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…..”

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

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TOPIC

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OBJECTIVESOF

PRESENTATION

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ToCreateConfidenceNotTo

RaiseHighClaims.

ToCreateAwarenessAboutCVA&MS.

ToHintOn- HowToApproach

InAYURVEDAPractice

ToCreateALinkOfThoughtProcesses.

ToBePassionateAbout

Ayurveda&ToKeepLovingIt.

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CASEREPORT- ONSTROKE(CVA)

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AGE/SEX 54/Male

DIAGNOSIS Patient diagnosed as K/C/O Stroke, (CT Brain – Multiple lacunar infarcts)Bed ridden

SINCE 4 Days

CHIEFCOMPLAINTS

• 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.

PANCHAKARMAPROCEDURESADOPTED

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S.NO. PROCEDURE DURATION

1 Rookshana (Rooksha choorna pinda svedana,Takra dhara,Kshara basti)and Talam(Rasnadi choorna withKsheerabala taila101)

1stto18thday

2 Snehapana (withKalyanaka ghritam) 19thto23rdday

3 Sarvanga abhyanga(withKottamchukkadiTaila) followedbyBashpa Svedana (withDashmoola kwatha)

24thto27thday

4 Virechana (withTrivruth Avaleha,ErandaTaila,Triphala kwatha)

28thday

ROOKSHANAPROCEDURE

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PROCEDURE DRUGAND DURATION

RookshaChoornaPinda Svedana

TwoPottalis (each250gm)made-upofJadamayadi choorna

Thesethreeprocedureswerefollowedsimultaneouslyduringthefirst18days.25-30minofPindaSvedanafollowedby30minTakra DharaandKshara Basti.

Takra Dhara 2liters ofTakra (buttermilk)wasprocessedwith50gmeachofpowdersofMustha (Cyperus rotundus)andAmalaki(Emblica offcinalis)

Kshara Basti 320mlGomutra Arka wasmixedwith100gmeachofGuda (Jaggery)andChincha kalka (50mlpasteofTamarindusindica)and10gmeachofSaindhavaLavana and 10gm powderofShatapushpa (Anethum sowa)

ORALMEDICATIONSDURINGPANCHAKARMATREATMENT

S.NO. DRUGS NAME DOSE DURATION

1 Guduchayadi kashayam 15ml +30ml lukewarm water TID

Before food

2 Kaishor guggulu 500mg TID Before food

3 AmrutothharamKashayam+Abhyarishta+ HingvashtakChoorna

(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 SCORINGBEFORETREATMENT

SCORING AFTERTREATMENT

STROKESPECIFICQUALITYOFLIFE(SSQOL)

75/245(rangefrom49-245)

175/245

CASEREPORT- ONMULTIPLESCLEROSIS

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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, Takradhara, Kshara basti) and Talam (Rasnadi choornawith Ksheerabala taila 101)

1st to 7th day

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

3 Sarvanga Abhyanga (with Bala AshwagandhadiTaila) 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 bastiNirooha basti

22nd to 37th day

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TREATMENTSCHEDULE(1)- ROOKSHANA

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PROCEDURE DRUG AND DOSE

Rooksha choornaPinda 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 Svedanafollowed by 30 min Takra Dharaand Kshara Basti.

Takra Dhara 2 liters of Takra (buttermilk) was processed with 50gm each of powders of Mustha(Cyperus rotundus) and Amalaki (Emblicaoffcinalis)

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 Svedanafollowed by 40 min Pizhichil and Shirobasti

2 Talapothichil with Ksheerbala (101) taila & Amalaki Choorna

3 Pizhichil with Ksheerbala taila + Tilataila

4 Shirobasti with Ksheerbala taila + Tilataila

TREATMENT SCHEDULE (4)• After completion of Kala basti, Nasya and Shashtika Shali

Pinda Svedana were adopted.S.NO. PROCEDURE DURATION

1 Nasya with Brahmi ghritam MukhaAbhyanga with Asanbilvadi Taila and Mridu Nadi Svedana with Dashmoolakwatha 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 +30mllukewarm 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. ASSESSMENTCRITERIA

SCORINGBEFORE TREATMENT

SCORINGAFTER TREATMENT

1 Kurtz Expanded Disability Status Scale (EDSS)

6/10 8/10

2 Functional Assessment of Multiple Sclerosis (FAMS)

122/232 158/232

QOLSCALEFORMULTIPLESCLEROSIS

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S.NO. QOL SCALE SCORINGBEFORE TREATMENT

SCORINGAFTER 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.

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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

METABOLICSYNDROME

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• Multiplesclerosis(MS)isthemostcommoninflammatorydemyelinatingdiseaseofthecentralnervoussystem.

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

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METABOLICSYNDROME

• Itisestimatedthatnearly50%ofpeoplewithMShaveatleastoneVDRFatthetimeoftheirMSdiagnosis

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§ 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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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

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UnilateralWeakness SuddenWeaknessornumbnessoftheface,armorleg &progressesrapidlyinhemiplegicpattern

Speech Disturbances(Dysphasiaand Dysarthria)

Difficultyspeakingorunderstandingspeech

Visual Deficit DifficultyseeingwithoneorbotheyesAtaxia lossofbalanceorcoordinationComa faintingorunconsciousnessSevereheadachewithnoknowncause

AYURVEDAPERSPECTIVE

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• ClinicalpresentationofStrokeissimilartothediseasePakshaghatamentionedunderVatavyadhi inAyurvedatexts.

• SymptomsofPakshaghata :• Vama/DakshinaPakshacheshtanivritiorKarmakshya– LeftorRightside,Lossoffunctionordeteriorationoffunctionsofanysideofbody

• VakStambha– DifficultyinSpeaking

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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)

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MULTIPLE SCLEROSIS§ Multiple sclerosis (MS)

literally means “many scars,”

§ Autoimmune disease of the CNS.

§ Characterized by chronic inflammation, demyelination, gliosis (scarring), and neuronal loss

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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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MULTIPLE SCLEROSISAbnormal 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

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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

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CLINICALFEATURESOFMS

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WEAKNESS OF LIMBS ; LOSS OF STRENGTH IN LIMBS AND FATIGUE

DOURBALYA (KAPHAKSHAYA & MAJJAKSHAYA)

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

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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]

CHECKPOINT1

GO TO STAGE 3

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STA

GE

2S

TAG

E 3

AVRITA DOSHA & AMA LAKSHANA SUBSIDE &

SAMYAK LANGHANA LAKSHANA OBSERVED

KOSHTHA SHUDDHI / MRIDU SAMSHODHANA

(WITH ERANDA TAILA & MILK

SHUDDHA VATA CHIKITSA

CHECKPOINT2

NoImprovement

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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

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OUTCOMEOFTREATMENT

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After2weeksofVirechana;patientwasabletomovehisrightupperlimbatelbowjointandwasabletowalkforsomedistancewithoutsupport.

1Lateronfollowupafter36dayswithcontinuationofsameinternalmedicinesshowedverygoodremissionofclinicalsymptomsandimprovedqualityoflife.

2PatientwasonTabamlodipine5mgforhypertensionduringandafterthetreatment.

3

CONCLUSION

CVA

GBS

MS

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PACHANA

SHODHANA

BRUHMANA

DANKESCHON………..

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