ALLINDIAINSTITUTEOFAYURVEDA(An autonomous institution under the Ministry of AYUSH, Govt. of India)

Gautampuri, Sarita Vihar, NEW DELHI

20/09/19

“Gurubhyo Namaha ………….”

“ Tameka Vaidyam Shirasa Namami…..”

EAA2019 2

Dr. Prasanth DharmarajanAssistant Professor & ConsulatantDepartment of Panchakarma All India Institute of AyurvedaGautampuri, Sarita viharNew Delhi – India

20/09/19 EAA2019 3

TOPIC

9/20/19 EAA2019 4

OBJECTIVES

OF

PRESENTATION

EAA2019 20/09/19 5

ToCreateConfidenceNotTo

RaiseHighClaims.

ToCreateAwarenessAboutCVA&MS.

ToHintOn- HowToApproach

InAYURVEDAPractice

ToCreateALinkOfThoughtProcesses.

ToBePassionateAbout

Ayurveda&ToKeepLovingIt.

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CASE

REPORT- ON

STROKE

(CVA)

9/20/19 EAA2019 7

AGE/SEX 54/Male

DIAGNOSIS Patient diagnosed as K/C/O Stroke,

(CT Brain – Multiple lacunar infarcts)

Bed ridden

SINCE 4 Days

CHIEF

COMPLAINTS

• Loss of function or deterioration of functions of left side of

body(Vama Paksha Cheshta Nivriti or Karmakshya

• Heaviness in affected limb (Gurutaa)

• Difficulty in Speaking(Vak Stambha)

EXAMINATION • Muscle tone - Stiff muscles

• Muscle strength in right upper and lower limbs was zero

• Babinski sign was positive.

PAST HISTORY Patient was on allopathic medications for Hypertension since 2

years.

PANCHAKARMA

PROCEDURES

ADOPTED

9/20/19 EAA2019 8

S.NO. PROCEDURE DURATION

1 Rookshana (Rooksha choorna pinda svedana,

Takra dhara,Kshara basti)and Talam

(Rasnadi choorna withKsheerabala taila

101)

1stto18th

day

2 Snehapana (withKalyanaka ghritam) 19thto23rd

day

3 Sarvanga abhyanga(withKottamchukkadi

Taila) followedbyBashpa Svedana (with

Dashmoola kwatha)

24thto27th

day

4 Virechana (withTrivruth Avaleha,Eranda

Taila,Triphala kwatha)

28thday

ROOKSHANA

PROCEDURE

9/20/19 EAA2019 9

PROCEDURE DRUGAND DURATION

Rooksha

Choorna

Pinda Svedana

TwoPottalis (each250gm)made-upof

Jadamayadi choorna

Thesethree

procedures

werefollowed

simultaneously

duringthefirst

18days.25-30

minofPinda

Svedana

followedby30

minTakra Dhara

andKshara Basti.

Takra Dhara 2liters ofTakra (buttermilk)was

processedwith50gmeachofpowdersof

Mustha (Cyperus rotundus)andAmalaki

(Emblica offcinalis)

Kshara Basti 320mlGomutra Arka wasmixedwith

100gmeachofGuda (Jaggery)and

Chincha kalka (50mlpasteofTamarindus

indica)and10gmeachofSaindhava

Lavana and 10gm powderof

Shatapushpa (Anethum sowa)

ORALMEDICATIONSDURING

PANCHAKARMATREATMENT

S.NO. DRUGS NAME DOSE DURATION

1 Guduchayadi kashayam 15ml +30ml lukewarm

water TID

Before food

2 Kaishor guggulu 500mg TID Before food

3 Amrutothharam

Kashayam+Abhyarishta+ Hingvashtak

Choorna

(15ml+ 15ml+5gm) +30ml

lukewarm water TID

After food

4 Erand taila 10ml with lukewarm milk Bed time

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OBSERVATIONS

S.NO. ASSESSMENT CRITERIA SCORING BEFORE

TREATMENT

SCORING AFTER

TREATMENT

1 National Institute of Health Stroke

Scale (NIH-SS)

42(range from 0 to 42) 11

2 Barthel Index (BI) 35/100 75/100

3 European Stroke Scale 45/100 75/100

QOLSCALEFORSTROKE

QOLSCALE SCORING

BEFORE

TREATMENT

SCORING AFTER

TREATMENT

STROKESPECIFIC

QUALITYOFLIFE

(SSQOL)

75/245(range

from49-245)

175/245

CASEREPORT- ONMULTIPLESCLEROSIS

9/20/19 EAA2019 17

AGE/SEX 28/M, VATA PITTA PRAKRUTI

HISTORY Bed ridden – unable to move – send away from all modern hospitals with no hope on further prognosis – Diagnosed case of MS.

CHIEF COMPLAINTS • Weakness in both upper and lower limbs (Dourbalya - Kapha Kshaya & Majja Kshaya) unable to walk

• Feeling that body parts are swollen, wet (Staimitya, Gurutwa)

• Spasticity & Muscle Spasm (Sankocha)

• Tingling sensations(Harsha)

• Feelings that body parts are tightly wrapped (Veshtana )

EXAMINATION • Lack of coordination• Changes in reflexes

• Weakness in arms or legs

• Spasticity in muscles

DIAGNOSIS Patient diagnosed as K/C/O Multiple Sclerosis, Demyelination,Multiple level disc protrusion

Panchakarma procedures adoptedS.NO. PROCEDURE DURATION

1 Rookshana (Rooksha choorna pinda svedana, Takra

dhara, Kshara basti) and Talam (Rasnadi choorna

with Ksheerabala taila 101)

1st to 7th day

2 Snehapana (with Brahmi ghritam) 8th to 12th day

3 Sarvanga Abhyanga (with Bala Ashwagandhadi

Taila) followed by Bashpa Svedana (with

Dashmoola Kwatha)

13th to 16th day

4 Virechana (with Trivruth Avaleha, Draksha Phanta) 16th day

5 Samsarjana karma 17th to 21st day

6 Kala basti Anuvasan basti

Nirooha basti

22nd to 37th day

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TREATMENTSCHEDULE(1)- ROOKSHANA

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PROCEDURE DRUG AND DOSE

Rooksha choorna

Pinda Svedana

Two Pottalis (each 250gm) made-up of

Jadamayadi choorna

These three procedures

were followed

simultaneously during the first 7

days. 25-30 min of Pinda Svedana

followed by 30 min Takra Dhara

and Kshara Basti.

Takra Dhara 2 liters of Takra (buttermilk) was processed

with 50gm each of powders of Mustha

(Cyperus rotundus) and Amalaki (Emblica

offcinalis)

Kshara Basti 200ml Goumutra Arka was mixed with 50gm

each of Guda (Jaggery) and Chincha kalka

(50ml paste of Tamarindus indica) and 10gm

each of Saindhava lavana and 10gm powder of

Shatapushpa (Anethum sowa)

TREATMENT SCHEDULE (2)- BRUHMANA

Anuvasan Basti Nirooha Basti

• Masha taila (80ml) +

Dhanwantaram taila (70ml)

• Kapikachhu kalka (15gm)

• Saindhav lavana (10gm)

• Madhu (80ml)

• Saindhav lavana (10gm)

• Sneha- Kalyanak ghritam (80ml)

• Kalka- Pootayavaanyaadi (30gm)

• Kwatha- Balamooladi ksheerpaka

(400ml) + Majja (100ml)

KALA BASTI

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TREATMENTSCHEDULE(3)

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S.NO. PROCEDURE DURATION

1 Patra Pinda Svedana with

Karpasasthyadi taila

These four procedures

were followed

simultaneously during the

Kala basti. 25-30 min of

Patra Pinda Svedana

followed by 40 min

Pizhichil and Shirobasti

2 Talapothichil with Ksheerbala (101)

taila & Amalaki Choorna

3 Pizhichil with Ksheerbala taila + Tila

taila

4 Shirobasti with Ksheerbala taila + Tila

taila

TREATMENT SCHEDULE (4)

• After completion of Kala basti, Nasya and Shashtika ShaliPinda Svedana were adopted.

S.NO. PROCEDURE DURATION

1 Nasya with Brahmi ghritam Mukha

Abhyanga with Asanbilvadi Taila and

Mridu Nadi Svedana with Dashmoola

kwatha for 5min.

38th to 45th day

2 Shashtik Shali Pinda Svedana with

Balamoola kwatha

38th to 45th day

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ORALMEDICATIONSDURINGPANCHAKARMATREATMENT

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S.NO. DRUGS NAME DOSE DURATION

1 Ashtavargam kashyam 10ml +30ml

lukewarm water TDS

Before food

2 Sudarshana Ghan Vati 2 Tab TDS Before food

3 Saraswatarishta

+

Balarishta

(15ml+ 15ml) +30ml

lukewarm water TDS

After food

4 Narasimha rasayana 1TSF with lukewarm

water

Bed time

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OBSERVATION

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S.NO. ASSESSMENT

CRITERIA

SCORING

BEFORE

TREATMENT

SCORING

AFTER

TREATMENT

1 Kurtz Expanded

Disability Status Scale

(EDSS)

6/10 8/10

2 Functional Assessment

of Multiple Sclerosis

(FAMS)

122/232 158/232

QOLSCALEFORMULTIPLESCLEROSIS

9/20/19 EAA2019 29

S.NO. QOL SCALE SCORING

BEFORE

TREATMENT

SCORING

AFTER

TREATMENT

1 MULTIPLE SCLEROSIS

QUALITY OF LIFE (MSQOL)-

54

22/54 42/54

2 MULTIPLE SCLEROSIS

RATING SCALE REVISED (MSRS-R)

16/28 22/28

RESULTS

9/20/19

• Afterfirstweekoftreatmentpatientshowedmildreductioninpainandstiffnessinbothlowerextremities.

• Aftertwoweeksoftreatmentpainandstiffnessinbothlowerextremitiesweremoderatelyreduced.Musclepowershowedimprovementtogradeone(flickeringofmovement).

• Afterthreeweeksoftreatmentpainandstiffnessinbothlowerextremitieswereverymild.

• Kurtzke EDSSscorealsoimproved.Patientcouldwalkupto30meterswithcruches.

• Deeptendonreflexesofkneeandanklewerenormal.

• Kurtzke EDSSscoreimprovedindicatingrequirementofconstantbilateralassistance(canes,crutches,braces)andcanwalkabout20meterswithoutresting.

• Patientwasdischargedafter7weeksoftreatmentandwasaskedtocontinueoralmedicationsandapplicationofBalaAshwgandhadi taila tothewholebodyregularly.

• Heiskeepingfineandcomesforfollowupwithfathertillthehospitalwalksinsidetothehospitalalonewithoutsupport.

EAA2019 30

METABOLIC SYNDROME

§ Metabolic syndrome is

characterized by cluster of risk

factors including

Ø Obesity,

Ø Insulin resistance,

Ø Hypertension,

Ø Hypertriglyceridemia &

Ø Low HDL cholesterol.

§ The Metabolic syndrome has known as an independent risk factor of

stroke20/09/19 EAA2019 31

METABOLIC

SYNDROME

9/20/19 32

• Multiplesclerosis(MS)isthemostcommoninflammatorydemyelinatingdiseaseofthecentralnervoussystem.

• Recentresearchsuggestsanimportantplausibleroleofvasculardiseaseriskfactors(VDRFs)suchassmoking,obesity,hyperlipidemia,hypertension,diabetes,andmetabolicsyndromeonMSpathogenesis.

EAA2019

METABOLIC

SYNDROME

• Itisestimatedthatnearly50%ofpeoplewithMShaveatleastoneVDRFatthetimeoftheirMSdiagnosis

9/20/19 EAA2019 33

§ Stroke is the sudden death of brain cells

in a localized area due to inadequate

blood flow (infarction).

§ Stroke is the leading cause of adult

disability.

§ Sixty percent of survivors have

disabilities in arm or leg .

STROKE

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9/20/19 EAA2019 35

CAUSESOFSTROKE

CEREBRALINFARCTION (85%)

INTRACEREBRAL HAEMORRHAGE (10%)

§ Mostly due to thromboembolic

disease secondary to

atherosclerosis in the major

extra cranial arteries.

§Usually results from rupture of a blood

vessel within the brain parenchyma: a

primary intracerebral haemorrhage.

§It may also occur with subarachnoid

haemorrhage (5%)

CLINICALFEATURESOFSTROKE

9/20/19 EAA2019 37

UnilateralWeakness SuddenWeaknessornumbnessoftheface,arm

orleg &progressesrapidlyinhemiplegicpattern

Speech Disturbances

(Dysphasiaand Dysarthria)

Difficultyspeakingorunderstandingspeech

Visual Deficit Difficultyseeingwithoneorbotheyes

Ataxia lossofbalanceorcoordination

Coma faintingorunconsciousness

Severeheadachewithnoknowncause

AYURVEDA

PERSPECTIVE

9/20/19

• ClinicalpresentationofStrokeissimilartothediseasePakshaghatamentionedunderVatavyadhi inAyurvedatexts.

• SymptomsofPakshaghata :

• Vama/DakshinaPakshacheshtanivritiorKarmakshya– LeftorRightside,Lossoffunctionordeteriorationoffunctionsofanysideofbody

• VakStambha– DifficultyinSpeaking

EAA2019 38

PAKSHAGHATA

NIDANA(CAUSATIVE FACTORS)

VATA PRAKOPA(AGGRAVATION OF

VATA)

SIRA-SNAYU SHUSHKTA

(DRYING UP OF VESSELS)

SANDHIBANDHA VIMOKSHANA

(JOINTS BECOME LAXED AND VIGOURLESS)

PAKSHAGHATA(STROKE)

20/09/19 EAA2019 39

MULTIPLE SCLEROSIS

§ Multiple sclerosis (MS)

literally means “many

scars,Ӥ Autoimmune disease of the

CNS.

§ Characterized by chronic

inflammation,

demyelination, gliosis

(scarring), and neuronal

loss

20/09/19 EAA2019 40

MULTIPLE SCLEROSIS

§ These scars, or lesions, consist mostly of dead nerve

cells, whose axons have been denuded of the myelin

sheaths

§ Risk factors for MS include vitamin D deficiency,

exposure to Epstein-Barr virus (EBV) after early

childhood, and cigarette smoking.

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9/20/19 EAA2019 42

MULTIPLE SCLEROSIS

Abnormal immune system response

Inflammation in the central nervous system

Damages/destroys myelin, oligodendrocytes and Nerve fibers

Produces damaged areas (lesions or scars) along the nerve, which can be detected on MRI

Slows or halts nerve conduction – producing the neurologic signs and symptoms of MS

20/09/19 EAA2019 43

TYPES OF M.S

There are 4 types of MS

qRelapsing-remitting MS (RR-MS)

qPrimary-progressive MS (PP-MS)

qProgressive-relapsing MS (PR-MS)

qSecondary-progressive MS (SP-MS)

RELAPSING-REMITTING MS (RR-MS)

Morethan80%ofthecases

Definedclinicalexacerbationofneurologicalsymptoms

Followedbycompleteorincompleteremissionduringwhichthepersonfullyorpartiallyrecoversfromthedeficitsacquiredduringrelapse

PRIMARY-PROGRESSIVE MS (PP-MS)

10to20%ofindividualswithMSarediagnosedwithPP-MS

Gradualprogressionofthediseasefromitsonset

Nooverlappingrelapsesandremissions

PROGRESSIVE-RELAPSING MS (PR-MS)

Rare

InitiallypresentingasPP-MShowever,duringthecourseofthediseasetheindividalsdeveloptrueneurologicexacerbations

Steadyprogressionofclinicalneurologicaldamagewithsuperimposedrelapsesandremissions.

SECONDARY-PROGRESSIVE MS (SP-MS)

SP-MSischaracterizedbyasteadyprogressionofneurologicaldamagewithorwithoutsuperimposedrelapsesandminorremissions

IndividualswithSP-MSwillhaveexperiencedaperiodofRR-MS,whichmayhavelastedfrom2to40years

Anysuper-imposedrelapsesandremissionsfadeovertime

JATHARAGNIMANDYA

FORMATION OF AMA SROTOAVARODHA

GATA VATA

PRAKOPA

IMPROPER NOURISHMENT OF

DHATU - MAJJA DHATU

MAJJA DHATU KSHAYA &

KAPHA KSHAYA

MULTIPLE SCLEROSIS

VATA

FILLING THE SROTAS DEVOID

OF SNEHADI GUNA

SARVANGA VATA PRAKOPA

LAKSHANA 20/09/19 EAA2019 49

CLINICAL

FEATURES

OFMS

9/20/19 EAA2019 50

WEAKNESS OF LIMBS ; LOSS OF

STRENGTH IN LIMBS AND FATIGUE

DOURBALYA (KAPHA

KSHAYA & MAJJA

KSHAYA)

Spasticity & Muscle Spasm Sankocha (Vata Prakopa)

Tingling sensations Harsha (Vata Prakopa)

Prickling sensations Suchivat Bhedana (Vata Prakopa)

Painful burning sensation Daha (Pittavrita Vata)

Formications, (sensation of having insects crawling on or under the skin)

Pipplikasancharan (Vata Prakopa)

feelings that body parts are swollen, wet, Staimitya (SamaVata)

Feelings that body parts are tightly wrapped Veshtana (Vata Prakopa)

CLINICALFEATURESOFMS

9/20/19 EAA2019 51

Optic Neuritis (ON) - Diminished Visual Activity Tamodarshana (Majja Kshaya)

Ataxia Kampa/Vepathu (Vata Vikara)

Bladder dysfunction; Urinary Retention, Difficulty

in initiating the urine

Mutrasanga (Vata Vikara)

Constipation Vibandha (SamaVata)

Depression Manasada (Vata Vikara)

Vertigo Bhrama (Majja Kshaya)

Decreased Libido, Impotence Shukrakshaya (Majja Kshaya)

STROKE&MSASVATAVYADHI

1

Pakshaghata hasbeenmentionedunderthespectrumofVatavyadhi inAyurvedatextswithsimilarclinicalpresentationtoStroke.

2

MShasnotbeenmentionedasaseparatedisease,butmostofthesymptomsofMSaresimilartoVata Prakopa,SamaVataandMajja Kshaya Lakshana mentionedinAyurvedatexts.

YES

NO

STA

GE

1

VATA

VYADHI

§ ASSESSMENT OF

DOSHAVRITA VATA

LAKSHANA

§ ASSESSMENT OF AMA

DOSHA LAKSHANA

ROOKSHANA - ROOKSHA

SVEDANA, PARISHEKA,

LEPA

[TILL AVRITA DOSHA & AMA

LAKSHANA SUBSIDE &

SAMYAK LANGHANA

ATTAINED]

CHECK

POINT1

GO TO

STAGE 3

20/09/19 EAA2019 53

STA

GE

2S

TA

GE

3

AVRITA DOSHA &

AMA LAKSHANA SUBSIDE &

SAMYAK LANGHANA

LAKSHANA OBSERVED

KOSHTHA SHUDDHI / MRIDU

SAMSHODHANA (WITH ERANDA TAILA & MILK

SHUDDHA VATA CHIKITSA

CHECK

POINT2

NoImprovement

20/09/19 EAA2019 54

STAGE 3.1

SHUDDHA VATA CHIKITSA

§ ABHYANGA

§ SNIGDHA SVEDANA

(PATRAPINDA SVEDA,

SHASTIKA SHALI PINDA

SVEDA )

§ BRUMHANA BASTI

YAPANA BASTI

§ BRUMHANA NASYA

STAGE 3.2

STAGE 3.3

STAGE 3 CHIKITSA CAN BE

INCORPORATED WITH

SHIROPICHU/SHIROBASTI/

SHIRODHARA IN

SHIROGATA VATA AVASTHA

e.g.

§ NEURO DEGENERARTIVE

DISEASES OF BRAIN

§ FACIAL PALSY

§ STROKE

20/09/19 EAA2019 55

OUTCOMEOFTREATMENT

EAA2019 9/20/19 56

After2weeksofVirechana;patientwasabletomovehisrightupperlimbatelbowjointandwasabletowalkforsomedistancewithoutsupport.

1

Lateronfollowupafter36dayswithcontinuationofsameinternalmedicinesshowedverygoodremissionofclinicalsymptomsandimprovedqualityoflife.

2

PatientwasonTabamlodipine5mgforhypertensionduringandafterthetreatment.

3

CONCLUSION

CVA

GBS

MS

20/09/19 EAA2019 57

PACHANA

SHODHANA

BRUHMANA

DANKESCHON………..

9/20/19

EAA2019

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