals suggested that theenema originated from a bird called the Ibris, which makes use of the curve of itsbeak to purge itself through the part by which it is most conductive to health for theheavy residue of food stuffs to be excreted. It was supposed to blow into its rectumthe water of Nile (Lilico J.1641 Ann. Med. History, 3rd series, 3.55).Ancient primitive tribes in the Amazon, central Africa and remote parts ofAsia practiced enemas in the rivers, usually as part of magic-medical practicesperformed by priests and colon cleansing therapeutic treatment were an important partof Taoist training regimens and also observed from different approaches in Hinduism.Also ṛtual enemas were practiced in Mayan Ceremonials and many otherCentral American and South American Indian tribes, in fact some survival tribes havecontinued their traditional colon cleansing practice to the present day.In the United States the popularity of colon cleansing treatments wereremarkable in the early decades of the 20thcentury, when colon irrigation machineswere commonly seen.During the 1920s and 1930s years, enemas were regularly used as a standard practiceamong most physicians and implemented as common treatment in most hospitals. Itwas not until the 50s when the use of enema therapy started gradually to decreasebefore the colon cleansing therapy resurged by the end of the 20th century(http://www.enemakit.com/enema_history.html).SAṂHITĀ PERIOD: Caraka Saṃhitā (2ndcentury B.C.):It is one of the oldest text books of Ᾱyurveda which is still practiced bythe physicians since centuries. Detailed description about vasti karma isavailable in this Saṃhitā. Siddhī Sthāna is the particular section of this bookwhich deals with the Pañcakarma procedures and full knowledge of vastikarma, out of 12 chapter of Siddhī Sthāna, 8 chapters contribute to vasti and infirst 2 chapters properties of vasti, Samyakayoga, Ayoga lakṣana and
  • 104. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 92indications and contra indications have been mentioned. This denotes theimportance of vasti in the field of Kāyacikitsā. Suśruta Saṃhitā (2 A.D.):Ᾱcaryā Suśruta has devoted 4 chapters completely for the descriptionof vasti in Cikitsā Sthāna (Su.Ci.35-38). In these chapters detailed informationregarding vasti Netra, indications, contraindications, complications andclassification of vasti etc., are available. Bhela Saṃhitā (600 B.C.):In this Saṃhitā vasti mātriya siddhī, Upakalpana siddhī, Phalamātrāsiddhī, Doṣa vyāpad siddhī are the four chapters which deal with thedescription of vasti. The scattered references about indication of vasti inparticular disease are also available. Hārita Saṃhitā (600 B.C.):In Hārita Saṃhitā, third chapter of Sutra Sthāna gives informationregarding vasti apparatus and conditions suitable for vasti karma. Scatteredreferences at other places are also available.SAṈGRAHA PERIOD: Aṣṭāṉga Saṉgraha (6thCen.):In Aṣṭāṉga Saṉgraha, 19thchapter of Sutra Sthāna have been devotedto vasti only. In this chapter classification, indications, contraindications,dosage, process of administration etc. have been described in detail. Also 4chapters of Kalpa Sthāna have been contributed to vasti. In these chapters,description regarding importance of vasti, different types of vasti, vasti vyāpadetc. are available. Aṣṭāṉga Hṛdaya (7thCen.):In this Saṃhitā mainly the compilation of Caraka and Suśruta Saṃhitāalmost and one chapter of Sutra Sthāna describes vasti. This chapter providesinformation regarding classification, indications, contraindications, process of
  • 105. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 93administration and Vasti Netra etc. 4thchapter of Kalpa Sthāna named as VastiKalpa describes different types of drugs to be used for vasti and next chapterVasti Vyāpad Siddhī explains the complications of vasti and their treatment. Kāśyapa Saṃhitā (6thCen.):Kāśyapa Saṃhitā, the prime Saṃhitā of Kaumārbhṛtya, Vasti has beenexplained in Siddhī Sthāna and Khila Sthāna. Vasti Vieśeṣanīya Adhyāya inKhila Sthāna contains the secrets of vasti therapy. There is no treatment asgood as vasti for the diseases of Śākhāgata, Koṣṭagata, Sarvāṉga orArdhāṉgagata because these are caused due to the vitiation of Vāta and vastiis the supreme treatment for alleviation of Vāta (Kā.Khi.8:3). Siddhī Sthāna,Rajaputrīya Siddhī, Vasti Karmīya Siddhī and Maṉgal Siddhī these chapterstotally deal with vasti. Cakradatta (11thCen.):Cakrapāṇī has contributed two chapters to described Anuvāsana andNirūha vasti named as Anuvāsana Adhikāra and Nirūha Adhikārarespectively. Cakradatta almost follow Caraka Saṃhitā for the procedures ofvasti administration. Cikitsā Sāra Saṉgraha (12thCen.):Vaṉgasena in Cikitsāsāra Saṉgraha has devoted “VastiKarmādhikāra” chapter for description of vasti. Śāraṉgadhara Saṃhitā (13thCen.):Ᾱcaryā Śāraṉgadhara devoted 3 chapters of Uttara Khaṉda namelyVasti Kalpana Vidhī, Nirūha Vasti Kalpana Vidhī and Uttara Vasti KalpanaVidhī, which describes various aspects of Anuvāsana vasti, Nirūha vasti andUttara vasti respectively. Bhāvaprakāśa (16thCen.):Bhāvamiśrā has described both Anuvāsana and Nirūha vasti inParībhāṣā prakarana 7; and definition of Anuvāsana and Nirūha. Anuvāsana
  • 106. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 94is a type of vasti which is given with medicated oil. Nirūha vasti is one whichis given with Kaśāya, Kśira and Taila. Bhāvaprakāśa follows Śāraṉgadharaalmost in every respect.b. ETYMOLOGY OF VASTIThe word "Vasti" is derived from the root vas by adding tic pratyaya.I. Nābherardhobhāge Mutrādhāre Sthāne||It denotes an organ situated below the umbelicus which holds the urineII. Vasu Nivāse|| (Vācaspatyam)To reside, to stayIII. Vas Acchādane|| (Vācaspatyam)To cover, to coatIV. Vasteḥ Avrṛnotī Mutram||It denotes an organ, which covers the urineV. Auṣadha Dānārthe Dravyabhede||It denotes an instrument used for the administration of the medicine.VI. Vas Snehāchhādane Prahāraneṣu||Coating of Sneha for the elimination.VII. Vasta Gaṉdha Ardane||Gaṉdha denotes bad smell hence it refers to „mala‟ and the verb„Ardane‟ is derived from „Ardagatou Yacane ca’ denotes the movement (inthe colon) and to beg (drawing of waste material in the colon from all over thebody).VIII. Vas Vāsane Surabhikarane|| (Vācaspatyam)To produce effect of pleasant smell.
  • 107. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 95Meanings of vasti: Vasti denotes a karma wherein the drugs administered (Auṣadhadānārtha)through the anal canal stay for certain time in the body (Nivāse), then producesthe coating of the Sneha in the body (Snehācchādana) and draws the wastesubstances from all over the body into the colon and eliminates them out of thebody (Surabhikarane). An organ for the reservoir of urine i.e. urinary bladder. An instrument used for the administration.c. NIRUKTII. Nabhīpradeśam Katīpārśwakukṣīm Gatwā Shakṛtdoṣacayam Viloḍya||Saṃsnehya Kāyam Sapurīṣaḥ Samyak Sukhainetī caya Sa Vasti||(Ca.Si.1:40-41)Ᾱcārya Caraka has defined the vasti as the procedure in which thedrug prepared according to classical reference is administered through rectalcanal, reaches up to the Nabhī, katī, parśwa, kukṣī pradeśa churns theaccumulated Puriṣa and doṣa and spreads the unctuousness (potency of thedrugs) all over the body and easily comes out along with the churned Puriṣaand doṣas.II. Vastinā Dīyate Iti Vasti||(AH.Su.19:1)III. Vastibhirdīyate Yasmāt Tasmāt Vastirīti Smṛtaḥ||(Śā.U.K.5:1)The apparatus used for introducing the medicated materials is made upof vasti or urinary bladder of animal.d. CLASSIFICATION OF VASTIVasti is the procedure and method of drug administration. So it can beadministered through various routes with the use of different drugs, for differentperiod and for various purposes.
  • 108. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 96Vasti can be classified as follows:I. On the Basis of Special Purpose with Special Indications:Madhutailika Vasti Siddha Vasti Yuktaratha VastiYāpana Vasti Picchā VastiPicchila Vasti Vaitrana VastiII. On the Basis of chief action:Snehana Vasti. Bṛmhana Vasti. Śamana Vasti.Lekhana Vasti. Śodhana Vasti. Saṉgrāhīka Vasti.Rasāyana Vasti. Vājīkarana Vasti. Balavarṇakṛta Vasti.Chakṣuṣya Vasti. Dīpana Vasti.III. On the Basis of Action on the Doṣa and Dūṣya:Vātahara Vasti. Pittahara Vasti. Kaphahara Vasti.Śonita Doṣahara Vasti. Doṣa Saṃsargahara Vasti. Utkleśana Vasti.Śodhana Vasti. Śamana Vasti. Doṣahara Vasti.IV. On the Basis of Specific indications:Pramehahara Vasti. Visarpahara Vasti. Raktapittahara Vasti.Kuṣṭahara Vasti. Vātaraktahara Vasti. Gulmahara Vasti.Abhiṣyṉdahara Vasti. Kṛmihara Vasti. Dāhaghna Vasti.Mutrakṛcchrahara Vasti. Parīkartikāhara Vasti.V. On the basis of Nature of the Vasti Dravya:Mṛdu Vasti. Madhyama Vasti. Tīkṣṇa Vasti.VI. On the Basis of Rasa predominance in the Vasti Dravya:Madhura Rasa Skaṉdha Dravya Vasti. Ᾱmla Rasa Skaṉdha Dravya Vasti.Lavana Rasa Skaṉdha Dravya Vasti. Kaṭu Rasa Skaṉdha Dravya Vasti.Tikta Rasa Skaṉdha Dravya Vasti. Kaśāya Rasa Skaṉdha Dravya Vasti.
  • 109. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 97VII. On the Basis of chief Drug:Kṣīra Vasti. Māṃsa Rasa Vasti. Gomutra Vasti.Rakta Vasti. Kśāra Vasti. Dadhimastū Vasti.Ᾱmlakaṉjī Vasti. Prasannakṛta Vasti. Surākṛta Vasti.Ᾱsavakṛta Vasti.VIII. According to the Dose of the Vasti:Dvādaśa Prasṛta Vasti. Ekadaśa Prasṛta Vasti, Nava Prasṛta Vasti.Aṣṭa Prasṛta Vasti Sapta Prasṛta Vasti, Ṣaḍa Prasṛta Vasti.Pañca Prasṛta Vasti. Catuḥ Prasṛta Vasti.IX. On the Basis of Adhiṣṭhāna:i. Pakwāśayagata vasti:Vasti dravyas administered through anal canal into the colon (Pakwāśaya) iscalled Pakwāśayagata; it includes both Nirūha and Anuvāsana vasti. According to thetype of dravyas it is further classified in to two subtypes;1. Snaihīka vasti :In this type the mainly four types of Sneha in the form of medicatedTaila, Ghṛta, Vasā and Majjā is administered through the rectal canal into thecolon. This Snaihīka vasti is classified into three types according to the dose. Sneha vasti: The quantity of Sneha vasti is decided ¼th to the quantity of theNirūha. So, 6 pala (288 ml) Sneha is administered. Anuvāsana Vasti: Anuvāsana term can be used for the Snaihīka vasti too. TheSneha vasti which will not cause any harm even if it is retained for one dayand can be administered every day after taking food (Su.Ci.35:18).Thequantity of this vasti is half to the Sneha vasti i.e. 3 Pala (144 ml). Mātrā Vasti: In this type minimum quantity of Sneha i.e. ½ Pala (72ml) isadministered.It can be given without code of conduction.2. Nirūha vasti:In this type of vasti, Kaṣāya is the dominant content.The vasti whicheliminate the vitiated doṣa from the body. Which increases the strength of thebody because of its potency is called Nirūha vasti (Su.Ci.35:18), (AS.Su.28:6).
  • 110. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 98Nirūha vasti also called as Ᾱsthāpana vasti; the meaning of this vastican be understood easily by its Name. Ᾱsthāpana vasti stabilizes the age(Vaya) or Ᾱyu, stabilizes the normal functions of doṣa and dhātu and stabilizesdeha i.e strength of the body so called Ᾱsthāpana vasti (Su.Ci.35:18),(AS.Su.28:6).The Kaśāya, Madhu, Saiṉdhava, Sneha and Kalka are the ingredientscommonly used in Nirūha vasti. Instead of Kaśāya, Māṃsa Rasa, Kṣīra,Mutra, Ᾱmlakāṉjī, Dadhīmastu, Rakta etc., also can be used.ii. Garbhāśayagata vasti:The drugs are administered through the vagina in to the uterus(Garbhāśaya), is called Garbhāśayagata vasti.iii. Mutrāśayagata vasti:The drugs are administered through the urethra into the urinary Bladder(Mutrāśaya) is called Mutrāśayagata vasti. Garbhāśayagata and Mutrāśayagata vastiboth are called as Uttara vasti.iv. Vrana vasti:The drugs are introduced in to the Vrana for its śodhana and ropanapurpose. It is mentioned by Suśṛuta.X. Classification According to the fixed schedule:According to the disease and condition of the patient we can use one of thefollowing schedules;i. Karma vasti: In this schedule, 30 vasti’s are being administered out of which 18 Anuvāsanaand 12 Nirūha. Initially one Anuvāsana is administered then 12 Nirūha and 12Anuvāsana are given alternately and at last 5 Anuvāsana should be given.Every day one vasti can be given. Kaśyapa having different opinion, hescheduled 30 vasti like 24 Anuvāsana and 6 Nirūha. At first 5 Anuvāsana
  • 111. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 99should be given then 1 Nirūha and 3 Anuvāsana alternately given and at last 4Anuvāsana should be administered given (Kā.Khi.8:10) He also mentioned that this Karma vasti could be given in the patient havinggood strength and Vāta predominance (Kā.Khi.8:7). According to Bhela,Karma vasti includes 24 vasti, (Bhe.Si.5:28)ii. Kāla Vasti: Caraka mentioned that it includes half number of vasti to that of Karma vasti.But Cakrapāṇī opined that it includes 16 vasti. According to Vāgbhaṭa itincludes 15 vasti. He missed out one Anuvāsana in this Schedule. Day first 1Anuvāsana can be given then Afterwards 6 Anuvāsana and 6 Nirūha givenalternatively and at last 3 Anuvāsana are administered. Kaśyapa mentioned 12 Anuvāsana and 3 Nirūha, 3 Anuvāsana in thebeginning then 1 Nirūha and 3 Anuvāsana alternately and at last 3 Anuvāsanaare given. He also mentioned that this schedule can be used in the patientshaving moderate strength and in the disease where along with Vāta, Pitta alsoa vitiated doṣa (Kā.Khi.8:8-9).iii. Yoga Vasti: Caraka mentioned that it includes 8 vasti out of which 5 Anuvāsana and 3Nirūha. First day 1 Anuvāsana then 3 Nirūha and 3 Anuvāsana alternativelyand at last 1 Anuvāsana should be given. Kāśyapa indicates same number of vasti with same Nirūha and Anuvāsanaschedule. According to Kaśyapa, due to less use of Sneha it is mild in Action.This vasti schedule called Yoga vasti. It is used in the patients having KaphaSaṃsarga along with Vāta vitiation. Kaśyapa mentioned the vasti courses according to their use in pediatricpatients. Though in classics there are few numbers of vasti schedulesaccording to doṣas like 9, 7, 4, and 5 respectively for Vāta, Pitta and Kaphaand in Swastha. Schedule is to be mentioned in such way that not a Singlevasti i.e. Nirūha/Anuvāsana extent beyond the seven day. According to Ḍalhana, vasti schedule i.e. Karma, Kāla and Yoga for Vāta,Pitta and Kapha predominance respectively.
  • 112. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 100 Gayādāsa also mentioned the schedule according to the indication as; Karma vasti can be used when there is a marked vitiation of the doṣa dueto the Balavadvigraha. Kāla vasti is to be given in the patients where moderate vitiation of doṣasdue to seasonal changes occurs. Yoga vasti can be given in the patients where mild vitiation of doṣas isthere. It can be given in Swastha for attainment of Vṛṣyatva.e. VASTI – INGREDIENTSThe importance of each of the ingredient for the preparation of Nirūha vastidravya in general can be explained as follows:I. Madhu (Honey):It is considered as the best among the vehicles, as it contains varioussubstances in it, which denotes its drug (potency of the drug) carrying capacity(Ca.Su.27:249). Owing to its Sukṣma Guna it reaches upto the micro channels, in turncarry the drug (potency of the drug) at the molecular level through the microchannels. Further it is tridoṣahara; hence it is always wholesome and can be used inall the conditions.Table No. 14 – Properties of Madhu in Ᾱyurveda and in Modern scienceSr ᾹYURVEDA Sr MODERN SCIENCE1 Kaśāya 1 Auspicious.2 Madhura 2 Catalytic3 Rūkṣa 3 Increases osmotic permeability4 Chedī 4 Penetrates into minute capillaries5 Kapha Raktha Pitta hara 5 Instant energizer6 Viṣahara 6 Antibacterial7 Yogavāhī 7 Hygroscopic8 Sūkṣma mārgānusārī 8 Antioxidant9 Paicchilya, BahulatvamII. Saiṉdhava Lavana (rock salt):Lavana (salt) in general are having the properties like, Viṣyaṉdī, Sukṣma,Tīkṣna, Uṣṇa and Vātaghna and promotes the evacuation of bladder and rectum
  • 113. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 101(AH.Su.6:143). Owing to the Sukṣma (micro or extremally small) property it helps thedrug (potency of the drug) to reach in to the micro channels, Saiṉdhava (rock salt)mixed with honey, is capable of liquefying the Kapha and breaking it into minuteparticles for their easy elimination. Similarly it may liquefy the morbid doṣa saṉghātaand breaks it into smaller particles by virtue of its Uṣṇa and Tīkṣna propertyrespectively and thus helps their elimination. Apart from this, Saiṉdhava (rock salt)destroys the Picchila, Bahula and Kaśāya properties of Madhu (honey), and makesclose union with it to form a homogeneous mixture (Kā.Khi.8:41). The properties ofSaiṉdhava viz; Ᾱyurvedic: Madhuram, Tridoṣahara, Laghu, Anuṣṇam, Avidāhī,Agnīdīpanam, Tīkṣṇathvam, Modern science: Regulating acid-alkaline balance, maintaining osmosis,activation of ATP phase, removes excess acidity and generates hydro electricenergy in cells for nerve cell communication.III. Sneha (lipids):It includes Ghṛta, Taila (oil), Vasā, Majjā (bone marrow) and each one ishaving its specific properties accordingly it produces beneficial effects. Sneha ingeneral is Vātahara, Mṛdukara (Produces softness in the channels and tissues, in turnhelps for easy elimination of waste substances) and destroys the compact mala andremoves the obstruction in the channels produced by the mala i.e. Malānām VinihaṉtīSaṉgam (Ca.Si.1:7).Owing to the Snigdha Guna, it produces unctuousness in the body in turnhelps for easy elimination and by Sukṣma Guna it helps the drug (potency of the drug)to reach in to the micro channels. Apart from these functions, it protects the mucousmembrane from the untoward effect of irritating drugs in the vasti dravya.IV. Kalka Dravya (paste of herbs):It serves the function of Utkleśana or doṣaharana or Saṃśamana dependingupon its contents and is selected accordingly. It gives required thickness to the vastimaterial. Less quantity or absence of Kalka (paste of herbs) makes the vasti dravyathin which comes out immediately after administration. Excess quantity of the Kalka
  • 114. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 102(paste of herbs) makes the vasti dravya thick and difficult for administration and maynot come out within the expected time.V. Kwātha (Decoction Drugs):It is the Drava dravya (liquid part), usually the Kaṣāya (decoction of herbaldrugs) is used, but as per the need Kṣīra (milk), Māṃsarasa (decoction of meat),Ᾱmlakānjī, cow urine, Dadhīmastu etc. are also used in place of decoction of herbaldrugs or for the preparation of kwātha (decoction of herbal drugs) itself. The drugsused for the preparation of Kalka and Kwātha are selected on the basis of doṣa, dūṣyaand srotas involved in the pathogenesis of the disease, hence they are the mainconstituents of the vasti dravya.VI. Ᾱvāpa Dravya:They are used sometimes in order to make the vasti either Tīkṣṇa or Mṛdu andto affect the particular doṣa. Examples: Gomutra is added to make the vasti dravya Tīkṣṇa and to eliminate the Kaphadoṣa. Ᾱmlakānjī is added to make the vasti dravya Tīkśṇa and to eliminatenirūpastaṃbhita Vāta. Kṣīra is added to make the vasti Mṛudu and to alleviate Pitta doṣa. Māṃsarasa is added to increase the tissue enhancing capacity of the vastidravya. In this way, each and every constituent of the vasti dravya is having its ownimportance. Hence proper justification is necessary for their selection.f. METHOD OF ADMINISTRATION OF VASTIVasti is praised by all the Ᾱcāryas for its significant results. In order to achievethese results, to its maximum extent care must be taken at all the steps starting fromselection of the patient till the completion of the vasti therapy. Vasti karma can beclassified into three phase viz. Pūrvakarma, Pradhānakarma and Paścātakarma, asfollows;
  • 115. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 103I. Pūrva Karma:It includes the selection of the patient, Śodhana karma and selection of thedrugs for the vasti karma, dosage, duration and schedule.i. Selection of Patient:In order to decide these things, consideration of several factors inminute details is essential, those factors are; Doṣa, Auṣadha, Deśa, Kāla,Sātmya, Agnī, Satva, Oka, Vaya and Bala. Caraka says that the vasti preparedand administered after considering all these factors critically, is certainlycapable of providing the significant results, the benefits of all the karma andultimately success (Ca.Si.3:6).ii. Śodhana Karma (Virecana):The patient who is fit for Nirūha vasti, in them Snehana and Swedanafollowed by Śodhana karma has to be done. Then after getting Proper Bala,Anuvāsana can be administered (AH.Su.19:20/2). Śodhana karma includes,mainly both Vamana and Virecana. Here, in context of Pakṣāghāta, Virecanais the line of treatment explained by Caraka, „Pakṣāghāte tu Virechana’. SoVirecana is beneficial than Vamana before Yoga vasti.iii. Anuvāsana vasti before Nirūha (Snehana):After attaining Snigdha lakṣanas with the help of Anuvāsana vasti,Ᾱsthāpana vasti has to give for Srotośodhana (AH.Su.19:35). As theAbhyaṉtara Snehapāna is contraindicated, the Abhyaṉtara Snehana is to bedone by administering the Anuvāsana vasti one day prior to Nirūha vastiparticularly in those who are fit for Anuvāsana vasti. If the patient is havingmore Rūkṣata then initially 2-3 Anuvāsana vasti can be given and if the patientis not fit for Anuvāsana vasti and is having much more Snigdhata and MalaSaṉcaya then Nirūha vasti may be directly administered after subjecting thepatient for Abhyaṉga & Swedana. Bāhya Snehana is to be performed bySārvadaihīka Abhyaṉga.
  • 116. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 104iv. Swedana:Preferably Bāṣpa Sweda is advised.v. Food before Vasti:Nirūha vasti has to be administered in empty stomach, whileAnuvāsana in Ᾱrdrapānī avasthā means just after light diet.vi. Preparation of the Vasti dravya:Mixing of the ingredients of the vasti dravya plays significant role ingetting the expected results. First of all the ingredients are to be taken in therequired quantity by measuring them. The ingredients should be mixed bytrituration in the order of Madhu/Guda (jaggery), Saiṉdhava, Sneha, Kalka,Kwātha and then Ᾱvāpa dravya one by one gradually till it becomes ahomogeneous mixture. Then it should be churned further to make it more fineand homogeneous and heated in water bath to make it Sukhoṣṇa i.e. nearer tothe normal body temperature. (Ca.Si.3:23-24).Characteristics of a well prepared vasti dravya: A well prepared vastidravya should not run quickly out of the hand nor it should stick/coat orremain steady on the hand. It should be uniform mixture without separation(Saṃhata) of its contents (CD.73:8).After preparing the vasti dravya, it is to be filled in the vasti putakawhich is clean and devoid of putaka doṣa, then the vasti netra which is cleanand devoid of doṣa is to be tied with the vasti putaka in such a way that airwill not be present in the putaka, then a cotton piece is to be kept in the hole ofthe vasti netra.II. Pradhāna Karma:It includes advice to the Patient, vasti pranidhāna, vasti pratyāgamana andobserving the Samyaka yoga, Ayoga and Atiyoga Lakṣana.i. Advise to the patient:Patient is to be asked to pass his natural urges before vasti pranidhānaand not to laugh, cough, sneeze and yawnings while administering vasti.
  • 117. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 105ii. Vasti Pranidhāna:Vasti is to be administered when the patient is having the symptoms ofJīrnāhāra and is not very much hungry. After performing SāravadehīkaAbhyaṉga and Bāṣpa Sweda, the patient is asked to lie down in the left lateralposition on the vasti table, which should be cleaned and covered with the bedsheet, then is asked to keep his left hand below the head as a pillow, to extendthe left leg completely and to flex the right leg at the Knee Joint keeping onthe left leg by flexing the hip Joint.Then Sukhoṣṇa Sneha is to be applied in the anal region and on thevastinetra, remove the cotton piece and the air bubble if any and keep thethumb on the netra till introducing it. Then introduce the vastinetra graduallyin the parallel direction to that of the vertebral column up to 1/4 part of thenetra i.e till the nearer karṇikā fixes over the anus. Then hold the vasti putakain the left hand and keep the right hand on the putaka and press it graduallywith the constant pressure neither too fast nor to slow without tremoring thehand. By asking the patient to breathing and push the vastidravya in to therectum till a little quantity remains in the putaka otherwise Vāyū will enter into the Pakwāśaya, and then withdraw the vasti netra gradually.Then the patient is asked to lie down in the supine position graduallyand Sphikatādana is to be done slowly and softly for 3-4 times and the footend of the table or the legs of the patient are to be lifted three times slowly.The patient is then asked to lie in a comfortable position with a pillow belowthe hips till he gets the urge for defecation and when he/she gets the urge askhim/her to sit in Utkatāsana and pass the urge.iii. Vasti Pratyāgamana:One Muhurta (48 minutes) is the maximum period of time withinwhich the pratyāgamana of vasti should occur. If it does not occur then it willcause untoward consequences like Vāta pratilomatā, Viṣṭabdhatā, Sūla, Arati,Jvara and even death (Su.Ci.38:18-19). Hence if it does not comes out withinthe stipulated time period certain measures are to be undertaken for the vasti
  • 118. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 106pratyāgamana like administration of the Tīkṣṇa vasti, Phalavartī, Swedanaover the pelvic region, Utrāsana (Showing fear) and administration ofVirecana Auṣadhī. Till the pratyāgamana takes place, the physician shouldobserve the patient. However Kāśyapa opines that Yāpana vasti owing to itsMṛudu nature retains for longer time, and Tīkṣṇa vasti comes out in 100 Mātrāperiods, hence Atītīkṣṇa vasti should not be administered.iv. Yoga - Ayoga - Atiyoga Lakṣaṇa:1. Samyaka Yoga Lakṣaṇa:Prasṛṣṭa Vitakatā, Prasṛṣṭa Mutratā, PrasṛṣṭaVāta, Kramena - Mala, Pitta, Kapha and Vāyū visarjana, Laghutā, Rūcī,Agnīdiptī, Ᾱśaya Laghutā, Rogopaśamana, Prakṛtīsthitatā, Bala Vṛddhi(Ca.Si.1:41).2. Ayoga Lakṣaṇa:Śiro Hṛt - Guda - Vasti – Meḍhra Vedanā,Śotha, Pratīśyāya, Parīkartikā, Hṛllāsa, Vātasaṉga, Mutrasaṉga,Swāsakṛcchratā, Alpa Vega, Alpa Vasti pratyāgamana, Alpa Mala- AnilPratyāgamana, Arucī, Gaurava. In Ayoga, measures for vasti pratyāgamanashould be undertaken (Ca.Si.1:42).3. Atiyoga Lakṣaṇa:These lakṣaṇas are similar to that of VirecanaAtiyoga. i.e. Aṉgasuptī, Aṉgamarda, Klama, Kaṃpa, Nidrā, Daurbalya,Tamapraveśa, Unmāda, Hikkā. In atiyoga, Grāhi, Dīpana, Pācana Auṣadhī isto be administered and according to symptoms it is to be managed.(Ca.Si.1:43).III. Paścāta karma:If Samyaka Nirūḍhita lakṣaṇas are not observed, then again vasti may beadministered preferably after administering an Anuvāsana vasti and further 3rd or 4thNirūha vasti may be administered on next day till getting the Samyaka Nirūdhitalakṣaṇa (AH.Su.19:49).
  • 119. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 107i. Pathya Ᾱhāra - Vihāra and administration of Anuvāsana vasti:After observing the Samyaka Niruḍhita lakṣaṇa, the patient is advisedto take hot water bath and light diet in accordance with the dominance of doṣai.e. Yusa, Kṣīra and Māṃsarasa in Kapha, Pitta and Vāta dominant conditionsrespectively or in general, Māṃsarasa with rice is to be taken. The hot waterbath and food taken prevents the occurrence of diseases produced by agitatedand moving Mala caused by vasti (AH.Su.19:51). The patient should also beadvised for not doing heavy laborious work, day sleep, sexual intercourse etc.and in the evening Anuvāsana vasti is to be administered.ii. Parīhāra Viśaya:Certain things are strictly prohibited, both during the vasti course andeven after the vasti course for a time period twice the vasti course period(Parīhāra Kāla). The things to be avoided are as follows: loud speech, joltingmovement, long wayfaring, constant sitting, and indigestion, intake ofunwholesome food, day sleeping and sexual intercourse.g. VASTI DOṢASI. Inappropriate nozzles and complications arising out of their use:The eight types of nozzles (Netras) which are not to be used for administrationof enema and complication arising out of their use are as follows:Table No. 15 - Characteristics of nozzles complications by their useSr CHARACTERISTICS OFNOZZLESCOMPLICATIONS BY THEIR USE1 Hṛsva (Smaller in size) Aprāptī (Enema fluid not reaching itsdestination)2 Dīrgha (Longer in size) Atigatī (Enema fluid penetrating farabove)3 Tanu (Thinner in shape) Kṣobha (Irritation caused by theinstability of the nozzle in the rectum)4 Sthūla (Thicker in shape) Karṣana (Bruising the wall of rectum)5 Jīrna (Worn out) Kṣaṇana (Causing injury to the rectum)6 Śithila baṉdhana (Loose fixation) Srāva (Leaking out of the enema fluid)7 Parśva chidra (Having holes inside) Guda pīda (Causing pain in the rectum)8 Vakra (Curved) Jihma gatī (Tortuous passage of fluid)
  • 120. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 108II. Inappropriate Vastis (Bladders) and complications arising out of their use:The eight types of vasti’s (Bladders used as receptacles) which are not to beused for the administration of enema and the complications arising out of their use areas follows:Table No. 16 – Characteristics of vasti and complications by their useSr CHARACTERISTICS OF VASTI COMPLICATIONS BY THEIR USE1 Viṣama (Irregular in shape) Gatī- vaiṣamya (Irregular flow of enemafluid)2 Māṃsala (Fleshy) Visratva (Enema fluid smell fleshy)3 Chinna (Torn) Srāva (Leakage of the fluid)4 Sthūla (Thick) Daurgrāhya (Difficulty in handling)5 Jalika (Having network of smallperforations)Nisrāva (Exudation of enema fluid fromthe receptacle)6 Vātala (Having air inside) Phenila ( Frothiness of fluid )7 Ati snigdha (Excessively unctuous) Chyutī (Slipping away of the receptacle )8 Klīnna (Putrified ) AdhārayatvaIII. Defective techniques employed by the physician for administering vasti:i. Savāta (pushing the enema –fluid along with air )ii. Atidṛta (pushing the enema –fluid too rapidly )iii. Utkṣīpta (injecting the enema fluid too high )iv. Tiryak (injecting the enema fluid too obliquely )v. Ullupta (pushing the enema fluid again after interruption )vi. Kaṃpita ( shaking the nozzle while injecting the enema fluid)vii. Atiga (excessive insertion of the nozzle)viii. Bāhyaga (wrong pushing so that instead of entering the anal canal enemafluid flows outside )ix. Maṉdati vega (compressing the receptacle either too slowly so that theenema fluid doesnot reach the colon , or too forcibly as a result of whichthe enema fluid rapidly enters and reaches the distant part of thealimentary canal).
  • 121. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 109IV. Complication arising out of anucchvāsa:If the enema receptacle is tied to the nozzle without taking out the airfrom the bladder, or if the entire amount of fluid is rushed into the rectumwithout leaving any residue in the bladder (Vasti), then the Vāyū (air) enteringinto the rectum which causes colic pain and piercing pain.V. Complications arising out of rapid insertion of nozzle:If the nozzle is inserted rapidly or taken out hurriedly and if it ispushed very high, then there will be pain in the lumber region, anus and calfregion; stiffness of the bladder and pain in the thighs.VI. Complications caused by oblique insertion of nozzle:If the enema nozzle is inserted obliquely or passage is obstructed bythe anal sphincters, and if there is blockage because of the fibres in the recipeitself, then the fluid will not flow into the rectum.VII. Complications arising from interrupted administration of vasti:If the enema receptacle is compressed again after an interruption, thenthe aggravated Vāyū being obstructed in the rectum causes pain in the chestand head, and prostration of the thighs.VIII. Complications caused by shaking of nozzle during administration of vasti:If the anus gets injured because of the nozzle then there will be burningsensation, sneezing and edema.IX. Complications caused by excessive penetration of nozzle:If the nozzle is excessively penetrated (or inserted repeatedly ), then itcauses injury to the anal sphincters leading to pain, burning sensation, prickingpain, prolapsed of the anus and discharge of fecal matter.X. Effects of slow vasti:If the receptacle is inadequately compressed, then the enema fluid doesnot reach its destination, and comes out quickly.
  • 122. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 110XI. Effects of forceful administration of vasti:If the enema fluid is injected with excess of force, then the fluid eithergets retained in the gastro intestinal tract, or goes up to reach the throat.XII. Vasti Vyāpada:Vyāpada (Complications) are produced due to the defects in thevastinetra, vastiputaka and abnormal position of the patient whileadministering vasti and improper administration. These Vyāpadas can berectified by taking precautions and proper care. But certain other Vyāpada thatoccurs are of serious nature and are mainly due to the misunderstanding of thephysician and they should be effectively managed. They are as follows:Ayoga, Atiyoga, Klama, Adhmāna, Hīkkā, Hṛtprāptī, Urdhavaprāptī,Pravāhīkā, Śiroartī, Aṉgartī, Parīkartikā and Parisrāva. The reasons, thesymptoms and the management of each of these Vyāpad are described in detailin the texts.h. YOGA VASTIDescription of Yoga vasti given by different Ᾱcāryas as follows; Caraka mentioned that Yoga vasti includes 8 vasti out of which 5 Anuvāsanaand 3 Nirūha. First day 1 Anuvāsana then 3 Nirūha and 3 Anuvāsanaalternatively and at last 1 Anuvāsana should be given. Kāśyapa enunciates rationales of Yoga vasti. Kāśyapa indicates same numberof vasti with same Nirūha and Anuvāsana schedule. According to Kāśyapa,due to less use of Sneha it is mild in action. This vasti schedule called Yogavasti. It is used in the patients having Kapha Saṃsarga along with Vātavitiation.Kāśyapa mentioned the vasti courses according to their use in pediatricpatients. Though in classics there are few numbers of vasti schedulesaccording to doṣas like 9, 7, 4, and 5 respectively for Vāta, Pitta and Kaphaand in Swastha. Schedule is to be mentioned in such way that not a single vastii.e. Nirūha/Anuvāsana extent beyond the seven day.
  • 123. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 111 According to Ḍalhana this vasti schedule i.e. Karma, Kāla and Yoga for Vāta,Pitta and Kapha predominance respectively. Gayādāsa also mentioned the schedule according to the indication like; Karmavasti can be used when there is a marked vitiation of the doṣa due to theBalavadvigraha. Kāla vasti is to be given in the patients where moderatevitiation of doṣas due to seasonal changes occurs. Yoga vasti can be given inthe patients where mild vitiation of doṣas is there. It can be given in Swasthafor attainment of Vṛṣyatva. Since in case of Yoga vasti, the duration is of 8 days, so there is anticipationthat these vasti with the course of treatment can penetrate up to the deeper anddeeper tissues situated in the body and thus can root out even the obstinateVāta disorders explained by Suśruta. Nirūha, if given alone without Anuvāsana may provoke Vāta due to itsexclusive Śodhana property. Thus to avoid this adverse effect of Nirūha,Anuvāsana vasti assembled in between Nirūha Vvsti (Ca.Si.4:50). Of all the therapeutic measures suggested for Vāta disorders, Anuvāsana andNirūha treatment par excellence for Vātik disorders, because immediately afterentering the Pakwāśaya, they strike at the very root of morbid Vāta and whenit is overcome in the Pakwāśaya even the entire morbid Vāta dwelling in theother parts of the body could be alleviated (Ca.Su.20:13). Once proper cleansing of Srotas is achieved by giving appropriate Nirūhavasti, Anuvāsana administered after that promotes Bala and Varṇa(Ca.Si.1:29). This clearly indicates Srotośodhaka property of Nirūha vasti andBṛṃhana nature of Anuvāsana vasti. Cakrapāṇī says Anuvāsana are Bṛṃhanavasti (on Ca.Su.22:18). Nirūha should be given in conditions where diseases develop due tocombination of doṣas concealed or deeply seated diseases and in vitiation ofRakta and Kapha doṣa (Kā.Si.1:37). Other advantages of Nirūha are Vayasthāpana (checking of aging process);and promotion of Bala (strength, energy), Medhā (intellect), Svara (phonation)and Varṇa (complexion) (Ca.Si.1:27).
  • 124. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 112 Vasti is also useful in Staṃbha (stiffness), Vigrathita Purīṣa (constipation,hard stool), Kṣīneṉdriya and in the diseases, where Vāta moves in differentextremities (Ca.Si.1:32-34). Vāgbhaṭa says vasti promotes Śukra, Medhā(intellect), and Agni (AS.Kal.5:25). Even it clears doṣa dwelling in Anusrotas(micro channels). In the study Māṣātmaguptādī Kwātha and Kalka of Śatapuṣpā were used forNirūha; and Māṣātmaguptādī Taila was used for Anuvāsana vasti.i. MODE OF ACTION OF VASTIProbable mode of action of vasti in view of Ᾱyurvedic and Modernscience as follows; Vasti is the best treatment for Vāta doṣa as said by Ᾱcārya Caraka „VastiḥVātaharānām‟ (Ca.Su.25:40). It is the best amongst Pañcakarma because itcontrols the Vāta. Vāta is the chief in three doṣas and it is the leader of Pittaand Kapha. How vasti works and how it becomes able to cure the diseases ofall over body, though it is given to Pakwāśaya, to understand this Ᾱcāryas hasgiven very good examples. Vasti enters the Pakwāśaya which is the main Sthāna of Vāta doṣa and whichis the originator of all vikāras. By subsiding the Vāta, all vikāra located in theother parts of the body also become allayed just as by the eradication of theroots of a plant, the stem, branches, sprouts, fruits, leaves etc. also vanish(Ca.Si.1:31). Ᾱcārya Caraka has said that man grows strong by means of the Sneha vastijust as a tree fed with water at its roots, puts forth green leaves, delicatesprouts and in due time grows into a big tree full of blossom and fruit. Vasti is given to Pakwāśaya, then how it reaches to whole body and curesdiseases of all over body? Here Ᾱcārya Suśruta clarifies that, the Vīrya of vastidrugs reach all over the body through the srotas in the same way as the waterpoured at the root of the plant reaches up to leaves. He has further explainedthat even though vasti drugs quickly comes out alone or with Mala, their Vīryaact over the whole organism by the action of Apāna and the other Vāyū. Thisaction takes place just like as sun draws moisture from the earth.
  • 125. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 113Then Suśruta has mentioned the importance of Vāyū in the productionof disease and how vasti is able to control that Vāyū? He has said, as theaggravation of all the doṣa of the body is principally dependant on thederangement of the bodily Vāyū, an aggravated condition of later may hencelead to the dissolution of the body and consequently the application of thevasti and nothing else is the only means of coping with the aggravation ofVāyū, just as the sea coast is the only barrier to the swollen and wind agitatedsurf of the sea (Su.Ci.35:30). Same thing is mentioned by Ᾱcārya Caraka about the action of vasti, vastiwhen lying in the Pakwāśaya draws by its Vīrya and morbid doṣa lodged inthe entire body from the foot to the head, just as the sun situated in the skysucks up the moisture from the earth (Ca.Si.7:64).Supportive views from the Modern Science:Bṛṃhana vasti improves the health of the bacterial flora of the intestinethereby enhancing the production of Vit. K and B complex (Patel B.N. etal.1966). Both the Vitamins are very much essential particularly B complexplays significant role in preventing degenerative neurogical disorders.i. The route of drug administration depends upon the following factors: Physical and chemical properties of the drug (Solid, liquid, Gas), solubility,stability, pH, irritability. Site of desired action: Generalized and not approachable or localized andapproachable. Rate and extent of absorption of the drug from different sources. Effect of digestive Juices and first pass metabolism of the drug. Rapidity with which the response is desired. Condition of the patient.The drug administered through systemic route is intended to be absorbed into theblood and distributed all over the body including the site of action through circulation(K.D.Tripathi).
  • 126. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 114ii. Transmucosal Routes:Drug absorption through a mucosal surface is generally efficientbecause the stratum corneum epidermis, the major barrier to absorption acrossthe skin, is absent. Mucosal surfaces are usually rich in blood supply,providing the means for rapid drug transport to the systemic circulation andavoiding, in most cases, degradation by first-pass hepatic metabolism.iii. Rectal Transmucosal Administration:Medications may be administered by the rectal mucosal route forsystemic effects if other more preferable routes are not available for thetreatment of nausea and vomiting, sedation, control of seizures, analgesia, orantipyretics. Rectal administration provides rapid absorption of many drugsand may be an easy alternative to the intravenous route, having the advantageof being relatively painless, and usually no more threatening to children thantaking a temperature. However, rectal administration of drugs should beavoided in immunosuppressed patients in whom even minimal trauma couldlead to formation of an abscess.The rate of rectal transmucosal absorption is affected by the following factors: Formulation (time to liquefaction of suppositories) Volume of liquid Concentration of drug Length of rectal catheter (site of drug delivery) Presence of stool in the rectal vault pH of the rectal contents Rectal retention of drug(s) administered Differences in venous drainage within the rectosigmoid region.Anatomical differences in hemorrhoidal venous drainage of the rectummay substantially influence the systemic drug level achieved. Drugsadministered high in the rectum (drained by the superior rectal veins) areusually carried directly to the liver and, thus, are subject to metabolism. Drugs
  • 127. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 115administered low in the rectum are delivered systemically by the inferior andmiddle rectal veins before passing through the liver.Rectal pH may also influence drug uptake by altering the amount ofdrug that is ionized. The greater lipid solubility of non-ionized drugs enhancestheir movement across biological membranes. The pH of the rectal vault inchildren ranges from 7.2 to 12.2. This pH range favors absorption of thebarbiturates that will remain in a nonionized state because their pH is near thephysiologic range (~7.6).Despite the limitations associated with drug absorption in the rectum,many drugs usually administered by the intravenous and orogastric routeshave also been administered rectally. Sedatives commonly administered bythis route include midazolam, diazepam, and ketamine. In children, the rectalroute is convenient for the administration of benzodiazepines to treat statusepilepticus because an intravenous line is not required. The rectal dosegenerally must be higher than the dose administered intravenously or orally.The extent of the increase depends on the factors that affect absorption (listedearlier). The most important considerations are the slow onset of effect(minutes) and the prolonged duration of effect (hours). The peak blood levelsvary considerably from patient to patient. The potential for rapid and almostcomplete absorption has serious implications, when drugs with cardiac orpulmonary depressant effects are administered.iv. Modern views about the elimination and absorption through the colon: Elimination of the waste products of digestion and metabolism in the form ofstool is the main function of colon. A large fraction of faecal mass is of nondietary origin because appreciable amounts of faeces continue to pass duringprolonged starvation (Harrison). It indicates the elimination of systemic wasteproducts. The mucosal surface of G.I.T. is composed of a remarkably dynamicpopulation of epithelial cells that are highly developed in the capacity fortransmembrane absorption and secretion (Harrison).
  • 128. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 116 Water moves in both directions across the mucous membrane of both smalland large intestine until the osmotic pressure of the intestinal contents equal tothat of plasma (William F. Ganong). The absorptive capacity of the colon makes rectal instillation a practical routefor drug administration, especially in children, many compounds includinganaesthetics, sedatives, tranquilizers and steroids are absorbed rapidly by thisroute. Some of the water in enema is absorbed and if the volume of enema islarge, absorption may be rapid enough to cause water intoxication (Willium F.Ganong). The main function of the colon is absorption of water, Sodium and otherminerals and converts the isotonic chyme to semisolid faces by absorbing 90% of the fluid (William F. Ganong). Colon normally absorbs 1-2 liters/day, but is capable of absorbing almost 6liters/day (Robbins). Various nutritive end products are absorbed from the mucosa ofgastrointestinal tract mainly through the Na+channels and other ion channels(Willium F. Ganong). The absorptive capacity of the mucosa of the Large intestine is great, Na+isactively transported out of the Colon and water follows the osmotic gradientthus generated (William F. Ganong). Except vit B12 and folate, all other water soluble vitamins are absorbed bycarriers that are Na+co-transporters eg. Thiamine, riboflavin, niacin,pyridoxine, pantothenate and ascorbic acid (Willium F. Ganong). The major site of production and absorption of short chain fatty acids is thecolon. Traditionally the lipids were thought to enter the enterocytes by passivediffusion, but there is some evidence that carriers are involved (William F.Ganong). Absorption of the protein: At least seven different transport system transportsthe amino acids into the enterocytes, five of these require Na+and co-transportaminoacids (William F. Ganong).
  • 129. REVIEW OF LITERATUREEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 117 Although the rectum is not a usual site for absorption of ingested nutrients,drugs introduced by rectum may be absorbed there. Thus, drugs introduced bythis route may have systemic effects as well as local effects (Harrison). Certain irritant and unpleasant drugs can be put into rectum as suppositories orretention enema for systemic effects (K.D. Tripathi). Colon mucosa under the effect of medication can be made to absorb theunusual substances also (C.C. Chatterjee).
  • 130. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 118DRUG REVIEWIn Ᾱyurveda, the success of Cikitsā depends upon four important factors;Vaidya, Dravya, Parīcarīkā and Rogī and termed as „Cikitsā Catuṣpāda‟ and all areresponsible for the cure of disease. Though the physician occupies the most importantposition in these four, he became lame without drug. Hence, the drug is a secondimportant factor for the cure of disease. The comprehensive knowledge of the drug isvery important to physician because without precise knowledge of the drug, thepatient cannot be treated properly. On the basis of Ᾱyurvedic therapeutic principles ofPakṣāghāta (Ischaemic Stroke), Yoga vasti has been selected. Māṣātmaguptādī yogais explained by Cakradatta and Bhaiṣajya Ratnāvalī in Vātavyādhī Adhikāra.Contents of Yoga vasti are as follows; Anuvāsana vasti: Māṣātmaguptādī Tailam – 120 mlSaiṉdhava lavana – 6 gmsŚatapuṣpā – 6 gms. Nirūha vasti: Mākṣika – 50 gmsSaiṉdhava – 6 gmsTila taila – 50 mlŚatapuṣpā – 6 gmsMāṣātmaguptādī Kwatha – 250 ml.All the drugs were taken and prepared in the pharmacy of TTD‟s Sri SrinivasaMangapuram Ᾱyurvedic Pharmacy, Tirupati.I. Māṣātmaguptādī Taila:The Māṣātmaguptādī taila prepared according to Taila pāka procedurementioned in classics.i. Requirements:The following medicines used for Taila pāka procedure in mentionedquantity;
  • 131. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 119Table No. 17 – Ingredients of Māṣātmaguptādī TailaSr. INGREDIENTS QUANTITY1 Māṣa (Phaseolus mungo) 860 gm2 Ᾱtmaguptā (Mucuna prurita) 860 gm3 Atīviṣā (Aconitum heterophyllum) 860 gm4 Eraṉḍa (Ricinus communis) 860 gm5 Rāsnā (Inula racemosa) 860 gm6 Śatāvhā (Anethum sowa) 860 gm7 Saiṉdhava (Rock salt) 860 gm8 Māṣa bīja churna 24 kg9 Balā mūla churna 24 kg10 Tila taila 24 litersii. Preparation:For the preparation of Māṣātmaguptādī taila as per classics, kalka:taila: kwātha are taken in following ratio;Kalka : taila : kwātha = 1 parts : 4 parts : 16 parts = 6 kgs : 24 liters : 96 liters. Kalka: The fine powder of seven drugs which were Māṣa, Ᾱtmaguptā,Atīviṣā, Eraṉḍa, Rāsnā, Śatāvhā, Saiṉdhava taken in equal quantity thatmeans 860 grams each. Then add sufficient quantity of water into finepowder and made it into paste form which was taken as kalka for Tailapāka. Taila: Twenty four liters of Tila taila was taken for preparation of taila. Kwātha: The kwātha also prepared as per mentioned in classics. The drugsfor kwātha preparation are Māṣa bīja churna and Balā mūla churna 24 kgeach. The coarse powder of above drugs should be put in a wide mouthpot. In this add 768 liters of water and boil it, till it remains 1/8ththatmeans up to 96 liters. While boiling on the fire stir it continuously withladle. After getting desired amount of water, take it out from fire and filterit.
  • 132. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 120iii. Procedure: First of all oil is heated and the kalka prepared from above said drugs wasadded to the heated Tila taila. After properly mixing kalka in taila, 96 liters of kwātha prepared fromMāṣa and Balā added into the Tila taila. The Agni which was given for taila pāka should be Madhyama. While boiling the taila in between we have to stir with ladle. Boiling continued till it syarted to attain Sneha Siddhī lakṣanas. As Madhyama pāka is preferred for the purpose of vasti karma(Ca.Kal.12:104), so Sneha pāka is done up to attaining the Madhyamapāka lakṣanas i.e. up to the time the kalka become „Nirasa komala‟(Śā.M.K.9:15/2) and which easily slides down from the ladle(Ca.Kal.12:103/1). When oil attains the Madhyama pāka lakṣanas the oil is taken away fromheat and allowed to get cooled. When oil is properly cooled it is filtered with a cloth and collected in a dryvessel. The prepared oil is packed and supplied in 200 ml bottles.II. Māṣātmaguptādī kwātha churna:Instead of preparing kwātha, kwātha churna has been prepared for easyway to carry, distribute and freshly prepared on the day of administration ofNirūha vasti.i. Requirements:The following drugs were used to prepare Māṣātmaguptādī kwāthachurna;
  • 133. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 121Table No. 18 – Ingredients of Māṣātmaguptādī kwātha churnaSr. INGREDIENTS QUANTITY1 Māṣa (Phaseolus mungo) 5.14 kg2 Ᾱtmaguptā (Mucuna prurita) 5.14 kg3 Atīviṣā (Aconitum heterophyllum) 5.14 kg4 Eraṉḍa (Ricinus communis) 5.14 kg5 Rāsnā (Inula racemosa) 5.14 kg6 Śatāvhā (Anethum sowa) 5.14 kg7 Saiṉdhava (Rock salt) 5.14 kgii. Preparation:For the preparation of Māṣātmaguptādī kwātha churna drugs requiredwere Māṣa, Ᾱtmaguptā, Atīviṣā, Eraṉḍa, Rāsnā, Śatāvhā, Saiṉdhava takeninto equal quantity of 5.14 kg each.iii. Procedure: For the preparation of 36 kg of kwātha churna, coarse powder of abovesaid drugs taken into equal quantity of 5.14 kg each one. Then this mixture placed into mixer for twenty minutes and mixedproperly. The prepared kwātha churna packed into 750 gm each packet. Preparation of kwātha should be done on the day of administration of vastionly.III. Description of the Drugs:i. Māṣa: Latin name: Phaseolus mungo L. Family: Fabaceae Names in different language:Hindi- Urad, English- Black gram, Marathi- Udad, Tamil- Uluṉtu,Telugu- Minappu, Malayalam- Ulinnu.
  • 134. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 122 Saṉskṛt names:Kṛṣṇavṛṉta, Kaṃboji, Hayapucchikā, Mansamāṣa,Siṃhamukhī, Swādumāṣa, Mahāsahā, Ᾱrdramāṣa, Siṃhavinna. Gana: Palaśādī Varga (BP.). Botanical Description:A creeper is also known as Teramnus labialis. Leaves - 2 to 4 cms.long, compound and trifoliate. Leaflets - oval shaped. Flower stalk - bearsviolet flowers. Legume - 3 to 6 cms long slightly crooked containing 8 to10 seeds. Habitat: Mainly India. Properties: Rasa: Madhura, Tikta Guna: Laghu, Snigdha Vipāka: Madhura Vīrya: Śīta Doṣa: Vāta Pittaśāmaka, Kaphavardhaka. Srotogāmitva: Rakta, Śukra Dhātu: Rakta, Śukra, Rasāyana. Chemical Composition:It contains albuminoids 22.7 %, Starch 55.8 %, Oil 2.2 %, Fibre 4.8%, and Ash 4.4%. “An analysis of some samples grown in the BombayPresidency shows moisture 6.05 to 11.95; Ether extract 1.25 to 2.60;Albuminoids 19.81 to 27.50; Soluble Carbohydrates 50.05 to 60.69;Woody fibres – 4.25 to 5.90 and Ash 3.45 to 5.35”. (Bombay Govt. Agri.:Bulletin).It contains minerals like Ca, P, Mg, Cu and K; and vitamins likecarotene, thiamine, riboflavin, niazin, choline, folic acid. Vitamin B12 ispresent in minute quantity. A suceinoxidas with properties similar to thoseof muscle enzyme has been obtained. Globulin, albumin, prolamin andglutelin are the proteins found. Allantoin, glutathione is also present. It‟s agood source of lysine, valin, amino acids, leucines, etc. (Wealth of India –Raw materials Vol. X). Part used: Seed.
  • 135. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 123 Internal use:It is used in the treatment of Bell‟s palsy, hemiplegia, rheumatoidarthritis, bleeding disorders, abdominal colic, spermatorrhoea, burningsensation. Carak has advised to feed the cow with leaves of Māṣa and toconsume cow‟s milk as an aphrodisiac. Parts used :Whole plant and roots. Indications:Gudakīla, Ᾱrdita, Śwāsa, Paktīshūla, Vāta roga. Also used ingastric catarrh, dysentery, diarrhea, cystitis, paralysis, piles, rheumatismand affections of liver and of nervous system (Indian Material Medica).ii. KAPIKACCHU: Botanical Name: Mucuna prurita Family: Fabaceae Names in different languages:Hindi- Kouṉc, English- Cowhage or cow-itch, Punjab- Aalukusi,Marathi- Khājkuhilī, Gujarati- Kavāc, Tamil- Punai kalī, Telugu-Dūlagondī, Kannada- Nasukunnī, Malayalam- Naikorana. Synonyms:Ᾱtmaguptā, Ryaproktā, Kandurā, Markatī, Svayaṃguptā,Lāṉgulī, Adhyaṉdā, Guptaphala, Svaguptā, Ajadāphala. Classification: Caraka: Balya, Madhura skaṉdha, Purīṣa virajanīya Suśuta: Vidārīgaādhādī, Vātaśāmana Vāgbhaṭa: Vidāryādī, Dūrvādī gana. Morphology:It is herbaceous twinning annual. Leaves are trifoliate, grey silkybelow; leaflets elliptic, broadly ovate or rhomboid ovate, unequal at thebase. Flowers, in axillary, pendulous racemes, purple. Fruits- pods,curved, turgid, longitudinally ribbed, 6-10 cm, densely clothed with gray
  • 136. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 124or pale-brown bristles (causes intense itCing and dermatitis). Seeds are 4-6in number and ovoid. Chemical constituents: Seeds- L-dopa, mucunine, mucunadine, prurienine, purienine,tryptamine. Seed oil- stearic, palmitic, myristic, araCidic, oleic, linoleic acidsand sterol, Podtrichomes-5 hydroxytryptamine Whole plant- choline, enzyme- protease- mucunain. Severalalkaloids have been isolated. Properties: Rasa: Madhura, Tikta Guna: Guru, Snigdha Vīrya: Uṣṇa, Śīta Vipāka: Madhura Karma: Vāta-pittahara, Balya, Bṛṃhana, Vājikarana Srotogāmitwa: Māṃsa Doṣa: Tridoṣasrotogāmi. Dhātu: Śukra, Māṃsa, Meda, Raktagāmi. Mala: Purīṣa. Distribution & Habitat:All over India (More in the tropical regions). Internal uses: Nervous System: The roots and seeds are tonic for the neurons. Theroot is useful in hemi paresis and facial palsy. The seed - powder isuseful in Parkinson‟s disease. Digestive System: The legumes are anthelmintic for roundworm.Trichomes 0.3-0.5 gm is given mixed with butter, jaggery orhoney. Next day a laxative is given, round worm are killed andexpelled out. Reproductive system: The seeds are very useful in oilgospermiaand impotence. Seeds soaked in the root extract relieve vaginallaxity. The oil from seeds is useful in leucorrhoea. Urinary System: The root has diuretic property, renal dysfunction.
  • 137. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 125 Important Yogas or Formulations:Vānarīgutikā, Māṣabalādīpācana. The seed powder 10- 15 gm.Three times in a day has been shown to be useful in Parkinson‟s disease. Indications:Mūtra-kṛcchra, Vātavyādhī, Parkinsonism, Klaibya, Kaṣṭārtava. Part Used:Seeds, root, pod-hair. Dosage:Seed powder 3-6 g; root decoction 48– 96 ml; pod hair powder 125 mg. Therapeutic Uses: Vātavyādhī: Decoction of the seeds of Kapikacchu for one month,which improve the strength of arms (CD.). Kṛmī: The pod hair powder (125 mg) is given with jaggary, honey,or butter. Atīsāra: Root paste is used in Pakva Raktātīsāra. Vājīkarana: Seeds are boiled in milk along with wheat and takenwith ghee.iii. ATĪVIŚĀ: Botanical Name: Aconitum heterophyllum Family: Ranunculaceae Synonyms:Arūna, Ardra, Upaviṣa, Kaṣāya Kṛṣṇa, Ghuna Vallabha, Candrī,Pīta Vallabha, Pratīviṣa, Bhaṉgura, Madhya-deśastha, Mahauṣadha,Mādrī, Mṛdvī, Rakta, Viśva, Viṣama, Viśa, Śiśubhaiṣajya, Śuka Kaṉda,Śukla Kaṉda, Śṛngika, Śyāma Kaṉda, Śveta, Śveta Kaṉda, Śveta vaca. Names in different languages:Marathi – Atīviṣa, Persian – Vajjcturki, Punjabi – Atīs, Tamil - AtīVidayam, Telugu – Atī Vasa, Bengali – Ataic, English – Indian Atees,Hindi – Atīs, Gujarati – Atīvakhani kalī, Kannada – Atīviṣā, Malyalam –Atī Vidayam.
  • 138. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 126 Classification: Caraka Saṃhitā: Lekhanīya, Arśoghna, Tikta Skaṉdha, Śirovirecana. Suśṛuta Saṃhitā: Pippalyādī, Mustādī, Vacādī, Lekhanīya, Arśoghna. Aṣṭāṉga Saṉgraha: Mustādī, Vachadī Aṣṭāṉga Hṛdaya: Mustādī, Vacādī, Pippalyādī. Introduction:Caraka considered this drug as Pratīviṣa, but Suśṛuta considersA.palmatum as Pratīviśa. It described under Lekhaniya, Arsoghna Vargas,Tikta skaṉdha, Śirovirecana dravya. Morphology:Roots biennial, paired, tuberous; whitish or grey. Stem is erect,simple or branched, from 15-20 cm high and glabrous below, finelycrispo-pubescent in the upper part. Leaves heteromorphous, glabrous:lowest on long petioles (13cm); blade orbicular- cordate or ovate-cordatein outline with a usually narrow sinus (1-1.5 cm deep); usually 5- lobed tothe middle, amplexicaul. Inflorescence is slender raceme or a lax, leafypanicle, crispo-pubescent; Sepals bluish or violet (rarely whitish);navicular obliquely erect, shortly or obscurely beaked, 18-20 mm high, 8-9mm wide. Carpels are 5, elliptic-oblong. Follicles are contagious, linear-oblong, straight, 16-18 mm long. Seeds are in pyramidal, 3-4 mm long,blackish brown. Distribution:Commonly found in sub-alpine and alpine zones Himalayas fromIndus to Kumaon at 2000-5000 m (6000-16000 ft.). Chemical Constituents:Atidine, hetisine, heteratisine, Diterpene alkaloids, heterophylline,heterophylline, heterophyllidine heterophyllisine, hetidine, atidine andAtisenol, a new entatisene diterpenoid lactone from roots. F-dishydrçatisine, hetidine, hetisinone, heteratisine, hetisine,benzylleteratisine, beta sitosterol, carotene and beta isoatisine fromrhizomes. Distribution & Habitat:Maharashtra and Himalayas.
  • 139. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 127 Properties: Rasa: Kaṭu, Tikta Guna: Laghu, Rukṣa Vīrya: Uṣṇa Vipāka: Kaṭu Karma: Dīpana, Pācana, Grāhī, Tridoṣahara, Śothahara,Viśaghna, Kṛmīhara, Arśoghna, Jvarahara, Kāsahara Prabhāva: Viśa hara Srotogāmitva: Rakta, Māṃsa Doṣa: Tridoṣaghna. Dhātu: Majjā, Rakta, Śukra, Meda. Mala: Mūtra, Purīṣa, Sweda. Parts Used:The tuberous root is medicinally used both alone and incombination. Yogaratnākara mentioned that Harītakī may be used as thesubstitute for Ativisã. External uses:The crushed leaves, mixed with Saiṉdhava are applied focally. Theseeds crushed in honey are applied locally on throat, in tonsillitis. Nasalinsufflations of roots are beneficial in headache (especially migraine). Internal uses: Respiratory System: The juice of roots along with milk is anexpectorant Root powder is given orally in cervical lymphadenitis. Digestive System: Seed and root are used in ascites. Seeds arelaxative. Urinary System: The seeds are diuretic; the root decoction reducesburning of urinary tract. It increases volume of urine. Reproductive System: Root is used in sperrnatorrhoea. Thedecoction of roots is also used in burning of vagina. Indications:Atīsāra, Jwara, Kāsa, Bālaroga, Viśaroga, Ᾱmadoṣa, Chardī,Kṛmīroga, Agnimāṉdya, Raktapitta, Yakṛd roga, Tṛṣṇā, Pīnasa, Arśa,Pittodara etc.
  • 140. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 128 Dosage:Root powder l-3g per day (divided doses). Overdose (More than 5-6g) leads to symptoms like dryness of mouth, tremors etc. Therapeutic Uses: Bala roga: Atīviṣa alone or along with Karkatasṛṉgī and Pippalī incase of cough and fever (AH.U.2:57). Atīsāra: Atīviṣā + Bhāṉga + Vacā as powder Jvarātīsāra: Śuṉṭhī, Kutaja, Musta, Guḍuci and Atīviśā are givenorally in the form of decoction. Grahanī: The decoction made of Atīviśā, Śuṉṭhī and Musta isadministered orally to destroy the Ᾱma (Ca.Ci.15:98). Mūtrakṛcchra: Atīviśā, Ᾱmla dravyas, Śuṉṭhī, Gokṣura, Kaṉtakārīare made as Peyā (gruel) and given along with Phānita (jaggerysyrup) (Ca.Su.2:22).iv. ERAṈḌA: Botanical Name: Ricinus communis Linn. Family: Euphorbiaceae. Names in different languages:Hindi- Eraṉḍa, English- Castor, Bengali- Rehri, Telugu- Amudamu,Tamil-Ᾱmanakku, Bengali- Bhereṉḍa, Marathi- Eraṉḍī, Malayalam-Avanakku; Gujarati- Diveligo. Synonyms:Gaṉdharvahasta, Urūbaka. Vyāghrapuccha, Citraka,Uttänpatraka, Vyādaṃbaka, Amaila. Classification: Caraka: Bhedanīya, Aṉgmardapraśamana, Svedopaga. Suśṛuta: Vidārīgaṉdhādī, Adhobhāgahara. Vãgbhata: Vidārīgaṉdhādī. Morphology:An evergreen, glabrous shrub, 2-5 m high. Leaves: Palmately 7-many-lobed, loboes oblong to linear, acute or acuminate. Flowers: In largeterminal subpanicled racemes; in a dense globose head of branched
  • 141. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 129filaments and anthers; yellowish. Fruits: Capsules, globosely oblong,smooth or echinate. Seeds: Oblong, smooth, mottled. Flowers and fruitsoccur almost throughout the year. Habitat and Distribution:Cultivated throughout India and commonly found in the wild. Chemical Constituents: Seeds and Leaves: ricinine (toxic alkaloid). Seed coat: Lupeol, lipids, phosphatides etc. Seed oil: arachidic, ricinoluc, palmitic, strearic etc., acids: hexadecanoic, hydrocyanic & uric acids; squalene and tocopherols Properties: Rasa: Madhura, Kaṭu, Kasāya Guna: Snigdha, Tīkṇa, Sukṣma Vīrya: Uṣṇa Vipāka: Madhura Karma: Kapha Vātahara, Recana, Vṛṣya (root). Srotogāmitva: Rakta, Majjā, Śukra. Doṣa: Vāta Kapha Pitta. Dhātu: Śukra, Rakta, Majjā. Part Used: Root, leaf, seed, oil. Indications:Vātavyādhī, Plīhāroga, Udāvarta, Vastiśūla, Gulma,Aṉtravṛddhī, Śirśūla, Prameha, Vātarakta etc. Internal uses: Nervous System: Due to its properties of decreasing Vāta helps inrejuvenating, analgesic, relieving body ache it is used in diseasesdue to Vāta such as hemiplegia. Facial palsy, sciatica, tremors aswell as headache and body ache. Castor oil is best purgatīve. Digestive System: It is Dīpana being Uṣṇa Vīrya, Bhedana byTīkṣṇa guna, anthelmintic by its property of Snigdha. Therefore itis used in ascites, abdominal colic, tumours, hepatospleenomegalyand piles. Oil taken at breakfast cures chronic constipation. Tomake it palatable, it is always taken by preparing emulsion with hot
  • 142. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 130tea. Black masala prepared from castor roots is a very goodcarminative. Respiratory System: It is Kaphaghna by its Uṣṇa and Tīkṣṇaproperty; therefore it is useful in bronchitis and asthma withpredominance of Kapha. This effect is attributed to the presence ofKapha in stomach while castor oil effectively removes Kapha bypurgatīon. Urinary System: Dysuria and bladder pain are relieved by reducingpain and diuretic action. Reproductive System: Aphrodisiac together with Śodhana propertyof drug is a rare combination which is found in castor oil. It isMadhura, Snigdha, Therefore it is used in conditions ofspermatorrhoea, lactogenic disorders and vaginal disorders. It isbest in rheumatic arthritis. Paste of tender leaves prepared in wateris given in snakebite. Its emetic and purgatīve effect removes thesnake poison from the body. (Paste is locally applied at the site ofsnake bite). This action can also be seen in aconite and opiumpoisoning. Juice of castor leaves is given in jaundice where bile isdrained into the intestine. Dosage:Root powder: 3-5gm, Decoction: 50-10 ml, Seed: 1-5 numbers,Oil: 5-10 ml. Important Yoga:Eraṉḍamūlādī kādhā, Eraṉḍa-Saptaka Kaśāya, RāsnāeraṉḍādīKaṣāya, Siṃhanāda guggulu, Vātārī guggulu, Hiṉgu triguna taila,Eraṉḍādī taila. Therapeutic Uses: Ślipada: Eraṉḍa taila mixed with cow‟s urine .may be taken forone month while consuming diet of rice & milk (Su.Ci.19). Kāsa: Kṣāra of Eraṉḍa leaves is mixed with Trikaṭu, oil & jaggaryis useful on oral administration (Ca.Ci.18).v. RĀSNĀ:
  • 143. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 131 Latin Name: Inula racemosa. Family: Asteraceae. Synonyms:Yuktarasa, Rasya, Suvaha, Rasana, Rasā, Elāparnī, Surasā,Sugaṉdhā, Surabhī, Rasādhya, Śreyasī, Atirasā, Gaṉdhamūla,Gaṉdhanakulī. Classification: Caraka: Anuvāsnopaga, Vayasthāpana Suśṛuta: Arkādī, Śleṣma Saṃśamana. Habitat: Kashmir, Uttar Pradesh. Properties: Rasa: Tikta Vipāka: Kaṭu Guna: Guru Vīrya: Uṣṇa Prabhāva: Viṣaghna Karma: Śotha, Swāsahara. Doṣa: Vāta, Kapha. Best among Vātahara. Morphology:Rāsnā is a shrub, 3-6 cm in height. Chemical Composition:Inulin, volatile oil, alantolactone, Sapomin, Beta- sitesteroids. External use:Rāsnā is Śṛeṣṭha for Śitāpanayana, Pralepanānām (Ca.su.25).Externally it is useful in Ᾱmavāta, Kaṉḍughna, Jwaraghna, Twak Vikāra. Internal use: Digestive System: Adhmānahara, Udaraśūla and also useful inindigestion. Respiratory System: In this it is mainly used in Śwāsa, Kāsa,Bronchitis, Pleuritis. Part used: Patra, Kaṉda. Actions: Kaphavātjita, Ᾱmapacanī, Śūlaghna, Viśaghna (BP.).
  • 144. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 132 Formulations:Aśvagaṉdhādī tailam, Prasārani, Rāsnādī Kwātha, Māṣa Tailam,Māṣabalādi Yoga, Rāsnā saptaka kwatha, Rāsnā Pañchaka kwatha.vi. ŚATA PUṢPᾹ: Botanical Name: Anethum sowa. Family- Apiaceae. Names in different languages:Hindi- Śoyo, English- Dill or Dill-seeds, Telugu- Śadāpa vittulu,Tamil- Śatakuppī, Bengali- Śaluka, Marathi- Śepu, Gujarati- Śuva. Synonyms:Atilaṃbī, Karavī, Madhura, Śitachatra. Classification: Caraka: Asthāpanopaga, Anuvāsanopaga. Morphology:A perennial herb of 30-90 cm high. Leaves are bipinnate ortripinnate, linear. Flowers are white coulored and petals yellow coloured,style smaller in size. Fruit is 4x2 mm, dorsal intermediate ridges distinct;slender; vittae large, solitary in each furrow, 2 on the commissure. Distribution & Habitat:Often cultivated throughout the tropical and subtropical India. Chemical composition:Seeds: 3 to 5% volatile fragrant oil. Fruit or seed oil: Caryonedihydrocan,one limonene apiol, dill-apial bergarno, transdihydrocarv betacaryophyllene, cugenol, cis-ocimene; difffuran, beta sitostero1. Properties: Rasa: Kaṭu, Tikta Vīrya: Uṣṇa Guna: Laghu, Tikṣṇa Vipāka: Kaṭu Karma: Vāta-Kapha hara, Dīpana. Habitat:
  • 145. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 133Everywhere in India. Internal uses: Nervous System: Brain tonic and useful for eyes. It is useful inweakness of eye sight. Digestive System: Reduces dyspepsia, vomiting as it is Dīpana,Pācana, and Anulomana. Basically, it is purgatīve in nature. It isalso used in distension, pain in abdomen, dysentery and piles. Indysentery it acts as Ᾱmapācaka and Anulomaka of Vāta and itremoves Ᾱmadoṣa out of the body. Because of this, it reducesspasms. Fried fennel and ginger powder should be taken inspasmodic pain to reduce the spasm along with other medications.Root is used as purgatīve. It is extremely useful remedy forabdominal colic. Circulatory System: Useful for the heart. As it is Rakta prasādana,it is useful in heart diseases and also in blood disorders. Respiratory System: Kaphaghna and expectorant. So used inKaphaja Kāsa and asthma. Urinary System: Diuretic useful in dysuria, urine retention. Reproductive System: Induces menstruation and increases breastmilk secretion, Useful in dysmenorrhoea, menstrual obstructionand mastitis.vii. SAIṈDHAVA LAVANA: Latin Name: Sodii chloridum. Chemical Formul: NaCl Varga: Lavana Varga (RRS.), Harītakyādī Varga (BP.). Properties: Rasa: Lavana, Madhura Guna: Laghu, Snigdha Vīrya: Śīta Vipāka: Madhura Doṣaghnatā: Tridoṣahara especially Vātahara. Actions & Uses:
  • 146. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 134Vibaṉdhahara, Anulomana, Netrya, Vṛṣya, Dīpana, Rocana,Virecana, Mukharogahara, Vātānulomana, Chakṣuṣya. It is also used indyspepsia, other abdominal and eye disorders. Pharmacological Action:It is digestive stimulant, laxative, beneficial for eyes, virilific, andnon-irritant and light. Chemical Constituents:It is the mineral form of the sodium chloride occurs on crystallinemassive and granular to compact forms. It is a white transparent and cubicin shape, which contains NaCl, KCl, CaSo4, CaCl2, MgCl2 and NaHCo3.The chloride content is 59.64 w/w and sulphide content is 10.40 w/w. Itsspecific gravity is 2.17. Formulations:Dvātriṉśaka Guggulu, Rasona kalka, Hiṉgwāṣṭaka churna etc.viii. BALᾹ: Botanical Name: Sida cordifolia Linn. Family: Malvaceae. Names in different languages:Hindi- Khiraintī, Telugu- Cittamuttī, Malayalam- Vellurum,English- Country Mollow, Tamil- Paniyar Tuttul, Kannada- Hettuti Synonyms:Vātya, Vātyālikā, Vātyapuṣpī, Vātyai, Hadroudani. Classification: Caraka Saṃhitā: Balya, Bṛṃhanīya, Prajāsthāpana. Suśṛuta Saṃhitā: Vātaśaṃśamana. Introduction:The root of the herb is known as a good tonic and immunemodulator, mainly using for vãta rogas. Bhãvamisra mentioned fourvarieties; Balā: S. cordifolia
  • 147. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 135 Atībalā: A.indicum Nāgabalā: S. veronicaefolia Mahābalā: S. rhombifolia. Morphology:A small downy erect herb or shrub, 1.2 m in height with longbranches and sometimes rooting at nodes. Leaves are cordate, oblong,ovate or ovate oblong, very downy on both surfaces; petiole as long as theblade. Flowers small, tawny yellow or white, carpels 10. Fruits are with apair of awns on each carpel. (Flowers and grows wild along the roadsides,throughout sub-tropical and tropical India, ascending up to 1,200 m. Chemical composition:Major components of seeds are alkaloids. Alkaloid contains mainlyephedrine. It also contains fatty acid, mucin, potassium nitrate and resin,hypaphorine, vasicinone, vascicine, vasicinol, choline, betaine, phytosteroletc Part Used: Root. Dosage: Decoction 50-100 ml, powder 4-6 g. Properties: Rasa: Madhura Vīrya: Śīta Guna: Laghu, Snigdha, Picchīla Vipāka: Madhura Karma: Balya, Bṛṃhana, Vṛṣya Srotogāmitva: Rakta, Māṃsa. Doṣa: Vāta-Pitta hara Dhātu: Rakta. Maṃsa, Śukra, Oja (enhancer). Distribution & Habitat:All over India and Srilanka. External use:Paste is analgesic and alleviates edema. It is locally applied overinflammation and eye disorders. Internal use:
  • 148. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 136 Central nervous System: Being neural tonic and Vātaśāmak, it isuseful in Vāta disorders like paralysis, facial palsy etc. Digestive System: Emollient and astringent, useful in flatulence. Circulatory System: Cardiac tonic and alleviates haemorrhagicdisorders, hence used in cardiac debility, haemorrhagic disorders. Reproductive System: Aphrodisiac and useful in spermatorrhoea Urinary System: Diuretic, so useful in dysuria. Important Yogas or Formations:Balādī kwatha, Balādya ghṛta, Balādyariṣṭa, Caṉdanabalālakṣādītaila etc. Indications: Raktapitta, Vātavyādhī, Prameha, Kṣaya. Therapeutic uses: Aṉtra vṛddhī: Balā kṣīra is added to Eraṉḍa taila and administeredorally (CD.) Galagaṉḍa: Balā, Atībalā and Devadārū are powdered and giventhrough oral route (Su.Ci.l8). Vātavyādhī: Balā Yuṣa is the best for Vātaroga (VM.).ix. TILA TAILA: Latin Name: Sesamum indicum. Family: Pedaliaceae. Names in different languages:Saṉskṛt: Tila, Assamese: Simmasim, Bengali: Tilagachh, English:Sesame, Gingelly: oil Seeds, Gujrati: Tall, Hindi: Tila, Teel, Tili, Kannada:Accheellu, Malayalam: Ellu, Marathi: Tila, Oriya: Til, Punjabi: Til, Tamil:Ellu, Telugu: Nuvvulu, Urdu: Kunjad. Properties: Rasa: Madhura, Kaśāya Guna: Sukṣma, Uṣṇa, Vyavāyi Virya: Uṣṇa Vipāka: Kaṭu Doṣaghnatā: Vātahara Karma: Balya, Twacya, Medhā-Agni Vardhana. Parts used: Seed
  • 149. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 137 Chemical composition:Numerous studies on the minor constituents of the Tila oil have ledto the conclusion that the oil contains two constituents, sesamin andsesamolin, which are not found in any other vegetable oil. Anothercompound, sesamol, a phenolic antioxidant, is usually present in traces[Mittal, et, al , lndian Oilseeds J., 1956, 1(1), 38].Sesamin has got three stereoisomeric forms namely sesamin,asarinin and epiasarinin, each of them existing in two enantiomorphicforms. Sesamin is present in sesame oil in a concentration of 0.5 to 1.0 percent. Sesamolin is a minor constituent of sesame oil. Both sesamin andsesamolin are active synergists of pyrethrins, the latter being about fivetimes more potent than sesamin. Sesamolin readily hydrolyzed by mineralacids to give sesamol (C7H6O3, m.p. 65.5°) and samin (C13H14O5, m.p.103°). Sesamin and sesamolin exhibit little antioxidant activity, butsesamol shows pronounced activity. Recent study: Dietary substitution of sesame oil, in nifedipine-takinghypertensive patients, has an additive effect in the reduction ofblood pressure and plays an important role in the modulation ofelectrolytes and in the reduction of lipid peroxidation and elevationof antioxidants. (Sankar D et al.) Asia Pac J Clin Nutr. 2004;13(Suppl):S107. Feeding of sesamin an active principle of Tila Taila inhibits theenhancement of aortic O2- production in DOCA(Deoxycorticosterone acetate) -salt hypertensive rats, and thiseffect may contribute to the antihypertensive effect of sesamin.Sesamin feeding-induced improvement of endothelial dysfunctionseems to result from the above antioxidative and antihypertensiveeffects. (Nakano D et al.)BiolPharm Bull. 2003 Dec; 26 (12):1701-5. Diet containing 24% sesame oil reduces levels of serum and livercholesterol, liver LDL cholesterol, and liver lipids. The mechanismlying behind it is probably the high degree of unsaturation (85%) of
  • 150. DRUG REVIEWEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 138sesame oil and the presence of linoleic acid. (Satchithanandam S etal), Int J Vitam Nutr Res. 1996;66(4):386-92. Diet containing sesamin reduces hepatic ischemia reperfusioninjury by inducing both antioxidant and anti-inflammatoryactivities. The antioxidant and anti-inflammatory properties ofsesamin (a non-fat constituent of sesame oil) have been attributedto an increased accumulation of dihomo-y linolenic acid, aprecursor of 1-series prostaglandins, and the decreasing productionof proinflammatory 2-series prostaglandins and 4-seriesleukotrienes by inhibiting the delta-5 desaturase activity.(Utsunomiya T et al.), Hepatogastroenterology. 2003 Sep-Oct;50(53):1609-13.
  • 151. MATERIALS and METHODSEffect of Māṣātmaguptādi Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 139MATERIALS and METHODSResearch is a scientific and methodical study, investigation orexperimentation, in order to establish facts and analyze their significance. Clinicalresearch involves the application of existing knowledge to the new demands ofsociety, thus clinical study is the essence of any research work. It further rectifies thehypothesis and improves its practical applicability.Ᾱyurveda, the ancient science of medicine is also based on facts, which wereexperiment several times by our Ᾱpta Ᾱcāryas. But, in present era, strong necessity isnoticed to reprove, assess, modify and modulate those old concepts for their widerapplicability and acceptability by latest quantitative parameters, to absolutesatisfaction of everyone, including modern man, with a view to placing Ᾱyurveda as anational system of medical treatment.As a part of clinical study Pakṣāghāta (Hemiplegia) was taken. According toᾹyurveda, Pakṣāghāta is included under Vātavyādhī and considered as KṛcchraSādhya or Yāpya.In Modern medicine it can be correlated with CVA, which includes episodesof focal brain dysfunction due to focal ischemia, which makes patient physicallydisable. As explained by Ᾱcāryas, in the context of Yāpyatā of Pakṣāghāta, theModern science also believes that the brain tissues once damaged cannot beregenerated by any therapies, which leads to permanent neurological deficit. Hencethe disease has a poor prognosis, making the person disabled dependent. In Modernmedicine, management of hemiplegia is not effective. The therapies are morerehabilitative in nature. So the groups of patient suffering from Pakṣāghāta usuallyapproach Ᾱyurvedic Hospitals.In such conditions Ᾱyurveda can offer to a considerable extent. Thetherapeutic modalities included in the present study are Snehapāna, Abhyaṉga andSwedana, Virecana and main modality as Yoga vasti with Māṣātmaguptādī tailam andKwatha churnam. The vasti has got important place in Pañcakarma therapy becauseof its wide and effective use and also it is said to be Ardha or Purna Cikitsā. So the
  • 152. MATERIALS and METHODSEffect of Māṣātmaguptādi Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 140preparatory procedures for vasti and Yoga vasti with Māṣātmaguptādī taila andkwatha churna will be helpful for Saṃprāptī vighatana of Pakṣāghāta.I. Aims and Objectives:This study entitled as “Effect of Māṣātmaguptādī Yoga vasti in Pakṣāghātaw.s.r. to Ischemic stroke” and Aim of the study is;i. To do the literary study of Pakṣāghāta and hemiplegia in detail.ii. To review the literature about vasti.iii. To study the efficacy of Māṣātmaguptādī tailam and kwatha in themanagement of Pakṣāghāta.II. Materials:The Yoga vasti includes Nirūha with Māṣātmaguptādī kwātha and Anuvāsanavasti with Māṣātmaguptādī tailam.i. Māṣātmaguptādī tailam:Māṣātmaguptādī tailam is quoted by Cakradatta and BhaiṣajyaRatnāvalī in Vātavyādhī Adhikāra and it contains 10 ingredients as; Māṣa,Ᾱtmaguptā, Atīviṣā, Eraṉḍa, Rāsnā, Śatāvhā, Saiṉdhava, Balā Kwatha, MāṣaKwatha, Tila Taila.ii. Māṣātmaguptādī Kwatha:Ingredients of Māṣātmaguptādī kwatha are Māṣa, Ᾱtmaguptā, Atīviṣā,Eraṉḍa, Rāsnā, Śatāvhā, Saiṉdhava and Balā.The preparation of Māṣātmaguptādī taila and kwātha explained in thecontext of drug review.iii. Materials to administer vasti:Vasti yaṉtra, Madhu, Śatapuṣpā kalkaSaiṉdhava lavana, Mortar & pestle, measuring flaskDisposable gloves.
  • 153. MATERIALS and METHODSEffect of Māṣātmaguptādi Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 141III. Methods:Thirty patients of Pakṣāghāta were registered for clinical study from theO.P.D. of Dept. of Pañcakarma of S. V. Ᾱyurvedic College and Hospital, Tirupati.These 30 patients were kept in I.P.D. under supervision while undergoing abovementioned treatment to observe the Samyak lakṣanas of snehana, Virecana and vastiin accordance to the relief in signs and symptoms.A detailed history taking and physical examinations were carried out in thesepatients. Relevant data along with the elaborated assessment of functional disability,pain, neurological deficit, motor system assessment are collected on the day of 0, 30thand 60thin the specially designed case Performa. In this study total 30 patients ofPakṣāghāta fulfilling the selection criteria were registered as;i. Inclusion Criteria: Age between (18 – 60yrs) Patients of Pakṣāghāta with or Without Facial Paralysis Medically stable, fully conscious and oriented.ii. Exclusion Criteria:Haemorrhagic stroke, Space occupying lesions,Moderate to severe Hypertension, IDDM,Malignant conditions, Epilepsy,Severe Metabolic Disorder, PregnancyLactation.iii. Study design:Except Antihypertensives and Antidiabetic drugs, the rest of the medicinesthat patients were taking, were discontinued throughout the study. The preparatoryprocedure for vasti as follows;1. Dīpana-Pācana:Prior to the administration of Abhyaṉtara Snehapāna, Dīpana andPācana were advocated in the patient with Citrakādī Vatī and also advice todrink Luke warm water. This was done for 2- 3 days or prolonged till ᾹmaPācana and Agnidīpana were observed.
  • 154. MATERIALS and METHODSEffect of Māṣātmaguptādi Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 1422. Snehapāna:After Ᾱma pācana and Agnidīpana, Snehapāna with „Tila Taila‟ wascommenced in progressively increasing dose for 7 days starting from 30 ml to150 ml. Dose of the Sneha was manipulated by considering the Agni, Koṣṭa,Bala, Vaya, etc. of the patient. Patients were advised to follow below saidregimen during Snehapāna; To take Koṣṇa Sneha in morning hours after the food taken on theprevious night has been digested with Koṣṇa Jala as anupāna. To drink sukhoṣṇa Jala throughout the Snehapāna to facilitate thedigestion and assimilation of Sneha. Not to eat anything until he/she feels hungry. Patient has to take Drava, Uṣṇa, Anabhiṣyaṉdī Ᾱhāra. Not to expose Pravāta, Ᾱtapa etc.Samyak Snehana lakṣanas were keenly observed and charted each day.Snehapāna was continued till the appearance of Samyak Snigdha Lakṣanas. Inmajority of patients, these were achieved in 5 – 7 days.3. Abhyaṉga and Swedana:After observation of Samyaka Snigdha Lakṣana the patients weresubjected to Abhyaṉga and Swedana for next three days. Abhyaṉga with Balātailam and Baṣpa Sweda advised.4. Virecana Karma:Thereafter, Virecana Karma was advocated by „Eraṉḍa Tailam‟ withUṣṇa jala. The dose of the Eraṉḍa Tailam selected as per the Koṣṭha of thepatients. The Virecana drug was given after the completion of the KaphaKāla, i.e., between 7- 9 am.The patients were directed to take Uṣṇa jala after every 20-30 minutes.After appearance of Samayak Virechan lakṣanas, Drava and Uṣṇa Ᾱhāraadvised from the afternoon of the same day or when he/she feels hungry andwere allowed to take rest.
  • 155. MATERIALS and METHODSEffect of Māṣātmaguptādi Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 1435. Saṃsarjana Krama:As per the Śuddhi of the patients, they were kept on Saṃsarjana kramaas given in the classics for reviving the strength of Agni then finally resumedto normal diet.6. Yoga vasti:Yoga vasti has to be started after 7 days, from the first day ofSaṃsarjana krama. Yoga vasti includes 5 Anuvāsana and 3 Nirūha vasti, asfirst and last Anuvāsana and between them alternate 3 Nirūha and 3Anuvāsana vasti.7. Parīhāra Kāla:Parīhīra Kāla should be followed for double the days of vasti. In Yogavasti this regimen has to follow for the 16 days. Certain things are strictlyprohibited, both during the course of vasti and even after the vasti. The thingsto be avoided are as follows: loud speech, constant sitting, and indigestion,intake of unwholesome food, day sleeping and sexual intercourse etc.8. Follow up:Post treatment evaluation of selected disorder on 30thand 60thday fromthe starting day of treatment by using the classical Ᾱyurvedic evaluationcriteria for Pakṣāghāta, Barthel Index and motor system assessment criteria.iv. Criteria of Assessment:The improvements in the patients were assessed on the basis of the criteriagiven below; Subjective parameters include Rūjā, Vākstaṃbha and Barthel Index,while objective parameters include finger movement, motor function of arm, motorfunction of leg, muscle tone, muscle power reflexes, sitting from lying down, standingfrom sitting position, walking capacity, walking stairs and gradings of respectiveparameters explained in Annexure.
  • 156. MATERIALS and METHODSEffect of Māṣātmaguptādi Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 144v. Statistical Analysis:The results are presented as mean ± SD& SEM and subjected to ANOVAfollowed by Turkey multiple comparison test of 30 patients in group. The values of*p<0.05 were considered significance.Values are expressed in mean ± SD of 30 observations (n=30). Comparisonbetween 0 day Vs 30thday from 0 day Vs 60thday was done.ns - Non-significantSignificant - * p < 0.05,Highly Significant - ** p < 0.01,Extremely Significant - *** p < 0.001.Statistical significant test for comparison was done by ANOVA followed byTurkey multiple comparison test.
  • 157. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 145OBSERVATIONS and RESULTSStatistical analysis in regards to age, sex, marital status, and dietary habit etc. of30 patients who are included in the study is elaborated in the following paragraphs;Graph No. 1 and Table No. 19 – Age wise distributionIt was found that 20 % patients belonged to the age group of 31 – 40 years; samenumbers of patients were seen in 41 -50 years of age group. 60% belonged to age groupof 50 -60 years.Graph No. 2 and Table No. 20 – Sex wise distributionOut of the registered patients, 70 % patients were of male gender while remaining30% patients were belonged to female gender.010203040506070809010031-40 41-50 51-60 TOTALNo. of Patients 6 6 18 30% 20 20 60 1006 6183020 2060100AGE WISE DISTRIBUTIONNo. of Patients %0102030405060708090100MALE FEMALE TOTALNo.of Patients 21 9 30% 70 30 100219307030100SEX WISE DISTRIBUTION
  • 158. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 146Graph No. 3 and Table No. 21 - Religion wise distributionReligion wise 86.67 % patients were observed to be Hindu religion, while the rest13.33 % patients were Muslims.Graph No. 4 and Table No. 22 – Marital status wise distribution96.67 % patients were married while only one patient (3.33 %) patient wasunmarried.020406080100HINDU MUSLIM TOTALNo. of Patients 26 4 30% 86.67 13.33 1002643086.6713.33100RELIGION WISE DISTRIBUTION0102030405060708090100MARRIED UNMARRIED TOTALNo. of Patients 29 1 30% 96.67 3.33 1002913096.673.33100MARITAL STATUS WISE DISTRIBUTION
  • 159. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 147Graph No. 5 and Table No. 23 – Education wise distributionOut of all patients registered 80 % were literate and others (20%) areilliterate.Graph No. 6 and Table No. 24 – Occupation wise distributionOccupation wise 66.67 % patients were field worker, 10 % patients were deskworker and 23.33% patients were house wives.0102030405060708090100LITERATE ILLITERATE TOTALNo. of Patients 24 6 30% 80 20 100246308020100EDUCATIONAL STATUS WISE DISTRIBUTION020406080100FIELDWORKDESKWORKHOUSEWIFETOTALNo. of Patients 20 3 7 30% 66.67 10 23.33 10020373066.671023.33100OCCUPATION WISE DISTRIBUTION
  • 160. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 148Graph No. 7 and Table No. 25 – Deśa wise distribution90 % patients were belonging to Jāṉgala Deśa, 3.33 % patients were belonging toSādhārana Deśa while remaining and 6.67% patients were belonged to Anupa Deśa.Graph No. 8 and Table No. 26 – Ᾱhāra wise distribution93.33 % patients were consuming mixed diet, while rest (6.67%) was consumingvegetarian diet.0102030405060708090100ANUPA JANGALA SADHARANATOTALNO. OF PATIENTS 2 27 1 30% 6.67 90 3.33 1002271306.67903.33100DESA WISE DISTRIBUTION0102030405060708090100VEGETARIANMIXED TOTALNO. OF PATIENTS 2 28 30% 6.67 93.33 100228 306.6793.33100AHARA WISE DISTRIBUTION
  • 161. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 149Graph No. 9 and Table No. 27 – Built wise distribution90% of patients are with medium built and 10% of patients with lean built and noone with heavy built.Graph No. 10 and Table No. 28 – Addiction wise distribution13.33 % patients were addicted of smoking, 10 % were addicted of alcoholand 36.67 % patients were addicted of smoking and alcohol. Remaining patients did notreport any notable addiction.0102030405060708090100LEAN MEDIUM HEAVY TOTALNo. of Patients 3 27 0 30% 10 90 0 10032703010900100BUILT WISE DISTRIBUTION0102030405060708090100SMOKING ALCOHOLSMOKING+ALCOHOLNIL TOTALNo. of Patients 4 3 11 12 30% 13.33 10 36.67 40 1004 311 123013.331036.6740100ADDICTION WISE DISTRIBUTION
  • 162. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 150Graph No. 11 and Table No. 29 – Stress wise distribution93.33% of patients possessed emotional stress, while others (6.67%) are innormal status.Graph No. 12 and Table No. 30 – Śārīra prakṛtī wise distribution70 % patients were of Vāta-Pitta Deha Prakṛtī, 16.67 % patients were of Vāta-Kapha Prakṛtī and remaining 13.33% patients were having Pitta-Kapha Deha Prakṛtī.0102030405060708090100PRESENT ABSENT TOTALNo. of Patients 28 2 30% 93.33 6.67 1002823093.336.67100STRESS WISE DISTRIBUTION0102030405060708090100VATA-PITTAVATA-KAPHAPITTA-KAPHATOTALNO. OF PATIENTS 21 5 4 30% 70 16.67 13.33 100215 4307016.67 13.33100SARIRA PRAKRTI WISE DISTRIBUTION
  • 163. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 151Graph No. 13 and Table No. 31 – Satva wise distributionSatva 46.67 % patients were of Madhyama Satva, 53.33 % patients were of AvaraSatva, while no one has Pravara Satva.Graph No. 14 and Table No. 32 – Vyāyāma Śaktī wise distribution23.33% patients were in Madhyama category, others (76.67%) in Avara andno patient presented with pravara Vyāyāma śaktī.020406080100PRAVARAMADHYAMAAVARATOTALNO. OFPATIENTS 0 14 16 30% 0 46.67 53.33 100014 1630046.6753.33100SATVA WISE DISTRIBUTION0102030405060708090100PRAVARA MADHYAMAAVARA TOTALNO. OF PATIENTS 0 7 23 30% 0 23.33 76.67 100072330023.3376.67100VYAYAMA SAKTI WISE DISTRIBUTION
  • 164. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 152Graph No. 15 and Table No. 33 – Affected limb wise distributionIn 66.67% of patients affected side in Pakṣāghāta was right half of bodywhile in others (33.33%) with left half of body.Graph No. 16 and Table No. 34 – Chronicity wise distributionOn observation of the duration of illness, 40 % patients were suffering fromdisease since 0 – 6 months. 36.67 % patients were of 7 months – 12 year chronic, 10% ofpatients were of 13 – 18 months chronic and same percentage of patients were of 19 – 24months and 3.33% of patients were in category of 25 – 30 months.0102030405060708090100RIGHT LEFT TOTALNo. of Patients 20 10 30% 66.67 33.33 10020103066.6733.33100AFFECTED LIMB WISE DISTRIBUTION01020304050607080901000-6Months7-12Months13-18Months19-24Months25-30MonthsTOTALNo. of Patients 12 11 3 3 1 30% 40 36.67 10 10 3.33 10012 113 3 13040 36.6710 103.33100CHRONICITY WISE DISTRIBUTION
  • 165. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 153Graph No. 17 and Table No. 35 – Past history of disease wise distributionOn observation of past history of diseases it was found that that 6.67 % of patientswere having history of Diabetes mellitus, 53.33 % patients had history of Hypertension,30 % patients had that of DM and HTN both. Remaining 10 % patients were not havingthe history of disease.Graph No. 18 – Symptoms wise distribution0102030405060708090100DM DM, HTN HTN NIL TOTALNO. OF PATIENTS 2 9 16 3 30% 6.67 30 53.33 10 10029163306.673053.3310100PAST HISTORY OF DISEASE WISE DISTRIBUTION05010030030 306170 2224 91000100 1002056.6706.6773.3313.3330SYMPTOM WISE DISTRIBUTIONNO. OF PATIENTS %
  • 166. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 154Table No. 36 – Symptoms wise distributionSr. SYMPTOMS NO. OF PATIENTS %1 Ceṣṭa Nivṛttī 30 1002 Acetanatā 0 03 Rūjā 30 1004 Saṉkoca 30 1005 Ᾱrdita 6 206 Vākstaṃbha 17 56.677 Śoṣa 0 08 Incontinence of urine 2 6.679 Constipation 22 73.3310 Kaṃpa 4 13.3311 Headache 9 30Symptomatology observed in the present study Ceṣṭā Nivṛttī, Rūjā, Saṉkocha wasobserved in all the patients. 20% presented with Ᾱrdita; Vākstaṃbha was featured in56.67%. No one was presented with Acetanatā and Śoṣa while Kaṃpa was found in13.33%.and headache in 30% of patients. Only 2 patients (6.67%) suffered withincontinence of urine. Major number of patient (73.33%) presented with constipation.
  • 167. OBSERVATION and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 155RESULTSIn the present study, samples of 30 patients were selected and underwentmentioned treatment. Treatment was advocated according to the plan of study, i.e.Snehapāna, Abhyaṉga and Swedana, Virecana Karma, Saṃsarjana Krama and YogaVasti. The efficacy of therapy was adjudged on varied parameters and the results werederived after execution of statistical methodology. The effect of therapy has beenpresented here.
  • 168. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 159DISCUSSIONDiscussion is the main step in any research. It is the process of examining thefacts through their merits and demerits to obtain proper knowledge about facts. Toreach up to the depth of the knowledge the discussion is the important step whichhelps in understanding the subject and guides to conclusive judgment. Beforeestablishment of truth as conclusion, Discussion is mandatory.Pañcakarma is the modality of treatment that is significantly contributing forthe global acceptance of Ᾱyurveda. Vasti, one of the procedure of Pañcakarma, isgenerally praised by all ancient Ᾱcārya and designated as principal treatment of Vātadisorders. Vāta disorders are very infamous for their chronic course andunmanageable nature. In this regard vasti therapy will prove a benefit to the patientsof Vātavyādhī. If such treatment of Vāta disorder is targeted mainly on the disorderslike Pakṣāghāta, certainly it will prove its effect on improving disability and othersigns and symptoms. Taking this aspect in mind present clinical study was designed tolook into effect of Vasti Karma with Māṣātmaguptādī Yoga in Pakṣāghāta.Discussion of the facts, which have emerged from the study, can be doneunder the following heading; for interpretation of implication of results.I. Discussion on demographic dataII. Discussion effect of therapies on parametersIII. Discussion on drug aspectIV. Discussion on Yoga Vasti.I. DISCUSSION ON DEMOGRAPHIC DATA: AGE:Among the 30 patients of Pakṣāghāta, maximum numbers of patients(60%) were from the age group of 51-60 years; 20% were from 41-50 agegroup and 20% were from 31-40 years of age group. Ᾱcārya Suśruta has statedthat Parīhānī Kāla of Madhyama Avasthā sets in at the age group of 40-70years (Su.Su.35:35). This is Vāta prakopa Kāla and beginning of the ageingprocess and degenerative changes. This leads to Kṣaya of Śārīra Bala and allthe dhātus and results in Vāta prakopa. Thus the incidence of Pakṣāghāta
  • 169. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 160increases in this senile age group as provocated Vāta acts as a predisposingfactor. The textual screening also verifies the above observation, assertingthat, “Age is probably the risk factor best correlated with stroke.” SEX:Higher incidence was observed in males (70%) than females (30%).This supports the statement, “stroke affects males 1.5 times more often thanfemales. But latest data show that, overall, the incidence and prevalence ofstroke are about equal for men and women. This may be because females havebeen entered also to the professional life and in intellectual fields. Therefore,both sexes have the same tension and stressful background, which can lead toHTN, and stroke. Studies show that aging women sustain a large burden forstroke due to decrease in reproductive hormone (Estrogen). RELIGION:86.67% of patients who opted for study were from Hindu Communityand 13.33% were Muslims. Nothing specific can be drawn from thisobservation, as this could be a result of demographical dominance of thatregion. EDUCATIONAL STATUS:In the present study maximum patients (80%) were literate, whileremaining was illiterate (20%). It may be due to urban habitat of the patients.So, it would be premature to correlate this finding with any aspect of thedisease. OCCUPATION:A larger part of the sample compromised of field workers (66.67%),while desk workers comprised of 10% and remaining house wives of 23.33%.Atīvyāyām, Rātrījāgrana, Alpāśana, financial crises and mental stress may bethe cause of prevalence of disease in field workers leads to Vāta prakopa. Indesk workers because of sedentary life style, stress leads to ᾹvaranajanyaVāta Prakopa. The incidence among house wives may be due to constrains ofhousehold, financial tension, irregular diet habits and vega vidharana.
  • 170. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 161 MARITAL STATUS:In the present study majority of the patients (96.67%) were married.Nothing specific can be drawn from this observation in relation to thismorbidity. HABITAT:Distribution of maximum patients (90%) among Jāṉgala deśa can bedue to geographic location of the institute. 6.67% of patients from Ᾱnūpa andremaining 3.33% from Sādhārana Deśa. DIETARY HABITS:In this study, majority of patients (93.33%) were notified to take mixedtype of Diet, while only 2 patients (6.67%) found to be vegetarian type of diet.Intake of Guru, Uṣṇa, Lavana, Atīsnigdha and in Atīmātrā Ᾱhāra leads tovitiation of Vāta and Kapha doṣa, which in turn vitiates Agni Vyāpāra andhence produces Ᾱma – the initiator of pathogenesis and can lead toMārgāvarodhajanya Pakṣāghāta. ADDICTION:Study of addiction reveals 36.67% of patients were found to behabitual to smoking and alcohol, 13.33% of patients addicted to smoking and10% habitual while remaining patients (40%) don‟t have any addiction. Alladdictions affect the Agni along with that these addictions increase Rukṣa,Vyavāyi, Vikāsi Guna of Vāta. They also suppress the immuno modulatorymechanism and provoke Vāta. In long run these addictions may be a cause ofOjakṣaya and leads to neurological disorders. Modern textual references alsoquote smoking, consumption of alcohol, etc. to be grave risk factors for stroke. MENTAL STATUS:Maximum patients had stress (93.33%) and only 2 patients had soundmental status. This shows the definite involvement of Manovaha srotas inPakṣāghāta.
  • 171. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 162 PRAKṚTĪ:All the patients‟ exhibitated a Dvaṉdwaj doṣic constitution, withmajority of Vāta-Pittaja (70%) Prakṛtī, follwed by Vāta-Kaphaja (16.67%)and Pitta-Kaphaja (13.33%) Prakṛtī. This data suggests that the diseaseoccurrence is more in Vāta-Pittaja dominant Prakṛtī. SATVA and VYᾹYᾹM ŚAKTĪ:Maximum number of patients were having Avara satva (53.33%) and46.67% of patients having Madhyama Satva.this study reveals that 76.67% ofpatients having Avara Vyāyāma Śaktī while 23.33% shows MadhyamaVyāyāma Śaktī, whether no one had Pravara Satva and Vyāyāma Śaktī. Thishighlights towards weak mental and physical contribution leading to doṣicimbalance. PRESENTING SIDE:A greater portion means 66.67% patients presented with righthemiplegia. All the patients had right-handedness, i.e., left cerebraldominance. [The left hemisphere is dominant in almost all right handed peopleand in most lt. handed people]. This finding goes in favor to the textualreference that arteries of the left side of the brain are embolised more oftenthan those of right and left MCA is the vessel most often affected. CHRONICITY:A wide variation was observed, i.e., the patients presented from 0month of onset to 3 years of chronicity. Maximum patients (40%) had achronicity of 0-6 months, 36.67% of patients had a chronicity of 7-12 months.This shows the gradual change in the trend and awareness of people to thebenefits of authentic Pañcakarma therapy of Ᾱyurveda in early stage ofdisease. ASSOCIATED DISEASES:53.33% patients were hypertensive and 6.67% had Diabetes Mellituswhile 30% patients presented with both HTN and DM. Hypertension is the
  • 172. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 163risk factor that most significantly correlates with stroke. Also, the associationbetween hypertension and cardiac disease is well known, makingcardioembolic brain infarction more likely. Hypertension plays a role in theatherodegenerative process in the vessels resulting in occlusive and embolicstroke. Diabetes is also associated with an increased risk of stroke. It fastensthe process of atherosclerosis and leads to large lacunar infarcts. SYMPTOMS:Symptomatology observed in the present study Ceṣṭā Nivṛttī, Rūjā,Saṉkocha was observed in all the patients. 20% presented with Ᾱrdita;Vākstaṃbha was featured in 56.67%. No one was presented with Acetanatāand Śoṣa while Kaṃpa was found in 13.33%.and headache in 30% of patients.Only 2 patients (6.67%) suffered with incontinence of urine. Major number ofpatient (73.33%) presented with constipation.II. DISCUSSION ON EFFECT OF THERAPIES ON PARAMETERS:The effects of the therapies were assessed statistically with ANOVA test, onthe basis of changes observed in the sign and symptoms, Barthel Index and withneurological examination. Statistically Rūjā had a mean score of 2.4 on the 0 day, which was reduced to1.43 0n 30thday and 1.20 on 60thday. The „p‟ value is < 0.0001 means resultwas found to be extremely significant. The „p‟ value is extremely significanton 0 vs. 30 day and 0 vs. 60 day, with minute change in mean value in both ofthem. Prior to the treatment mean value of Vākstaṃbha was 3.67 which wereincreased up to 4.07 and 4.17 on 30thand 60thday. The mean value shows mildchanges but „p‟ value is non-significant statistically. Barthel Index mean score presented as 52.50, 63.33 and 65.67 on 0, 30thand60thday respectively. The „p‟ value is less than 0.05 i.e. statistically significanton 0 vs. 30 day when compared to p < 0.001 on 0 vs. 60 day shows highlysignificant result. The mean score of finger movement of upper limb was 0.97 on the day 0,which was increased to 1.70 and 1.83 on 30 and 60thday. The P value shows
  • 173. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 164significant improvement (p< 0.01) on 0 vs. 60 day compared to p< 0.05 on 0vs. 30 day. Mean score was 0.73, 1.20 and 1.27 on 0, 30 and 60 dayrespectively which shows minute change but statistically improvements infinger movement of lower limb were non-significant. The Mean score of parameter lifting the hand shows minimal raised value as2.40, 3.10 and 3.20 on respective days but „p‟ value was non-significant. On the 0 vs. 30 day „p‟ value of dorsiflexion of wrist was non-significant but0n 0 vs. 60 day it shows significant „p‟ value (p<0.05) means which showsmild improvement from 0 to 60thday of treatment. While about plantarflexion, mean score was 0.80, 1.43 and 1.80 on 0, 30 and 60thday whichshows that non-significant „p‟ value on 0 vs. 30thday becomes highlysignificant on 0 vs. 60thday. Before treatment (on 0thday) the mean score for flexion of the elbow was1.33, raised to 2.33 and 2.43 on 30, 60thday respectively and statisticallyimprovement was extremely significant (p< 0.001). And the extension ofelbow shows highly significant results (p< 0.01) on both 0 vs. 30thand 0 vs.60thday. The „p‟ value of Abduction of shoulder remain less than 0.05 on 0 vs. 30thand 0 vs. 60thday which means it shows significant results and mean scoreraised from 1.30 to 2.13 and 2.23. Flexion shows non-significant results whilein extension of shoulder mean score raised from 1.33 to 2.00 and 2.13respectively which indicates the non-significant „p‟ value on 0 vs. 30thdaybecomes significant on 0 vs. 60thday. There was minimal rise in mean score of dorsiflexion of ankle from 0 to 60thday but „p‟ value shows non-significant results. While plantar flexion showssignificant results (p< 0.05) on 0 vs. 60thday compared to non-significant on 0vs. 30thday. Prior to the treatment mean score of flexion of knee was 2.10 becomes 3.10and 3.23 0n 30thand 60thday respectively which indicates highly significantresults (p<0.01). In case of extension, statistically result was highly significanton 0 vs. 30thday and extremely significant on 0 vs. 60thday. On the 0 vs. 30thday the „p‟ value of abduction and extension of hip showsextremely significant results (p<0.001) and the same on 0 vs. 60thday as mean
  • 174. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 165score raised from 1.83 to 2.63 and 2.87 of abduction and from1.70 to 2.67 and2.80 of extension. The mean score of flexion of hip was 1.40 on 0 day raisedto 2.13 0n 30thday and 2.43 on 60thday which indicates that result was highlysignificant on 0 vs. 30thday becomes extremely significant on 0 vs. 60thday. The parameter muscle tone of upper limb shows extremely significant resulton 0 vs. 60thday, which was just significant on 0 vs. 30thday. While in case oflower limb muscle tone, mean score 3.00 reduced to 2.27 and 2.03 showshighly significant result on 0 vs.30thday and extremely significant on 0 vs.60thday. The result about muscle power of both upper and lower limb, as there israised value of mean score 2.60 to 3.03 and 3.27 for upper limb and 3.17 to3.57, 3.77 for lower limb from 0 to 60thday which shows mild relief clinicallybut statistically it was non-significant. The reflexes biceps, triceps, supinator, knee and ankle shows least changein mean score but „p‟ value was non-significant statistically. Before treatment the mean score of sitting from lying down was 2.47 raisedto 3.47 and 3.50, indicates extremely significant result (p<0.001). The „p‟ value of standing from sitting was significant (p<0.05) on 0 vs. 30thday becomes highly significant on 0 vs. 60thday. On the 0thday mean score of walking capacity was 2.07, 3.07 and 3.17indicates highly significant result (p<0.01) on 0 vs. 30thday and extremelysignificant (p<0.001) on 0 vs. 60thday. The parameter walking stairs shows mild raised mean score from 0thday to60thday i.e. from 0.70 to 1.03 and 1.07 respectively but it was non-significantresult statistically.III. DISCUSSION ON DRUG ASPECT:i. Probable mode of action of Drugs: Māṣa: Māṣa is having Madhura Rasa, Snigdha guna, along with it is Balyaand Kaphavardhaka, which helps to do Śamana of Vāta in Pakṣāghāta.
  • 175. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 166 Ᾱtmaguptā: By its Madhura Rasa, Guru and Snigdha guna, Madhura Vipāka,Balya karma, it is mainly indicated in Vātavyādhī like Pakṣāghāta,Kaṃpavāta. Atīviṣā: As Atīviṣā is having Tikta Rasa and Uṣṇa Vīrya, pacifies theaggravated Vāta in Pakṣāghāta. Eraṉḍa: Eraṉḍa is best Vātahara due its Uṣṇa Virya, Snigdha Guna andSrotośodhana activity by its Tīkṣṇa, Sukṣma Guna. Rāsnā: Rāsnā Vātaharānām|| explained by the Caraka in 25thChapter of SutraSthāna. Śatapuṣpā: Śatapuṣpā included in Ᾱsthāpanopaga and Anuvāsanopaga Ganaby Caraka, which indicates its role in vasti to pacify the Vāta. Saiṉdhava: Saiṉdhava lavana having Lavana and Madura Rasa, SnigdhaGuna and chiefly due to its Uṣṇa Vīrya with Vātānulomaka, Srotośodhaka andSukṣmasrotogāmi action useful in Pakṣāghāta. Balā: As explained by Caraka for Vāta Śamana, Bṛṃhana is the maintreatment and mainly Balā is having Balya and Bṛṃhana action. In Vātavyādhīmany formulations contain Balā, as main ingredient. Tila Taila: Taila is the best Vātahara drug and having Sukṣma, Uṣṇa, Vyavāyiguna helps in Pakṣāghāta.IV. DISCUSSION ON YOGA VASTI:i. Probable mode of action of Yoga vasti: Different Ᾱcāryās mentioned different numbers of Yoga vasti but while forthis study we have selected Ᾱcārya Caraka’s view. Caraka mentioned thatYoga vasti includes 8 vasti out of which 5 Anuvāsana and 3 Nirūha. First day1 Anuvāsana then 3 Nirūha and 3 Anuvāsana alternatively and at last 1Anuvāsana should be given. Nirūha, if given alone without Anuvāsana may provoke Vāta due to itsexclusive Śodhana property. Thus to avoid this adverse effect of Nirūha,Anuvāsana Vastis are assembled in between Nirūha Vastis (Ca.Si.4:50). Since in case of Yoga vasti, the duration is of 8 days, so there is anticipationthat these vastis with the course of treatment can penetrate up to the deeper
  • 176. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 167and deeper tissues situated in the body and thus can root out even the obstinateVāta disorders explained by Suśruta and in Pakṣāghāta as there isinvolvement of Rakta, Māṃsa, Meda dhātu, Yoga vasti plays important role intreatment of Pakṣāghāta. Of all the therapeutic measures suggested for Vāta disorders, Anuvāsana andNirūha treatment par excellence for Vātik disorders because immediately afterentering the Pakwāśaya, they strike at the very root of morbid Vāta and whenit is overcome in the Pakwāśaya even the entire morbid Vāta dwelling in theother parts of the body could be alleviated (Ca.Su.20:13). As there is Vāta isthe main doṣa in the pathogenesis of Pakṣāghāta along with Pakṣāghāta isincluded under Vātaja Nānātmaja Vyādhī, the Nirūha and Anuvāsana vastimainly help in Saṃprāptī Vighatanam. Once proper cleansing of Srotas is achieved by giving appropriate Nirūhavasti, Anuvāsana administered after that promotes Bala and Varṇa(Ca.Ci.1:29). This clearly indicates Srotośodhaka property of Nirūha vasti andBṛṃhana nature of Anuvāsana vasti, as there is Mārgāvarodha andAkarmanyatā, Balahāni in Pakṣāghāta. Cakrapānī says Anuvāsana areBṛṃhana vastis (on Ca.Su.22:18).ii. Probable mode of action in view of Modern Science:Vasti is considered to be important treatment in Ᾱyurveda; not only curesdisease but also helps in preventing the disorders. Various theories have beenpostulated to explain the mechanism of action of vasti in human body. A few possiblemechanisms of action can be taken into consideration to establish the action of vasti.1. The CNS (Central Nervous System) and ENS (Enteric Nervous System)communicated by Vagus nerve. ENS cells in the gut communicate with thebrain via sympathetic nerves that pass to and from a gut through thetransformer called sympathetic ganglia. These nerves connect to the spinalcord and then to the base of the brain. In addition, the parasympathetic link tothe base of the brain via the Vagus nerve from upper gut and the sacral nervesfrom the colon.The gut and the brain use various neurotransmitters like serotonin,dopamine, glutamate; nor-adrenaline and nitric oxide are in the gut.
  • 177. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 168So vasti may acts via Enteric Nervous System (ENS). By theadministration of vasti, neurons in the gut will get stimulated and they pass theimpulse to the brain stem and thus increasing the action potential of bothmotor and sensory systems, thereby helping the hemiplegic patients.2. Large intestine absorbs water, electrolytes and some vitamins; similarly someof the nutrients of vasti are also absorbed into the system.3. Vasoactive Intestinal Peptide (VIP) is a hormone produced in various parts ofthe body including the gut and hypothalamus of the brain. The VIP induces thesmooth muscle relaxation, dilates the periphery vessels. So vasti may actthrough the VIP and vasti may hormonizes the production of VIP‟s.4. Around 400 varieties of bacterias have been colonized in the large intestinewhich lives a symbiotic life with human beings. They help us to synthesize thevitamins like vit. B 12, vit. K, etc., and also detoxicates certain substances.Vasti dravyas probably facilitate the hormony of various colonies ofintestinal flora, thus improving the process of synthesizing and detoxification.5. In olden days Colon therapy is used as detoxifying technique. This therapyirrigates the large intestine with water and cleans out the toxins andaccumulated waste lining its wall, which will be helpful in removal of waste,will improve colon function, digestion and nutrient absorption function.Prevents the carcinoma of colon and useful in constipation, colitis and irritablebowel syndrome etc.6. High colonic irrigation kills harmful bacteria, parasites, yeast infections andviruses. So vasti may also work as colon therapy helps as a detoxifyingtechnique.7. Vasti works as enterogenous stimulation, thereby improving the localcirculation to the sacrum, pelvis and sacral plexus, the lower limb in particularand total body in general.8. Various research works have found that elevated levels of Serum nitrate areseen in Pakṣaghāta (Ischaemic cerebral infarction) patients after theadministration of vasti. This Serum nitrate is a marker for vasodilatation.
  • 178. DISCUSSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 169OVERALL EFFECT OF THERAPY:Table No. 39 - Overall effect of therapySr GRADE No. OF PATIENTS %1 No improvement (0%) 0 02 Mild Improvement (1% - 25%) 14 46.663 Moderate Improvement (26% - 50%) 13 43.334 Marked Improvement (51% - 75%) 3 105 Remarkable Improvement (76% - 100%) 0 0The overall response of therapy was assessed on the basis of improvement inindividual patients. Complete cure was not observed in any patient. 10% patientsshowed marked relief, 43.33% patients showed moderate response and mildimprovement was observed in 46.66% of patients.So Yoga vasti is a better therapy module in improving the disability inhemiplegic patients when compared with other contemporary rehabilitative therapies.
  • 179. SUMMARY and CONCLUSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 170SUMMARY AND CONCLUSIONThe present thesis entitled “Effect of Māṣātmaguptādī Yoga vasti inPakṣāghāta w.s.r to Ischemic Stroke” has been endeavored with following aims andobjectives:i. To do the literary study of Pakṣāghāta and hemiplegia in detail.ii. To review the literature about vasti.iii. To study the efficacy of Māṣātmaguptādī tailam and kwatha in themanagement of Pakṣāghāta.The whole topic is elaborated in the following sections:I. The first section i.e. Introduction, consists need of importance of theselecting of Pakṣāghāta (Ischaemic stroke) as a research area and need ofᾹyurvedic management, as well as need of selecting Māṣātmaguptādī yoga forpresent study are mentioned.II. The second section deals with the Review of literature. It is furthersubdivided into three parts.i. The first part contains historical review of Pakṣāghāta and the previousresearch works performed on it and Ᾱyurvedic concept of Pakṣāghāta. Inthis chapter first of all a detail description regarding Pakṣāghāta accordingto Āyurvedic point of view has been given which deals with Niruktī,Bheda, Nidāna pañcaka, Sāpekṣa nidāna and Sādhyāsādhyata ofPakṣāghāta. At last cikitsā sutra, Upadrava and Pathyāpathya ofPakṣāghāta has been discussed.ii. The second part deals with historical review of hemiplegia and Modernconcept of hemiplegia. Then detail description of Ischemic stroke fromModern point of view includes historical review, etymology, etiology,prodromal symptoms, symptomatology, pathogenesis, differentialdiagnosis, diagnosis, investigatīons and prognosis and lastly managementof stroke and complications of Ischemic stroke.iii. The third part is Vasti review consists of historical review of vasti,etymology, Niruktī, classification of vasti, its ingredients, pūrva karma,pradhāna karma and its methodology, pascāt karma, vasti doṣas,
  • 180. SUMMARY and CONCLUSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 171description about Yoga vasti and lastly mode of action of vasti has beendescribed.III. The third section termed as Drug review commences with a description ofproperties along with pharmaco-dynamics of the drug selected for the studyand also method of its preparation.IV. The fourth section entitled as Materials and Methods commences with aimsand objectives of present research work, materials used, methods applied forstudy includes study design of therapies, Criteria for assessment of patientsbefore and after treatment and lastly brief explanation about statisticalanalysis.V. In the fifth section different observations from the study are presented indetails along with the results obtained with statistical analysis in this studyhave been presented in the form of tables and graphs along with briefdescription of the same.VI. The sixth section entitled Discussion describes the logical interpretation ofthe observations and results obtained from the clinical study.VII. The seventh section comprises of Summary and conclusion on the wholestudy.
  • 181. SUMMARY and CONCLUSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 172CONCLUSIONThe conclusion drawn from the whole study is presented below: Pakṣāghāta is one among the Madhyama roga mārga Vyādhī. Pakṣāghāta is aKarmeṉdrīya pradhāna vikāra also Ᾱvaranajanya Vyādhī. It is caused by Ᾱhāraja, Vihāraja, Mānasika and Kālaja Nidāna. The Nidānafor Pakṣāghāta are Divāswapna, Atī Cintā, Avyāyāma, Snigdha Bhojana,Guru Bhojana, Tīkṣṇa Bhojana, Atī Lavana sevana, Rātrījāgarana. Risk factors like HTN, DM, smoking and alcohol were present in most ofpatients. The predominant doṣa are all the five type of Vāta with dominancy of Vyānaand Prāna Vāyū along with Pitta and Kapha. The dūṣya involved in the manifestation of Pakṣāghāta are Rasa, Rakta, andMeda. Among 30 patients 60% of patients fond to be in the age group between 51-60years. The males (70%) are more affected with the disease Pakṣāghāta. Morenumber of patients (66.67%) was doing field work. Stress was in 93.33% ofpatients. Maximum number of patients presented with avara Satva (53.33%) andVyāyāma śaktī (76.67%). In 66.67% of patients affected side in Pakṣāghātawas right half of body. 90% of patients had past history of illness as DM,HTN. Among the symptoms, no one presented with sensory loss and wasting.Incontinence found in only 2 (6.67%) patients and Kaṃpa in 4 (13.33%)patients. Ceṣṭa nivṛttī and Saṉkocha found in all 30 patients. Barthel Index includes score of activities of daily livings as feeding, bathing,personal toilet etc. The mean score of Barthel Index was 52.50, 63.33 and65.67 on 0, 30thand 60thday respectively, shows highly significant results. Motor parameters in neurological examination showed moderateimprovement, clinically it is a good sign. Finer movements restored very slowly and percentage of improvement iscomparatively less to that of gross.
  • 182. SUMMARY and CONCLUSIONEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 173 Speech aspect improved but it is not up to the mark. Reflexes remain unchanged throughout the procedure but after the treatmentthere was relief in clonus. There is marked relief in sitting from lying down and in walking capacity. So Yoga vasti preceded by Snehapāna, Abhyaṉga and Swedana, Virecanakarma, Saṃsarjana krama significantly improves the signs & symptoms ofPakṣāghāta as well as the activities of daily livings there by making better thequality of life of the patients. Though the present study has shown significant improvement in hemiplegicpatients, it is a time bound study and conducted only on 30 patients and it isidentified as focal area for further research on large number of patients, withlonger follow up and controlled methods.
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  • 187. BIBLIOGRAPHYEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 17848. Sindhu M. A study on aetiopathogenesis of Pakṣāghāta w.s.r toCerebrovascular accident, 2009, P.G. Thesis.49. Singh R H. Pañcakarma therapy. 2007 edition. Published by ChaukhambaSanskrit Series Office, Varanasi.50. Sir Monier Monier - William, Sanskrit English Dictionary, published byThe Bhaktivedanta Book, 2002.51. Studies on Medicinal Plants and Drugs in Dhaṉvantarī nighaṉtu,Commentary by Vd. D. K. Kamat, Edited by Dr. S. D. Kamat, 2002edition. Published by Chaukhamba Sanskrit Pratisthan, New Delhi.52. Suśruta Saṃhitā (Ancient Indian Surgery) of Suśruta, Edited withEnglish Translation and explanatory notes by Dr. G. D. Singhal, 2007edition, Published by Chaukhamba Sanskrit Pratisthan, Delhi.53. Suśruta Saṃhitā of Suśruta with Nibaṉdhasārasaṉgraha Commentary byḌalhana, Edited by Yadavji Trikamji Acharya, 1994 edition, Published byChaukhamba Surbharati Prakashan, Varanasi.54. V.M. Gogate. Ayurvedic Pharmacology and Therapeutic uses of MedicinalPlants. 1stEdition. Published by Bharatiya Vidyabhavan SPARC, Mumbai.55. V.S. Apte, The Student’s Sanskrit English Dictionary. Published byauspices of Govt. Of India 1963.56. Vaṉgasena Saṃhitā (Cikitsā Sāra Saṉgraha) Hindi translation by Dr.Rajiv Kumar Rai, Edited by Dr. Ram Kumar Rai, 2010 edition, Publishedby Prachya Prakashan, Varanasi.57. Yogaratnākara of Lakṣmipatī Śāstrī, 9thEdition. Published byChaukhambha Orientalia Varanasi.
  • 188. BIBLIOGRAPHYEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 179Address of Web Sites:1. www.empiremedicine.com2. www.americanheart.org3. www.strokecenter.org4. www.2strokejournal.org5. www.docguide.com6. www.stroke.ahajournals.org7. www.clinicaltrials.gov8. www.healthysuccess.ca/celltocell.htm9. www.healing.about.com10. www.journeyofhearts.org11. www.stanfordhospital.com12. http://medlib.med.utah.edu13. http://www.neurologyindia.com/article14. http://www.strokecenter.org/trials15. http://www.drugdigest.org16. http://www.mskcc.org17. http://www.hear.org18. http://www.emedicine.com19. http://neuro.psyc.memphis.edu
  • 189. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 180ANNEXURESDEPARTMENT OF PANCHAKARMATTD’S S.V. AYURVEDIC COLLEGE & HOSPITAL, TIRUPATI, A.P.TOPIC: EFFECT OF MASHATMAGUPTADI YOGA VASTI IN PAKSHAGHATW.S.R. TO ISCHAEMIC STROKE.NAME OF THE SUPERVISOR: Dr. A. SANKAR BABUNAME OF THE INVESTIGATOR: Dr. SHANKAR L. MANECERTIFICATE BY INVESTIGATORI certify that I have disclosed all details about the study in the terms easilyunderstood by the patient.Date: .................... Signature of Investigator: ..........................................CONSENT BY THE PATIENTI have been informed to my satisfaction, by the attending physician, thepurpose of clinical trial and the nature of treatment, possible risks, follow-up,including the laboratory investigations to be performed to monitor and safeguard mybody functions.I am also aware of my right to opt out of the trial at any time during the courseof the trial without having to give the reasons for doing so.I, exercising my free power of choice, hereby consciously give my consent to beincluded as a subject in this clinical trial.Name of the patient: ………………………………………….Signature of the patient: .........................................................Name of the witness: ………………………………………….Signature of the witness: ………………………………………
  • 190. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 181DEPARTMENT OF PANCHAKARMATTD’S S.V. AYURVEDIC COLLEGE & HOSPITAL, TIRUPATI, A.P.TOPIC: EFFECT OF MASHATMAGUPTADI YOGA VASTI IN PAKSHAGHATW.S. R. TO ISCHAEMIC STROKE.NAME OF THE SUPERVISOR: Dr. A. SANKAR BABUNAME OF THE INVESTIGATOR: Dr. SHANKAR L. MANECASE REPORT – SCREENINGName of the patient: ………………………………………………………....Age: ………. Sex: ………….Address: …………………………………………………………………….....……………………………………………………………………..Research Case No: ……………I.CRITERIA FOR INCLUSION YES NOi. Age between (18 – 60yrs)ii. Patients of Pakshaghat with orWithout Facial Paralysisiii. Medically stable, fully conscious& oriented.II.CRITERIA FOR EXCLUSIONi.Haemorrhagic strokeii.Space occupying lesionsiii.Moderate to severe Hypertensioniv. IDDMv. Epilepsyvi. Malignant conditionsvii. Severe Metabolic Disorderviii. Pregnancy & Lactation
  • 191. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 182DEPARTMENT OF PANCHAKARMATTD’S S.V. AYURVEDIC COLLEGE & HOSPITAL, TIRUPATI, A.P.TOPIC: EFFECT OF MASHATMAGUPTADI YOGA VASTI IN PAKSHAGHATW. S. R TO ISCHAEMIC STROKE.CASE SHEETI. IDENTIFICATION DATA:Name of the patient: ………………………………………………………………..Age: ……… Sex: ……..Address: …………………………………………………………………………….……………………………………………………………………………OPD Regd No: ……………….. IPD Regd No : …………………..Date of admission: ………………… Date of discharge: ………………Research case No: ………………….Educational Status: literate/ IlliterateOccupation: Deskwork/ Field workIndicate nature of work: ……………………………………………..Religion: Hindu/ Muslim/ Christian/ OthersMarital Status: Married/ Unmarried/ Widower/ widow/ DivorceeDiagnosis:Progress: Rapid/Slow/StationaryResult: Cured/Improved/Discontinued
  • 192. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 183II. CHIEF COMPLAINTS WITH DURATION: YES NODURATIONi. Hatva Pakshamekam (Affected Side: Right/ Left) :ii. Chesta Nivrittam (Loss of function) :iii. Achetanam (Loss of sensation) :iv. Rujam (Pain sensation):v. Sankocham (Spasticity):vi. Arditam (Facial palsy):vii. Vakstambham (Aphasia/ Dysphagia/ Dysarthria):viii. Shosham (Muscle wasting):ix. Incontinence/ Retention of Urine:x. Incontinence/ Retention of Motion:xi. Associated Complaints : …………………………………………………………………………………………………………………...III. HISTORY OF PRESENT ILLNESS:i. Mode of onset of Disease: Acute/ Insidiousii. Duration of disease: ……………………………………………………………iii. Condition during Attack: Active/ Diseased Working/ Sleepingiv. Symptoms during Attack: Giddiness/ Vomiting /Involuntary movementsv. Treatment History:1. Types of Medication with duration: Allopathic/Ayurvedic/Homeopathic/OtherIf yes, specify …………………………………………… ……………………....………………………………………………………………..2. Results:IV. HISTORY OF PAST ILLNESS:i. Associated with present illness: Yes NoIf yes, specify with duration: ……………………………………………………..……………………………………………………..ii. Any other significant illness: …………………………………………………….
  • 193. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 184V. FAMILY HISTORY:VI. PERSONAL HISTORY:i. Place : Anupa/ Jangala/ Sadharanaii. Diet : Vegetarian/ Mixediii. Appetite : Good/ Moderate/ Pooriv. Digestion : Good/ Moderate/ Poorv. Micturition : Frequency : ………………….vi. Bowel : Regular/ Constipatedvii. Sleep : Normal/ Disturbed/ Excess/ Insomniaviii. Addictions: Smoking/ Tobacco / Alcohol/ Othersix. Emotional Stress : Yes/ Nox. Dependency : Yes/ NoVII. MENSTRUAL HISTORY:i. Age of Menarche:ii. Age of Menopause:iii. Quantity: Normal/ Scanty/ Moderate/ ExcessiveIV. Type: Regular/ Irregular/ Poly/ Oligo/ Amenorrhoea/ Dysmenorrhoea.VIII. OBSTETRIC HISTORY:i. Gravidity :ii. Parity :iii. Abortion :iv. Living :IX. ROGI PARIKSHA:i. PHYSICAL EXAMINATION:1. Built: Lean/ Moderate/ Heavy2. Gait: Normal /Abnormal3. General appearance: Ill Looking/ Anxious/ Normal4. Body weight: …………kgs
  • 194. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 1855. Blood pressure: …………mm of Hg6. Pulse rate: …………/min7. Respiration rate: …………/min8. Edema: Absent/ Present (Pitting/ Non pitting/ Generalized/ Localized)9. Anemia: Yes/ No10. Icterus: Yes/ No11. Clubbing: Yes/ No12. Deformities: Yes/ Nii. ASHTAVIDHA PARIKSHA :1. Nadi:2. Mutra:3. Mala:4. Jihva:5. Shabda:6. Sparsha:7. Drik:8. Akriti:iii. DASAVIDHA PARIKSHA :1. Prakriti : Vata/ Pitta/ Kapha/ VP/ VK/ PK/ Sama2. Vikriti : Balavan/ Madhyama/ Heenabala3. Sara :4. Samhanana : Uttama/ Madhyama/ Heena5. Pramana : Samyaka/ Heena/ Adhika6. Satmya : Purvakaleena : Sarvarasa/ Vyamishra/ EkarasaAdyatana : Sarvarasa/ Vyamishra/ Ekarasa7. Satva : Pravara/ Madhyama/ Heena8. Aharashakti : Purvakaleena : Abhyavaharana : Jarana :Adyatana : Abhyavaharana : Jarana :9. Vyayamashakti : Purvakaleena : Uttama/ Madhyama/ HeenaAdyatana : Uttama/ Madhyama/ Heena10. Vayah : Bala/ Madhyama/ Vriddha.
  • 195. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 186iv. SYSTEMIC EXAMINATION1. Central Nervous System:A. Motor Symptoms:a. Bulk of muscle: Normal/Wasted/ Atrophic/ Flabby/ Pseudo hypertrophic/Dystrophicb. Tone of the Muscle: Hypertonia/ Hypotoniac. Power of the Muscle: Right: Upper limb - Lower limb -(MRC Grading) Left: Upper limb - Lower limb -d. Lower Extremities: Posture:Ability to stand:Ability to walk:e. Upper Extremities: Posture:Ability to lift the hand at the level:f. Reflexes:Deep Reflexes: Right LeftKnee:Ankle:Biceps:Triceps:Supinator:Superficial Reflexes: Right LeftPlantar:Abdominal:Corneal:Conjunctival:(Grading = 0 - Absent, 1 - Present, 2 - Brisk, 3 - very brisk, 4 - clonus)g. Co-Ordination:Upper limbs (Finger Nose Test):Lower limbs (Heel Shin Test):Rhomberg’s Test:
  • 196. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 187B. Sensory Symptoms:Pain :Temperature :Crude touch :Fine touch :Vibration Sense :C. Involuntary Movements:D. Cranial Nerves:E. Higher functions:Consciousness :Orientation : Time/Space/PersonSpeech :Memory & Intelligence:2. Cardio vascular System: ……………………………………………………….3. Respiratory System: …………………………………………………………….4. Urogenital System: ……………………………………………………………...5. Digestive System: ……………………………………………………………….X. Activities of Daily Living (ADL) Score [BARTHEL INDEX] :Sr ASSEESSMENT CRITERIA WITH HELP INDEPENDENT SCORE1 Feeding 5 102 Moving from wheelchair to bedand return5-10 153 Personal Toilet (Wash face,comb hairs, shave, clean teeth)0 54 Getting on & off toilet(Handling clothes, wipe, flush)5 105 Bathing self 0 56 Walking on level surface 5-10 157 Ascend & descend stairs 5 108 Dressing 5 109 Controlling bowels 5 1010 Controlling bladder 5 10TOTAL 40-50 100
  • 197. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 188XI. ROGA PARIKSHA:i. NIDANAPANCHAKA:1. Hetu:2. Purvarupa:3. Rupa:4. Upashaya/ Anupashaya:5. Samprapti:Dosha :Dushya :Srotas :Adhishthana :6. Sapeksha nidana:7. Vyadhivinishchaya:8. Sadhyasadhyatva:9. Arishta lakshana:ii. INVESTIGATIONS:1. URINE: Routine:Microscopic:2. HAEMATOLOGY:A. Hb : gm%B. T.C. : cells/cmmC. D.C. : P % , L % , E % , M % , B %D. ESR : mm/hrE. Blood sugar: RBS …………..mg/dl FBS ………….mg/dl PPBS…………….mg/dlF. Liver Function Test: ……………………………………………………………..G. Lipid Profile: ……………………………………………………………………H. Blood Urea: ……………………………………………………………………..
  • 198. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 189I. Serum Creatinine:J. Uric acid:K. X-ray:L. CT Scan/ MRI:XII. CHIKITSA:i. Deepan & Pachana:ii. Snehapana:Samyak Snigdha Lakshanas:iii. Abhyanga & Swedana:iv. Virechana karma:v. samsarjana Krama:vi.YOGA VASTI (8 Days) :Anuvasana Vasti with Mashatmaguptadi tailam (5 days)Niruha Vasti with Mashatmaguptadi Kwatham (3 days)vii. Parihara Kala:XIII. PATHYAPATHYA:i. Pahya:ii. Apathya:DAY VASTI RETENTION TIME1 Anuvasana Vasti2 Niruha Vasti3 Anuvasana Vasti4 Niruha Vasti5 Anuvasana Vasti6 Niruha Vasti7 Anuvasana Vasti8 Anuvasana Vasti
  • 199. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 190CLINICAL ASSESSMENTPatient’s name: ………………………………………… Age: ……… Sex: …….OPD Regd No: ……………… IPD Regd No: ………………Research Case No: …………..Date of Assessment:Stage of Assessment: 0 day / 30 day / 60 dayI. Subjective Parameters:i. Hatva Pakshamekam :(Affected Side: Right/ Left)ii. Chesta Nivrittam :(Loss of function)iii. Achetanam :(Loss of sensation)iv. Rujam :(Pain sensation)v. Sankocham :(Spasticity)vi. Arditam :(Facial palsy)vii. Vakstambham :(Aphasia/ Dysphagia/Dysarthria)viii. Shosham :(Muscle wasting)ix. Incontinence/Retention of Urine :x. Incontinence/Retention of Motion :
  • 200. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 191II. Activities of Daily Living (ADL) Score [BARTHEL INDEX]:Sr ASSEESSMENT CRITERIA WITH HELP INDEPENDENT SCORE1 Feeding 5 102 Moving from wheelchair to bedand return5-10 153 Personal Toilet (Wash face,comb hairs, shave, clean teeth)0 54 Getting on & off toilet(Handling clothes, wipe, flush)5 105 Bathing self 0 56 Walking on level surface 5-10 157 Ascend & descend stairs 5 108 Dressing 5 109 Controlling bowels 5 1010 Controlling bladder 5 10TOTAL 40-50 100III. Objective Parameters:i. Finger Movement :ii. Motor function of Arm :iii. Motor function of leg :iv. SLRT : Rt-Lt-v. Muscle tone (Rigidity / Spasticity) :vi. Muscle power (MRC Grading) :vii. Reflexes :viii. Hand grip power :ix. Loss of sensation :
  • 201. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 192x. Facial Palsy :xi. Pain :xii. Speech :xiii. Sitting from lying down :xiv. Standing from sitting position :xv. Walking capacity :v. Walking stairs :vi. Gait :SIGNATURE OF INVESTIGATOR SIGNATURE OF SUPERVISOR
  • 202. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 193CLINICAL ASSESSMENTPatient’s name: ………………………………………… Age: ……… Sex: …….OPD Regd No: ……………… IPD Regd No: ………………Research Case No: …………..Date of Assessment:Stage of Assessment: 0 day / 30 day / 60 dayI. Subjective Parameters:i. Hatva Pakshamekam :(Affected Side: Right/ Left)ii. Chesta Nivrittam :(Loss of function)iii. Achetanam :(Loss of sensation)iv. Rujam :(Pain sensation)v. Sankocham :(Spasticity)vi. Arditam :(Facial palsy)vii. Vakstambham :(Aphasia/ Dysphagia/Dysarthria)viii. Shosham :(Muscle wasting)ix. Incontinence/Retention of Urine :x. Incontinence/Retention of Motion :
  • 203. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 194II. Activities of Daily Living (ADL) Score [BARTHEL INDEX]:Sr ASSEESSMENT CRITERIA WITH HELP INDEPENDENT SCORE1 Feeding 5 102 Moving from wheelchair to bedand return5-10 153 Personal Toilet (Wash face,comb hairs, shave, clean teeth)0 54 Getting on & off toilet(Handling clothes, wipe, flush)5 105 Bathing self 0 56 Walking on level surface 5-10 157 Ascend & descend stairs 5 108 Dressing 5 109 Controlling bowels 5 1010 Controlling bladder 5 10TOTAL 40-50 100III. Objective Parameters:i. Finger Movement :ii. Motor function of Arm :iii. Motor function of leg :iv. SLRT : Rt-Lt-v. Muscle tone (Rigidity / Spasticity) :vi. Muscle power (MRC Grading) :vii. Reflexes :viii. Hand grip power :ix. Loss of sensation :
  • 204. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 195x. Facial Palsy :xi. Pain :xii. Speech :xiii. Sitting from lying down :xiv. Standing from sitting position :xv. Walking capacity :v. Walking stairs :vi. Gait :Overall Clinical Assessment:Improved / Stationary / DeterioratedSIGNATURE OF INVESTIGATOR SIGNATURE OF SUPERVISOR
  • 205. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 196CRITERIA OF ASSESSMENT WITH GRADINGS:The improvement in the patients was assessed on the basis of the criteria givenbelow.i. Subjective Parameters:1. RUJA:0 - No Pain1 - Mild Pain2 - Moderate Pain3 - Severe Pain.2. VAKSTAMBHA (LOSS OF SPEECH):0 - Global aphasia1 - Utter voice2 - Speak few words3 - Speak with difficulty4 - Normal.3. BARTHEL INDEX [Activities of Daily Living (ADL) Score]:Sr ASSEESSMENT CRITERIA WITH HELP INDEPENDENT SCORE1 Feeding 5 102 Moving from wheelchair to bedand return5-10 153 Personal Toilet (Wash face,comb hairs, shave, clean teeth)0 54 Getting on & off toilet(Handling clothes, wipe, flush)5 105 Bathing self 0 56 Walking on level surface 5-10 157 Ascend & descend stairs 5 108 Dressing 5 109 Controlling bowels 5 1010 Controlling bladder 5 10TOTAL 40-50 100A score of 0 is given in all of the above activities when the patient cannot meetcriteria as defined above.
  • 206. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 197ii. Objective Parameters:1. FINGER MOVEMENT:0 - Unable to flex & extend1 - Able to flex not extend2 – Able to flex & extend with difficulty3 – Able to flex & extend with easily4 – Normal2. MOTOR FUNCTION OF ARM:a) Ability to lift the hand:0 – Unable to lift1 – Up to the level of abdomen2 – Up to the level of chest3 – Up to the level of head4 – Above the level of headb) Wrist:Dorsiflexion: Plantar flexion:0 – Unable to dorsiflex 0 – Unable to flex1 – 00to 2001 – 00to 2002 – 210to 4002 – 210to 4003 – 410to 6003 – 410to 6004 – 610to 700(Normal) 4 – 610to 700(Normal)c) Elbow:Flexion: Extension:0 – Unable to flex 0 – Unable to extend1 – 00to 6001 – 00to 6002 – 610to 12002 – 610to 12003 – 1210to 15503 – 1210to 15504 – 1560to 1600(Normal) 4 – 1560to 1600(Normal)d) Shoulder:Abduction: Flexion:0 – Unable to abduct 0 – Unable to flex1 – 00to 6001 – 00to 6002 – 610to 12002 – 610to 12003 – 1210to 17503 – 1210to 17504 – 1760to 1800(Normal) 4 – 1760to 1800(Normal)Extension:0 – Unable to extend1 – 00to 1502 – 160to 3003 – 310to 4504 – 460to 600(Normal)
  • 207. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 1984. MOTOR FUNCTION OF LEG:a) Hip:Abduction: Flexion:0 – Unable to abduct 0 – Unable to flex1 – 00to 1501 – 00to 3002 – 160to 3002 – 310to 6003 – 310to 4003 – 610to 9004 – 410to 450(Normal) 4 – 910to 1200(Normal)Extension:0 – Unable to extend1 – 00to 1002 – 110to 2003 – 210to 2904 – 300(Normal)b) Knee:Flexion: Extension:0 – Unable to flex 0 – Unable to extend1 – 00to 4001 – 00to 4002 – 410to 8002 – 410to 8003 – 810to 12003 – 810to 12004 – 1210to 13504 – 1210to 13505 – 1360to 1400(Normal) 5 – 1360to 1400(Normal)c) Ankle:Dorsiflexion: Plantar flexion:0 – Unable to dorsiflex 0 – Unable to flex1 – 00to 501 – 00to 1502 – 60to 1002 – 160to 3003 – 110to 1503 – 310to 4504 – 160to 200(Normal) 4 – 460– 500(Normal)5. MUSCLE TONE:0 – No Increase1 – Slight increase with catch and release2 – Minimal resistance through range following catch3 – More marked increase tone through range of movementwith difficulty4 – Considerable increase in tone, passive movement difficult5 – Affect part rigid.
  • 208. ANNEXURESEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 1996. MUSCLE POWER:0 – No movement1 – Flicker of contraction2 – Movement when effect of gravity eliminated3 – Movement against gravity but not against resistance4 – Movement against resistance5 – Normal7. REFLEXES:0 – Absent1 – Normal2 – Brisk3 – Very brisk4 – Clonus8. SITTING FROM LYING DOWN:0 – Unable1 – With support with difficulty2 – With support easily3 – Without support with difficulty4 – Without support easily9. STANDING FROM SITTING POSITION:0 – Unable1 – With support with difficulty2 – With support easily3 – Without support difficulty4 – Without support easily10. WALKING CAPACITY:0 – Unable1 – With support (less than 10 ft.)2 – With support (more than 10 ft.)3 – Without support (less than 10 ft.)4 – Without support (more than 10 ft.)11. WALKING STAIRS:0 – Unable1 – With support2 – Without support.
  • 209. OBSERVATIONS and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 156Table No. 40 - Effect of Māṣātmaguptādī Yoga vasti on subjective parametersTable No. 41 – Effect of Māṣātmaguptādī Yoga vasti on objective parametersPatients Parameters 0 day 30 day P value 60 day P valueGroup A(30PATIENTS)Mean SD SEM Mean SD SEM Mean SD SEMRUJA 2.43 0.5683 0.1038 1.43 0.6261 0.1143 ***p<0.001 1.20 0.6644 0.1213 ***p<0.001VAKSTAMBHA 3.67 1.42 0.2597 4.07 1.202 0.2194 ns 4.17 1.053 0.1923 nsBARTHELINDEX52.50 16.596 3.030 63.33 14.582 2.662 * p<0.05 65.67 13.942 2.545 ** p<0.01Patients Parameters 0 day 30 day P value 60 day P valueGroup A(30PATIENTS)Mean SD SEM Mean SD SEM Mean SD SEMFingermovementUpperlimb0.97 0.8503 0.1552 1.70 1.149 0.2098 * p<0.05 1.83 1.117 0.2039 ** p<0.01Lowerlimb0.73 0.8683 0.1585 1.10 1.029 0.1878 ns 1.27 1.081 0.1973 nsLIFT THE HAND 2.40 1.429 0.2609 3.10 1.296 0.2366 ns 3.20 1.186 0.2166 nsWristDorsiflexion0.60 0.7240 0.1322 1.20 1.126 0.2057 ns 1.27 1.081 0.1973 * p<0.05Plantarflexion0.80 0.8867 0.1619 1.43 1.223 0.2233 ns 1.80 1.157 0.2112 ** p<0.01ElbowFlexion 1.33 0.8841 0.1614 2.33 1.124 0.2053 ***p<0.001 2.43 1.040 0.1899 ***p<0.001Extension 1.20 0.9613 0.1755 2.13 1.279 0.2336 ** p<0.01 2.67 1.311 0.2394 ** p<0.01ShoulderAbduction 1.30 1.208 0.2205 2.13 1.408 0.2570 * p<0.05 2.23 1.331 0.2430 * p<0.05Flexion 1.63 1.520 0.2774 2.27 1.437 0.2623 ns 2.40 1.354 0.2473 nsExtension 1.33 1.093 0.1996 2.00 1.114 0.2034 ns 2.13 1.106 0.2019 * p<0.05AnkleDorsiflexion0.83 0.8339 0.1523 1.37 1.217 0.2222 ns 1.47 1.279 0.2339 nsPlantar 0.93 0.015 0.1853 1.57 1.251 0.2284 ns 1.77 1.305 0.2382 * p<0.05
  • 210. OBSERVATIONS and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 157flexionKneeFlexion 2.10 1.348 0.2461 3.10 1.185 0.2163 ** p<0.01 3.23 1.135 0.2072 ** p<0.01Extension 2.17 1.392 0.2541 3.10 1.242 0.2267 * p<0.05 3.20 1.243 0.2269 ** p<0.01HipAbduction 1.83 0.7915 0.1445 2.63 0.9279 0.1694 ***p<0.001 2.87 0.7303 0.1333 ***p<0.001Flexion 1.40 0.6747 0.1232 2.13 0.9371 0.1711 ** p<0.01 2.43 0.8584 0.1567 ***p<0.001Extension 1.70 0.6513 0.1189 2.67 1.093 0.1996 ***p<0.001 2.80 0.9613 0.1755 ***p<0.001MuscletoneUpperlimb3.17 1.117 0.2039 2.40 1.003 0.1832 * p<0.05 2.07 1.048 0.1914 ***p<0.001Lowerlimb3.00 0.7878 0.1438 2.27 0.9072 0.1656 ** p<0.01 2.03 0.8899 0.1625 ***p<0.001MusclepowerUpperlimb2.60 1.354 0.2473 3.03 1.273 0.2323 ns 3.27 1.143 0.2086 nsLowerlimb3.17 1.234 0.2253 3.57 1.040 0.1899 ns 3.77 0.7737 0.1413 nsReflexesBiceps 2.57 0.5683 0.1038 2.53 0.5713 0.1043 ns 2.53 0.5713 0.1043 nsTriceps 2.35 0.5526 0.1026 2.40 0.6215 0.1135 ns 2.37 0.6687 0.1221 nsSupinator 2.10 0.7589 0.1385 2.00 0.7428 0.1356 ns 2.00 0.7428 0.1356 nsKnee 2.47 0.7303 0.1333 2.43 0.7279 0.1329 ns 2.47 0.7303 0.1333 nsAnkle 2.50 0.9738 0.1778 2.43 0.9714 0.1774 ns 2.43 0.9714 0.1774 nsSITTING FROMLYING DOWN2.47 0.9371 0.1711 3.47 0.8604 0.1571 ***p<0.001 3.50 0.8200 0.1497 ***p<0.001STANDING FROMSITTING0.93 1.172 0.2141 1.83 1.464 0.2673 * p<0.05 2.07 1.461 0.2667 ** p<0.01WALKINGCAPACITY2.07 1.202 0.2194 3.07 1.081 0.1973 ** p<0.01 3.17 0.053 0.1923 ***p<0.001WALKING STAIRS 0.70 0.7022 0.1282 1.03 0.6149 0.1123 ns 1.07 0.6397 0.1168 ns
  • 211. OBSERVATIONS and RESULTSEffect of Māṣātmaguptādī Yoga Vasti in Pakṣāghāta w.s.r to Ischaemic Stroke 158 Values are expressed in mean ± SD of 30 observations (n=30). Comparison between 0 day Vs 30thday, 0 day Vs 60thday. ns - Non significant * p<0.05, ** p<0.01, ***p<0.001. Statistical significant test for comparison was done by ANOVA followed by Turkey multiple comparison test.Statistical Analysis:The results are presented as mean ± SD& SEM and subjected to ANOVA followed by Turkey multiple comparison test of 30 patientsin group. The values of *p<0.05 were considered significance.

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