Introduction
Hemiplegia is the commonest manifestation of a 'stroke' with neurological deficit affecting the face, limbs and trunk on one side or either side of the body. Impulses for voluntary movement are transmitted by the pyramidal tracts or upper motor neurons. Damage to these pyramidal tracts due to any lesion, trauma, ischemia or hemorrhage produces paralysis. In Ayurveda, it can be correlated with 'Pakshaghata'. When Vata getting aggravated, dries up the
Srotas and Snayu (tendons) of one side (half) of the body, makes the organ/ parts of that side incapable of functioning and loss of sensation.
Aetiology
1. Cerebro-vascular accidents (Stroke)
i. Cerebral hemorrhage
ii. Sub - arachnoid hemorrhage
iii. Cerebral thrombosis
iv. Internal carotid artery thrombosis or stenosis
v. Cerebral embolism
vi. Venous sinus thrombosis
2. Hypertensive encephalopathy
3. Cerebral tumors
4. Acute encephalitis
Pathogenesis
Damage to the pyramidal tracts produces impairment or loss of voluntary movement from interruption of the conduction of motor impulses.
Risk factors
1. Age
2. Sex
3. Hypertension
4. Diabetes mellitus
5. Smoking, Alcohol abuse
6. Obesity
7. Hyperlipidemia
Clinical features
1. Unilateral loss of voluntary power in the affected arm, leg and in the lower face
2. Clasp-knife type spasticity
3. Tongue is protruded towards the paralysed side (in facial palsy)
4. Upper limb flexed at the elbow and wrist forearm slightly pronated
5. Movement of the hand and fingers are more affected than those of upper arm
Investigation
1. Haemogram
2. Lipid profile
3. C T Scan /MRI
4. Doppler studies of the Neck
5. CSF examination
6. X - Ray Spine
7. ECG.
Management approaches
a. Prevention
1. Add masha (black gram), kulattha (horse gram), palandu(onion), rasona (garlic),
Shunthi/Ardraka (ginger), mulaka (radish), kushmanda (ash gourd), mudga (green
gram) in regular diet
2. Use fruits like dadima (pomegranate),Amra (mango), draksha (grape) etc.
3. Consume low fat and high fiber diet and Rasayana drugs
4. Control the treatable risk factors like diabetes mellitus, hypertension, heart diseases
5. Take neccessry treatment of hypertension (if any)
6. Control cholesterol level and weight
7. Practice regular exercises
8. Avoid excessive use of pungent, astringent and/ or salty, oily/ fatty food and
incompatible diet, chana (bengal gram), peas, barley etc.
9. Avoid excessive starvation, excess exercises, suppressing of natural urges and
awakening in the nights
10. Avoid alcohol consumption, smoking
11. Avoid discontinuation of any regular medication without medical advise
b. Medical management
Line of treatment (Charaka. Chikitsa sthana. 28/100)
1. Nidana parivarjana (avoidance of aetiological factors) - Management of treatable risk factors and diseases like hypertension, acute encephalitis, heart disease etc. and avoid trauma.
2. Samshodhana chikitsa - (Bio-cleansing therapies) followed by aamana chikitsa
(Palliative therapy) should be advocated.
i. Snehana (Oleation): massage with medicated oils such as
• Maha narayana taila
• Sahacharadi taila
• Dhanvantara taila
• Karpasasthyadi taila
• Prabhanjana vimardana taila
• Kshirabala taila
• Mahamsha taila
• Bala taila
ii. Svedana (Medicated fomentation)
•Shashtika shali panda sveda (made from shashtika shali(Navara Rice), Bala mula, Ashvagandha mula and milk)/Patra pind sweda for 7-14 days
• Sarvanga sveda for 7 - 14 days
iii. Virechana (Purgation) Decoction of the following is helpful with decoctions of (a) Draksha (Vitis vinifera) - 10 gm,
or
(b)Aragvadha Phala Majja(Cassia fistula Fruit Rind) - 10gm
or
(c) Haritaki (Terminalia chebula seedless fruit powder/decoction) - 10 gm
or
(d) Katuki (Picrorhiza kurroa) - 5 gm along withEranda (Ricinus communis) taila – 1 teaspoon. Or Eranda taila(Caster oil) 10 - 20 ml with half glass of milk at nighti
iv. Vasti (medicated enema) • Matra vasti with Narayana taila 50 ml daily for 7 - 14 days
• Kashaya vasti for 15 days (Kala vasti krama) Eranda mula kvatha - 480 ml,Taila - 240 ml,Honey - 240 ml, Kalka - 30 gm,Saindhava lavana - 15 gm
• Kshira vasti 350 - 500 ml for 7 - 14 days
v. Nasya karma/ Brinhana nasya with Purana ghrita (old ghee) / Narayana taila /Ksheera bala taila 8-8 drops in both nostrils for 7 days
vi. Shirovasti with medicated oils (Narayana taila / Ksheera bala taila / Chandana bala lakshadi taila) daily 45 minutes for 7 days
vii. shirodhara with medicated liquids (Narayana taila / Ksheera bala taila / Chandana bala lakshadi taila / decoctions etc.) daily 45 minutes for 21 days
(above said formulations are common in practice but dose should be adjusted by the physician according to patient's condition).
3. Drug Therapy - All therapeutic measures may be started after crossing the acute phase of attack.
SINGLE MEDICINAL PLANTS
|
Drug |
Dosage (per dose) |
Vehicle |
Duration |
|
Ashvagandha (Withania somnifera Dunal) Powder |
3-5 gm |
Milk |
15 days |
|
Brahmi (Bacopa monnieri Linn.) svarasa |
5-10 ml |
Water |
15 days |
|
Rasona (Allium sativum Linn.) kshira paka |
5-10 ml |
Water/ milk |
15 days |
|
Eranda (Ricinus communis Linn.) taila |
5-10 ml |
Milk |
3 days |
FORMULATIONS
|
Drug |
Dosage (per dose) |
Vehicle |
Duration |
|
Gandharva hastadi kvatha |
10-20 ml |
Water |
15 days |
|
Sahacharadi kvatha |
10-20 ml |
Water |
15 days |
|
Maharasnadi kvatha |
10-20 ml |
Water |
15 days |
|
Brahmi vati |
125-250mg |
Water |
15 days |
|
Manasa mitra vataka |
125 mg |
Rasnasaptaka kvatha |
15 days |
|
Vatari guggulu |
1-1.5 gm |
Warm water |
15 days |
|
Trayodashanga guggulu |
1-1.5 gm |
Warm water |
15 days |
|
Balarishta |
10-20 ml |
Water |
15 days |
|
Ashvagandharishta |
15-30 ml |
Water |
15 days |
|
Hingutriguna taila |
5 ml |
Lukewarm water |
15 days |
|
Chandana bala lakshadi taila |
external use |
|
15 days |
|
Kshirabala taila |
external use |
|
15 days |
|
Mahamasha taila |
external use |
|
15 days |
|
Maha narayana taila |
external use |
|
15 days |
|
Narayana taila |
external use |
|
15 days |
|
Sahacharadi taila |
external use |
|
15 days |
|
Dhanvantara taila |
external use |
|
15 days |
|
Karpasasthyadi taila |
external use |
|
15 days |
|
Prabhanjana vimardana Taila |
external use |
|
15 days |
|
Vatagajankusha rasa |
125-250 mg |
Honey |
15 days |
|
Vatakul!ntaka rasa |
125-250 mg |
Honey |
15 days |
|
Rasaraja rasa |
65 - 125 mg |
Honey |
15 days |
|
Yogendra rasa |
125-250 mg |
Rasona svarasa and honey |
15 days |
|
Brihatvata chintamaanii rasa |
125-250 mg |
Honey |
15 days |
|
Ekangavira rasa |
125-250 mg |
Honey |
15 days |
Initially 2 times in a day after meal for 15 days followed by condition of patient and physician's direction.
NOTE: Out of the drugs mentioned above any one of the drug or in the combination may be prescribed by the physician.The duration of the treatment may vary from patient to patient. Physician should decide the dosage (per dose) and duration of the therapy based on the clinical findings and response to therapy.
Names of the medicines ending with the word Rasa may be taken with caution and of slandered manufacturing quality under the guidance of qualified Ayurveda physician only as they contain mercury and may not be free from side effects
c. Yogic practices - The following yogic practices are beneficial in Hemiplegia; however, these should be performed only under the guidance of qualified Yoga therapist.Duration should also be decided by the Yoga therapist.
1. Practice of Pranayama (Anuloma Viloma, Nadi shodhana, Bhramari and meditation alongwith the practice of Yama and Niyama
2. Deep relaxation technique, Yoga nidra
3. Asanas to correct the postural imbalances
Counselling - Advise the patient to -
1. Be active and optimum use of affected part
2. Grasp the spastic arm at wrist with unaffected arm and push it above head regularly (10-15 times at each time) for atleast 3-4 times a day
3. Continue exercises as suggested by the physiotherapist
4. To increase the practice of exercise gradually
5. Take balanced diet
6. Maintain healthy body weight
7. Limit salt intake and fat in diet
8. Control of hypertension and diabetes mellitus
9. Check lipid profile periodically
10. Avoid over exertion
11. Avoid smoking and alcohol consumption
Indications for referral
1. Further deterioration
2. Patient with head injury and requires surgical intervention.
3. Not responding to medication
The other neurological conditions like monoplegia (paralysis of one limb), paraplegia(paralysis of both lower limbs) and quadriplegia (paralysis of all four limbs) are also to be managed in the similar manner.
Reference
AYURVEDIC MANAGEMENT OF SELECT GERIATRIC DISEASE CONDITIONS
CENTRAL COUNCIL FOR RESEARCH IN AYURVEDA AND SIDDHA
Department of AYUSH, Ministry of Health & Family Welfare
Government of India, New Delhi - 110 058 2011
