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Comparative management study of Pakshaghata with Mashadi Yoga By ISHWAR Y PATIL, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - ...

Comparative management study of Pakshaghata with Mashadi Yoga By ISHWAR Y PATIL, Department of Kayachikitsa, Post graduate studies and research center D.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, Gadag - 582 103

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  • Comparative management study of Pakshaghata with Mashadi Yoga By ISHWAR Y PATIL Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore In partial fulfillment of the degree of Ayurveda Vachaspati M.D. In Kayachikitsa Under the Guidance of Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P. (German) M.A., [Ph.D] (Jyotish) Department of KayachikitsaPost Graduate Studies & Research CenterD.G. MELMALAGI AYURVEDIC MEDICAL COLLEGE, GADAG 2007-2010
  • D.G.M.AYURVEDIC MEDICAL COLLEGEPOST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582103 This is to certify that the dissertation “Comparative management study of Pakshaghata with Mashadi Yoga” is a bonafide research work done by ISHWAR Y PATIL in partial fulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences, Bangalore, Karnataka. Date: Guide Place: Prof. Dr. Shiva Rama Prasad Kethamakka M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish) Professor in Kayachikitsa DGMAMC, PGS&RC, Gadag
  • J.S.V.V. SAMSTHE’S D.G.M.AYURVEDIC MEDICAL COLLEGEPOST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103Endorsement by the H.O.D, principal/ head of the institution This is to certify that the dissertation entitled “Comparative management study of Pakshaghata with Mashadi Yoga” is a bonafide research work done by ISHWAR Y PATIL under the guidance of Prof. Dr. Shiva Rama Prasad Kethamakka, M.D. (Ayu) (Osm), C.O.P (German), M.A., [Ph.D] (Jyotish), Professor in Kayachikitsa in partial fulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D. (Kayachikitsa)” Under RajeevnGandhi University of Health Sciences, Bangalore,Karnataka. . Professor & HOD (Dr. G. B. Patil) Dept. of Kayachikitsa Principal, PGS&RC DGM Ayurvedic Medical College, Date: Gadag Place: Gadag Date: Place:
  • Declaration by the candidateI here by declare that this dissertation / thesis entitled “Comparativemanagement Study of Pakshaghata with Mashadi Yoga” is a bonafideand genuine research Work carried out by me under the guidance ofProf. Dr. Shiva Rama PrasadKethamakka, M.D. (Ayu) (Osm) M.A.(Jyotish), [Ph.D (Jyotish)], Professor inKayachikitsa, DGMAMC,PGS&RC, Gadag.DatePlace ISHWAR Y PATIL
  • Copy right Declaration by the candidateI here by declare that the Rajiv Gandhi University of Health Sciences, Karnatakashall have the rights to preserve, use and disseminate this dissertation/ thesis inprint or electronic format for the academic / research purpose.DatePlace ISHWAR Y PATIL© Rajiv Gandhi University of Health Sciences, Karnataka
  • Acknowledgement Any research is not an individual effort. It is a contributory effort of many hearts, handsand heads. I am very much thankful to the subjects of this study. I am extremely happy to expressmy deepest sense of gratitude to my beloved and respected guide Prof. and H.O.D. Dr. K. ShivaRama Prasad, M.D. C.O.P. (German) M.A. [Ph.D.] for his guidance and timely help. I am sincerely grateful to Dr. G. B. Patil, Principal, for his encouragement and providingall necessary facilities for this research work. I express my gratitude to Dr. V. V. Varadacharyuluformer Professor and H.O.D for his advice and encouragement in every step of this work. I extend my gratitude to Dr. R.V.Shettar,Dr Varadacharylu Dr. G. Purushottamacharyulu,Dr.P.Shivaramudu, Dr.Suresh Babu, Dr.Madhav Diggavi, Dr.M.C.Patil, Dr.G.S.Hiremath,Dr.G.Danappagoudar.Dr.S.N.Belawadi,Dr.Nidugundi,Dr.Samudri,Dr.Kuber sanq Dr.Mulgund.Dr. J. Mitti, Dr. Mulki Patil,Dr.Yasmin,Dr Ashok Patil,Dr.Swami,Dr.Veena. Kori, Dr Suvarna,Dr Shakuntala Garawad and Dr Aihole. I express my immense gratitude to my statistician Nandakumar, Tippanagoudar (Lab), V.B.Mundinamani (librarian) and Shyavi and Kerur for facilitating me books for my thesis. My deep senses of gratification to my inspirations of this study are my parentsYallanagouda.B.Patil. and Tungabai.Y .Patil and grand parents Bhimanagoda, Rangavva andYallappa,Bhimavva. I express my deepest sense of gratitude to My uncle L.M.Handi andLalitha.M. Handi. and my brothers family Siddu Patil , Nilamma Patil And Chinmay Patil Iexpress my heartfelt gratitude to my brothers ,Siddalingeshwar , Dr Parashuram andSomashekhar for constant help and encouragement to move ahead. I take this moment to expressmy thanks to all my Post gratude colleagues, Dr. V S Kanthi, Dr.Bodake, Dr. Praveen Naik ,DrShakuntala ,Dr Sanathkumar,Dr shabareesh, Dr Rajesh ,Dr Jayashankar, Dr Deepak, Dr C CHiremath, Dr Bupesh, Dr Ashaa , Dr Sevanthika , Dr Palled, Dr Gorpade, Dr Jadhav, Dr DeepaDr Ashok M.G. Dr. Shivaleela, Dr. Kamalakshi, Dr. Sulochana, Dr.Vijayalakshmi, Dr. Sanjeev,Dr.Neeraj, Dr. Veena. Jigalur,Dr P V Joshi , Dr. Adarsha, Dr. Nataraja, Dr. Uday, Dr Shailej, Mr.Shakti Dr. Ravi , Late Dr. Shivakumar ,Dr Bhagesh ,Dr Vijayamahantesh, Dr Babasaheb ,Drbarawal ,Dr surej ,Dr joshi Dr Anish , Dr Das ,Dr Renukraj Dr Sangamesh ,Dr Vijay Chavadi,Sanjeev Raddi, Dr Satish ,Dr Raghava Dr Anitha ,Dr Prajwal, Dr Harshavardhan Dr AnilManaguli ,Dr Kashinath,Dr Nagaraj sajjan ,Dr gurubasavraj, all GAMC Bangalore friends , JNVAlamatti friends,AOL friends. Last but not least I express my deepest thankfulness whose names are not taken here buthelped me a lot along with my kith and kilns to my family members. ISHWAR Y PATIL
  • Contents of “Comparative management study of Pakshaghata with Mashadi Yoga” By ISHWAR.Y.PATILChapter Content Page No. 01 Introduction 1 to 4 02 Objectives 5 to 8 03 Literary Review 9 to 70 04 Materials and Methods 71 to 77 05 Results 78 to 107 06 Discussion 108 to 120 07 Conclusion 121 to 123 08 Summary 124 to 126 09 Bibliographic reference 1 to 8 10 Annexure -1 Master charts 1 to 18 11 Annexure -2 Case sheet 1 to 8 “Comparative Management study of Pakshaghata with Mashadi Yoga” 1
  • Tables of“Comparative management study of Pakshaghata with Mashadi Yoga”Sl Content PageNo. no.1 Guna Vachaka aetiological factors vitiating vata 172 Trauma (Abhighata) Provoking vata 193 Psychic factors vitiating vata 204 Rupa according to various acharya 335 Composition of Trial drug 576 Grade of tendon reflexes 767 The Medical Research Council Scale for grading muscle function 768 Showing the distribution of patient’s according to age groups 789 Showing the distribution of patients according to Gender 7910 Showing distribution of patients by Religion 8011 Showing distribution of patients by Occupation 8112 Showing distribution of patients by Economic Status 8213 Showing distribution of patients Type of diet 8414 Showing distribution of patients Overall response 8515 Showing distribution of patients by Agni 8616 Showing distribution of patients by Nidana (Ahara) 8717 Showing distribution of patients by Nidana (Vihara) 8818 Showing distribution of patients by Manasika Hetu 8919 Showing distribution of patients by Emotional Status 9020 Showing distribution of patients by Presenting Complaints 9121 Showing distribution of patients by Associated Complaints 9322 Showing distribution of patients by Presenting Complaint 9423 Showing distribution of patients by Facial Nerve Examination 9524 Showing distribution of patients by Motor System Examination 9725 Showing distribution of patients by Reflex 9826 Showing distribution of patients by Upper Motor Neuron Examination 10027 Showing distribution of patients by Lower Motor Neuron Examination 10128 Showing distribution of patients by Results : Subjective Criteria 10329 Showing distribution of patients by Results : Objective Criteria 10330 Comparative Study of Group A and Group B after treatment 10431 Comparative Study of Group A and Group B After follow up 10532 Shows analysis for Before Treatment and After treatment 10633 Shows Analyses for Before Treatment and After Treatment 106 “Comparative Management study of Pakshaghata with Mashadi Yoga” 2
  • Figures and Photos of “Comparative management study of Pakshaghata with Mashadi Yoga”Sl. Content Pageno. no.1 Showing distribution of patients by age 792 Showing distribution of patients by gender 803 Showing distribution of patients by religion 814 Showing distribution of patients by occupation 825 Showing distribution of patients by Economic status 836 Showing distribution of patients by type of diet 847 Showing distribution of patients by Overall response 858 Showing distribution of patients by Agni 869 Showing distribution of patients by Nidana (Ahara) 8710 Showing distribution of patients by Nidana (Vihara) 8811 Showing distribution of patients by Manasika Hetu 8912 Showing distribution of patients by Emotional Status 9113 Showing distribution of patients by Presenting Complaints 9214 Showing distribution of patients by Presenting Complaints 9315 Showing distribution of patients by Presenting Complaints 9516 Showing distribution of patients by Facial Nerve Examination 9617 Showing distribution of patients by Motor System Examination 9818 Showing distribution of patients by Reflex 9919 Showing distribution of patients by Upper Motor Neuron Examination 10120 Showing distribution of patients by Lower Motor Neuron Examination 102 “Comparative Management study of Pakshaghata with Mashadi Yoga” 3
  • ABBREVATIONS UsedA.H ASHTANGA HRIDAYA D.N DHANVANTARI NIGHANTUA.S. ASHTANGA SAMGRAHA Y.R YOGA RATNAKARACha. S CHARAKA SAMHITA MCA MIDDLE CEREBRAL ARTERYSU.S SUSHRUTA SAMHITA PCA POSTERIOR CEREBRAL ARTERYBha. BHAVA PRAKASHA C.V.A CEREBRO VASCULAR ACCIDENTPraHa. S HARITA SAMHITA HTN HYPERTENSIONKaa. S KASHYAPA SAMHITA L.M.N LOWER MOTOR NEURONEC .D CHAKRADATTA T.I.A TRANSIENT ISCHEMIC ATTACKSh.s SHARANGADHARA SAMHITA U.M.N UPPER MOTAR NEURONVs.S VANGASENA SAMHITA I.C.H INTRA CEREBRAL HEMORRHAGES..St .M SHABDASTOMA MAHANIDHI S.A.H. SUB ARACHNOID HEMORRHAGEB .R BAISHAJYA RATNAVALI CSF CEREBRO SPINAL FLUIDM.N MADHAVA NIDANA B.T BEFORE TREATMENTK .N KAIDEVA NIGHANTU A.T AFTER TREATMENTR.N RAJA NIGHANTU A.F AFTER FALLOW UP “Comparative Management study of Pakshaghata with Mashadi Yoga” 4
  • Abstract Abstract of “Comparative management Study of Pakshaghata with Mashadi Yoga”Key words: Pakshaghata, Paksha, Akarmanyatha, Chesta Nivritti, Ruja, Sankocha, Shosha,Sandhibhandha, Vakstambha , CVA, Paralysis Pakshaghata is one of the Central nervous system diseases, considered as Vata Vyadhi inAyurveda occurs mainly due to vitiation of Vata. The present study objectives are to evaluate theefficacy of Mashadi yoga in Pakshaghata. A simple random sampling technique with Double blidclinical trial is adopted here. Pakshaghata express the important signs as the ShareeraAkarmanyata, Chesta Nivritti, Hasta Pada Ruja, Hasta Pada Sankocha, Sira Snyu Shosha,Sandhibandha Vimokshana and Vakstambha either to Right or Left Side of the body. The Mode of onset is understood as sudden or gradual with the association ofHypertension or Diabetes. Loss of functions of limbs - with or without involvement of face isobserved here. It affects either left half or Right half or both sides even. It may include face sometimes and may not. Pakshaghata is etiology of vataja ahara and vihara as aggravates Vata andimpair the functions of Pitta and Kapha simultaneously. The manifestation of condition may besudden or gradual with the involvement of central nervous system. It may be of lower motorneuron or upper motor neuron according to contemporary understanding. The condition is causedcommonly by high blood pressure there by increasing intracranial pressure will lead to rupture ofvessels intern causing the thrombus. The areas in the brain which affected by thrombus will startdegenerate. The parts and function of the body which are connected to the particular part will behampered or lost. Mashadi Yoga is mainly related to pacify the Vata as Vata is the main cause ofPakshaghata. All ingredients of Mashadi Yoga are Vatashamaka. Masha is Mamsaprasadaka,Atmagupta is vrishya, Rasna is best vatahara, Bala Rejuvinates all body parts Urubuka is bestvatanulomaka ,Rohisha is vedanastapaka and mutrala, Ashwagandha is nervine tonic .The Samedrugs is used for both groups to prepare the kwath for oral administration and Nasya taila forinternal administration From the analyses except Stroke Recovery Score Card, Barthel indexand Grip test all other parameters shows highly significant as P <0.05. The Subjective parametersshow high significance with Mashadi yoga in both groups. Among subjective and objectiveparameters, the objective parameter Stroke Recovery Score Card, the Barthel Index and GripTest shows non-significant. The Subjective parameter Akarmanyata, Chesta Nivritti, Ruja Sankocha, Shosha,Sandhibhandha and vakstambha showed highly Significant in the both Group after fallow up inthis study. Thus it is fair to conclude that the Mashadi Yoga is effective in Pakshaghata. “Comparative Management study of Pakshaghata with Mashadi Yoga” 1
  • CHAPTER -1 INTRODUCTION Pakshaghata is one among the Vata nanatmaja vikara1 . Pakshaghata is a most distressingdisease among Vatavyadhi. It is mentioned to be very difficult to cure due to its deep seatednature. A variety of pathological processes of Vata are described by the Ayurvedic classics to beresponsible for the manifestation of Pakshaaghaata. The pathological phenomena of Vata playingcentral role in the manifestation of Pakshaghata are Shuddha Vata Prakopa, Anyadosha SamsristaVata Prakopa and Dhatu kshayajanya Vata Prakopa “Comparative Management study of Pakshaghata with Mashadi Yoga” 1
  • Condition similar to Pakshaaghaata in modern medical science is the Hemiplegia. similarto Pakshaghata Hemiplegia also caused by a wide spectrum of disease processes like vasculardisorders, infective disorders of brain tissue, tumors, trauma etc. among these vascular disorder ofthe brain referred to as cerebrovascular accident (CAV) or stroke is the commonest cause ofhemiplegia2 . It is the 3rd leading cause of death in the developing country. Stroke is not a diseasein itself but is heterogeneous group of disorders. Hemiplegia is one of the most frequentclinical presentations of stroke (CVA)3. Though the Hemiplegia/stroke related mortality issteadily declining in the west, it has been rising in India. This is due to the fact that the lifeexpectancy has increased and urbanization has changed the life style. This changing life style leads to vitiation of vata, chief among Tridosha and dynamicentity of life and locomotion. One of the conditions is stated as a consequence of vitiated Vata isPakshaghata (Hemiplegia). Pakshaghata 4 has been enlisted amongst the eighty types ofNanatmaja Vata Vyadhies and is considered to be prominent of all Vata vyadhies. This disease has been described in almost all Ayurvedic literature under Vatavyadhi. Pakshaghata may be defined as loss of voluntary functions of one side of the body.Charaka – the foundation stone of Chikitsa describes Pakshavadha5 (Pakshaghata) by saying thatmorbid vata beholds either side of body, dries up sira and snayu of that part rendering it deadand producing cheshta-nivritti along with ruja and vakstambha. Acharya Sushruta6 has describedthis ailment more precisely. He has considered pathological involvement of the joints of one halfof the body along with sensory loss of affected part in Pakshaghata. Ardit described by AcharyaCharaka includes in Paralysis of all parts of one side of the body (including face),i.e., complete hemiplegia. The pittanubandhita and kaphanubandhita lakshanas ofPakshaghata have been mentioned in Mdhava Nidana7 . The description of Pakshaghata can be interpreted with Hemiplegia. Modern medicalscience attributes this condition as damage to brain or CNS 8 structures caused byabnormalities of the blood supply. Hemiplegia is defined as paralysis of musculature of the face, “Comparative Management study of Pakshaghata with Mashadi Yoga” 2
  • arm and leg on one side of the body. It is the most frequent distribution of paralysis in humanbeings. Hemiplegia is caused by a variety of clinical conditions like CVD9, trauma, braintumor and abscess, syphilis, meningitis, etc., but CVD exceeds all others in frequency. Pakshaghata presents itself as a functional disability more than an organic fault. Itproduces a very miserable, dependent and prolonged crippled life with constantmental trauma. If he or she is the only earning member, the family has to face endless problems.Due to this, patient goes in extreme state of depression and frustration. In such a disease if anyhelp is extended to the sufferer, it will be a great advantage to the patient, a good credit to thephysician and in turn to the science itself. With advent of modern drugs, the pattern of disease has grossly changed, where the drugsonly assuage the symptoms temporarily and the underlying pathology goes on progressively toworsen the condition. Though ample research is being carried out for alleviating the disease andnew avenues are being explored for treating early ischemic injury by thrombolytic10 agents,Neuro protectants, anti oxidants, etc. Followed by physical rehabilitation, physiotherapyetc., yet the disease have not been dominated and remain incurable. To add it up, the adverse effects pose distant threat to the well- being. Therefore, theAyurvedic therapeutics has attracted considerable glamour for providing safe and effectiveremedies. Numerous researches have been done time and again to reprove the worth of thesemedicaments. Yet there is a necessity for perusing further research to find out some safe,effective and cheap remedy Taking all the above points into consideration, its poor prognosis andnature of inertia, the disease was selected, to find a measure that could help in restoring quality inlife of paralyzed patients. Ayurveda has broadly clarified treatment into three parts, i.e., Nidanaparivarjana, Shodhana and Shaman chikitsa. Many therapeutic principles have beenrecommended in Ayurvedic classics for the treatment11 of Pakshaghata. Acharya Charaka hasadvised time of treatment for Pakshaghata. Although a number of projects have been carried “Comparative Management study of Pakshaghata with Mashadi Yoga” 3
  • out using this principle of Charka at various research institutes, we have evolved adifferent pattern of treatment which falls under the principles boundaries of Charaka inwhich shodhan and Shaman principles are also involved. A sincere effort has been made toevaluate the combined effect of Shodhana and Shaman therapies12 and only Shamana therapyexplained for the management of Pakshaghata.Stroke – Incidence, Prevalance and mortality rate in India 13 It has been noted that stroke incidence may vary considerably from country to country.The prevalence of stroke in India was estimated as 203 per 100,000 populations above 20 years,amounting to a total of about 1 million cases. The male to female ratio was 1.7. Around 12% ofall stroke occurred in population below 40 years. The estimation of stroke mortality was seriouslylimited by the method of classification of cause of death in the country. The best estimate derivedwas 102,000 deaths; which represented 1.2 % of total deaths in the countryResearches on Pakshaghata (1) Evaluation of classical line of treatment in Pakshaghata,by Chidanad, P.G. Thesis ,1992, Mysore. (2) Evaluation of the Comparative efficacy of shodhana and shamana in the management of the Pakshaghata with special reference to ischemic strokes, by U V Purad , P G Thesis , 2001 , Gadag (3) Management of Pakshaghata-A observational study, by Chandrakala S ,P.G. Thesis, 2002,Mysore. (4) A clinical study on Pakshaghata (Hemiplegia), by Sudhir Raj N, P.G. Thesis, 2003, Bijapur. (5) A-Comparative study of effect of samshodhana and samshaman in Pakshaghata, by Devgirikar v p, P.G. Thesis, 2004, Udupi. “Comparative Management study of Pakshaghata with Mashadi Yoga” 4
  • CHAPTER 2 OBJECTIVES OF THE STUDY Pakshaghata is a ‘Vata vyadhi’14. Then why this problem has been selected forResearch work? There are certain specific reasons behind the selection of problem. Inrecent era everybody wants to succeed in his /her field and to go ahead than others. Soit becomes necessary that each and everyone should have some extra qualities whichmake his personality different to others. Success depends on individual’s workingefficiency, knowledge and personality. Thus personality plays an important role toachieve goals and to place one on the top in the society. A good personality helps not “Comparative Management study of Pakshaghata with Mashadi Yoga” 5
  • only in business and carrier but also in day to day communication. The increaseddemand of hard workers is evident by number of jobs and interviews and is in greatdemand in public. Factories are better run by the numbers of laborers .In the presentstudy of Pakshaghata patients are disabled form working .Because of loss of functionsof hand and leg .this dreadful disease make person to inactive and burden for thefamily members to carry out his daily regimens. Despite of its prevalence and its high cost management as well as disability,Pakshaghata has been paid proper attention and functioning for Stroke research inscandalously. In spite of advance of modern medicine and neuro imaging it issurprised to note that there is no standard medical treatment of strokes so far. It isreported that with present status of treatment the effect of infarction or hemorrhagecan not be reserved The dead neurons can not be visualized and the degree ofimprovement is commonly observed is to be attributed up to some extent, to therecovery of damage but viable cells of the periphery to infarction. The use of thrombolytics, anticoagulants and vasodilators are found to beineffective and does not increase blood flow through the damaged area .There is nodrug which improves series of mental functions particularly higher cortical functionssuch as learning ability, memory ability to think, consciousness etc. vascular surgerycan alter the progress of stroke, but a very few patients are fit for surgery and theefforts put the high financial burden. Ayurveda is gaining a global popularity for the effective ,majority of thetreatment in Pakshaghata because almost all patients become victims of physicaldisability after the latest treatment of modern medicine , therefore patients are alsopreferring to go to ayurvedic treatment after the acute phase of stroke. Mashadi Yoga is classical herbal combination which is mentioned in Chakra “Comparative Management study of Pakshaghata with Mashadi Yoga” 6
  • data, the same combination is mentioned by saharngadhara in the management ofPakshaghata .Here Mashadi Yoga Kwatha for oral administration and Mashadi YogaTaila for Nasya karma is administered to evaluate the efficacy of Mashadi YogaKwatha and Taila as comparative management of study of Pakshaghata with MashadiYoga. Therefore, there is a need for proper understanding of such problems of thesociety through Ayurvedic perspectives and to find some effective steps ofmanagement. The present research work has been planned with following aims andobjectives.Aims and objectives of the study:1. To study the disease Pakshaghata with its etiopathology and symptomatology toAyurvedic as Well as modern literature.2. To asses the efficacy of Mashadi Yoga 15 Kwatha (Oral) in the management of Pakshaghata. 163. To asses the efficacy of Mashadi Yoga Taila (Nasya) in the management ofPakshaghata.4. To evaluate the comparative efficacy of Mashadi Yoga kwatha and MashadiYoga Taila in the management of Pakshaghata.5 To study about Ayurvedic approach in the field of Vata Vyadhi.Reasons to Choose Following Therapies for Present Study: Ayurveda believes that the management of Vata vyadhi, which are givingagony to body and Manas, disability of functioning, burden for family members fordaily regimens. Considering these factors present study is undertaken to minimize theDisability, which is the typical nature of this disease. Here an attempt is estimated tomake the sufferer free from clinical symptom. Mashadi Yoga mentioned in “Comparative Management study of Pakshaghata with Mashadi Yoga” 7
  • Chakradatta17 said to be time tested. This Mashadi Yoga contains mainly Vatashamaka dravays. Vata dosha is the main culprit to cause Pakshaghata, so MashadiYoga Kwatha is administered orally Sharangadhara18 advocates the similarcombination with slight modification in the ingredients for Nasya karma so itsefficacy on Oral use Nasya karma effect is compared. In Chakradatta, Mashadi Yoga is advised for Oral administration. This isgiven in the form of Kwatha which is having eranda as one of the ingredient whichwill have the effect of virechana karma as the chikitsa sutra of Pakshaghata is“Snehanam swedanam Pakshaghate virechanam”19 . This line of treatment iseffortlessly followed. In Sharangadhara samhita the same combination of drugs are used for Nasyakarma in the management of Pakshaghata. As the Pakshaghata is considered under thecerebro-vascular accidents (CVA,) the pathology lies in the brain the medication hasto be reached at same site, so “nasa hi shiraso dwaram”20 the Nasya karma willdefinitely useful in the management of Pakshaghata.Research question: Whether Mashadi Yoga Kwatha administered orally is effective or MashadiYoga Taila in Nasya karma is effective .The same can be interpreted as whethervirechana is effective or shirovirechana is effective in the management ofPakshaghata.Hypothesis:(1) Oral administration of Mashadi Yoga Kwatha will act as Vatahara andVirechaka21.(2) Mashadi Yoga Taila for Nasya karma will act as Shirovirechaka. “Comparative Management study of Pakshaghata with Mashadi Yoga” 8
  • CHAPTER -3 REVIEW OF LITERATUREHISTORICAL REVIEWVEDIC KALA (PRE-SAMHITA PERIOD) Which have been claimed as ‘Vatakritasya Bheshaja’23 and ‘Vatakrita Nasani’respectively Blumefield interprets the word Vatakrita as the disorder caused by Vata.The words Pakshaghata and Pakshavadha are not mentioned in Vedas butAngabheda24 mentioned in Atharvaveda and Pangu25 mentioned in Rigveda indicatesthe knowledge regarding the Pakshaghata related diseases in that era.SAMHITA KALA: Detailed description regarding Pakshaghata has been mentioned by theAcharya in the Samhita Granthas.CHARAKA SAMHITA: Pakshavadha and Pakshagraha are considered among the ailments ofMadhyama Roga Marga, i.e., Marm-Asthi-Sandhi Marga26 Pakshavadha has beenlisted under eighty Nanatmaja Vata Vikaaras27 Detailed description of the disease has “Comparative Management study of Pakshaghata with Mashadi Yoga” 9
  • been given as Pakshavadha28 “Swedanam Sneha Samyuktam PakshaghateVirechanam” is the line of treatment given by Acharya Charaka. Jejjata (9thCen.) clarifies this by saying that Swedana and Virechana should be administeredalong with Sneha. Gangadhara (19th Cen.) comments that Snehayukta Swedana andSnehayukta Virechana should be given in Pakshaghata.BHELA SAMHITA AND HARITA SAMHITA: A brief description on Pakshaghata29 is available in both these Samhita. 20thChapter of third Sthana of Harita Samhita deals with Pakshaghata related diseasesnamely Ekanga Vata and Ekanga Pakshaghata.SUSHRUTA SAMHITA 30: In the first chapter of Nidana Sthana aetiopathogenesis, clinical features andprognosis of Pakshaghata have been described. The role of Urdhvagami, Adhogami,and Tiryaga Dhamanis in the pathogenesis of Pakshaghata has been shown. LakshanaAnyatara Pakshahanana, Sandhi Bandhana Vimoksha has been added here. Treatmentof Pakshaghata has been described in Maha Vata Vyadhi Adhyaya of Chikitsa Sthana(Su. Chi. 5/19). Sushruta has highlighted Vata Vyadhi among Ashta Mahagada in Su.Su. 33. Commentator Dalhana interprets Akarmanyata as Ishatkarma kshayamam -partial loss of function, where patient is unable to maintain stance and tends to fall.He interprets Achetana as Alpachetana, referring to partial loss of sensation.SANGRAHA KALA:ASHTANG SANGRAHA AND ASHTANG HRIDAYA 31: Similar description of Pakshaghata is found in both these Samhita. In AstangaSamgraha, the general Nidana of Vata Vyadhi, signs, symptoms and prognosis of “Comparative Management study of Pakshaghata with Mashadi Yoga” 10
  • Pakshaghata has been given in 15th chapter of Nidana Sthana The treatment has beenhighlighted in Chikitsa Sthana 23rd chapter. In Astanga Hridaya, Pakshaghata has been described in 15th chapter of NidanaSthana and 21st chapter of Chikitsa Sthana. The term Anyatara Paksha Nasha hasbeen used here and interpreter Arundatta (11th Cen.) interprets word Anyatara as rightor left side of the body. Line of treatment is same as that given by Charaka with theonly difference that Sneha is mentioned instead of Swedana.KASHYAPA SAMHITA32: Pakshaghata has been listed among 80 types of Nanatmaja Vata Vyadhi in thisSamhita (K.S. Su. 27-28). It is also included in the list of persons fit for Swedana(K.S. Su. 23-22). More details of Pakshaghata are not found in the available edition ofthis Samhita.MADHAV NIDANA 33: Madhava Nidana is considered to be the most authentic text of diagnosticvalue. Pakshaghata has been described in detail here. General description of causativefactors, pathogenesis, signs and symptoms of all Vata Vyadhi is found in 22ndchapter. In addition to the general symptoms of Pakshaghata, Pitta and KaphaAnubandha Lakshana have also been described. Interpreter Vijaya Rakshita (14thCen.) has differentiated Pakshaghata from Adaranga Vata by giving illustration of‘Ardhanarishwaravat’ to the former and ‘Narsimhavat’ to the later.NYAYA CHANDRIKA:The Lakshana “Sandhibandha Vimoksham” has been interpreted by Gayadas as“Sandhibandhan Kaphasanhitabhih Dhamanibhih Kritan Mokshayan PakshaghatamKuryat.” “Comparative Management study of Pakshaghata with Mashadi Yoga” 11
  • CHAKRADATTA 34: Majority portion of this Grantha deals with the treatment of various diseases.Vatavyadhi Chikitsa has been described in details in 22nd chapter. Some formulationshave been indicated for the treatment of Pakshaghata and amongst them one has beenselected for the present study.VANGASENA SAMHITA 35: The 24th i.e., Vatavyadhi adhikara, chapter deals with the pathogenesis,prognosis, symptomatology of Pakshaghata. Prognosis is described in detail. Sneha,Swedana, Virechana is the line of treatment given here. Basti described forAkshepaka has been described to be administered in Aksheena patient ofPakshaghata.SHARANGADHARA SAMHITA36: In this Samhita, very little description is found regarding the disease.Pakshaghata has been enumerated among the 80-Vaatik Nanatmaja disorders (Sh.S.Pu. 7/107). Some formulations of Pakshaghata have been mentioned in Sh. M. 2/92;and Sh. M. 2/142.BHAVAPRAKASH 37: Following the footprints of Madhavakara, detailed description bas beenpresented in B.P. M. 24/205-207, 262,263.YOGRATNAKARA38: Description similar to that of Madhava Nidana is found in the VatavyadhiNidana chapter. Formulations of Pakshaghata are also indicated.BHAISHAJYA RATNAVALI 39: This text deals mainly the only the treatment of various diseases. DetailedChikitsa of Vatavyadhi has been described in the 26th chapter named as Vata Vyadhi “Comparative Management study of Pakshaghata with Mashadi Yoga” 12
  • Chikitsa. Some drug formulations have also been indicated for Pakshaghata. In othertreatises i.e. Kalyaanakaaraka of Ugradityacharya (9th Cent.), Chikitsakalika byTisatacharya (10th Cent.), Shodhal’s Gada Nigraha (12th Cent.), Rasa RatnaSamuchhaya 21st chap. (13th Cent.) etc., a synoptic description is found as presentedin the earlier classics.HISTORY OF CEREBROVASCULAR ACCIDENT: Hippocrates, the father of medicine, first recognized stroke over 2,400 yearsago. At this time stroke was called apoplexy, which means "struck down by violence"in Greek. This was due to the fact that a person developed sudden paralysis andchange in well-being. Physicians had little knowledge of the anatomy and function ofthe brain, the cause of stroke, or how to treat it. It was not Untill the mid-1600s that Jacob Wepfer found that patients whodied with apoplexy had bleeding in the brain. He also discovered that a blockage inone of the brains blood vessels could cause apoplexy. Medical science continued to study the cause, symptoms, and treatment ofapoplexy and, finally, in 1928, apoplexy was divided into categories based on thecause of the blood vessel problem. This led to the terms stroke or "cerebral vascularaccident (CVA)." Stroke is now often referred to as a "brain attack" to denote the factthat 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. The term brain attack also conveys amore urgent call for immediate action and emergency treatment by the general public.Today, there is a wealth of information available on the cause, prevention, risk, andtreatment of stroke. Even then much less is known about the treatment of the stroke,there is no any satisfactory and widely acceptable measure for the stroke. “Comparative Management study of Pakshaghata with Mashadi Yoga” 13
  • Review of PakshaghataEtymology: In Sanskrit language each word is considered to be Shakti Swarupa and behind theword its meaning invariably entangles. The word Pakshaghata also bears a meaning that ishallmark of the disease itself, as explained hereby. This word is composed of two pada i.e.‘Paksha’ and ‘Aghata’40 detailed meaning of which are as under.Paksha:It is of masculine gender and its various meaning is as follows in different texts.• Dehangama – Shabdakalpadrum41• Parshwa - Vachaspatyama• Dehardha - Vachaspatyama• Dehangabheda - Vachaspatyama• Paksha Sharirardham – Dalhana• Paksha Ardha Narishwaravat – Vijayarakshita• The flank or side or the half of anything - Monier Williams Acharya Charaka has used the Pada ‘Paksha’ in different contexts. It has been usedfor describing 15 days, feather of bird and one side of the body. Acharya Sushruta has used this ‘Pada’ while describing the disease Pakshaghata.Dalhana has commented on this by rightly saying it as Paksham Sharirardham. Ashtanga Samgraha and Ashtanga Hridaya42 have also used this pada whiledescribing the disease Pakshaghata, the meaning of Paksha being taken as one side of thebody. Madhava Nidana has also incorporated the pada Paksha in Pakshaghata.Vijayarakshita the commentator of Madhava Nidana explains it as Ardhanarishwaravat givinga clear idea about terminology used. In contemporary literature like Sharangadhara Samhita, Bhava Prakasha andYogaratnakara43 the word Paksha has been used with meaning of half of the body during the “Comparative Management study of Pakshaghata with Mashadi Yoga” 14
  • description of Pakshaghata. We can conclude doubtlessly from the foregoing description thatword “Paksha” depicts one side of the body.Ghata: It is of masculine gender and is derived as below:An + Han + GhanHan + Vich + Bhave + Layut (Halayudh Kosha) The suffix ghata of the word Pakshaghata has also been used in terms likeMutraghata, Marmaghata, etc. The word Aghata bears same meaning as Ghata. Its variousmeanings are as follows -Vadha44 - ShabdakalpadrumMarane - VachaspatyamKilling, Blow,Injury – Monier WilliamsTerm Pakshavadha is also used as a synonym of Pakshaghata.So, we will have a brief view of word Vadha. It is of masculine gender and is derived asfollows –Hananam iti, Han + Ap, Vadhadesha. Its various meanings are as follows:Prana Viyoga Phalaka Vyapar – Shabdakalpadruma Killing, Destruction - Monier WilliamsDestruction, Blow - V. S. ApteThus, the etymology of Pakshaghata goes like this –  Pakshashaya Dehardhashaya ghatam vinashanam yasmat yatrava  Pakshashaya aghataha iti pakshaghataha  Pakshashaya ghataha iti pakshaghata  Pakshashaya vadhaha iti pakshavadhaFrom all the above description we can draw the bottom line that the meaning of wordPakshaghata is loss of function of one half of the body and its modern homologue isHemiplegia “Comparative Management study of Pakshaghata with Mashadi Yoga” 15
  • CLASSIFICATION OF PAKSHAGHATA: While describing the prognosis of Pakshaaghaata, Aacharya Sushruta has classifiedthe disease in three types as per their aetiopathogenesis. The three types of Pakshaaghaata areas follows  Shuddha Vataja Pakshaaghaata:- The Pakshaaghaata where the Vata is aggravated on account of its own Nidana  Anyadosha Samsrista Pakshaaghaata: - Where the Vata associated with other Dosha to manifest the disease.  Kshaya Hetuja Pakshaaghaata: - Where the Vata is aggravated as a consequence of Dhatu Kshaya.  Aachaarya Sushruta has used the terms Samanwita, Samsrista, Anwita, Samyukta etc as synonym of Aavarana45 in the context of description of  Aavarana. So here the term Anyadosha Samsrista can be understood as Anyadosha Aavrita, as there are only three routes for the aggravation of Vata.NIDANA The word Nidana46 carries two meanings in Ayurvedic classics, viz - causativefactors and diagnosis. The former one will be discussed here. Acharya Charakadefines Nidana as under – Nidana is defined as the factors, which cause the disease. Treatment becomes easierby knowing the causative factors of a disease. In this light it has been clearly stated that‘Nidana Parivarjanam’ is one type of Chikitsa. According to Ayurveda, considerationof aetiological factors is important for the diagnosis, prognosis and line of treatment. With the review of Ayurvedic literature it is evident that no specificaetiological factor has been described separately for Pakshaghata. Disorders of Vata,including Pakshaghata have been classified as Nanatmaja Vata Vyadhis, so all thefactors vitiating vata in the body are likely to be the root cause of Pakshaghata. Hence, thegeneral causative factors of vata vyadhi or factors vitiating vata dosha in the body may be “Comparative Management study of Pakshaghata with Mashadi Yoga” 16
  • regarded as the aetiological factors of Pakshaghata as well. Though the causativefactors remain same in all vatavyadhis, different forms appear like Pakshaghata,Gridhrasi, etc. This is because of the Samprapti vishesha of vitiated vata. The Nidana of Vatavyadhi and Vata prakopa given in Ayurvedic texts have been classified here under eightmain headings, which are tabulated below.GUNA VACHAK AETIOLOGICAL FACTORS VITIATING Vata Table no. 1Sl .no Aetiological Ch. Su. A.S A.H Bh.P M.N Sh C.D Y.R Factors1 Ruksha + + + + + + + + +2 Sheeta + + + - + + + - -3 Laghu + + - - + + + - -4 Katu - + + - + - - + +5 Tikta - + + + + - - + +6 Kashaya - + + + + - - + +7 Daruna + - - - - - - - -8 Khara + - - - - - - - -9 Vishada + - - - - - - - -Guna Vachaka aetiological factors vitiating vata: The qualities of vata as described in Ayurvedic texts are ruksha,laghu, sheeta, khara, sukshma, chala47. According to the principles of Ayurveda, samanya isthe cause of increase and vishesha is the cause of decrease of all things at all time. . Henceexcess intake of the above gunayukta ahara causes rukshata, laghuta, shitalta, darunta,kharata in the body and when body gets affected by these gunas, vayu makes its place inthe body and eventually it becomes aggravated.-Vata vyadhies are compared to the diseases of nervous system. The nerve cells are coveredby myelin sheath, which is chiefly made up of fat. It gives nourishment to the nerve fibres.This fat can be taken as snigdha substance.- By excess intake of ruksha gunahara, the nourishing material of nerve will be decreased andthis will cause dhatukshaya, which in turn leads to vata prakopa and Pakshaghata. “Comparative Management study of Pakshaghata with Mashadi Yoga” 17
  • -Excess intake of ahara having katu, tikta and kashaya rasa causes vitiation of vata.48-Excessive ingestion of Katu rasa causes Bala Kshaya, Bhrama and on account of havingvayu and agni mahabhuta in preponderance, it generates various kinds of vata disorders inthe legs, arms, sides and back along with giddiness, pain etc. In Pakshaghata also leg, arm andsometimes face of one side of the body is affected by Vata.- Tiktarasa when taken in excess causes shosha of Rasa, Rakta, Mansa, Meda, Asthi andMajjadhatu and produces many vata disorders by virtue of ruksha, khara and vishadaguna 49-Kashaya rasa is khara, vishada and ruksha. Its atiyoga causes various Vata disorderslike Pakshavadha, Ardita, etc.Nutritional aetiological factors provoking vata:-Anashana or Alpashana reduces bala, varna, upachaya, veerya; impairs eight sara,sharir, mana, buddhi, indriyas and is cause of eighty types of vata vyadhies. 50-Atimatra bhojan leads to vitiation of all three doshas. These doshas reside in the kukshi andproduce various disorders. Amongst them vitiated vata produces shira sankuchan, stambha.-Abhojana, ajeerna bhojana, atibhojana, vishamashana leads to angnimandya. This impairsthe production of rasadhatu and thus results in kshaya of subsequently produced dhatus.This dhatukshaya causes vata prokopa.-Ama is produced by ajeernashana and adhyashana .This ama dosha obstructs thepath of vayu (margavarana) which results in vitiation of vata 51-Kordusha, Shyamaka, Nivara, etc., being kudhanya vargadravyas, vitiates vata by theirruksha guna and katu vipaka. Bidal varga dravyas like Mudga, Masura, Makushtha, Chanaka,Kalaya etc. vitiates vata by their Kashaya rasa, katu vipaka and shita guna. These dietaryhabits, from the nutrition point of view, are less nourishing, making body weak and thenervous system more irritable and produce various nervous disorders.Karma Vachaka etiological factors vitiating vata:-Excessive sexual indulgence makes the body ruksha 52 and this is the cause of vata prakopa. “Comparative Management study of Pakshaghata with Mashadi Yoga” 18
  • Ativyavaya causes shukra dhatu kshaya and this leads to kshaya of all dhatus according to thetheory of PraTilaoma Kshaya. This dhatu kshaya results in vata prakopa. Charaka mentionsbalanasha, ekanga and sarvanga roga, manoavasada, etc., vitiates Doshas due to ativyavayaand indirectly pointes towards Pakshaghata. Acharya Sushruta hasclearly mentionedexcessive sexual indulgence as the direct cause of Pakshaghata. 53-Atijagaran / Ratrijagaran increase the ruksha guna in the body and there by vitiates vata.Charaka mentions that keeping awake at night diminishes rasa dhatu and viscosity ofbody fluid.-Divasvapna causes aruchi, avipaka, agninasha, etc. 54 this leads to ama production and resultsin avaranjanya vata prokopa.-Ativyayama causes dhatukshaya and this leads to vitiation of vata. The maindamaging effect of such exertion is on the pranavaha and mamsavaha srotas givingrise to may disorders.-Suppression of natural urges produces the symptoms of excitation of vata byvitiating it for example, suppressing the urge of Apana vayu cause many vatajanyadiseases. 55Trauma (Abhighata) Provoking vata: Table No.2Sl .no Aetiological Ch. Su. A.S A.H Bh.P M.N Sh C.D Y.R Factors1 Abhighata + + + - + + + - -2 Marmaghata + - - - - + - - -3 Balvad Vigraha - + + - - - - - -4 Prapatana + + - - + + - - -5 Prapeedana - + - - - - - - -6 Vikshepa - - + - - - - - --Acharya Chakrapani says that Abhighata can be of two types – Doshabhighata andMarmabhighata. Head is considered as a vital part (marma), the seat of Indirya and Prana56 Shiromarmaghata causes diseases like Ardita, Manyastambha, Mukta, Cheshta-Nasha 57.Which are seen in Pakshaghata? “Comparative Management study of Pakshaghata with Mashadi Yoga” 19
  • -Injury to lohitaksha marma causes loss of blood and leads to Pakshaghata. Injury to 58kakshadharamarma also causes Pakshaghata . Abhighata, balvad vigraha, prapatan,prapidan, etc. cause achaya purvak vata prakopa.Psychic factors vitiating vata: Table No. 3Sl .no Aetiological Ch. Su. A.S A.H Bh.P M.N Sh C.D Y.R Factors1 Chinta + - - + + + + + +2 Shoka + - + + + + + + +3 Krodha + - - - - - - - -4 Bhaya + - - + + - + + -5 Kama + - - - + - + - -6 Apravritta - - + + - - - - - vegadharana7 Utkranta - + - - - - - - --Emotional stress of mind, i.e., kama, krodha, bhaya, chinta, etc., are likely totrigger the psycho-physiological mechanism liberating neuro humors and hormones inthe body which may have direct bearing with the excitation of Vata and production of severalpsychosomatic disorders. Vata is predominant in rajo guna Psychic causes, which arepredominant of rajo guna, will vitiate vata and in turn cause vata vyadhi.-Mana is Ubhayendria. Both the sensory and motor functions are governed bymana. Abnormality in mana causes disturbance in sensory and motor function and causesPakshaghata.-In a person suffering from chinta, shoka, etc., the matra yukta pathya ahara is also notdigested properly leading to ama formation and agnimandya. This can lead tomargavarodh janya Pakshaghata.Season and time provoking vata: The cyclic effect of season, time, day-night, temperature produce a rhythmic effect onHuman body. The doshas of the body are also affected. Grishma, Varsha, Shishirseasons; Bhuktante, Jeernante, end of day and night are the kala for vitiation of vata. “Comparative Management study of Pakshaghata with Mashadi Yoga” 20
  • Nidanarthakar Diseases provoking vata: Disease, which acts, as the causative factor for other disease is knownas Nindanarthakarroga. Dhatuskhaya, Ama, Rogatikarshana, etc., comes under thiscategory because they vitiate vata and causes various vata disorders. Ama causesmargavaranjanya vataprakopa. Ama when combines with vata (vata sanshrishta ama)leads to many vata vyadhies .59Improper treatment induced vata prakopa: Vitiation of vata due to improper management may be treated as a complication oftherapies. Excessive use of Panchakarma, Rakta Mokshana, etc. causes excessive lossof body elements, malas which leads to riktata of srotasa and in turn provokes vata. AcharyaCharaka quotes that vata gets vitiated either by dhatukshaya or margavarana. 60We cansee that all the above said factors vitiate vataeither by causing dhakushaya or by obstructing the normal gati of vata.ETIOLOGY The World Health Organization (WHO) defines stroke as “Rapidlydeveloping clinical symptoms and/or signs of focal and at times global, loss of cerebralfunction with symptoms lasting more than 24 hours. Hemiplegia is a classical sign of stroke.THE ETIOLOGICAL FACTORS OF STROKE:I. CAUSES OF ISCHEMIC STROKE (IS): IS results from several etiological factors out of which three arepredominant: Thrombosis, embolism and lacunars disease.Causes of Atherosclerotic (Thrombotic) Stroke 61 – Atherosclerosis a progressive pathological state where blood vesselsdevelop fibroproliferative, fatty lesions that express as occlusive plaques is thevascular disease that contributes most frequently to thrombosis. Ischemic stroke resultingfrom thrombosis are often classified as having atherothrombotic. This is predisposed by “Comparative Management study of Pakshaghata with Mashadi Yoga” 21
  • Hypertension – Initiates and accelerates the cerebral atherosclerotic disease,probably by degeneration of the small vessel wall. Hyperlipidemia/obesity – Affects thelarge vessels. Intimal thickening by deposition of cholesterol and often bycalcification and ulceration leading to breaching of internal elastic lamina.Diabetes – Hastens the atherosclerotic process in both large and small arteries.Myxodema – Also found to be a cause.Smoking – Aggravates the process by decreasing HDL cholesterol and reducing cerebralblood flow.Causes of Cerebral Embolism Embolism of an intracranial artery is a complication of many disorders, which allowthrombi or other material such as cholesterol, air or fat to enter the circulation in such a waythat it reaches the brain. Causes are:-Cardiac Origin 62 :  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.  Complications of cardiac surgery.  Valve prostheses.  Non-bacterial thrombotic (Marantic) endocardial vegetations.  Prolapsed mitral valve.  Paradoxical embolism with congenital heart disease.   Trichinosis.Non Cardiac Origin 63  Atherosclerosis of aorta and carotid arteries (mural thrombus, atheromatus material).  From sites of cerebral artery thrombosis (basilovertebral, middle cerebral)  Thrombosis in pulmonary veins.  Fat, tumor or air.  Complications of neck and thoracic surgery. “Comparative Management study of Pakshaghata with Mashadi Yoga” 22
  • Undetermined origin of ParalysisCauses of Lacunar infarction: -  Hypertension  Atherosclerosis  Diabetes  Small-vessel diseases such as infectious or non-infectious arteritis.Cryptogenic causes: Moyamoya disease, Fibromuscular dysplasia, Binswanger’s subcorticalarteriosclerotic encephalopathy, leuko-araiosis, Winiwarter-Buerger disease and AorticArch syndrome (Non inflammatory).Other Unusual causes: Vasculopathies resulting from drug abuse and oral contraceptive pills,congophilic angiopathy, cerebral malaria, Homocystinuria-vasculitis, Arteritis (Syphilitic,tuberculous, rheumatic, Takaysu’s disease, collagen disease, etc.), Migraine/vasospasm,Arterial hypotension and anoxic encephalopathy, cerebral thrombophlebitis,Dissecting aortic aneurysm, Demyelinating conditions–Multiple sclerosis andencephalomyelitis, Ergotism, diphtheria, Hypercoaguable states (i.e. defects in thefibrinolytic system) such as ProteinC & S deficiency, resistance to activated proteinC & antithrombin III deficiency.II. CAUSES OF INTRACRANIAL HAEMORRHAGE 64  Primary (hypertensive) intracerebral haemorrhage.  Ruptured saccular aneurysm.  Ruptured arteriovenous mal formation.  Undetermined causes (normal B.P., no aneurysm or AVM)  Trauma including post traumatic delayed apoplexy.  Hemorrhagic disorders: Leukemia, aplastic anemia, sickle cell disease, polycythemia vera, thrombocytopenic purpura, liver disease, complication of anticoagulant therapy, hyperfibrinolysis, hypofibrinogenemia, haemophilia, Christmas disease, Hyperviscocity syndrome.  Hemorrhage into primary and secondary brain tumors.  Septic embolism, mycotic aneurysm. “Comparative Management study of Pakshaghata with Mashadi Yoga” 23
  •  With hemorrhagic infarction, arterial or venous.  With inflammatory disease of arteries and veins (Polyarteritis, lupus erythematosus).  With arterial amyloidosis.  Miscellaneous rare types: After vasopressor drugs, upon exertion, during arteriography, during painful urologic examination, as a late complication of early life carotid occlusion, complication of carotid-cavernous AV fistula, anoxemia, migraine, teratomatous malformations, Herps simplex encephalitis, Acute necrotizing hemorrhagic encephalopathy.RISK FACTORS OF STROKE65 The American Stroke Association has identified several factors that increase the riskof stroke. The more risk factors a person has, the greater the chance that he will have a stroke.Medical conditions that increase stroke risk 66:-  Transient ischemic attacks (TIAS): TIAS are “mini strokes’. They are strong  Predictors of stroke. A person who’s had one or more TIAS is almost 10 times More 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. The effective treatment of high blood pressure is key reason for the accelerated decline in the death rates of stroke.  Diabetes mellitus: Diabetes is an independent risk factor for stroke.  Heart disease: People with heart disease have more than twice the risk of stroke as Those whose hearts work normally. Atrial fibrillation in particular raises the risk For stroke. Recent MI is also a major cause of death among stroke 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 blood cell count is a risk factor for stroke. The reason is that more RBCs thicken the blood and make clots more likely.Controllable risk factors and life style choices:-  Smoking: Recent studies have shown cigarette smoking to be an important risk factor for stroke.  Obesity, elevated cholesterol and elevated lipids. “Comparative Management study of Pakshaghata with Mashadi Yoga” 24
  •  Physical inactivity – A sedentary lifestyle.  Excessive alcohol intake.  Illegal drug use: Intravenous drug abuse carries a high risk of stroke from cerebral emboli.  Oral contraceptive pills: It increases the risk of venous thromboembolism.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 are about equal for men & women. However, at all age, more women than men die of stroke.  Heredity and Race: The chance of stroke is greater in people who have a family history of stroke. African – Americans and Hispanic Americans are at higher risk than white Americans. This may be due in part to hypertension and dietary differences.Other factors:  Season & Climate: Stroke deaths occur more often during periods of extremely hot or cold temperatures.  Socioeconomic factors: There’s some evidence that people of lower income and 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 Heart Association)  Sleeping for more than eight hours at night, snoring and daytime drowsiness is associated with an increased risk for stroke. (Feb. 2001, American stroke Association’s 26th International stroke conference).  Low potassium intake may increase risk for stroke. (Aug. 13, 2002 – Journal of American Academy of Neurology).PURVARUPA According to Ayurveda clinical features of a disease are divided into twoparts – Purvarupa and Rupa. Before full-fledged manifestation of disease, thesymptoms which are developed in the initial stage with the localization of doshas in aparticular area of the body are called Purvarupa. These symptoms are exhibited during thesthanasanshraya avastha of shatkriyakala of the disease 67 Termination of the disease atthis stage may save the patient from the damage, which may be done by the complete “Comparative Management study of Pakshaghata with Mashadi Yoga” 25
  • manifestation of the disease. Purvarupa of Pakshaghata is not described in any text.Pakshaghata being a vata vyadhi;purvarupa of vata vyadhi can be taken as that ofPakshaghata. Acharya Charaka68 mentions Avyakta Lakshana as the purvarupa of any vata vyadhi.Acharya Chakrapani has interpreted the term ‘Avyakta’ as the rupa presented in lesser degree.Vijayarakshita gives very clear meaning of the term Avyakta. According to him thesymptoms that are not manifested clearly are Purvarupa and these are due to: - Less severe causative factors - Very less or mild symptoms - Less Avarana of Doshas (M.N. 1/5-6, Madhu.) Vijayrakshita has designated AvyaktaLakshanas under vishishta purvaurpas . Thus 69general symptoms of vata vyadhi , viz., Sankocha, Romaharsha, Pralapa, etc., if occur inmild form can be taken as purvarupa. Loss of voluntary movements of the limbs is thecardinal feature of Pakshaghata. Hence weakness in limbs may be considered asPurvarupa of Pakshaghata. The symptoms of Kaphanubandha and PittanubandhaPakshaghata if occur in mild form before the stroke may be considered asvishishta purvarupa of Pakshaghata.PRODROMAL SYMPTOMS 70CEREBRAL THROMBOSIS – Premonitory symptoms are common and exist for hours,days or months before the onset of paralysis. They are given name as TIA.Transient cerebral Ischemic attacks:- Since the aim of treatment in CVD71 is the prevention of a majorstroke, the management of the TIA72 may be considered first. TIA is theepisodes indicating ischemia of some part of cerebral hemisphere or the brain stem. They aredefined as episodes of temporary and focal cerebral dysfunction of vascular origin leaving nopersistent neurological deficit and lasting less than 24 hours. Attacks indicatingischemia in the distribution of one carotid artery are often referred to as episodes of carotid “Comparative Management study of Pakshaghata with Mashadi Yoga” 26
  • insufficiency, those involving the brainstem as vertebro– basilar insufficiency. In carotidartery disease the transient warning attacks consist of monocular blindness, hemiplegia, hemianesthesia, disturbances of speech and language, confusion, etc. In vertebro-basilar systemthe prodromata take the form of episodes of dizziness, diplopia, numbness, andimpaired vision in one or both visual fields, dysarthria.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 sudden onset,resembling that of ‘Stroke-in evolution’, have been described. A convulsion mayoccur at onset and there is sometimes headache.CEREBRAL HAEMORRHAGE: The onset is usually sudden like a bolt from blue without any prodromal symptoms.But the patient may be known to be hypertensive and there may have been premonitorysymptoms such as transitory speech disturbances or attacks of weakness of a limb.Severe headache, vomiting, loss of consciousness and convulsions are accompanied at theonset.Intracranial Aneurysms 73 May produce symptoms by compressing the structures in their vicinicty. Patientsmay suffer from recurrent headaches, typical migraine, convulsions, TIAs. SAHfrom a cerebral angioma may occur without previous warning but is more oftenpreceded by symptoms and signs of the cerebral lesion.PATHOPHYSIOLOGY OF HEMILEGIA / PARALYSIS 74 There are two major categories of brain damage in stroke – Ischemia andHemorrhage, which result in the destruction of brain tissue via abnormalities in the brain’sblood supply. Ischemic stroke is a consequence of a lack of blood flow where brain tissue isstarved of oxygen and vital nutrients. Hemorrhagic stroke is the rupture of a blood vessel andthe subsequent release of blood into the extravasuclar space with in the cranium. Either kind “Comparative Management study of Pakshaghata with Mashadi Yoga” 27
  • of stroke can occur anywhere in the brain and consequences range from minimal disability toparalysis or death. Ischemic stroke account for 80-86% of all stroke whereas hemorrhagicstroke accounts for 14-20%.ISCHEMIA: Ischemia can be further subdivided into three different mechanisms:thrombosis, embolism and decreased systemic perfusion.Thrombosis: Thrombosis refers to an obstruction of blood flow due to a localized occlusiveprocess within one or more blood vessels. The lumen of the vessel is narrowed or occluded byan alteration in the vessel wall or by superimposed clot formation. The commonest type ofvascular pathology is atherosclerosis in which fibrous and muscular tissues overgrow in thesub intima, and fatty materials form plaques that can encroach on the lumen. Next, plateletsadhere to the plaque crevices and form clumps that serve as nidi for the deposition of fibrin,thrombin and clot. Atherosclerosis affects chiefly the larger extracranial and intracranialvessels.-Occasionally clot forms within the lumen because of primary hematologicalproblems.-In hypertensive patients, increased arterial tension leads to hypertrophy of themedia of small arteries and arterioles and deposition of fibrinoid material into the vessel wall,sometimes with atherosclerosis, is seen.-Lacunar infarcts are among the commonest cerebrovascular lesions. When small arteries orarterioles already thickened as a result of hypertension are occluded by thrombus or embolusfrom larger atherosclerotic vessels, this may cause areas of micro infarction, whichultimately lead to small slit-like cavities known as lacunes. Some affected vesselsshow lipohyalinosis. In sever hypertension multiple lacunes may be found in putamen,pons, thalamus, internal capsule, etc. There is tendency for Atheromatous plaques to form at branching and curves of the “Comparative Management study of Pakshaghata with Mashadi Yoga” 28
  • cerebral arteries. The most frequent sides are in the ICA at the carotid sinus, in the cervicalpart of the vertebral arteries and at their junction to form the basilar at the main bifurcation ofthe MCA, in the PCA as they wind around the midbrain, and in the ACA as they curve overcorpus callosum.Embolism75: An embolus is a foreign body that is transported from one part of the circulatorysystem to another where it becomes impacted. The process is known as embolism.Approximately 99% of all emboli are pieces of a dislodged thrombus, hence thecommon term thrombo embolism. Other forms of emboli are fat, air, tumor, bone marrow,atheromatous material and clumps of bacteria. Embolic material typically originates in theheart (valves, endocardium, atrial or ventricular clots or tumors), major arteries (eg-aorta,carotid, vertebral) or systemic vein. In contrast to thrombosis, embolic luminalblockage is not due to localized process originating within the blocked vessel. Brainembolism is essentially a manifestation of heart disease. Any region of the brain may beaffected; the territory of the MCA, particularly the upper division is most frequently involved.The arteries of the left side of the brain are embolized more often than those of right, chieflythe MCA. Large embolic masses can block large vessels (sometimes the carotids in the neck);white tiny fragments may reach vessels as smaller 0.2 mm in diameter. The embolic materialmay remain arrested and plug the lumen solidly but in many cases it breaks up into fragments,which enter smaller vessels and disappear completely. Because of the rapidity with whichembolic occlusion develops, there is not much time for collateral influx to becomeestablished. Following impaction of an embolus, a thrombus usually forms in the vessel andmay spread distally or less frequently proximally and the area of brain deprived of bloodsupply is infracted. If an embolus impacts and then moves on, arterial blood may then enterthe infarcted area. Thus embolism is the commonest cause of hemorrhagic infarction. Whenthe embolus is infected, meningitis or cerebral abscess may develop, or when the infection isof low virulence, embolism may be followed by infective softening of the vessel wall and “Comparative Management study of Pakshaghata with Mashadi Yoga” 29
  • aneurysm formation - mycotic aneurysm. Fat embolism may occur as the result of fatglobules being set free into the circulation after the fracture of one of the long bones, passingthrough the pulmonary circulation and so reaching the brain. In an embolism, gas bubblesmay appear in the arterial circulation of the CNS in Caisson disease or air can enter thecirculation accidentally during cardiac surgery, venous catheterization etc.Decreased systemic Perfusion: In this circumstance, diminished flow to brain tissue is due to low systemic perfusionpressure. The most common causes are cardiac pump failure and systemichypotension. In such cases, the lack of perfusion is more generalized than in localizedthrombosis or embolism and affects the brain diffusely and bilaterally. Poor perfusion is mostcritical in border zone or so-called watershed regions at the periphery of the major vascular-supply territories. Asymmetrical effects can result from preexisting vascular tensions,causing an uneven under perfusion.Local brain effects of Ischemia by all three above mentioned mechanism:- When blood flow to a brain region is reduced, survival of the at-risk tissue usuallydepends on the duration of compromised blood flow and the availability of collateralcirculation to the cells. Generally, the sooner circulation is restored to occluded neural tissue;the more likely ischemic damage can be reserved. Prolonged vascular blockage results inirreversible ischemic damage and cell death, an event termed infarction. Surrounding the core of infracted neural tissue is a region with reduced,but not entirely blocked, cerebral blood flow (CBF). This marginally profuse area is calledthe ischemic penumbra. Infracted neural tissue is characterized by local CBF below 10mL/100 g/min (normal CBF is approx. 50 mL/100 g/min.), where as CBF in the Penumbra ispresumed to be 10-20 mL/100 g/min. Scientists believe that infracted tissue cannot besaved but that the ischemic penumbra represents potentially reversibly damagedneural tissue. “Comparative Management study of Pakshaghata with Mashadi Yoga” 30
  • When neurons are rendered ischemic, a number of biochemical changes occurs whichpotentiate and enhance cell death: K+ moves across the cell membranes into the extra cellularspace and Ca ++ moves into the cell which ultimately leads to mitochondrial failure.Decreased O2 availability leads to production of oxygen free radicals, which causesperoxidation of fatty acid and severely damages the cell function. With decreasedoxygen availabity, anaerobic glycolysis leads to an accumulation of lactic acid and a decreasein pH. The resulting acidosis also greatly impairs cell metabolic functions. In regions ofischemia, concentrations of excitatory neurotransmitters especially glutamate isincreased which causes vulnerable neurons to receive toxic exposure to glutamateand there by increasing the likelihood of cell death. Glutamate entry opens membranes andincreases Na + & Ca ++ influx into cells. Large influxes of Na+ are followed by entry ofchloride ions and water, causing cell swelling and oedema. In chronic phase, glial scarsform and macrophages gradually ingest the necrotic tissue debris, within the infarct leading toshrinkage of the volume of the infracted tissue or a frank cavity. These afore mentioned local metabolic changes cause a self-perpetuatingcycle of changes that lead to increasing neuronal damage and cell death.INTRACRANIAL HAEMORRHAGE 76: This is the third most frequent cause of stroke. There are four varieties of intracranialhemorrhage – extradural, subdural, subarachnoid and intracerebral. The first two areinvariably traumatic.Intracerebral Haemorrhage – The term intracerebral hemorrhage describes bleeding directly into thebrain substance. The commonest cause of intracerebral arterial hemorrhage is rupture of anatheromatous artery in a hypertensive individual. Hypertension causes medialhypertrophy in small arteries and arterioles, which leads to degeneration of media andproduces a thickened but brittle vessel. Bleeding diatheses, vascular malformations, ruptureof saccular aneurysm and vasculopathies such as amyloid degeneration or “Comparative Management study of Pakshaghata with Mashadi Yoga” 31
  • segmental lipohyalinosis can also cause bleeding into the brain. The degree of damage willdepend on the location, rapidity, volume and pressure of the bleeding. The extravasations form a roughly circular or oval mass, which disrupts the tissueand grows in volume as the bleeding continues. Adjacent brain tissue is displaced andcompressed. Intracerebral hemorrhages are at first soft and dissect along whitematter fiber tracts. When bleeding dissects into the ventricles or onto the surface of thebrain, blood is introduced into the cerebrospinal fluid. The blood clots andsolidifies, causing swelling of adjacent brain tissues. Later the clot is absorbed, and isreplaced by a neuroglial scar or by a cavity containing yellow serous fluid. During absorptionof the clot, gliosis occurs in the wall of the cavity with phagocytosis of destroyed neuraltissue by compound granular corpuscles. Hemorrhage may be described as massive, small, slit and petechial. Massive refers tohemorrhages several centimeters in diameter; small applies to that 1 to 2 cmin diameter. Slit refers to hypertensive hemorrhage, which lies subcortically atthe junction of white and gray matter, and petechial are pinpoint hemorrhages.Subarachnoid hemorrhage: Here blood leaks out of the vascular bed onto the brain’s surface and is disseminatedquickly via the spinal fluid pathway into the spaces around the brain. The commonest causeis a ruptured aneurysm, which releases blood rapidly at systemic blood pressure;suddenly increasing intracranial pressure, where as bleeding from other causes isusually lower and at lower pressures.RUPA77When the disease is fully established there is full clinical manifestation, this is called Rupa ofthe disease . The characteristic symptoms and signs appear clearly in the fifthkriyakala, i.e., vyakti avastha of the disease. All eighty types of vata vyadhies have beenclassified under five main headings by some eminent scholars of Ayurveda, viz. (1)Akarmanyata Pradhana vata vyadhi, (2) Kampa Pradhan vata vyadhi, (3) Shoola Pradhana “Comparative Management study of Pakshaghata with Mashadi Yoga” 32
  • vata vyadhi, (4) Shosha Pradhana vata vyadhi and (5) Stambha Pradhana vata vyadhi. Pakshaghata is included mainly under the Akarmanyata Pradhana vata vyadhi because its cardinal feature is Cheshta Nivritti (Loss of voluntary functions of one side of the body). Though vata is dominant in this disease, the association of pitta and kapha also found. Various symptoms of Pakshaghata according to different Acharyas are tabulated below:- Rupa (Symptoms) According to various Acharyas: Table No. 4Sl Symptoms Ch. Su. A.H M.N Bh.P BS Y.R VR1 Akarmanyata /Chesta nivritti + + + + + + + -2 Paksha Hanana + + + + + + -3 Vichetana /Achetana - + + + + + + -4 Paksha Vimoksh - + - - - - - -5 Sandhi Bandhan Vimoksh - + + + + + + -6 Ruja + - - - - - - -7 Vakstambh + - - - - - - -8 Hasta Pada Sankoch + - - - - - - -9 Toda + - - - - - - -10 Shoola + - - - - - - -11 Patyasan - + - - - - -12 Kampa - - - - - - - +13 Daha/ Santap/ Murcha - - - + + + + -14 Shaitya/ Shotha/ Guruta - - - + + + + - Cheshta Nivritti / Sharirardha Akarmanyata: Loss of motor activity is known as cheshta nivritti. It is hallmark in the diagnosis of Pakshaghata. Exaggerated vata travels through the Urdhva, Adhaha and Tiryag dhamanis performing vishosh of sira and snayu, loosening their grip and thus leading to vaam or dakshinpaksha hanana.78 . Acharya Dalhana interprets ‘Akarmanyata’ as ‘Ishatkarmakshamam’ i.e. Partial loss of function of half of the body. He says that when there is Akarmanyata patient tends to fall. Vijayrakshita specifies ‘Ardh’ as Ardhanarishwarvat, affection of one side of the body; ‘Paksha’ as ‘Bahu, Kaksh, Parshvadi Parts’, Anyatra as left of right half; and Akarmanya as Ishatche 79 shtakshamaha. Arundatta while commenting gives the meaning of Akarmanya as less strength to perform the activities. 80.This cardinal feature is produced mainly due to vitiation of Prana and Vyana Vayu. The main seat of Prana vayu is Mastishka and is the controller “Comparative Management study of Pakshaghata with Mashadi Yoga” 33
  • 81of Buddhi, Hridaya, Indriya and Chitta. . All types of movements occur due to properfunctioning of Karmendriyas, which are governed by Pranavayu. Hence, inPakshaghata, the abnormality in the motor function (cheshta nivritti) is due toimpaired function of Prana vayu. The Vyana vayu controls the circulation of Rasa and Rakta and is also responsiblefor various types of movements, viz., Gati, Prasarana, Akunchana, etc. In abnormality ofVyana vayu, various movements of the body are either diminished or lost completely. Henceby the vitiation of Prana and Vyana vayu, loss of voluntary functions of one side of the bodytakes place. Akarmanyata may be attributed to shosh of nerves due raised levels of ruksha,shita, kahar gunas of Prana vayu and a fall in the levels of chala guna of vyan vayu. Pittavrittavyana leads to cheshta sanga 82. Udanavritta vyana leads to cheshta hani . Pittavritta vyanaresults in gatravikshepasanga. Kaphavritta vyana leads to gatisanga 83.Ardhakaya Vichetana / Sharirardha Achetana 84-85: Chetana means sensation or consciousness and achetana means loss of sensation orconsciousness. The term achetana has been used by Sushruta Acharya and vichetana byVagbhata. Acharya Dalhana interprets the word achetana as alpachetana – partial diminutionof sensation. He further says that the presence of this feature raises the mortality. . Gayadasinterprets it to be complete loss of chetana. Todara explains vichetana as Ishadsparshavignana, i.e., less sensation. Another commentator Chandra interprets it asvigata sangya which means loss of consciousness. Vijayarakshita’s opinion onvichetana is partial diminution of sensation, where tactile, etc. sensory functions aremaintained to some extent.By the sannikarsha of atma, mana, indriya and their artha,gyana or perception of sense is produced. (Ch. Su. 8/12). Hence when there is alteration inthis pathway or in mastishka – center of jnanendriyas, sensory impairment is produced.Achetana/Vichetana is caused by vitiation of Prana and Vyana vayu. Sensation is the functionof jnanendriya and vitiation of Prana vayu leads to Pancha jnanendriya 86Upaghata Vitiation of Vyana vayu leads to Anga suptata (loss of tactile sensation) . “Comparative Management study of Pakshaghata with Mashadi Yoga” 34
  • Hemiplegia with sensory loss on opposite side is seen in MCA occlusion. Sensory lossis also encountered in PCA occlusion, thalamic hemorrhage, etc.Sandhi Bandhana Vimoksha: Sushruta and Vagbhata have described this symptom. Sandhibandhanavimokshameans losseness/laxation of joints. As per the description given by Sushruta, when vitiatedvayu travels through Urdhavagami, Adhogami and Tiryagadhamanies, it loosens thesandhibandhana. Gayadas interprets word dhamani as snayu. Sandhibandhan is made up ofsnayu and shleshaka kapha in particular . Vimoksha is vishishtamoksha, i.e., laxation ofsnayu. Vimoksha means shlathikarana (Hemadri) or vimochayan (Dalhan), i.e.,sublaxation or dislocation of joints on the affected side. This may be due to fallin the level of snigdha guna of kapha due to rise in the ruksha guna of vata. In Modernscience, sublaxation of shoulder is described as a complication of stroke.Vakstambha: This symptom is mentioned by Acharya Charaka only in reference to Pakshaghata.Vak means speech and stambha means to stop, to arrest, to cease, etc. Henceobstruction in speech or loss of speech is vakstambha. Four types of deformities of speechhave been described in classics, viz. Mukatva, Gadagadatva, Minminatva and Vaksanga.According to the samprapti, anyone can occur. Vakstambha results due to vitiation of Pranaand Udana vayu. Vakpravritti is one of the important functions of Udanavayu. Due toabnormality of Udanavayu patient may suffer from this complaint. Kaphavritta Udana resultsin vakgraha. Usually the abnormality is present in the Indriyayatana where the vak indriyamoola is present. If the Pranavayu, which controls all the indriyas, is affected,then vakstambha may occur. According to site of the lesion in brain various disorders ofspeech and language like dysarrthria, aphasia, etc. occur.Ruja:- It is an associated symptom of Pakshaghata which is found on the affected side of thebody. Acharya Charaka mentions ruja as a symptom of Pakshaghata and toda and shoola as “Comparative Management study of Pakshaghata with Mashadi Yoga” 35
  • the symptoms of Ekanga roga. Ruja means pain and any kind of pain is always associatedwith vayu. ‘Santat Ruk’ has been mentioned as a symptom in Asthi-Majjagatavata inPakshaghata there is involvement of snayu and sira. When vayu gets aggravated insnayu, shoola is produced and when vayu gets aggravated in sira, manda ruja is 87produced Pittavritta Prana vayu also results in ruja Pain present is said to be a goodprognostic sign. While describing the prognosis of Pakshaghata it has been mentionedthat the patient should not be taken for the treatment if there is no pain. Pain isfound in RSDS (reflex sympathetic dystrophy syndrome), occurring as acomplication of stroke.Sira Snayu Vishosha: Acharya Charaka and Vagbhata have mentioned this symptom.Chakrapanidatt differentiates Ekangaroga and Pakshaghata and includes this symptomunder Ekanga roga, where as Vagbhata considers them as same. When sira and snayu areaffected by vitiated vayu, due to increased level of shita and rukshaguna of vayu, vishoshaof siraand snayu takes place and this results in kshaya. Sirasnayuvishosha represents itselfas stambha (rigidity), hasta pada sankocha (contraction), vakrata, etc.Daha/ Santapa/ Murcha: These are the pittanubandhit lakshanas of Pakshaghata. Acharya Charaka has statedthat though vata vyadhies are vata dominant diseases, still they are accompanied by theassociation of Pitta and Kapha 88. Acharya Sushruta has clearly stated that when vitiatedvata comes in association with pittadha, santap and murcha are produced89 Bhavaprakash states that ‘Daho Bahya’ and ‘Santapa Abhyantarah’. According toDalhana, daha, santap, etc. are produced due to increase in the level of ushana guna of pitta.In pittavritta saman vayu, daha is found.90. In pittavritta Vyana vayu daha is produced all overthe body, i.e., internal as well as external. Prana vayu when obstructed by pitta, Murcha isproduced. “Comparative Management study of Pakshaghata with Mashadi Yoga” 36
  • Shaitya/ Shoth/ Guruta: These are the kaphanubandhit symptoms of Pakshaghata. Acharya Sushruta says thatwhen vitiated vayu comes in contact with kapha, shaitya, shoth and guruta are produced.Both vayu and kapha have shita guna. So when both come in contact, the level of shita gunais increased and shaitya is manifested. Vitiation of vyana vayu results in shopha Gaurava is aproperty of kapha.Kampa: It is a vata nanatmajvikar due to elevation of Chala guna in chief and alsoan associant of snayu prapta vata There is physiological kshaya of shukra in old agepersons leading to Rasakshaya and vata prokopa, which manifests as kampa Inlesions of mid brain and thalamus, tremor, ataxia, and/or choreoathetoid movementsare encountered.SYMPTOMATOLOGY The common mode of expression of CVD is the stroke, defined as a sudden non-conclusive, focal neurological deficit. Hemiplegia stands as a classical sign of CVD in whichparalysis occurs of one side of the body affecting both arm and leg andsometimes face. Hemiplegia is most commonly seen in damage to the UMN above the levelof the foramen magnum. A discrete lesion of the spinal cord in the uppercervical region may produce hemiplegia but this is rare.CLINICAL FEATURES OF HEMIPLEGIA 1. STAGE OF ONSET :- If the responsible cerebral lesion is acute the paralysis is at first flaccid (Shockeffect). In complete hemiplegia the arm is affected more than the leg and thedistal movements suffer more than proximal ones. The lower face is more affected than theupper. The trunks muscular are weakened on the affected side but the ocular muscles andthose of mastication escape, as they have dual innervations from bothhemispheres. “Comparative Management study of Pakshaghata with Mashadi Yoga” 37
  • Determination of the side of hemiplegia in an unconscious patient – Away from the paralysed side – A transient conjugate deviation of the head and eyestowards the unparalysed side may be observed for a few days. On the hemiplegia side –  Check puffs out during respiration.  Nasolabial fold obliterated.  Corneal reflex diminished  Pain stimulation less effective  More absolute flaccidity of limbs (dropping test)  Paralysed leg extended and assumes position of external rotation while healthy one tends to be semi flexed.  Pupil large on the side of hemorrhage. Eyelid release test: Eye-lid slides down slowly after both the eyelids are pulled upand released simultaneously.  Temperature of paralysed side usually higher.In conscious patients – (On affected side)  Weakness of closure of the eyes and the orbicularis muscle  Weakness of the lower face when the patient is asked to show teeth with flattening of the nasolabial fold and the base of the tongue may be higher.  In slighter cases- weakness of dorsiflexion of the wrist and clumsiness of the fine finger movements with the thumb-finger test, weakness of the extensors of the fingers and elbow joint, and in the leg there is inability to dorsiflex the affected foot as powerfully as that on the unaffected side, with weakness of the flexors of the knee and hip.  The tendon reflexes may be abolished for some hours.2. Stage of Recovery (Residual Hemiplegia) :-In chronic progressive lesion and in stage of recovery of acute lesions there is:  Spasticity making its appearance of “Clasp-Knife” variety. Hence the tendon reflexes return, become greatly exaggerated and may be accompanied by clonus.  The abdominal and cremasteric reflexes on the affected side remain absent and the plantar response is clearly extensor. “Comparative Management study of Pakshaghata with Mashadi Yoga” 38
  •  As the spasticity is greatest in the flexor muscles of the upper limb, the arm is Adducted at the shoulder, flexed at the elbow, wrist and fingers, with the forearm Slightly pronated.  Spasticity being greater in the extensor muscles of lower limb; it is extended at the hip and knee joints.  The gait is characteristic, the paralysed leg being dragged round in semi circle (circumduction), the toes scrapping the floor.  Weakness of the affected side of face  Tongue protruded to the affected side of face  Certain involuntary associated movements in the affected limbs.The spastic gait in hemiplegia During the process of recovery, movement usually returns first at the proximal joints,cruder movements are regained first while delicate activity of the fingers and toes is the lastto return. Power returns first, with hypertonic, to the flexor muscles of the arm, in accordancewith the physiological principle that primitive function is the last to be destroyed and the firstto recover. Thus patient may soon be able to elevate and abduct the affected upper limb at theshoulder and to flex the elbow, fingers and wrist. In the lower limb, power returns first to theextensors of the hip and knee, and to the adductors. The upper abdominal reflex returnsbefore the lower, the planter reflex may become flexor. The recovery of aphasia usuallyprecedes recovery of paralysis.LOCALIZATION OF THE LESIONS PRODUCING HEMIPLEGIA The following are some distinctive symptoms of lesions of the corticospinal tract atdifferent points in its course –CORTICAL LESION:- A cortical corticospinal lesion produces monoplegia or paralysis of even smallermuscle group, Aphasia (if dominant cortex is involved), cortical sensory loss. Jacksonianfits may occur if the lesion is in or near the cortex.SUBCORTICAL LESION:- Weakness predominates in one limb but the whole of the opposite side is affected,impairment of postural sensibility and tactile discrimination by involvement of “Comparative Management study of Pakshaghata with Mashadi Yoga” 39
  • thalamocortical sensory fibres; crossed homonymous hemianopia by damage to opticradiation.INTERNAL CAPSULE:- It is the commonest site and presents with a pure motor and isolated hemiplegia, hemianesthesia if lesion in posterior one-third part. Sometimes homonymous hemi anopia on thesame side may be present.LESIONS IN THE MIDBRAIN91  Weber’s Syndrome: IIIrd nerve palsy with crossed hemiplegia.  Benedikt’s Syndrome: IIIrd nerve affection on the side of lesion with tremors, hypertonia and ataxy on opposite side.  Facial diplegia of the supranuclear type.SAMPRAPTI Samprapti deals with the underlying pathological changes of a disease leading to itsclinical manifestation. Vagbhata has described that nature of the vitiation of doshas and itsrepercussion on the system leading to establishment of the pathological lesions producingclinical manifestation should be treated as the domain of samprapti 92. Each and every stepfrom a healthy state to a diseased one is included in samprapti. By knowing the samprapti, themortality and morbidity can be prevented by blocking the pathogene. Conventionally thesamprapti can be of two types:1) Samanya Samprapti – This is a common pathogenesis among various types of a singledisease.2) Vishishta Samprapti – This is a specific pathogenesis for a particular subtype.SAMANYA SAMPRAPTI OF VATA VYADHI: Acharya Charaka says that on account of various aetiological factors, vata getsvitiated and fills up the rikta strotas of the body causing various kinds of vata vyadhi, whichaffects the whole body or some specific part of it93. Chakrapanidatta has commented on word‘Rikta’ as the strotas becomes hollow and devoid of snehadi substances. The descriptionseems similar to the process of demyleation94 of nerves. According to Charaka vayu also getsvitiated by Dhatukshaya and Margavarana. “Comparative Management study of Pakshaghata with Mashadi Yoga” 40
  • Vata prokopa due to Dhatukshaya: Langhana, laghu and ruksha ahara, etc., lead to rasa kshaya. Atimaithuna leads toshukra kshaya. Because of this Kshaya of the Dhatus, the strotas becomes rikta and vata getsvitiated. This can be compared with the degenerative changes in the nervous system leadingto various nervous disorders. Hemiplegia caused by cerebral heamorrhage also comes underthis category because it causes rakta dhatu kshaya.Vata prakopa due to Margavarna: Causative factors like ama, vegasandharana, marmaghata, etc., cause Margavarana,which means the obstruction of the path. Here the obstruction may be complete or partialleading to riktata of the Srotas beyond the site of obstruction and leads to vata prokopa. Sangatype of Srotodushti occurs in such cases. Hemiplegia due to cerebral embolism, cerebralthrombosis comes under this category.VISHISHTA SAMPRAPTI OF PAKSHAGHATA. Acharyas have mentioned vishishta samprapti of Pakshaghata which is as under:Acharya Charaka says that vayu beholds either side- right or left of the body, dries up the siraand snayu of that part rendering it dead and producing loss of movements, along with ruja andvakshambha 95. According to Acharya Sushruta, Exaggerated vata traverses through the urdhvaga,adhoga and tiryaka dhamanis, lossens the sandhi bandha and leads to vam or dakshin pakshahanan96. The word dhamani has been interpreted by Dalhan as those of only affected half areinvolved. Ashtanga Hridaya– Here there is combination of the views of Charaka and Sushruta.He says that vayu holds half of the body, dries up sira and snayu, loosens sandhi bandha andleads to Ardhakaya Akarmanyata and Vichetana. 97Samprapti has been clarified into six typesby Acharya Charaka which are described here with respect to Pakshaghata “Comparative Management study of Pakshaghata with Mashadi Yoga” 41
  • Sankhya & Vidhi 98: Sankhya is to denote the number of the major types of the disease usually based onthe involvement of doshas. There are three types of Pakshaghata as said in Madhava Nidanaa. Shuddha Vatajab.Pittanubandhic. Kaphanubandhi Vidhi means variety. According to Gangadhara vidhi means Visheshana. So, specialvariety of the disease is vidhi samprapti (sub type). Pakshaghata can be classified into severalsub types as follow –1. Aetiological classification:a. Dhatu kshayajany: Asrika Srava – Haemorrhageb.Margavaranjanya : Asrika Shosa – Thrombosis, Embolism2. Clinical classification:a.Pakshaghata - Ardita (Hemiplegia including Facial nerve paralysis)b.Ardhanga Vata (Hemiplegia Excluding facial nerve paralysis)c. Ekanga Vata (monoplegia)3. Prognostic Classification –a. Sadhya – Sanyukta Doshajab.Krichcha Sadhya – Shuddha Vatajc. Asadhya – Dhatu kshayajanyaVikalpa: This can be taken as Amshansha Kalpana. In Amshansha Kalpana the predominanceof different properties of a Dosha is considered. In Pakshaghata the dosha involved isparticularly vata, however association of pitta and kapha is also found. In Pakshaghataruksha, shita, laghu and sukshama gunas of vayu are increased leading to atrophy, lowtemperature of affected part and atrophy of muscles respectively. Chala guna of vayu isdecreased which leads to loss of voluntary movements.Pradhanya: Depending upon the Taratambhava of Doshas involved, Pradhanya samprapti can beexplained. Pakshaghata being a Nanatmaja vata vyadhi, vata dosha is affected. But it may be “Comparative Management study of Pakshaghata with Mashadi Yoga” 42
  • preceded by the involvement of Kapha and Pitta producing pittanubandhi and kaphanubandhiPakshaghata. Shuddha vataj can be taken as swatantra and doshanubandhita as partantra.Stroke/Hemiplegia is found secondary to HT, hyperlipaemia, heamorrhagic diathesis, tumors,etc.Bala: When Nidana, purvarupa, rupa, dosha and dushya are more in number and are verystrongly involved the disease is said to be Balvana (severe) and vice versa. This knowledge isvery helpful to understand the prognosis of the disease. In stroke the severity depends uponthe aetiology involved and the site and size of lesion. Haemorrhage is most severe, embolismis less severe but difficult to cure and thrombosis is least sever. The greater the extent of thearea of cerebral damage the worse is the outlook. Previous stroke, unconsciousness, HT, etc.,if present then stroke can be considered as Balvana.Kala: Depending upon the age of the patient, time of occurrence of disease with respect toseason, day and night, time of increase and decrease of the disease, etc., kala samprapti can beunderstood. Pakshaghata being a vatika disease is likely to be precipitated in vata prakopakala. Modern science has also give different age and time of onset according to the aetiologyinvolved.SAMPRAPTI GHATAKA Consideration of Dosha, Dhatus, Upadhatus, Mala, Srotas, Ama, Agni, Udbhava,Sanchar, Adhishthan, etc., is the important aspect of Samprapti. Their assessment has to bedone in relation to Pakshaghata.1. Dosha:-  In Pakshaghata, the main culprit is vata dosha. Prana and Vyana vayu are predominantly affected and subsidiary Udana, Smana and Apana are involved.  Pitta and Kapha are also involved in particular type of Pakshaghata.  Besides sharira doshas, Manas doshas are also involved. Raja is supposed to vitiate vata and Tama is entangled with Kapha. The role of psychic factors is well established in hypertension, which is a potent cause of stroke. “Comparative Management study of Pakshaghata with Mashadi Yoga” 43
  • 2. Dushya :-- In Pakshaghata Rasa, Rakta, Mamsa, Meda, Majja, Sira, Snayu, Dhamani and Mala (Pittaand Kapha) are involved. Vitiated vata afflicts the above mentioned Dushya and inducesneeds necessary for Pakshaghata.- Due to the aetiological factors, firstly the Rasa dhatu is affected. Rasa dhatu kshaya leads tokshaya of all the successive dhatus- In this disease sira-snayu Vishosha is a symptom encountered. The vitiated vata affects thesira and snayu leading to its shosha. The mula sthana of mamsa is snayu Snayu is upadhatu ofMeda and Sira is upadhatu of Rakta. So when sira and snayu get deformed, automaticallyRakta, Mamsa and Meda dhatus also get affected.- Mamsa Dhatu can be interpreted with the three tunics of blood vessels. Mamsa dhatu dushtiby vitiated vata can cause loss of elasticity of the blood vessels. Due to this, the vessels do notrespond by dilatation or constriction in conditions of hypertension and hypotension. As aresult ischemic or hemorrhagic stroke can occur. The vitiated Vayu because of its rukshata,kharata, etc., properties affects the blood vessels and does sclerotic changes. Along with this,it does shoshan karma on the blood, changes its viscosity, making it more susceptible to clot.Hence vitiated vayu affects both, sthnastha dhatu (vessels) and margastha dhatu (blood).- Meda dhatu dushti can cause hyperlipidaemia. This leads to blocking of the vessels bycholesterol leading to Atherosclerotic ischemia.- The adhishthana of Pakshaghata is mastishka. Mastishka is referred as Shirastha majjaHence derangement of majja dhatu is chief in Pakshaghata.3. Agni:- All diseases are due to the hypofunctioning of Agni99. Usually in vata prakriti personsand in vata vyadhi the agni remains Vishama So in Pakshaghata also the agni remainsVishama. As a functional sequlae of vishamagni, dhatvangi mandya occurs. “Comparative Management study of Pakshaghata with Mashadi Yoga” 44
  • 4. Ama:- Due to hypo functioning of agni, undigested or semi digested material is produced. Itis know as ama. Dhatvagnimandya leads to dhatugatavastha of ama. The production of dhatumalas is also impaired, whereby they are produced in abundance, especially Rasa and Raktadhatu malas (mala rupa pitta and kapha). Ama (snigdha, pichchila, guru, etc., gunas) interactswith dhatus and malas rendering them sama. The prakupit vata circulates these saam entitiesthroughout the body via the Urdhva, Adah and Tiryag Dhamanis and in turn do sroto uplepaand in advanced stage – margavaran.5. Srotas:-- In Pakshaghata Rasavaha, Raktavaha, Mamsavaha, Medovaha and Majjavaha srotas areinvolved. The term srotas has been used as synonym of sira, dhamani, rasayani, rasavahini,nadi, marga, etc100 . These terminologies have been used to describe the structure and functionof nerve in Ayurveda.- Sushruta has used the word dhamani whereas Charaka and Vagbhatta have used the termsSira and Snayu while describing the pathogenesis of Pakshaghata.- Apart from that there is definite involvement of “Manovaha srotas” in Pakshaghata leadingto impairment in the functions of mana which include disturbance in the higher functions ofthe brain, i.e., consciousness, memory, general intelligence, etc.6. Srotodushti:- Atipravritti, Sanga, Siragranthi and Vimarga-gamana are four types of srotodushti.All these are observed in Pakshaghata. Obstruction of cerebral vessels due to atherosclerosis,thrombus or embolus leading to ischemia can be considered as sanga. Various types ofaneurysms, atheroma can be considered as siragranthi. Rupture of vessels leading tohemorrhage can be considered as atipravritti and vimarga-gamam.7. Roga Marga 101 : Pakshaghata has been enumerated among the ailments of Madhyam Roga Marga. “Comparative Management study of Pakshaghata with Mashadi Yoga” 45
  • 8. Udbhava: In Pakshaghata main dosha involved is vata. Pakvashaya is the main habitat of vatawhich is the udbhava sthan of Pakshaghata.9. Sanchara: Various types of Dhamani, Sira, Srotas and Rasayani can be considered as sancharasthatna in Pakshaghta.10. Adhishthana:In Pakshaghata mainly the functions of Karmendriyas are affected. Charaka has mentionedthat shira (head) controls the functions of the Indriyas. So the Adhishthana of this disease canbe taken as shira, especially the cortex and motor pathways.11. Vyakti sthan: In Pakshaghata either the left or right side of the body is paralyzed, so theaffected side of the body may be taken as vyakti sthan. “Comparative Management study of Pakshaghata with Mashadi Yoga” 46
  • Schematic representation of probable Samprapti of Pakshaghata NIDANA Agantuj (Bahyaabhighata) Kapha, Pitta Prakopaka Ahar Vihar Agnimandya Dhatvagnimandya Amotpatti Samotpatti Margavarana VATA PRAKOPADhamani Rasavahini Sancharana (Prasara) Mastishkastha Majja (Sthan Sanshraya) Dosha Dushya Sammurchchana Majja Vaha Sroto Dushti Sanga Siragranthi Vimargagamana Prana ,vyana vikriti Indiyamoolopaghata Pakshaghata (Vyakti) “Comparative Management study of Pakshaghata with Mashadi Yoga” 47
  • UPADRAVAS 102 Due to negligence or improper treatment, the doshas of the main diseaseget aggravated and manifest themselves as another disorder. Such disorders are referred to asUpadravas (complication). They are disease itself, either big or small, and manifest in thelater period of the main disease. By pacifying the main disease, upadravas are often pacified.But as they appear in the later stage it becomes more afflicting because a person is alreadysuffering from the main disease. Upadravas of Pakshaghata, in particular, have not been listedin any of the samhitas. So the general upadravas of vata vyadhies can be considered as that ofPakshaghata. Acharya Sushruta has described the upadravas of Ashta Mahagada includingVata vyadhies in general and that of vata vyadhies in particular. 103Upadravas of Ashta Mahagada: Prana-Mansa Kshaya, Shwas, Trishna, Shosh, Vaman, Jwara, Murchha, Atisara andHikka. Acharya further states that vatavyadhies which present along with theseupadravas are varjaniya.Upadravas of vata vyadhi : 104 Shotha, Supta Twacha, Bhanga, Kampa, Aadhaman, Ruja and Arti. Patient usually diesif the vata vyadhi co-exist with any of the above-mentioned Upadravas. Madhavkar has added 105few more upadravas to that mentioned by Acharya Sushruta. They are Visarpa, Daha,Ruk, Sanga, Murchha, Aruchi, Agnimardava, Kshina mansa bala. In Charaka Samhita there is no independent description of upadravas of vata vyadhior Pakshaghata. However, while describing the Sadhyasadhyata of Pakshaghata he mentionsthat Pakshaghata devoid of any upadravas should be treated. Chakrapani interpretsthat these upadravas are those of Avarana, i.e., Hridroga, Pliha, Vidhradhi, Gulma andAtisara.SADHYATA-ASADHYATA A physician should have clear idea regarding the prognosis of thedisease before starting the therapy. He should know whether the disease is sadhya, kashta “Comparative Management study of Pakshaghata with Mashadi Yoga” 48
  • sadhya, yapya or asadhya. Good results are obtained in sadhya vyadhies, but if the physicianundertakes the treatment of asadhya vyadhi, he will suffer loss of money and will tarnish hislearning and fame106. Sushruta and Vagbhata have included vata vyadhies under Mahagada and according 107to them all the Mahagada are dushchikitsya by nature. Pakshaghata being a vata vyadhi isalso considered as dushchikitsya. Acharya Charaka while explaining the sadhyasadhyataof some vata vyadhies including Pakshaghata has mentioned that these diseases may ormay not cured even after careful treatment because of the asthimajjagata avastha of thediseases and their deep seated nature. But if these diseases occur in strong persons and are ofrecent origin and without any complications, should be treated by the physician. According to Sushruta Acharya, Pakshaghata resulting from vata alone(withoutanubandha) is krichha sadhyatam (curable with much difficulty) and that resultingfrom anubandha of pitta and kapha is sadhya (curable). Pakshaghata presenting after kshaya 108is asahdya (incurable) Gayadas interprets the word kshaya and says that kshaya may be oftwo types (1) Caused by excessive bleeding is asadhya, (2) Caused by excessive exercise like wrestling is kashtasadhya. Acharya Vagbhata in this context says that Pakshaghata caused by shuddha vata iskrichha sadhyatama (Atikrichhasadhya – Indu), that caused by samsrushta dosha is krichhasadhya and that caused by kshaya is asadhya109. Madhavkara and Bhavmishra have the sameopinion as that of Sushruta. In addition they have described that Pakshaghata occurring ingarbhini, sutika, bala, vruddha, kshina, accompanied by vedana nasha should not be treated. 110Pakshaghata caused by excessive bleeding should also be avoided In Kalyankaraka it has been mentioned that Pakshaghata caused due to ‘Kshata’ isasadhya (vatarogadhikara). Acharya Sushruta has emphasized that after one year the diseaseshould not be treated because it comes under asadhya category. Arishta laxanas of vatavyadhies in general have been described by Acharya Sushruta. Patients with swelling, loss of “Comparative Management study of Pakshaghata with Mashadi Yoga” 49
  • sensation, fractures, kampa, aadhmana, etc., are killed by vata vyadhies. By devyoga, vata 111vyadhies, which are generally asadhya, can sometimes become sadhya 112 ,113,114 ,115 116, 117PATHYA – APATHYA(Ch.S. Su.S. A.H.; Y.R.; C.D.; Bh.R.) Drugs and regimen that are beneficial to the body and the srotas and do not adverselyaffect the body and mind, are termed as pathya (wholesome). Where as, those, which haveadverse effect on body and mind and are incompatible to health, are considered to be apathya(unwholesome) Pathya and apathya depends upon various factors such as matra, kala, kriya,bhumi, deha, dosha, etc. Hence it differs from person to person. Pathya catalyses thedrug action and thus plays a major supporting role in the treatment of disease. In Ayurvedicclassics, separate pathya-apathya for Pakshaghata is not given. Hence the pathya-apathya ofvata vyadhi can be taken as that for Pakshaghata.PATHYA FOR VATA VYADHIES: AHAR:1 .Anna Varga:- Kulthi, Mash, Godhooma, Raktabha Shali, Navina Tilaa, one yearold Shashtikashali.2. Phala Varga:- Amla rasayukta phala, Draksha, Dadima, Jambira, Parushka, Badar, Pakwa Tal, Rasala, Nagaranga, Tintindi Phala.3.Shaka Varga: - Vartaka, Lashuna, Patola, Shigru.4.Dugdha Varga: - Ghrita, Dugdha, Kilota, Dadhi kurchika. Taila Varga – Tilaa Taila, Rubu Taila, Sarshapa Taila.5. 6. Drava Varga – Yusha, Vasa, Majja, Kullatha rasa, Mamsa rasa, Dhanyamla, Go Mutra. 7.amsa Varga – Varities of Gramya, Anupa, Audak, Jangala mamsa M8. Anya – Tambula, Matsyandika, Prasarani, Gokshura, Neema Kshirkakoli.9. All dietary articles having madhur, amla, lavana rasa, ushna veerya, snigdha guna and having brihana and vrishya properties are compatible for patients ailin From vatavikaras.VIHARA: Sukhoshna parisheka, Nirvata sthana, Abhyanga, Mardana, Basti,Swedanam, Avgahana, Upanaha, Agnikarma, Bhushaiya, Snan, Aasana, Taildroni, Shiro “Comparative Management study of Pakshaghata with Mashadi Yoga” 50
  • basti, Shayanam, Samvahanam, Nasya, Agni-Atapa sewan, Snigdha-Ushnalepa,Bramhacharya. Use of Kesar, Agar, Tejapatra, Kooth, Ela, Tagar, Silk clothes, woolen clothes, softbedding. To live in a place which has good sunlight, but devoid of direct wind.APATHYA FOR VATA VYADHIES:AHARA: Trunadhanya, Kalaya, Chanaka, Rajmasha, Kathillaka, Nishpava beeja,Neevar,Kanguni, Bimbi, Kesheruk, Shara, Vainava, Kordusha, Shyamak Churna,Kuruvinda,Mudga, Yava, Karir, Jambu, Trunaka, Kramuka, Mrunal,Talaphalasthimajja,Shaluka, Tinduka, Bala Tal, Shimbi, Patra Shaka, Udumbar, Lake andriver water,Shitambu, Dugdha, Rasabha, Viruddha anna, Kshara padartha, Shushkamamsa,Dushita Jala. Diet with Katu, Tikta, Kashaya rasa and ruksha and shita properties.VIHAR: Vyayama, Vyavaya, Atibramana, Prajagarana, Vegavidharana, Chardi,Shrama,Anashana, Rakta mokshana, Chinta, Ati-Gaja, Ashwa, Yana Sevana.CHIKITSA The term chikitsa is derived from the root “Kit Rogapanayane” i.e., to adoptmeasures against the disease (Shabdastom Mahanidhi). Rukpratikriya, i.e.,counteraction of ruja is chikitsa. Chikitsa aims not only at the radical removal of the diseasebut also guides for the restoration and maintenance of normal health. Disease is caused by thedisequilibrium of the doshas. Hence different process carried out to achieveequilibrium is termed as chikitsa According to Acharya Sushruta chikitsa is defined as the removal of the causativefactors .Vagbhata defines it as the disintegration of Samprapti. On the whole all kinds of vatavyadhies have predominance of vata. So in general antivata treatment is good for all of themincluding Pakshaghata. The word antivata treatment refers to the use of all kinds of drugs,food and life style, which helps to subside vata. In Ayurvedic classics the general “Comparative Management study of Pakshaghata with Mashadi Yoga” 51
  • treatment of vata vyadhi has been discussed in detail. Pakshaghata being a vatavyadhi,this general vata vyadhi treatment is applicable to it also.GENERAL LINE OF TREATMENT OF VATA VYADHI Acharya Charaka has advised Snehan, Swedan, Sanshodhan and Sanshamantreatment for vata vyadhi in general. 118Snehan:1. The main principle for snehan is to observe whether vata dosha is vitiated alone or it isassociated with other doshas and whether it is occluded or not.2. If there is simple provocation of vata without any kind of occlusion, it should be treated atfirst with oral administration of snehan like ghee, fat, oil and marrow.3. The person when over strained by sneha, should be comforted by rest for some time andthen again he should be given sneha with milk, dilute gruels, meat juices, payasas, andkrishara mixed with salt and acid articles. 4. Sneha should be administered by Anuvasan, Nasya and demulcent food. 119Swedan: When samyaka sneha is done, the patient should be subjected to swedan therapy bymeans of Nadi sweda, Prastarasweda, Sankar sweda, etc., mixed with snigdha dravyas.SPECIFIC TREATMENT FOR PAKSHAGHATA The line of treatment of Pakshaghata, in particular, described in various Ayurvedicclassics is tabulated underneath: Acharya Charaka mentions as the treatment for Pakshaghata Chakrapani hasnot commented on this verse. Acharya Jejjata interprets this as snehayukta swedan and snehayukta virechan. Gangadhara has opined the same as Jejjata.-Acharya Sushruta describes the specific line of treatment of Pakshaghata asfollows: A patient of Pakshaghata who is not emaciated, has pain in the affectedpart, habitually observes the rules of diet and regimen and who can afford to pay for thenecessary accessories should be taken for the treatment. Initially, snehan and swedan are to beconducted followed by mridu vaman and virechan. This is to be followed by Anuvasan and “Comparative Management study of Pakshaghata with Mashadi Yoga” 52
  • Asthapan basti. After this the general directions and remedial measures laid down underthe treatment of Akshepaka should be imparted at proper time. Mastishkaya,Shirobasti, Abhyanga by Anu taila, Salvanaupnaha sweda and Anuvasan by Balatailaare the specific measures described. All these above mentioned measures should befollowed carefully for a continuous period of three or four months.-Vagbhata’s view regarding the specific treatment of Pakshaghata is similar to that ofCharaka. He says that snehana and snehayukta virechan should be adopted -Chakradattahas described a number of combinations for the Shaman Chikitsa of Pakshaghata. One ofsuch combination named ‘Mashatmaguptadi Kwatha’ which contains Masha, Atmagupta,Eranda, Bala, has been selected for the present study with modification. Otherformulations include MashabaladiKwath, Swalparasonapinda. Various tailas like MashaTaila, Maha MashaTaila, ect., have been described.Bhavprakasha has advocated the use of Mashadi Kwath, Mashadi Taila andGranthikadi Taila in the treatment of Pakshaghata 120-In Bhaishajya Ratnavali shodhan measures like Tikshna Virechan and Basti have beendescribed 121-Brihanmajjishthadi Kwath and Mashadi Nasya 122 are described in Sharangdhara Samhita forPakshaghata.-In Yogratnakara the treatment given is similar to that of Chakradatta 123CONCEPT BEHIND SELECTION OF PRESENT THERAPIES Two types of therapies Shodhan Purvak Shaman and Shaman have been selected forthe present study in order to compare their efficacy in the management of the disease.Virechan has been selected for the shodhan purpose. 28/100 this is the line of treatment ofPakshaghata given by Acharya Charaka. A different patter of treatment which falls under theprinciple boundaries of Charaka has been evolved for the present study which involves bothshodhan and shaman principles. Pakshathata is one of the well-known Nanatmaj diseasesof vata. In this disease, “Comparative Management study of Pakshaghata with Mashadi Yoga” 53
  • Acharya Charaka and other Acharyas have advocated virechan. According to generalprinciple, basti is the general shodhanchikitsa in vata vyadhi whereas virechan is mainlyadvocated in pittajavyadhi. So there may arise a difference of opinion regardingthe administration of virechan in cases of Pakshaghata. For better understanding of theimportance of Virechan in Pakshaghata it is necessary to know the virtues of Virechan citedin the classics.MANAGEMENT OF STROKEMANAGEMENT OF ACUTE ISCHEMIC STROKE After the clinical diagnosis of stroke is made, an orderly process of evaluation andtreatment should follow. The first goal is to prevent or reverse brain injury. Before startingthe therapy, it should be first confirmed by CT that whether the stroke is ischemic orhemorrhagic. The second goal is to know the complete mechanism for preventing futurestroke 124 . Treatment designed to reverse or lessen the amount of tissue infarction fall with infive categories: (1) Medical support (2) Thrombolysis (3) Anticoagulation (4) Antiplatelet agents (5) Neuroprotectection.MEDICAL SUPPORT: In the acute stage of cerebral ischemia, maintenance of vital signs, potency ofairway and fluid and electrolyte balance and prevention of complications -pulmonary aspiration, seizures, thrombophlebitits, bedsores, etc. are mandatory. Unless thereare major cardio-pulmonary problems, in the early stages head-low or flat position in bed ispreferred.Anoxia should be prevented by keeping the airway patent and clearing the throatSecretions by gentle suction with a sterile catheter. Elevated BP should not be lowered unless there is malignanthypertension or concomitant MI. When faced with competing demands of myocardium and “Comparative Management study of Pakshaghata with Mashadi Yoga” 54
  • brain, heart rate lowering with the B-adrenergic blocker esmolol can be a first step todecrease cardiac work and maintain BP. If BP is low, raising it isadvisable, using intravenousfluids or vasopressor drugs to enhance perfusion within the ischemic penumbra.Fever if present should be treated with antipyretics.Cerebral edema should be treated by hyperosmolar solution (e.g. IV mannitol) and Waterrestriction. Hypovolemia should be avoided. Trials are under way to test the clinical benefitsof craniotomy and elevation of the skull (hemicraniectomy) for larger hemispheric infarctswith marked cerebral oedema.PHYSICAL THERAPY AND REHABILITATION Physiotherapy aims at treatment and care for patients with a neurologicaldisease, attempting restoration of full function and health. The top priority is toestablish independent functioning at the earliest. Treatment must commence immediatelyafter the onset of hemiplegia. Progress is more rapid if the patient is treated two-three times aday in the early stages. In long standing cases, however, a full range of passive movementsshould be carried many times a day. The purpose is to avoid contracture and peri-arthritis, especially at theshoulder, elbow, hip and ankle. Soreness and aching in the paralyzed limbsshould not be allowed to interfere with exercise. Patients should be moved from bed tochair as soon as the illness permits. Nearly all hemiplegics regain the ability to walk to someextent, usually within 3 to 6 months’ period and this should be primary aim in rehabilitation. Since problems arising from hemiplegia are different for each individual and alterfrom day to day, physiotherapy doesn’t bear a fixed regimen and beneficial activities are tobe carefully selected and progressed. Therefore, rehabilitation has to be practicedwith ingenuity. Speech therapy should be given in appropriate cases. As motor function improves,and if mentality is preserved, instruction in the activities of daily living and the use of variousspeech devices can assist the patient in becoming at least partly independent in the home. “Comparative Management study of Pakshaghata with Mashadi Yoga” 55
  • DRUG CONTEMPLATION Acharya Charka. In Ayurveda Aushadha is considered as one of the four foldconstituents of chikitsa –chatushpada and which has been placed next to the physician Thedrug is ‘an agent’ which a physician employs as an instrument in restoring the equilibrium ofthe body tissues In modern ages WHO stresses importance of drug and defines it as asubstance or product that is used or intended to be used to modify or explore physiologicalsystem or pathological status for the benefit of the recipient. Ayurveda was the first to give an elaborate description of varioustherapeutic measures calculated to aim at, not merely the radical removal of the causativefactors but also at the restoration of Doshika equilibrium. According to Ayurveda, the drugsor diet articles that reverse or break the Samprapti is ideal for the particular disease.The consideration of recipes during the line of treatment for particular ailments has agreat importance. The samprapti ghataka, the signs and symptoms produced in particulardisease and the line of treatment laid down is to be considered for the selection of drug orcombination. Though Pakshaghata is said to be a krichhasadhya disease, many therapeuticprinciples have been recommended in Ayurvedic classics. The chikitsa sutra ofPakshaghata given by Acharya Charka is 28/100”. Keeping this main principle inconscious, two types of chikitsa have been selected to know their efficacy on the disease,which is produced herein under:SHODHAN CHIKITSA: Under this regimen, shrovirechan therapy has been selected with employing“Mashadi Yoga Taila” to carry out nasya.SHAMAN CHIKITSA: Under this regimen “MashadiYoga” Kwatha is used for AntahaParimarjan(Internal Medication) made up of a formulation cited in ChakradattaVata Vyadhi Chikitsa . “Comparative Management study of Pakshaghata with Mashadi Yoga” 56
  • INGREDIENTS OF MASHADI YOGA Masha Atmagupta Rasna Bala Urubaka RohishaAswagandha Hingu Saindhava lavana
  • DRUG REVIEW 1. Mashadi Taila 125:Name of Drug: Mashadi Taila Reference:Classification: Mashadiquath.First the quath of drugs was prepared, and it was prepared in Tila taila with the kalka ofsame drugs as per the directions mentioned in Ayurvedic classics.Dose: 1 to 1.5 litre per patientTable No 5. COMPOSITION OF TRIAL DRUG:S.N SANSKARIT NAME BOTANICAL NAME PROPORTION1 Masha Phaseolus mungo 1Part2 Atmagupta Mucuna prurita 1Part3 Rasna Pluchea lanceolata 1Part4 Bala Sida cardfolia 1Part5 Urubuka Ricinus cummunis 1Part6 Rohisha Cymbopogon martini 1Part7 Ashwagandha Withania somnifera 1Part8 Hingu Ferula narthex 1Gram9 Saindhava Lavana Rock salt 1Gram. 126-130TILA TAILA :Latin name:Sesamum IndicumFamily: PedaliaceaeRasa: Madhur, Kashaya, TiktaGuna: Guru, Snigdha, Tikshna, Sukshma, Vyavayi, Vikasi, Sara, Vishada “Comparative Management study of Pakshaghata with Mashadi Yoga” 57
  • Veerya: UshnaVipaka: MadhurDoshaghnata: Vata, KaphaPart used: Bija, TailaPhysical characteristics: (Taila)Appearance – Pale yellow. Liquid with light pleasant ordour.Density: between 0.916 – 0.92Solidifies at – 5’C and forms buttery mass.Chemical Composition: (Analysis of seeds)Moisture: 4.1 – 6.5% Fat : 43 to 56.8% Protien: 43 to 56.8% Carbohydrates : 9.1 to25.2% Crude fibres: 2.9 to 8.9% Mineral matter : 4.1 to 7.4% Oxalic acid : 1.72%Phosphorus : 0.47 to 0.62% Chem. composition of Tila taila (esp. fats) Liquid Fats (70%appx.). Solid fats: (12-14% appx). Glycerides Stearin acid Oleic Acid Palmitin acidLinoleic Acid Myristin acid crystalline substance: Compound: - sesamol – Sesamin theseeds are fairly rich in Vit. A, B and C. Trace elements in the seed include iron, iodine,zinc, cobalt, molybdenum and nickel. Oil is source of protein for human nutrition. Theprincipal protein is globulin. Sesame oil is rich in oleic and linoleic acid which togetheraccount for 85% of the total fatty acids. Stearin, palmitin and myristin are also present. Ithas a relatively high percentage of unsaponifiable matter. Small amount of phospholipidsis present. A crystalline substance sesamin and phenol compound seasamol is present.Sesamolin is also found. (Wealth of India).Karma: Brimhanam, Balya, Vataghna, Shoola Prashamanam, Pathya, Deepan, Vrishya,Agnivardhak, Medhavardhak, Vranhit, Twachya, Matiprad, Stanya. Rogaghnata: “Comparative Management study of Pakshaghata with Mashadi Yoga” 58
  • Sarvaroghar (Sanskarat) the virtues of Tila taila mentioned above lead to select it for thestudy of Shirobasti in Ardit by ‘Mashadi taila’. 131-1341) Masha:Latin Name : Phaseolus radiatusFamily : LeguminosaeSub family : PapilonateGana : Palashadi Varg (Bh.P.)Synonyms : Mansala, Baladhya, Vrushtakar, Kuruvinda, Dhanyavir, Pitrya, Pitrujyottama.Rasa : MadhurGuna : Guru, SnigdhaVeerya : UshnaVipaka : MadhurDoshaghnata : Vatashamak, Kaphapitta VardhakPart used : BijaChem. Compsition: It contains minerals like Ca, P, Mg. Cu and K; and Vitamins like carotene,thiamine, riboflavin, niacin, choline, folic acid, Vit B12 is present in minutequantity. Asuceinoides with properties similar to those of muscle enzyme hasbeen obtained.Globulin, albumin, prolamin and glutelin are the proteins found.Allantoin, glutathione isalso present. It’s a good source of lysine, valin, aminoacids, leucines, etc. (Wealth ofIndia – Raw materials Vol. X).It contains albuminoids 22.7%, starch 55.8%, oil 2.2%,fibre 4.8% and Ash 4%. An analysis of some samples grown in Bombay presidency “Comparative Management study of Pakshaghata with Mashadi Yoga” 59
  • 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 fibers – 4.25 to 5.90 and Ash 3.45 to5.35.(Bombay Govt. Agri. Bulletin).Karma: Rochaka, Vatanashaka, Sara, Stransana, Balya, Shukrala, Brimhana, Stanya,Bhinna Mutra Mala.Rogaghnata: Gudakila, Ardita, Swasa, Paktishula, Vata Roga.Actions and uses: It is used in rheumatism, affection of nervous system and disease ofliver. In Indo-China countries black gram is considered as diuretics and is used in dropsyand cephalagia. (Kirt. & Basu. I).It is the most demulcent cooling as well as nutritious ofall pulses, also aphrodisiac, lactogene and nervine tonic. The pulses shows markedcholesterolelowering effect (in serum, liver and aorta) when fed to rats receiving normalorhypercholesterolemic diet, serum phospholipids levels are alsolowered.(Chem,Abstr.1971,74,10942)Also used in gastric catarrh,dysentery ,diarrhoea,cystitis, paralysis, piles, rheumatism and affections of liver and of nervous system.(Indian Meteria Medica). 135-1362) Atmagupta :(Kaucha bija)Latin name : Mucuna PruritaFamily : LeguminosaeSub-family : PapilionateGana : Balya, Madhurskandha (Ch.) Guduchyadi (Bh.P.) Vidarigandhadi, Vata Sanshamana (Su.)Synonyms : Kapikachachu, Markati, Rhushyaprokta, Kandura, Ajaha Pravrushayani, Dusparsha, Adhyanda, Langali, Shukshimbi “Comparative Management study of Pakshaghata with Mashadi Yoga” 60
  • Rasa : Madhura, TiktaGuna : Guru, SnigdhaVeerya : SheetaVipaka : MadhurPraphava : Shukrala, VajikaraDoshaghnata: Vata-Pitta ShamakPart Used : BijaChem. Composition: Seeds contain moisture 9.10%, Protein 25.03%, fibre 6.75%, ehtr 2.96%, mineralmatter 3.96%, Calcium 0.16%, iron 0.02%, phosphorus0.47%, sulphur and mangaese arealso present in minute quantitities. It also contain four new alkaloids, viz, – mucadine,mucuadinine, mucuadinin and pruriendine. Mucunin, mucunadin and nicotine are presentin small amount. Seedsalso contain L-dopa (1.5%), gluterthione, lecithin, gallic acid anda glucoside.Aminoacids, viz; histidine, lysine, methionine, phynyalanine, tyrosine,leucine,aspartic acid, glutamic acid are also present. Seeds contains oils having fattyacidssuch as stearic, palmitic, mystric and arachidic acid.Karma: Brimhana, Vijikarana,Vrishya, Balya, Artavajanana, Vatahar, Krimighna,Yonisankoschaka, Mootrala,Vatashamana, Raktapitta Nashaka, DushtavranaNashaka.Rogaghnata: Nadidaurbalya,Vata Vyadhi, Klaibya, Krimi, Karshya, YoniShaithilya, Daurbalya, Kshaya, Kashtartava,Moortrakrichcha.Action and Uses: Mucuna pruriens is known to produce itching; this is because of its histaminereleasing property. No toxic effects were reported by any research workers. It also has “Comparative Management study of Pakshaghata with Mashadi Yoga” 61
  • protiens and fatty acids which help in nutrition. (Wealth of India).It is effective intreatment of parkinsonism through anticholenergic activity.(Ramaswamy et. al 1979). Itis found to reduce cholesterole content of liver and blood in rats. (Singh et. al. 1976,plant et.al.1968). Seed extract showed antifungal activity and antihelmintic activity.(Bhatnagar et. al., Neogi et.al.) Which is in suppor twith Ayurvedic texts stating itskrimighna property. It is astringent, laxative, antihelmintic, hypotensive, spasmodic, a potentantiparkinsonian, hypocholesterolemic, antifungal, anti-inflammatory, aphrodisiac andnervine tonic. L-dopa free fraction of seed exhibited potent antiparkinson effect in micein 200mg/kg. (Database on medicinal plants used in Ayurveda, vol.II and pharmacognosyof Indigenous drugs-CRAS). 1373) Rasna:Latin name: Pluchea lanceolataFamily: CompositaeGana: Anuvasanopaga, Vayasthapana (Ch.) Arkadi, Shleshmasamshamana (Su.)Synonyms : Yukta, Surabhi, Sughandha, ElaparniRasa : TiktaGuna : GuruVeerya : UshnaVipaka : KatuPrabhava : VishaghnaDoshaghnata : Kapha-Vata Shamaka, Shreshtha Vatashamak.Part Used : Moola (root) “Comparative Management study of Pakshaghata with Mashadi Yoga” 62
  • Chem. Compsotion: The leaves of Rasna contain quarsitin and izoramaneitin.Pluchin is Extracted from Rasna Panchang. (PVS).Karma : Vatahar, Aamapachana, Vishahar, PachanRogaghanata : Kasahar, Shophahar, Kamphar, Udarroghar, Shvasahar.Action & Uses : It generally acts on disordered of nervous system and also in Degenerative diseases.4) Bala: 138-139Latin Name : Sida CordifoliaFamily : MalvaceaeSubfamily : PapilonateGana : Balya, Brumhaniya, Prajasthapana, Madhurskandha (Ch.) Vataskamshamana (Su.)Synonyms : Vatyayani, Vatyalak, Kharayashtika, Vatyalika, Vatya, Bhadrodani.Rasa : MadhurGuna : Laghu, Snigdha, PicchilaVeerya : SheetaVipaka : MadhurDoshaghnata: Vata-Pitta ShamakPart Used: Moola (Panchang)Chemical Composition: Whole plant contains alkaloids to the extent of 0.085%. Seeds contain muchlarger quantities of alkaloid, i.e., 0.32%. The main portion of the alkaloid was identifiedto be ephedrine. The hydrochloride of the alkaloid occurs in colourless needless m.p. “Comparative Management study of Pakshaghata with Mashadi Yoga” 63
  • 215.5 and is freely soluble in watr, but sparingly soluble in absolute alcohol. Fatty oil,phytosterol, mucins, potassium nitrate, resins, resin acids, etc.are also present but no taninor glucoside is present.Karma: Balakarak, Vrushya, Kantikara, Vatahara, Dhatuvardhaka, Raktapittahara,Ojovardhaka, Sangrahik.Rogaghnata: Vatarog, Raktapitta, Vrana, Kshaya, Mutratisara, Pittatisara.Action & Uses: Roots are used in nervous and urinary disease and disorders of blood and bile. It isalso useful in bleeding piles, strangury, haematuria, gonorrhea, cystitis, leucorrhea, andchronic dysentary, nervous disease as hemiplegia, insanity, facial paralysis and in asthmaas a cardiac tonic. (Wealth of India).Roots are regarded as cooling, astringent, stomachicand tonic, aromatic, bitter,febrifuge, demulcent and diuretic, (Chopra & De. 1930) haveshown the presenceof a sympathomimetic alkaloild whose pharmacological actionclosely resembles that of ephedrine and they throught that the alkaloid was undoubtlyephedrine.Later Ghosh & Dutt (1930) have shown that the sympathomimetic alkaloidreferred to above showed all chemical and physical characteristics of ephedrine.So, itsuse as a cardiac stimulant in the old Hindu medicine has thus a naturalbasis.Pharmacological action causes marked and persitance raise of bloodpressure inanaesthetized or decerebrated animals.5) Urubuka 140:Latin Name : Ricinus CommunisFamily : EuphorbiaceaeGana : Bhedaniya, Angamardaprashaman, Swedopaga, Madhurskandha, (Ch). “Comparative Management study of Pakshaghata with Mashadi Yoga” 64
  • Vidarigandhadi, Vatasamshaman, Adhobhaghar (Su.) Guduchyadi Varga (Bh. P.)Synonyms : Chitra, Gandharvahasta, Shukleranda, Aamanda, Vardhaman, Panchangula, Vyadambak, Dirghadanda, Taruna, Rubuk, Vatari.Rasa : Madhur, Anurasa-Katu, KashayaGuna : Guru, Snigdha, Tikshna, SukshmaVeerya : UshnaVipaka : MadhurDoshaghnata : Kapha-Vata ShamakPart used: MoolaChem. Composition: Root and root bark contains inorganic materials like potassium, sodium,magnesium, chloride, nitrate, iron, aluminium, manganese, calcium, carbonate andphosphate gallotanins. Root shows presence of phenolic constituents.Anthraquinonederivaties are absent in the water extract of the root powder.Powder mixed with water,shaken and left to stand for sometimes yields a mucilagenous substance. Root bark shwsthe presence of steroid having m.p.1590’ (Seshadri et. al. 1968). Ricinine is a watersoluble alkaloid present in the seed coat, leaves and stems.Karma: Vatahara, Vrushya, Deepan, Grahi, Bhedan, Rechan, Sara, Vayasthapan,SrotovishodhanaRogaghnata: Gridhrasi, Amavata, Gulma, Prameha, Vatavikar,Udavarta,Anaha,Antravridhdhi, Arochaka, Arsha, Jvara, Krimi, Kushtha, Mutrakrichcha,Pandu,Pliharog, Pravahika, Shlipada, Shotha, Shoola, Udara, Swasa. “Comparative Management study of Pakshaghata with Mashadi Yoga” 65
  • Action & Uses: Purgatives, cures muscular rheumatism, paralysis, tremor, asthma, cough,colickypains, Carminative, anti-inflammatory and emmenagogue. The root of the plantisuseful as an ingredient of various prescriptions for nervous diseases andrheumaticaffections such as lumbago, pleurodynia and sciatica.The pharmacological researcheshave shown that fraction II of the alcoholic extract of the root bark showed potent anti-inflammatory activity on experimental animals comparable to aspirin and corticosteroids.(Sharma et. al. 1969) (Banerjee et. al. 1978) also reported that apart from its purgativeactivity, the plant possesses efficacy in chronic rheumatic affections (Pharmacognosy ofIndigenous drugs (CCRAS)). 1416) Rohisha :Latin Name : Cymbopogon MartiniFamily : GramineaeSynonyms : Kattruna, Saugandhika, Bhutee, Rohishatruna, Shyamak, DevajagdhakaRasa : Katu TiktaGuna : Ruksha, Laghu, TikshnaVeerya : UshnaVipaka : KatuDoshagnata : Kaphagna-VatagnaPart Used : Moola and PatraChemical Composition: The leaves contain aromatic oil (Ganoil) which is brownish blue, has a rose like aroma and tastes like ginger “Comparative Management study of Pakshaghata with Mashadi Yoga” 66
  • Action and Uses:External uses: Analgesic and anti-inflammatory action helps in rheumatoid arthritis, synovitis, dermatitis and alopecia.Internal uses: Since rohisha is an appetizer, digestive, Carminative and antihelimentic, it is useful in many disorders of the gastrointestinal tract . It is useful in cough ,cold and asthma as it reduses the congestion of the respiratory tract .It acts as a Galactogogue due to its rasa and raktagamitva . Rohisham is also used in dysuria. Since it is diaphoretic, it is used in fever caused by kaphavata.7) Ashwagandha: 142Latin Name : Withania SommiferaFamily : SolanaceaeGana : Balya, Brimhaniya, Madhuraskandha (Ch.)Synonyms : Varahakarni, Ajogandha, Vajigandha, Balada, etc.Rasa : Tikta, Katu, MadhurGuna : Laghu, SnigdhaVeerya : UshnaVipaka : MadhuraDoshaghata : Kapha-VatashamakPart Used : MoolaChemical Composition: The roots contain bitter alkaloid somniferin, resin, fat, colouring matter, reducingsuger, phytosterol, ipuranol, mixture of saturated and unsaturated acids and alkaloid like “Comparative Management study of Pakshaghata with Mashadi Yoga” 67
  • visamine is present (Nadkarni). It also contains cuscohygrine, anahygrine, trophine,anaferine, glycoside, withanole, Amlastarch, sarkara, and aminoacids (PVS)Karma: Vatahar, Balya, Rasayani, Shukral, Brimhaniya. Rogaghnata: Kas, Shwas,Kshaya, Vranahar, Shophahar, Kshyahar, Granthi, Urusthambha, Shosha, Vatavyadhi,Upadamsha, Vandhyatva, Udarrog, Nidranash, etc.Action and Uses: The powder of root of Aswagandha was reported with an action causingconsiderable reduction of inflammation in rats. It showed changes in the concentration ofmuch serum. This activity is suggesting that several compounds persent in it possiblyinteract with liver protien synthesis. (Analbalgin K. 1981). The effect of drug onsynthesis of collagen and in the corporation of C proteins of granulating agent. Itinhibits synthesis of collagen and marked reduction in granulomatous tissue formation. Italso suggests prophylactic effect in the same.(Begam et.al. 1982). Various workssuggests fast acting and durableAnti- inflammatory activity. Withaferine A is the most important alkaloid and, this is inconcentration of 10 mg/ml inhibited the growth of various gram positive bacteria acidand gram negative bacilli. The lactone showed strong therapeuticactivityinexperimentallyinduced abcessess, the effect being some what stronger than thatof penicillins.Itisantibiotic due to presence of an unsaturated lactone rings. It also has inhibitoryactivity in vitro against human carcinoma (Wealth of India 1976). Itis also consideredasimmunomodulator drug. “Comparative Management study of Pakshaghata with Mashadi Yoga” 68
  • 1438) HinguLatin Name : Ferula foetidaFamily : UmbellifereaeGana : Sangnastapana ,Deepaniya ,Katuka Skanda(C),Pippalyadi ,Ushakadi (S)Synonyms : Varahakarni, Ajogandha, Vajigandha, Balada, etc.Rasa : KatuGuna : Laghu, Snigdha,tikshna and saraVeerya : UshnaVipaka : KatuDoshaghata : Kapha-Vatashamak and Pitta vardhakaPart Used : LatexChemical Composition: 6 to 17 % volatile oil.This contains rason oil and allylpersulphide which emits a special smell. 65 %resin,wax etc.Action and Uses: It is stimulant analgesic ,sangnastapaka and anticonvulsant by its ushna veerya.it is useful in paralysis,facial palsy,torticollis , sciatica and epilepsy .Action on digestivesystem isstimulates appetite,digestive and improves taste because of pungent and ushnaproperty on circulatory system it is cardiac stimulant , in vataja cardiac disorder,pericardial effusion and cardiac pain . External uses: Analgesic, Vata alleviating and stimulant properties help inflatulence by topical application .Hingu water is applied to reduse swelling and pain ofguinea worms. “Comparative Management study of Pakshaghata with Mashadi Yoga” 69
  • 9) Saindhava Lavana : 144 Synonyms: Sindhu lavana ,sitasiva , nadeya and siva English name: Rock salt Gana: Virechana (ca, su.) Rasa: lavana Guna: Snigdha, Laghu Veerya: sheeta Vipaka: Madhura Doshgnata: Tridosha hara Karma: Chakshushya, vibhandha hara and mukha roga hara. Chemical composition: It is miniral form of sodium chloride occurs in crystallinemassive and granular compact forms. It soublity in water is 3.5 to 7gma per 100 gms ofwater at 0 degree centigrade and 39.8 gm / 100 gm at 100 degree centigrade Properties: Rock salt promotes digestion 4 ceel formation, act as stimulant so it isused in the treatment of sprain, it is also used in treatment of goiter. It is given orally inthe heart cramp. Also helps in the prohibiting pathogenesis and diuretic action. “Comparative Management study of Pakshaghata with Mashadi Yoga” 70
  • CHAPTER 4 MATERIALS AND METHODS Research is un biased investigation or inquiry in a systemic manner to establish newinvention and facts, correcting or modifying the old one The ultimate aim of any research in thefield of medical science is to find suitable remedies for particular ailment and to promote healthResearch methodology involves the systemic procedures by which the researcher starts from theinitial identification of problem to its final conclusion.The materials and methods of the present study consist ofSources of dataa) Patient: Patients are selected from O.P.D of D.G.M.A M.C. and H. after fulfilling theInclusion and exclusion criteriab) Literary: Required literary information for the intended study is procured from both theAyurvedic and Modern textbooks and they are updated with recent journals of both the Faculties.c) Trail drug:Abhyantara: Mashadi Yoga Kwatha is used.Nasya : Mashadi Yoga Taila is used.Preparation of Mashadi Yoga Kwatha: The course powder of all the drugs of Mashadi Yoga are mixed properly and weighing 24gms of kashaya choorna packed in air tight plastic pouches. when ever the kashaya to beprepared instantly , by adding 400 ml of water to the kashaya choorna and reduced to 100ml (1/4), it is filtered and taken orally .Preparation of Mashadi Yoga Taila: First of all in any preparation of the taila which are administered internally are subjected “Comparative Management study of Pakshaghata with Mashadi Yoga” 71
  • for murchana, here the tila taila is taken and with the murchana dravya process was carried out.All the drugs of Mashadi Yoga is taken in the form of course powder and kashaya is preparedaccording to classical instructions .The murchita tila taila and kashaya is mixed ,it is kept forboiling until the taila paka sidda lakshana is observed and tested.The medicine was kept in airtight glass container .d) Instruments • Sphygmomanometer for assessment of The Grip test. • Knee Hammer for checking the Reflexes. • Measuring Tape for measuring the Muscle Atrophy.Method of collection of data:(a) Study design: The patients with Pakshaghata within the age group of 30 yrs to 70 yrs. were selected Randomly from O.P.D of D.G.M.A M.C. and H. after fulfilling the inclusion and exclusionCriteria irrespective of their sex, occupation and socio-economic status. The size of sample was30 excluding the dropouts. The present study is a double group study where in, patients wereassigned in two groups. It is a Simple randomSampling comparative clinical observation.SAMPLE SIZE: The study is undertaken in two groups. 1. In group A minimum of 15 patients are taken for Oral administration. 2. In group B minimum of 15 patients are taken for Nasya.30 patients were taken for the planed study as a double group.INCLUSIVE CRITERIA 1. Patient belongs to either gender are included. 2. Age groups of 30-70Years are included. 3. Patients with classical sign and symptoms of Pakshaghata are included. a) Chesta nivrutti and Ruja in dakshina pradesh b) Chesta nivrutti and Ruja in Vama pradesh “Comparative Management study of Pakshaghata with Mashadi Yoga” 72
  • c) Vak stambha d) Sankocha and shoola in pada. e) Sankocha and shoola in hasta. 4. Flaccid hemiplegia – ICD 10 G -82 5. Spastic hemiplegia ” ” 6. Unspecified hemiplegia ” ”EXCLUSIVE CRITERIA 1. Congenital cerebral palsy - ICD 10 G80 2. Infantile cerebral palsy – ICD 10 G80 3. The patient with secondary systemic involvement 4. Patient suffering with any other systemic disorder viz. a) Renal failure, b) Hepatic disorders c) Endocrine systemic disordersDiagnostic criteria As per the clinical features of Pakshaghata mentioned in classics, cases are diagnosed.Stroke recovery score card, The Barthel index and Grip test are used to grade the Severity andchronicity of Pakshaghata. They are- 1. Chesta nivrutti and Ruja in dakshina pradesh 2. Chesta nivrutti and Ruja in Vama pradesh 3. Vak stambha 4. Sankocha and shoola in pada. 5. Sankocha and shoola in hasta.POSOLOGYGroup A – Mashadi Kwatha orally - 96ml/ 24 hrs in divided doses i.e. 48ml BDGroup B – Mashadi Taila Nasya -8drops in each nostrils for 7days continuously followed by 3days rest done for Three Avritti i.e. 1 to 7 days Nasya, 3 days rest, 11 to 17 days Nasya, 3 daysrest, 21 to 27 days Nasya, 3 days rest .STUDY DURATIONGroup A - Abhyantara - Thirty days. “Comparative Management study of Pakshaghata with Mashadi Yoga” 73
  • Group B - Nasya - Mashadi Taila Nasya -8drops in each nostril for 7days Continuously followed by 3 days rest. Administered For Three Avritti i.e. 7+3 x 3.Follow up: - Thirty days for both groupsASESSMENT OF RESULTS: The subjective and Objective parameters of base line data to post medication datacompared for assessment of the final results. All the results are analyzed statistically forsignification using unpaired‘t’-test.Subjective parameter:Signs and Symptoms of Pakshaghata are considered as1. Chesta nivrutti and Ruja in dakshina pradesh2. Chesta nivrutti and Ruja in Vama pradesh3. Vak stambha4. Sankocha and shoola in pada.5. Sankocha and shoola in hasta. Objective parameter: 1. Stroke recovery score card 2. The Barthel index 3. Grip testINVESTIGATION: 1. Random Blood Sugar 2. Platelet count 3. Prothrombin Test 4. Complete urine examinationAssessment Criteria: Assessment of signs/symptom before and after was main criteria.Assessment of Variables: Clinical assessment was made for the severity of the disease and for the clinical “Comparative Management study of Pakshaghata with Mashadi Yoga” 74
  • Improvement regarding for the severity of individual symptoms assessment was framed Asfollows.ASSESMENT OF OBJECTIVE VARIABLES:1 .STROKE RECOVERY SCORES CARD: Difficulty Scale 1 = None 2 = A little 3 = some what 4 = A lot 5 = Severe2. THE BARTHEL INDEX: Ability Scale 0 = unable 5 = needs help 10 = independentHANDGRIP TEST: With the patient lying flat, measure the maximal handgrip force by having the patientgrip a semi-inflated sphygmomanometer cuff as hard as possible. Then, with a secondsphygmomanometer, measure the rise in diastolic blood pressure after a 30% handgrip sustainedfor 5 minutes. The diastolic pressure should rise >16mmHg; in autonomic disorders it will rise<10mmHg.Hand grip power: For measuring handgrip power calf of B.P. apparatus was inflated up to 20 mmHg. Thiswas counted as 0 mmHg. After that the rise in pressure was measured. Grading for assessment of grip 0 = 30 – 40 mm Hg 1 = 20 – 30 mm Hg 2 = 10 – 20 mm Hg. 3 = 0 – 10 mm Hg. “Comparative Management study of Pakshaghata with Mashadi Yoga” 75
  • ASSESSMENT OF GAITObserve the patient walking at a brisk pace, including turning. Pay particular attention to: • Reduced arm swing • Stooped posture • Lurching to one side • Asymmetry and loss of smoothness of steps • Increased breadth of base (transverse distance between steps) • Excessive stiffness or floppiness at the ankle or knee joints • Associated involuntary movements • Apparent pain. Table No.6 Grade of tendon reflexes as follows: Grade Tendon reflexes 0 Absent 1 Present (as a normal ankle jerk) 2 Brisk (as a normal knee jerk) 3 Very brisk 4 Clonus.Table No. 7 The Medical Research Council Scale for grading muscle function Grade 0 Complete paralysis Grade 1 A flicker of contraction only Grade 2 Power detectable only when gravity is excluded by appropriate postural adjustment Grade 3 The limb can be held against the force of gravity, but not against the examiners resistance Grade 4 The limb can be held against gravity and against some resistance, but is not normal (a percentage estimate, or a grade of 4+, 4 or 4- is often applied) Grade 5 Normal power “Comparative Management study of Pakshaghata with Mashadi Yoga” 76
  • SUBJECTIVE VARIABLES: a) Chesta nivrutti and Ruja in dakshina pradesh b) Chesta nivrutti and Ruja in Vama pradesh c) Vak stambha d) Sankocha and shoola in pada. e) Sankocha and shoola in hasta.ASESSNMENT ON CLINICAL IMPROVEMENT: Clinical improvement of the disease was based on improvement in the clinical findingand reduction on the severity of the symptoms of the disease grading for theClinical improvement for individual variables.Grading for the clinical improvement for individual variables: 1. Good: Able to walk independently Able to hold the things Able to flex and extend at joints2. Moderate: Able to walk with support Struggle to hold the things Able to flex and extend at joints with support3. Poor: Not able to walk Not able to hold things Not able to flex and extend at joints4. No response: No change in the movements No change in the holding the things No change in joint movementsStatistical analysis: The data were collected from both groups before, during and after treatment and at theend of follow up and statistically analyzed by using student ‘t’ test in consultation with thebiostatistician. “Comparative Management study of Pakshaghata with Mashadi Yoga” 77
  • CHAPTER – 6 RESULTS Present study is having two groups, registered 15 patients in each Groups, Group- A andGroup –B, and no one patient was left out the trial. The 30 patients of Pakshaghata, fulfilling thecriteria of diagnosis and inclusive criteria were included as Double Group for the present study.All the patients were examined before and after the trail, according to the case sheet format givenin the annex. Both the subjective and objective criteria were recorded along with validation ofdisease state. The data recorded are presented under the following heading A. Demographic data B. Evaluating disease Data C. Result of the Mashadi Yoga D. Statistical analysis Observation of demographic data:A1) Table No.8 Showing the distribution of patient’s according to age groups No. of patients and percentage Age Group A Group B Total group No. of % No. of % No. of % patients patients patients 30-40 07 46.67 % 08 53.33 % 15 50% 40-50 04 26.67 % 06 40.00 % 10 33.33% 50-60 02 13.33 % 01 6.67 % 03 10% 60-70 02 13.33 % 00 00 % 02 6.67% 15 100 15 100 30 Among the 15 patients of Group -A, 07 patients are in between the age group of 30-40years (46.66%), out of this 3 got good response,3 moderate and 1 poor response. 04 patients arein between the age group of 40-50 years(26.67%) out of which 4 got good response.2 patients are “Comparative Management study of Pakshaghata with Mashadi Yoga” 78
  • in between the age group of 50-60 years (13.33 %), out of this 2 got moderate response.2 patientsare in between the age group of 60-70 years (13.33%), out of which 1 got good response .1 gotmoderate response in this study. Among the 15 patients of Group -B, 08 patients are in between the age group of 30-40years (53.33%), out of this 7 got good response and 1 moderate response. 06 patients are inbetween the age group of 40-50 years(40%) out of which 5 got good response and 1 got poorresponse.1patient is in between the age group of 50-60 years (6.67 %), out of this 1got goodresponse. no patients are registered in between the age group of 60-70 years in this study . Overall: out of 30 patients 15 (50%) from 30-40 age group, 10 (33.33%) from 40-50group and 03(10%) were from 50-60 group and 02(6.67%) from 60-70 group .Figure No. 1 Showing distribution of patients by age 16 15 14 12 10 10 30-40 8 8 40-50 7 6 50-60 6 60-70 4 4 3 2 2 2 2 1 0 0 Group A Group B TotalA2) Table. No. 9 Showing the distribution of patients according to Gender No. of patients and percentageGender Group A % Group B % Group A and B %Male 06 40.00 % 06 40.00 % 12 40%Female 09 60.00 % 09 60.00 % 18 60% Among 15 patients of Group -A, 06 patients (40 %) are males out of this 2 got good , 3moderate and 1 poor response. 09 patients (60 %) are Females in this Group, out of this 6 gotgood, 3 moderate response. “Comparative Management study of Pakshaghata with Mashadi Yoga” 79
  • Among 15 patients of Group -B, 06 patients (40 %) are males out of this 6 got good . 07patients (60 %) are Females in this Group, out of this 7 got good, 1 moderate, 1 poor response.Overall: distribution of male was 12 (40%) and female was 18 (60%).Figure.No.2 showing distribution of patients by gender 18 18 16 14 12 12 10 9 9 Male 8 Female 6 6 6 4 2 0 Group A Group B TotalA3) Table.No.10 Showing distribution of patients by ReligionReligion No .of patients and percentage Group A % Group B % Group A and B %Hindu 05 33.33 % 13 86.67 % 18 60%Muslim 10 66.67 % 02 13.33 % 12 40%Christians 00 00 % 00 00% 00 00% Among the 15 patients of Group –A, 05 patients are Hindus (33.33%), out of this 2patients got good, 2 falls under moderate and other 1 got poor response. 10 patients areMuslims(66.67%)out of this 6 got good and 4 got moderate response. None of the patients areChristians, in this study. Among the 15 patients of Group –B, 13 patients are Hindus (86.67%), out of this 11 “Comparative Management study of Pakshaghata with Mashadi Yoga” 80
  • patients got good, 1 falls under moderate and other 1 got poor response 02 patients are Muslims(13.33 %) out of this 2 got good response. None of the patients are Christians, in this study.Overall: Among 30 patients, Hindus were 18(60%), 12 (40%) were Muslims and no Christian 00(00%) were registered.Figure.No. 3 Showing distribution of patients by religion 18 18 16 14 13 12 12 10 10 Hindu 8 Muslim Christian 6 5 4 2 2 0 0 0 0 Group A Group B TotalA4) Table.No.11 showing distribution of patients by OccupationOccupation No of patients and percentage Group A % Group B % Group A and B %Sedentary 04 26.67% 05 33.33% 09 30%Active 06 40 % 05 33.33% 11 36.67%Labour 05 33.33% 05 33.33% 10 33.33% Among 15 patients of Group -A, 04 (26.67 %) are Sedentary, out of this 2 patients gotgood response and 2 got Moderate response. 06 (40 %) are Active, out of which 3patients got “Comparative Management study of Pakshaghata with Mashadi Yoga” 81
  • good and 3 falls under moderate response. 05 (33.33 %) are Laborer in occupation out of this 3got good, 1 got moderate response and other 1 poor response in this study. Among 15 patients of Group -B, 05 (33.33 %) are Sedentary, out of this 4 patients got good response and 1 got poor response. 05 (33.33 %) are Active, out of which 5 patients got good response. 05 (33.33 %) are Laborer in occupation out of this 4 got good ,1 got moderate response and other 1 poor response in this study. Overall: out of 30 patients 09 (30%) were Sedentary, 11(36.67%) were Active, 10(33.33%) were Labors. Figure.No.4 showing distribution of patients by occupation12 11 1010 98 6 Sedentary6 5 5 5 5 Active 4 Labour420 Group A Group B Total A5) Table.No.12 showing distribution of patients by Economic Status Eco. Status No of patients and percentage Group A % Group B % Group A and B % Poor 06 40.00 % 05 33.33 % 11 36.67% Middle 08 53.33 % 08 53.33 % 16 53.33% High 01 6.67 % 02 13.33 % 03 10% “Comparative Management study of Pakshaghata with Mashadi Yoga” 82
  • Among 15 patients Group -A, 06 (40 %) are under Poor class, out of this 4 got good, 1moderate and 1 poor response.08 (53.33 %) are of Middle class, out of this 4 got good, 4 gotmoderate response .1 patient (6.67 %) are from Higher class, got moderate responses in thisstudy. Among 15 patients Group -B, 05 (33.33 %) are under Poor class, out of this 4 got goodand 1 moderate response.08 (53.33 %) are of Middle class, out of this 7 got good and 1 got poorresponse .2 patients (13.33 %) are from Higher class, got good responses in this study. Overall 11 (36.67%) patients were poor, 16 (53.33%) were middle class and 03 (10%)patients were of higher class.Figure.No.5 showing distribution of patients by Economic status 16 16 14 12 11 10 8 8 Poor 8 Middle class 6 6 Higher 5 4 3 2 1 2 0 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 83
  • A6) Table. No. 13 Showing distribution of patients Type of dietDiet No of patients and percentage Group A % Group B % Group A and B %Vegetarian 06 40.00 % 10 66.67 % 16 53.33%Mixer 09 60.00 % 05 33.33 % 14 46.67% Among 15 patients of Group -A, 06 (40 %) were Vegetarians out of this 4 got good and 2moderate response. 09 patients (60 %) had Mixed diet out of this 4 got good, 4 moderate and 1got poor response. Among 15 patients of Group -B, 10 (66.67 %) were Vegetarians out of this 9 got goodand 1 moderate response. 05 patients (33.33 %) had Mixed diet out of this 4 got good and 1 gotpoor response.Overall: out of 30 patents 16 (53.33%) were vegetarians and 14 (46.67%) were of mixed dietFigure.No.6 showing distribution of patients by type of diet16 1614 141210 10 98 Vegetarian 6 Mixed6 5420 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 84
  • A7) Table No. 14 Showing distribution of patients Overall responseResponse No of patients and percentage Group A % Group B % Group A and B %GR 08 53.33% 13 86.67% 21 70%MR 06 40% 01 6.67% 07 23.33%PR 01 6.67% 01 6.67% 02 6.67% Among 15 patients of Group -A, 08 (53.33 %) were good responded, 06 (40%) were 1moderately responded. 01 patient (6.67 %) was poor responded. Among 15 patients of Group -B, 13 (86.67 %) were good responded, 01(6.67%) was 1moderately responded. 01 patient (6.67 %) was poor responded. Overall: out of 30 patients, 21(70%) patients showed good response, 07 (23.33%)patients showed moderate response and 02 (6.67%) patients showed poor response. Figure.No.7 showing distribution of patients by Overall response 25 21 20 15 13 GR MR 10 PR 8 7 6 5 2 1 1 1 0 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 85
  • A8) Table No 15 Showing distribution of patients by AgniAgni No of patients and percentage Group A % Group B % Group A and B %Samagni 01 6.67% 03 20% 04 13.33%Mandagni 04 26.67% 03 20% 07 23.33%Teekshnagni 07 46.67% 05 33.33% 12 40%Vishamagni 03 20% 04 26.67% 07 23.33% Among 15 patients of Group –A , 01 patient having samagni ,03 patients havingvishamagni, 07 patients having tikshnagni and 04 patients having mandgni . Among 15 patients of Group –B , 03 patient having samagni ,04 patients havingvishamagni, 05 patients having tikshnagni and 03 patients having mandgni .Overall: Out of 30 patients, 04 (13.33%) were having Samagni, 07 (23.33%) were havingMandagni, 12 (40%) were having Teekshna and 07(23.33%) were having Vishamagni.Figure.No.8 showing distribution of patients by Agni 12 12 10 8 7 7 7 Samagni 6 Mandagni 5 Teekshnagni 4 4 4 4 Vishamagni 3 3 3 2 1 0 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 86
  • B1) Table. No. 16 Showing distribution of patients by Nidana (Ahara)Nidana No of patients and percentage Group A % Group B % Group A and B %Adyashana 09 60% 08 53.33% 17 56.67%Anashana 06 40% 07 46.67% 13 43.33%Ushna 12 80% 09 60% 21 70%Sheeta 03 20% 06 40% 09 30%Ruksha 06 40% 08 53.33% 14 46.67%Drava 09 60% 07 46.67% 16 53.33% Among 15 patients of Group –A, 09 patients do adyashana , 06 patients do anashana, 12patients consume ushna padartha, 03 patients consume sheeta padartha, 06 patients consumesruksha padartha and 09 patients consume drava padartha. Among 15 patients of Group –B , 08patients do adyashana ,07 patients do anashana, 09 patients consume ushna padartha, 06 patientsconsume sheeta padartha ,08 patients consumes ruksha padartha and 09 patients consume dravapadartha. Overall: Out of 30 patients ,17(56.67%) patients do adyashana ,13 (43.33%) patients doanashana ,21 (70%)patients use ushna padartha , 09 (30%) patients consume sheeta padartha,14(46.67%) patients consumes ruksha padartha and 16 (53.33%) patients consume dravapadartha.Figure.No.9 showing distribution of patients by Nidana (Ahara) 25 21 20 17 Adyashana 16 15 Anashana 14 13 Ushna 12 S heeta 10 9 9 9 9 Ruksha 8 8 7 7 Drava 6 6 6 5 3 0 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 87
  • B2) Table.No.17 showing distribution of patients by Nidana (Vihara)Nidana No of patients and percentage Group A % Group B % Group A and B %Vegadharana 10 66.67% 9 60% 19 63.63%Atapasevana 4 26.67% 10 66.67% 14 46.67%Adhwagamana 9 60% 8 53.33% 17 56.67%Athivyayama 10 66.67% 8 53.33% 18 60%Prajagarana 5 33.33% 5 33.33% 10 33.33%Athi Maithuna 10 66.67% 11 73.33% 21 70% Among 15 patients of Group –A, 10 patients do vegadharana, 04 patients doatapasevana, 09 patients do adhwagamana , 10 patients do athivyayama, 05 patients doprajagarana and 10 patients do athimaithuna . Among 15 patients of Group –B, 09 patients do vegadharana, 10 patients doatapasevana , 08 patients do adhwagamana , 08 patients do athivyayama, 05 patients doprajagarana and 11 patients do athimaithuna Overall: out of 30 patients, 19 (63.63%) patients do vegadharana,14(46.67%) patients do atapasevana, 17(56.67%) patients do adhwagamana , 18(60%)patients do athivyayama, 10(33.33%) patients do prajagarana and 21(70%) patientsdo athimaithunaFigure.No.10 showing distribution of patients by Nidana (Vihara) 25 21 20 19 18 17 V e ga dha ra na 15 14 A t a pa s e v a na A dhwa ga m a na 11 10 10 10 10 10 10 A t hiv ya ya m a 9 9 P ra ja ga ra na 8 8 A t hi M a it huna 5 5 5 4 0 G ro up A G ro up B T o tal “Comparative Management study of Pakshaghata with Mashadi Yoga” 88
  • B3) Table.No.18 showing distribution of patients by Manasika HetuManasika No of patients and percentageHetu Group A % Group B % Group A and B %Krodha 8 53.33% 10 66.67% 18 60%Shoka 9 60% 4 26.67% 13 43.33%Bhaya 11 73.33% 10 66.67% 21 70% Among 15 patients of Group –A, 08 patients having krodha, 09 patients havingshoka and 11 patients having bhaya. Among 15 patients of Group – B, 10 patients having krodha, 04 patients havingshoka and 10 patients having bhaya. Overall: out of 30 patients 18(60%) patients having krodha, 13(43.33%) patientshaving shoka and 21 (70%) patients having bhaya .Figure.No. 11 Showing distribution of patients by Manasika Hetu 25 21 20 18 15 13 Krodha 11 Shoka 10 10 10 9 Bhaya 8 5 4 0 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 89
  • B4) Table.No.19 showing distribution of patients by Emotional StatusMano No of patients and percentagepareeksha Group A % Group B % Group A and B %Intact 10 66.6% 08 53.3% 18 60%Elevated 05 33.3% 07 46.6% 12 40%Depressed 05 33.3% 04 26.6% 09 30%Anxious 05 33.3% 05 33.3% 10 33.33%Fear 10 66.6% 08 53.3% 18 60%Anger 04 26.6% 08 53.3% 12 40%Worries 10 66.6% 11 73.3% 21 70%Phobias 03 20% 05 33.3% 08 26.67%Stress 05 33.3% 07 46.6% 12 40% Among 15 patients of Group –A ,10 patients were intact , 05 patients wereelevated, 05 patients were depressed, 05 patients were anxious, 10 patients were havingfear, 04 patients were having anger, 10 patients were having worries , 03 patients werehaving phobias and 05 patients having stress. Among 15 patients of Group –B, 08 patients were intact, 07 patients wereelevated, 04 patients were depressed, 05 patients were anxious, 08 patients were havingfear, 08 patients were having anger, 11 patients were having worries, and 05 patientswere having phobias and 07 patients having stress. Overall: out of 30 patients, 18 (60%) patients were intact, 12(40%) patients wereelevated, 09(30%) patients were depressed, 10(33.33%) patients were anxious, 18(60%)patients were having fear, 12(40%) patients were having anger, 21(70%) patients werehaving worries, and 08 (26.67%) patients were having phobias and 12 (40%) patientshaving stress. “Comparative Management study of Pakshaghata with Mashadi Yoga” 90
  • Figure.No.12 showing distribution of patients by Emotional Status25 2120 Intact 18 18 Elevated15 Depressed Anxious 12 12 12 11 Fear10 10 10 10 10 9 Anger 8 88 8 7 7 Worries 5 5 5 5 5 5 Phobias 5 4 4 Stress 3 0 Group A Group B TotalB5) Table.No.20 showing distribution of patients by Presenting ComplaintsComplaints No of patients and percentage Gr A % Gr B % GrA&B %Shreera Akarmanyata (Ak) 15 100 % 15 100 % 30 100%Achetana (Ac) 12 80 % 12 80 % 24 80%Shareera Patana (Pt) 11 73.33 % 10 66.67 % 21 70%Chesta Nivritti (CN) 15 100 % 15 100 % 30 100%Paksha (Left) (Lt) 08 53.33 % 8 53.33 % 16 53.33%Paksha (Right) (Rt) 05 33.33 % 4 26.67 % 09 30%Paksha (Both) (Bt) 02 13.33 % 3 20 % 05 16.67%Hasta Pada Ruja (Rj) 15 100 % 15 100 % 30 100%Hasta Pada Sankocha (Sn) 11 73.33 % 10 66.67 % 21 70%Sira Snayu Sankocha (Ss) 10 66.67 % 9 60 % 19 63.33%Sandhibandha Vimokshana (Sv) 08 53.33 % 8 53.33 % 16 53.33%Vakstambha (Vk) 09 60 % 5 33.33 % 14 46.67% Almost all the symptoms selected as the presenting complaint as analyzed reflects thesaid complaints of the text, Shreera Akarmanyata (15 patients), Achetana (12 patients),Shareera Patana (11 patients), Chesta Nivritti (15 patients) , Paksha (Left) (08 patients) “Comparative Management study of Pakshaghata with Mashadi Yoga” 91
  • Paksha (Right) (05 patients), Paksha (Both) (02 patients), Hasta Pada Ruja (15 patients),Hasta Pada Sankocha (11 Patients), Sira Snayu Sankocha (10 patients), SandhibandhaVimokshana(08 patients), Vakstambha (09 patients). The cardinal signs ShreeraAkarmanyata ,. Achetana, Chesta Nivritti. Almost all the symptoms selected as the presentingcomplaint as analyzed reflects the said complaints of the text, Shreera Akarmanyata (15patients), Achetana (12 patients), Shareera Patana (10 patients), Chesta Nivritti (15 patients) ,Paksha (Left) (08 patients) Paksha (Right) (04 patients), Paksha (Both) (03 patients),Hasta Pada Ruja (15 patients), Hasta Pada Sankocha (10 Patients), Sira Snayu Sankocha(09 patients), Sandhibandha Vimokshana(08 patients), Vakstambha (05 patients) . Thecardinal signs are Shreera Akarmanyata , . Achetana, Chesta Nivritti, Hasta Pada Sankocha. Overall: out of 30 patients, Shreera Akarmanyata (30 patients), Achetana (24patients), Shareera Patana (21 patients), Chesta Nivritti (30 patients), Paksha (Left) (16patients) Paksha (Right) (09 patients), Paksha (Both) (05 patients), Hasta Pada Ruja (30patients), Hasta Pada Sankocha (21 Patients), Sira Snayu Sankocha (19 patients),Sandhibandha Vimokshana(16 patients), Vakstambha (14 patients)Figure.No.13 Showing distribution of patients by Presenting Complaints Shreera Akarmanyata (Ak) 30 30 30 30 Achetana (Ac) 25 24 Shareera Patana (Pt) 21 21 20 Chesta Nivritti (CN) 19 16 16 Paksha (Left) (Lt) 15 15 15 15 15 15 15 14 12 12 Paksha (Right) (Rt) 11 11 10 10 10 10 9 9 9 Paksha (Both) (Bt) 8 8 8 8 5 5 5 5 Hasta Pada Ruja (Rj) 4 3 2 Hasta Pada Sankocha (Sn) 0 0 Group A Group B Total Sira Snayu Sankocha (Ss) Sandhibandha Vim okshana (Sv) “Comparative Management study of Pakshaghata with Mashadi Yoga” 92
  • B6) Table.No.21 showing distribution of patients by Associated Complaints Complaints No of patients and percentage Group A % Group B % Group A and B % Hypertension 15 100% 15 100% 30 100% Diabetes 12 80% 10 66.67% 22 73.33% Head ache 10 66.67% 09 60 % 19 63.33% Vomiting 10 66.67% 09 60 % 19 63.33% Kampavata 06 40% 04 26.67% 10 33.33% Obesity 12 80% 08 53.33 % 20 66.67% In Group –A, Hypertension 15 patients, Diabetes Mellitus 12 patients, Head ache 10 patients, Vomiting 10 patients, Kampavata 06 patients and Obesity 12 patients. In Group –B, Hypertension 15 patients, Diabetes Mellitus 10 patients, Head ache 09 patients, Vomiting 09 patients, Kampavata 04 patients and Obesity 08 patients. Overall: out of 30 patients, Hypertension 30 patients, Diabetes Mellitus 22 patients, Head ache 19 patients, Vomiting 19 patients, Kampavata 10 patients and Obesity 20patients Figure.No. 14 Showing distribution of patients by Presenting Complaints30 3025 2220 20 Hypertension 1919 Diabetes15 15 15 Head ache 12 12 Vomiting10 1010 10 10 99 8 Kampavata 6 Obesity5 40 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 93
  • B7) Table.No.22 showing distribution of patients by Presenting ComplaintComplaint No of patients and percentage Group A % Group B % Group A and B %Family H/o 06 40% 10 66.67% 16 53.33%Sudden 11 73.33% 06 40% 17 56.67%Gradual 04 26.67% 09 60% 13 43.33%Day 05 33.33% 04 26.67% 09 30%Night 10 66.67% 11 73.33% 21 70%Vata 07 46.67% 06 40% 13 43.33%Pitta 05 33.33% 04 26.67% 09 30%Kapha 03 20% 05 33.33% 08 26.67% Among 15 patients of Group –A ,06 patients having family history, 11 patientshad sudden onset ,04 patients had gradual onset , 05 patients had day onset, 10 patientshad night onset , 07 patients had onset in vata kala , 05 patients had onset in pitta kalaand 03 patients had onset in kapha kala . Among 15 patients of Group –B ,10 patients having family history,06 patients hadsudden onset ,09 patients had gradual onset , 04 patients had day onset, 11 patients hadnight onset , 06 patients had onset in vata kala , 04 patients had onset in pitta kala and05 patients had onset in kapha kala . Overall: out of 30 patients , 16 patients having family history,17 patients hadsudden onset ,13 patients had gradual onset , 09 patients had day onset, 21 patients had “Comparative Management study of Pakshaghata with Mashadi Yoga” 94
  • night onset , 13 patients had onset in vata kala , 09 patients had onset in pitta kala and 08 patients had onset in kapha kala . Figure. No. 15 Showing distribution of patients by Presenting Complaints25 2120 Family H/o 17 16 Sudden15 Gradual 13 13 Day 11 1110 10 10 Night 9 9 9 8 Vata 7 6 6 6 Pitta 5 5 5 5 Kapha 4 4 4 3 0 Group A Group B Total B8) Table.No.23 showing distribution of patients by Facial Nerve Examination Examinations No of patients and percentage Group A % Group B % Group A and B % Muscle 11 73.33% 9 60% 20 66.67% Movement Tenderness 9 60% 6 40% 15 50% Taste 9 60% 5 33.33% 14 46.67% Elevated 5 33.33% 3 20% 08 26.67% Hyoid Bone Secretion of 10 66.67% 5 33.33% 15 50% Saliva Lacrimation 6 40% 4 26.67% 10 33.33% “Comparative Management study of Pakshaghata with Mashadi Yoga” 95
  • Among 15 patients of Group –A , 11patients showed muscle movements ,09patients showed tenderness, 09patients had taste perception , 05 patients had elevatedhyoid bone, 10 patients showed secretion of saliva and 06 patients showed lubrication . Among 15 patients of Group –B, 09 patients showed muscle movements, 06patients showed tenderness, 05 patients had taste perception, 03 patients had elevatedhyoid bone, 05 patients showed secretion of saliva and 04 patients showed lacrimation . Overall: out of 30 patients, 20 patients showed muscle movements, 15 patientsShowed tenderness, 14 patients had taste perception, 08 patients had elevated hyoid bone,and 15 patients showed secretion of saliva and 10 patients showed lacrimationFigure.No.16 showing distribution of patients by Facial Nerve Examination 20 20 18 16 15 15 14 14 Muscle Movement 12 Tenderness 11 Taste 10 10 10 99 9 Elevated Hyoid Bone 8 8 Secretion of 6 6 Saliva 6 5 5 5 Lacrimation 4 4 3 2 0 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 96
  • B9) Table.No.24 Showing distribution of patients by Motor System ExaminationExaminations No of patients and percentage Group A % Group B % Group A and B %Muscle 9 60% 8 53.33% 17 56.67%WastingDisuse 10 66.67% 12 80% 22 73.33%AtrophyFasciculation 6 40% 4 26.67% 10 33.33%Hyper 3 20% 6 40% 09 30%ToniaHypo Tonia 11 73.3% 9 60% 20 66.67%Rigidity 11 73.3% 10 66.67% 21 70% Among 15 patients of Group –A, 09 patients having muscle wasting, 10 patientshaving disuse atrophy, 06 patients having fasciculation, 03 patients having hypertoniamuscle, 11 patients having hypotonia of muscle and 11 patients had rigidity. Among 15 patients of Group –B, 08 patients having muscle wasting, 12 patientshaving disuse atrophy, 04 patients having fasciculation, 06 patients having hypertoniamuscle, 09 patients having hypotonia of muscle and 10 patients had rigidity. Overall: out of 30 patients ,17 patients having muscle wasting , 22 patients havingdisuse atrophy , 10 patients having fasciculation, 09patients having hypertonia muscle,20patients having hypotonia of muscle and 21 patients had rigidity . “Comparative Management study of Pakshaghata with Mashadi Yoga” 97
  • Figure. No. 17 Showing distribution of patients by Motor System Examination 25 22 21 20 20 Muscle 17 Wasting 15 Disuse Atrophy 12 Fasciculation 1111 10 10 10 10 Hyper 9 9 9 8 Tonia 6 6 Hypo Tonia 5 Rigidity 4 3 0 Group A Group B Total B10) Table.No.25 showing distribution of patients by ReflexReflex No of patients and percentage Group A % Group B % Group A and B %Jaw Jerk 12 80% 10 66.67% 22 73.33%Bicepse Jerk 9 60% 8 53.33% 17 56.67%Supinator Jerk 7 46.67% 8 53.33% 15 50%Triceps Jerk 12 80% 9 60% 21 70%Knee Jerk 8 53.33% 8 53.33% 16 53.33%Ankle Jerk 8 53.33% 7 46.67% 15 50%Superficial 7 46.67% 10 66.67% 17 56.67%Abd. ReflexPlantar Reflex 6 40% 9 60% 15 50% “Comparative Management study of Pakshaghata with Mashadi Yoga” 98
  • Among 15 patients of Group –A 12 patients showed jaw jerk positive, 09 patients showed bicepse jerk positive, 07 patients showed supinator jerk, 12 patients showed tricepse jerk, 08 patients showed knee jerk, 08 patients showed ankle jerk, 07 patients showed superficial abdominal reflex and 06 patients showed plantar reflex. Among 15 patients of Group –B, 10 patients showed jaw jerk positive, 08 patients showed bicepse jerk positive, 08 patients showed supinator jerk, 09 patients showed tricepse jerk, 08 patients showed knee jerk, 07 patients showed ankle jerk, 10 patients showed superficial abdominal reflex and 09 patients showed plantar reflex. Overall: out of 30 patients, 22 patients showed jaw jerk positive, 17 patients showed bicepse jerk positive, 15 patients showed supinator jerk, 21 patients showed tricepse jerk, 16 patients showed knee jerk, 15 patients showed ankle jerk, 17 patients showed superficial abdominal reflex and 15 patients showed plantar reflex. Figure.No.18 showing distribution of patients by Reflex25 22 2120 Jaw Jerk 17 17 16 Bicepse Jerk15 15 15 15 Supinator Jerk 12 12 Triceps Jerk10 10 10 Knee Jerk 9 9 9 88 88 8 Ankle Jerk 7 7 7 6 Superficial Abdominal Reflex 5 Plantar Reflex 0 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga” 99
  • B11) Table.No.26 showing distribution of patients by Upper Motor Neuron ExaminationExamination No of patients and percentage Group A % Group B % Group A and B %Increased Tone 7 46.67% 9 60% 16 53.33%Spastic Posture 10 66.67% 8 53.33% 18 60%Brisk Tendon 4 26.67% 3 26.67% 07 23.33%ReflexHemiplegic 9 60% 11 73.33% 20 66.67%GaitParaplegic Gait 4 26.67% 2 13.33% 06 20%Quadriplegic 2 13.33% 2 13.33% 04 13.33%Gait Among 15 patients of Group –A , 07 patients showed increase tone , 01 patients showed spastic posture , 04 patients sowed brisk tendon reflex , 09 patients having hemiplegic gait, 04 patients showed paraplegic gait and 02 patients showed quadriplegic gait. Among 15 patients of Group –B, 09 patients showed increase tone, 08 patients showed spastic posture, 03 patients showed brisk tendon reflex, 11 patients having hemiplegics gait, 02 patients showed paraplegic gait and 02 patients showed quadriplegic gait. Overall: out of 30 patients, 16 patients showed increase tone, 18 patients showed spastic posture, 07 patients showed brisk tendon reflex, 20 patients having hemiplegics gait, 06 patients showed paraplegic gait and 04 patients showed quadriplegic gait. “Comparative Management study of Pakshaghata with Mashadi Yoga”100
  • Figure.No.19 showing distribution of patients by Upper Motor Neuron Examination 30 30 25 22 20 20 Hypertension 1919 Diabetes 15 15 15 Head ache 12 12 Vomiting 10 1010 10 10 9 9 8 Kampavata 6 Obesity 5 4 0 Group A Group B Total B12) Table.No.27 showing distribution of patients by Lower Motor Neuron ExaminationExamination No of patients and percentage Group A % Group B % Group A and B %Flaccid paresis 3 20% 2 13.33% 05 16.67%Loss of Reflex 4 26.67% 2 13.33% 06 20%Weakness of 15 100% 15 100% 30 100%Nerve RootFoot Drop 12 80% 9 60% 21 70%Quadriceps 9 60% 7 46.67% 16 53.33%WeaknessPeripheral 7 46.67% 5 33.33% 12 40%Neuropathy “Comparative Management study of Pakshaghata with Mashadi Yoga”101
  • Among 15 patients of group –A , 03 patients having flaccid paresis, 04 patients having loss of reflex , all 15 patients having weakness of nerve root , 12 patients having foot drop , 09 patients having quadriceps weakness and 07 patients having peripheral neuropathy. Among 15 patients of group –B , 02 patients having flaccid paresis, 02 patients having loss of reflex , all 15 patients having weakness of nerve root , 09 patients having foot drop , 07 patients having quadriceps weakness and 05 patients having peripheral neuropathy overall :out of 30 patients , 05 patients having flaccid paresis, 06 patients having loss of reflex , all 30 patients having weakness of nerve root , 21 patients having foot drop , 16 patients having quadriceps weakness and 12 patients having peripheral neuropathy Figure.No.20 showing distribution of patients by Lower Motor Neuron Examination30 3025 Flaccid paresis 21 Loss of Reflex20 Weakness of Nerve Root 17 1615 15 15 15 Foot Drop 12 12 Quadriceps Weakness10 10 9 9 9 Peripheral Neuropathy 77 7 6 6 Superficial Abdominal Reflex 5 5 5 4 3 22 Plantar Reflex 0 Group A Group B Total “Comparative Management study of Pakshaghata with Mashadi Yoga”102
  • C. Result of the Mashadi YogaC1) Table.No.28 showing distribution of patients by Results: Subjective CriteriaSubjective Group -A Group-B Group –A &BCriteria BT- A AT -A AF- A BT-B AT-B AF-B BT-AB AT-AB AF-ABAkarmanya 2.93 2.06 1.53 2.73 1.8 1.13 2.83 1.93 1.33Chesta 2.93 2.06 1.53 2.73 1.8 1.13 2.83 1.93 1.33NivrittiRuja 2.93 2.06 1.53 2.73 1.8 1.13 2.83 1.93 1.33Sankocha 2.93 2.06 1.53 2.73 1.8 1.13 2.83 1.93 1.33Shosha 2.93 2.06 1.53 2.73 1.8 1.13 2.83 1.93 1.33Sandhi 2.93 2.06 1.53 2.73 1.8 1.13 2.83 1.93 1.33vibhandhaVaksthamba 2.93 2.06 1.53 2.73 1.8 1.13 2.83 1.93 1.33C2) Table.No.29 Showing distribution of patients by Results : Objective CriteriaObjective Group -A Group-B Group –A &BCriteria BT- A AT -A AF- A BT-B AT-B AF-B BT-AB AT-AB AF-ABStroke 28.73 39.8 52.13 28.26 40.4 54.4 28.66 40.10 53.27RecoveryScore CardBarthel 33.66 47.86 58.46 23 49.46 58.4 28.33 48.66 58.43IndexGrip Test 37.33 44 50 36 45.33 47.33 36.66 44.66 48.66 “Comparative Management study of Pakshaghata with Mashadi Yoga”103
  • D) Statistical analysisD1) Table.No.30 Comparative Study of Group A and Group B after treatmentParameter Group Mean SD SE PSE T- P- Remarks Value ValueStroke A 39.8 5.321 1.374 1.904 0.31 >0.05 NSRecovery Score B 40.4 5.110 1.319CardBarthel Index A 47.866 11.939 3.083 4.549 0.351 >0.05 NS B 49.466 12.955 3.345Grip Test A 44.00 7.367 1.902 2.701 0.492 >0.05 NS B 45.333 7.432 1.919Shreera A 2.0666 0.258 0.066 0.124 2.14 >0.05 NSAkarmanyatha B 1.8 0.414 0.106Chesta Nivritti A 2.066 0.25 0.066 0.124 2.14 >0.05 NS B 1.8 0.414 0.106Ruja of A 2.066 0.258 0.066 0.124 2.14 >0.05 NSHasta & Pada B 1.8 0.414 0.106Sakocha of A 2.066 0.258 0.066 0.124 2.14 >0.05 NSHasta & Pada B 1.8 0.414 0.106Sosha of A 2.066 0.258 0.066 0.124 2.14 >0.05 NSSira & Snayu B 1.8 0.414 0.106Sandibandha A 2.066 0.258 0.066 0.124 2.14 >0.05 NS B 1.8 0.414 0.106Vaksthamba A 2.066 0.258 0.066 0.124 2.14 >0.05 NS B 1.8 0.414 0.106 To know the comparative efficacy of the treatment procedure, the statisticalanalyses is done by using Un-paired t-test, by assuming that the mean effect treatmentprocedures is same in both the groups after treatment. “Comparative Management study of Pakshaghata with Mashadi Yoga”104
  • From the analyses all parameters shows non-significant (as P>0.05). i.e., the meaneffects of treatment are same in all parameters.D2) Table.No.31 Comparative Study of Group A and Group B After follow upParameter Group Mean SD SE PSE T- P- Remarks Value ValueStroke A 28.733 7.106 1.835 2.392 0.195 >0.05 NSRecovery Score B 28.266 5.945 1.535CardBarthel Index A 58.466 16.418 4.240 6.053 0.010 >0.05 NS B 58.4 16.728 4.320Grip Test A 50.00 6.546 1.690 2.071 1.289 >0.05 NS B 47.333 7.988 2.063Shreera A 1.533 0.639 0.165 0.117 3.418 <0.01 HSAkarmanyatha B 1.133 0.351 0.090Chesta Nivritti A 1.533 0.639 0.165 0.117 3.418 <0.01 HS B 1.133 0.351 0.090Ruja of A 1.533 0.639 0.165 0.117 3.418 <0.01 HSHasta & Pada B 1.133 0.351 0.090Sakocha of A 1.533 0.639 0.165 0.117 3.418 <0.01 HSHasta & Pada B 1.133 0.351 0.090Sosha of A 1.533 0.639 0.165 0.117 3.418 <0.01 HSSira & Snayu B 1.133 0.351 0.090Sandibandha A 1.533 0.639 0.165 0.117 3.418 <0.01 HS B 1.133 0.351 0.090Vaksthamba A 1.533 0.639 0.165 0.117 3.418 <0.01 HS B 1.133 0.351 0.090 From the analyses except Stroke Recovery Score Card, Barthel index and Griptest all other parameters shows highly significant as P <0.05. “Comparative Management study of Pakshaghata with Mashadi Yoga”105
  • D3) Table.No.32 shows analyses for Before treatment and After treatmentParameter Mean Net SD SE T-value P-value Remarks BT AT MeanStroke Recovery 54.4 40.4 14.00 2.449 0.632 22.15 <0.001* HSScore CardBarthel Index 23.00 49.466 33.8 8.752 2.260 14.95 <0.001* HSGrip Test 36.00 45.333 9.333 5.936 1.533 6.08 <0.001* HSAkarmanyatha 2.733 1.8 0.933 0.457 0.118 7.90 <0.001* HSChesta Nivritti 2.733 1.8 0.933 0.457 0.118 7.90 <0.001* HSRuja 2.733 1.8 0.933 0.457 0.118 7.90 <0.001* HSSakocha 2.733 1.8 0.933 0.457 0.118 7.90 <0.001* HSSosha 2.733 1.8 0.933 0.457 0.118 7.90 <0.001* HSSandibandha 2.733 1.8 0.933 0.457 0.118 7.90 <0.001* HSVaksthamba 2.733 1.8 0.933 0.457 0.118 7.90 <0.001* HSD4) Table.No.33 Shows Analyses for Before Treatment and After TreatmentParameter Mean Net SD SE T-value P-value Remarks BT AF MeanStroke Recovery 54.4 28.266 26.133 7.130 1.841 14.19 <0.001* HSScore CardBarthel Index 23 58.4 44.066 15.727 4.061 10.85 <0.001* HSGrip Test 36 47.333 11.333 6.399 1.652 6.86 <0.001* HSAkarmanyatha 2.733 1.133 1.6 0.632 0.163 9.81 <0.001* HSChesta Nivritti 2.733 1.133 1.6 0.632 0.163 9.81 <0.001* HSRuja 2.733 1.133 1.6 0.632 0.163 9.81 <0.001* HSSakocha 2.733 1.133 1.6 0.632 0.163 9.81 <0.001* HSSosha 2.733 1.133 1.6 0.632 0.163 9.81 <0.001* HSSandibandha 2.733 1.133 1.6 0.632 0.163 9.81 <0.001* HSVaksthamba 2.733 1.133 1.6 0.632 0.163 9.81 <0.001* HS * = More highly significant “Comparative Management study of Pakshaghata with Mashadi Yoga”106
  • To know among which Group treatment procedure is more effective, thestatistical analyses is done by using paired t-test, by assuming that the treatmentprocedure same in all parameters as P<0.05. Further, the parameter Stroke RecoveryScore Card and Barthel Index is effective after treatment, rest of subjective parametersare more significant after the follow up. The parameter Grip Test is having equal effectafter treatment and follows up.Conclusion: The parameters Stroke Recovery Score Card and Barthel Index are notrequired for this treatment. But the subjective parameters require the follow up. Thefurther research can be conducted by considering age, chronicity, and causes for thedisease. “Comparative Management study of Pakshaghata with Mashadi Yoga”107
  • CHAPTER -6 DISCUSSION To reach up to the depth of the knowledge the ‘Uha’ is importantstep in the gnanagrahana prakriya. It is the step, which helps in understanding thesubject with reference to its merits and demerits and guides to conclusive judgment.The success achieved without the exercise of reasons is indeed success resulting bychance. This exercise of reasons is necessary in order to open the truth. It is the dutyof research scholar to bring out the truth, which is collected in the ancient treaties. Inthis aspect the Uha or discussion becomes a necessary part of any researchwork. It is the exercise of churning milk in order to draw the butter of conclusion. 145 Cerebrovasular diseases (C.V.D.) or strokes rank foremost among all thedisorders of the CNS. This ‘brain attack’ is the third leading cause of death in theWestern World. In practice ‘stroke’ refers to an umbrella of conditions caused by theocclusion or hemorrhage of blood vessels supplying brain. ‘Hemiplegia’ is one suchcondition occurring as a sequel of stroke. Hemiplegia described in the modern texts can be correlatated orinterpreted with Pakshaghata, which is enlisted under eighty Nanatmaja vatavyadhies in Ayurveda. The signs and symptoms of Pakshaghata given in our classicsresemble with the condition Hemiplegia as described by modern science. The detailsymptomatology and treatment of Pakshaghata has been described inAyurvedic classics from last 5000 years, while the knowledge of this condition tothe modern medical science is just two centuries old. Vata is omnipresent and is heldresponsible for all sorts of revealed and concealed activities of the body. “Comparative Management study of Pakshaghata with Mashadi Yoga”108
  • Normal functions of vata are almost similar to that of nervous system.Karmendriya (motor) functions are governed by Vyana Vayu which isregulated by Prana vayu seated in Shira (Brain). Shira is known as Indriyayatana andIndriyamoola and can be compared to sensory, motor and special centers present inthe brain. Upaghata to this Indriyamoola leads to derangement of Prana and Vyanavayu resulting in Pakshaghata. Hence the main vayus involved are Prana andVyana,but subsidiary Udana, Samana and Apana are also involved. Tarpak andShleshak kapha are also related to normal functioning of various actions. Hence they should not be over look two types of samprapti is observed mainlyin Pakshaghata, Margavaranajanya and Dhatukshayaganya. Vata gets exaggerated byany of these and this morbid vata alters the structural and functional status ofone half of the body causing Sankoch, Karmahani, Vakrata. Diminishedactivities of the affected half may be accompanied with facial involvement, Vednaand Vakasanga. In Hemiplegia restricted movement of one side of the body, involvingthe arm and leg, flaccid weakness initially, hypertonic responses, increasedtendon jerks, spasticity, stiffness and muscular atrophy in late stages have beendescribed. Disorders of speech also occur acc. to the pathology. Blending the twoschools of thoughts it can be notified that the description of the disease given bymodern science was well explained ages ago. The concept regarding the pathogenesis of Hemiplegia developed bymodern age neuro pathologists seems to be an exact replica of what hasbeen explained in Ayurveda in terms of sroto dushti. The cardinalsymptom of Pakshaghata is cheshtahani which indicates the decrease in the chalaguna of Vayu. According to the principle of ‘Ekadeshiya Vriddhi, Anyadeshiya “Comparative Management study of Pakshaghata with Mashadi Yoga”109
  • Kshaya”, vriddhi (hyperfunctioning) of vata occurs in Mastishka and Kshaya(hypofunctioning – loss of activities of extremities) is seen in shakha inPakshaghata. The agantuja factor has also been contemplated in thepathological process of Pakshaghata. For the treatment of vata vyadhies, Ayurveda has authentic remedy ascompared to the Allopathic science. In this project an attempt has beenmade to find out the effective way to mitigate the suffering of patients,ailing from Pakshaghata. The treatment has been selected in compliancewith the principles propounded in the classics. The clinical trial was conducted in a randomized sample of 30patients resolved into two subgroups of fifteen each. The first group wasadministered Oral administration of Mashadi Yoga Kwatha and the second group wastreated with Nasya karma with Mashadi Yoga taila. The drugs and doses have alreadybeen described. In material and methods. The end results of each therapywere assessed individually on various parameters, monitored cautiously,subjected to biostatistician analyses and finally inferences were drawn andhereby put forward:DISCUSSION OF THE OBSERVATIONSAGE: In the Group -A, 15 patients of Pakshaghata, maximum number ofpatients (46.67%) were from the age group of 30-40 years; 26.67% were from 40-50age group and 13.33% were from 50-60 years of age group. AcharyaSushruta has stated that Parihani kala of Madhyama Avastha sets in at the agegroup of 40-70 years (Su. Su. 35/35). This is vata prakopa kala and beginning “Comparative Management study of Pakshaghata with Mashadi Yoga”110
  • of the ageing process and degenerative changes. This leads to kshaya of sharira Bala and all the dhatus and results in vata prokopa. Thus the incidence ofPakshaghata increases in early 40 age group as provocated vata acts as a predisposingfactor in present modern life style. Nowadays life expectancy has come down to the55-60 years the textual screening also verifies the above observation, asserting that,“Age is probably the risk factor best correlated with stroke.”SEX: Higher incidence was observed in Group -A females (60%) thanmales (40%) and in Group -B females (60%) than males (40%). ThisContradict the statement, “stroke affects males 1.5 times more often than females.But latest data shows that, overall, the incidence and prevalence of stroke areabout equal for men and women. This may be because females have been entered alsoto the professional life and in intellectual fields. Therefore, both sexes have the sametension and stressful background, which can lead to HTN, and stroke. Studies showthat aging women sustain a large burden for stroke due to decrease in reproductivehormone (Estrogen).RELIGION: In Group –A, 66.67 % of patients who opted for study were from HinduCommunity and 33.33% were Muslims. And in Group –B 86.67% of patients whoopted for study were from Hindu Community and 13.33% were Muslims. Nothingspecific can be drawn from this observation, as this could well be a ,result ofdemographical factors.OCCUPATION: In Group –A , 40% of Active group ,33.33% of Laborers and 26.67%ofSedentary Peoples are opted for study . In Group –B , 33.33% of Active group “Comparative Management study of Pakshaghata with Mashadi Yoga”111
  • ,33.33% of Labours and 33.33%of Sedentary Peoples are opted for study .InLaborers ,Active groups might have lead to vata prakapo. Ativyayam,Ratrijagrana, Alpashana, financial crises and mental stress may be the cause ofprevalence of disease in Active workers and laborers due to vata prakopa. Theincidence among house wives may be due to constrains of household,financial tension, irregular diet habits and vega vidharana.SOCIO-ECONOMIC STATUS: In Group -A 40% of Poor,53.33% of middle and 6.67% of higher class areopted for study . In Group -B 33.33% of Poor,53.33% of middle and 13.33% ofhigher class are opted for study . This can be a reflection of the type of patientscoming to the O.P.D. of the institute. Also, these are only people in the society, whoface maximum strain physically and mentally to maintain their livingstandards, in this heavy inflation period. Malnutrition, tension, etc. mightlead to vata prakopa and thedisease.DIETARY HABITS: In this study, Group -A patients (60%) were notified to take mixed type ofDiet, which is a common trend among the Hindus, these days. Intake of Lavan andKatu rasa (66.67%), Madhur rasa (54.16%) predominantly may be taken as factors ofvitiation of vata and kapha dosha, which in turn vitiates agni vyapara and henceproduces ama – the initiator of pathogenesis and can lead tomargavarodhajanya Pakshaghata.ADDICTION: Study of addiction reveals In Group –A 60% of patients chew the tobaccoand 40% of patients were found to be Alcoholic. In Group –B, 80% of patientschew the tobacco and 20% of patients were found to be Alcoholic. “Comparative Management study of Pakshaghata with Mashadi Yoga”112
  • All addictions affect the agni making it vishama. They also suppress the immunomodulatory mechanism and provoke vata. In long run these addictions may be a causeof ojakshaya and leads to neurological disorders. Modern textual references alsoquote smoking, consumption of alcohol, etc. to be grave risk factors for stroke.AGNI & KOSHTHA: While studying the patients in respect to agni and koshtha it was found thatmaximum no. of patients were having vishamagni (50%) and krura koshtha (50%)in the both Groups This shows the dominance of vata in predisposing this condition.PRAKRITI: All the patients of Group A and B exhibitated a Dvandwaj Doshicconstitution, with majority of Vata-Kaphaja (45.83%) Prakriti, follwed by Vata-Pittaja (29.17%) and Pitta-Kaphaja (25%) Prakriti. This data suggests that the diseaseoccurrence is more in Vata-Kaphaja dominant Prakriti. In manas Prakriti,maximum patients were having ‘Rajasika – Tamasika Prakriti (66.67%) followedby Rajasika-Satwika (33.33%) Prakriti. Hence this demonstrates that personswith Rajasika-Tamasika Prakriti are more prone to this disease.MENTAL STATUS: Maximum patients had sound mental status (54.16%) but few were found tobe Angry (16.67%), Anxious (12.50%). This shows the definiteinvolvement of Manovaha srotas in Pakshaghata. Stroke may create apseudobulabar state, with rapid shifts from laughing to crying (BIB. 21)PRESENTING SIDE: A greater portion, 53.33% patients presented with Left hemiplegia.All the patients had leftt-handedness, i.e., right cerebral dominance. [The RT.Hemisphere is dominant in almost all lt. Handed people and in most lt. Handed “Comparative Management study of Pakshaghata with Mashadi Yoga”113
  • people ]This finding not goes in favor to the textual reference that arteries of the leftside of the brain are embolised more often than those of right and left MCA is thevessel most often affectedCHRONICITY: A wide variation was observed, i.e., the patients presented from 1 week ofonset to 13 years of chronicity. Maximum patients had a chronicity of 2-3 years. Thereason could be majority of the patients had previously taken allopathic medicinesand then not seeing any further hopes for recovery were revert back to Ayurvedicinstitutions later. But 2 patients were reported to the hospital directlywithout undergoing any other therapy. This shows the gradual change in the trend andawarness of people to the benefits of authentic Panchakarma therapy of Ayurveda.NIDANA: Adhyashana, Ati Amla ,Lavana ,Katu Rasa Sevan, Ati Vyayam, RatriJagarana, Excessive Smoking, Diwaswapna and Veg Sandharana were observed asaetiological factors for this disease in this study. These observed data goes in favorwith classical vata prakopaka nidanas in the texts. Atisawari (Driving) was observedin 12.50% patients who can be compared with Rathakshobha. AtiRathakshobha leads to Indriyoparodha. Convincing epidemiological datastrongly relate cigarette smoking with stroke and both extracranial and intracranialatherosclerosis In Agantuja Nidan, fall and accidents were observed in 12.50% and8.33% respectively. Abhighata directly induces Pakshaghata by Shiromarmabhighata146 In Manasik nidan, Bhaya was observed in 4.17% of patients which is the knowncause of vata prakopa.TIME OF ONSET: In group –A, 66.67% patients, stroke occurred during night hours “Comparative Management study of Pakshaghata with Mashadi Yoga”114
  • followed by 33.33% patients in whom stroke occurred in morning. Ingroup –B, 73.33% patients, stroke occurred during night hours followed by26.67 % patients in whom stroke occurred in morning. Usually theoccurrence of thrombotic stroke is noted on waking or soon after risingin the morning.MODE OF ONSET: In this study Group –A, (73.33%) had stroke of sudden onset, 26.67% hadgradual onset and Group –B, (40%) had stroke of sudden onset, 60% had gradualonset. Stroke due to cerebral embolism and rupture of saccular aneurysm has suddenonset. A few of atherothrombotic, haemorrhagic, and lacunar strokes can also developsuddenly.DOSHANUBANDHA: In Group -A Maximum patients (46.67%) had Vatanubhandha,33.33% ofpittanubhandha and 20% of kaphanubhandha was found. In Group –B Maximumpatients (40%) had Vatanubhandha,26.67 % of pittanubhandha and 33.33% ofkaphanubhandha was found. This observation is also pertinent to the testimony thatmajority of strokes are results of Atherosclerotic changes in the blood vessels due toobesity, Hyperlipidaemia, Diabetes, Myxoedema, etc. ASSOCIATED DISEASES: In Group-A, 100% patients were Hypertensive and 80% had DiabetesMellitus were noticed. In Group-B, 100% patients were Hypertensive and66.67% had Diabetes Mellitus were noticed. Hypertension is the risk factor that mostsignificantly correlates with stroke. Also, the association between hypertension andcardiac disease is well known, making cardioembolic brain infarction more likely.Hypertension plays a role in the atherodegenerative process in the vessels resulting in “Comparative Management study of Pakshaghata with Mashadi Yoga”115
  • occlusive and artery-to- artery embolic stroke. Diabetes is also associated with anincreased risk of stroke. It fastens the process of atherosclerosis and leads tolarge extracranial disease and lacunar infarcts.SPECIFIC SYMPTOMS AT ONSET: The history of associated symptoms at onset of Pakshaghata in presentstudy reveals 66.67% patients suffered from headache, 66.67% patients complainedof vomiting ,40% patients complained kampavata and 80 % patients had obesityand in Group -B 60% patients suffered from headache, 60% patients complained ofvomiting ,26.67% patients complained kampavata and 53.33% patients had obesity.Cerebral haemorrhage is often accompanied by all these above-mentioned symptoms.In few cases of thrombotic strokes headache and loss of consciousness is encounteredacc. toextent of lesion. Localized Headache of moderate severity is presentin embolic stroke.EFFECT OF THERAPIES Note worthy results were observed by both the therapies but Nasya therapyproved to be more efficacious in improving the disease compared to OralAdministration. The comparative relief conferred by each therapy on individual isdiscussed here underEFFECT ON AKARMANYATA The relief conferred by Gr.-An on Akrmanyata of limbs was 33.33%where as in Gr.-B limbs showed 66.67% relief. It may be inferred from the aboveresults that Nasya therapy played a significant role in alleviating Akarmanyata incomparison to only Oral administration. This proves the efficacy of Nasya in thisdisease by its srotovishuddhi and Indriya-prasadana properties. Both the Kwathaand Taila have strong vatashamak properties which may have checked the Prana and “Comparative Management study of Pakshaghata with Mashadi Yoga”116
  • Vyana dushti, more effectively after Nasya.EFFECT ON CHESHTA NIVRITTI: The relief conferred by Gr. -A on Cheshta Nivritti of upper limb andlower limb was 33.33% where as in Gr. - B upper limb and lower limb showed66.67% relief. It may be inferred from the above results that Nasya therapy played asignificant role in alleviating cheshta nivritti in comparison to only Oraladministration. This proves the efficacy of Nasya in this disease by itssrotovishuddhi and Indriya-prasadana properties Taila have strong vatashamakproperties which may have checked the Prana and Vyana dushti, more effectivelyafter Nasya karma.EFFECT ON RUJA: Patients of Gr.-A showed 33.33% gratification where as in Gr. B 66.67%relief was rendered in ruja. The groups showed highly significant results butGr-.B was more efficacious than Gr. - A. Ruja might have been checked by thevatahar property of the Taila. This vatahar property might have been more effective torelieve pain after Nasya karma.EFFECT ON VAKSANGA: The relief observed in Gr.-A was 33.3% where as in Gr. - B relief renderedwas up to 66.67% . Thus Nasya karma played a significant role in curingvakasanga in comparison to only shaman chikitsa. Nasya by its srotoshodhanproperty might have relieved the avarana of Udana by Kapha and also mighthave checked the prana vayu dushti which is controller of vak indriyamoola.Taila have vatahara and kaphahara properties, which might have helped in curingvaksanga. This supports the role of therapies in Udana and Prana dushti.EFFECT ON HEADACHE: “Comparative Management study of Pakshaghata with Mashadi Yoga”117
  • Highly significant results were obtained in both the groups. Howeverthe percentage relief in Gr. A was 33.33% and in Gr. B it was 66.67%.Headache is one of the disease described in Rakta pradoshaja vyadhies and Nasya isstated as the choice of therapy pacifying rakta dhatu vitiation. Also,Vata shamakproperty of Mashadi Yoga Taila and shirashoola nashak property of Taila (Bh.P)might have helped in relieving the symptom.EFFECT ON INSOMNIA: In Group-A 33.33% relif was foundand in Group-B 66.67% relif wasfoundand in insomnia, in comparison to Nasya karma and Oral administration.shodhana action of nasya might have helped in pacifying Insomnia better.Insomnia is caused by Ruksha, Laghu guna of vayu. The Snighda and Guruproperties of Mashadi Taila might have acted by sedating the aggravated vata.EFFECT ON CONSTIPATON: Both the therapies were evaluated to be almost equally efficacious inrelieving the constipation with 60% relief in group A and 80% relief in group B. Thisshows the Anolomaka property of therapies and supports the action of therapies onApana Kshetra and their role in Apana Vayu dushti.EFFECT ON POWER: nasya therapy was judged to be more cogent in improving the power of boththe limbs (Upper limb – 40. %, Lower limb – 33.33%). While the power gained byshaman therapy was 33.33% in upper limb and 40% in lower limb. This shows thatthere was more increase in the muscle power of the lower limb. The main seat of vayuis below Nabhi and if this is conquered by virechan the regional effects shows betterresults and hence lower limb might have showed more improvement. The musclestrength might have achieved by Vatanashak, Balya, Bruhaniya and Dhatuvardhaka “Comparative Management study of Pakshaghata with Mashadi Yoga”118
  • properties of Mashadi Yoga kwatha. But they might have been more effectiveafter Nasya karma which is also having property of doing “Dhatusthiratvam”EFFECT ON TONE: Analytical study of the previous tabulations throws light on the fact that thescore of raised tone was seen to retrogress at a higher pace in Gr. A as compared toGr. B. Upper limb showed 40% improvement and Lower limb showed 33.33%improvement in Gr. A, while in Gr. B 33.33% and 40% improvement was observed inupper and lower limb respectively. Hypertonia/ rigidity may be co-related to Stambhwhich may occur due to irksome vata or when vata is obstructed by kapha. BothMashadi Yoga Taila by their antagonistic fractions to vata, like Madhur rasa,Singdha, Guru, Mridu guna, Ushan veerya might have helped in reducing the rigidity.Abhyantar Taila pan may be held more responsible for being serviceable inconquering stambh because it does abhyantar snehan and swedan. The results werefar better when shaman chikitsa was administered after Nasya karma.EFFECT ON VOLUNTARY MOVEMENTS: Significant improvement was offered by nasya therapy in increasing thevoluntary movements, where UL showed 40% improvement and LL showed53.33% improvement as compared to the shaman Chikitsa which showed 26.67%and 3.33% improvement in UL and LL respectively. Increase in the power anddecrease in tone (rigidity) might have improved the range of movements of the limbs.EFFECT ON STANCE/ GAIT: Gr. A showed highly significant result with 53.33% improvement. Gr. B alsoshowed significant improvement upto 40%. Improvement in stance/gait can be dueto increased power, decreased tone and improved degree of movements. “Comparative Management study of Pakshaghata with Mashadi Yoga”119
  • EFFECT ON REFLEXES: Reflexes remained unchanged after the treatment. Hence both these therapieswere ineffective on the reflexes. The reason could be that the duration of the therapywas short. Ankle clonus was observed in two patients of Gr. A. After Nasya karmathe clonus was completely cured but after few days of Naysa karma, duringthe shaman therapy clonus re-appeared.EFFECT ON BIOPHYSICAL PARAMETEREFFECT ON BLOOD PRESSURE: In group A significant results were seen in lowering the Systolic B.P(33.33%) and Diastolic B.P (13.33%). In group B systolic B.P. Was lowered by40%, which statistically showed improvement at 13.33% level whilediastolic B.P was lowered which was insignificant. Main dosha involved inH.B.P. are Vata and Pitta. Both are checked by the nasya therapy .MashadiYogaTaila has vata-pitta shamak propery, which might also have helped inlowering the raised pressure. Thus nasya showed better B.P. lowering effect.OVER ALL RESPONSE OF THERAPY: The over all response of each therapy was assessed on the basis ofimprovement in individual patients.GROUP A- SHAMAN CHIKITSA: Complete cure was not observed in anypatient. 53.33% patients showed marked relief, 26.67% patients showed moderateresponse and mild improvement was observed in 6.67% of patients.GROUP B – NASYA CHIKITSA: Complete cure was not found in anypatient.7.33% patients showed marked relief. Moderate response wasobserved in 53.33% patients. 6.67% patients showed mild improvement to thetherapy. It is evident that Nasya karma proved better over Shaman Chikitsa. “Comparative Management study of Pakshaghata with Mashadi Yoga”120
  • CHAPTER – 7 CONCLUSION On the basis of the study “Comparative management study of Pakshaghata withMashadi Yoga double group study”, the conclusions can be drawn as follows: Pakshaghata is one among the vata nanatmaja vikara147. Pakshaghata is a mostdistressing disease among Vatavyadhi. It is mentioned to be very difficult to cure due toits deep seated nature. A variety of pathological processes of Vata are described by theAyurvedic classics to be responsible for the manifestation of Pakshaaghaata. Thepathological phenomena of Vata playing central role in the manifestation of Pakshaghataare Shuddha Vata Prakopa, Anyadosha Samsrista Vata Prakopa and DhatukshayajanyaVata Prakopa. Condition similar to Pakshaaghaata in modern medical science is the Hemiplegia.Similar to Pakashaghata Hemiplegia also caused by a wide spectrum of disease processeslike vascular disorders, infective disorders of brain tissue, tumors, trauma etc. among “Comparative Management study of Pakshaghata with Mashadi Yoga” 121
  • these vascular disorder of the brain referred to as cerebrovascular accident (CAV) orstroke is the commonest cause of hemiplegia. It is the 3rd leading cause of death in thedeveloping country. Acharya Charaka has used the Pada ‘Paksha’ in different contexts. It has beenused for describing 15 days, feather of bird and one side of the body. Acharya Sushruta has used this ‘Pada’ while describing the disease Pakshaghata.Dalhana has commented on this by rightly saying it as Paksham Sharirardham. Ashtanga Samgraha and Ashtanga Hridaya have also used this pada whiledescribing the disease Pakshaghata, the meaning of Paksha being taken as one side of thebody. Madhava Nidana has also incorporated the pada Paksha in Pakshaghata.Vijayarakshita the commentator of Madhava Nidana explains it as Ardhanarishwaravatgiving a clear idea about terminology used. In contemporary literature like Sharangadhara Samhita, Bhava Prakasha andYogaratnakara the word Paksha have been used with meaning of half of the body duringthe description of Pakshaghata. We can conclude doubtlessly from the foregoingdescription that word “Paksha” depicts one side of the body. Diagnosis as ‘Pakshaghata’ is loss of function of vama or dakshina , hasta andpada involvement , with or without involvement of face. Therefore pakshaghata iscorrelated with paralysis in this study. Here in the study, Group –A and Group B consist of15 patients each of pakshaghata are Studied , In group –A, 46.67 % were in between the agegroup of 30-40 years and in Group –B 53.33% were in between the age group of 30-40 years. As such vyasana is Concerned in Group –A, 66.67% were habituated to take tobacco and40 % alcoholic and In Group –B 80%were habituated to chew tobacco and 33.33% were “Comparative Management study of Pakshaghata with Mashadi Yoga” 122
  • alcoholic . Regarding food habits 80 patients were interested to take the ahara which is havingpredominance of Amla and Lavana were liked to take ushna ahara in both groups. Among viharaja hetus66.67% patients had the history of Atapasvana , 60%Adwagamana , 66.67 %Ati vyayama , 66.67Vegadharana , 53.3% had krodha and 73.3 % had shoka as manasika hetus. This fact suggests alink between psychological factors and Pakshaghata Religion is not having any relation with Pakshaghata because in Group –A 66.67 %ofMuslim patients were affected, and in Group –B 86.67% of Hindu patients were affected. Occupation is having relation with the mode of work they do here in both Groups activegroup of people are more affected 40 % in group –A and 33.33 % in Group –B. Because of ativyayama will lead to aggravation of the vata. Related to anubhandha vedana , 100% of patients having Hypertension, 80% of theDiabetes mellitus, 80 %of the patients having Obesity here Hypertension ,Diabetes and Obesityare having indirect relation to cause the disease Pakshaghta . In Pakshaghata patients in Both A and B Groups among 15 patients each maximum(53.33 %) were affected on left side of the body. It indicates that left side of the body is more 148prone to be affected by Pakshaghata .The ingredients of Mashadi Yoga are mainly Vatahara,Balya, Mutrala, , Medya and nervine tonic in action149 . The Mashadi Yoga result implicationover the lakshanas and pathogenesis of Pakshaghata exhibited 6.67 % success. 33.33% reductionin the Akarmanyata, Achetana, 150 Ruja ,Sankocha 151 ,Shosha,Sandhibhandha and Vakstambha 152patients suggests action of the Mashadi Yoga Nasya153 is given marked improvement ascompared to the Mashadi Yoga Kwatha Administered Orally . “Comparative Management study of Pakshaghata with Mashadi Yoga” 123
  • CHAPTER - 8 SUMMARY The present thesis entitled “Comparative Management study of Pakshaghatawith Mashadi”study of Shaman and Nasya chikitsa in the management of Pakshaghata(Hemiplegia)” has been endeavored with following aims and objectives:1. To study the aetiopathogenesis, symptomatology and progress of Pakshaghata.2. To assess the efficacy Nasya chikitsa in the management of this disease.3. To assess the efficacy of shaman chikitsa in the management of this disease.4. To compare clinically the effects of both the therapies.5. To find out cheap and effective remedy for this disease. The research methodology was derived essentially from the exhaustiveAyurvedic literature. Proper planning and methodical execution of the principles laid inthe texts were religiously followed while conducting the study. For better understandingof the concepts and in order to facilitate the study pattern, the study was carried out in “Comparative Management study of Pakshaghata with Mashadi Yoga” 124
  • two parts: Conceptual and Clinical. The volume begins with the conceptual study. Tracing the historicaldevelopments and providing a glimpse of previous works, this monograph is a readyassess of the basic information about the integral components of the bodyresponsible for functioning of Karmendriyas and involved in samprapti of Pakshaghatain chief, i.e., five types of vayu, Tarpak-Shleshak kapha, Mana, Mastishka, etc. Conceptof nerves has also been included. The modern physiologic anatomy of the motor systemwas traced and was found to run parallel to our concept. This part alsopresents the compilation of NidanaPanchaka, Sapeksha Nidana, Updrava, Sadhya-Asadhyata, Pathya -Apathya and Chikitsa along with concept behind selection ofpresent therapies. The present day modern knowledge of the subject has also beenexpressed in unison. For therapeutic trial in this study, specific formulations wereemployed to carry out the selected therapeutic maneuver. There were: -For Group A: Shaman ChikitsaMashad i Yoga Kwtha orally - 96ml/ 24 hrs in divided doses i.e. 48ml BDFor Group B: - Nasya chikitsa (Mashadi Taila)8drops in each nostrils for 7days continuously followed by 3 days rest done for ThreeAvritti i.e. 1 to 7 days Nasya, 3 days rest, 11 to 17 days Nasya, 3 days rest, 21 to 27 daysNasya, 3 days rest. Probable mode of action of selected combination, Mashadi Yoga Kwatha willhave virechana effect on sampraptivighatan of the disease was proposed after deepand thorough study of classical texts and after collecting references in favor ofthe potentials of selected drugs to fight against disease. This is dealt under drug chapter. “Comparative Management study of Pakshaghata with Mashadi Yoga” 125
  • For clinical part of the study, 30 uncomplicated patients having cardinal signs andsymptoms of Pakshaghata were selected from the O.P.D. And I.P.D. of DGMAyurvedic Medical College and Hospital Gadag. They were sub-divided intotwo groups, 15 patients in each group. Each group was assigned to fixedtreatment schedule. In group A, patients underwent Oral administration of Mashadi YogaKwatha. While in Group B Nasya chikitsa was given. Total duration of treatment inboth groups was kept 1 month. Prior to advent of the treatment, a detailed proforma was duly filled andappropriate laboratory investigations were carried out to assess the generalcondition of the patients and to exclude any other associated offendingpathology. Laboratory investigations were repeated after completion of the therapy. Incase of I.P.D. patients, daily follow up was done and O.P.D. patients were adjoined forthe follow up after every 10 days. The effect of therapies on cardinal andassociated, Doshanubandh, modern parameters was adjudged and analyzed critically.The results of the entire contrive were subjected to statistical analysis in order to find outthe significance of each mode of therapy. The final results were interpreted and graded as complete cure, marked relief,moderate response, mild improvement and no change. Critical assessment of the totaleffect of the therapy on individual patient, revealed Nasya therapy to be demonstrative ofbetter results in combating pathology and symptomatology of the disease ascompared to Shaman therapy. Summarizing the clinical findings, it may bepostulated that Nasya Chikitsa is more consistent in the management of Pakshaghatathan Shaman Chikitsa. “Comparative Management study of Pakshaghata with Mashadi Yoga” 126
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  • 84) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana chapter 1/64-66 edition 1st 1998, Pub: choukambha Sanskrit series office varanasi page no.1385) G.D. Singhal edited Ayurvedic clinical diagnosis based on Madhavanidana part-I chapter 22/42 edition 2004, Pub: choukambha orientalia vanaransi page no.39786) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.12587) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.125 th88) P.V. Sharma edited Charakasamhita vol-I sutrastana chapter 20/11 edition-8 2004 pub: choukambha orientalia , varanasi, page no. 26989) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana chapter 1/64-66 edition 1st 1998, Pub: choukambha Sanskrit series office varanasi page no.1390) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.125 91) John Walton edited Brains disease of the nervous system edition 10th 1993 pub :oxford medical publications pp22492) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.13293) Ram karan sharma edited Charaka samhita vol-V chikitsa stana chapter 28/53-55 nd edition 2 2001, pub: choukambha Sanskrit series office varanasi page no.7694) P.V. Sharma edited Charaka samhita vol-I chikitsta stana chapter 28/53-55 th edition-8 2004, pub: choukambha orientalia , varanasi, page no. 3595) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.1996) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana chapter 1/64-66 edition 1st 1998, Pub: choukambha Sanskrit series office varanasi page no.1397) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.12598) G.D. Singhal edited Ayurvedic clinical diagnosis based on Madhavanidana part-I chapter 22/42 edition 2004, Pub: choukambha orientalia vanaransi page no.39799) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.103100) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.19101) P.V. Sharma edited Charakasamhita vol-I sutrastana chapter 20/11 edition- th 8 2004 pub: choukambha orientalia , varanasi, page no. 269 “Comparative Management study of Pakshaghata with Mashadi Yoga” 5
  • 102) G.D. Singhal edited Ayurvedic clinical diagnosis based on Madhavanidana part-I chapter 22/42 edition 2004, Pub: choukambha orientalia vanaransi page no.397103) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana st chapter 1/64-66 edition 1 1998, Pub: choukambha Sanskrit series office varanasi page no.13104) Ibid105) G.D. Singhal edited Ayurvedic clinical diagnosis based on Madhavanidana part-I chapter 22/42 edition 2004, Pub: choukambha orientalia vanaransi page no.397106) P.V. Sharma edited Charakasamhita vol-I sutrastana chapter 20/11 edition- th 8 2004 pub: choukambha orientalia , varanasi, page no. 269107) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana chapter 1/64-66 edition 1st 1998, Pub: choukambha Sanskrit series office varanasi page no.13108) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana st chapter 1/64-66 edition 1 1998, Pub: choukambha Sanskrit series office varanasi page no.45109) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.125110) K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341111) Bhishagratna sri Bhram Shankar Shastri edited Yoga ratnakara purvardha Vata vyadi chikista reprint edition 2005, Pub: choukambha Sanskrit sastan varanasi page no.518112) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.19113) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana chapter 1/64-66 edition 1st 1998, Pub: choukambha Sanskrit series office varanasi page no.13114) Bhishagratna sri Bhram Shankar Shastri edited Yoga ratnakara purvardha Vata vyadi chikista reprint edition 2005, Pub: choukambha Sanskrit sastan varanasi page no.518115) P.V. Sharma edited Chakra dutta vata vyadi chikista chapter 22/24-25 edition 2nd 1998 Pub : choukambha orientalia , varanasi, page no. 186116) K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341117) Bhishagratna sri Bhram Shankar Shastri edited Yoga ratnakara purvardha Vata vyadi chikista reprint edition 2005, Pub: choukambha Sanskrit sastan varanasi page no.510118) Bhishagratna sri Bhram Shankar Shastri edited Yoga ratnakara purvardha Vata vyadi chikista reprint edition 2005, Pub: choukambha Sanskrit sastan varanasi page no.518119) Ibid “Comparative Management study of Pakshaghata with Mashadi Yoga” 6
  • 120) K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341121) Rajeshwari dutta shastri edited Bhaishagya ratnavali chapter 26 edition 18th revised 2005 Pub: choukambha orientalia , varanasi, page no. 531122) Parashuram Shastri edited Sharangadhara samhita uttara khanda chapter 8/36-37 edition 3rd 1983 Pub: choukambha orientalia , varanasi, page no. 344123) Bhishagratna sri Bhram Shankar Shastri edited Yoga ratnakara purvardha Vata vyadi chikista reprint edition 2005, Pub: choukambha Sanskrit sastan varanasi page no.518124) National stroke association .http://www.stroke center.org/trials/scales/scales overview.htm125) Parashuram Shastri edited Sharangadhara samhita uttara khanda chapter 8/36-37 edition 3rd 1983 Pub: choukambha orientalia , varanasi, page no. 344126) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.19127) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana st chapter 1/64-66 edition 1 1998, Pub: choukambha Sanskrit series office varanasi page no.13128) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.125129) G.D. Singhal edited Ayurvedic clinical diagnosis based on Madhavanidana part-I chapter 22/42 edition 2004, Pub: choukambha orientalia vanaransi page no.397130) Bhishagratna sri Bhram Shankar Shastri edited Yoga ratnakara purvardha Vata vyadi chikista reprint edition 2005, Pub: choukambha Sanskrit sastan varanasi page no.518131) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.19132) Kaviraj kunjalal bhishagratna edited Shusrut samhita vol-II nidhana stana st chapter 1/64-66 edition 1 1998, Pub: choukambha Sanskrit series office varanasi page no.13133) Kaviraj Atridev Gupta edited Astanga hridayam nidana stana chapter 15/38-40 reprint edition 2005 Pub: choukambha Sanskrit series samstana varanasi page no.125134) K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341135) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.19136) K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341137) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.19138) K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341 “Comparative Management study of Pakshaghata with Mashadi Yoga” 7
  • 139) Bhishagratna sri Bhram Shankar Shastri edited Yoga ratnakara purvardha Vata vyadi chikista reprint edition 2005, Pub: choukambha Sanskrit sastan varanasi page no.518140) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.19141) K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341142) P.V. Sharma edited Chakra dutta vata vyadi chikista chapter 22/24-25 edition 2nd 1998 Pub : choukambha orientalia , varanasi, page no. 186143) K.R. Srikant murty edited Bhava prakasha madyam khanda vol-II chapter 24/209 edition 2002, Pub: choukambha krishnadas academy varanasi page no.341144) Parashuram Shastri edited Sharangadhara samhita uttara khanda chapter 8/36-37 edition 3rd 1983 Pub: choukambha orientalia , varanasi, page no. 344 145) John Walton edited Brains disease of the nervous system edition 10th 1993 pub :oxford medical publications pp224146) Ram karan sharma edited Charaka samhita vol-VI siddhistana chapter 9/4 nd edition 2 2005, pub: choukambha Sanskrit series office varanasi page no.326147) P.V. Sharma edited Charakasamhita vol-I sutrastana chapter 20/11 edition- th 8 2004 pub: choukambha orientalia , varanasi, page no. 269148) P.V. Sharma edited Chakra dutta vata vyadi chikista chapter 22/24-25 edition 2nd 1998 Pub : choukambha orientalia , varanasi, page no. 186149) Ibid150) Ram karan sharma edited Charaka samhita vol-V, chikitsa stana chapter 28/3 edition 2004, pub: choukambha Sanskrit series office varanasi page no.19151) Ibid152) Ibid153) Parashuram Shastri edited Sharangadhara samhita uttara khanda chapter rd 8/36-37 edition 3 1983 Pub: choukambha orientalia , varanasi, page no. 344 “Comparative Management study of Pakshaghata with Mashadi Yoga” 8
  • Annex -1 Master charts Data of trial TABLE N O-1 : S HOWING DEMOGRAPHIC DATA IN PATIENTS of Group A and BSl. OPD Age Sex Religion Economic Occupation Diet Remarks no. status M F H M P M H S A L V M Response1 3717 36 + - - + - + - - - + - + MR3 3715 52 - + + - + - - - + - + - MR5 3885 31 + - + - - - + - + - - + MR7 1426 51 - + + - - + - + - - - + MR9 4105 36 - + + - + - - - + - - + GR11 4171 63 + - + - - + - + - - + - MR13 4110 37 + - - + + - - - - + - + PR15 4135 48 + - + - - + - - + - + - GR17 4524 45 - + + - - + - - + - + - GR19 4606 38 - + - + - + - - + - - + MR21 4719 65 - + + - + - - + - - + - GR23 4738 38 + - - + + - - - - + - + GR25 5696 46 - + + - - + - - - + + - GR27 4944 38 - + + - - + - + - - - + GR29 4609 42 - + + + - - - - + - + GRGroup –A Total 06 09 10 05 06 08 01 04 06 05 06 09 8G,6M,1PGroup -BSl.. OPD Age M F H M P M H S A L V M Response2 4609 43 - + - + - + - + - - - + GR4 3788 39 - + + - + - - - + - + - GR6 3884 28 - + + - - - + - + - + - GR8 3939 46 - + + - - + - + - - + - GR10 4132 37 + - + - + - - - - + + GR12 4320 38 + - + - - + - + - - + - GR14 4125 34 - + + + - - - - + + GR16 4461 42 - + + - - + - + - - + PR18 4536 55 + - + - - - + - + - + - GR20 4698 34 - + + - + - - - - + + - MR22 4435 37 - + + - + - - - - + + GR24 4774 40 + - + - - + - - - + + - GR26 4226 49 - + + - - + - + - - + - GR28 5064 37 + - + - - + - - + - + - GR30 5069 46 + - + - - + - - + - + - GRGroup - B Total 06 09 13 02 05 08 02 05 05 05 10 05 13G,1M,1 NOTE; SEX:M-MALE,F-FEMALE, RELIGION: H-HINDU, M-MUSLIM, ECONOMIC STATUS:P-POOR,M-MIDDLE,H-HIGHER CLASS;OCCUPATION: S-SEDENTARY, A-ACTIVE, L-LAIBOUR DIET: V-VEGITERIAN, M-MIXED “Comparative Management study of Pakshaghata with Mashadi Yoga” 1
  • TABLE-2: SHOWING THE CHIEF COMPLAINTS OF GROUP A AND BSl. no. Ak Ac Pt Ch Paksha Ruj Sa Sh Sa Vk Ni L R Bt Bn St1 + - - + + - - + - - - +3 + + - + + - - + + - - +5 + - - + - + - + - - - +7 + - - + - + - + - - - +9 + + + + - + - + + + + -11 + + + + + - - + + + + +13 + + + + + - - + + + + -15 + + + + - - + + + + + -17 + + + + - + - + + + - -19 + + + + - - + + + + + +21 + + + + + - - + + + - +23 + + + + + - - + + + + +25 + + + + + - - + + + + -27 + + + + - + - + + + + +29 + + + + + - - + - - - -Total 15 12 11 15 8 5 2 15 11 10 08 09Group –B2 + - - + + - - + - - - -4 + + - + - + - + + - - -6 + - - + + - - + - - - -8 + + + + + - - + + + + -10 + + + + - + - + + + + +12 + + + + + - - + + + + -14 + + + + - - + + + + + -16 + + + + - - + + + + + +18 + + - + - - + + - - - +20 + + + + - + - + + + - +22 + - - + + - - + - - - -24 + + + + - + - + + + + +26 + + + + + - - + + + + -28 + + + + + - - + - - - -30 + + + + + - - + + + + -Total 15 12 10 15 8 4 3 15 10 09 08 05Note : Ak- AKARANYATHA , AC-ACHETANA , PT- PATANA , CH NI CHESTANIVRITTI , PAKSHA: L-LEFT , R-RIGHT , BT –BOTH , RUJ - RUJA , SA –SANKOCHA ,SH-SHOSHA ,SA BN –SANDHI BANDHA , VK ST –VAK STAMBHA “Comparative Management study of Pakshaghata with Mashadi Yoga” 2
  • TABLE-3 : SHOWING THE ANUBHANDHA VEDANA OF GROUP –A AND B Group –A Sl. no. HTN DM HDA VMT KMVT OBST 1 + + + + - + 3 + + - - - - 5 + + + + - + 7 + - + + + + 9 + + + + - + 11 + + - - + - 13 + + + + - + 15 + + - - - + 17 + - + + - + 19 + + + + + - 21 + - - - + + 23 + + + + + + 25 + + + + - + 27 + + - - + + 29 + + + + - + Total 15 12 10 10 06 12 Group -B Sl. no. HTN DM HDA VMT KMVT OBST 2 + + - - - + 4 + + + + + - 6 + + - - - - 8 + - + + - + 10 + + - - - + 12 + - + + + - 14 + + + + + - 16 + + - - - - 18 + + + + - + 20 + - + + - - 22 + + - - - + 24 + - + + + - 26 + - - - - + 28 + + + + - + 30 + + + + - + Total 15 10 09 09 04 08NOTE : HTN – HYPERTENSION , DM –DIABETES MELITUS ,HAD –HEAD ACHE, VMT – VOMITING ,KMVT – KAMPAVATA , OBST – OBESITY . “Comparative Management study of Pakshaghata with Mashadi Yoga” 3
  • TABLE-4 : SHOWING THE ADYATANA VYADHI VRITTANTA OF GROUP –A AND B Group –ASl. Family h/o Pakshaghata Mode of onset Period of onset Dosh Involvedno Present Absent Sudden Gradual Day Night V P K1 - + - + - + + - -3 - + + - + - - + -5 + - + - - + + - -7 - + - + - + + - -9 + - + - - + + - -11 - + + - + - - + -13 - + + - - + - - +15 + - - + + - - + -17 - + + - + - - + -19 + - + - - + + - -21 - + - + - + - - +23 - + + - - + - - +25 - + + - - + + - -27 + - + - + - - + -29 + - + - - + + - -Total 06 09 11 04 05 10 07 05 03Group- BSl.no. Present Absent Sudden Gradual Day Night V P K2 + - + - - + + - -4 + - + - + - - + -6 + - + - - + + - -8 - + - + - + - - +10 + - - + - + - - +12 + - - + + - - + -14 + - - + - + + - -16 - + - + - + + - -18 - + - + - + - - +20 + - - + - + + - -22 - + + - - + + - -24 + - - + + - - + -26 + - + - - + - - +28 - + - + + - - + -30 + - + - - + - - +Total 10 05 06 09 04 11 06 04 05NOTE :DESHA INVOLVED: V –VATA , P- PITTA , K-KAPHA . “Comparative Management study of Pakshaghata with Mashadi Yoga” 4
  • TABLE-5 : SHOWING THE VAYAKTIKA VRITTANTA (AHARA) OF GROUP –A AND B Sl. no. Diet Agni NtM Mt Rasa pradhanatha V M S V T M H L R I M A L Kt T Ks 1 - + - - + - + - - + - + + + - - 3 + - - - + - + - + + + + - + - 5 - + - - + - + - - + - - + + - - 7 - + - - + - + - - + - + + + - - 9 - + - + - - - + - + + - + - - - 11 + - + - - - - + + - + + + - + + 13 - + - + - - - + - + + - + - - - 15 + - - - - + - + + - + + + - + - 17 + - - - - + - + + - + - + - + + 19 - + - - + - + - - + - + + + - + 21 + - - + - - + - - + - + + + + - 23 - + - - + - + - - + - + + + - - 25 + - - - - + - + - + + - + - + - 27 - + - - + - + - - + - + + + - - 29 - + - - + - + - - + + + + - - Total 06 09 1 3 7 4 8 7 3 12 7 10 15 8 6 3 Group –B 2 - + - - - + - + - + - + + + - - 4 + - - - - + - + + - + + + - + - 6 + - - - + - + - - + - - + - - + 8 + - - - + - - + - + - + + + - + 10 + + - - - - + + - + - - - - - 12 + - + - - - + - + - + + + - + + 14 + - + - - + - - + - - + + - - 16 + - - + - - + + - + + + - + - 18 + - - - - + - + + - - - - - + + 20 + - - - + - + - + - - + - + - - 22 + - + - - + - - + - + + + + - 24 + - - - + - - + - + - + + - - + 26 + - - + - - + - + + - - + + + 28 + - + - - - - + - + - + + + - - 30 + - - + - - + - + - + + + - + Total 10 05 3 4 5 3 7 8 8 7 5 10 11 8 6 7 NOTE : DIET: V-VEGETARIAN,M-MIXED;AGNI: S-SAMAGNI ,V-VISHAMAGNI,T-TEEKSHNAGNI,M-MANDAGNI;NTM-NIGHT MEAL:H-HEAVY, L-LIGHT,MT:MEAL TIME,R-REGULAR ,I-IRREGULAR;RASAPRADHANATA : M-MADHURA,A-AMLA,L-LAVANA,KT-KATU, T-TIKTA,KS-KASHAYA “Comparative Management study of Pakshaghata with Mashadi Yoga” 5
  • TABLE-6 : SHOWING THE VAYAKTIKA VRITTANTA (VIHARA) OF GROUP –A AND BSl. Kosta Snana Mala Pr Mutra Pr Vys Nidra Vyayamano M m K U S s R L C R M S T A S D H M A1 - - + - + - - + - - + - - + - + - - +3 - - + - - + - - - - + - + - - + - + -5 - - + - + - - - + - + - + + - + - + -7 + - - + - - + - - + - - - - + - - + -9 - - + + - - - - + - - + + - - + + - -11 - - + - - + - - + - + - + + - + + - -13 - + - + - - - + - + - - + + + - - - +15 - + - - + - - - + - + - + + - + + - -17 - - + + - - - - + - + - - - - + - + -19 - - + - + - - + - - + - + - - + + - -21 + - - - + - + - + + - - - - + - - + -23 - + - - + - - - + - - + + + - + - - +25 - - + - - + - - + - + - + - - + - - +27 - - + + - - - - + - + - - - - + - + -29 - - + + - - - - + - + - + - - + + - -Total 2 3 10 6 6 3 2 3 10 3 10 2 10 6 3 12 5 6 4Group -BSl.no M m K U S s R L C R M S T A S D H M A2 - - + - + - - + - - - + + - + - - - +4 - + - - - + - - + - + - + - - + - + -6 - - + + - - - - + - + - + - - + - + -8 + - - + - - - + + - - + - + - - + -10 + - - + - - - + - - - + + - - + - - +12 - - + - + - - - + - + - + + - + + - -14 - + - + - - - + - + - - + - + - - - +16 + - - + - - - + - + - + - - + - - +18 - - + + - - - - + - - + - + + - - + -20 - - + - + - - + - - + - + - - + + - -22 + - - + - - + - - - + - - - + - - - +24 - + - - + - - + - - - + + + - + - - +26 - - + - - + - - + + - - + - + - - - +28 - - + - + - - - + - + - - + - + - + -30 - - + + - - - - + - - + + + + - - - +Total 4 3 8 7 6 2 1 5 9 3 7 5 12 5 7 8 2 5 8NOTE : KOSTA:M-MRUDU,m-MADHYAMA,K-KRURA;SNANA:U-USHNA,S-SHEETA,s-SAMASHEETOSHNA;MALA PRAVRITTI:R-REGULAR, L-LOOSE,C-CONSTIPATION;MUTRA PRAVRITTI: R-REGULAR, M-MORE,S- SCANTY;VYASANA:T-TOBACCO,A-ALCOHOL,NIDRA:S-SOUND,D-DISTURB;VYAYAMA:H-HEENA,M-MADHYAMA,A-ATI “Comparative Management study of Pakshaghata with Mashadi Yoga” 6
  • TABLE-7 : SHOWING THE MANO PAREEKSHANA OF GROUP –A AND BGroup –ASl.no Int Ele Dep Anx Fer Ang Wor Pho Str1 + - - - + - + - -3 + - - - + - + - -5 + - - - + - + - -7 + - - - + - - - -9 + - - - + - + - -11 - + + + - + - + +13 + - - - + - + - -15 + - - - + - - - -17 - + + + - - + + -19 - + + + - + + - +21 - + + + - + + - +23 - + + + - + - + +25 + - - - + - + - -27 + - - - + - - - -29 + - - - + - + - -Total 10 05 05 05 10 04 10 03 05Group -BSl.no Int Ele Dep Anx Fer Ang Wor Pho Str2 + - - - + - + - -4 + - - - + + + - -6 + - - - + - + + +8 - + - - - + - - -10 + - - - + - + - -12 - + + + - + - + +14 + - - - + - + - -16 + - - - + + + + +18 - + + + - - + + -20 - + + + - + + - +22 - + - + - + + - +24 - + + + - + - + +26 + - - - + - + - -28 - + - - - - - - +30 + - - - + + + - -Total 08 07 04 05 08 08 11 05 07NOTE :INT-INTACT,ELE-ELEVATED,DEP-DEPRESSED,ANX-ANXIOUS,FER-FEAR, ANG- ANGER,WOR-WORRIES,PHO-PHOBIAS, STR-STRESS . “Comparative Management study of Pakshaghata with Mashadi Yoga” 7
  • TABLE-8 : SHOWING THE NIDANA (AHARA) OF GROUP –A AND BGroup – ASl.no Mad Aml Lav Kat Tik Ksh Ads Ans Usn She Ruk Drv1 - + + + - - + - + - - +3 + + + - + - + - + - - +5 - - + + - - + - + - - +7 - + + + - - - + + - + -9 + - + - - - - + + - + -11 + + + - + + - + + - + -13 + - + - - - + - + - - +15 + + + - + - - + - + + -17 + - + - + + + - - + - +19 - + + + - + - + + - + -21 - + + + + - + - + - - +23 - + + + - - + - - + - +25 + - + - + - - + + - + -27 - + + + - - + - + - - +29 + + + - - + - + - - +Total 7 10 15 8 6 3 09 06 12 03 06 09Sl.no Mad Aml Lav Kat Tik Ksh Ads Ans Usn She Ruk Drv2 - + + + - - + - + - - +4 + + + - + - - + + - + -6 - - + - - + + - - + - +8 - + + + - + - + + - + -10 + - - - - - - + + - - +12 + + + - + + - + - + + -14 - - + + - - + - + - - +16 + + + - + - + - - + + -18 - - - - + + + - - + - +20 - + - + - - - + + - + -22 - + + + + - + - + - - +24 - + + - - + - + - + + -26 + - - + + + - + + - + -28 - + + + - - + - - + - +30 + + + - + + - + - + -Total 5 10 11 8 6 7 08 07 09 06 08 07NOTE :MAD-MADHURA,AML-AMLA,LAV-LAVANA,KAT-KATU,TIK-TIKTA,KSH-KASHAYA,ADS-ADYASHANA,ANS-ANASHANA,USN-USHNA,SHE-SHEETA , RUK-RUKSH,DRV-DRAVA. “Comparative Management study of Pakshaghata with Mashadi Yoga” 8
  • TABLE-9 : SHOWING THE NIDANA OF VIHARA AND MANASIKA OF GROUP –A AND BGroup –A Vihara ManasikaSl.no Vdh Atp Adw Aym Prj Amt Krd Shk Bhy1 + - + + - + + - +3 + - + + - + + + +5 + - + + - + + - +7 + - - + - - - + -9 + - - + - + + - +11 - + - - + - - + -13 + - + + - + + - +15 + - - + - - + + +17 - - + - + + - + +19 - + + - + + - + +21 - + + - + + - + +23 - + - - + - - + -25 + - + + - + + - +27 + - - + - - - - -29 + - + + - + + + +Total 10 04 09 10 05 10 08 09 11Group –BSl.no Vdh Atp Adw Aym Prj Amt Krd Shk Bhy2 + - + + - + + - +4 + + + + + + + - +6 + - + + - + + - +8 - + - - - - + - -10 + - + + - + + - +12 - + - - + - - + -14 + - - + - + + - +16 + + + + - + + - -18 - + + - - + - - +20 - + - - + + - + +22 + + + - - + - + +24 - + - - + - - + -26 + - + + - + + - +28 - + - - - - + - -30 + + + + + + + - +Total 09 10 08 08 05 11 10 04 10NOTE :VIHARA:VDH-VEGA DHARANA,ATP-ATAPA SEVANA,ADW-ADWAGAMANA, AYM-ATI VYAYAMA, PRJ-PRAJAGARANA,AMT –ATI MAITUNA , KRD-KRODHA, SHK-SHOKA, BHY –BHAYA “Comparative Management study of Pakshaghata with Mashadi Yoga” 9
  • TABLE-10 : SHOWING THE FACIAL NERVE EXAMINATION OF GROUP –A AND B Group- A Sl.no Mus Mv Tenderness Taste Elev Hyd Sec saliva Lacrimation 1 + + + - + + 3 + - + - + - 5 + + - - + - 7 - + + + - + 9 + - - - + - 11 - + + - + - 13 + + + - - + 15 - - + + + - 17 + - - - + - 19 + + - + + - 21 - - + - - + 23 + + + + + - 25 + + + - - + 27 + + - + + - 29 + - - - - + Total 11 09 09 05 10 06 Group –B Sl.no Mus Mv Tenderness Taste Elev Hyd Sec saliva Lacrimation 2 + + - - - + 4 + - + - + - 6 + + - - - - 8 - + - + - - 10 + - - - + - 12 - - + - - - 14 + + + - - + 16 - - - - + - 18 - - - - - - 20 + + - + + - 22 - - + - - - 24 + - - - + - 26 - + + - - + 28 + - - + - - 30 + - - - - + Total 09 06 05 03 05 04NOTE : MUS MV-MUSCLE MOVEMENT,ELEV HYD-ELEVATED HYOID BONE, SEC SALIVA-SECRETION OF SALI “Comparative Management study of Pakshaghata with Mashadi Yoga” 10
  • TABLE-11 : SHOWING THE MOTOR SYSTEM EXAMINATION OF GROUP –A AND B Inspection Postural abn movts Palpation Tone PowerSl.no Mw Da Fs Tr My Dy Tt Cr Wm Fb Pl Hr Hp Rg Hm Lm1 + + - - - + - - + - - - + + + +3 - - - + + + - - - + + - + + + +5 + + + - - + - + + + - - + + + +7 - + - - + + - - - - - - + + - -9 + + - - - + - - + + - - + + - -11 - - + - - - - + - - - + - - + +13 + + - + + + - + + - + - + + - -15 - - + _ - - - - - - - + - - + +17 + + - - - + - - + + + - - - - -19 + + - - - + - - + - - - + + - -21 - - + + + + - - - - - - + + - -23 - - + - - - - + - - - + - - + +25 + + - - + + - - + + + - + + - -27 + + + - - + - + + - - - + + + +29 + + - + + + - - + - - - + + + +Total 09 10 06 04 06 12 00 05 09 05 04 03 11 11 08 08Group -BSl.no Mw Da Fs Tr My Dy Tt Cr Wm Fb Pl Hr Hp Rg Hm Lm2 + + - - - + - - + - - - + + + +4 + + - + + + - - + + + - + + + +6 - + - - - - - + - - - - + + + +8 + + - - + - - - + - - - + - - -10 - + - - - + - - - - - + - + + +12 - - + - - - - - - - - + - - + +14 + + - + - + - - + - + - + + - -16 - - + - - - - - - - - + - - + +18 + + - - - - - - + + + - + + - -20 - + - - - + - - - - - + - + + +22 + + - - - - - - + - - - + - - -24 - - + - - - - - - - - + - - + +26 + + - + + + - - + + + - + + - -28 + + + - - - - + + - - + - + + +30 - + - - + + - - - - - - + + + +Total 08 12 04 03 04 07 00 02 08 03 04 06 09 10 10 10 NOTE : INSPECTION:MW-MUSCLE WASTING, DA-DISUSE ATROPY, FS-FASCICULATION; POSTURE AND ABNORMAL MOVEMENTS: TR-TREMOUR,MY-MYOCLONUS,DY-DYSTONIA, TT-TETANY,CR-CRAMP; PALPATION: WM-WASTED MUSCLE,FB-FIBROSIS, PL-POLYMYOSITIS;TONE:HR-HYPERTONIA,HP-HYPOTONIA, RG-RIGIDITY;POWER:HM-HAND MUSCLE,LM-LEG MUSCLE. “Comparative Management study of Pakshaghata with Mashadi Yoga” 11
  • TABLE-12 : SHOWING THE REFLEXES OF GROUP –A AND B Group –ASl.no Jw J Bi J Su J Tr J Kn J An J SA Rf Pl Rf1 + + + + + + + +3 + + - + + - + -5 + + + + - + - +7 + - - - - - - -9 + + + + + - + -11 - + - + + + - +13 + - - + - - - -15 + + + + + - + +17 + - - - - - - -19 - + - + - + + -21 + + + + + + - +23 + + + + + + + -25 + - - - - - - -27 + + + + + + - +29 - - - + - + + -Total 12 09 07 12 08 08 07 06Group –BSl.no Jw J Bi J Su J Tr J Kn J An J SA Rf Pl Rf2 + + + + + + + +4 + + - + + - + -6 + + + + - + + +8 - - - - - - - +10 + - + + + - + -12 - + + + + + - +14 + - - - - - + -16 + + + + + - + +18 - - - - - - - +20 - - - + - + + -22 + + + + + - - +24 + + + - + + + +26 + - - - - - + -28 + + + - + + - +30 - - - + - + + -Total 10 08 08 09 08 07 10 09NOTE: JW J-JAW JERK,BI J-BICEPSE JERK,SU J-SUPINATOR JERK,TR J-TRICEPSE JERK, KN J-KNEE JERK, AN J-ANKLE JERK,SA RF-SUPERFICIAL ABDOMINAL REFLEXES,PL RF-PLANTAR REFLEXES. “Comparative Management study of Pakshaghata with Mashadi Yoga” 12
  • TABLE-13 : SHOWING THE CO-ORDINATION OF THE LIMBS GROUP –A AND B Group –A Co-ordination of Upper limb Co-ordination of Lower limb Sl.no FNT DYDKNS FN MNTS HST ST & GT SMI 1 + + + + + + 3 + + + + + - 5 + + + - - - 7 + - - - - - 9 + - + + + - 11 + + + + - + 13 + - - - - - 15 + + + + + - 17 + - + - - - 19 + - - + - + 21 + + + - + - 23 + + + - + - 25 + - - - - - 27 + + + - + + 29 + - + + - - Total 15 08 11 07 07 04 Group –B Sl.no FNT DYDKNS FN MNTS HST ST & GT SMI 2 + + + + + + 4 + + - + + - 6 + + + + - + 8 + - + - - - 10 + - + + + - 12 + - + + + + 14 + - - - - - 16 + + + + + - 18 + - - - - - 20 + - - + - - 22 + + + + + - 24 + - + - + + 26 + - + - - - 28 + + + - - + 30 + - - + + + Total 15 06 10 09 08 06NOTE :FNT:FINGER NOSE TEST, DYDKNS-DYSDIADOCHOKINESIS.FN MNTS-FINE MOVEMENTS, HST-HEEL SHIN TEST,ST&GT –STANCE AND GAIT,SMI-SEGMENTAL MOTOR INNERVATION “Comparative Management study of Pakshaghata with Mashadi Yoga” 13
  • TABLE-14 : SHOWING THE UPPER MOTOR NEURON EXAMINATON OF GROUP –A AND BGroup –ASl.no In tn Sp pst Br t rf Bl wk Py wk Ex plt Hem Par Qud1 + + + - + + + - -3 - + - - - - + - -5 + + - + - + - + -7 - - - - - - + - -9 + + + - + - - - +11 - + - + - + - + -13 + - - - - - + - -15 + + + - - - + -17 - - - - - - + - -19 - + - + - + + - -21 - + - - + + - + -23 + + + - + + - - +25 - - - - - - + - -27 + + - - + + - + -29 - - - - - + + - -Total 07 10 04 03 05 08 09 04 02Group -BSl.no In tn Sp pst Br t rf Bl wk Py wk Ex plt Hem Par Qud2 + + + - + + + - -4 - + - - - - + - -6 + + - + - + - + +8 - - - - - - + - -10 + + - - - - - - -12 + + - - + + - -14 + - - - - - + - -16 + + + - - - + -18 - - - - - - + - -20 + - - + - + + - +22 - + - - + - - + -24 + - + - - + - - -26 - - - - - - + - -28 + + - - - - + - -30 - - - - - + + - -Total 09 08 03 02 02 07 11 02 02NOTE :IN TN-INCREASED TONE,SP PST-SPASTIC POSTURE,BR T RF-BRISK TENDON REFLEX,BL WK-BLADDER WEAKNESS,PY WK-PYRIMIDAL WEAKNESS,EX PLT-EXTENSOR PLANTARS,HEM-HEMIPLEGIC,PAR-PARAPLEGIC,QUD- QUADRIPLEGIC “Comparative Management study of Pakshaghata with Mashadi Yoga” 14
  • TABLE-15 : SHOWING THE LOWER MOTOR NEURON EXAMINATON OF GROUP –A AND BGroup –ASl.no DMT M W FSN F PRS LS RF W NR FT D QD W P NP1 + + - - + + + + -3 + - + + - + + - +5 + + - - - + + + -7 - - - - - + - - -9 + + - - + + + + +11 - - + - - + - + -13 + + - - - + + - -15 + - + - - + + + +17 + + - + + + + - +19 + + - - - + + - -21 + - - - - + + + -23 - - + - - + - - +25 + + - - - + + + -27 + + + + - + + + +29 + + - - + + + + +Total 12 09 05 03 04 15 12 09 07Group -BSl.no DMT M W FSN F PRS LS RF W NR FT D QD W P NP2 + + - - - + + + -4 + - + + - + + - +6 + + - - + + + + -8 - - - - - + - - -10 + + - - - + - + +12 - - + + - + - - -14 + + - - - + + - -16 - - - - - + + + -18 + - - - + + + - +20 + + - - - + - - -22 - - - - - + + + -24 - - + - - + - - +26 + + - - - + - - -28 + - - - - + + + +30 + + - - _ + + + -Total 10 08 03 02 02 15 09 07 05NOTE :DMT-DECREASED MUSCLE TONE, MW –MUSCLE WASTING,FSN-FASCICULATION, F PRS-FLACCID PARESIS, LS RF-LOSS OF REFLEX,W NR-WEAKNESS OF NERVE ,FT D-FOOT DROP,QD W-QUADRICEPSEWEAKNESS,P NP-PERIPHERAL NEUROPATHY “Comparative Management study of Pakshaghata with Mashadi Yoga” 15
  • TABLE-16 : SHOWING THE RESULTS OF OBJECTIVE CRITERIA OF GROUP –A AND BGroup –A Stroke Recovery score Card The Barthel Index Grip TestSl no BT AT AF BT AT AF BT AT AF1 45 42 38 65 75 90 40 50 503 55 36 29 45 55 65 30 50 605 37 31 26 60 65 90 40 50 607 45 35 28 65 40 35 40 50 509 60 47 38 30 55 60 40 50 5011 47 50 42 30 58 57 40 50 5013 58 43 31 45 55 60 40 40 4015 52 34 19 65 40 35 40 40 5017 57 39 21 00 35 55 40 40 5019 57 40 31 00 40 55 30 30 4021 56 41 33 35 45 65 30 40 5023 63 47 25 00 40 60 30 40 5025 53 39 20 00 40 55 30 30 4027 51 37 20 00 40 60 40 50 6029 46 36 30 65 35 35 50 50 50Group –B Stroke Recovery score Card The Barthel Index Grip TestSl no BT AT AF BT AT AF BT AT AF2 60 45 35 30 55 60 40 50 504 55 40 37 40 70 75 40 50 606 45 35 29 30 80 95 30 50 508 60 47 35 30 55 60 50 60 6010 61 46 33 30 55 60 30 40 4012 60 47 35 30 52 51 30 40 4014 49 36 21 00 40 60 30 50 5016 54 37 30 00 40 40 30 40 4018 42 32 25 60 30 25 50 50 5020 58 41 22 05 45 70 30 40 4022 61 44 29 25 55 65 30 40 4024 51 36 19 00 45 55 30 40 4026 54 39 22 00 40 65 30 30 4028 45 35 29 65 40 35 50 50 5030 61 46 23 00 40 60 40 50 60 NOTE :BT-BEFORE TREATMENT, AT-AFTER TREATMENT, AF-AFTER FOLLOWUP “Comparative Management study of Pakshaghata with Mashadi Yoga” 16
  • TABLE-17 : SHOWING THE RESULTS OF SUBJECTIVE CRITERIA OF GROUP –A AND B Group –A Shareera Akarmanya Chesta Nivritti Hasta paada RujaSl no BT AT AF BT AT AF BT AT AF1 3 2 2 3 2 2 3 2 23 3 2 2 3 2 2 3 2 25 2 2 2 2 2 2 2 2 27 3 2 2 3 2 2 3 2 29 3 2 1 3 2 1 3 2 111 3 2 2 3 2 2 3 2 213 3 3 3 3 3 3 3 3 315 3 2 1 3 2 1 3 2 117 3 2 1 3 2 1 3 2 119 3 2 2 3 2 2 3 2 221 3 2 1 3 2 1 3 2 123 3 2 1 3 2 1 3 2 125 3 2 1 3 2 1 3 2 127 3 2 1 3 2 1 3 2 129 3 2 1 3 2 1 3 2 1Group -B Shareera Akarmanya Chesta Nivritti Hasta paada RujaSl no BT AT AF BT AT AF BT AT AF2 2 2 2 2 2 2 2 2 24 2 2 1 2 2 1 2 2 16 3 1 1 3 1 1 3 1 18 3 2 1 3 2 1 3 2 110 3 2 1 3 2 1 3 2 112 3 2 1 3 2 1 3 2 114 3 2 1 3 2 1 3 2 116 3 2 1 3 2 1 3 2 118 2 1 1 2 1 1 2 1 120 3 2 1 3 2 1 3 2 122 3 2 2 3 2 2 3 2 224 3 2 1 3 2 1 3 2 126 3 2 1 3 2 1 3 2 128 2 1 1 2 1 1 2 1 130 3 2 1 3 2 1 3 2 1 NOTE :BT-BEFORE TREATMENT, AT-AFTER TREATMENT, AF-AFTER FOLLOWUP “Comparative Management study of Pakshaghata with Mashadi Yoga” 17
  • TABLE-18 : SHOWING THE RESULTS OF SUBJECTIVE CRITERIA OF GROUP –A AND BGroup –A Sankocha of H&P Sosha of Sr & Sn Sandhibandha Vm VakstambhasSl no BT AT AF BT AT AF BT AT AF BT AT AF1 3 2 2 3 2 2 3 2 2 3 2 23 3 2 2 3 2 2 3 2 2 3 2 25 2 2 2 2 2 2 2 2 2 2 2 27 3 2 2 3 2 2 3 2 2 3 2 29 3 2 1 3 2 1 3 2 1 3 2 111 3 2 2 3 2 2 3 2 2 3 2 213 3 3 3 3 3 3 3 3 3 3 3 315 3 2 1 3 2 1 3 2 1 3 2 117 3 2 1 3 2 1 3 2 1 3 2 119 3 2 2 3 2 2 3 2 2 3 2 221 3 2 1 3 2 1 3 2 1 3 2 123 3 2 1 3 2 1 3 2 1 3 2 125 3 2 1 3 2 1 3 2 1 3 2 127 3 2 1 3 2 1 3 2 1 3 2 129 3 2 1 3 2 1 3 2 1 3 2 1Group -BSl no BT AT AF BT AT AF BT AT AF BT AT AF2 2 2 2 2 2 2 2 2 2 2 2 24 2 2 1 2 2 1 2 2 1 2 2 16 3 1 1 3 1 1 3 1 1 3 1 18 3 2 1 3 2 1 3 2 1 3 2 110 3 2 1 3 2 1 3 2 1 3 2 112 3 2 1 3 2 1 3 2 1 3 2 114 3 2 1 3 2 1 3 2 1 3 2 116 3 2 1 3 2 1 3 2 1 3 2 118 2 1 1 2 1 1 2 1 1 2 1 120 3 2 1 3 2 1 3 2 1 3 2 122 3 2 2 3 2 2 3 2 2 3 2 224 3 2 1 3 2 1 3 2 1 3 2 126 3 2 1 3 2 1 3 2 1 3 2 128 2 1 1 2 1 1 2 1 1 2 1 130 3 2 1 3 2 1 3 2 1 3 2 1NOTE :BT-BEFORE TREATMENT, AT-AFTER TREATMENT,AF-AFTER FOLLOWUP “Comparative Management study of Pakshaghata with Mashadi Yoga” 18
  • Case sheet SPECIAL CASE SHEET FOR “Comparative management study of Pakshaghata with Mashadi yoga” POST GRADUATE STUDIES AND RESEARCH CENTER (KAYACHIKITSA) D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG Guide: Scholar: Dr. K. Shiva Rama Prasad Dr. Ishwar. Y. Patil 1) Name of the Patient Sl.No 2) Gender Male Female OPD No 3) Age Years IPD No 4) Religion Hindu Muslim Christian Other 5) Occupation Sedentary Active Labour 6) Economical status Poor Middle Higher middle Higher class 7) Address Ph No: Pin 8) Birth data Place of Birth AM Month Year Time Hours Minutes PM 9) Selection Included Excluded 10) Schedule dates Initiation completion 11) Result Cured Moderate Mild Unchanged improvement improvement INFORMED CONSENT I Son/Daughter/Wife of amexercising my free will, to participate in above study as a subject. I have been informed to my satisfaction, by the attendingphysician the purpose of the clinical evaluation and nature of the drug treatment. I am also aware of my right to opt out of thetreatment schedule, at any time during the course of the treatment.EzÀÄ £Á£ÀÄ ²æÃ/²æêÀÄw _________________________________________________ £À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ PÉÆqÀĪÀ aQvÁì ¸ÀªÀÄäw.¥Àæ¸ÀÄÛvÀ £ÀqÉ¢gÀĪÀ aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtð ªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ 0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ w½¢gÀÄvÀÛ£É. Witnesss Signature gÉÆV0iÀÄ gÀÄdÄ / Patients Signature “Comparative Management study of Pakshaghata with Mashadi Yoga” 1
  • Case sheetPradhana vedana (Chief complaints)Date of stroke Date of Admission Lakshana Bheda Duration RemarkShareera Akarmanya Achetana PatanaChesta NivruttiPaksha Dakshina / VamaRuja / Shoola Paada HastaSankocha Paada HastaSosha Sira SnayuSandhibandha Vimokshana (loosen) Samyak (Intact)Vaksthambha Present / AbsentAny symptoms observedbefore to stroke?Anubandha vedana (Associated complaints) Lakshana Duration Family history RemarkHypertensionDiabetesHeadacheVomitingKampavataObesityPoorva vyadhi vrittanta (H/O Previous illness) : Adhyatan vyadhi vrittanta (H/O Present illness) Lakshana Family H/O Paralysis Present / Absent Mode of Onset Sudden Gradual Period of onset Day ( ) Night ( ) Vata ( ) Pitta ( ) Kapha ( ) Vyaktika Vrittanta (Personal History) Ahara ViharaDiet Vegetarian / Mixed Kostha Mrdu / Madhyama /KruraAgni Sama / Vishama / Teekshana / Manda Snana Usna /Sita / Samasitoshna jalaMatra Heena / Madhyama / Ati Mala pravrutti Regular / Loose /ConstipationNight meal Heavy / Light Mutra pravrutti Regular /More / ScantyMeal time Timely / Irregular Vyasana Tobacco / Alcohol / OtherRasa M/A/L/K/T/Ks Nidra Sound / Disturbed Vyayama Heena / Madhyama /Ati Regular /Irregular Treatment History if any –“Comparative Management study of Pakshaghata with Mashadi Yoga” 2
  • Case sheetPAREEKSHANAAsta sthā Pareeksha : na1 Nadi Dosha V ( ) P ( ) K ( ) VP ( ) VK ( ) PK ( ) VPK ( ) Gati2 Mala3 Mootra Frequency Day Night4 Jihwa5 Shabda6 Sparsha7 Druk8 AkrutiVital examination1 Temp /F 4 Blood Pressure / mm of Hg2 Pulse /min 5 Height cms3 Respiration /min 6 Weight Kgs. Mano Pareekshan (Examination of Mental and Emotional Status)Intact ( ) Elevated ( ) Depressed ( )Anxious ( ) Fear ( ) Anger ( ) Worries ( ) Phobias ( ) Stress ( ) Others - specify ( )Nidana Ahara Vihara ManasikaLavana Adhyashan Vega dharana KrodhaKatu Anashan Atapasevan ShokaAmla Ushana Adhwagamana BhayaTikta Sheeta Ati vyayamaKashaya Ruksha PrajagaranaMadhura Drava Ati maithunaSystemic Examinationsystem Darshana Sparshana PrashnaRespiratoryCardio vascularCentral nervousGastro intestinal tractPer abdomenCNSFacial nerve in specific Muscle movement Tenderness Taste Elevation of hyoid bone Secretion of saliva LacrimationMOTOR Inspection Muscle wasting Disuse atrophy FasciculationSYSTEM Posture and tremor Myoclonus Dystonia abnormal Tetany Cramp movements Palpation Wasted muscles Fibrosis Polymyositis Tone Hypertonia Hypotonia Rigidity Power Hand muscles Leg muscles“Comparative Management study of Pakshaghata with Mashadi Yoga” 3
  • Case sheet Reflexes Jaw jerk Biceps jerk Supinator jerk Triceps jerk Knee jerk Ankle jerk Superficial plantar reflex abdominal reflexes Coordination Finger-nose test. Dysdiadochokinesis. Fine movements Upper Limb Coordination Heel-shin test Stance and gait Segmental motor Lower Limb innervation UMN Increased tone Spastic posture Brisk tendon reflexes UMN bladder pyramidal weakness extensor plantars weakness Gait Hemiplegic Paraplegic Quadriplegic LMN Decreased muscle Muscle Wasting Fasciculation tone Flaccid paresis Loss of reflexes Weakness of nerve root Gait Foot drop Quadriceps Peripheral weakness neuropathyINVESTIGATIONRandom Blood Sugar Prothrombin testPlatelet count Urine examinationASESSMENT OF RESULTSSUBJECTIVE CRITERIA Lakshana Bheda Before After Follow UpShareera Akarmanya Achetana PatinaChesta NivruttiPaksha Dakshina / VamaRuja / Shoola Paada HastaSankocha Paada HastaSosha Sira SnayuSandhibandha Vimokshana SamyakVaksthambha Present / AbsentOBJECTIVE CRITERIA Criteria Before After Follow Up1)Stroke Recovery Score Card (SRSC)2)The Barthel Index (BI)3)Grip Test (GT)“Comparative Management study of Pakshaghata with Mashadi Yoga” 4
  • Case sheetTREATMENT SCHEDULEGroup – A : Oral Mashadi kwatha: 96 ml/24 hrs i.e. 48 ml BDSchedule Date Observation / instructions0 day = Initiation11th day = 1st observation21st day = 2nd observation31st day = Test completion60th day = Final Follow UpGroup – B: Mashadi Taila Nasya 8 Drops in each nostrilsSchedule Date Observation / instructions1st day = 1st Nasya Initiation2nd day3rd day4th day5th day6th day7th day8th to 10th day = Rest11th day = 2nd Nasya Initiation12th day13th day14th day15th day16th day17th day18th to 20th day = Rest21st day = 3 rd Nasya Initiation22nd day23rd day24th day25th day26th day27th day28th to 30th day = Rest60th day = Final Follow Up Scholar:Guide: Dr. Ishwar. Y. PatilDr. K. Shiva Rama Prasad“Comparative Management study of Pakshaghata with Mashadi Yoga” 5
  • Case sheet 1) STROKE RECOVERY SCORE CARDThe person filling this form out is (chek one) Difficulty ScaleStroke survivor Care giver/Family member 1 = NoneHow much time has passed since your last stroke? ____________ 2 = AlittleStroke Rehab Status; 3 = some whatInitial therapy Finished therapy & on home exercise program 4 = A lotHave returned to therapy 5 = SevereAm not in therapyCHANGES IN ACTIVITIES & PARTICIPATION Before After Follow Up 1. Communication – ability to talk with other people, write, understand what you read & what people say and used body language. Includes aphasia, or the loss of ability to communicate normally, which may affect your ability to talk, understand read & write or deal with numbers. 2. Movement- ability and strength to walk, balance lift &carry objects pick up and grasp something. Using public transportation, drive, move around on your own with help of equipment (e.g., wheel chair, walker, cane) at home or in the community. 3. Activity in social, community &civic life- ability & comfort level to be active in social, community & civic events that you enjoy 4. Energy level- fatigue or low energy, feeling worn down & exhausted .this is different from weakness, sleepiness or being over stimulated. 5. Sexuality- the quality of sexual relationship after stroke. This differs from person to person 6. Support &Relationship- the ability to maintain interest in people &recreational activities, remain connected ,relate with strangers, & cope with changes in how or with whom you spend time or deal with the attitudes of friends & family 7. Managing daily activities- managing the details of daily life ,including things like looking after your health ,bathing, washing the hands brushing teeth , shaving ,grooming & bathing 8. Quality of life- the ability to participate in things that are meaningful & that provide you purpose in lifeCHANGES IN BODY FUNCTION 9. Pain-Any increase in how often you feel pain ,how severe the pain is, or any new pain(compared to a ”chronic” pain that has continued for a long time ).pain felt after stroke commonly includes headache as well as pain in back, shoulder ,hip, abdomen, arm and neck. 10. Control of bowel and bladder-The ability to control bowel and bladder function (often referred to as incontinence),wetting or soiling cloth or bedding, constipation ,the need to go to the bathroom often, or strong and sudden urges to go to the bathroom 11. Sleep-trouble falling asleep or not being able to sleep through the night, causing you to feel tired the next day. This is different from a low energy level or fatigue. 12. Eating- changes or problems with appetite, weight gain or loss, swallowing issues, consuming enough food or fluids, and sense of taste and smell.CHANGES IN PERSONALITY BEHAVIOR AND THINKING 13. Emotion and coping- changes in how you feel, your mood, your emotions This can include sad feelings, depression, anxiety, mood swings crying, laughter or anger when there is no reason for it or when it is normally inappropriate. 14. Thinking- concentration, attention span, memory, understanding what people say, and finding solutions to everyday problems. 15. Personality or Behavior Changes- problems being impulsive, angry, or being genuinely unaware that your memories are inaccurate. Total ( 0-75 ) “Comparative Management study of Pakshaghata with Mashadi Yoga” 6
  • Case sheet 2) THE BARTHEL INDEX Before After FollowActivity Up1) Feeding0 = unable5 = needs help cutting, spreading butter, etc., or requires modified diet10 = independent2) Bathing0 = Dependent5 = independent(or in shower)3) Grooming0 = needs to help with personal care5 = independent face /hair/teeth/shaving(implements provided)4) Dressing0 =dependent5 = needs help but can do about half unaided10 = independent (including buttons, zips, laces, etc.)5) Bowels0 = incontinent(or needs to be given enemas)5 = occasional accident10 = continent6) Bladder0 = incontinent, or catheterized and unable to manage alone5 = occasional accident10 = continent7) Toilet use0 =dependent5 = needs some help, but can do something alone10 = independent (on and off, dressing, wiping.)8) Transfers(bed to chair and back)0 = unable, no sitting balance5 = major help(one or two people, physical),can sit10 = minor help (verbal or physical)15 = independent9) Mobility(on level surface)0 = immobile or < 50 yards5 = wheelchair independent , including corners, > 50 yards10 = walk with help of one person(verbal or physical)> 50yards15 = independent(but may use any aid; for example, stick)>50 yards10) Stairs0 = unable5 = needs help (verbal, physical, carrying aid)10 = independent Total (0-100) 3) GRIP TEST Before After FollowGRIP TEST: With the patient lying flat, measure the maximal handgrip force by Uphaving the patient grip a semi-inflated sphygmomanometer cuff as hard aspossible. Handgrip sustained for 5 minutes . “Comparative Management study of Pakshaghata with Mashadi Yoga” 7
  • Case sheetHANDGRIP TESTWith the patient lying flat, measure the maximal handgrip force by having the patientgrip a semi-inflated sphygmomanometer cuff as hard as possible. Then, with a secondsphygmomanometer, measure the rise in diastolic blood pressure after a 30% handgripsustained for 5 minutes. The diastolic pressure should rise >16mmHg; in autonomicdisorders it will rise <10mmHg.ASSESSMENT OF GAITObserve the patient walking at a brisk pace, including turning. Pay particular attention to:  Reduced arm swing  Stooped posture  Lurching to one side  Asymmetry and loss of smoothness of steps  Increased breadth of base (transverse distance between steps)  Excessive stiffness or floppiness at the ankle or knee joints  Associated involuntary movements  Apparent pain.Grade tendon reflexes as follows:  0 Absent  1 Present (as a normal ankle jerk)  2 Brisk (as a normal knee jerk)  3 Very brisk  4 Clonus .The Medical Research Council Scale for grading muscle functionGrade 0 Complete paralysisGrade 1 A flicker of contraction onlyGrade 2 Power detectable only when gravity is excluded by appropriate postural adjustmentGrade 3 The limb can be held against the force of gravity, but not against the examiners resistanceGrade 4 The limb can be held against gravity and against some resistance, but is not normal (a percentage estimate, or a grade of 4+, 4 or 4- is often applied)Grade 5 Normal powerBefore Notes After Notes“Comparative Management study of Pakshaghata with Mashadi Yoga” 8