A CLINICAL STUDY TO EVALUATE THE EFFICACY OF VIRECHANA ...

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“ A CLINICAL STUDY TO EVALUATE THE EFFICACY OF

VIRECHANA KARMA IN PAKSHAGHATA ”

BY Dr. RAKSHA KUMARI

B.A.M.S Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment Of the requirements for the degree of

AYURVEDA VACHASPATI

DOCTOR OF MEDICINE (Ayu)

In

PANCHAKARMA

Under the guidance of Dr. SHREEKANTH U. M.D. (Ayu)

Former Dean, Professor & H O D P.G.Studies in

Department of Panchakarma, SDMCA Udupi.

Co-Guide Dr. NIRANJAN RAO M. D.

Department of P.G. studies in Panchakarma. S.D.M. COLLEGE OF AYURVEDA, KUTHPADY, UDUPI

2011-12

(Ayu) Professor

Department of Panchakarma, SDMCA Udupi.

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled“A Clinical Study to Evaluate the

Efficacy of Virechana Krama in Pakshaghata” is a bonafide and genuine research

work carried out by me under the guidance of Dr.Shrikanth U, M.D.(Ayu.), H.O.D &

Professor and co-guidance of Dr.Niranjan Rao, M.D.(Ayu.) Professor, P.G. Department

of Panchakarma , SDM College of Ayurveda, Udupi.

Signature of Candidate

Date: Dr. Raksha Kumari,

Place: Udupi P.G. Department of Panchakarma,

SDM Ayurveda College, Udupi.

III



CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A Clinical Study to Evaluate the

Efficacy of Virechana Karma in Pakshaghata” is a bonafide research work done by

Dr. Raksha kumari, in partial fulfillment of the requirement for the degree of in

Ayurveda, under my guidance.

Signature of Guide

Dr. Shrikanth U, M.D. (Ayu.), Former Dean, Professor, H.O.D & Guide, Date: Dept. of Post Graduate studies in Panchakarma, Place: Udupi SDM College of Ayurveda, Udupi.

IV



ENDORSEMENT BY THE H.O.D, PRINICIPAL/HEAD OF THE INSTITUTION

This is to certify that the dissertation entitled “A Clinical Study to Evaluate the

Efficacy of Virechana Karma in Pakshaghata” is a bonafide research done by

Dr. Raksha kumari, under the guidance of Dr. Shrikanth U, M.D.(Ayu.),H.O.D &

Propfessor and co-guidance of Dr. Niranjan Rao, M.D.(Ayu), Professor, P.G. Department

of Panchakarma , S.D.M.College of Ayurveda, Kuthpady, Udupi.

Signature of the Guide Signature of the Principal

Dr. Shrikanth U, M.D. (Ayu.), Dr. U.N.Prasad, M.D. (Ayu),

Former Dean, Professor and H.O.D, Principal,

Post Graduate studies in panchakarma, SDM College of Ayurveda,

SDM College of Ayurveda, Udupi. Udupi.

Date:

Place: Udupi

V

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that The Rajiv Gandhi University of Health Sciences,

Bangalore, Karnataka shall have the rights to preserve, use and disseminate this

dissertation/ thesis in print or electronic format for academic/ research purpose.

Date: Signature of the Candidate

Place: Udupi Dr. Raksha Kumari

© Rajiv Gandhi University of Health Sciences.

Dedicated to

My Beloved Son Adhrit

My Husband

Mr. Gangadhar.V. Shetty,

Beloved Parents

Sri .Babanna Shetty Smt .Parvathy Shetty

&

Adored Teachers

V1

ACKNOWLEDGEMENT

On this delightful occasion of successful accomplishment of my work, I offer

my salutation to the Almighty for having bestowed upon me enough strength to discharge

my duties, immaculately.

I am in podgy of words while paying my affable regards to my husband

Mr.Gangadhar.v.shetty & my dearly loved parents Sri.Babannna shetty, Smt.Parvathy

shetty, in whom I experience the blessings of God, for their supports, sacrifice &

encouragement which brought me up to this stage. My inner strength, really none other

than my beloved brother Guru charan shetty & my son Adhrit shetty , I wish to offer my

earnest thanks to marvelous father-in-law Sri.Venkappa shetty, mother-in-law

Smt.Shakunthala shetty, their continuous prop up, suggestion, adore & care is the

energetic force in each & every steps of my life.

I sincerely express my deep sense of gratitude to Rajashri Dr. Veerendra Heggde.

It is the sacred time to avail opportunity by extending my deepest sense of

indebtedness to my pioneer guide, my preacher Dr.Shrikanth.U for the extent of his

dynamic and pricey guidance throughout the study. I would like to put on record the

affection and care with which my esteemed Guide directed me during the study.

It is indeed a pleasing privilege for me to express my profound greatfulness and

indebtedness to my esteemed coguide, my preacher Professor & Co-Guide, Dr.Niranjan

Rao, whose masterly suggestions & ablest guidance at every step which has molded,

twisted, and enlightened my elfin work into achievement. Besides this, his flavorful

prosperity always provided me enough courage to filch up with each & every task.

I am thankful to my teachers Dr.Rajalaxmi M.G and Dr. Padmakiran , for their

help, encouragement and suggestions during the work.

VI1

I wish to proffer my sincere thanks to Prof. Dr. U. N. Prasad, Principal, S.D.M.

College of Ayurveda, for his encouragement and support.

I cannot budge further before thanking to my precious friends Dr.Vignesh

Hoblidhar, Dr Shankar, Dr.Vishwanath Wasedar, & Dr.Varun Dorai for being with me by

providing honest support to surmount each & every obstacle successfully.

It is gaffe to my element if I won’t tell thanks to all my seniors & also express

appreciation to my all dearest juniors. Special thanks to Dr.Anand, Dr.Nagaraj and

Dr.Mahantesh for their academic support. I thankful to my dearest friends Mr.Dinesh

shetty and Mr.Adarsh.

I am extremely thankful to the Panchakarma staff and S.D.M.Ayurveda hospital staff and

Mr.Shanthappa for their kind co-operation, which was indispensable for the successful

completion of this work. I am thankful to our Librarian for providing me with the books I

needed in library.

I am very thankful to Sampark Xerox and all my volunteers for their brand teamwork,

which was very much requisite for the booming sleeve up of this work.

And last but not least I want to thanks all my patients for their trust and patience.

who cooperated me through-out this work without whom it’s impossible & I thanks all

those who have directly or indirectly contributed to the successful completion of this

thesis work.

Dr. Raksha Kumari

ABSTRACT Vatavyadhi consider as mahagada, Pakshaghata is one among mentioned by

Acharyas. Pakshaghata may be correlated with the stroke phenomena.

Paralysis is loss of voluntary movement due to interruption of motor pathway at any

point from the cerebrum to the muscle fiber, it can occur with a cerebrovascular disorders

degenerative neuromuscular diseases or CNS infection. The common brain disorder is

cerebrovascular accidents (CVA) also called a stroke or brain attack1

Stroke incidence and mortality rates found to be higher in developing than in

developed countries for first time

. Stroke is a leading

cause of serous long term disability in the United states.

2.

Ischaemic strokes are caused by either cerebral thrombosis or embolism and

account for 50%–85% of all strokes worldwide. ( 2009)

Haemorrhagic strokes are caused by subarachnoid haemorrhage or intracerebral

haemorrhage and account for 1%-7% and 7%-27% respectively of all strokes

worldwide.( 2009)

3

In many developed countries the incidence of stroke is declining but the actual

number is increasing because of ageing populations

Virechana is the chiefly advocated, purificatory measure in this disease and all the

acharyas mentioned virechana is one among the chief line of treatment for

pakshaghata. So it is bagged in the present study for treatment purpose. In

pakshagata snehana and snehayukta virechana explained by acharya vagbhata.

4.

5

Eranda is said to be shresta vatahara & taila is considered best to combat

aggravated vata. Gandarvahasta eranda taila6

which consist the above & fulfil

both the needs.

OBJECTIVES OF THE STUDY:

Conceptual study of virechana karma and pakshaghata will be taken up.

To evaluate the effect of virechana karma in patients suffering from Pakshaghata

clinically.

STUDY DESIGN:

It is a single blind clinical study with Pre test and Post test design, were in

minimum of twenty patients diagnosed as Pakshaghata of either sex will be

selected.

All the patients falling in inclusion criteria will be subjected to Virechana karma.

Patients were randomly selected.

INTERVENTIONS:

Purvakarma:

Deepana,Pachana with Chitrakadi vati &Agnitundi vati for 7days.

Snehapana (Arohana krama) with-Moorchita ghrita –3-7days

Abhyanga with Moorchita taila & Swedana- Ushna jala snana - 4 days

Pradhanakarma:

• Virechana karma with Gandarvahasta eranda taila 50 -100ml + 100ml dugda

(According to the agnibala, kosthabala and vyadhibala dose will be selected)

Paschatkarma.

• Samsarjana krama depending on the shuddhi laxanas for 3-7 days.

• Avoidence of astamaha varjyakara bhavas.

Assessment will be done before administration of virchanakarma (BT)

At the end of virechana karma assessment will be done (AT)

After 15 days followup will be done (FU)

Total duration of study will be maximum of 40 days.

RESULTS :

Motor parameters in Neurological maping showed 2 to 4 folds of improvement.

However, this improvement is recording after the completion of therapy &

specifically after pariharakala.

Reduced strength improved is in faster phace when compared to complete loss of

strength.

It has certain limitation in the treatment of chronic patients which is observed

during study.

Key Words: Pakshaghata, virechana karma, snehana, swedana, gandharva hastadi

eranda taila, Stroke.

VIII

LIST OF ABBREVIATIONS USED

1. After Followup AF

2. After Treatment AT

3. Ashtanga Hridaya AH

4. Ashtanga Sangraha AS

5. Before Treatment BT

6. Bhavaprakash Bh.P

7. Bhela Samhita BS

8. Caraka Samhita CS

9. Chikitsa sthana Ch

10. Dhanvantari Nighantu Dh.N

11. Equals =

12. Grams gms

13. Greater than or equal to ≥

14. Harita Samhita HS

15. In Patient Section IP

16. Kashyapa Samhita KS

17. Lesser than or equal to ≤

18. Madhav Nidana M.N

19. Mean Difference Diff

20. Metacarpo Phalanges And Inter Phalangeal Mcp & IP

21. Meta tarso Phalanges MTP

22. Millimetre mm

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23. Millimeter of mercury mm of Hg

24. Monier William Dictionary MW

25. Number Of Patients No.of.Pts

26. Out Patient Section OP

27. Percentage %

28. Plus or Minus ±

29. P Value P

30. Sharangadhara Samhita Sh..S

31. Shaligrama Nighantu Sh.N

32. Standard Deviation S.D

33. Standard Error of Mean S.E.M

34. Sushrut Samhita SS

35. Sutra Sthana S

36. Uttara Khanda U

37. Vachaspatyam Va

38. Vangasena V.S

39. Yogaratnakar YR

40.Years Yrs

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CONTENTS

Serial No. Description Page No.

01 INTRODUCTION 1-3

02 OBJECTIVES OF THE STUDY 4

03-A REVIEW OF LITERATURE 5 – 97

03-B CONCEPTUAL STUDY OF VIRECHANA 5 – 49

03-C CONCEPTUAL STUDY OF

PAKSHAGHATA 50 – 85

04 DRUG REVIEW 86 - 97

05 METHODOLOGY 98 - 103

06 OBSERVATION AND RESULTS 104 - 117

07 NEUROLOGICAL PARAMETERS 118 - 148

08 DISCUSSION 149 - 163

09 CONCLUSION 164 - 165

10 DRUGS PHOTOS 166

11 SUMMARY 167 -168

12 BIBLIOGRAPHY 169 – 188

13 ANNEXURE 189 - 206

14 NEUROLOGICAL MAPPING 207

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LIST OF TABLE Sr.No. Name of Table Page No.

1. VIRECHANA KALPAS ACC. CHARAKA 17

2. VIRECHANA KALPAS ACC. SHARANGADHAR 19

3. VIRECHANA YOGYA 20

4. VIRECHANA AYOGYA 22

5. SNEHA DRAVYA AND ANUPANA 26

6. SNEHA JEERYAMANA AND JEERNA LAKSHANA 27

7. SAMYAK SNIGDHA LAKSHANA 27

8. ASNIGDHA LAKSHANA 28

9. ATISNIGDHA LAKSHANA 28

10. DOSE OF VIRECHANA DRUG IN DIFFERENT FORM 30

11. CRITERIA FOR ANTIKI, VEGIKI AND MANIKI

SHUDDI OF VIRECHANA KARMA

33

12. SAMYAK YOGA LAKSHANAS OF VIRECHANA 34

13. AYOGA LAKSHANAS OF VIRECHANA 34

14. ATIYOGA LAKSHANAS OF VIRECHANA 35

15. DIET AND REGIMEN 37

16. RASA SAMSARJANA 39

17. AYOGA & ATIYOGA LAKSHANS OF VYAPATH 40

18. VIRECHANA VYAPATH ACC. TO ACHARYAS 40

19. VIRECHANA VYAPATH WITH THEIR TREATMENT 41

20. AHARAJA NIDANA 60

21. VIHARAJA NIDANA 61

22. AGHATAJA NIDANA 62

23. MANASIKA NIDANA 62

24. KALAJA NIDANA 63

25. TREATMENT FOR VATA VYADHIS 81

26. VIRECHANA FOR VATA VYADHI 82

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27. PATHYA APATHYA 82

28. RASA PANCHAKA OF CHITRAKADI VATI 86 -87

29. GHRITA 88 -89

30. INGREDIENTS OF MOORCHITA TAILA 91-92

31. MOORCHITHA TAILA GUNAS 96-97

32. CHEMICAL COMPOSITION OF TAILA 98

33. PROPERTIES OF GANDHARVAHASTADI ERANDA

TAILA

100

34. STANDARD SYMPTOM SCORING 101-103

35. AGE WISE DISTRIBUTION 104

36. SEX WISE DISTRIBUTION 105

37. RELIGION WISE DISTRIBUTION 105

38. EDUCATION WISE DISTRIBUTION 106

39. MARITAL STATUS WISE DISTRIBUTION 106

40. SOCIO- ECONOMICAL STATUS WISE DISTRIBUTION

107

41. OCCUPATION WISE DISTRIBUTION 107

42. DESHA WISE DISTRIBUTION 108

43. ASSOCIATED DISEASE WISE DISTRIBUTION 108

44. DIET WISE DISTRIBUTION 109

45. NIDRA WISE DISTRIBUTION 109

46. HABITS WISE DISTRIBUTION 110

47. PRAKRUTI WISE DISTRIBUTION 110

48. SATVA WISE DISTRIBUTION 111

49. SARA WISE DISTRIBUTION 111

50. RASA SATMYA WISE DISTRIBUTION 112

51. SAMHANANA WISE DISTRIBUTION 112

52. AHARA SHAKTI( ABHYAVARANA SHAKTI) WISE DISTRIBUTION

113

53. AHARA SHAKTI( JARANA SHAKTI) WISE DISTRIBUTION

113

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54. VYAYAMA SHAKTI WISE DISTRIBUTION 114

55. VAYA WISE DISTRIBUTION 114

56. KOSHTA WISE DISTRIBUTION 115

57. DURATION OF ILLNESS 115

58. AFFECTED SIDE 116

59. AFFECTED PREDOMINANT LAKSHANA 116

60. EFFECT ON BICEPS REFLEX 118

61. EFFECT ON TRICEPS REFLEX 119

62. EFFECT ON BRACHIORADIALIS REFLEX 119

63. EFFECT ON KNEE REFLEX 120

64. EFFECT ON ANKLE REFLEX 120

65. EFFECT ON POWER – SHOULDER 121

66. EFFECT ON POWER – ELBOW 122

67. EFFECT ON POWER – WRIST 122

68. EFFECT ON POWER – HIP 123

69. EFFECT ON POWER – KNEE 124

70. ROMBERG’S TEST 124

71. FINGER NOSE 125

72. HEEL SHIN TEST 126

73. EFFECT ON FINGER MOVEMENT IN HAND 126

74. EFFECT ON TOE MOVEMENT IN LEG 127

75. EFFECT ON LIFTING OF ARMS AT SHOULDERS 128

76. EFFECT ON LIFTING OF LEG AT HIP 128

77. EFFECT ON SITTING FROM LYING DOWN POSTURE 129

78. EFFECT ON STANDING FROM SITTING POSTURE 130

79. EFFECT ON WRIST DROOPING 130

80. EFFECT ON FOOT DROOPING 131

81. LOSS OF SPEECH 132

82. EFFECT ON MUSCLE TONE IN HAND 132

XIII

83. EFFECT ON MUSCLE TONE IN LEG 133

84. EFFECT ON MUSCLE STRENGTH IN HAND 134

85. EFFECT ON MUSCLE STRENGTH IN LEG 134

86. EFFECT ON HAND GRIP POWER 135

87. EFFECT ON FOOT PRESSURE 136

88. EFFECT ON WALKING TIME 136

89. EFFECT ON PAPER HOLDING 137

90. KARMA KSHAYA 138

91. KARMA HANI 138

92. VAK STAMBHA 139

93. SANKOCHA 140

94. SANDHI – BANDHA VIMOKSHA 140

95. RUJA 141

96. TODA 142

97. SHOTHA 142

98. SAMYAK SNIGDHA LAKSHANA ACC. TO DAYS 143

99. TOTAL AMOUNT OF ABHYANTARA SNEHA 144

100. SAMYAK SNIGDHA LAKSHANA 144

101. SAMYAK SWINNA LAKSHANA 145

102. ANALYSIS OF LATENCY PERIOD 145

103. ANALYSIS OF DURATION OF VIRECHANA 146

104. ANALYSIS OF VEGIKI 146

105. ANALYSIS OF MANIKI 147

106. ANALYSIS OF ANTIKI 147

107. ANALYSIS OF LAINGIKI 148

XIV

List of Graphs

Serial No. Description Page No.

01 AGE WISE DISTRIBUTION 104

02 SEX WISE DISTRIBUTION 105

03 RELIGION WISE DISTRIBUTION 105

04 EDUCATION WISE DISTRIBUTION 106

05 MARITAL STATUS WISE DISTRIBUTION 106

06 SOCIO- ECONOMICAL STATUS WISE DISTRIBUTION

107

07 OCCUPATION WISE DISTRIBUTION 107

08 DESHA WISE DISTRIBUTION 108

09 ASSOCIATED DISEASE WISE DISTRIBUTION 108

10 DIET WISE DISTRIBUTION 109

11 NIDRA WISE DISTRIBUTION 109

12 ADDICTION WISE DISTRIBUTION 110

13 PRAKRUTI WISE DISTRIBUTION 110

14 SATVA WISE DISTRIBUTION 111

15 SARA WISE DISTRIBUTION 111

16 RASA SATMYA WISE DISTRIBUTION 112

17 SAMHANANA WISE DISTRIBUTION 112

18 AHARA SHAKTI( ABHYAVARANA SHAKTI) WISE DISTRIBUTION

113

19 AHARA SHAKTI( JARANA SHAKTI) WISE DISTRIBUTION

113

20 VYAYAMA SHAKTI WISE DISTRIBUTION 114

21 VAYA WISE DISTRIBUTION 114

22 KOSHTA WISE DISTRIBUTION 115

23 DURATION OF ILLNESS 115

24 AFFECTED SIDE 116

25 AFFECTED PREDOMINANT LAKSHANA 117

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26 EFFECT ON BICEPS REFLEX 118

27 EFFECT ON TRICEPS REFLEX 119

28 EFFECT ON BRACHIORADIALIS REFLEX 119

29 EFFECT ON KNEE REFLEX 120

30 EFFECT ON ANKLE REFLEX 121

31 EFFECT ON POWER – SHOULDER 121

32 EFFECT ON POWER – ELBOW 122

33 EFFECT ON POWER – WRIST 123

34 EFFECT ON POWER – HIP 123

35 EFFECT ON POWER – KNEE 124

36 ROMBERG’S TEST 125

37 FINGER NOSE 125

38 HEEL SHIN TEST 126

39 EFFECT ON FINGER MOVEMENT IN HAND 127

40 EFFECT ON TOE MOVEMENT IN LEG 127

41 EFFECT ON LIFTING OF ARMS AT SHOULDERS

128

42 EFFECT ON LIFTING OF LEG AT HIP 129

43 EFFECT ON SITTING FROM LYING DOWN POSTURE

129

44 EFFECT ON STANDING FROM SITTING POSTURE

130

45 EFFECT ON WRIST DROOPING 131

46 EFFECT ON FOOT DROOPING 131

47 LOSS OF SPEECH 132

48 EFFECT ON MUSCLE TONE IN HAND 133

49 EFFECT ON MUSCLE TONE IN LEG 133

50 EFFECT ON MUSCLE STRENGTH IN HAND 134

51 EFFECT ON MUSCLE STRENGTH IN LEG 135

52 EFFECT ON HAND GRIP POWER 135

53 EFFECT ON FOOT PRESSURE 136

XVI

54 EFFECT ON WALKING TIME 137

55 EFFECT ON PAPER HOLDING 137

56 KARMA KSHAYA 138

57 KARMA HANI 139

58 VAK STAMBHA 139

59 SANKOCHA 140

60 SANDHI – BANDHA VIMOKSHA 141

61 RUJA 141

62 TODA 142

63 SHOTHA 143

64 SAMYAK SNIGDHA LAKSHANA ACC. TO DAYS

143

65 TOTAL AMOUNT OF ABHYANTARA SNEHA 144

66 SAMYAK SNIGDHA LAKSHANA 144

67 SAMYAK SWINNA LAKSHANA 145

68 ANALYSIS OF LATENCY PERIOD 145

69 ANALYSIS OF DURATION OF VIRECHANA 146

70 ANALYSIS OF VEGIKI 146

71 ANALYSIS OF MANIKI 147

72 ANALYSIS OF ANTIKI 147

73 ANALYSIS OF LAINGIKI 148

INTRODUCTION

Introduction

“A Clinical Study to Evaluate the Efficacy of Virechana Karma in Pakshaghata” Page 1

INTRODUCTION

Vata is the regulator of other Doshas, the disease caused by Vata Dosha is of

much importance. Pakshaghata took a prime position among all other Vata Vyaadhi.

Pakshaghata is a severe blow to the sufferer’s life. It makes the patient cursed creature so

far his activities are concerned. The patient not only suffers a bodily illness but also go

through a severe mental depression on account for inability to attend such duties as are

essential for personal hygiene and maintenance of his own cleanliness and attire.Such a

person irrespective of religion, age, sex or socioeconomic status, faceses a very miserable

and dependent life. This disease not makes the person only crippled but also makes him /

her burden to the family. If he or she is the only earning member in the family, the family

has to face endless problems. The condition similar to Pakshaghata, in modern science is

the hemiplegia. The commonest cause of hemiplegia is cerebrovascular accident or

stroke. The term stroke defines rapidly developing clinical symptoms and signs of focal,

and at times global, loss of cerebral function lasting more than 24 hours, or leading to

death, with no apparent cause other than of vascular origin. The ischemic stroke refers to

a vascular insufficiency (thromboembolism) rather than hemorrhage.

The most common brain disorder is the cerebrovascular accident which affects

500,000 people a year and represents the third leading cause of death, behind heart

attacks and cancer. Cerebrovascular accident is characterised by abrupt onset of

persisting neurological symptoms.

Current demographic trends suggest that the Indian population will survive

through the peak years of occurrence of stroke (age 50-60 yrs) and Stroke survivors in the

elderly with varying degree of residual disability will be a major medical problem. The

available data from community surveys from different regions of India for 'hemiplegia'

presumed to be of vascular origin indicate a crude prevalence rate in the range of 200 per

100,000 persons. Thus, the anticipated costs of rehabilitation of 'stroke-victims' will pose

enormous socio-economic burden on our meager health-care resources, similar to what is

now faced by industrialized nations in the West. Therefore, early diagnosis, intensive

treatment and prevention of strokes at any age should be our main strategy in the national

health planning

Introduction


About 80% of all acute ischemic strokes are from cerebral infarction and 10% of them

die within 30 days. Among the stroke-survivors, almost 50% will experience some

disability. The main goals of therapy are to rapidly restore and maintain adequate blood

supply to ischemic tissue with aim to minimise brain damage, and there by minimize

neurologic deficit and disability, and to improve the quality of life after the manifestation

of stroke.

Hemiplegia is a symptom and it can be manifest from a wide variety of disease

processes. Each disease process is supposed to having different Sampraapti. So the

treatment of the hemiplegia due to different condition will also vary.As it is said that

dissolution of Sampraapti is the treatment. So to treat a disease it is indispensable to

obtain the detail knowledge of Sampraapti of the disease.

Pakshaghata is described in almost all text as a Vata Nanatmaja Vyaadhi,

which means it get manifest only due to Vaata Dosha involvement. The line of treatment

of Pakshaghata is described as Virechana. But Virechana cannot be applied in Suddha

Vaataja condition. Describing the indication of Virechana in Vaatavyaadhi, in Charka

Samhitaa it has been said that, Virechana is indicated in that condition of Vaata where the

Vaata is obstructed by Pitta, Rakta, Kapha and Meda. Snehapaana is the main line of

treatment for the Suddha Vaataja disorder. But Snehapaana cannot be applied for

Pakshaghata resulting from cerebrovascular accident. If Snehapaana is given to a patient

of cerebrovascular accident, there is every chance of recurrence of CVA, as Snehapaana

may enhance atherosclerosis precipitating thrombosis and embolism. Therefore it is

necessary to approach Pakshaghata resulting from CVA in a different angle other than

Suddha Vataja condition keeping the above facts in the mind the present study has been

carried out to study the etio – pathogenesis of Pakshaghata due to cerebrovascular

accident and to establish a standard Samprapti for the same.

The present study has been carried out in two parts; 1- conceptual study and 2-

clinical study. Conceptual study includes disease review and drug review. Disease review

starts with the classification of Pakshaghata and all the aspect of Pakshaaghaata with

Introduction


respect to Nidaana, Purvarupa, Rupa, Upashaya and Sampraapti. This part also contains

detail description of cerebrovascular accident with etiology, risk factor, signs, symptoms

and etiopathogenesis. Drug review starts with the properties and indication of Virechana.

In addition to this exhaustive description of Guna Karma of all the drugs used for the

study has been given referring different literatures.

For clinical study 20 patients were registered and given deepana & pachana,

snehapana for 3-7days till patients attains samyak snigdha lakshana, Sarvaanga

Abhyanga & Sarvanga Baspa Sweda for 4days, virechana was given and advised to

follow the samsarjana krama.

As per Ayurvedic principles Virechana karma is not a mere bowel cleansing

procedure. Apart from that, it also has systemic effects. Hence, to show the efficacy of

Virechana as a treatment regimen as well as to compare Virechana with simple bowel

cleansing action in a subsidiary group Koshthashuddhi was done.

On observation it was found that not a single etiological factor or risk factor of

cerebrovascular accident is related to the Suddha Vaataja condition. The Nidaana

observed for CVA are also not Vaata Prakopaka rather they vitiate other Dosha.

Virechana is indicated in the Vaata Vyaadhi where Vaata is obstructed with other factors

like Kapha, Pitta, Rakta and Meda. On the basis of the above facts it has been concluded

that Pakshaghata due to cerebrovascular accident is manifested due to the Aavarana of

Vaata with other factors like Kapha, Pitta, Rakta and Meda.

In addition to this virechana also clears the intellect, improves the strength of sense

organ, potentiates all Dhatu, increases body strength, improves Agni & delayed old age.

OBJECTIVES

Objectives of the Study

“A Clinical Study to Evaluate the Efficacy of Virechana Karma in Pakshaghata ” Page 4

OBJECTIVES OF THE STUDY:

Objectives of the study:

To evaluate the effect of virechana karma in patients

suffering from Pakshaghata clinically.

Conceptual study of virechana karma and pakshaghata will

be taken up.

REVIEW OF

LITERATURE

Virechana Review


VIRECHANA REVIEW HISTORICAL REVIEW

Historical review of virechana karma:

Vedas are the oldest source of information regarding the disease and its treatment A close

review of the history of various systems of medicinal science reveals the fact that the

treatments was prevalent from time immemorial, but only very few references are

available about Virechana in Vedic times.

PURANA KALA

Agnipurana7

Agni purana has stated virechana as best treatment for the diseases caused due to

Pitta.Trivrth as best virechaka dravya. It is indicated in urdhwaga rakta pitta, jwara,

hridroga.But detail description of Virechana was not found.

:

In Manu smrithi, it is told that snana is done after the completion of vamana and

virechana.

Vinayapitaka(Buddha literature):

In the text Vinaya pittaka, Buddha period, virechana was given to Bhagwan Buddha by

inhaling some powder spread over uthplapatra.

Kasika

It was explained that Panchakarma was common method of treatment which prescribed

Poorvakarma such as Snehana, Swedana and Panchakarma, Annasamsarjana etc.

8

SAMHITA KALA:

1.CHARAKA SAMHITA

Sutra Sthana:

• 1st

• 2

chapter Deerghanjeeviteeya Adhyaya contains Moolinis and Phalinis used for

Virechana. nd

• 4

chapter Apamaargatanduleeya Adhayaya contains important purgative drugs. th chapter Shat virechana Shatashrateeya Adhyaya mentioned about

Virechanopaga drugs.

Virechana Review


• In 15th

• In 16

chapter Upakalpaneeya Adhayaya described about Sambhara Sangraha,

Dose of Virechana, Yogya, Ayoga, Atiyoga laxanas, virechana vidhi and its

benefits. th

• In 20

chapter Chikitsaprabrutiya adhyaya explained about Complications & its

management. th

Vimana Sthana:

chapter Maharoga Adhayaya mentioned about Utility of Virechana karma

in Nanatmaja pittajaVikaras.

• Virechana dravya kalpa sangraha mentioned in 8th

chapter rogabhishagjiteeya

Vimana adhyaya.

Kalpa sthana:

• Different formulations of tilwaka explained in 3rd

• Different formulations of shyamatrivrit described in 7

chapter Tilwaka Kalpa Adhyaya th

• Different formulations of chaturangula mentioned in 8

chapter Shyama trivrit

Kalpa Adhyaya. th

• Formulations of sudha mentioned in 9

chapter Chaturangula

Kalpa Adhyaya. th

• Different formulations of saptalashankini described in 10

chapter sudha kalpa adhyaya. th

• In 11

chapter Saptala

shankini Kalpa Adhyaya. th

chapter Danti dravanti Kalpa Adhyaya Different formulations of

dantidravanti explained.

Siddhi Sthana:

• Virechana purva ahara,samyog,heena & atiyoga laxanas,Samsarjana krama,

Shuddhi are described in 1st chapter kalpana siddhi.

• In 2nd chapter Panchakarmeeya Siddhi described about Virechya and Avirechya.

• Complication manifested due to ayoga and atiyoga and its management

are mentioned in 6th

chapter Vamana Virechana Vyapad Siddhi.

Virechana Review


2. SUSHRUTA SAMHITA

Sutra Sthana:

• Description of Virechana dravyas can be reffered in 38th chapter

Dravyasangrhaniya adhyaya.

• Adho bhaga dosha hara dravyas are mentioned in 39th chapter Samshodhana

samshamaniya.

• In Dravya vishesha vignaneeya adhyaya Adhobhaga Prabhava of Virechaka

drugs are described.

• Different formulations for the Virechana karma are mentioned in 44th chapter

Virechana dravya vikalpaneeya adhyaya.

Chikitsa Sthana:-

• Virechana process, Phamacodynamics of virechana, , Ayoga, Atiyoga and

Samyak yoga of Virechana,Virechya –Avirechya, importance of dosha nirhana

mentioned in 33rd chapter Vamana virechana sadhya upadrava chikitsitam

adhyaya.

• Complication of Virechana karma described in 34th Vamana Virechana vyapat

Chikitsitam Adhyaya.

• In 39th chapter Aturopadrava Chikitsitam Adhyaya explained about samsarjana

karma.

3.KASHYAPA SAMHITA:

Siddhi Sthana:

• Detailed discription of Virechana Karma Heena, Madhyama, Uttama Shuddhis,

Regimen to be followed after Virechana, utility of Virechana Karma in Bala roga,

Vyapat of Virechana is mentioned in 3rd chapter Vamana Virecahna Adhyaya.

• In 7th chapter panchakarmeeya siddhi described about Yogya Ayogya for

Virechana.

Virechana Review


Khila sthana:

• Virechana Karma and Samsarjana Krama described in 7th chapter

Samshuddhi Visheshaneeya Adhyaya.

4. ASTHANGA SANGRAHA:

Sutra sthana:

• Detailed description of Virechana Karma, Pharmacological actions of

Virechana dravyas, Virechya, Avirecya are mentioned in 27th chapter Vamana

Virechana Vidhi Adhyaya.

Kalpa sthana:

• Different formulations of Virechana Karma mentioned in 2nd chapter

Virechana kalpa Adhyaya.

• Vyapat and its Management explained in 3rd chapter vamana virechana vyapat

siddi

5. ASHTANGA HRIDAYA:

Sutra sthana:

• Detailed description of Virechana Karma is described in 18th chapter Vamana

Virechana Vidhi Adhyaya.

Kalpa sthana:

• Detailed description of Virechana process is mentioned in 2nd chapter Virechanaa

Kalpa Adhyaya.

• Virechana Vyapat with its treatment is mentioned in 3rd chapter Vamana

Virechana Vyapat Adhyaya.

6. BHELA SAMHITA:

Kalpa sthana: Chapters deal with preparations of

• Chaturangula.

• Dantiphala.

Virechana Review


• Shankini.

• Shyamatrivrit.

Siddhi Sthana:

• 1st chapter vamana virechana siddhi deals with samyak,ayog & atiyoga laxanas of

virechana.

• 4th chapter Vamana Virechana Siddhi Adhyaya deals with detailed description of

Virechana Karma

7. CHAKRADATTA:

Detailed description of Virechana Karma available in 71st chapter Virechana

adhikara.

8. SHARANGADHARA SAMHITA:

Poorva kanda:

• Description of four types of virechana dravya laxanas available in 4th chapter

Deepana Pachana Adhyaya.

Uttara kanda:-

• In 4th chapter Virechana Vidhi Adhyaya Virechana karma described in detail

9. VANGASENA:

89TH CHAPTER Virechana adhikara Adhyaya detailed description of Virechana

karma and virechana yogas available.

10. BHAVA PRAKASHA

Details regarding virechana and Pathya and Apathya during Virechana karma in

6th chapter Mishra Prakarana Adhyaya.

Purgation in western medicine.

In Mesopotamian Civilization Physicians of Mesopotamia were using Virechana to treat

pain abdomen.

In seventeen century Handersn has written in his book that it was customary to use

Purgatives.

Virechana Review


NIRUKTI

The process by which the vitiated doshas are eliminated through the adhobhaga i.e guda

marga, is called ‘Virechana.This is widely used shodana therapy, is less stressful with

least complication.Virechana in broader term denotes both vamana and virechana9.

Etymology:-

(1) Virechana 10: V+Rich+ Nich, lytu-malade: nissernam...... (Vachaspathyam).

(2)Virechanaha11:V+Rich+Nich, lytu-Visheshena rechathete ...... (Shabdakalpadruma)

The Vircehana word is derived from the ‘Rich’ dhatu ,‘Nich’ &’Lyut’ pratyaya & with

‘Vi’ upasarga.

It also means Maladehe nissaranam i.e. expelling out the malas.

"Ricir" - evacuation.

"Ric" - Viyojana (separation).

Virechana word is derived from the ‘Rich’ dhatu, ‘Rich’ meaning – To empty, evacuate,

leave, and give up12.

The root ‘Rich’ is also very important to understand the systemic action of Virechana.

According to Charaka, the Virechana drugs first get digested in Amashaya then reaches

to Hridaya, Dhamani, macro and micro channels (srotases) of the body and reach the site

where Doshas are accumulated13.

Virechana drugs soften the compactness (Sanghata) of the Doshas and break the bigger

molecules to smaller ones. This process occurs in a proper way by separation (Viyojana)

and combination (Samparchana) of doshas.

Up to this stage the action of Virechana is known as its systemic effect and it is obviously

governed by Viyojana and Samparchana components of Virechana dravya.

Definition:

iÉ§É SÉåwÉWûUhÉqÉÔkuÉïpÉÉaÉÇ uÉqÉlÉ xÉÇ¥ÉMüqÉ,AkÉÉåpÉÉaÉÇ ÌuÉUåcÉlÉ xÉÇ¥ÉMüqÉç .....| 14

The act of expelling Doshas through Adhobhaga is known as Virechana. Here the

meaning of Adhobhaga is ‘Guda’ as commented by Chakrapani.

ÌuÉUåMüÉå qÉÑZÉmÉÏiÉÇ aÉÑSqÉaÉåïhÉÉliÉ:ÎxjÉiÉxrÉ SÉåwÉxrÉ ÌlÉ:xÉÉUhÉÇ ...| 15

The procedure in which the drug is administered orally, acts on morbid Doshas,

specifically on Pitta and expels them out through anal route.

Virechana Review


ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç |UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||16

The procedure where the morbid Dosha is expelled out in the form of Drava either

pakva or apkva state.

ÌmÉ¨Éå iÉÑ ÌuÉUåMÇü zsÉåwqÉxÉÇxÉ×¹å uÉÉ iÉixjÉÉlÉaÉiÉå uÉÉ zsÉåwqÉhÉÏÌiÉ |

urÉMÑüsÉÉlÉç xÉÍ³ÉmÉÉiÉÉåijÉÉlÉç mÉæÌ¨ÉMüÉlÉç MüTü ümÉæÌ¨ÉMüÉlÉç |17

xÉÇxÉ×¹ÉlÉç MüTüqÉÔsÉÉÇ¶É xÉëÇxÉlÉëålÉÉprÉÑmÉ¢üqÉåiÉç ||18

Even though Virechana is best line of treatment modality for pittadosha it can act on

kaphasamsrusta pitta or pittasthanagat kapha. And moreover in case of vatasyopakrama

mridu shodhana indicated which refers to mridu Virechana karma. So Virechana is major

line of treatment for morbid pittadosha & also it act on morbid kapha and vata dosha.

Thus action of Virechana is seen on all tridosha.

Paryaya19:

Instead of word Virechana the following terms were used in different context, these all

can be consider as synonyms for virechana,

• Vireka,

• Rechana,

• Adhobhagahara.

• Anulomana

• Praskandana.

According to the Sanskrit– English dictionary the different meanings are- Purgative,

Cathartic, Evacuant and Aperient.

IMPORTANCE OF VIRECHANA:

Virechana is a ultimtae procedure for elimination of Pitta Dosha20, 21 Indu explains that in

the vitiation of Kevala Pitta, Pitta associated with Kapha and in Pittasthana Gata Kapha

Virechana is the obvious treatment procedure to be followed22.

Charaka explains that Virechana drug after entering Amashaya dislodges the vitiated

Pitta Dosha and henceforth pacifies all Pitta Vikara of the body23.

Virechana Review


Virechana also cleanses sense organs i.e. improves their function. Just as removal of

water from its reservoir destroys various organisms and plants residing in it, in the similar

manner removal of excessive Pitta destroys the various symptoms caused due to it24.

Virechana is mentioned as Shodhana procedure in Dusthi of Rasa, Rakta, Mamsa, Asthi,

and Majja & Shukra Dhatus. Hence in majority of the Dhatupradoshaja Vikaras

Virechana is the better option.

Virechana dravya guna karma:

The guna of virechana dravya are ushna, tikshna, sukshma, vyavayi, vikashi, these

qualities are common in vamana aoushadam, but virechana dravya has adhobagahara

prabhavam. Virechana dravya has jala and prithwi mahabootha predominance25.

CLASSIFICATION OF VIRECHANA DRUGS:

The drugs which produce Virechana are known as Virechaka dravyas. According to

references available Virechana drugs may be classified in following 6 groups,

I) Virechana Dravyas According to their origin & parts used

a) Animal origin

b) Plants origin

c) Miscellaneous

II) According to the mode of action

a) Anulomana

b) Samsrana

c) Bhedana

d) Rechana

III) According to the intensity of action

a) Mrudu

b) Madhyama

c) Tikshna

IV) According to the Rukshata & Snigdhata view.

V) Virechana drugs according to the seasons

VI) Virechana drugs according to kalpanas.

Virechana Review


I. Virechana drugs according to their origin and parts used:

a) Animal origin:

• Urine. 26, 27, 28, 29

• Milk

• Takra

b) Plant Origin:

c) Miscellaneous

Classification of virechana dravyas based on parts used 30, 31, 32:-

1. Mulini virechana dravya. -Hastidanti, Shyama, Trivrit, Adhoguda,

Saptala, Danti, Gavakshi, Vishanika,

Ajagandha, Dravanti, Avartaki.

2. Phalini virechana dravya - Shankhini, Vidanga, Anupa, Sthalaja, Prakeerya,

Udakeerya, Abhaya, Anthakotrapuspi,

Kampillaka, Aragwada

3. Ksheera virechana dravya - Snuhi ksheera, Arka

4. Twak virechana dravya - Tilwaka

5. Patra virechana dravya - Swarna patri, Aragwada

B) Based on Parts of the Dravya used 33:

Sushruta describes the following drugs with priority for Virechana Karma.

Classification of virechana dravyas based on parts used and agraoushda

Mula - Shyama Trivrith

Phala - Haritaki

Twak - Tilwaka

Swarasa - Karvellaka

Dugdha - Snuhi

Taila - Erandam

c) Miscellaneous:

As Madya, Dhanyamla34, Guda, Ikshu Rasa, Payas, Krishara, Ushna Jala, some

minerals - Swarna, Kamsya, Manahsila, Gandhaka, Ratna, Uparatna, Samudraphena

also have Sara properties.

Virechana Review


II. Virechana drugs according to their mode of action by Sharangadhara

Acharya Sharangdhara has classified according to the action of the Virechana

dravyas.

a) Anulomana 35 :

M×üiuÉÉ mÉÉMÇü qÉsÉÉlÉÉÇ rÉiÉç ÎpÉiuÉÉ oÉlkÉqÉkÉÉå lÉrÉåiÉç |iÉŠÉlÉÑsÉÉåqÉlÉÇ ¥ÉårÉÇÇ mÉëÉå£üÉ WûUÏiÉMüÐ ||

These drugs will digest the Apakwa (undigested material) malas and bring them to

adhomarga for defecation process. That is these drugs will facilitate the defecation

process. eg: Hareetaki (Terminalia Chebula).

Sushruta considers Sara as the synonym of Anulomana. According to Dalhana

Anulomana causes expulsion of Vata and Kapha. 36

According to Raja Nighantu, Bhoutika composition of Anulomana drugs is similar to that

of Virechana drugs i.e. Prithvi and Aap Mahabhuthas.

b) Sramsana :

mÉ£üurÉÇ rÉSmÉ£üurÉÇ ÎvsÉ¹Ç MüÉã¹ã qÉsÉÉÌSMüqÉç | lÉrÉirÉkÉ:xÉëÇxÉlÉÇ iÉSè rÉjÉÉ xrÉÉiÉç ¢üiÉqÉÉsÉMüqÉç|37

The drugs which expel the malas adhered to the lumen of intestines in to the rectum

without digesting (Paka) them. Eg: Aragwada (Casia Fistula).

In the context of Jwara Chikitsa it has been mentioned that Sramsana eliminates the Pitta

and Kapha situated in Pakwashaya38.

c) Bhedana :

qÉsÉÉÌSMüÇqÉoÉ®Ç cÉ oÉ®Ç uÉÉ ÌmÉÎhQûiÉÇ qÉsÉæ:| ÍpÉiuÉÉÅkÉ: mÉÉiÉrÉÌiÉ, iÉSè pÉãSlÉÇ MüOÒûÌMü rÉjÉÉ|39

The drug which disintegrates the ‘Abaddha’ (unformed) or ‘Baddha’ (formed) or

‘Pindita’ (dried fecal mass) forms of Malas by facilitating penetration into it and then

evacuating through the lower gut, is known as Bhedana. Eg: Katuki.

Bhedana is a process in which Shareera Mala Nirharana is brought about40.

Charaka has described a group named as ‘Bhedaneeya’. This includes Shyama (Trivrit),

Arka, Urubuka (Eranda), Agnimukhi (Kalikari), Chitra (Danti), Chitraka, Chirabilva,

Shankhini, Sakuladani (Katuki) and Swarnaksiri41.

d) Rechana :

ÌuÉmÉYuÉÇ rÉSmÉYuÉÇ uÉÉ qÉsÉÉÌS SìuÉiÉÉÇ lÉrÉåiÉç | UåcÉirÉÌmÉ iÉ¥ÉårÉÇ UåcÉlÉÇ Ì§ÉuÉ×iÉÉ rÉjÉÉ ||42

Virechana Review


The drug which eliminates digested (Pakwam) and undigested (Apakwam) Malas or

Doshas by making them watery through the lower gut is known as ‘Rechana’ eg:

Trivrit.

Virechanopagas:

There are certain drugs which help in enhancing the action of Virechana Dravyas is

known as Virechanopaga. The drugs described are Draksha, Gambari, Parushaka,

Abhaya, Amalaka, Vibhitaka, Kuvala Badara, Karkandhu, and Pilu43

III) Virechana drugs according to intensity of action:

According to the degree of potency of the drugs, the Virechana may be classified into

the following categories.

A) Mridu Virechana44:

The drug which is Mridu in Veerya or when combined with opposite Veerya or given

in low dosage, given to the Ruksha patient and causes less purgation is known as Mridu

Virechana. Those drugs are specifically indicated in weak patients having mild natured

diseases. These drugs may also be given to the patients who have been Shodhita

previously or having Alpa Dosha or whose Koshta is unknown. Charaka is of the view

that the physician should not hesitate to use Mridu Virechana drugs in weak patients

having more Doshas because even repeated elimination of Doshas in small quantity

may cure the disease.45

The patient who have not taken Virechana drugs in past and whose Koshta is

unknown in such persons Sushruta recommends the use of Mridu Virechana drugs in

the beginning and after knowing the Koshta required drug may be prescribed 46

Sharangdhara recommends the use of Mridu Virechana drugs in Mridu Koshta (eg.

Draksha, Milk, Caster oil, Warm water etc.) 47. Drugs effective in Mridu Koshta are

Guda, Ikshu Rasa, Mastu, Ullodita Dadhi, Payas, Kshira, Sarpi, Kashamari, Triphala,

Pilu and Taruna Madya48.

B) Madhya Virechana:

The drugs which are moderate in qualities are known as Madhya Virechana drugs.

The drugs are specifically indicated in the patients having Madhya Roga (disease with

moderate symptoms). The administration of these drugs in Balavan rogi is useless

Virechana Review


because, they are unable to eliminate Dosha completely49. Sharangdhara recommends the

use of Madhyama Virechana in Madhyama Koshta. Eg: Trivrit, Katuki and Aragvadha50.

C) Teekshna Virechana :

The drugs, which cause severe motions (Mahavega) and eliminates the Doshas in large

quantity by quick (Kshipra) and gentle (Sukha) purgation without causing either much

depression (Glani), is known as Teekshna Virechana.

According to Charaka, the drug which has been kept away from water, heat and

organisms, cultivated in proper Desha and Kala and which has been given Bhavana with

the drugs of same Veerya acquires the Teekshna properties. This type of drugs having all

the required properties, when given in prescribed dosage to the patient who has been well

Snehita and Swedita, then it causes Teekshna Virechana. Sharangdhara recommends use

of Teekshna Virechana drugs in Krura Koshta persons51.

Charaka recommends the use of these drugs in the strong (Balavan) patients all the

symptoms of the diseases i.e. Teekshna Vyadhi52. It has been further mentioned that the

use of these drugs should be avoided in Durbala (weak), Shodhita, and patient having

Alpa Dosha and whose Koshta is unknown, otherwise it may cause untoward effects of

these patients. Sushruta is of the view that Teekshna drugs given in Mridu Koshta having

Deeptagni, passes out quickly without eliminating Doshas properly53, Snuhi Kshira is

considered as the best amongst these drugs54. More over Sharangdhara recommend the

other drugs like Hemakshiri, Danti, etc. explained in Krura Koshta may also be included

in this group.

IV) Classification based on guna of drug:

In many places in Ayurveda, the uses of Sneha Virechana and Ruksha Virechana have

been recommended.

The drug used in the form of oil or the preparation containing Sneha is known as Sneha

Virechana, eg: Eranda Taila. Vagbhata recommends the use of Sneha Virechana in all

patients except Snigdha patients55. The use of Sneha Virechana in the patients who have

been given higher dosage of Sneha is contraindicated because, due to this, the moving

Doshas may again adhere in the Srotas56. Sneha Virechana should be administered in

Sama-Shitoshma Kala57.

Virechana Review


The preparations, which do not contain Sneha, may be known as Ruksha Virechana. Its

use has been recommended in the Snigdha patients who have been comparatively taken

more Sneha.

V) Virechana drugs according to seasons 58

Varsha – trivrit, kutaja, pippali, shunti along with draksha and madhu as anupana.

Sharad – shyama trivrit, durallabha, musta, sharkara, udhichya, and shweta chandana

with yasti madhau and draksha swarasa as anupana.

Shishira/vasanta – shyama & aruna trivrit, pippali, nagara with honey.

Greeshma – shyama trivrit with sugar

Hemanta– trivrit, chitraka, pata, ajaji, sarala, vacha, hemakshiri churna with warm water.

All season – trivrit, danti, hapusha, saptala, katuki, swarnakshiri bavana with gomutra.

Adhamalla in Sharangdhara commentary mentioned that the drugs for Virechana

in Shishira, Vasanta and Hemanta Rutu are same. Kasiram Vaidya in his commentary

opined that Saindhava, Vriddhadaru, Shyama and Trivrit are to be used for Virechana in

Hemanta Rutu. Charaka mentions Trivrit Chitraka, Patha, etc. to be used for Virechana in

Hemanta Rutu.

VI) According to Kalpana:

Different forms of yogas are prepared to help in enhancing the potency, shelflife and

convenience. According to Sushruta following 8 preparations are useful.

i) Ghrita yoga ii) Taila yoga iii) Kshira yoga

iv)Madya yoga v) Mutra yoga VI) Mamsarasa yoga

vii) Bhaksanna yoga viii) Avaleha yoga

Kshira, Rasa, Kalka, Kashaya, Kwatha and Sita are respectively Laghu.

Table No. 1 Showing Virechana kalpas according to Charaka.59

Kalpana Trivrth Argvada Tilvaka Sudha Saptala

Shankini

Danti

Dravanti

Amla kanji 2 1 1 1 1 1

Mutra 22 - 1 - - -

Tushodaka 2 - - 1 1 1

Maireya 2 - - - 1 -

Virechana Review


Yusha 2 - - 1 - 2

Kwatha 1 2 1 - 11 -

Churna 32 - - 1 1 6

Tarpana 8 - - 1 - -

Ksheera 2 - - - - -

Mamsa ras 2 - - 4 - 6

Ikshu ras 1 - - - - 1

Swarasa 6 2 1 2 - -

Leha 1 1 3 1 3 6

Modhaka 7 - - - - -

Raga shadava 4 - - - - -

Sura Madhya 3 1 2 2 5 4

Souvira 2 1 1 1 1 1

Sidhu - 1 1 - 1 1

Uthkarika 1 - - - - 1

Gritha 4 2 4 4 8 6

Taila - - - - 6 2

Chatusneha - - - - - 1

Asavarishta - 1 1 - - 5

Greya - - - 1 - -

Yavagu - - - - - 1

G.Specific formulations for Virechana

Formulations for virechana based on dosha involvement:-

Vata Pradhana - Trivrit + Saindhava + Shunthi + Kanji or Mamsasara

Pitta Pradhana - Trivrit Choorna + Draksha Kvatha

Kapha Pradhana - Triphala Kvatha, Gomutra, Trikatu

Children between the Age group of 4-12 years - Draksha rasa+ Aragvadha phala majja

H. Dosage of Virechana drugs according to Matra and Kosta:

Virechana Review


Matra of the Virechana drug should be in such a quantity, that the desired effect of

Shodhana may be achieved and may be able to avoid Atiyoga. This should be decided

according to Dosha, Atura Bala, Bheshaja, Kala, Desha, Agni, Koshta, Shareera, Ahara,

Satmya, Satwa, Prakriti, Vaya, Sama Avastha and Vikara61.

Table No. 2 Virechana kalpas according to Sharangadhara60

Kalpana Heena for Mridu

Koshta

Madhyama for

Madhyama Koshta

Uttama for

Krura Koshta

Kwatha 8 tolas 4 tolas 2 tolas

Kalka, Choorna 4 tolas 2 tolas 1 tola

According to Sushruta61:

1, 2 and 3 Tolas Matra is mentioned for Mridu, Madhyama and Krura Koshta

respectively.

I. Nature of Koshta and Virechana62:

qÉ×²Ï qÉÉ§ÉÉ qÉ×SÒMüÉå¸å qÉkrÉMüÉå¸å cÉ qÉkrÉqÉÉ |

¢ÔüUå iÉÏ¤hÉÉ qÉiÉÉ SìurÉæqÉ×ïSÒqÉkrÉqÉiÉÏ¤hÉMæü: ||

Acharya Sharangdhara opines that – for the person Mridu Kostha, Virechana drugs must

be mild and their dose should be in minimum; for the Madhyama medium dose and for

Krura Kostha persons, the Virechana drugs should be Tikshna and its dose in minimum.

J. Virechana Drugs According to Dosha63:

Virechana Dravyas used as per the Dosha:-

Vataja vikara - Snigdha, Ushna virya with Lavana

Pittaja vikara - Kashaya, Madhura Rasa Pradhana

Kaphaja Vikara - Katu Rasa Pradhana

VIRECHANA VIDHI:--

Virechana Vidhi can be studied under 3 main headings:

Purva Karma (Pre Therapeutic Procedure)

Pradhana Karma (Therapeutic Procedure)

Paschat Karma(Post Therapeutic Procedure)

Virechana Review


A) PURVAKARMA:

1) Sambhara Samgraha

2) Aatura Pariksha

3) Aatura Siddhata

4) Matra Vinishchaya

Sambhara Samgraha64:-

Ahara: Shali.Mudga, Maasha, Yava, Tila, Dugdha, Gritha Ushana jala, Mamsa etc.

Aushadha:Deepananeeya, Paachaneeya, Upashamaneeya, Vatahara, Sneha, Swedana,

Virechana drugs like Draksha, Triphala, Suoveerak etc.

Equipments: Achamani,Udaka koshta, Sharava, Darvi, Tula, Manabhanda, Dhum

anetra, Sutra, Karpasa etc. ghata, etc.

Atura Pariksha65: Before performing Virechana karma it is necessary to know patient

fitness in terms of his/her Dosha, Dushya, Atura Bala kala, Desha, Agni, koshta, Sharir

& Ahara Satma, Satva etc. for proper adminstration of Verchana karma..

Virechana Yogya

Table No. 3 Showing Virechana Yogya

Virechana Yogya Ch.Si66 Sus.Chi67 A.S. 68 A.Hr. 69 K.Si. 70 Sha.S.U71

Pranavaha srotoduhti vikara

Shwasa + - - - - -

Kasa + - - - - -

Parshvaruja + - - - - -

Annavaha srotoduhti vikara

Aruchi + + + - - +

Avipaka + - + - - -

Visuchika + + + - - +

Alasaka + + + - - -

Chardi + + + + - +

Udakavaha srotoduhti vikara

Udara + + + + - +

Rasa pradoshaja vikara

Virechana Review


Pandu + + - - + +

Jwara + + + + - +

Aruchi + + - - - +

Avipaka + - + - - -

Hridroga + + - - + +

Rakta pradoshaja vikara

Kamala + - - + + -

Vidradhi - + + + - +

Netradaha + + - - - +

Aasyadaha + + - - - +

Vatarakta + + + + - +

Kustha + + - + + +

Paittika vyadhi + + + - - -

Visarpa + + - - + -

Pliha + + + + - +

Vyanga + - + + - -

Nilika + - - + - -

Urdva Raktapitta + + + + + -

Mamsa pradoshaja vikara

Arbuda + + - - - -

Galaganda + - - - - -

Meda pradoshaja vikara

Prameha + + - + + +

Yoni Dosha + + + + - +

Retodosha + - + + - -

Mootravaha srotoduhti vikara

Mutraghata + + + + - +

Purishavaha srotoduhti vikara

Arsha + + + + + +

Bhagandara + + + - - +

Virechana Review


Udavarta + - + + +

Vibhandha - + + + + -

Pakvashaya shoola + + + + - -

Other

Visphota - - - - + +

Vatavyadhi - - - - + +

Garavisha - + + + + +

Some other indications for Virechana are:

• In Swastha72, 73.

• Utkleshita Pitta.

• Pitta Sthanagata Alpa Kapha

• Kapha Sthanagata Bahu Pitta74

• Pakwashayagata Pitta or Kapha Pitta 75

• Pittavrita Vata

• Kaphavrita Vata 76

• Shonita Roga 77

• As Purvakarma in Rasayana and Vajikarana 78, 79

Table No.4 Showing Virechana Ayogya

Virechana Ayogya Ch.Si 80 Sus.Chi 81 A.S 82 A.Hr. 83 K.Si. 84 Sha.S.U85

Physiological condition

Langitha + - + - - -

Upavasita + - - - - -

Durbalendriya + - - - - -

Durbala + - - - + -

Alpagni + + + + - +

Shranta + + - - - +

Pipasita + + - - - +

Karmabharadhvahata + + - - - -

Virechana Review


Daruna koshtha + - + + - -

Kshama + - - - - -

Kamadivyagra + + - - - -

Bhakta + + - - - -

Sukumara - - - - + -

Navaprasuta - + - - - +

Rathri Jagarana - - + - - -

Atiruksha + - + - - +

Bhayoptapta - + - - - +

Chinta prasaktha + - - - - -

Maithuna prasaktha + - - - - -

Adhyayana prasaktha + - - - - -

vyayama prasaktha + + - + - -

Garbhini + + - - - -

Age related condition

Vriddha + + - - +

Bala + + - - +

Pathological condition

Kshatkshina + + - - - +

Atikrisha + - - - + -

Atisthula + + - - + +

Muktanala + - + - - -

Atisara - - + + - -

Adhoga Raktapitta + + + + - -

Shosha - - - - - -

Rajayakshma - - + - - -

Urustambha - - - - + -

Madatyaya + + + - - +

Talushosha - - - - + -

Hridroga - - - - + -

Virechana Review


Traumatic condition

Abhighata + - - - - -

Subhaga + - - - - -

Kshataguda + + + - - -

Shalyardita + + + + - +

Saama condition

Nava Jwara + + + + - +

Nava Pratishyaya - + - - - -

Some vataroga condition

Kevala Vataroga - - - - + -

Hanugraha - - - - + -

Ardita - - - - + -

Purvakarma related conditions.

Nirudha + - + - - -

Atisnigdha + + + + - +

Anupasnigdha - - - - + -

Pakshahata - - - - + -

Atura Sidhata:-

Pachana and deepana:-

Ama is considered as one among the etiological factor in most of disease, & Shodhana in

ama state is said to be contraindication. If Samshodhana medicine is taken in the

condition of Ajirna, it will lead to Vibandha and Glani. If the Doshas are in Ama

conditions and anybody tries to remove these Dosha forcefully then it will destroy the

body. If the condition of patient is associated with Ama then Shodhana can only be done

after the Pachana of Ama by Deepana, Pachana so it is necessary to administer deepan &

pachana drugs before the virechana to attain nirama state86.

Snehana & Swedana:

Snehana includes both Abhyantara (oral ingestion of unctuous material) and Bahya

Snehana (external application of unctuous material) .Abhyantara Snehapana followed by

Virechana Review


Sarvanga Abhyanga along with Sarvanga Sweda (Whole body sudation) are performed

prior to Virechana87.

Snehapana procedure is to be followed after observing Nirama Lakshanas. The required

Sneha should be administered early in the morning at Suryodayakala after observing

Jeerna Ahara Lakshanas of the previous meal and when the patient is empty stomach.

The duration of Sneha Pana should be 3 to 7 days88, 89.

Importance:

Action of Snehana and Swedana prior to shodhana explained by Charaka in following

way.Due to Snehana there will be further vriddhi of doshas, and increase in

fluidity(Vishyandana) and due to Swedana dosha paka along with removal of

obstruction at the enterance of the channels.Because of this the doshas leave the Shakha

and comes to the Koshta90.

Sushrutha says Samshodana given without oleation and fomentation will destroy the

body like the dry wood91.

Abhyantara Snehapana:

Shodhananga Snehapana is done untill the attainment of ‘Samyak Snigdha Lakshanas’

which can be achieved in 3, 5 and 7 days in Mrudu, Madhyama, and Krura Koshta

respectively.

Thus, Shodhananga Snehapana can be carried out for a maximum period of 7 days

otherwise it will create Sneha Satmyata92. However, if Samyak snigdha lakshanas are not

achieved with in 7 days then it can be continued after one day interval. Dose of Sneha for

shodhana mentioned in various classics is as follows93, 94.

Sneha Matra.

Madhyama Matra - Charaka Samhita, Ashtanga Sangraha

(Dose which digests in 12 hours)

Uttama Matra (Dose which digests in 24 hours) - Ashtanga Hrudaya.

Uttama & Madhyama Matra- Chakarapani

Virechana Review


Shodhananga Snehapana can be administered in 2 methods:

a) Arohana Snehapana

b) Sadyo Snehapana

a) Arohana Snehapana:

Kalyanakaraka first mentioned about increasing dose schedule. He clearly mentioned that

Shodhanartha Abhyantara Sneha pana has to be taken in increasing order (“Krama

Vardhitam Pibet”). Vangasena also followed Kalyanakaraka’s Vardhamana dose

schedule.

b) Sadyo Snehapana: Sadyo Snehapana involves administration of large quantity of

Sneha to achieve Snigdha Lakshana immediately or within short duration. It is generally

indicated in Bala, Vriddha, Balaheena, Mrudu koshta, Alpa dosha, Raja, Raja samipya,

Sneha parihara asahishnushu95.

Table No.5 Showing Sneha Dravya and Anupana96:

Sneha Anupana

Ghirta Ushnodaka

Taila Yusha

Vasa & Majja Manda

Bhallataka & Tuvaraka Taila Shita Jala

In general Ushnodaka can be administered as Anupana for all Sneha.

Sneha dravya can be administered in 2 ways,

1) Accha Peya 97– denotes consumption of Sneha without mixing with other food

articles.

2) Pravicharana98 – denotes administering Sneha by mixing with food articles

either in the form of Odanadi (24 in number) or Rasa Pravicharana (64 in

number). Among them, Accha Peya is considered as superior for the purpose of

Shodananga Snehapana.

Virechana Review


Administration of Sneha for Shodhana99:

On the day of Snehapana, when the raising sun has attained golden yellow colour,

individual exhibiting Jeerna ahara lakshana (symptoms of digested food of the previous

night) except kshudha (hunger), after performing auspicious rituals, Snehapana is done.

After snehapan individual should be observed for Sneha Jeeryamana (symptoms of

Sneha undergoing digestion) and Sneha Jeerna (symptoms of digested Sneha) Lakshanas.

Table No. 6 Showing Sneha Jeeryamana and Jeerna Lakshana100:

Sneha Jeeryaman Lakshana Sneha Jeerna Lakshana

Shiroruja Shirorujadi Jeeryamana

Lakshana prashamana

Bhrama Vatanulomana

Nisthiva Swasthyata

Murcha Kshut shuddi

Sada Trishna shuddi

Arati Udgara shuddhi

Klama, Trishna, Daha Laghuta

Table No.7 Showing Samyak Snigdha Lakshana:

Lakshana Ch.Sa.101 Su.Sa.102 As. Hr. 103 Sh.S 104

Vatanulomana + - + +

Deepta agni + - + +

Snigdha varcha + - + +

Asamhatha Varcha + - + +

Angha Mardava + - + +

Snigdha anga + - + +

Snigdha twak - + - -

Vit Shaithilya - + - -

Glani - + - +

Angha laghava - + - +

Adhastat sneha darshana - + - -

Virechana Review


Snehodwega - + - +

Vimalendriya - - - +

Table No.8 Showing Asnigdha Lakshana.

Table No.9 Showing Atisnigdha Lakshana.

Lakshana Ch. Sa.

109

Su. Sa. 110 As. Hr. 111 Sh.S112

Pandutha + - - -

Gaurava + - - -

Jadya + - - -

Avipakwa Purisha + + - -

Tandra + - - -

Aruchi + + - -

Utklesha + - - -

Mukha srava + + + +

Guda srava - + + -

Lakshana Ch.Sa.105 Su. Sa.106 As. Hr.107 Sh.S108

Grathitha purisha + + - -

Ruksha purisha + + - -

Agnimandya + + - -

Vayu pratiloma + + - -

Khara Gatra + _ - -

Ruksha Gatra + - - -

Uro vidaha _ + - -

Daurbalya _ + - -

Dur varna - + - -

Krichrat anna Pachana _ + - -

Susnigdha Lakshana Viparyaya _ _ + +

Virechana Review


Ghrana srava - + -

Guda daha + + - +

Bhakta dwesha - + - +

Pravahika - + - +

Purishaati pravritti - + - -

Bahya Snehana & Swedana113:

After attainment of Samyak Snigdha Lakshanas, Abhyanga and Swedana should be

advised for either once or twice on the rest day (vishrama kala) and just prior to

Pradhana karma on the day of Virechana.

SWEDANA:-

Dosha Vilayana’ takes place through the Swedana. According to Vagbhata, by the action

of Snehana and Swedana, the morbid Doshas are liquefied, dissolved and are brought to

koshta114. Dalhana also mentions that the Dosha which are lodged in Shakha are made to

move towards to Koshta by Snehana and Swedana. Vagbhata mentions that the waste

products are removed from the shakhas by these two procedures of Snehana and Swedana

in the same fashion as dirt of cloth is removed by soap and water. 115

Bhojana Vyavastha:

During the procedure of Abhyanga and Swedana, Snigdha, Drava, Ushna bhojana,

Mamsarasa, Pramanayukta, Anabhishandhi, NatiSnighdha, Asankeerna, Odana, Amla

rasa Phala is recommended116.

Before pradhana karma the diet should be such that, it does not increase ‘Kapha’

otherwise Vamana may occur117.

‘Manda Kapha’ term is used for the state of Kapha, which is desired for the proper

Virechana.

MATRA VINISCHIYA:

1. The dose of Virechana Yoga should be decided according to Vyadhibala, Aturabala

and Agnibala. If the dose given more than Vyadhibala, may cause another Vyadhi. If it

Virechana Review


is more than Agnibala it may cause Ajeerna, Vishtambha, and if it is more than

Aturabala then it may cause Atipravrtti or Apravrtti. So, the dose should be in Sama

Pramana only and also the dose of Virechana drug of an individual is one which expels

only morbid Dosha out of the body without manifesting any complication118.

DOSE OF VIRECHANA DRUG IN ITS DIFFERENT FORM119-

Table No.10

Form Of

Medicine Koshta Dose119 Sus120 Sha121 Van122

1

Any form

Krura Uttama Tikshana Tikshana 1 pala

Madhyam Madhyam Madhya Madhya ½ pala

Mrudu Heena Mrudu Mrudu 1 Karsha

2

Kwatha

Krura Uttama

1 Anjali

(4 pala)

8 Karsha

2 pala Madhyam Madhyam 4 Karsha

Mrudu Heena 2 Karsha

3

Churna

Krura Uttama

1 Karsha

- 2 Karsha

Madhyam Madhya 1 Karsha 1 Karsha

Mrudu Heena - ½Karsha

4

Svarasa

Krura Uttama - 8 Karsha

1 pala Madhyam Madhyam - 4 Karsha

Mrudu Heena - 2 Karsha

5

Kalka

Krura Uttama

1 Karsha

- -

Madhyam Madhyam 1 Karsha

Mrudu Heena - -

6

Modaka

Krura Uttama - - -

Madhyam Madhyam - 1 Karsha -

Mrudu Kaneeya - - -

7 Hima&

phanta

Krura Uttama

1 Anjali

(4 pala)

8 Karsha -

Madhyam Madhyam 4 Karsha -

Mrudu Heena 2 Karsha -

Virechana Review


PRADHANA KARMA: This includes:-

1) Administration of Virechana Yoga.

2) Observations : a) Aushadi Jeerna-Ajeerna Lakshana.

b) Hritadosha Lakshana.

3) Shuddhi Lakshana.

4) Management of Vyapada.

1. Administration of Virechana yoga:

• Before administering the Virechana yoga, the physician must confirm regarding

the following: The diet taken by the patient on the previous day must be digested.

• Patient is in mentally balanced state, i.e., without any passions like angry, fear etc.

• It should be kept in mind that whether the patient got sound sleep on the previous

night or not. Because at the time of drug administration patient must not be

drowsy/ sleepy123.

• After confirming diet taken by the patient on the previous day has been digested,

patient has to offer oblations and worships before taking the drug.

• If patient is fit for Virechana karma on the day of Virechana karma, after

performing the Sarvanga sweda patient is advised to be in empty stomach124.

• Virechana drugs are administered at 9-10 AM i.e ‘Shleshma kale gate’ after

• Shleshma kala has passed, in appropriate dose and with appropriate anupana125. If

drug is adminsterd in shelma kala and/or after consuming food then, kaphadosha

may cause avarana over grahani resulting in mandagni, gourava, Shula,Admana &

even Vamana may produced as a complication126.

8

Sneha

- - - - 2 Karsha

or1 pala - - - -

- - - -

9

Ushna

jala as

Anoopan

Mrudu - - - 2 pala

Madhyam - - - 4 pala

Krura - - - 8 pala

Virechana Review


Measures after virechaka Oushadha sevana127:

• Just after administration of Virechana Yoga, cold water should be sprinkled on

the face to avoid vomiting.

• Patient is asked to rinse mouth with hot water and asked to smell the fragrance of

jambeera or Surabhi etc.whichever he/she likes.

• Pateint is advised that neither to induce Vegas nor to suppress them.

• Advise to stay in Nirvata place, be in comfort position and avoid sleep,

suppression of natural urges; consume hot water little by little.

Vega pravartanopaya128:

For Vatanulomana and Yogavahi action lukewarm water is taken. Ifmedicine

composed of Jayapala is given then hot water is contraindicated. If Virechna Vega is

not initiated then Tapa Sweda with help of palm over abdominal region which may

help to stimulate peristaltic movement.

OBSERVATIONS:

A) Aushadha Jeerna Lakshana129:

The following signs and symptoms of Virechana are to be observed – Vatanulomana,

Swasthya, Khsudha, Trishna, Urjamanaswita, Indriya Laghuta and Udgara Shuddhi

Once Jeerna Lakshana appears but still only small amount of morbid doshas are

expelled or not yet all, then Physician should administer one more dose of Virechan

drug depending on patient bala130

B) Ajeerna Aushadha Lakshana:

If the drug is not digested it will produce some painful symptoms such as Klama,

Daha, Angasadam, Bhrama, Murcha and Shiroruja.

In this case the Virechana drug should not be repeated immediately, as the drug may

produce severe purgation. In some cases if the drug is digested but proper elimination

of doshas didn’t occurred, then next day again Virechana drug should be given.

C) Hritadosha Lakshana:

The Virechana is considered as Kaphanta and Hritadosha, when Vata, Pitta and

Kapha come out in succession. Gatra Daurbalya and Laghuta are the associated

Virechana Review


symptoms. If Virechana persists even after manifestation of Hritadosha lakshanas,

then vamana should be given. 131

If Aushadhi Jeerna Lakshanas are manifested, but Hritadosha Lakshanas are not

found, then Virechana Yoga should be given next day. Even then Virechana does not

occur then Snehana and Swedana should be done again and thereafter Virechana

drug should be administered after 10 days132.

A) Shuddhi Lakshana133-136:

Finally shuddhi lakshana must assess in terms of Subjective parameters like Laingiki

and Antiki & Objective Parameters like Vaigiki &Manaki. But among these more

importance should be given to Laingiki Shuddhi.

Showing Criteria for Antiki, Vegiki and Maniki Shuddhi of Virechana Karma. 137

Table No.11

Shuddhi Pravara Madhyama Avara

Vegiki 30 Vegas 20 Vegas 10 Vegas

Maniki 4 Prastha 3 Prastha 2 Prastha

Antiki Kaphanta Kaphanta Kaphanta

Vegiki shuddhi:

The number of Vegas should be counted after leaving the first 2-3 Vegas, as it contain

only fecal matter. Then it should be counted till the Kapha comes out.

Maniki Shuddhi:

While narrating the Avara, Madhyama and Pravara shuddhi, Charaka mentioned the

quantities of the same as two, three and, four prastha respectively.

In the context of Vamana, Virechana and Rakta mokshana, prastha should be taken as

13½ pala138

Antiki Shuddhi:

The word anthiki means final or terminal

The symptoms which indicate the end process of Virechana can be considered "Antiki

Lakshana,.kaphanta is the desired antiki lakshana.

Virechana Review


Table No.12 Samyak Yoga Lakshanas Of Virechana Karma

Lakshanas C.S139 S.S140 Va141

Sroto Vishuddhi + - -

Indriya Prasadana + + -

Shareera Laghuta + + -

Agnivriddhi + - -

Anamayatwa + + -

Kramataha Vit Pitta Kaphagamana + + -

Vatanulomana - + -

Absence of Ayoga Lakshanas - - +

Table No.13 Showing Ayoga Lakshanas of Virechana karma

Lakshanas C.S S.S Va

Kapha Prakopa + + +

Pitta Prakopa + + +

Vata Prakopa + - -

Agnimandya + + -

Gaurava + + -

Pratishyaya + - +

Tandra + - -

Chardi + - -

Aruchi + + +

Vata Pratilomana + - Vatagraha

Daha - + +

Hridaya Ashuddhi - + +

Kukshi Ashuddhi - + +

Kandu - + +

Vit Sanga + + +

Mutrasanga - + -

Peedika - - +

Virechana Review


Table No.14 Atiyoga lakshanas of Virechana karma

Lakshanas Charaka Sushruta Vagbhata

Kapha Kshaya Vikara + + -

Pitta Kshaya Vikara + - -

Supti + - -

Angamarda + - -

Klama + - -

Vepathu + - -

Nidra + - -

Balabhava + - -

Tamah Pravesha + - -

Unmada + - -

Hikka + - -

Murcha - + -

Guda Bhramsha - - -

Kapha Pitta rahita Shweta Udaka

Nihssarana

- - +

Kapha Pitta rahita Lohita Udaka

Nihssarana

- - +

Mamsa Dhavana vat udaka srava - - +

Medokhandavat Srava - - +

Trishna - - +

Bhrama - - +

Netra praveshanam - - +

Raktakshayaja Vikara + - -

Chakrapani explains though Ayoga, Atiyog and Mithyayoga are described everywhere

accordingly in the text, but in case of vaman and virechan there is no need to consider

Mithyayoga as a separate entity.

Virechana Review


In these procedures, expulsion occur in 4 different ways

• Atipravrutii – Excessive expulsion.

• Asamyak pravrutii – Expulsion by improper way.

• Apravrutii – Cessation of process of expulsion or improper elimination.

• Alpapravrutii – Expulsion in lesser quantity.

Here apravrutti and alpapravrutii are included in ayoga. As asamyak Pravruti means

expulsion through opposite route, it indicates that expulsion of vitiated

Dosha is not in a quantity, which is expected, so it must be considered under the term of

ayoga and not mithyayoga142.

Kashyapa Acharya being Paediatrician, to practise Virechana Karma especially for Bala

he has been identified Mrudu and/ Sukha type of virechana and Manaki and Vaigiki

parameters143.

PASCHAT KARMA144-146

Pariharya Vishaya: -

Once it is confirmed that Virechana Vegas are stop, then advise patient to wash hands,

feet and face147. And advise to avoid ashta mahadosha bhavas148 i.e.1.Ucchabhashana,

2.Rathakshobha, 3.Atichankramana, 4.Atiasana, 5.Adhyashana, 6.Ahita bhojana,

7.Diwaswapna, 8.Maithuna. Based on shuddui lakshana especially Vaigiki advise

patient to follow Samsarjana karma.

Regimens to be adopted after Virechana karma till the patient able to take normal diet

are termed as Paschat karma. As the Virechana karma eliminates dushita Pitta dosha, the

patient shouldn’t be allowed to take heavy diet, because there is derangement in power

of jatharagni. In this condition if heavy diet is given, it will suppress the digestion power

further and causes the vitiation of Agni. So to prevent such condition, samsarjana karma

is adopted.

a) Samsarjana Krama :

As said above, to restore the strength of agni.The patient has to be given the following

varieties of diets, from the same day evening or from the next day morning149

Virechana Review


After Samshodhana Karma, Agnimandya occurs because the Doshas reach the

Amashaya (Jejjata), so Peyadi Krama is recommended to increase the Agni gradually up

to the normal level.

According to Chakrapani the elimination therapy diminishes the doshas as well as

Dhatus, that’s why patient need immediate Dhatu Vardhaka Ahara in terms of Peyadi

Samsarjana karma.

Acharya Charaka gives beautiful example to explain this, just as the agni flares up by the

fuel like dry grass,cow dung,etc.The person who has undergone shodana karma150-151,

agni will gradually gets improved by following samsarjana krama. Hence it is decided

according to shudhi. i.e. for pravara shuddhi, madhyama shuddhi and avara shuddhi,

samsarjana krama is done for 3,5,7 days respectively 152

Showing the Diet Regimen153

Table No.15

Days Time Pradhana shuddi Madhyama

shuddi Avara shuddi

1st Morning - - -

Evening Peya Peya Peya

2nd Morning Peya Peya Vilepi

Evening Peya Vilepi Krita/Akrita yusha

3rd Morning Vilepi Vilepi Krita/Akrita yusha

Evening Vilepi Akrita yusha Normal diet

4th Morning Vilepi Krita yusha -

Evening Akrita yusha Akritamamsa rasa -

5th Morning Krita yusha Krita mamsa rasa -

Evening Krita yusha Normal diet -

6th¸ Morning Akrita mamsa rasa - -

Evening Krita mamsa rasa - -

7th Morning Krita mamsa rasa - -

Evening Normal diet - -

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Instead of Peyadi Krama, Sushruta mentions Kulatha, Aadhaki and Jangala

Mamsarasa154. Dalhana clarifies, Sushruta however agrees Peyadi Krama and he says that

incase of Ksheena Kapha, Peya should be given. Mamsarasa should be given to Vata

pradhana patients having Deeptagni. If Kapha dominance is there according to Dosha and

Prakriti, then Kulatha Yusha should be given. The Peyadi Krama ends on 7th day of

Pradhana Shuddhi patient.Acharya Sushrutha has opined samsarjana krama in respect to

bala of the patient155. For the individuals having good strength, three annakala are

advised, 2 annakala for madhyama bala and one annakala for lesser strength person.

b) Tarpana :

In case of ayoga of Virechana (insufficient elimination of vitiated doshas) associated with

predominance of Kapha, Pitta, if the doshas still retained in the body and if the patient is

having habit of taking alcohol, he shouldn’t be given Peyadi Samsarjana Krama. Instead

he must be given Tarpana i.e., thin or thick soup prepared with Deepana and Pachana

drugs like, Pippali, Dadima etc.

In Tarpana, Swaccha Tarpana in place of Peya and Ghana Tarpana in place of Vilepi

should be given, according to Chakrapani156. Jejjata mentions Mudga, Yusha and

Mamsarasa in place of Peya. Arunadatta recommends Laja Saktu, Jirnashalyodana and

Mamsarasa for 3 Annakalas.

Rasa samsarjana krama:

To maintain the normal status of Dosha especially in Amaashaya and Pakvashya,

rasasamsarjana krama is identified in classics. Here particular Rasaatmaka food articles

are given to patient with proper order and this can be consumed along with Peyadi

Samsarjana karma or after it.

Virechana Review


Table 16. Showing Rasa Samsarjana.

Acharya Charaka and Sushrutha have given a special sequence of rasa intake in

samsarjana krama to be followed to avoid the chances of vitiation of doshas.

Acharya Charaka has advised to take madhura, amla and hridhya, snigdha ahara to pacify

vata.Amla lavana to increase agni, Madhura and tikta rasa to pacify pitta dosha, kashaya

and katu rasa to pacify kapha dosha159.

Acharya Sushrutha opined that rasa should be started with Madhura and Tiktha to

increase the Agni and to pacify vata pitta. Then snigda, amla, lavana and katu rasa to

reduce vata, kapha dosha followed by madhura tikta rasa to pacify vata pitta dosha,

thereafter kashaya katu rasa to pacify kapha pitta160.This is followed to do sarva rasa

abyasa for the patient during samsarjana krama.

VYAPATH 161-163

Vyapath are the complications occurring due to improper handling of shodana

karma.Acharaya Charaka has explained 10 vyapath; Chakrapani has divided this 10

Vyapada in two groups i.e. Ayoga and Atiyoga.

Author Rasa Effect on Dosha

Charaka157

Snigdha,amla,Swadu Pakwashaya stitha upashamanartha

Amla, Lavana Urdhwastitha agni sandukshanartha

Swadu, Tikata Pitta shamanartha

Kashaya, katu Pitta, urdwastita kapha shamanartha

Sushruta158

Swadu, Tikata Pravraddia agni hetu vata

pittastavjayartamgne sameekaranarta

Snigdha,amla,Lavana,

katu

Vata kaphavajayartamagne sandhukshanarta

Swadu, Tikata Pitta vatavajayarta

Virechana Review


Table No.17 Showing the Ayoga and Atiyoga Lakshanas of Vyapath.

Ayoga Atiyoga

Adhamana

Hritgraha

Gatragraha

Kandvadi Vibhramsha

Upadrava

Klama

Srava

Jivadana

Vibramsha

Gudabramsha

Sanjnabhramsha

Table No.18 Showing the Virechana Vyapath According to Acharyas.

Vyapath Charaka Sushrutha Vagbhatta

Adhmana + + +

Parikartika + + +

Parisrava + + +

Hrdgraha + - +

Gatragraha + - Sarvangagraha

Jivadana + + +

Vibhramsha + -

Guda

Vibhramsha

Stambha + - -

Klama + - -

Upadrava + - -

Vamana - + +

Savashesha Aushadhitva - + +

Jirna Aushadhitva - + +

Hina Aushadhitva - + -

Vata Shula - + Vedana

Ayoga - + +

Atiyoga - + +

Hridaya-Upasarana - + -

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Vibandha - + -

Pravahika - + +

Visamjnata - - +

Table No.19 Showing virechana vyapat with their treatment.

Vyapada Lakshana Chikitsa

Adhmana Adhmana UdavartaNabhi, Prustha,

Parshva, Shiroruja, Shvasa, Vit

Mutra, Vata Sanga

Abhyanga, Sveda, Phalavarti,

Niruha, Anuvasana,

Udavartahara Chikitsa

Parikartika

Gud Parikartana

Tivrashula, Piccha, Rakta,

Mala Pravritti

Langhana, Pachana, Ruksha,

Ushna Bhojana Yashtimadhu

,Snehabasti

Parisrava Alpa Mala Pravritti, Kandu, Shopha,

Kustha, Gaurava, Agnimandya,

Staimitya, Aruchi, Panduta

Vamana, Virechana, Grahani

Chikitsa. Asava, Arishta

Hridgraha Hikka, Shvasa, Kasa, Parshvashula,

Lalasrava, Akshivibhrama, Shula,

Dantatikitkitayana, Jihva, Khodati

Sangyanasha

Snigdha Lavana, Sveda,

Yasti Taila, Anuvasana,

Tikshna Nasya, Vamana,

Basti

Angagraha Stambha, Vepathu, Toda

Pindikodveshtana, Manthanavat

Pida

Vatahara

Snehana

Svedana

Jivadana Rakta Chandrika, Udakasrava, Guda

Bhransha, Trishna, Murchha, Mada

Pittahara, Raktapana,

Raktabasti, Piccha Basti,

Ghrita Manda, Anuvasana

Vibhransh

a. Guda

b. Sanjya

c.Kandu,

Only Mala Excreted not Doshas,

Gudabhransha, Sanjna Bransha,

Kandu, Pidika, Kustha, Roga

Kashaya Lepa, Snehana

Mridu Sveda

Manonukula Chikitsa

Tikshna Shodhana After

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Snehapana

Stambha Vatavarodha, Gudastambha,

Gudshula, Alpalpa Mala Pravritti

Langhana, Pachana, Tikshna

Basti, Virechana

Upadrava Stambha, Sula, Gatragraha,

Sarvanga Vedana

Snehana, Svedana

Vataghna Chikitsa

Klama Tandra, Gaurava, Klama, Daurbalya,

Angasada

Langhana, Pachana, Sneha,

Tikshna, Shodhana

Vamana by

virechana

Yoga

Vamana Snehana, Svedana,

Virechana

Ayoga Vibhransha, Hikka,

Pindikodveshtana, Kandu, Urusada,

Vaivarnyata

Roganusara Chikitsa

Gomutra Niruha

Atiyoga Ativirechana Mridu Vamana,

Raktapitta vat Chikitsa

“PAKASHAGATE VIRECHAN”

1) Virechana is the treatment for pittadosha but in vatavyadhi virechana is effective

than basti, which is the treatment of choice for vatadosha. Because Pakshavadha

is basically a caused due to prana vayu obstructed, the natural direction of prana

vayu is from above downwards. In virechana this proper direction of pranavayu is

achived better than basti.

2) In pakshavadha upadhatus of rakta i.e. Sira and Kandara vitiated for upadhatu

treatment is given for main dhatu and treatment for rakta dhatu is raktamokshana

and virechana, therefore viechana is useful in pakshavadha.

3) Virechana, the main line of treatment cannot be applied in kevala Vata condition.

Virechana is the line of treatment for Vata Vyaadhi condition where Vata is

associated with Kapha, Pitta, Rakta and Meda. Highly effectiveness of Virechana

in Pakshaghata supports the fact that its Samprapti is due to Aavarana of Vaata

with Pitta, Rakta, Kapha and Meda.

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4) Pakshagata is also said to be a disease of majjavaha srotas. Majja dhatu and pitta

are said to be form same origin ‘Ya Eva Pittadharakala sa Eva Majjadhara kala’.

Therefore treatment for majja and virechana is best treatment for pitta. Therefore

virechana is the treatment of choice in pakshagata.

5) The adhishthana of Pakshaghata is Indriyayatana (Mastishka). Mastishka is

referred as Mustulunga (Ch. Si. 9/101). Dalhana describes the word Mustulunga

as Ghritakaram and Mastishka Majja (Su. Sha. 10/42, Dal.) He further describes

Mastishka Majja as Majja dhara kala and again says that Majja dhara kala and

pitta dhara kala are one and the same. In pitta dhara kala vikriti, Virechana is the

best shodhana chikitsa. As Majja dhara kala and pitta dhara kala are same,

Virechana may also act well in Majja dhara kala vikriti. So, Virechana can be

adopted in case of Pakshaghata.

6) Kaphanubandhita and Pittanubandhita Pakshaghata have been described in

Madhava Nidna. This can be compared with kaphavritta and pittavritta vata

respectively. In treatment of both these conditions Virechana has been mentioned

(Ch. Chi. 28/184,185,189).

7) Virechana Karma is a specific process for elimination of pitta dosha (Ch.

Su25/40). It also eliminates kapha dosha either associated with pitta dosha or

situated in pitta sthana (A.S. Su. 27). Virechana Karma is also said to be capable

of mitigating vata dosha. Mridu Sanshodhanaa (Virechana) has been indicated for

the treatment of vata dosha. (Ch. Vi. 6/16; A.H. Su. 13/1; Ch. Chi. 28/84). Hence

dushti of all the three doshas is checked by this Karma.

8) In Pakshaghata the main dosha involved is vata. The natural abode of vata is

Pakvashaya (A.H Su. 12/1). In Pakvashaya gata vata, Virechana is indicated.

(Su. Chi. 4/5).

9) In case of Samsargaja dosha, i.e., if vata is affected by pitta and kapha both, then

pitta should be controlled first (Ch. Chi. 28/188) and for controlling pitta,

Virechana is considered to be best. Hence in Doshanubandhita Pakshaghata

Virechana can be considered as a treatment.

10) Vagbhata has mentioned Mridu Sanshodhanaa (Virechana) in the general line of

treatment of vata (A.H. Su.13/1), which can also be adopted for Pakshaghata.

Virechana Review


11) Mridu Sanshodhanaa has been mentioned in treatment of Margavarna. (Ch. Chi.

9/25). Hence in margavaranjanya Pakshaghata Mridu Sanshodhanaa, i.e.,

Virechana can be advocated.

12) Majjavaha sroto dushti takes place in Pakshaghata and in order to combat the

morbidity related to Majja, timely shuddhi has been mentioned. (Ch. Su. 28/28).

So here Virechana can be taken as a shodhana measure.

13) If we see the general line of treatment for vata vyadhi given by Acharya Charaka

in Chikitsasthana 28th chapter, then after snehana and Swedana, Virechana has

been mentioned as main shodhana measure. In the patients contraindicated for

Virechana, vasti has been mentioned. Hence Virechana is considered to be

treatment of choice in vata vyadhi and so in Pakshaghata.

14) Virechana Karma possesses the property of purifying the vitiated dhatus (Ka. Si).

It has been advised as a treatment in all dhatu dushti janya vikaras, viz., Rakta,

Mansa, Meda, Majja, Shukra gata vikaras. (Ch. Su. 28/25) Srotovishuddhi,

Impairment of function of Mana, Buddhi Prasadana, impairment of Indriyas

encountered in Pakshaghata, sanga type of srotodushti encountered in

Pakshaghata are checked by virechana. Virechana imparts strength to the body

and stabilizes all the dhatus. Hence useful in dhatukshayajanya Pakshaghata. (Ch.

Si. 1/17; Su. Chi. 33/27; A.H. Su. 18/60).

Therefore by all the above statements it can be concluded that Virechana is the

best Shodhana for Pakshaghata.

Acharya Charaka has given brief description how Virechana dravya acts in the body

which is as follows. The drugs which are Ushna, Tikshna, Shukshma, Vyavayi and

Vikashi reach to the heart by virtue of their potency and circulate through the large and

small Srotas due to its Sukshma and Vyavayi properties and pervade entire body. Then

they liquefy the morbid elements by virtue of their Agneya Guna and crumble them by

virtue of its Tikshna Guna. Then this liquefies and crumbled mass Looses contact with

the wall and the channels in the unctuous body, just like the honey, not adhered to the

unctuous vessel. This morbid mass now passes through the minute capillaries and moves

Virechana Review


towards Kostha by virtue of the Anu, Pravana Bhava of the drug and ultimately reaches

the Amashaya. From here it forces the morbid factors through the anal route due to the

Bhautika predominancy of Jala and Prithvi and Adhobhaga Prabhava

MODE OF ACTION OF VIRECHANA164:

Action of Virechana Karma can be understood in the following two ways.

1. Systemic – By which it brings down the morbid Doshas, particularly Pitta from the

periphery to Amashaya or Pakwashaya.

2. Local evacuant – This is concerned with the evacuation of these doshas in the form of

mala from the gut by Adhobhaghahara property.

Both the action and related factors are being described here in detail -

a) Virechana yoga gets absorbed and due to Veerya, it reaches to the Hridaya, then the

Dhamanis and thereafter it reaches to Sthula and Anu Srotas i.e. macro and micro

channels of the body.

b) The Vyavayi Guna, drug is responsible for quick absorption.

c) The Vikashi Guna causes softening and loosening of the bond by Dhatu (Shaithilya

Karma).

d) Due to Ushna Guna, the Dosha Sanghata (compactness) is disintegrated

(Vishyandana).

e) Action of Teekshna Guna is to break the Mala and Dosha in micro form. According to

Dalhana it is responsible for quick transmission (Dosha Sravana Karatwa).

f) Due to Sookshma Guna by reaching in micro channels, disintegrates androgenic toxins

which are then excreted through micro channels (Anupravana Bhava).

g) Mainly due to Prabhava, Prithwi-Jala constitution and presence of Sara Guna

Virechana occurs. This is the evacuant action.

Virechana Review


MODE OF ACTION OF VIRECHANA KARMA

CATHARTICS - MODERN VIEW

The terms laxatives, cathartics, purgatives, aperients and evacuants often are used

interchangeably. However, there is distinction between Laxation and catharsis.

Laxation means – the evacuation of formed fecal material from the rectum, whereas

Catharsis means – the evacuation of unformed, usually watery fecal material from the

entire colon. Most of the commonly used agents promote Laxation but some actually are

cathartics.

Classification of Cathartics:

These drugs are usually classified according to their mechanism of action. The purgatives

available for use mainly act in one of the following three ways-

Virechana Review


• By increasing the volume of intestinal contents, thus distending the bowel and

eliciting the peristaltic reflex.

• By liquefying and lubricating the intestinal mass.

• By direct irritation of the bowel.

Hence they are classified in the following manner-

1. Stimulant or Irritant Cathartics.

2. Osmotic Cathartics.

3. Bulk laxatives.

4. Emollient laxative or Lubricant Cathartics.

1. Stimulant or irritant laxatives:

In this group, mainly 3 types of drugs are identified.

i) Anthraquinone group ii) Diphenylmethane derivatives iii) Ricinoleic acid

Anthraquinone group:

These are derivatives of plants such as aloe, cascara and senna.

These agents can produce giant migrating colonic contractions as well as induce

water and electrolyte secretion. They are poorly absorbed in the small bowel, but

because they require activation in the colon the laxative effect is not noted until 6

to 12 hours, after ingestion.

Diphenylmethane derivatives:

Examples in this group are: Bisacodyl, Phenolphthalein.

Pharmacological section is not shown clearly but drug acts as a stimulant mainly

on the large bowel after 6 hours and produces soft semi liquid stools associated

with a little gripping.

Ricinoleic acid:

Important among Ricinoleic acid is caster oil. Ricinoleic acid acts as an irritant

and produces purgation. As Ricinoleic acid acts on small intestine, it produces

Virechana Review


copious, liquid stool with associated fluid loss. The action is quicker than

Anthraquinone and is evident within 2 to 3 hours.

2. Osmotic Purgatives:

The osmotic purgative consists of salts, which though highly soluble, are poorly

absorbed from the alimentary tract. Such preparations exert an osmotic effect and, thus

retain water in sufficient amount to form an isotonic solution in the lumen of the bowel.

This distends the bowel and stimulates peristalsis, as well as liquefying the bowel

contents, making evacuation more rapid. The efficacy of the saline Cathartics is, thus

related to the osmotic activity exerted by the unabsorbed fraction within the intestinal

lumen.

These preparations will act both on small and large intestines, and therefore, produces

watery evacuation within 3-6 hours. Because of their quick consent of action, they are

early in the morning before breakfast. Patients should be instructed to take plenty of

water along with these drugs.

2. Bulk forming laxatives:

These are various natural or semi synthetic polysaccharide and cellulose derivatives.

eg. Bran, Psyllium preparation, Methyl cellulose, Calcium polycarbophil. These agents

absorb water and swell-up, thus providing the stimulus of mechanical distinction for

evacuation. Their action is mild and is usually seen 12 to 36 hours after ingestion.

3. Stool Wetting Agents and Emollient laxatives:

The best examples are liquid paraffin, Olive oil, Docusate salts, etc. By oral

administration it is not significantly absorbed and exerts softening and lubricating

effects on feces. These laxatives are mild in action and usually seen 1 to 3 days after

ingestion and itself does not initiate peristalsis.

General mechanisms of action:

Laxatives generally have been thought to act in one of the following ways:

1. Retention of intraluminal fluid, by hydrophilic or osmotic mechanisms.

Virechana Review


2. Decreased net absorption of fluid, by effects on small and large bowel fluid and

electrolyte transport.

3. Effects on motility by either inhibiting segmenting (non-propulsive) Scontractions

or stimulating propulsive contractions.

Classification according to the site of action -

a) Purgatives acting on the small intestine eg. Castor oil

b) Purgatives acting on the large intestine eg. Anthraquinone group

c) Purgatives acting on both large and small intestine eg. Saline laxatives

C. Classification according to source -

a) Vegetable purgatives. eg. Castoroil, Oliveoil, Croton oil, Oleos, Senna,

Cascara sagrada, etc.

b) Mineral purgatives. Eg: Saline purgatives, liquid paraffin, etc.

c) Synthetic purgatives. Eg: Phenolphthale

DISEASE

REVIEW

Disease Review


DISEASE REVIEW

NIRUKTI

Pakshaghata has been derived from “Pakshyasya Aghata iti Pakshaghata”. The

word Pakshaghata is composed of two Sanskrit words i.e. Paksha + Aghata. The

individual meaning of these words is as follows –

Paksha:

• According to Vachaspathyama – Paksha + Aghata i.e. Parshva matre – means

side167

• According to Shabdakalpadruma – Parshvamatram – means Parshva means

dehanga

168

• According to Shabdasthoma mahanidhi – Parshwa means side. Dehardha means

half of the body.

.

Paksha Dehangam = Part

Paksha Parshva = Flank or side

169

170

Paksha Dehardha = Half of body

Paksha Dehanga bheda = Member of body

171

Acharya Sushrutha while explaining about Pakshaghata has used the word “Paksha”

Dalhana commented on this by saying it as “Shareerardham”.

172

Ashtanga sangraha and Ashtanga Hridaya also used the word “Paksha” which

gives the same meaning as mentioned by Sushrutha. Vijayarakshita, commentator of

Madhava nidana explains the meaning of “Paksha” as “Ardhanarishwaravat” 173

Sharangadhara Samhita, Bhavaprakasha, Yogaratnakara have used the word

Paksha with the meaning as half of the body. From the above it implies that the word

Paksha refers to one Side of body.

.

AGHATA – It derived as follows according to Vachyaspatya and Shabdasthoma

mahanidhi

Han + Ghanj

Hanana – to kill

Disease Review


AGHATA:

The word Aghata is derived from the word “An+Han+Ghan”

“Han+Vich+Bhave+Lyut” 174

The word Aghata depicts different meanings. Some are as follows

Aghata Vadha = Killing ” 175

Aghata Hanana = Destruction ”

From the Aghata Prahara = A Blow”

176

177

Putting all these meaning together, the word Ghata means Killing, Blow, and Injury

In Ayurveda the word Ghata have been quoted in various contexts like Marmaghata,

Mutraghata etc. It shows reduced activities.

• Vadha – to kill

Prahara – to kill with a blow.

VADHA:

“Hananam iti”

Han+ap, vadha desha

178

Vadha Ghata

Vadha Hanana

Vadha Prana viyoga phalaka vyapara

So the word vadha means killing

179

180,

Pakshaghata: According to Shabdhakalpadruma Pakshaghata has been defined

as – “Pakshaghata Dehangasya Ghatam Vinashanam Yasmat Yatra va”

destruction, and blow. From above

description it shows that Ghata and Vadha have similar meaning. So also, Pakshaghata

and Pakshavadha are having same meaning. Based on the meaning of the individual

term paksha, vadha and aghata the word pakshagana is derived as under.

It means loss of function of one side of the body. Sir Williams confined the meaning of

Pakshaghata to one stroke or hemiplegia only.

Definition of Hemiplegia

The term hemiplegia is derived from a compound Greek word.

Here hemi means half and plegia means paralysis or stroke.

Disease Review


Therefore, hemiplegia can be defined as a clinical feature of one side weakness or

paralysis in upper and lower extremities and a part of face.

Hemiplegia is the commonest manifestation of a stroke with a paralysis effect on

the face, limbs and trunk or one side of the body.

STROKE:

Synonyms – Apoplexy, Cerebrovascular Accidents.

The term stroke is defined as a rapid onset of focal neurological deficit, over minutes or

hours resulting from the diseases of the cerebral vasculature and its contents.

PARALYSIS:

It is derived from the words – ‘para’ – besides, beyond; and ‘lysis’ – breaking up or

death. Paralysis is loss of voluntary movement due to interruption of motor pathway at

any point from the cerebrum to the muscle fiber. Summing up, Hemiplegia means

paralysis of one half of the body affecting both arm and leg and sometimes face181

.

HISTORICAL REVIEW

VEDIC KALA (2500B.C-1000BC)

Vedas are considered to be the oldest epics of the world. Scattered references of Vaata

Dosha and disorders related to Vaata are found in vedas. Five types of Vaata have been

listed in Athervaveda, namely; Praana, Apaana, Vyaana, Samaana, and Udaana.

(A.V.10.2:13). Pippali (A.V. 6.109:3) and Vashanaka (A.V.6.44:33) two drugs have been

mentioned in Atharvaveda which have been claimed as ‘Vaatakritasya Bheshaja’ and

‘Vaatakrita Naasani’ respectively. Blumefield interprets the word Vaatakrita as the

disorder caused by Vaata. Pakshaghata and Pakshavadha are not mentioned in Vedas but

Angabheda (A.V.9.13.1:22) mentioned in Atharvaveda and Pangu (R.V.2.15:7)

mentioned in Rigveda indicates the knowledge regarding the Pakshaghata related

diseases in that era182, 183, 184

.

Disease Review


UPANISHAD:

1. In Prashaopanishad – Gati of Udana Vayu and Importance of Vyana vayu are

mentioned185

2. In Ramayana – importance of Vayu has been discussed in relation to health

. 186

3. In Garuda purana – Various vata prakopa nidanas have been explained

.

4. In Vishnu purava – Various gunas of vayu have been mentioned

187

188

.

SAMHITA KALA (1000BC-100AD):

Detailed description regarding Pakshaghata has been mentioned by the achaarya in the

Samhitaa Granthas.

CHARAKA SAMHITA: (1000 BC- 2nd AD)

Pakshavadha and Pakshagraha are considered Madhyama Roga Maargaja vyadhi, i.e.,

Marm-Asthi-Sandhi Maarga (Ch. Su.11/49). Pakshavadha considered one among eighty

Naanaatmaja Vaata Vikaaras (Ch.Su. 20/11) and detailed description of the disease has

been given as Pakshavadha (Ch. Chi. 28/53, 54). Aachaarya Charaka is given the line of

treatment as“Swedanam Sneha Samyuktam Pakshaghate Virechanam”. Jejjata (9th Cen.)

clarifies this by saying that Swedana and Virechana should be administered along with

Sneha in pakshagata. Gangadhara (19th Cen.) comments that Snehayukta Swedana and

Snehayukta Virechana should be given in Pakshaghata.

Bhela and Harita Samhita (1000 BC- 2nd cent.AD)

Only a brief description of Pakshaghata is available in both these Samhitas. In third

Sthana of Harita Samhita 20th Chapter some information regarding diseases related to

Pakshaghata namely EkangaVaata and Ekanga Pakshaghata is available.

SUSHRUTA SAMHITA: (2nd cent. A.D)

Aetiopathogenesis, clinical features and prognosis of Pakshaghata have been described in

the first chapter of Nidaana Sthaana. The role of Urdhvagaami, Adhogami, and Tiryaga

Dhamanis in the pathogenesis of Pakshaghata has been explained. Lakshana, Anyatara

Pakshahanana, Sandhi Bandhana Vimoksha has been added here. In Mahavata Vyadhi

Disease Review


Adhyaya of Chikitsa Sthana( Su. Chi. 5/19) treatment of Pakshaghata has been described.

Vaata Vyaadhi has highlighted among Ashta Mahagada in Sh.Su. 33. Akarmanyata as

Ishatkarmakshayamam - partial loss of function, where patient is unable to maintain

stance and tends to fall has interpreted by commentator Dalhana. He interprets Achetana

as Alpachetana, referring to partial loss of sensation.

SANGRAHA KALA (100AD-800AD):

ASHTANG SANGRAHA AND ASHTANG HRIDAYA: (2-6th cent. AD)

Similar description of Pakshaghata is found in both these Samhita. In ashtaanga

Samgraha, the general Nidaana of Vata Vyadhi, signs, symptoms and prognosis of

Pakshaghata has been given in 15th chapter of Nidana Sthana. The treatment has been

highlighted in Chikitsa Sthana, 23rd chapter.

Pakshaghata has been described in Ashtaanga Hridaya 15th chapter of Nidaana

Sthaana and 21st chapter of Chikitsaa Sthaana. The term Anyatara Paksha Naasha has

been used here and commentator Arundatta (11th

Cen.) interprets word Anyatara as right

or left side of the body. Line of treatment is same as that given by Charaka with the only

difference that Sneha is mentioned instead of Swedana.

KASHYAPA SAMHITA:

In this Samhita Pakshaghata has been listed among 80 types of Nanatmaja Vata Vyaadhi

(K.S. Su. 27-28). It is also included in the list of Swedana arha (K.S. Su. 23-22). More

details of Pakshaghata are not found in the available edition of this Samhitaa.

MADHAV NIDAANA: (7th cent. AD)

Pakshaghata has been described in detail here. General description of causative

factors, pathogenesis, signs and symptoms of all Vaata Vyaadhi is found in 22nd chapter.

In addition to the general symptoms of Pakshaghata, Pitta and Kapha Anubandha

Lakshana have also been described. Commentator Vijaya Rakshita (14th Cen.) has

differentiated Pakshaghata from Adharaanga Vaata by giving illustration of

‘Ardhanaarishwaravat’ to the former and ‘Narsimhavat’ to the latter.

Disease Review


NYAAYA CHANDRIKAA:

Gayadas has been interpreted the Lakshana “Sandhivandha Vimoksham” as

“Sandhibandhaan Kaphasanhitaabhih Dhamanibhih Kritan Mokshayan Pakshaghatam

Kuryaat.”

Chakradatta(12th cent. AD)

Detailed description of Vatavyadhi Chikitsa has been described in 22nd chapter. For the

treatment of Pakshaghata some formulations are indicated.

Vangasena Samhita(12th cent. AD)

In Vatavyadhyi-Adhikara a detailed desription of Pakshaghata is explained with its

pathogenesis, prognosis and symptomatology. The line of treatment given here Snehana,

Swedana and Virechana.

Sharangadhara Samhita (13th cent. AD)

In Purvakhanda of Sharangadhara samhita had enumerated Pakshaghata among the 80-

Vata Nanatmaja disorders (7/107). In Madhyamakhanda 2/92; and 2/142 some

formulations for Pakshaghata are mentioned.

Bhavaprakasha (15th cent. AD)

Detailed description of pakshagat is present in B.P. M. 24/205-207, 262,263.

Yogaratnakara (17th cent. AD)

Description of Vatavyadhi similar to that of Madhava Nidana is found in the Nidana

chapter. Some specific treatments are indicated for Pakshaghata.

Bhaishajya Ratnavali (18th cent. AD)

In the 26th chapter named as Vata Vyadhi Chikitsa detailed description of Chikitsa of

Vatavyadhi is present. For Pakshaghata some drug formulations are also indicated. Other

treatises i.e in Kalyanakaraka of Ugradityacharya(9th Cent.), Chikitsakalika by

Disease Review


Tisatacharya (10th Cent.), Shodhal’s Gada Nigraha (12th

Hippocrates (400 B.C.): He observed that there were many blood vessels

connected to the brain. He notified the most significant fact regarding

Hemiplegia, that “If the patient has the lesion of the left side of the head, spasm

seizes the right side of the body; if the lesion is on the right side of the head;

spasm seizes the left side of the body.”

Cent.), Rasa Ratna

Samuchchaya 21st chap. (13th Cent.) etc.

Galen (131-201A.D.): described the anatomy of the brain and its blood vessels.

The 16th century is truly designated as the age of Anatomy.

Andreas Vesalius (1541-1564) produced sketches of brain, nerves, etc., after

extensive experimental studies.

The 17th century is known as century of physiology. Several discoveries took

place in this century.

William Harvey (1578-1657 A.D.) described the circulation of blood.

In 18th

Giovanni Battista Morgagni (1682-1771) is a father of Pathology described one

case of hemiplegia. He recognized that paralysis was on the side of the body

opposite to the brain lesion.

century the focus attention was shifted to pathology and the cause of

disease.

19th century gave rise to many discoveries, new theories and emergence of

modern medicine.

John Cheyne (1777-1836) described the morbid appearance of patient’s brain

and neurological abnormalities in detail.

Fisher termed the temporary short-lived episodes of neurological symptoms as

Transient Ischemic Attacks (TIAs).

In 20th century progress in medical science geared up.

The work of British physiologist-Charles Scott Sherrington on nervous system

led to the better understanding of nervous diseases including Hemiplegia. He

assigned the functions of co-ordination to the nervous system, studied the levels

of nervous integration, the proprioceptive system, the higher controlling centres

and central inhibitors. Today, there is a wealth of information available on the

Disease Review


cause, prevention, risk, and management of stroke. However, in spite of all this

information and breakthroughs there is no any confirming treatment to reduce the

risk of death and disability.

CLASSIFICATION OF PAKSHAGHATA:

Aachaarya Sushruta while describing the prognosis of Pakshaghata has

classified the disease in three types as per their aetiopathogenesis.

The three types of Pakshaghata are as follows:

1) Suddha Vaataja Pakshaghata:- where the Vaata is aggravated on account of its

own Nidaana

2) Anyadosha Samsrista Pakshaghata: - where the Vaata is associated with other

Dosha to manifest the disease.

3) Kshaya Hetuja Pakshaghata: - where the Vaata is aggravated as a consequence

of Dhaatu Kshaya.

Acharya Sushruta has used the terms Samanvita, Samsrista, Anvita, Samyukta etc

as synonym of Avarana in the context of description of Avarana.

The routes of Vata Prakopa are:

1. Svanidanjanya Vata Prakopa: Due to indulgence in its own Nidana the Vata

gets provocated.

2. Margavaranajanya Vata Prakopa: The normal functions of Vata depend on

three factors viz. Avyahata Gati, Vata to be seated at its own natural site, Vata to

be remains in its normal quality. When there is obstruction of the path of the Vayu

by other Dosha or Dushya, the Avyahata Gati of Vata is hampered and Vayu get

provocated. This type of vitiation of Vata is called Margavaranajanya Vata

Prakopa.

3. Dhatu Kshaya Janya Vata Prakopa: When there is Dhatu Kshaya, there

develops some vacum in the Dhatu which get filled by Vayu and the Vata get

provocated. This type of Vata Prakopa is called Dhatu Kshaya Janya Vata

Prakopa. Svanidanajanya Vata Prakopa results in the manifestation of Suddha

Vataja Pakshaghata. Margavarana Janya Vata Prakopa results in the manifestation

of Anya Dosha Samsrista Pakshaghata and Dhatu Kshaya Janya Vata Prakopa

Disease Review


results in the manifestation of Kshayahetuja Pakshaghata. The Dhatu Kshaya

Janya Pakshaghata has again classified as two types by Acharya Gaydas as,

a. Sonitaatisritikrita Dhatu Kshaya Janya Pakshaghata and

b. Balavadvigrahadita Dhatu Kshaya Janya Pakshaghata.

CLASSIFICATION AS PER CAUSES OF HEMIPLEGIA:

SUDDEN ONSET HEMIPLEGIA:

o Cerebrovascular Accident

o Intracranial infection - Encephalitis, meningitis, congestive attacks of GPI

o Trauma - Depressed fracture of skull

o Todd’s paralysis (Post ictal)

o Hysterical

GRADUAL ONSET HEMIPLEGIA:

o Cerebral Tumor

o Chronic subdural hematoma

o Infections - cerebral abscess, meningitis and encephalitis

o General paralysis of insane

o Congenital defects - cerebral agenesis

TRANSIENT OR RECURRENT HEMIPLEGIA:

o Transient ischemic attacks

o Hypertensive encephalopathy

o Post epileptic

o Congestive attack of GPI

o Hysterical

o Multiple sclerosis

o Hemiplegic migraine

Hemiplegia caused by each of the above disease has got different aetiopathogenesis

and line of management. All the above causes of hemiplegia can be categorized under the

three groups of Pakshaghata considering their nature of disease process and

Disease Review


etiopathogenesis. But this requires a thorough study of each of above disease in term of

Nidana Panchaka to determine their Samprapti in terms of Ayurveda.

Synonyms

In Ayurveda different paryayas or synonyms has been used to denote the disease

process, avayava, etiology, pathology, etc. Pakshaghata, Pakshavadha, Ardhangavata,

Pakshagraha, Ekanga vata, Pakshahata, etc. Before having full fledged description of

Pakshaghata first we will acquaint ourselves with etymology of Pakshaghata.

NIDANA

The word Nidana bears two meanings, one is causative factor and other is

diagnosis. Nidana may be dosha aggravating, disease aggravating or aggravating both. It

may also be classified as a general one and specific one. The importance of Nidana in the

management of any disease can be well understood from the verse. To understand various

nidana, each can be classified systematically under four categories.

1) Aharajanya, 2) Viharajanya, 3) Manasa and 4) Anya. Nidana described in various

Ayurvedic texts are as below:

Charaka Samhita: In Charaka Samhita, specific nidana of Pakshaghata are not

described. General Nidana of Vatavyadhi can be taken as a token for Pakshaghata also.

The nidana mentioned in Ch. Chi. 28 are as under.

1) Aharajanya: Excessive intake of annadravya which are Ruksha, Shita, Laghu in

Guna, Alpa Anna Sevana, Langhana and Ama. Her Vijayrakshita says that Ama

causes Prakopa by Avarana.

2) Viharajanya: Ativyavaya, Atiprajagarana, Atiplavana, Ativyayama,

Dukhashaiyya, Dukhasana, Divaswapna, Vegadharana and Atiadhva.

3) Manasa: Atichinta, Shoka, Krodha and Bhaya.

4) Agantuja: Abhighata, Marmaghata, Gaja apatamsana, Ushtra aptamsana, Ashwa

apatamsana and shigra Yana apatamsana. Here Vijayrakshita gives one more

meaning of the word ‘Apatamsana’. He says that besides ‘Patanam’ and

‘Dhatuksharana’ it also means ‘Ucchvasarodha’ i.e. difficulty in inspiration

caused by riding on elephant, camel, horse or other fast vehicle.

5) Miscellaneous: Vishama Upachara, Dosha Atisravana, Asruka Atisravana, Dhatu

Sankshaya, Rogatikarshana and Riktasrotasa are other nidana of vatavyadhi.

Disease Review


Aharaja Nidana: Table no- 20

Aetiological Factors Ch. Su.189 A.S190 A.H191 Bh.P 192 193

Alpa/Pramita Anna + - + + +

Laghu Anna + - + - +

Langhana + - - - -

Abhojana/Anashana + + - - +

Vishamaashana - + - - +

Adhyashana - + - - -

Vishtambhi - - - - -

Shushka Shaaka - + - - -

Vallura (Shushka Maamsa) - + - - -

Varaka(Kudhaanya) - + - - -

Uddaalaka - + - - +

Koradusha - + - - -

Shyaamaaka - + - - +

Nivaara - + - - +

Mudga - + - - +

Masura - + - - +

Aadhaki - + - - +

Harenukaa (Kalaaya Bheda) - + - - -

Nishpaava - + - - +

Kalaaya - + + - -

Khesari (Triput) - - + - +

Chanaka - - + - +

Makushtha - - - - +

Varati - - - - +

Mangalya (Masura Bheda) - - - - +

Satina (Kalaaya Bheda) - - - - +

Bhukte hi Ajeerneh Ashanam - - - - +

Bisa, Shaaluka, Tinduka - - + - -

Karira, Kaalinga, Jaambava - - + - -

Disease Review


Viharaja Nidana: Table no- 21

Aetiological Factors Ch. Su.189 A.S.190 A.H. 191 Bh.P192 193

Ati Vyavaaya + + + + +

Ati Prajaagaran + + + + +

Langhana + + + - +

Plavana + + - - -

Pratarana - + + - +

Atiadhva + - + - -

Ati Vyaayaama + + + + -

Ativicheshtaa + - - - -

Dukhashayya + - - - -

Dukha-Aasana + - - - -

Divaaswapna + - - - -

Atiadhyayana - + + - -

Pradhaavana + - + - -

Bhaaraharana - + - - -

Vegasandhaarana + + + + +

Uchchabhaashana - - + + -

Gajaaticharyaa - + + - -

Turangaaticharyaa - + - - -

Ratha-Aticharyaa - + - - -

Pada Aticharyaa - + - - -

Yaan (Ati Savaari) - - - - -

Shaityataa - - - - +

Ati Shrama - - - - +

Gadhochchadana - - + - -

Trushitaasana - - + - -

Kshudhitambupana - - + - -

Disease Review


Aghataja Nidana: Table no- 22

Maramaghata:

Shiromarmaghata leads to Ardita, Spandana, Svarahani, Cheshtanasha, Mukatva etc194 Trauma to

Lohitaksha Marma leads to excessive blood loss, Pakshavadha and even death195

Same principle is applicable where Sushruta mentioned Pakshaghata as a Vranopradrava.

Pakshaghata is a consequence of Kakshadhara Marmaghata

. Due to Doshaja

Aghata on this Marma, Sira and Snayu Shosha takes place, this leads to Pakshavadha.

196.

This is because of Snayu are

intensively involved in this Marmaghata.

Manasika Nidana: Table no- 23

Aetiological Factors Ch. Su. 189 A.S.190 A.H.191 Bh.P 192 193

Chintaa + - - + +

Shoka + - + + +

Krodha + - - - -

Bhaya + - - + +

Kaama + - - - +

Apravritta Vegodirana - - + + -

Utkanthaa - - + - -

Aetiological Factors Ch. Su.189 A.S.190 A.H.191 Bh.P.192 193

Abhighaata + + + - +

Marmaaghaata + - - - -

Balvad Vigraha - + + - -

Prapatan – Gaj, Ushtra, Ashva,

Yaan, Tara (Tree), Atiuccha

Patanam

+ + - - +

Prapidana / Prahaara (Dandaadi) - + - - -

Ashma / Shila / Loha / Kashtha –

Utkshepa, Vikshepa, Bhramana,

Chalana

- - + - -

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Kalaja Nidana: Table no- 24

PraVaata - + - - -

Grishma Ante - - + + -

Jeerna Ante - + - - -

Ahoratri Ante - - + + +

Shishir Ritu - - - - +

Varshaa Ritu - + + - +

Pradoshe - - - - -

Bhukta Ante - - - + -

Shita Kaala - + - - -

Abhra - + - - -

Prabhaata Kaala - + - - -

Aparaahna - + + - -

Himam - - - - +

PraagVaata - - + - +

CAUSES OF CEREBROVASCULAR ACCIDENT:

Stroke is the clinical term for acute loss of circulation to an area of the brain, resulting in

ischemia and a corresponding loss of neurologic function. Classified as either

hemorrhagic or ischemic, strokes typically manifest with the sudden onset of focal

neurologic deficits, such as weakness, sensory deficit, or difficulties with language.

Ischemic strokes have a heterogeneous group of causes, including thrombosis, embolism,

and hypo perfusion, whereas hemorrhagic strokes can be either intraparenchymal or

subarachnoid. The lists of causes of different groups of stroke are as follows.

Causes of thrombotic stroke:

a) Arterial: - Atherosclerosis, arteritis, syphilis, collagen diseases

b) Venous :- Cortical thrombophlebitis, post partum or post operative

thrombophlebitis

Causes of embolic stroke: - Embolisms are usually from,

a. Heart: - Auricular fibrillation, myocardial infarction, infective endocarditis

Disease Review


b. Arteries: - Detachment of an atheromatous plaque usually from the aorta or the

carotid artery

c. Veins: - Thrombophlebitis usually from the veins of lower limb and pelvis

d. Miscellaneous: - Post cardiac surgery, caisson’s disease

Causes of hemorrhagic stroke: - Hemorrhage are usually from the rupture of

a. Berry’s aneurisms

b. Atherosclerotic vessel

c. Angiomatous malformation

d. Hypertensive encephalopathy

RISK FACTORS OF STROKE:

Irreversible risk factors

Age

Sex (Male are more effected than female except in very young and very old)

Race (Afro-Carribbean > Asian >European)

Hereditary

Modifiable risk factors

Hypertension

Heart disease (heart failure, atrial fibrillation)

Diabetes mellitus

Hyperlipidemia

Obesity

Smoking

Excess alcohol consumption

Polycythemia

Oral contraceptive

Disease Review


PURVA RUPA

The Purvarupa for Pakshaaghaata in particular has not been described in

Ayurvedic text. How ever purvarupa of vaata vyaadhi in general has been described by

Aachaarya Charaka by saying that Avyakta Lakshana is the Purva Rupa of any vaata

vyaadhi. Here, Chakrapani has commented that Avyakta means few or mild symptoms

and Gangadhara has also opined the same. Vijayarakshita has thrown more light on the

word Avyakta and says that the symptoms that are not manifested clearly are Purva Rupa

and these are due to –

Less severity of causative factors

Few or mild symptoms

Less Aavarana of Dosha

Purvarupa usually manifest due to the Sthaanasamsraya of Dosha at the time of

Dosha Dushya Sammurchchhanaa. Purvarupa will be more manifest when the Dosha get

provocated through usual route of Sanchaya, Prakopa and Prasara. This type of

provocation is found in Swanidaanajanya or Suddha Vaataja Pakshaghata. But in case of

Aavaranajanya the Vaayu is not get provocated through the route of Sanchaya, Prakopa

etc. rather the Vaayu get provocated suddenly due to Aavarana so Purvarupa are not

found in Aavaranajanya Pakshaaghaata.

PRODORMAL SYMPTOMS OF STROKE:

Prodormal symptoms are not found in stroke resulting from embolism and hemorrhage.

In this case the stroke manifests suddenly. But the stroke resulting from thrombosis some

times may show prodormal symptoms like,

difficulty in speaking,

weakness of arm or leg,

vertigo may be present

Disease Review


RUPA

The symptoms which evolve or are manifested in Vyakta Avasthaa of Shadvidha

kriyaakala are known as Rupa. Various symptoms of Pakshaghata described in Ayurvedic

literature are as follows:

Charaka Samhita:

The signs and symptoms of Pakshaghata as described by Aacharya Charaka are Vama or

Dakshina Pakshahanana along with-

• Cheshtaanivriti: Loss of voluntary movements, which is the cardinal symptom of

this disease.

• Ruja : Pain

• Vaakstambha : Aphasia or Dysarthria

Sushruta Samhita:

In Sushruta Samhitaa the symptoms of Pakshaaghaata are described as follows,

• Anyatara Pakshahanana

• Sandhi Bandha Vimoksha

• Akarmanyataa

• Acetanam (loss of sensation or consciousness)

Here, Sandhi Bandha Vimoksha and Anyatara Pakshahanana are described for the first

time

Ashtaanga Samgraha and Hridaya:

Vagbhata has followed Sushruta in describing the symptomatology of Pakshaghata (A.S.

Ni. 15/40-42).

Maadhava Nidaana:

In this text also the description of the clinical picture of Pakshaghata is of the same

opinion with that of Sushruta and Vagbhata. In Maadhava Nidaana in addition to general

symptoms of Pakshaghata the Pittaanuvandha and Kaphaanuvandha Lakshana of

Pakshaghata are also described. Pittaanuvandha Pakshaghata is characterized by Daaha,

Murchchhaa, and Santaapa. Kaphaanubandhi Pakshaghata is characterized by Shotha,

Gaurava and Stambha.

Disease Review


Sushruta and Vaagbhata have considered the word ‘Ekaanga Roga’ as synonym of

Pakshaghata.

Bhavaprakasha:

Bhavaprakasha has literally followed Maadhava Nidaana, while describing Pakshaghata.

SIGN AND SYMPTOMS OF CEREBROVASCULAR ACCIDENT:

The signs and symptoms of stroke depend upon the following factors.

Nature of vascular lesion

Duration of ischemia

Region of the brain supplied by the effected vessel

Status of the collaterals to that region

Vulnerability of neurons of that region

SAMPRAPTI

The process starting right from the vitiation of the dosha to the complete manifestation of

the disease is known as Samprapti197

1) General or Samanya Samprapti: This is a common pathogenesis among various types

of a single disease.

. Each and every step from a healthy state to a

diseased one are included in Samprapti. Knowledge of Samprapti is inevitable for

Vaidya, because blockage of the pathogenesis at any of the stage will terminate the

disease, thereby preventing the mortality and morbidity. Again it should be beared in

mind that different regimens are to be applied at different stages. Conventionally the

Samprapti can be of two types.

2) Specific or Vishishta Samprapti: This is a specific pathogenesis for a particular

subtype.

1) Samanya Samprapti of Pakshaghata: This is the general samprapti of pakshaghata

common for all vatavyadhi. The samanya samprapti of pakshaghata according to Charaka

Samhita is as under.

Disease Review


Charaka Samhita198

Acharya Charaka says that on account of various aetiological factors, Vata gets vitiated

and it fills up the rikta srotas of the body causing various kinds of vatavyadhi, which

affects the whole body or some specific part of it (Ch. Chi. 28/18). Besides its self

provocating Nidana, vayu is also vitiated by Dhatukshaya and Avarana in Srotasa (Ch.

Chi. 28/56).

:

Various causes leading to Vata Prakopa:

Langhana , Rasakshaya, Rikta srotasa ,Vataprakopa, Laghu, ruksha annasevana

Atimaithuna , Shukra kshaya, Marmaghata, Margavarana, Vegasandharana,

Margavarana, Ama

2) Vishishta Samprapti:

Charaka Samhita:

Vayu beholds either side – right or left of the body, dries up sira and snayu of that part

rendering it dead, along with Ruja and Vakstambha.

Sushruta Samhita:

Excessively agitated Matarishva holds on Adhoga, Urdhvaga and Tiryaka dhamanis,

loosens the sandhi bandha of either half of the body and renders it dead (Su. Ni. 1/60-61).

Here, Acharya Dalhana comments that Dhamani of only affected half are involved. Here

it comes to notice that samprapti described by Sushruta differs from that of Charaka in

following two ways.

• Involvement of Dhamani is considered instead of Sira snayu.

• Laxity of sandhi bandha is considered as a part of Samprapti.

Ashtanga Sangraha:

Vagbhata has assimilated samprapti of both Charaka and Sushruta and he says that Vayu

hold half of the body, dries up Sira and Snayu, loosens sandhi bandha and leaves either

half of the body dead (A. S. Ni. 15/40-42). Here, Vagbhata has considered Sira snayu as a

part of Samprapti instead of Dhamanis thus; following Acharya Charaka on the other

hand he has also considered laxity of joints as part of this Samprapti following Sushruta.

Disease Review


Madhava Nidana and Bhavaprakahsa:

Madhavakara and Bhavamishra have literally followed Vagbhata in this respect (M. Ni.

22/39-40; B. P. M. Kh. 24/205). Acharya Charaka has described six types of Samprapti,

which are described here in context with Pakshaghata.

1) Sankhya Samprapti: Various types of a disease are considered under this section.

There are three types of Pakshaghata as said in Madhava Nidana.

• Shuddha Vataja

• Pittanubandhi

• Kaphanubandhi

2) Pradhanya Samprapti: This samprapti is described by taking in account the Tara-

tama bhava of doshas. Pakshaghata is a Nanatmaja vatavyadhi so, naturally Vata

dosha is affected. But even in Vata, the subtypes chiefly affected are Prana vayu,

Udana vayu and Vyana vayu. Also, Pitta or Kapha may be associated in Pittanubadhi

and Kaphanubandhi Pakshaghata respectively. Pakshaghata which occurs due to its

own causes may be taken as svatantra, while that occurring due to other causal

factors like tumor, may be considered as paratantra.

3) Vidhi Samprapti: Vidhi means variety, but as per Gangadhara Vidhi means

visheshana. Thus it may be of two types: Nija and Agantuja, three types depending

on dosha and four types depending upon prognosis. Another meaning of Vidhi is

onset of disease depending on it there can be two types. One is of sudden Onset and

other is of gradual onset. Hemiplegia occurring due to haemorrhage, embolism is

examples of sudden onset, while that occurring due to neoplasm is of gradual onset.

4) Vikalp Samprapti: This can be taken as Anshansha kalpana. Quality of Vata like

Ruksha, Laghu are called as Ansha. In pakshaghata, usually Ruksha and Sheeta guna

are increased while Chala guna is decreased.

5) Bala Samprapti: When Nidana, Purvarupa, Dosha and Dushya are profound in

number and strongly involved then disease is said to be of Balavana type and vice

versa. Pakshaghata due to fulminating blood pressure along with anaemia and

affecting larger area of brain can be considered as Balavana.

6) Kala Samprapti: Kala Samprapti is understood in context of age of patient, time of

occurrence of disease with respect to season, day and night and time of increase or

Disease Review


decrease of disease. Pakshaghata occurring due to CVA usually occurs after 40 years

i.e. Vata prakopaka kala. Hemiplegia due to embolism usually occurs in young age.

Hemiplegia due to thrombosis usually occurs in Varsha ritu, last part of the day and

night. All these are Vata Prakopaka kala.

Samprapti Ghataka of Pakshaghata:

Samprapti Ghataka chiefly constitutes Dosha, Dushya, Srotasa, Ama and Agni. Detailed

descriptions of each in context of Pakshaghata are as under.

• SAMPRAPTHI GHATAKAS OF PAKSHAGHATA:

• Dosha - Pradhana Dosha- Vata Prakara -- Prana, Vyana, Udana

• Anubandhi - Pitta, Kapha

• Dushya - Dhatu--- Rasa, Rakta

• Upadhatu - Sira, Snayu,kandara

• Agni - May be affected

• Ama - May be present

• Srotas - Rasa Vaha, Rakta Vaha

• Sroto Dushti - Sangha

• Udhbhava sthana - Pakwashaya

• Sanchara sthana - Dakshina\ Vama Sira, Dhamani, Snayu

• Sthana samshraya - Shiras

• vyaktshana - Ardha Sharira

Dosha: Pakshaghata chiefly involves Vata dosha. Coming to its subtypes Prana,

Udana and Vyana are chiefly involved.

Dushya: In Pakshaghata Rasa, Rakta, Mamsa, Meda, Sira, Snayu, Dhamani and

Mala are involved.

Srotasa: In Pakshaghata Rasavaha, Raktavaha, Mamsavaha and Medovaha

srotasa are involved.

Srotodushti: Atipravritti, Sanga, Sira granthi and Vimargagamana are four types

of Srotodusti. All these types are observed in Pakshaghata. Paralysis occurs due to

Disease Review


obstruction in cerebral vessels leading to ischaemia. This can be considered as

Sanga. Various types of aneurysm can be considered as Siragranthi. Cerebral

haemorrhage can be considered as Atipravritti and Vimargagaman.

Ama: When quantum of Agni is decreased, it leads to production of undigested or

semidigested material. This is termed as Ama. This Ama possesses Snigdha,

Picchila guna and it causes obstruction in various Srotas. Srotorodha further

causes vitiation of dosha. Srotorodha also hampers nutrition of various dhatus

leading to dhatukshaya. In pakshaghata Rasagata and Raktagata Ama

(Thrombusembolism) are produced, which obstructs cerebral arteries causing

ischaemia in brain tissue and leading to its necrosis (dhatukshaya). All these

causes Vata prakopa i.e. increase in Ruksha, Shita guna of vayu and decrease in

its Chala guna (loss of voluntary movements).

Agni: All diseases occur due to vitiation of Agni. In Vatavyadhi Agni remains

Vishama. So, in Pakshaghata also the Agni remains Vishama.

Udbhava Sthana : Pakvashaya

Adhisthana : Ardhsharira

Interpretation and incorporation of Ayurvedic principles of aetiopathogenesis along

with modern findings in Pakshaghata

Prakriti as one of Nidana: During the time of Prakriti nirmana Kapha dosha is

responsible for Upachita Paripurna Anga, means Kapha dosha is responsible for normal

anatomical development. If due to any factors Kapha dosha is vitiated then there would

be absence of upachita paripurna anga i.e. anatomical anomaly.

We can correlate this anomaly with anomaly of circle of Willis, which is frequently

found in patients of stroke. Anatomically compromised circle of Willis is unable to

maintain normal blood flow in the brain predisposing the person towards the

development of stroke.

Dosha: Vata is the chief culprit of this disease. On being vitiated it induces various types

of pathology, which prepare the background for hemiplegia. Vata dosha also causes

Sankocha, which can be interpreted as follows –

Disease Review


Vasospasm is one of the factors that produce cerebral ischaemia. There is evidence that

cerebral vessels in animals as well as in man can go into a state of spasm as a result of

needling, manipulation and impaction of embolus. We can correlate these factors as

under.

Needling -A type of Abhighata, a Swaprakopaka Nidana of Vata.

Manipulation --A type of Abhighata, Swaprakopaka Nidana of Vata.

Embolus - A type of Avarana, causing Rikta Srotasa beyond obstruction thus vitiating

Vata dosha.

Dushya: Rasa, Rakta, Mamsa, Meda, Sira and Snayu are the Dushya of this disease.

Vitiated Vata afflicts the above-mentioned Dushya and induces a nidus necessary for

Pakshaghata. Due to excessive Ruksha, Khara type of Ahara, Rasa dhatu becomes devoid

of its Snehansha leading to Raukshya of succeeding dhatus as well as Sira and Snayu.

Anaemia is described as a potent cause of ischaemia in modern science. Presence of

anaemic condition in a person liable for transient ischaemic attacks increases his risk for

stroke by manifolds. Mamsa dhatu is also described as one of Dushya of Pakshaghata. If

we consider all three tunics of blood vessels as a representative of Mamsa dhatu then

understanding its role in Pakshaghata becomes easy. Excessive indulgence in Vata

prakopaka nidana like Ruksha, Sheeta, and Ahara-Vihara leads to loss of Snigdhata of

this dhatu. This leads to loss of elastic forces in blood vessels making it unable to respond

by dilatation or constriction in conditions of hypertension and hypotension. As a result,

there is either ischaemia or haemorrhage in the brain both of which can lead to stroke.

Meda dhatu is also considered as a dushya of Pakshaghata. We can interpret this in

following way. Plugging of vessels by cholesterol is a major cause of ischaemia. Also

increased levels of LDL with respect to HDL may be considered as a symptom of

Dushita Meda dhatu. This causes increased atherosclerosis leading to ischaemia.

Sira: Sira is also considered as Dushya of Pakshaghata. Chronic stenosis of either

internal carotid or basilar artery produces state of episodic insufficiency in circle of

Willis.

Disease Review


Agni: As per Ayurvedic principles each and every disease is directly or indirectly caused

due to vitiated Jatharagni. When quantum of this Agni is either increased or decreased it

may cause a disturbance in function of Bhootagni and Dhatvagni as well, leading to

various diseases. Finding of choleycystokinine, gastrin like hormones of Gastro-

intestineal tract in brain gives logical support to the above thinking. The factors or

enzymes responsible for dissolution of thrombus/embolus can be correlated with

Bhootagni. If these are disturbed then it leads to Pakshaghata.

Ama: Leaky Gut syndrome can occur when toxins, bacteria or incompletely digested

food molecules pass into blood stream due to break down of intestinal barrier and can

eventually affect brain. The same pathogenesis can occur in hemiplegia also. Ama in a

broad sense is any element, which is not completely digested or metabolized, it occurs

due to deficiency of enzymatic actions over its substrate. Ama is acquainted with

Pichchhila properties and atherosclerosis can be correlated with this. Atherosclerosis

plays a lions share in hemiplegia. Thrombus and embolism can also be categorized under

Ama, which are not dissolved by enzymes.

THE PHYSIOLOGICAL CORELATION OF MASTISHKA, MAJJA,

SIRASNAYU AND THE BRAIN:

To identify with the Ayurvedic point or view of the underlying patho-physiology of the

disease, it is quite necessary to look upon to the relevant description of the Sira, Snayu,

Majja Dhatu and the Mastishka, as well as the Avaraka pattern of provoking Vata. Such

pertinent facts denoted in different classics are given herewith: Shira is Sneha Vagbhata,

in a metaphoric illustration related Shira (brain) with root of plants and mentioned that as

diseases of Shira (brain) attack functional root of human kind, they should be treated as

early as possible. Hence Shira is Uttamanga of the body. Majja in the Shira is Mastishka,

opined Dalhana and Chakrapani. Sushruta mentioned Parshva Mastishka. Commenting

on this observation, Dalhana also noted Paschat Mastishka. He also correlated

Mastulunga with congealed Ghrita199. Meda is converted into Mastishka and Mastulunga

Disease Review


in Shira200. Mastishka develops from Prasada part of Asrika and Kapha201. Snayu are the

functional root of Mamsavaha Srotas202

Mamsa Holds various Sira that carry the Rasa Rakta complex, Snayus and Srotas

. 203.

Shira is a seat of Indriya-Pranavaha Srotasa204

There are 900 Snayus in the body and each has its root in Shira (brain). Peripheral nerves

may be interpreted as Snayu. Being a Mahamarma, Shira alsohas roots of all four types of

Sira i.e.Vatavaha, Pittavaha, Kaphavaha and Raktavaha deeply embedded in it. Literary

meanings of Avarana are obstruction, blocking, closing and covering.

. Here Indriya means various centers

present in the brain. Indriyavaha Srotasas are sensory pathways, while Pranavaha Srotasa

means motor nerves. Chakrapani commented that these Indriya-Pranavaha Srotasa are all

pervasive in the body, however they exist mainly in the Mastishka. This concept clearly

illustrates the existence of two open pathways, one from Shira to the body and another

from body to the Shira.

Avarana, as explained by Chakrapani, is Vegapratibandha and Gatihanana. All Avaranas

are explained by Shringagrahi Nyaya, defining exactly the involvement of Vata and other

Dosha. It is a general rule that the Dosha, which causes Avarana, displays its own

symptoms overpowering the symptoms of Vata, being encumbrance to it. Avarana is

evident in Pakshaghata. Hence, to cohere with the symptomatology and pathology of

Pakshaghata, understanding of Avaranas like Pittavritta Prana, Pittavritta Udana is

imperative. This Avritta Vata Dosha, of course, has to settle in Dhatus i.e. Dushya to

produce diseases. So the symptoms of Gata Vata also appear in Pakshaghata.

Nevertheless, no single Avarana process covers all symptomatology of Pakshaghata, so

the concept of Mishra (mixed) Avarana is pertinent here. Eighty five percent of strokes

are caused by cerebral infarction. Formation of a clot in one or more than one cerebral

arteries is the chief cause of cerebral infarction. There must be a substantial loss

(Shoshana) of Dravatva and Snigdhatva to form a clot in blood vessels. This Dravata

belongs to Rakta Dhatu, where as Snigdhata belongs to Meda Dhatu. Sushruta explains

the decisive role of Medogata Sneha in the formation of Sira. Siras are UpaDhatu of

Rakta. Without Vata there will not be any Shosha. The Guna that is responsible for

Shoshana is Ruksha. Vishada Guna absorbs Kleda (moisture) and Khara has same

Disease Review


qualities as that of Vishada. Thus, Khara, Ruksha and Vishada fractions of Vata Dosha

have ability to impart such type of Shoshana to Meda and Rakta.

Charaka clearly mentioned that Khara, Ruksha and Vishada Guna could cause

Pakshaghata. Pitta by virtue of its Ushna and Tikshna Guna can lead to Shosha of

Dravatva and Snigdhatva of Meda and Rakta respectively. Fire reduces water and it does

this more quickly when the wind blowsconcomitantly. It is the most common example

can be given in this regard. Now it is discernible from above discussion that Vata by its

Khara, Ruksha and Vishada Guna and Pitta by its Ushna and Tikshna Guna may produce

clot/clots in cerebral vessels. In Pakshavadha hoarded Doshas are located in the

Mastishka and wreak havoc on it. Prana Vayu Dushti is important In Pakshavadha. Along

with Prana Vayu, Udana and Vyana Vayu are another two to get involved in the

pathology.

Harita explained that intensively provoked Pitta, Marut, Shleshma, Udana and Prana get

settled in Shira (Brain) and lead to Nashtacheshtata. These elucidations explain the

mechanism of how Mastishka regulates all body functions and how vitiated Dosha

located merely in Shira can hamper all the movements of the body, which is seen in

Pakshaghata. Shiromarmaghata is described in our classics.

Trauma to Sadyapranahara Marma (Shira) commonly manifests in Indriya Artheshu

Asamprapti (sensory and motor loss), Mano-Budhhi Viparyaya (deranged mental

functions and loss of cognition ability), and a wide variety of severe pains.

Shiromarmaghata by Dosha leads to instantaneous death, but if the blow is not that

strong; it may result in death after time (7 or >7 days) or major disability or severe pain.

These all stages of Shiromarmaghata persist in the patients of Pakshavadha. All patients

have one or more than one stage according to severity of blow they receive to the

Shiromarma. Even a mild irritation/trauma (by Dosha) to the Marma(Shira) results in a

sudden and vigorous activation of Vata throughout the Sira (and Snayus) present in the

body. This reckless Vata produces all above-mentioned symptoms with loss of functions

of one or either side of the body and the patient lands up in the most common crippling

disorder e.i. Pakshaghata. This is a very brisk phenomena, that’s why suffix Vadha/

Ghata, which indicates that abruptness is used. Cerebral hemorrhage shows a clear

association of Pitta and dominancy of Rakta in its Samprapti. In case cerebral

Disease Review


hemorrhage along with Shosha of Sira and Snayus. Sira burst and blood comes out. When

Kapha is in the state of diminution then aggravated Vata and Pitta lead to Parishosha (of

Sira and Snayus), Sphutana (tears the cerebral vessels) etc. Some scholars consider it as

Urdhvaga Raktapitta. The Sira involved in Pakshaghata are Aruna type of Sira.

SAPEKSHA NIDANA

Sapeksha Nidana is very much important for the perfect start of a treatment. Many

diseases share common symptoms and it is the duty of the physician to demarcate these

resembling diseases. Pakshaghata is primely characterized by loss of voluntary

movements. Sapeksha nidana of Pakshaghata in this context with diseases having this

symptom is described as below.

Ayurvedic point of view

a) Pakshaghata and Ardita: All the texts have described these two diseases as

separate entities.

Charaka Samhita: We will have a birds eye view over pathology and symptomatology of

these two diseases to understand and differentiate each.

Pakshaghata: Vitiated Vata seizing the vessels, affecting the function of one side of the

body and constricting the veins afflicts the right or left side of the body, producing loss of

movement, pain and loss of speech.

Ardita: Aggravated Vata affects half of the body, diminishes the blood flow in affected

arms, knee and causes contraction of these parts. Either half of the face is distorted or

asymmetry of nose, brow, forehead, eye and jaw are produced. Morsel of food doesn’t go

straight into mouth but instead sideways, nose is curved during speech, eyes do not blink

and sneezing is suppressed. Speech becomes indistinct, stuttery and thick. Teeth are

loosened and there is pain in ears, eyes, temples, cheeks, hand, calves, thighs and feet.

This condition whether it occurs along with paralysis of half of the body or alone is called

Ardita or facial paralysis.

Here the symptoms like distortion of face, asymmetry of nose, brow, forehead, and eyes

are present only in Ardita and not in Pakshaghata. Here, Dradhabala adds that when force

Disease Review


of paroxysm is gone in Ardita, patients’ returns to normal and if this does not happen

then the patient remains afflicted. From this we can infer that unlike Pakshaghata, Ardita

occurs in paroxysms.

Chakrapani differentiates Ardita and Pakshaghata by saying that Ardita is associated with

Vega whereas Pakshaghata is not. Chakrapani has used the term Ardhanga vyapi Ardita

for Ardita and Ardhanga Vata for pakshaghata.

Sushruta Samhita: Describing Ardita, Sushruta says that neck and half of the face are

distorted longitudinally and bent. Tremors are experienced in face, speech deteriorates

and there is deviation of eyeball. Affected neck, chin and teeth become painful. These

symptoms can be correlated with facial paralysis.

Ashtanga Samgraha and Hridaya: In these two texts the description of Pakshaghata

and Ardita is similar to that of Charaka Samhita and hence the points of difference also

remain same.

Madhava Nidana: Commentator of Madhava Nidana has used Samanya Ardhanga Vata

for Pakshaghata and Vishishta Ardhanga ghata for Ardita.

Modern Review of Pakshaghata and Ardita: Facial paralysis described in Modern

Medicine can be correlated with Ardita. In facial paralysis, facial nerve is affected. As a

prodromal sign there may be pain behind the ear for previous one or two days after which

facial paralysis develops. Pain may be absent. Eyes on the affected side could not be

closed and it may water. Mouth is drawn towards opposite side, saliva may drool from

angle of mouth and during mastication, and food may collect between teeth and cheek.

There is numbness in affected side though there is no apparent loss of sensation. Lines of

expression are absent. Patient is unable to close his/her eyes and on attempting to do that

it rolls up. This is due to Lower motor neuron lesion in which both voluntary and

emotional movements are equally affected in upper as well as lower part of face.

Contrary to that hemiplegia is due to upper motor neuron lesion affecting one side of

Disease Review


body and only lower part of face. Jaw reflex is slightly exaggerated in hemiplegia

whereas it is decreased in facial paralysis.

b) Pakshaghata and Ekanga Ghata: In Pakshaghata, any one side of body is

affected whereas in Ekanga ghata any one of the four limbs is affected. Ekanga

ghata can be considered as monoplegia, which occurs due to less space occupying

lesion in cortex, on the contrary hemiplegia occurs due to involvement at level of

pyramidal tract, involving larger area. Vakstambha is an exclusive symptom

found in Pakshaghata, while Hastapada Sankocha and Sirasnayu vishosha may be

present in Ekanga ghata.

c) Pakshaghata and Sarvanga Vata: Sarvanga Vata is characterized by loss of

function of whole body. Thus, it is comparable with quadriplegia or double

diplegia or cerebral diplegia. There is loss of function of both upper and lower

limbs. On the contrary in hemiplegia only one side is affected. In most cases of

Pakshaghata, functioning of lower limb recovers and patient is able to walk with

little improvement but in Sarvanga Vata the patient is completely bed ridden.

d) Pakshaghata and Khanja-Pangu: Khanja is characterized by loss of function of

anyone lower limb. Patient becomes lame and walks limping. The lesion is in

lumbosacral plexus and so wasting is common, which is rare in hemiplegia (if it

occurs it may be due to disuse). In hemiplegia the lesion is in pyramidal tract and

Involvement of upper limb is usually present. Pangu is characterized by loss of

function of both lower extremities. This is comparable with paraplegia. Here also

the lesion is essentially in lower motor neuron or other local nerve plexus. There

is also loss of control over defecation and micturition, which are usually absent in

hemiplegia. Differential diagnosis should also be done between Pittanubandhi and

Kaphanubandhi Pakshaghata. In Kaphanubandhi Pakshaghata Shotha, Shaitya and

Stambha are present whereas in Pittanubandhi Pakshaghata symptoms of Pitta like

Murccha, Daha and Santapa are present.

Disease Review


SADHYA ASADHYATVA

Before starting the treatment of any disease it is wise to know its nature that it is of which

type Sadhya, Kashtasadhya, Yapya or Asadhya.

Various opinions in this regard in Ayurvedic literatures are as follows –

Charaka Samhita: Pakshaghata has been classified Yatnasadhya (Kashtasadhya) or

Asadhya because of the Gambhirya of the Sthana involved (Ch. Chi. 28-73-74).

Commenting on word Gambhirya, Chakrapani says that, it means Gambhira sthana

Ashraya.

Sushruta Samhita: Pakshaghata cause by shuddha Vata is considered

Kashtasadhya, one caused by Samsrushta dosha (Pitta or Kapha) as Sadhya and that

caused by Kshaya as Asadhya (Su.Ni. 1/63).

Commenting on word Kshaya Gayadas says that this Kshaya may be of two types-

• Kshaya caused by excessive bleeding

• Kshaya caused by excessive exercise like wrestling

Former type is Asadhya while latter is Kashtasadhya.

Ashtanga Sangraha: Vagbhatta’s view differs from Sushruta in this subject. As per him,

Pakshaghata caused by Shuddha vata Krucchasadhyatam (Atikrucchasadhya -indu), that

caused by samsrushta dosha is Krucchasadhya and that caused by Kshaya is Asadhya

(A.S. Ni.15/43).

Madhava Nidana: Madhavakara holds same view as Sushruta but in addition he says

that Pakshaghata accompanied by Vedana nasha and those of garbhini, sutika, bala,

vruddha, kshina should not be treated. Pakshaghta occurring due to excessive bleeding

should also be discarded (M. Ni. 22/43).

Bhavaprakasha: Bhavamishra has followed Sushruta Samhita in this context.

The prognosis of CVD is speculated by Modern neurologists on the basis of underlying

pathology.

Disease Review


PROGNOSIS OF CEREBROVASCULAR ACCIDENT:

Prognosis depends on the type of stroke, the degree and duration of obstruction or

hemorrhage, and the extent of brain tissue death. Most stroke patients experience some

permanent disability that may interfere with walking, speech, vision, understanding,

reasoning, or memory.

Thrombosis:

Approximately 70% of ischemic stroke patients are able to regain their independence and

10% recover almost completely. Approximately 25% of patients die as a result of the

stroke.When focal ischemic lesion is within the territory of the internal carotid artery, the

greater the extent of the area of cerebral damage, the worse the outlook. Previous strokes,

unconsciousness, association of sensory loss, hemiplegia are bad signs.The longer the

delay in onset of recovery, the poorer the prognosis.

Cerebral Embolism:

Cerebral embolism as such is rarely fatal unless the embolus lodges in the internal carotid

artery. The immediate mortality of cerebral embolism is 7-10%. Here the eventual

prognosis is determined by the progress of the condition causing embolism and the

gravity of the underlying illness – cardiac failure, MI, malignant growth, etc.

Cerebral Hemorrhage:

The location of a hemorrhagic stroke is an important factor in the outcome, and this type

generally has a worse prognosis than ischemic stroke. A cerebral hemorrhage may prove

rapidly fatal. A patient with a pontine hemorrhage or capsular hemorrhage which bursts

into one lateral ventricle is unlikely to survive more than a day or two, a progressive

hemorrhage in these sites proving fatal by causing brainstem compression. If the

hemorrhage is continuing there is a progressive depending of coma, indicated by inability

to rouse a formerly responsive patient and loss of corneal and papillary reflexes.

Disease Review


UPADRAVA

There is no separate description of Upadravas of Pakshaghata in Charaka Samhita,

but Upadravas of Avarana are mentioned. They are Hridroga, Vidradhi, Pleeha Roga,

Gulma, and Atisara. However the features mentioned in some of the Anyonyavruta Vata

and Anyavruta Vata can be considered as Upadravas of Pakshaghata since the patient are

frequently presented with these features like Sarvendriya Shoonyata (Murcha), Smruthi

and Balakshaya are present in an unidentified, improperly managed case of Pakshaghata.

Features of Shirograha, Uchwasa Nishwasa Sangraha and Mukha Shosha may be seen as

Upadrava of Pakshaghata associated with Hridroga in case of Pranavruta Udana. Sushruta

has elaborately described eight Maha Roga including Vatavyadhi in general. Specific

upadravas

of Vata Vyadhi are Shotha, Bhagna, Adhmana, Supta Tvacha, Kampa, etc.

TREATMENT FOR VATA VYADHIS- Table no- 25

THERAPY S.S C.S 205 A.S 206 V.S207 208

Snehana + - + +

Swedana + + + +

Virechana + + + +

Vamana + - + -

Anuvasana + - + +

Asthapana + - + +

Mastishkya + - - -

Shirobasti + - - -

Abhyanga + - - -

Upnaha + - - -

Yatha-Dosha Samsarga

chikitsa

- - + -

Rasayana - - + -

Disease Review


VIRECHANA AS TREATMENT FOR VATA VYADHI VIS - PAKSHAGHATA

Table no- 26

PATHYA APATHYA

In Ayurvedic classics, separate pathya apathyas for pakshagata have not been

mentioned, as it is one among the vatavyadhis, hence pathya apathyas of vatavyadhis

can be taken as that for pakshagata are as follows:

Table no- 27

OPINION IN DIFFERENT

SAMHITAS

VIRECHANA

Charaka samhit + 209

Kashyapa samhita + 210

Sushrutha. Samhita + 211

Vangasena + 212

Astanga Sanghara + 213

ANNA

VARGA

PHALA

VARGA

SHAKA

VARGA

DUGDA

VARGA

MAMSA

VARGA

ANYA AHARA

GUNAS

Kulattha Amlarasayukta

Phala

Vartaka Kshira Gramya Taila

Maasha Dadima Patola Ghrita, Anoopa Tambula

Godhuma Draksha Shigru Kilatam Audaka Matsyandika

Raktashali Jambira Lashuna Dhadikurchika Jangala Madhura rasa

Navina Tila Badara Amla and lavana

rasa

Puranashalyodana Snigdha ahara

Vrusyam

Disease Review


PATHYA VIHARA:

Sukhoshna Parisheka, Nirvata Sthana, Samvahana, Avagahana, Abhyanga,

Brahmacharya, Ushna Pravarana, Agni Aatapa Sevana, Snigdha Ushna Lepa

APATHYA AHARA VIHARA

All the vata prakopa karanas are to be avoided.

PAKSHAGATE VIRECHANA

Pakshagata is the disorder manifested due to vitiation of vata in association with pitta &

kapha in etiopathogenesis – Vatadosha is vitiated due to dietary factors like excessive

intake of foods having katu, tikta & kashaya rasa. Vata also vitiated due to excessive

strain & stressful conditions of life & irregularities in diet. When vitiated vata attains

strength for & external factors, it provocate & interacts with raktadhatu.

The normal functions of sira, snayu & khandara, which are upadhatus of raktadhatu, are

impaired due to interaction of rakta with vata. This result in into loss of functions of half

of the body.this painful condition is pakshagata. When pitta dosha is also vitiated along

with vatadosha, burning sensation, irriation & stroke are the

The most paradoxical thing about treatment of Pakshagata is “Pakshagate Virechanam”.

Usually Virechana is the treatment for pittadosha but in this vatavyadhi virechana is more

effective than basti, which is the treatment of choice for vatadosha because of the

following points.

Pakshavadha is basically a prana vayu veekar, the natural direction of prana vayu

is from above downwards. In virechana this proper direction of pranavayu is


In pakshavadha upadhatus of rakta i.e. Sira and Kandara vitiated for upadhatu



Virechana, the main line of treatment cannot be applied in Suddha Vata condition.



Disease Review


in Pakshaaghaata supports the fact that its Samprapti is due to Aavarana of Vaata


Pakshagata is also said to be a disease of majjavaha srotas. Majja dhatu and pitta




The adhishthana of Pakshaghata is Indriyayatana (Mastishka). Mastishka is








Kaphandubandhit and Pittanubandhit Pakshaghata have been described in



(Ch. Chi. 28/184,185,189).

Virechana Karma is a specific process for elimination of pitta dosha (Ch.






In Pakshaghata the main dosha involved is vata. The natural abode of vata is


(Su. Chi. 4/5).

In case of Sansargaja dosha, i.e., if vata is affected by pitta and kapha both, then




Disease Review


Vagbhata has mentioned Mridu Sanshodhanaa (Virechana) in the general line of


Mridu Sanshodhanaa has been mentioned in treatment of Margavarna. (Ch. Chi.



Majjavaha sroto dushti takes place in Pakshaghata and in order to combat the



If we see the general line of treatment for vata vyadhi given by Acharya Charaka

in Chikitsasthana 28th

Virechana Karma possesses the property of purifying the vitiated dhatus (Ka. Si).


Mansa, Meda, Majja, Shukra gata vikaras. (Ch. Su. 28/25) Srotovishuddhi,





Si. 1/17; Su. Chi. 33/27; A.H. Su. 18/60).

chapter, then after snehana and Swedana, Virechana has

been mentioned as main shodhana measure. In the patients contraindicated for

Virechana, vasti has been mentioned. Hence Virechana is considered to be

treatment of choice in vata vyadhi and so in Pakshaghata.



DRUG REVIEW

Drug Review

“A Clinical study to Evaluate the Efficacy of Virechana Karma in Pakshaghata” Page 86

DRUG REVIEW

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xÉÇmÉccÉåÌiÉ cÉiÉÑwMüÉåÅrÉÇ SìurÉÉhÉÉÇ aÉÑhÉ EcrÉiÉå || (cÉ.xÉÔ.9/7)

Drug place an important role in the Pada Chatushtayam. According to

Acharya Charaka says that an ideal medicine should possesses the qualities ‘Bahuta’,

‘Yogyata,’ ‘Anekavidhakalpana,’ and ‘Sampath’. Drug is a part of Cikitsa Catushpaada,

which has been placed next to the physician. The knowledge of the drug is very important

to physician because without knowledge of drug the patient cannot be treated properly. In

this way, all Ayurvedic classics advocate specific formulation for particular disease.

Drugs for Deepana Pachana : Chitrakadi Vati

It is explained in 15

214

th

Explained in the context of Ama pachana. chapter of charaka chikitsa i.e Grahanichikitsa.

By the intake of this it does the pachana of the Ama &Jataragni deepthi .

RASA PANCHAKA OF CHITRAKADI VATI - Table no- 28

Sl. no

Drug Latin Name

Rasa Guna Virya Vipaka Doshagnata Karma

1 Citraka

Plumbago zeylanica

Katu Laghu Ruksa

Ushna katu Kaphavata shamaka pita vardaka

Deepana Pachana Arsoghna

2 Pippali mula

Pipper Longum

Katu Laghu Ruksa

Ushna katu Vatakapha shamaka

Kasahara Deepana Swasahara

3 Yava Kshara

Potasii Carbonas

Katu Laghu Snigdha

Ushna Katu Kaphavata shamaka

Deepana Pachana

4 Sarja kshara

Impure carbonate of soda

Lavana Katu

Teekshna Ushna katu Vatashamaka Pachana

5

Saindhava

Sodi chloridium

Madhur Lavana

Laghu, Snigdha

Sheeta

Katu Tridosha shamaka

Deepana, Pachana Ruchya, Vrushya, Netrya

6 Sauvarcha Unaqua Katu Sneha, Ushna Katu Vata Deepana,

Drug Review


la

Sodium Chloride

Laghu, Vishada

shamaka

Rochna, Bedhana

7

Samudra

Sodi muris

Lavana, Tikta, Madhur

Guru, Snigdha

Ushna

Madhura

vatashamaka

Deepana, Ruchya, Pachna

8 Vida -

Lavana

Laghu ,Ushna, Teeksha, Sukshma

Ushna

Madhura

Kapha vata shamana

Hrudya Vatanulomna

9 Uadbhida

- Katu Guru Snigda

Sheetala

Katu

Vatashamaka Ruchya

10 Sunthi

Zingeber officinalis

Katu Guru Ruksa

Ushna Madhura Kaphavata shamaka

Truptighna Deepana Pachana

11 Pippali

Pipper Longum

Katu

Laghu Ruksa

Ushna Katu Vatakapha Shamaka

Kasahara Deepana Swasahara

12 Maricha

Pipper Nigrum

Katu Laghu Ruksa

Ushna

Katu Vatakapha Shamaka

Deepana

13 Hingu

Ferula Narthex

Katu Laghu Ruksa

Ushna Katu Kaphavata shamaka pitavardaka

Deepana

14 Ajamoda

Trachysp- ermum ammi

Katu Laghu Ruksa


Deepana

15 Cavya

Pipper Chaba

Katu Laghu Ruksa


Deepana

Drug Review


GHRITA - Table no- 29

GHRITA

SAMANYA

GUNAS

C.S. A.S.215

S.S.

216

H.S.

217

YO.R

218

BH.N.219 D.N.

220

R.N.

221

222

Smruthi

Vardhana

+ + + + +

Buddhi Vardhana + + + + +

Agni Vardhana + + + + + +

Sukra Vardhana + + +

Oja Vardhana + - +

Kapha Kara + - +

Meda kara + - -

Vatapittahara + + + - + + + +

Tridosha hara - - - + - - - +

Visha hara + + + + +

Shoshahara + +

Alakshmi hara + + +

Jawarapaham + +

Sarva Sneha

Uttama

+ + + + + +

Sheetam + + + + +

Madhuram + - + + + + + +

Sahasra Veeryam + +

Medha Vardana + + + + + +

Bala Vardana - + + + + + +

Ayu Vardhana - + - - + + + +

Chakshusayam + + + + + +

Bala and Vrudha

hitam

+ +

Praja hittam + +

Drug Review


Kanti hitam + + + + +

Lavanya - +

Sokaumaryarthi

hitam

+ +

Swararthi hitam + +

Kshatha, Ksheena

hitam

+ +

Parisarpa hitam + +

Shastra –

Agnihata – hitam

+ +

Vayasthapanakar + + + +

Unmada- hitam +

Vrushya + + + +

Suddhi krutam +

Shrma nashnam + +

Pushti + +

Rasayanam + +

Amrutham +

Papaghna +

Rakshoghna +

Guru +

Pavitram &

Mangalyam

+

Sugandham +

Rochanam +

Charu +

Hrudyam + +

Drug Review


PROPERTIES AND COMPOSITION OF GHRITA:

Ghritha provides energy to body it is more useful than the carbohydrates and

proteins , one gram of ghruta gives 9.3 colories.

GHRITA CONTAINS :

Tri -glycerides -97.098% Di- glycerides-0.25 - 1.4%

Monoglycerides – 0.16 - 0.038 % Ketoacid glycerides-0.015-0.018 %

Glycerylesters -0.011-0.05% Free fattyacids -0.1-0.44%

Phospholipids -0.2 -1.0% Vitamin –D8.5x 10.7gm ( per 100 gm)

Vitamin-E --24x10.3gm ( per 100 gm) Vitamin-K—1x10.4gm ( per 100 gm)

Butric acid – 4.5 -6.0 % Caporic acid -1.0-1.36%

Caprylic acid -0.9-1% Capric acid-1.5-1.8%

Lauric acid-6-7% Myristic acid -21-23%

Palmitic acid – 19-19.5% Stearic acid -11-11.5%

Arachidic acid -0.5-0.8% , Oleic acid - 27-27.5% , Linoleic acid – 4-5%

MOORCHITA TAILA223-228 –

Tila taila moorchhana was carried in the manjishtadi dravyas. It has madhura rasa,

madhura vipaka. Madhura makes the vata shamana by making srotoshuddhi, widening of

the srotases.

Drug Review


Table no- 30 Showing the properties of Moorchita tila taila.

No. Drug Latin

name Rasa Guna Veerya Vipaka Prayuktaanga

Dosha-

ghnata

Karma-

ghanata

01. Tila Sesamum

indicum

Katu, tikta,

kashaya

Guru Ushna Katu Beeja. Vata

nashaka

Vruna, shotha,

kushta.

02. Manjishtha Rubia

cordifolia

Madhura, katu Guru Ushna Katu Moola. Kapha-

pitta

nashaka

Kushta,

raktatisara,

03. Amalaki Emblica

officinale

Amla pradhana,

lavana varjita

pancharasa

Guru

ruksha

Sheeta Madhura Phala. Tridosha

shamaka

Raktapitta,

prameha.

04. Vibhitaki Terminalia

bellerica

Kashaya Laghu

ruksha

Ushna Madhura Phala. Tridosha

shamaka

Bhedana,

kasahara.

05. Mustha Cyperus

rotendus

Tikta kashaya Laghu

ruksha

Sheeta Katu Kanda Kapha-

pitta

nashaka

Trishna jwara

atisara

06. Haridra Curcuma

longa

Tikta, katu Laghu

ruksha

Ushna Katu Kanda Kapha-

pitta

nashaka

Twak vikara

meha shosha

pandu

07. Lodhra Symplocus

racemosa

Kashaya. Laghu,

ruksha.

Sheeta Katu Twak. Kapha-

pitta

nashaka

Raktatisara,

jwaratisara.

Drug Review


08. Haritaki Termminali

a chebula

Kashaya

pradhana lavana

varjita

pancharasa.

Laghu,

ruksha.

Ushna Madhura Phala. Tridosha

shamaka

Brimhana,

swasa kasa.

09. Kamala nala Nelumbo

nucifera

Madhura. Guru. Sheeta Madhura Stem. Kapha-

pitta

nashaka

Trishna, daha,

visarpa.

10. Vata ankura Ficus

bengalensis

Kashaya. Guru. Sheeta Katu Ankura. Kapha-

pitta

nashaka

Visarpa, daha,

vrana.

Drug Review


MOORCHITA TILA TAILA GUNAS - Table no- 31

SAMANYA GUNAS C.S S.S A.S. Dh.N. K.N Bh.N

Guru - + - - + +

Stharayam - - - - +

Bala- varna Karam - + - - - +

Saram - + - - - +

Vrushya - + - - - +

Vikasi - + - - + +

Vishadam - + - - + +

Madhuram + + - + +

Sukshama + + + - + +

Kshaya Anurasam + + - - + +

Tiktam - + + + + +

Kapha vatapham + + + - + +

Ushana veeryam + + + - + +

Pittalam + - - - - -

Hima sparsha +

Bruhmhna/Balayam + + - - + +

Raktapitta Kruta - - - - + +

Lekhanam - + - - + +

Banda-vid-mootra hita + + + - + +

Garbhasya vishodhanam - + - - + +

Deepanam - - - - + +

Buddhim, Medhyam + + - - + +

Vyavayi + + + - + +

Vranahita - - - - + +

Mehahita - - - - + +

Srotra-yoni-Shirashoola

nasanam

- + - - + +

Laghutakaram - - - - + +

Drug Review


Twachya + + + - + +

Keshya - - - - + +

Chakshushya - + + - + +

Abhyangaartha - + - - + +

Shukra Krita - - - - +

[Chinna-binna-chuti-

Utpista-Mathitha-Kshata-

picchata-darita-Abhinata-

vida-Bhagna] hita

-

+

-

+

+

+

Sphutita hita - + - + - +

Kshara/Agni-dagdha hita - + - + + +

Kshata hita - + - + - +

Basti, pana, Aanna-

sanskara Nasyakarama-

Akshi- pooma, Seka,

Abhyanga, Avagaha-hita

-

+

-

+

+

+

Tarapana/Preenanam - + - +

Pachanam - + -

Salakshna pureesham

Badhnati and skhalitam tu

Phavartate

- - - + -

Klama Nashanam - - - + -

Sandhimukta-hitam - - - + -

Vatahara - - - + - -

Shodhanam - + - - - -

Mamsa Sthrayam - + - - + -

Mardhavam - + - - + -

Krimighna - + + - + -

Ashit-pittajananam - + - - - -

Mriga-VyalaVridhata - + - + + -

Krushanaam-Bruhanya - - + - + -

Sthulanaam Karshanya - + - + -

Drug Review


Sanskarat-Sarva rogajita + - + + + -

Jara-Nirvaraka + - + - - -

Jita-Shrama + - + - - -

Agni-vardhanam + - - - - -

Na-Kaphakaram + - +

TAILA:Ch.su.13/12

Chemical Composition : Table no-32

Gandharvahasta Eranda taila 50-100 ml + 200ml milk

| -- -

Fatty acid Nomenclature Minimum Maximum

Palmitic C16:0 7.0 % 12.0 %

Palmitoleic C16:1 trace 0.5 %

Stearic C18:0 3.5 % 6.0 %

Oleic C18:1 35.0 % 50.0 %

Linoleic C18:2 35.0 % 50.0 %

Linolenic C18:3 trace 1.0 %

C20:1 Eicosenoic trace 1.0 %

http://www.answers.com/topic/palmitic-acid�

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http://www.answers.com/topic/linolenic-acid�

Drug Review


-

ERANDA :

Pharmacognostical profile:-

Latin Name : Ricinus communis

English Name : Castor

Natural order : Euphorbiaceae

Part used : Seed, Oil, Leaves, Root.

Gana : Bhedaniya, Svedopaga, Madhura Skandha. (Ch.)

Vidarigandhadi, Adhobhagahara,Vatasamshamana (Su.)

Pharmecodynamic profile :-

Rasa : Madhur (Anurasa) : Katu, Kashaya,

Guna : Snigdha, Tikshna, Sukshma

Virya : Ushna

Vipaka : Madhura

Doshaghnata : Kapha-Pittahara, Pittasara.

Karma : Sothahara, Vedanasthapana, Virechaka, Krimighna

Drug Review


Showing the properties of Gandharvahasta taila. (A.San.Chi.15/17)- Table no- 33

Ingredients Qua. Rasa Guna Veerya Vipaka Doshaghnata Action

Gandharvahasta

Moola

1 tola Kashaya Laghu,

snigdha

Sheeta Madhura Vata-pitta

shamaka

Vatavyadhi

shamaka

Yava 1 Adaka Madhura Guru,

snigdha


shamaka

Balya,

dhatuvardhaka.

Nagara ½ Kadava Katu Laghu,

ushna

Ushna Mahdura Vata-kapaha

shamaka

Deepana,

pachana

Eranda taila 1 prasta Kashaya Laghu,

snigdha


shamaka

Vidhradi,

gulma, shopa

METHODOLOGY

Methodology

“A Clinical study to Evaluate the Efficacy of Virechana Karma in Pakshaghata ” Page 98

METHODOLOGY

Pakshaghata is one of the vata vyadhi in which vitiated vata dosa results in

disturbance, in the functions of human body, which in turn leads to Chestanivruthi.

Virechana is considered as the foremost treatment for Pakshaghata. It not only serves

the purpose of alleviation of vitiated vata, but additionally promotes strength to the

body.

Keeping the above said facts in background, the present study aims at

assessing the efficacy of Virechana to manage the Pakshaghata.

Objectives of the study:

• To evaluate the effect of virechana karma in patients suffering from

Pakshaghata clinically.

• Conceptual study of virechana karma and pakshaghata will be taken up.

MATERIALS AND METHODS:

Source of data:

A minimum of 20 patients diagnosed as Pakshaghata will be selected for the study

taken from IPD of S.D.M Ayurveda Hospital Kuthpady, Udupi.

Method of data collection:

Pakshagahta where in, patients of either sex will be selected randomly.

A detailed proforma will be prepared considering all points pertaining to history,

signs and symptoms and examinations as mentoined in our classics and allied sciences to

confirm the diagnosis.

It is a clinical study to evaluate the efficacy of virechana karma by Gandarvahasta

eranda taila in pakshagata patients.

Inclusion criteria:

• Patients diagnosed as Pakshaghata (CVA with hemiplegia)

• Patients who are virechana yogya.

• Age group of 30-60 yrs.

Methodology


• Mild to moderate hypertensive will be considered.

• In case of the patients of pakshagata of sudden onset if there is unstable

hypertension such conditions are stabilized with appropriate treatment and later

taken up for the study.

Exclusion criteria:

Patients of Intracranial infection

Degenerative lesions

Intracranial space occupying lesions and truma.

Patient with altered sensorium.

Study design

This is a single blind clinical study with pretest and post test design where in

minimum of twenty patients diagnosed as Pakshaghata of either sex will be selected.

All the patients following inclusion criteria will be subjected to virechana karma in

pakshagata by Gandarvahasta eranda taila .

Duration of Study

1. Deepana & Pachana 3-7 days.

2. Snehanapana- 3-7 days.

3. Abhyanga & Sweda - 4 days.

4. Virechana Karma for 1 day (on the last day of abhyanga and swedana)

5. Samsarjana krama 3-7 days.

6. follow up 15 days.

Total duration of study:- maximum of 40 days

Intervention:

Purvakarma:

• Deepana,Pachana with Chitrakadi vati &Agnitundi vati for 7days.

• Snehapana (Arohana krama) with-Moorchita ghrita –3-7days

Methodology


• Abhyanga with Moorchita taila &

Swedana- Ushna jala snana - 4 days

Pradhanakarma:

• Virechana karma with Gandarvahasta eranda taila 50 -100ml + 100ml dugda

(According to the agnibala, kosthabala and vyadhibala dose will be selected)

Paschatkarma.

• Samsarjana krama depending on the shuddhi laxanas for 3-7 days.

• Avoidence of astamaha varjyakara bavas.

Assessment criteria:

Subjective parameters :-

1) symptoms of pakshaghata like chesta nivrutti, ruja, vaksthamba, graheetwa arda

shareera, sira snayu vishoshana hasta paada sankocha, thoda & shoola.

2) Lingiki and antiki features of virechana.

Objective parameters:-

1)Signs of samyak viriktha lakshana i.e. vegiki, maniki.

2)Neurological mapping.

Assessment - Before treatment

- After treatment - 1) after deepana & paachana

2) after snehana

3) after swedana

4) after virechana

5) after samsarjana karma

6) follow up 15days.

Investigations: Hb%, TC, DC, ESR, Serum electrolytes, Blood urea,serum creatinine,

Uric acid, RBS, ECG, CT scan if needed.

Methodology


A comprehensive clinical examination was done before and after treatment as per

the Standard symptom scoring.

Table no- 34

Finger Movement Score

No movement 0

Slight movement 1

Unable to hold the object 2

Able to hold with less power 3

Normal 4

Lifting of arm at Shoulder

No 0

Upto 45 1

Upto 90 2

Upto 135 3

Upto 180 4

Lifting of leg at Hip joint

No 0

Upto 45 1

Upto 90 2

Sitting from lying down

Unable 2

With support 1

Without support 0

Standing from sitting

Unable 2

Methodology


With support 1

Without support 0

Loss of Speech

Global aphasia 4

Utter voice 3

Speak few words 2

Speak with difficulty 1

Normal 0

Reflexes

Absent 0

Present 1

Brisk 2

Very brisk 3

Clonus 4

Muscle tone

No increase 0

Slight increase with catch and release 1

Minimal resistance through range following

catch

2

More marked increase tone through Range of

movement

3

Considerable increase in tone, passive

movement difficult

4

Affected part rigid 5

Muscle strength

Normal power 5

Methodology


Diminished 4

Movement against gravity 3

Movement with gravity eliminated 2

Flicker with attempting movement 1

No movement 0

Drooping of Wrist/Foot

Full 3

Moderate 2

Slight 1

No 0

Paper holding

Normal 2

Patient holds gently 1

Patient fails to hold paper 0

Handgrip Power test: The mercury level of Sphygmomanometer was kept steady at

10mm of Hg and patient was asked to press the cuff with maximum strength. First with

unaffected hand and then with affected hand. 3 readings were taken. Then mean of three

readings were calculated before treatment and after treatment.

Foot Pressure: Weighing machine was kept in upright position by giving support of

wall. Patient was asked to press with his leg on the machine as much as possible. Three

readings were taken, then mean of three readings were calculated before and after

treatment.

Walking time: Patient was asked to walk 50 feet distance in a straight line. The time

taken to walk the distance was recorded in seconds. It was then compared before and

after treatment.

OBSERVATIONS & RESULTS

Observations

“A clinical study to evaluate the efficacy of virechana karma in pakshaghata ” Page 104

OBSERVATIONS:

Total No. of patients registered for the study – 20

No. of patients completed the present clinical study – 20

Descriptive statistical analysis

The details of the descriptive statistical analysis in regards to age, sex, religion, marital

status, dietary habit etc of 20 patients suffering from pakshaghata is elaborated in the

following paragraphs.

Distribution of patients according to age:

Table No- 35 Graph Number:1

As shown in the table maximum of 35 % of the patients belonged to the age group of

51- 60 years, 30% of patients belonged to the age group of 41 to 50 years, 20% of

patients belonged to the age group of 61 to 70 years, and 15% patients represented the

age group of 30 to 40 years.

0

1

2

3

4

5

6

7

3

6

7

4

30-40 41-50 51-60 61-70

Age-Yrs No: of

Patients

%

30-40 03 15%

41-50 06 30%

51-60 7 35%

61-70 4 20%

Observations


Distribution of Patients According to Sex Table no- 36 Graph Number-2

Among 20 Patients taken to study maximum were Males .As shown in the Table 65 % of

the Patients were Males and 35% of the Patients were Females.

Distribution According to religion: Graph Number- 3 Table No- 37

Most of the patients included in the study were Hindus (65%) followed by Muslims

(15%) and Christians (20%).

02468

101214

sex

13

7

Male Female

02468

101214

13

34

Hindu Muslim christion

Sex No: of

Patients

%

Male 13 65%

Female 7 35%

Religion No: of Patients %

Hindu 13 65%

Muslim 3 15%

Christian 4 20%

Observations


Distribution of patients according to their Educational Qualification:

Table No.38 Graph Number-4

Among 20 patients of Pakshaghata 55% of the patients had primary education, 15% of

patients had high school education , graduates and uneducateds.

Distribution of Patients according to Marital Status.

Table No.- 39 Graph number-5

Among 20 patients 16 patients belonged to married group, 1 patients belonged to

Unmarried group and 3 patients belonged to widow group.

0

2

4

6

8

10

12

3

11

3 3

Uneducated Primary High Graduates

0

5

10

15

20 16

13

Married Unmarried

Education No: of

Patients

%

Uneducated 3 15%

Primary 11 55%

High school 3 15%

Graduates 3 15%

Marital

Status

No: of

Patients

%

Married 16 80%

Unmarried 1 5%

Widow 3 15%

Observations


Distribution of patients according to Socio-economic Status:

Table No- 40 Graph Number-6

Most of the patients were from lower middle class 45% followed by 30% 0f patients

belonging to poor class, 25%0f patient belonged to higher class .

Distribution of patients according to their Occupation:


06 patients were in Agriculture (30%), 05 patients were house wife (25%), and 05

patients were labour class(25%) and 04 patients were from business class(20%).

0

2

4

6

8

10

6

9

5

0

Poor Lower middle Higher Middle Rich

0

1

2

3

4

5

65 5

4

6

Labours House wife Business Agriculture

Socioeconomic Status

No: of

Patients

%

Poor 06 30%

Lower middle 9 45%

Higher Middle 5 25%

Rich 0 0%

Occupation No: Of Patients

%

Labours 5 25%

House wife 5 25%

Business 4 20%

Agriculture 6 30%

Observations


Distribution of Patients according to desha


In the present study that 70 % patients hailed from Anupa desha, 20% patients from

jangala and 10 % of patients are from sadharana desha.

Distribution of Patients according to associated diseases


60% of the patients included under chronic Hypertensive & DM group And 20% patients

were having association of HTN , and 10 % were not having any associated disease.

Jangala Anupa Sadharana

4

14

2

Desha

0

5

10

15

6

12

2

HTN HTN & DM Nothing specific

Desha No: of Patients

%

Jangala 4 20%

Anupa 14 70%

Sadharana 2 10%

Associated

Diseases

No: of

Patients

%

HTN 6 30

HTN & DM 12 60

Nothing specific 2 10%

Observations


Distribution of Patients according to diet


The present study shows that maximum No. of Patients in the study had mixed diet habit 65% where as 35% of them had Vegetarian diet. Distribution of Patients according to Nidra Table No- 45 Graph Number-11

The study shows that 75% of Pts suffered from disturbed & delayed sleep and 25% of

them had un-disturbed sleep.

0

5

10

15

7

13

Vegetarian Mixed

0

5

10

15

15

5

Disturbed & Delayed Un disturbed

Diet No: of

Patients

%

Vegetarian 07 35%

Mixed 13 65%

Nidra No: of Patients

%

Disturbed & Delayed

15 75%

Undisturbed 5 25%

Observations


Distribution of Patients according to addiction


The study shows that 30% of patients were addicted to alcohol, where as 25% of

patients had addiction to tea/ coffee, 20% of patients addicted to smoking, 15% of

patients addicted to tobacco chewing, 10%of patients addicted to snuffing.

Distribution of Patients according to prakruti Table No- 47 Graph Number-13

The study shows that majority of the patients belonged to Vata-pitta Prakruti (55%), 5

patients belonged to Vata-Kapha prakruti ( 25%) and 04 Patients belonged to Pitta-kapha

(20%),.

4

6

3

2

5

0

2

4

6

8

10

1211

45

Vata-pitta Pitta-kapha Vata-kapha

Habits No: of

Patients

%

Smoking 4 20%

Alcohol 6 30%

Tobacco

chewing

3 15%

Snuffing 2 10%

Tea/Coffee 5 25%

Prakruti No: of Patients

%

Vata-pitta 11 55%

Pitta-kapha 4 20%

Vata-kapha 5 25%

Observations


Distribution of Patients according to satwa


The study shows that most of patients in the study had Madhyama satwa 55%, while 30%

of them had Avara satwa, and 15% were having pravara satva .

Distribution of Patients according to Saara :

Table No- 49

Graph No- 15

Study showed 40% of the patients were of Mamsa sara ,were as 30% of the patients were

Twak sara,10% of patients are medosaara majja sara and asthisara respectively.

0

2

4

6

8

10

12

3

11

6

Pravara Madhyama Avara

012345678

6

8

21

3

twaksara mamsasara medosara majjasara

Satwa No: of

Patients

%

Pravara 3 15%

Madhyama 11 55%

Avara 6 30%

Sara Number

of Patients

%

twaksara 6 30%

mamsasara 8 40%

medosara 2 10%

majjasara 2 10%

asthisaara 2 10%

Observations


Distribution of Patients according to Rasa Saatmya :


Among 20 patients 12 were belonged to Eka rasa Saatmya( 60%), 40% of patient are

belongs to sarva rasa saatmya.

Distribution of Patients according to samhanana


The study shows that 15 patients had madhyama samhanana (75%) and 3 patients had

avara samhanana (15%) and only 2 patients were having Pravara samhanana (10%) .

02468

1012

12

8

Eka rasa Sarvarasa

0

5

10

15

2

15

3


rasasatmya No: of

Patients

%

Eka rasa 12 60%

sarvarasa 08 40%

Samhanana Number of

Patients

%

Pravara 2 10%

Madhyama 15 75%

Avara 3 15%

Observations


Distribution of Patients according to ahara shakti

Table No- 52 -53

Abhyavaran

shakti

Number

of Patients

% Jarana Shakti Number of

Patients

%

Pravara 1 5% Pravara 1 5%

Madhyama 17 85% Madhyama 17 85%

Avara 2 10% Avara 2 10%

Abhyavaran shakti Jarana Shakti

Graph Number-18 Graph Number-19

Maximum patients were having Madhyama Abhyavarana and Jarana shakti

(85%).followed by Avara Abhyavarana and Jarana shakti 10% and Pravara Abhyavarana

and Jarana shakti 5% .

0

5

10

15

20

1

17

2


0

5

10

15

20

1

17

2


Observations


Distribution of Patients according to vyayama shakti Table N0- 54 Graph Number-20

As karma kshya and karma hani are the cardinal features of Pakshaghata , therefore 80%

the patients were concluded under Avara vyayama shakti only 2 patients have madhyama

vyayama shakti.

Distribution of Patients according to vaya


In the present study 90% of pts belonged to Madhyama vaya and remaining 10% were

Vruddha.

0

5

10

15

20

02

18

Pravara Madyama Avara

02468

10121416

0

16

4

Bala Madhyama Vruddha

Vyayama

Shakti

Number

of

Patients

%

Pravara 00 00

Madyama 02 20%

Avara 18 80%

Vaya Number of

Patients

%

Bala 00 00

Madhyama 18 90%

Vruddha 2 10%

Observations


Distribution of Patients according to koshta


In the present study 80% of patients had Madhyama koshta, where as 15% had krura

koshta, and remaining 15% of patients had Mrudu koshta.

Distribution of Patients according to duration of illness


Maximum of 55% of patients gave the history of more than one and half months, (i:e

upto 6 months) and 15% gave the history of 31-40days, followed by 20% the history of

21-30 days and 10% Of the patient gave the history of 10-20 days were the minimum no.

of cases observed in study.

05

10152025303540

9

36

15

Mrudu Madhyama Krura

0

2

4

6

8

10

12

2

43

11

10-20 days 21-30 days

31-40 days >40 days

Koshta Number of

Patients

%

Mrudu 03

15%

Madhyama 16

80%

Krura 01

5%

Duration Number of Patients

%

10-20 days 2 10%

21-30days 4 20%

31-40days 3 15%

> 40 days 11 55%

Observations


Distribution of Patients according to side affected


60% of patients had right side affected while 40% had left side involvement. Distribution of Patients according to predominant lakshanas Table No : 59

Features Number of Patients

%

Karma kshaya 15 75%

Karma hani 5 25%

Vichetana 17 85%

Vakstambha 7 35%

Sankocha 16 80%

Sandhi bandha vimoksha 4 20%

Ruja 13 65%

Toda 7 35%

Shotha 3 15%

02468

1012

12

8

Right Left

Side

Affected

Number

of Patients

%

Right 12 60%

Left 8 40%

Observations


Graph Number:25

Karma kshaya was noted in 15 patients( 75%) and karma hani was noted in 05 patients

(25%). In this study loss of strength is considered as Karma hani and reduced in the

strength is considered as Karma kshaya.

0

5

10

15

15

5

karmakshaya karmahaani

NEUROLOGICAL PARAMETERS

Neurological Parameters


EFFECTS OF VIRECHANA KARMA ON DIFFERENT

NEUROLOGICAL PARAMETERS

The analysis was done statisticaly using version SPSS statistics 17.0 software.

Paired t- test was used for comparing the results.

BT- Before the initiation of virechana karma.

AT-Immediately after the completion of virechana.

AF- After the completion of follow up of 30 days.

Effect of treatment on Biceps Reflex- Table N0- 60

n BT

Mean

Follow up

Mean

Diff “d”

% Paired ‘t’ test

SD SE ‘t’ P

20

2.6

AT 2.25 0.35 13.46154 0.6386 ±0.1428 23.134 P<0.0001

AF 1.4 1.2 46.15385 0.5026 ±0.1124

Graph No- 26

Statistical analysis revealed that Biceps score showed an improvement of 13.46% soon

after the treatment and it was increased to 46.15% after follow up . This change is

statistically significant (P<0.001) with 19 degrees of freedom.

0

0.5

1

1.5

2

2.5

3 2.62.25

1.4

BT AT AF



Effect of treatment on triceps Reflex - Table No- 61

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.55

AT 2.35 0.2 7.843137 0.4894 ±0.1094 22.342 P<0.0001

AF 1.4 1.15 46.15385 0.5026 ±0.1124

Graph No.-27

Statistical analysis revealed that there was 7.84% improvement in triceps score after the

treatment .and after follow up it was increased to 46.15% . This change is statistically

significant (P<0.001).

Effect of treatment on Brachioradialis Reflex- Table No- 62

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.65

AT 2.35 0.3 11.32 0.4894 ± 0.109 24.218 P<0.0001

AF 1.4 1.25 47.16 0.5026 ± 0.112

Graph No. 28

00.5

11.5

22.5

3 2.55 2.35

1.4

BT AT AF

00.5

11.5

22.5

32.65

2.35

1.4

BT AT AF



Statistical analysis revealed that there was 11.32 % improvement in Brachioradialis score

during After treatment and was further increased to 46.15% during follow up. This

change is statistically significant (P<0.001)

Effect of treatment on Knee Reflex - Table N0- 63

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.35

AT 2.15 0.2 8.51 0.7452 ± 0.166 21.476 P<0.0001

AF 1.4 0.95 40.42 0.5026 ± 0.112

Graph No.- 29

Statistical analysis revealed that there was 18.30% improvement in knee reflex score

immediately after the treatment and after follow up it was further increased to 35.01% .

This change is statistically significant (P<0.001).

Effect of treatment on Ankle Reflex- Table No. 64

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.2

AT 2.15 0.05 20.37 0.5871 ± 0.1313 25.682 P<0.0001

AF 1.5 0.7 44.44 0.6070 ± 0.1357

0

0.5

1

1.5

2

2.52.35

2.15

1.4

BT AT AF



Graph No.- 30

Statistical analysis revealed that there was 20.37 % improvement in ankle reflex score

during AT and which was further improved to 44.44% during follow up. This change is

statistically significant (P<0.001).

Effect of treatment on Power-Upper limb; shoulder

Table Number- 65

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

1.9

AT 2.15 0.25 29.41 0.3078 ± 0.0688 2.337 P=0.0248

AF 2.65 0.75 38.23 0.3663 ± 0.0819

Graph Number- 31

0

0.5

1

1.5

2

2.52.2 2.15

1.5

BT AT AF

00.5

11.5

22.5

3

1.92.15

2.65

BT AT AF



Statistical analysis revealed that there was 29.41% improvement in score of power of

shoulder soon after treatment and was further increased to 38.23% after the follow up. This

is Statistically significant (P<0.001)

Effect of treatment on Power-Upper limb; Elbow

Table Number - 66

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.8

AT 3.1 0.3 12.28 0.4104 ± 0.0917 2.210 P=0.0332

AF 3.9 1.1 38.98 0.4472 ± 0.1000

Graph Number -32

Statistical analysis revealed that there was 12.28% improvement in score of power of elbow

soon after treatment and was further increased to 38.98% after the follow up. This change

that occurred with the treatment is statistically significant (P=0.0332).

Effect of treatment on Power-Upper limb; Wrist

Table Number- 67

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.95

AT 1.25 0.3 23.21 0.2236 ± 0.050 2.698 P=0.0104

AF 1.55 0.6 44.64 0.4443 ± 0.0993

0

1

2

3

42.8

3.1

3.9

BT AT AF



Graph Number - 33

Statistical analysis revealed that there was 23.21% improvement in score of power of wrist



Effect of treatment on Power-Lower limb; Hip Table Number- 68

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.7

AT 2.95 0.25 17.64 0.4702 ± 0.1051 2.147 P=0.0382

AF 3.2 0.5 43.13 0.2236 ± 0.0500

Graph Number - 34

0

0.5

1

1.5

2

0.951.25

1.55

BT AT AF

2.4

2.6

2.8

3

3.2

2.7

2.95

3.2

BT AT AF



Statistical analysis revealed that there was 17.64% improvement in score of power of Hip

soon after treatment and was further increased to 43.13% after the follow up. This is

statistically significant (P=0.0382).

Effect of treatment on Power-Lower limb Knee

Table Number- 69

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.65

AT 2.95 0.3 16.36 0.4894 ± 0.1094 2.494 P=0.0171

AF 3.6 0.95 46.15 0.2236 ± 0.0500

Graph Number - 35

Statistical analysis revealed that there was 16.36% improvement in score of power of knee



Effect of treatment on Romberg’s test

Table number - 70

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.8

AT 0.9 0.1 18.46 0.5231 ± 0.1170 10.17 P<0.0001

AF 1.3 0.5 30.76 0.3078 ± 0.0688

0

1

2

3

42.65

2.953.6

BT AT AF



Graph Number - 36

Statistical analysis revealed that there was 18.46% improvement in Romberg’s test soon

after treatment and later on ,there was further improvement to 30.76 % after the follow up.

This change is statistically significant (P<0.001)

Effect of treatment on Finger nose test

Table Number- 71

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

01

AT 1.1 0.1 13.33% 0.5871 ± 0.1313 10.568 P<0.0001

AF 1.65 01 39.39% 0.5525 ± 0.1235

Graph Number – 37

Statistical analysis revealed that there was 13.33% improvement in Finger nose test soon

after treatment and later on improvement was further increased to 39.33 % after the follow

up. This change is statistically significant (P<0.001).

00.20.40.60.8

11.21.4

0.80.9

1.3

BT AT AF

0

0.5

1

1.5

2

1 1.1

1.65

BT AT AF



Effect of treatment on Heel shin test

Table Number- 72

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

1.1

AT 1.3 0.2 16.66 0.7881 ± 0.1762 11.052 P<0.0001

AF 1.5 0.4 36.66 0.3078 ± 0.0688

Graph Number - 38

Statistical analysis revealed that there was 16.66 % improvement in Heel shin test soon

after treatment and later on improvement was further increased to 36.66% after the follow

up. This change that occurred is statistically significant (P<0.001).

Effect of treatment on Finger movement hand

Table Number- 73

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

1.1

AT 1.5 0.4 21.05% 0.6070 ± 0.1357 10.782 P<0.0001

AF 1.9 0.8 42.10% 0.3878 ± 0.0688

0

0.5

1

1.51.1

1.31.5

BT AT AF



Graph Number - 39

Statistical analysis revealed that there was 21.05 % improvement in Finger movement hand

soon after treatment and was further increased to 42.10 % after the follow up. This change

that occurred with the treatment is statistically significant (P<0.001).

Effect of treatment on Finger movement foot

Table Number- 74

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

1.05

AT 1.4 0.35 15.15% 0.2236 ± 0.1522 8.432 P<0.0001

AF 1.65 0.60 36.36% 0.6806 ± 0.0500

Graph Number - 40

Statistical analysis revealed that there was 15.15 % improvement in Finger movement foot

soon after treatment and was further increased to 36.36 % after the follow up. This change

that occurred with the treatment is statistically significant (P<0.001).

0

0.5

1

1.5

2

1.11.3

1.9

BT AT AF

0

0.5

1

1.5

2

1.05

1.41.65

BT AT AF



Effect of treatment on Lifting of arm at shoulders

Table Number- 75

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

1.05 AT 1.2 0.15 29.41 0.5231 ± 0.1170 9.488 P<0.0001

AF 1.7 0.65 38.23 0.2236 ± 0.05000

Graph Number- 41

Statistical analysis revealed that there was 14.89 % improvement in Lifting of arm at

shoulder soon after treatment and was further increased to 51.06 % after the follow up. This

change that occurred with the treatment is statistically significant (P<0.001).

Effect of treatment on Lifting of leg at hip

Table Number- 76

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

1.05

AT 1.15 0.1 34.28 0.4894 ± 0.1094 8.596 P<0.0001

AF 1.75 0.7 40 0.2236 ± 0. 05000

0

0.5

1

1.5

2

1.051.2

1.7

BT AT AF



Graph Number- 42

Statistical analysis revealed that there was 34.28% improvement in Lifting of leg at hip soon

after treatment and was further increased to 40% after the follow up. This change that

occurred with the treatment is statistically significant (P<0.001).

Effect of treatment on Sitting from lying down

Table Number- 77

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.2

AT 0.75 0.55 46.42 0.4104 ± 0.09934 12.457 P<0.0001

AF 1.4 1.2 85.71 0.4443 ± 0.09177

Graph Number - 43

0

0.5

1

1.5

2

1.05 1.15

1.75

BT AT AF

00.20.40.60.8

11.21.4

0.2

0.75

1.4

BT AT AF



Statistical analysis revealed that there was 46.42% improvement in Sitting from lying down

soon after treatment, and later on improvement was further increased to 85.71% after the

follow up. This change is statistically significant (P<0.001).

Effect of treatment on Standing from sitting

Table Number- 78

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.2

AT 0.85 0.65 41.37 0.5871 ± 0.1313 10.722 P<0.0001

AF 1.45 1.25 86.20 0.4104 ± 0.09177

Graph Number - 44

Statistical analysis revealed that there was 41.37% improvement in Standing from sitting

soon after treatment and which was further increased to 86.20% after the follow up. This

change is statistically significant (P<0.001).

Effect of treatment on Drooping wrist

Table Number- 79

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.9

AT 1.4 0.5 26.31 0.9947 ± 0.2224 7.292 P<0.0001

AF 1.9 1 52.63 0.7182 ± 0.1606

0

0.5

1

1.5

0.2

0.85

1.45

BT AT AF



Graph Number - 46

Statistical analysis revealed that there was 26.31% improvement in Drooping wrist soon

after treatment and which was further increased to 52.63% after the follow up. This change

is statistically significant (P<0.001).

Effect of treatment on Drooping foot Table Number- 80

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.7

AT 1.1 0.4 24.13 0.9119 ± 0.2039 5.445 P<0.0001

AF 1.45 0.75 51.72 0.8013 ± 0.1792

Graph Number - 46

Statistical analysis revealed that there was 24.13% improvement in Drooping foot soon


is statistically significant (P<0.001).

0

0.5

1

1.5

2

0.9

1.4

1.9

BT AT AF

0

0.5

1

1.5

0.7

1.1

1.45

BT AT AF



Effect of treatment on Loss of speech

Table Number- 81

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.15

AT 0.45 0.3 52.63 0.5104 ± 0.1141 7.025 P<0.0001

AF 0.95 0.8 84.21 0.3663 ± 0.08192

Graph Number - 47

Statistical analysis revealed that there was 52.63% improvement in Loss of speech soon


is statistically significant (P<0.001)

Effect of treatment on Muscle tone Upper limb:

Table Number- 82

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

1.9

AT 2.35 0.45 23.68% 0.4894 ± 0.1094 15.379 P<0.0001

AF 3.3 1.4 73.68% 0.7327 ± 0.1638

0

0.2

0.4

0.6

0.8

1

0.15

0.45

0.95

BT AT AF



Graph Number- 48

Statistical analysis revealed that there was 23.68%improvement in Muscle tone hand

soon after treatment and later on improvement was further increased to after the 73.68%

follow up. This change is statistically significant (P<0.001).

Effect of treatment on Muscle tone of lower limb:

Table Number- 83

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.1

AT 2.65 0.55 26.19% 0.5871 ± 0.1313 14.658 P<0.0001

AF 3.3 1.2 57.14% 0.7327 ± 0.1638

Graph Number- 49

0

1

2

3

4

1.92.35

3.3

BT AT AF

0

1

2

3

4

2.12.65

3.3

BT AT AF



Statistical analysis revealed that there was 26.19% improvement in Muscle tone of leg soon after treatment and later on improvement was further increased to to 57.14% after the follow up. This change is statistically significant (P<0.001).

Effect of treatment on Muscle strength of upper limb:

Table Number- 84

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.7

AT 3.2 0.5 18.51% 0.6156 ± 0.1376 21.138 P<0.0001

AF 3.95 1.25 46.29% 0.6048 ± 0.1352

Graph Number - 50

Statistical analysis revealed that there was 18.51% improvement in Muscle strength of upper

limb soon after treatment and later on improvement was further increased to to 46.29 %

after the follow up. This change is statistically significant (P<0.001).

Effect of treatment on Muscle Strength of Lower limb

Table Number- 85

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

2.85

AT 3.4 0.55 19.29% 0.5982 ± 0.1338 21.708 P<0.0001

AF 3.95 1.1 38.59% 0.6048 ± 0.1352

0

1

2

3

42.7

3.2

3.95

BT AT AF



Graph Number- 51

Statistical analysis revealed that there was 19.29% improvement in Muscle strength of lower

limb soon after treatment and later on improvement was further increased to

38.59 % after the follow up. This change is statisticaly significant (P<0.001).

Effect of treatment on Hand –grip power Table Number- 86

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.6

AT 0.7 0.1 16.66% 0.4702 ± 0.1051 5.339 P<0.0001

AF 1.1 0.5 28.33% 0.3078 ± 0.0688

Graph Number - 52

0

1

2

3

42.85

3.43.95

BT AT AF

00.20.40.60.8

11.2

0.60.7

1.1

BT AT AF



Statistical analysis revealed that there was 16.66% improvement in Hand grip power soon

after treatment and was further increased to 28.33 % after the follow up. This change that


Effect of treatment on Foot pressure

Table Number-87

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.75

AT 1.25 0.50 16.66% 0.4443 ± 0.9934 7.550 P<0.0001

AF 1.3 0.55 33.33% 0.4702 ± 0.1051

Graph Number- 53

Statistical analysis revealed that there was 16.66% improvement in Foot pressure soon after

treatment and was further increased to 33.33% after the follow up. This change that


Effect of treatment on Walking time

Table Number- 88

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.65

AT 0.7 0.05 7.69% 0.4702 ± 0.1094 5.940 P<0.0001

AF 1.1 0.45 39.23% 0.3078 ± 0.1051

00.20.40.60.8

11.21.4

0.75

1.25 1.3

BT AT AF



Graph Number- 54

Statistical analysis revealed that there was 7.69% improvement in walking time soon after

treatment and was further improvement to 39.23 % after the follow up. This change is not

statistically significant (P<0.001).

Effect of treatment on Paper holding in finger

Table Number- 89

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

20

0.6

AT 0.65 0.05 8.33 0.4894 ± 0.1094 5.339 P<0.0001

AF 1.15 0.55 31.66 0.3663 ± 0.0819

Graph Number - 55

Statistical analysis revealed that there was 8.33% improvement in Paper holding in finger

soon after treatment and further there was improvement to 31.66% after the follow up. This

change that occurred with the treatment is statistically significant (P<0.001).

00.20.40.60.8

11.2

0.65 0.7

1.1

BT AT AF

00.20.40.60.8

11.2

0.6 0.65

1.15

BT AT AF



OVER ALL EFFECT OF TREATMENT Effect of treatment on Karma kshya

Table Number- 90

n BT Mean

Follow up Mean

Diff “d”


SD SE ‘t’ P 15 2.86 AT 1.93 0.93 32.51 0.258 ± 0.066 14.00 P<0.005

AF 1.46 1.40 48.95 0.507 ± 0.013 10.697 P<0.001

Graph Number - 56

Statistical analysis revealed that there was 32.51% improvement in karma kshya soon

after treatment and was further increased to 48.95% after the follow up. This change that

occurred with the treatment is statistically significant (P<0.001) with degree of freedom 14.

Effect of treatment on Karma hani

Table Number- 91

n BT Mean

Follow up Mean

Diff “d”


SD SE ‘t’ P 05 1.82 AT 1.24 0.58 20.56 0.449 ± 0.744 7.760 P<0.001

AF 0.84 0.98 34.75 0.583 ± 0.869 11.248 P<0.001

00.5

11.5

22.5

32.86

1.931.46

BT AT AF



Graph Number -57

Statistical analysis revealed that there was 20.56% improvement in karma hani soon after

treatment and there was further improvement to 34.75% after the follow up. This change

that occurred with the treatment is statistically significant (P<0.001) with degree of

freedom 44.

Effect of treatment on Vaka stambha

Table Number- 92

n BT

Mean

Follow up

Mean

Diff “d”


SD SE ‘t’ P

03

0.15

AT 0.45 0.5 52.63 0.5104 ± 0.1141 7.025 P<0.0001

AF 0.95 0.8 84.21 0.3663 ± 0.08192

Graph Number - 58

00.5

11.5

22.5

32.82

2.241.84

BT AT AF

0

0.2

0.4

0.6

0.8

1

0.15

0.45

0.95

BT AT AF



Statistical analysis revealed that there was 52.63% improvement in vakstamba soon after

treatment and which was further increased to 84.21% after the follow up. This change is

statistically significant (P<0.001)

Effect of treatment on Sankocha

Table Number- 93

n BT Mean

Follow up Mean

Diff “d”


SD SE ‘t’ P 06 2.99 AT 1.96 1.03 34.44 0.496 ± 0.97 16.00 P<0.001

AF 1.93 1.06 35.45 0.539 ± 0.139 17.279 P<0.001

Graph Number - 59

Statistical analysis revealed that there was 34.44% improvement in sankocha soon after

treatment and there was further improvement to 35.45% after the follow up. This change

that occurred with the treatment is statistically significant (P<0.001) with degree of freedom

15.

Effect of treatment on Sandhi bhandha vimoksha Table Number- 94 n BT

Mean Follow up Mean

Diff “d”


SD SE ‘t’ P 14 2.96 AT 2.64 0.32 10.81 0.486 ± 0.63 6.325 P<0.001

AF 1.96 1.00 33.78 0.593 ± 0.77 13.579 P<0.001

00.5

11.5

22.5

3

2.99

1.96 1.93

BT AT AF



Graph Number - 60

Statistical analysis revealed that there was 10.81% improvement in Sandhi bhandha

vimoksha soon after treatment and there was further improvement to 33.78% after the

follow up. This change is statistically significant (P=0.001) with degree of freedom 25.

Effect of treatment on Ruja

Table Number- 95

n BT Mean

Follow up Mean

Diff “d”


SD SE ‘t’ P 13 2.00 AT 1.26 0.74 37.00 0.383 ± 0.903 22.279 P<0.001

AF 1.12 0.88 44.00 0.331 ± 0.577 15.232 P<0.001

Graph Number - 61

00.5

11.5

22.5

3

2.962.64

1.96

BT AT AF

0

0.5

1

1.5

2

2

1.261.12

BT AT AF



Statistical analysis revealed that there was 37.00% improvement in ruja soon after treatment

and was further improvement 44.00% after the follow up. This change that occurred with

the treatment is statistically significant (P<0.001) with degree of freedom 32.

Effect of treatment on Toda

Table Number- 96

N BT Mean

Follow up Mean

Diff “d”


SD SE ‘t’ P 07

2.00

AT 1.16 0.84 42.00 0.383 ± 0.903 9.220 P<0.001

AF 1.38 0.62 31.00 0.501 ± 0.118 5.169 P<0.001

Graph Number- 62

Statistical analysis revealed that there was 42.00% improvement in Toda soon after

treatment and it was further improvement only 31.00% after the follow up, Toda Symptom

were persist during the fallow up period. This change that occurred with the treatment is

statistically significant (P=0.001) with degree of freedom 17.

Effect of treatment on Shotha

Table Number- 97

n BT Mean

Follow up Mean

Diff “d”


SD SE ‘t’ P 13

2.78

AT 2.12 0.66 23.74 0.540 ± 0.094 7.091 P<0.001

AF 1.72 1.06 38.12 0.243 ± 0.421 25.886 P<0.001

0

0.5

1

1.5

2

2

1.161.38

BT AT AF



Graph Number - 63

Statistical analysis revealed that there was 23.74% improvement in shotha soon after

treatment and there was further improvement 38.12% after the follow up. This change is

statistically significant (P=0.001) with degree of freedom 32.

ANALYSIS OF VIRECHANA

Distribution of patients according to days of appearance of samyak snigdha lakshana

Table No: 98 Graph No. 64

About 45% of the patients developed samyak snigdha lakshana on 3rd day & 30% were on

4th day itself. But only two patients developed samyak snigdha lakshana on 5th day and 6th

day and 1 patient on 7th

day.

00.5

11.5

22.5

32.78

2.121.72

BT AT AF

0

5

10

3 4 5 6 7

9

6

2 21

No.of patients

Days Number of

patients

%

3 09 45

4 06 30

5 02 10

6 02 10

7 01 05



Total amount of abyantara sneha during the whole course of snehapana in Table No: 99 Graph No.- 65

Maximum 35% of the patients had consumed total amount of sneha in between 100-200 ml.

where as minimum of only 05% of patient consumed between 600-700 ml.

Analysis of samyak snigdha lakshana Table No: 100 Graph No.- 66

Among 20 patients, 95% of patients had Snigdha asmhata varcha feature where as minimum 35% of patients had Shaitya feature.

0

5

10

15

20

25

30

35

100-200ml 200-300ml300-400ml400-500ml500-600ml700-800

35

30

20

10

0

5

MAX.DOSE

0

10

20

30

40

50

60

70

80

90

100

16 18 19 17 16 18 8 7

80

9095

8580

90

4035

Laxshana

Dose

(In ml)

No. of patients

%

100-200 07 35

200-300 06 30

300-400 04 20

400-500 02 10

500-600 00 00

600-700 01 05

Lakshana Number of Patients

%

Vatanulomata 16 80%

Agnideepti 18 90%

Snigdha

asamhat varcha

19 95%

Gatramardava 17 85%

Twaksnigdhata 16 80%

Snehodvega 18 90%

Angalagava 08 40%

Shaitya 07 35%



Analysis of samyak Swinna lakshana Table No : 101 Graph No- 67

Among 20 patients, about 95%patients had tvak mardavata feature where as only 30% of

patient had Gourava nigraha feature.

Analysis of latency period Table No: 102 Graph No- 68

0

5

10

15

20

25

30

35

40

0 2 1 4 8 5

0

10

5

20

40

25

LAXSHANA

0

5

10

15

20

25

30

35

40

5 8 2 3 2

25

40

10

15

10

LATENCY PERIOD

Swinna Laxshana

Number of Patients

%

Sheeta shula Viparame

12 60

Stambha nigraha

11 55

Gourava nigraha

06 30

Mardavata 18 95

Sweda Pradurbhav

16 80

Deeptagni 13 65

Laghuta 15 75

Time In

minutes

Latency period

%

1-30 05 25%

31-60 08 40%

61-90 02 10%

91-120 03 15%

121-150 02 10%



Time required manifesting first Virechana Vega after administration of Virechana drug is

known as Latency period. In present study, Out of 20 patient’s maximum number of patients

i.e. 40% the latency period was between 31-60 minute range, where as in minimum of 10%

of patients latency period was between 121-150 minute range.

Analysis of Duration of Virechana Table No: 103 Graph No- 69

Out of 20 patients, in maximum number of patients i.e. 40% the duration of onset &

stoppage of Virechana was between 6 - 8 hours (361-480) minute and minimum of 10%

patients was between 2-4 hours(120-240)

Analysis of Vaigiki Shuddhi Table no: 104 Graph No- 70

0

5

10

15

20

25

30

35

40

2 6 8 4

10

30

40

20

Duration

0

10

20

30

40

50

60

0 8 12

0

40

60

VAIGIKI

Duration of Virechana

(min.)

Number of patients

%

120-240 02 10%

241-360 06 30%

361-480 08 40%

481-600 04 20%

Vaigiki Shuddhi

Number of

Patient

%

Pravara (21-30)

00 0%

Madhyama (11-20)

08 40%

Avara (1-10)

12 60%



Out of 20 patient’s, in maximum number of patients i.e.60% Avara Shuddi was found and

minimum of 08% of the patients exhibited with absence of Pravara Shuddi.

Analysis of Manaki of Virechana Table No: 105 Graph No- 71

Out 20 patients,In maximum number of patient it in ranges between 1001-2000 ml and in

one patient it was above 5000ml. Analysis of Anthiki of Virechana

Table No: 106 Graph No.- 72

0

5

10

15

20

25

30

35

40

45

5 9 2 1 2 1 0

25

45

10

5

10

5

0

DOSE

0

10

20

30

40

50

60

12 1 4 3

60

5

2015

ANTHAKI

Manaki

In ml

Number of patients

%

0-1000 05 25%

1001-2000 09 45%

2001-3000 02 10%

3001-4000 01 5%

40001-5000 02 10%

5001- 6000 01 05%

6001-7000 0 0%

Anthiki

Numberof

Patient

%

Kaphanta 12 60%

Pittanta 01 5%

Drava malanta

04 20%

Aushdhanta 03 15%



In maximum number of patient i.e. 60% exhibited Kaphant virechana,20% of dravanta, 15%

ausdhanta & minimum of 5 % with the Pittanta and virechana.

Analysis of Laingiki Lakshana of Virechana

Table no: 107 Figure No. - 73

Durably a Laingiki features are observed in maximum number of patients, other information as shown in above table.

0

10

20

30

40

50

60

70

80

90

12 16 18 13 6 14 8 4

60

80

90

65

30

70

40

20

LAINGIKI

Laingiki

Lakshana

Number of Patients

%

Laghuta 12 60

Agnivrddhi 16 80

Vatanulomana 18 90

Kramat Vit,

Pitta

Kaphagamana

13 65

Dourbalya 06 30%

Karsyata 14 70%

Kshut 08 40%

Trishna 04 20%

DRUGS PHOTOS

Virechana Dravya

DISCUSSION

Discussion


DISCUSSION

Pakshaghata is one among the Vatavyadhi characterized by cheshtanivruti. But

this Mahagada is having much more drastic expression on human life . The tragedy of

the Cerebro Vascular Accidents lies in the fact that it does not always kill rapidly in fact

it is the chief and most crippling diseases destroying body and mind alike.

Chikitsa in Ayurvedic terms not only aims at the radical removal of the disease

but also guides for the restoration and maintenance of normal health .Virechana is one

among the treatment modality for Pakshaghata.

Pakshagate Virechana has been selected for the study. While screening the

literatures it can be found that swedana and snigdha virechana in pakshagata which

pacifies the vitiated Vata dosha. Pakshaghata is vata-dominating disease even though the basti

karma is given prime shodhana karma instead of this charaka and vagbhata have adviseded

Virechana is specific shodhana for Pakshaghata.

PLAN OF STUDY:

The patients for the study were selected from the IPD section of SDMAH, Udupi.

20 patients fulfilling the inclusion criteria and presented with Prayatma Lakshana of

Pakshaghatha were registered.

Total number of patients registered – 20

Completed Present clinical study – 20

CLINICAL STUDY:

A single blind clinical study was conducted on Patients suffering from Pakshaghata.

Patients were randomly selected. In this study Virechana was administered with

gandharvahastadi eranda taila. Therefore, 1st- 7days sneha pana done with moorchita

ghrita. Next 4days abhyanga and bashpasweda done with moorchita taila. And on the 4th

day virechana karma administered. The following observations are made.

Discussion


CONCEPTUAL STUDY

Pakshaghata has been classified considering the Doshanuvandha in

and mentioned the characteristic symptoms of Kaphanubandha and Pittanubandha

Pakshaghata in Madhava Nidana. Pakshaghata is a Vata Nanatmaja Vyaadhi.

While describing the prognosis the disease has been described to be of 3 types as

1- Suddha Vaataja Pakshaaghaata, 2 –Anyadosha Samsrista Pakshaaghaata and –

kshayahetuja Pakshaghata. Here Anyadosha Samsrista can be understood as

Aavaranajanya Pakshaghata.




in Pakshaaghaata supports the fact that its Sampraapti is due to Aavarana of Vaata


Virechana is the treatment for pittadosha but in this vatavyadhi virechana is more

effective than basti, which is the treatment of choice for vatadosha. Because

Pakshavadha is basically a prana vayu veekar,the natural direction of prana vayu

is from above downwards. In virechana this proper direction of pranavayu is


In pakshavadha upadhatus of rakta i.e. Sira and Kandara vitiated for upadhatu






in Pakshaaghaata supports the fact that its Samprapti is due to Aavarana of Vaata


Pakshagata is also said to be a disease of majjavaha srotas. Majja dhatu and pitta




Discussion


The adhishthana of Pakshaghata is Indriyayatana (Mastishka). Mastishka is








Kaphandubandhit and Pittanubandhit Pakshaghata have been described in



(Ch. Chi. 28/184,185,189).

Virechana Karma is a specific process for elimination of pitta dosha (Ch.






In Pakshaghata the main dosha involved is vata. The natural abode of vata is


(Su. Chi. 4/5).

In case of Sansargaja dosha, i.e., if vata is affected by pitta and kapha both, then




Vagbhata has mentioned Mridu Sanshodhanaa (Virechana) in the general line of


Mridu Sanshodhanaa has been mentioned in treatment of Margavarna. (Ch. Chi.



Discussion


12.Majjavaha sroto dushti takes place in Pakshaghata and in order to combat the



13. If we see the general line of treatment for vata vyadhi given by Acharya

Charaka in Chikitsasthana 28th

14. Virechana Karma possesses the property of purifying the vitiated dhatus (Ka.

Si). It has been advised as a treatment in all dhatu dushti janya vikaras, viz.,

Rakta, Mansa, Meda, Majja, Shukra gata vikaras. (Ch. Su. 28/25) Srotovishuddhi,





Si. 1/17; Su. Chi. 33/27; A.H. Su. 18/60).

chapter, then after snehana and Swedana,

Virechana has been mentioned as main shodhana measure. In the patients

contraindicated for Virechana, vasti has been mentioned. Hence Virechana is

considered to be treatment of choice in vata vyadhi and so in Pakshaghata.



In the classics for pakshagata snigdha virechana is mentioned. Gandharva hastadi

eranda taila, Tilwaka ghrita and satala ghrita with payas are told.

OBSERVATIONS AND RESULTS:

Among the 20 patients included in this study belonged to the age group of 30 to

70 years. As shown in the table 15% of the patients belonged to the age group of

30 to 40 years, 30% of patients belonged to the age group of 41 to 50 years,

maximum of 35% of patients belonged to the age group of 51 to 60 years, and

20% patients represented the age group of 61 to 70 years.

Sex: In this study most of patients in the study were Males 65% and Female

patients were 35%.However outstanding to exceptionally small sample it cannot

be concluded that Male are more prone to Pakshaghata.

Discussion


Religion: Most of the patients included in the study were Hindus 65% followed by

Muslims 15% and Christians 20% This may be due to Hindu dominant population in

this area.

Educational status: The study showed that majority of patients have taken education

upto primary 55%, and High school 15% followed by Uneducated 15%, Graduates

were 15%, From the above said data no definite conclusion can be drawn regarding

education -disease relation.

Marital status: 16 patients belonged to married group, 3 patients belongs to widow

group and 1 patients belonged to Unmarried group.

Socio economic status: Most of the patients were from lower middle class 45%

followed by 30% patients belongs to poor class and 25% patient belonged to higher

middle class. As sample size was small so from the above said data no definite

conclusion can be drawn regarding Socio-economic status-disease relation .

Occupation: 5 patients were house wife 25%, 06 patients were in Agriculture 30%,

4 patients were from business class 20% and 05 patients were labour class 25%,

Inspite of different occupations most of the patients were having stressful life and

maximum among them were doing physically sternous work , which leads to the

provocation of Vata Dosha.

Desha: In the present study that 70% patients hailed from Anupa desha, 20% of

patients from jangala desha and 10 % from sadharana desha,as most of patients are

from areas near by udupi which is anupa desha.

Associated diseases:. Most of the patients included were Hypertensive 30% And

60% patients were having chronic association of HTN and DM , and 10 % were not

having any associated disease. These are the two diseases which are coming under

the major risk factors of Stroke.

Diet: The present study shows that maximum No. of Patients in the study had mixed

diet habit 65% where as 35% of them had Vegetarian diet. Non-vegetarian food takes

longer time for the digestion (Guru Paki) and food also contains more Sneha. This is

one of the important causes for Sroto Abhishyanda and Margavarodha.

Discussion


Nidra: The study shows that 75% of Pts suffered from disturbed & delayed sleep

and 25% of them had un-disturbed sleep. Disturbed & Delayed sleep itself is

suggestive feature of vata vridhi.

Addiction : The study shows that 20% of patients were addicted to smoking,

30%- Alcohol, 15% - tobacco, 10%- snuffing, 25% of patients are addicted to

tea/coffee etc. These are mentioned as risk factors for causing Cerebro Vascular

Accidents.

Prakruti: The study shows that majority of the patients belonged to Vata-pitta

Prakruti 55%, 04 Patients belonged to Pitta-kapha 20%, 5 patients belonged to

Vata-Kapha prakruti 25%. But no definite conclusion can be drawn from this

data.

Ahara shakti: Maximum patients were having 85% Madhyama Abhyavarana

and Jarana shakti, followed by Avara Abhyavarana and Jarana shakti are 10% and

Pravara Abhyavarana and Jarana shakti 5% .

Vyayama shakti : As karma kshya and karma hani are the cardinal features of

Pakshaghata , therefore 80% the patients were concluded under Avara vyayama

shakti only 20% 0f patients considered under madhyama vyayama shakti.

Vaya: In the present study 90% of pts belonged to Madhyama vaya and

remaining 10% were Vruddha. As discussed earlier most of the patients were

from parihani kala of vaya. Which is suggestive of vata prakopa.

Other observations The study showed following data :

The study shows that most of patients in the study had Madhyama satwa 55%,

while 30% of them had Avara satwa, and 15% were having pravara satva .The

study shows that patients had madhyama samhanana 75% and 3 patients had

avara samhanana 20% and only 2 patients were having Pravara samhanana

10% .

The study shows that 12 patients had Ekarasa satmya 60% and 08 patients

had sarvarasa satmay 40%.

In the present study 80% of patients had Madhyama koshta, where as 15% had

krura koshta, and remaining 5% of patients had Mrudu koshta This is a single

Discussion


blind clinical study and As the sample size is small, so It is very difficult to

conclude the relationship between these factors and Pakshaghata.

Duration:. Maximum of 55% of patients gave the history of more than one and

half months, (i:e upto 6 months) and 15% gave the history of 31-40days, followed

by 20% the history of 21-30 days and 10% Of the patient gave the history of 10 -

20 days were the minimum no. of cases observed in study. The patients in whom

acute phase was over were more in the study.

Nidana: the present study shows that 66% of patients gave the nidana each for

Ativyayama,Sheeta ahara and Chinta, 55% were taking Ruksha ahara, 50% were

suffering from Aama,. 40% each ,were having nidana as Ratrijagarana and

Plavana, 38% each were having Langhana, Alpamatra ahara sevana , Vega

sandharana and kroda as prominent nidana 33% were having Shoka as manasika

nidana , where as Roga atikarsana was seen in 60% of patients ( as they were

having chronic association of HTN or DM ). 13.88% were having habit of

Divaswapna, 80% addicted to alcohol and smoking and 5.55% gave history each

for Abhojana and Abhighata

Purvarupa: Patients gave the history of Ayasa, Bhrama, Shirashoola, Suptata,

Chimchimayana before the onset of disease. Though the Purvarupa of

Pakshaghata is not mentioned these can be considered as Purvarupa

Rupa: Karma kshaya was noted in 15 patients 75% and karma hani was noted in

5 patients 25%, In this study loss of strength is considered as Karma hani and

reduced in the strength is considered as Karma kshaya.

side affected : 60% of patients had right side affected while 40% had left side

involvement.

EFFECT OF TREATMENT: ON CLINICAL PARAMETERS

Effect on Reflexes:

Statistical analysis revealed that there was less improvement in all reflexes viz

‘Biceps’, ‘Triceps’, ‘Brachioradialis’, ‘Knee’ and ‘Ankle reflexes’ soon after the

treatment which was further more improved during parihara kala. This

improvement was seen in the patients who were suffering from Karma kshya,

Discussion


where as in patients suffering from Karma hani there was less change in reflex

score soon after treatment, but further significant change in reflex score during

follow up period i.e basti parihara kala. so it can be concluded that Virechana is

having more benefits in Karma kshya in addition to Karma hani.

Effect of treatment on Power -:

Statistical analysis revealed that there was improvement in power of upper limb

and lower limb soon after treatment which was further more improved during

parihara kala. This improvement was seen in the patients who were suffering from

Karma kshya, where as in patients suffering from Karma hani there was less

change in power score soon after treatment, but further improvement was seen

power score during parihahra kala. so it can be concluded that Virechana is

having more benefits in Karma kshya in addition Karma hani.

Effect of treatment on Romberg’s test:

Statistical analysis revealed that there was 18.46% improvement in Romberg’s

test soon after treatment and later on ,there was further improvement to 30.76 %

after the follow up. This change is statistically significant (P<0.001).From the

above data it can be concluded that effect of Virechana karma can be seen during

Parihara kala.

Effect of treatment on Finger nose test:

Statistical analysis revealed that there was 13.33% improvement in Finger

nose test soon after treatment and later on improvement was further increased to

39.39 % after the follow up. This change is statistically significant (P<0.001).

From the above data it can be concluded that effect of Virechana karma can be

seen during Parihara kala.

Effect of treatment on Heel shin test:

Statistical analysis revealed that there was 16.66 % improvement in Heel shin test

soon after treatment and later on improvement was further increased to 36.66 %

Discussion


after the follow up. This change that occurred is statistically significant

(P<0.001).From the above data it can be concluded that effect of virechana karma

can be seen during Parihara kala.

Effect of treatment on Finger Movement in Hand and Toe Movement in leg:

Statistical analysis revealed that there was Significant improvement in Finger

and Toe movement, Initially there was no movement in most of the patients and

the improvement seen afterwards was slight movement and unable to hold the

object in many of the patients and few patients were able to hold the object gently.

Effect of treatment on Lifting of arms at shoulder and Leg at Hip joint :

Statistical analysis revealed that there was improvement in Lifting of arm and

Leg . This improvement was seen in the patients who were suffering from Karma

kshya, where as in patients suffering from Karma hani there also improvement

seen. From the above data it can be concluded that Virechana is having more

benefits in Karma kshya additionally to Karma hani.

Effect of treatment on Sitting from lying down posture: and Standing from

sitting posture:

Statistical analysis revealed that there was mild improvement in Sitting from

lying down soon after treatment, but during Parihara Kala improvement

statistically significant this data is again suggestive of Action of Virechana

karma during Parihara kala. Whereas, in Standing from sitting posture the

41.37% improvement seen soon after treatment and which was further

increased to 86.20 % after the follow up i.e. parihara kala. This change is

statistically significant (P<0.001). During this study it was observed that the

rate of improvement was slow in the patients who were not able to sit . where

as the patients who were able to sit, improved a lot and were able to stand

soon after the treatment.

Discussion


Effect of treatment on Drooping in Wrist :

Statistical analysis revealed that there was 26.31 % improvement in Drooping

wrist soon after treatment and which was further increased to 52.63 % after the

follow up. This change is statistically significant (P<0.001). This improvement

was seen in the patients who were suffering from Karma kshya, where as in

patients suffering from Karma hani there was mild-modrate change recorded .

From the above data it can be concluded that Virechana karma is having more

benefits in Karma kshya as compared to Karma hani .

Effect of treatment on Drooping in Foot:

Statistical analysis revealed that there was 24.13% improvement in Drooping foot

soon after treatment and which was further increased to 51.72 % after the follow

up. This change is statistically significant (P<0.001).This improvement was seen

in the patients who were suffering from Karma kshya, where as in patients

suffering from Karma hani there was mild-modrate change recorded . From the

above data it can be concluded that Virechana karma is having more benefits in

Karma kshya as compared to Karma hani .

Effect of treatment on loss of speech:

Statistical analysis revealed that there was 52.63 % improvement in Loss of

speech soon after treatment and which was further increased to 84.21 % after the

follow up. This change is statistically significant (P<0.001). it was studied that

in the patients who came with difficulty in speech , or were able to speak few

words , full recovery was seen in them till the end of Parihara kala but in

Patients who came with global aphasia no improvement was recorded .

Effect of treatment on Muscle tone in Upper limb and Lower limb:

Statistical analysis revealed that there was improvement in Muscle tone of Upper

limb and Lower limb soon after treatment but improvement recorded during

parihara kala was statistically significant. This improvement was seen in the

patients who were suffering from Karma kshya, where as in patients suffering

Discussion


from Karma hani there was mild-modrate change recorded . From the above data

it can be concluded that Virechana karma is having more benefits in Karma kshya

as compared to Karma hani . and it provides benefits during Parihara kala.

Effect of treatment on Muscle strength in Upper limb and Lower limb:

Statistical analysis revealed that there was improvement in Muscle strength of

Upper limb and Lower limb soon after treatment but improvement recorded

during parihara kala was statistically significant. This improvement was seen in

the patients who were suffering from Karma kshya, where as in patients suffering

from Karma hani there was mild-modrate change recorded . From the above data


as well as Karma hani . and it provides benefits during Parihara kala.

Effect of treatment on Handgrip power and Foot pressure:

Statistical analysis revealed that there was mild improvement in Handgrip power

and Foot pressure soon after treatment as well improvement recorded during

parihara kala was also statistically significant . This improvement was seen in

the patients who were suffering from Karma kshya, where as in patients suffering

from Karma hani there was mild -modrate change recorded . From the above data


additionally to Karma hani .

Effect of treatment on walking time:

Statistical analysis revealed that there was 7.69% improvement in walking time

soon after treatment and was further improvement to 39.23% after the follow up.

This change is not statistically significant (P<0.001). As the grosser movements

require further involvement of other system / supports and the rehabilitation, it

requires much more time. Though the patients were unable to walk few of them

were able to walk with support and few without support after the follow up.

Discussion


Effect of treatment on Paper holding in Finger:

Statistical analysis revealed that there was 8.33% improvement in Paper holding

in finger soon after treatment and further there was improvement to 31.66% after

the follow up. This change that occurred with the treatment is statistically

significant (P<0.001). Initially there were no movements in the patients and the

maximum number of patients showed improvement in movements in the form of

flickering type to gravity eliminated movement. The duration of the present study

is at the most 24 days. In a neurological insult like stroke, the rehabilitation period

exceeds more than this. Hence the changes that are seen in Power both in upper

limb and as well as in lower limb may be further improved if this treatment

modality is used along with Shamana Aushadhi. The above said movements

which are the mixture of gross and finer movements, improved significantly after

administration of Virechana karma .

Effect of treatment on lakshanas:

absolute relief was seen in symptoms like karmakshya, Ruja, and there was

significant relief seen in Vakastambha, Shotha., Sankocha . were as minimum

relief was seen in case of Karma hani,. Sandhi bandhana vimoksha, and were as

toda symptom subsided soon after treatment but persist during fallow up period.

as time period for the study was only 40 days , may be more no. of patients are

needed to see result in this lakshana.

Samyaka Virikta Lakshanas:

Among all Samyaka virikta lakshanas laghuta, agnivriddi, vatanulomata,

karshyata, kale vegapravartanam were seen in majority of patients during the

treatment period where as Samyaka lakshanas like Ruchi, Agnideepti,

Rogaopshanti, Prakritista, indriya prasada and attaining Bala were best exhibited

during parihara kala .

Discussion


Number of evacuations

It was seen that number of evacuations varied from patient to patient as no two

individuals react alike under the same conditions. The reasons may lies in the

difference at the level of Nidana sevana, Dosha involvement, Samprapti.

Awareness of the patient for virechana procedure-

All patients were experiencing virechana for the first time in their life they

were fully educated about the therapy prior to administration .

It was recorded that in 2 case having pakshghata, but both pts showed

improvement in fine movements, muscle tone and muscle strength during

parihara kala.

One patient had constipation on 3rd day of snehapana and bleeding per

rectum, pain & burning sensation snehapana 4th

One patient had only 4 vegas on the day of virechana, till next morning he

had 7 vegas in the whoe night.It may be the effect of kala.

day, due fissure in ano.

Few patients had nausea and vomited due to smell of gandharvahastadi

eranda taila

Relation with food intake –

In ayurvedic texts it is recommended to give laghu snigdha bhojana during

snehapana & swedana karma, virechana should be given in empty stomach. but

practically it was observed that almost all the patients in whom virechana was to

administered were having a habit for bed-tea /coffee in morning hours, otherwise

they have head ache and nausea. Hence few were allowed to take tea or coffee in

small amount in extreme condition.

VIRECHANA KARMA IS BENEFICIAL IN PAKSHAGHATA BECAUSE OF

THE FOLLOWING REASONS:

• It pacifies Vitiated Vata Dosha.

• It acts as shodhana as all its contents holds the qualities of indriya prasadana.

Discussion


• Virechana is helpful in the Vatik disorder where the Vata is obstructed by Kapha,

Pitta, Meda & Rakta.

Improvement results seen after treatment and maintained further upto

parihara kala

Reflexes : Lakshanas :

Triceps reflexes Karma kshya

Brachioradialis reflexes Vichetana

Knee reflexes Vakastambha

Ankle reflexes Ruja, Toda, Shotha

Power with respect to movement –

Power of Upper Limb — Shoulder, Elbow, Wrist.

Power of Lower Limb — Hip, Knee, Ankle,.

Finger movement in Hand.

Lifting of arms at shoulder.

Lifting of leg at Hip joint

Standing from Sitting posture

Wrist drooping, Foot drooping

Loss of Speech

Hand - grip power

Foot pressure

Paper holding in Finger.

Results seen after treatment were less improvement and later changed to

significant during parihara kala:

Power of Upper Limb -Shoulder, Elbow, Wrist.

Power of Lower Limb - Hip, Knee, Ankle,.

Romberg’s test & Finger nose test

Heel shin test

Loss of Speech

Discussion


Sitting from Lying down posture

Finger movment- foot, hand

Lifting arm at shoulder

Lifting leg at hip

Wrist drooping, Foot drooping

Muscle tone in upper and lower limbs

Muscle strength in upper and lower limbs

Walking time.

Lakshanas –

Sankocha,Sandhi bandha vimoksha

Karma hani.

• Were as Toda symptom persist during fallow up period.

CONCLUSION

Conclusion


CONCLUSION CONCEPTUAL STUDY:

Virechana karma is one among the shodhana. Even though Virechana is best line

of treatment modality for pittadosha it can act on kaphasamsrusta pitta or

pittasthanagat kapha. And moreover in case of vatasyopakrama mridu shodhana

indicated which refers to mridu virechana karma.So Virechana is major line of

treatment for morbid pittadosha & also it act on morbid kapha &vata dosha. Thus

Virechana action seen on all tridosha.

Tila Taila (Sessamum indicum): - was used for internal Snehana which has got

Vaatahara, Balya, Medha Agnivardhana properties. It has been reported as

antihypertensive, protective against lipopolysaccharide stimulated oxidative

stress; it lowers liver & Serum cholesterol & liver LDL.

Ingredients of this gandharva hastad eranda taila is Gandharvahastad mool is

vatapitta shamaka, Yava is vatapitta shamaka, balya, dhatuvardhaka, Nagara is

vata kapha shamaka, deepana & pachana, Eranda taila is vatapitta shamak.

OBSERVATION:

35% of patients in this study belonged to Parihani awastha and 20% belonged to

vrudha awastha , which is characterized by Vataprakopa, Bhrishyamana Dhatu,

Kshiyamana Dhatu awastha.

Risk factors like Hypertension and Diabetes mellitus, Smoking, Tobacco

Chewing and alcohol were present in most of patients.

RESULTS:

Motor parameters in Neurological maping showed 2 to 4 folds of improvement.

However, this improvement is recording after the completion of therapy &

specifically after pariharakala.

Finer movements(28.33%) restored very slowly and percentage of improvement is

comparatively less to that of gross( 86.20%)

Speech (84.21%) and sensory (52.63%) aspects improved ,but it is not up to the mark

of gross motor movements.

Conclusion


Reduced strength (48.95%) improved is in faster pace when compared to complete

loss of strength (34.75%).

The author is putting forward a combination of Shodhana, Rasayana, relevant

shamana will yield, maximum benefit in the patients.

EFFECT OF VIRECHANA KARMA

• Virechana Karma is a specific process for elimination of pitta dosha (Ch.






• Virechana Karma possesses the property of purifying the vitiated dhatus (Ka. Si).


Mansa, Meda, Majja, Shukra gata vikaras. (Ch. Su. 28/25)

• Virechana drugs eliminate the doshas from the body, eradicate the diseases and

restore normal strength and complexion of the body. If it is adopted and practiced

properly, it prolongs the longevity of the individuals. (Ch. Su. 15/22)

• Properly administered Virechana Karma does srotovishuddi, laghuta, improves

the intellect and mental status. It increases strength of indriyas, stabilizes all the

seven dhatus, thus provides strength and power to the body. It potentiates the

jatharagni and decelerates the ageing process. (Ch. Si. 1/17; Su. Chi. 33/27; A.H.

Su. 18/60).

• Prior to administration of shodhana karma snehana and swedana is done.

Snehana and Swedana will cause utkleshana and vilayana of doshas respectively

and by these actions they move from shakha to koshta. These vitiated doshas have

to be thrown out of the body through the nearest route (Ch. Ni. 8/39). For this

purpose Virechana has been advised because of its wide range of action, i.e., both

on amashaya and pakvashaya.

SUMMARY

Summary


SUMMARY

The dissertation entitled “A Clinical Study To Evaluate the Efficacy of Virechana karma

in Pakshaghatha” is studied under 7 Chapters - Review of literature, Drug review,

Methodology, Observations and Results, Discussion ,Conclusion, summary.

CHAPTER -1 : This chapter named Review of literature further comprises of five

sections.

1) First section deals with Historical review in which the historical aspect related to

Basti. In Vedic literature scattered references of virechana is present. Purana’s

have detailed explanation about virechana. The different text books of Ayurveda

reviewed for virechana. The advancement of purgation therapy according to

History of Medicine briefly explained. It also includes previous works done on

virechana and vatavyadhis .

2) Second section deals with Conceptual Study of virechana in which first of all

Various Etymological derivation and definition are explained. Then the virechana

Classification is explained. Afterwards Procedure of virechana Karma is

explained along with Samyaka, Ayoga, Atiyoga Lakshanas. Later on Vyapats and

their respective treatment are explained.

3) Third section includes the study of Pakshaghata as found in Classics. It’s

Etymology, Definition, Nidana, Lakshana, Samprapti, Pathyapathya and

Treatment modalities are dealt in detail.

4) Fourth section deals with the rationality behind the use of virechana karma in

Pakshaghatha and the probable mode of action of virechana karma is explained.

CHAPTER -2 : Chapter named Drug review deals with the detailed description of

the drugs used in Vierchana karma i.e deepana-pachana, moorchita ghrita, moorchita

taila and gangdharvahastadi eranda taila its Chemical contents & pharmacological

properties, of drugs are explained.

Summary


CHAPTER -3 : The chapter named methodology describes the Protocol of study.

Here the effect of virechana karma was tried in patients suffering from Pakshaghatha.

Details of selection of patients, Methods followed, Criteria for assessment are

discussed. 20 patients were included in the study. 20 patients completed the therapy

and Follow up period.The role of virechana karma was analyzed on different

neurological parameters and Ayurvedic terminology.

CHAPTER -4 : This chapter exclusively narrates the observation and results of the

study. The detailed statistical analysis of the data presented is documented in Results.

CHAPTER -5 :This chapter deals with the discussion of entire clinical study. The

conceptual part virechana are explained. Clinical data is discussed in details. The

result obtained in clinical study, as well as Observations in it are discussed with

relevant opinions and arguments.

CHAPTER -6 : In this chapter the Conclusion drawn upon clinical study and

virechana were is enlisted accordingly.

CHAPTER -7 : Summary, summarized the whole thesis

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ANNEXURE

Annexure


PROFORMA “A CLINICAL STUDY TO EVALUATE THE EFFICACY OF

VIRECHANA KARMA IN PAKSHAGHATA”

By: Dr Raksha kumari Guide: Dr. Shreekanth. U Co-Guide: Dr. Niranjan Rao

DEPT OF PANCHAKARAMA S.D.M. COLLEGE OF AYURVEDA,

KUTHPADY, UDUPI.

Case NO:

NAME: DATE:

AGE: SEX: M/F O.P.D. NO:

EDUCATION: UN/ Pri/ Mid/High/Gr/PG

I.P.D.NO:

D.O.A.:

MARRITAL STATUS: M/UM/W/D D.O.D.:

OCCUPATION: LBR/HW/BS/S AG

DIAGNOSIS:

ECONOMIC STATUS: VP/P/LM/ MDL / R

POSTAL ADDRESS:

RESULT:

DESHA: J/A/S

LAKSHANAS:

Lakshana Duration Lakshana Duration

Karma

Kshaya

Hasta/Pada Sandhi bandha

vimoksha

Dakshina/Vama Sankocha

Karma

Hani

Hasta/Pada Ruja

Dakshina/Vama Toda

Vichetana Sotha

Vak stamba

VEDANA VRITTANTA:

Annexure


Chief complaints:

ONSET: 1.Sudden 2. During-Work/Sleep

PURVA VYADHI VRITTANTA: HTN / DM / others

CHIKITSA VRITTANTA :

KOUTUMBIKA VRITTANTA:

Ahara sambandhi

H/O DIET, VEG/MIXED

Time Dominant rasa

MORNING

AFT

EVNG

NIGHT

Rasa pradhanva : M/ A/ L / K / T / K

Diet habit : Abhojana /Akalabhojan / Kalabhojan / Samashana /

Adyashana / Vishamashana

Vihara sambandhi :

Vyavasayika vrittanta :

Sharirka shrama _________hours/day Manasik shrama _________ hours/day

Nidra : Divam : hours/day , Ratri hrs

Disturbed/ Un-disturbed,

If disturbed: Mental strain – Yes/ No if yes, since _________

Mala sambandhi: Bowel- regular/ irregular/constipated/loose/soft

Frequency – times / 24 hours

Mutra sambandhi:

Times/day times/night Colour Other

Personal history:

Habit Smoking Coffee/Tea Tobacco chewing Snuffing Alcohol

Quantity

Duration

Annexure


Prasava vrittanta

Graviada Parity Live Dead Abortion/Miscarriage: yes / no

Rajo pravritti vrittanta

Rajo darshana yrs; Rajo pravritti days: Regular /Irregular;

Associated

Symptoms if any: Shweta srava: Present /Absent; Rajonivritti :

ATURA BALA /DASHA VIDHA PARIKSHA

1. Prakrithi : sharirika V/P/K/ VP/PK/KV/VPK

Manasika- S/R/T

2 Vikrithi :

SAMPRAPTI GHATAKAS:

Dosha:

Dushya- Dhatu: Upadhatu: Mala:

Agni Ama:

Srotas:V/Rs/Rk/M/Med/As/MT/Sw/Su/ Sroto Dusti Prakara: S/Ap/Vm/Sg

Udbhava Sthana : Vyakta Sthana : Adhistana

3 Sara : R/Rk/M/Md/As/Mj/Su

4 Samhanana : P/M/A

5 Satva : P/M/A

6 Pramana : Darighya cms Bhara kg

7 Satmya : P/M/A eka rasa satmya/dwi rasa satmya/oka satmay/sarva rasa satmya

8 Ahara shakti : Abhya varana shakti Purva kalian : / P/M/A

jarana shakti Adhyatana : P/M/A

Agni –S/V/M/T

Kosta- Mr/Md/Kr

9 Vyama shakti : Purva kalian : P/M/A Adhyatana : P/M/A

10 Vaya :Bala/ Madhyama / Vriddha

ASTA STHANA PARIKKSHA

Nadi-v/p/k

Mala-p/v

Mutra-p/v

Jinhwa-lp/Alp

Shabda –p/v

Annexure


Sparsha –p/v

Drik-p/v

Akriti-p/v

ROGI PARIKSHA

GENERAL EXAMINATION

BUILT: Well/Moderate/Poor Nourishment: Well/ Moderate / Poor

Temperature: F Pulse Rate: /min

Resp. Rate: /min BP: mm of hg

Heart Rate: /min Pallor: Present / absent

Nail changes: Koilonychia/Platynychia Cyanosis: Present/ absent

Icterus: Present / absent Lymphadenopathy: Present/ absent

SROTAS PAREEKSHA

Srota Name Srota Name Srota Name

Pranavaha P/V Mamsavaha P/V Artavaha P/V

Annavaha P/V Medovaha P/V Purishavaha P/V

Udakavaha P/V Asthivaha P/V Mutravaha P/V

Rasavaha P/V Majjavaha P/V Swedavaha P/V

Raktavaha P/V Shukravaha P/V

SYSTEMIC EXAMINATION

Respiratory System

GIT System

Cardio Vascular System

Urogenital System

INDRIYA PARIKSHA

Manas:

Prajna: Present/ Absent

Dhee: Longterm: Preserved/Absent, Short term: Preserved/Absent

Dhruthi : Long-term : Preserved/Absent, Short-term : Preserved/Absent

Smruthi: Long term: Preserved/Absent, Short-term : Preserved/Absent

Mana pareeksha: Samjna/Medha/Krodha/Shoka/Harsha/Moha/Bhaya/Dhairya/

Mano artha : Chintya : Vicharya: Oohya : Dheya:

Sankalpa:

Manokarma: Indriyabhigraha: Svasya nigraha:

Annexure


HIGHER MENTAL FUNCTIONS

Level of consciousness- At onset at present:

(Fully conscious/ Drowsy/Stupor/Coma/Semi coma/Delirium/Confusion)

Attention: Easily obtained /Aroused/Apt of wonder/Inactive/Obeys command.

Talk: Much/ Little/Promptly/Slow/Fast/Hesitantly/Interruption, Coherently

Mood: Happiness/Sadness/Irritability/Fear/Worry/Restlessness/Excited/Normal.

Delusion: Present/absent

Hallucination: Visual: Present/absent Auditory: Present/absent

Orientation: To time Present/absent

Memory: Distant: Present/absent Recent: Present/absent

NASA PARIKSHA:

Ghrana nasha: Other:

Olfactory (1st) nerve: Anosmia / Parosmia

NETRA PARIKSHA

Bhruvyudassacha/ Vartma stambha / Vartma sankocha /Timira /Akshivyudasacha other:

Optic nerve

Pupilary reflex (1) Direct light reflex (2) Accomodation reflex

Myopia/Hypermetropia/Colour blindness Visual field:

Occulomotor, Trochlear, Abducens nerve

Nystagmus/Strabsimus/Diplopia/Ptosis.

Facial nerve:

Eyebrow raising test: Closing the eye against resistance:

Trigeminal nerve: Corneal reflex:

KARNA PARIKSHA

Karna shoola/ Ashabda shabda shravanam/ Uchai shruti/ Badirya/ Other

Vestibolo cochlear nerve

Rinnes test: Positive /Normal Webers test: Positive /Normal Vertigo :

Present /absent

JIWHA PARIKSHA:

Arasajnatha /Kashaya asyatha : Other:

Glossopharanygeal and Vagus nerve :

Annexure


Taste sensation in postr 1/3rd pf tongue : Dysphagia : Solid /Liquid

Hypoglossal nerve

Tongue wasting/ Fasciculation/ Deviated to left/ right

Facial nerve:

Taste sensation in anterior 2/3rd

1) Muscle tone : Normal /Atrophy / Hypertrophy

of tongue: present/absent

SPARSHANENDRIYA PARIKSHA

Sensory system:

Proprioception : Preserved/Affected Light touch : Positive /Normal

Vibration: Positive /Normal Thermal: Positive /Normal

2 point discrimination: Positive /Normal Graphesthesia: present /absent

Stereognosis: Identified / not identified

MUKHA PARIKSHA

Trigeminal nerve:

Sensation over face: Preserved/Affected Jaw jerk : Preserved/Affected

Facial nerve

Facial expression: Nasolabial fold: Smile:

Mouth inflation test: Teeth showing test:

Glossopharangeal and vagus nerve

Gag reflex: Present/ absent Uvula: Central /deviated to right/left

Acessory nerve

Shrugging of shoulders: Able/Not able

Sternocleido mastoid muscle: Normal/ Hypertrophied / Atrophied

Mukhatwam /Minimina / Gadgada /Vak sangha /Avyakta /Visheerna

Speech: Aphasia/ Dysphasia

Anarthria/Dysarthria/ Aphonia / Dysphonia/ Apraxia /Agnosia

PANI PADA

Pada shoola /Padabhramsha /Padasupti /Gulpha graham /Pindakodwestana /others

MOTOR SYSTEM

Muscle bulk: Normal /Atrophy / Hypertrophy

Annexure


2) Symmetry

3) Fasciculation

4) Contracture

5) Palpation : Tender /Doughy/ Woody

6) Leg drooping

7) Arm drooping

8) Muscle tone at joints : Wrist : Elbow : Knee: Ankle

9) Knee clonus:

10) Ankle clonus:

SUPERFICIAL REFLEXES Abdominal reflexes:

Babinski’s sign:

DEEP TENDON REFLEXES: SCORE

MUSCLE TENDON BT AT1 AT2

BICEPS

TRICEPS

BRACHIO

RADIALIS

KNEE

ANKLE

Movements of shoulder joint

Abduction -

Adduction -

Flexion -

Extension –

Rotation - Extend rotation and internal rotation -

Wrist Joint Movements

Dorsiflexion (extension) –

Palmar Flexion –

Ulnar and radial deviation –

Supination and pronation –

Elbow Joint Movements

Flexion -

Hyperextension -

Pronation and supination -

Range of Fore arm Movements

Annexure


Flexion and Extension -

Ulnar deviation

Radial deviation -

Pronation and supination -

Range of Hip Joint Movements

Flexion -

Abduction -

Adduction -

Extension -

Rotation in Flexion and Extension -

Range of Knee Joint Movements

Flexion and Extension -

HyperExtension -

Ankle Joint Movements

Dorsiflexion -

Plantat Flexion -

Eversion and Inversion

Foot movements

Metatersalphalangeal Joints

Flexion -

Extension -

Interphalangeal Joints

Eversion -

Inversion -

Flexion -

POWER GRADING WITH RESPECT TO MOVEMENTS

UPPER LIMB BT AT1 AT2

Adduction

SHOULDER Abduction

flexion

Extension

Flexion

ELBOW Extension

Flexion

Wrist Extension

Annexure


Supination

Forearm pronation

Flexion

M.C.P. &

I.P.

Extension

LOWER LIMB

HIP flexion

Extension

Adduction

Abduction

KNEE flexion

Extension

ANKLE Dorsi

flexion

Plantar

flexion

Adduction

Abduction

MTP & IP flexion

Extension

NOTE: BT- Before treatment, i.e first day of sneha pana

AT1- After complete treatment

AT2- Fallow up period

CO-ORDINATION TESTS:

TESTS BT AT1 AT2

ROMBERG’S TEST

TANDEM WALK:

FINGER NOSE TEST:

RAPID ALTERNATING

MOVEMENT

HEEL SHIN TEST

Annexure


OTHER TESTS:

TEST BT AT1 AT2

FINGER MOVEMENT HAND

LEG

LIFTING OF ARM

SHOULDERS/LEG AT HIP JOINT

HAND

LEG

SITTING FROM LYING DOWN

STANDING FROM SITTING

DROOPING WRIST

FOOT

LOSS OF SPEECH

MUSCLE TONE: HAND

LEG

HANDGRIP POWER

FOOT PRESSURE

WALKING TIME

PAPPER HOLDING IN FINGER

NIDANA SANKALANA:

FEUTURES PRESENT/ABSENT

Ruksha Ahara Dhatu Kshaya Chinta

Sheeta Ahara Langhana Shoka

Alpa matra Plavana Roga ati karshana

Laghu Anna

sevana

Ati vyayama Dukha shayya asanath

Ati Vyavaya Diva Swapna Krodha

Ati Jagarana Vega Sandharana Abhojana

Vishamaupachara Ama Marmaabhighata

Asrk Sravanadi Abhighata Shigra yana patansan

Annexure


RUPA SANKALANA

RUPA BT AT1 AT2

Karma Kshaya

Karma Hani

Vichetana

Vaksthambha

Sankocha

Sandhi Bandha Vimoksha

Ruja

Toda

Shotha

INVESTIGATIONS:

Blood Investigations- if needed

Hb%- TOTAL COUNT D IFFERENTIAL COUNT-

ESR- RBS- BLOOD UREA-

SERUM CREATININE ECG-

C.T. SCAN-

TREATMENT

POORVA KARMA: Administration of Deepana Pachana: with Agnitundi vati & Chitrakadi vati

Dose.........OD /BD/TDS/QDS/HS for....days

SNEHAPANA VIDHI: Name of Sneha given- moorchita ghrita with Ushana jala as Anupaana

SNEHAPANA DAY

Date

Time

Quantity

Time of

Snehajeernata

Annexure


SNEHA JEERYAMANA LAKSHANAS

LAKSHAN Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7

Shiroruk

Bhrama

Nishtiva

Moorcha

Saada

Aruchi

Klama

Trishana

Daha

Snehaudgar

Arati

SNEHA JEERNA LAKSHANAS

LAKSHANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7

Trishana

Kshudha

Udgarashudhi

Shiralaghavata

Vatanulomata

SAMYAK SNIGDHA LAKSHANAS

LAKSHANA Day-1 Day-2 Day-3 Day-4 Day-5 Day-6 Day-7

Vatanulomata

Agnideepti

Snigdha

asamhata

varcha

Gatramardava

Twaksnigdhata

Snehodvega

Klama

Shitya

Angalaghava

Annexure


VISHRAMA KALA:

Sarvanga abhyanga with moorchita taila followed by ushna jala snana

SAMYAK SWINNA LAKSHANAS

LAKSHNAS DAY1 DAY 2 DAY 3 DAY4

Sheeta uparama

Shoola uparama

Stambha nigraha

Gaurava nigraha

Mardavata

Sweda

virathi/sheetaartitva

Vyadi haani

Laghutava

Sweda srava

Agni deepti

Twak prasada

Bhakta shrudda

Strotasam nirmalatva

Nidra hani

Tandra hani

Annexure


PRADHANA KARMA:

Administration of Gandharvastadi Eranda taila _______ ml

Anupana : dugda

Time of administration of Virechana Dravyas-….......

1] MANIKI

No. of Vega Time Colour Consistency Virikta Dravys Water Consumed Urine 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

In put = ml

Out put = ml

Total Virikta (stool) dravya = ml

Total out put (urine stool) = ml

Annexure


SAMYAK VIRIKTA LAXANA

Samyak Yoga Ati Yoga Ayoga

Srotoshuddi Supti Angasaada

Angamarda Pratishyaya

Indriya prasada Klama Agnimandya

Laguta vepana Aruchi

Agnivrudhi Nidraabhava vatanulomana

Anamayatva Balaabhava vnmootrasanghai

Vit pitta kapha vata

Kramasha nissarana

Tama Pravesh paridaha

Vatanulomana Unmada Hrat ashuddi

Daurbalya Hikka Kukshiashudhi

Karshyata Moorcha Kandu

Hridhvarna shudhi Vidaha

Kshuth Parshwa Shoola Pitika

Thrishna Shakasankocha Vatavidgraha

KaleVegapravarthnam Brama Nabhistabdata

Visangnatva Kukshishoola

Trashna vatasanga

Shoonyata mandala

Jarjaribhava gourava

chimuchimayanam Shtevana

shoola Admana

Shopha Chardi

Medomamsodakavat srava Dourbalya

Kapha Pitarahita sweta

Udakanissarana

Alaghavam

Guda shoola Jangoru sadanam

Guda bramsha Tandra

Gudanissarana stimityam

netrpraveshanam bhrama

Annexure


OBSERVATION OF VITAL DATA & WEIGHT

Time Pulse Blood Pressure Resp.Rate Weight

PASCHAT KARMA

SUPERFICIAL REFLEXES

4+

- very brisk, hyperactive with clonus (rhythmic oscillations between flexion and

extension)

3+ - brisker than average : possibly but not necessarily indicative of disease.

2+ - average : normal

1+ - Some what diminished : low normal.

0+ - no response.

Standing from sitting

ANTHAKI

VEGAKI

MANAKI

LYNGIKI

OBSERVATION

Diet Regimen No. of Annakalas

Pravara Shuddhi Madhyama Shuddhi Avara Shuddhi

Peya

Veelepi

Akrita Yusha

Krita Yusha

Standing from sitting Score

Unable 2

With support 1

Without support 0

Annexure


Loss of Speech

Reflexes

Muscle tone

Muscle strength

Loss of Speech Score

Global aphasia 4

Utter voice 3

Speak few words 2

Speak with difficulty 1

Normal 0

Reflexes Score

Absent 0

Present 1

Brisk 2

Very Brisk 3

Clonus 4

Muscle tone Score

No increase 0

Slight increase with catch and release 1

Minimal resistance through range following catch 2

More marked increase tone through Range of movement with difficulty 3

Considerable increase in tone, passive movement difficult 4

Affected part rigid 5

Muscle strength Score

Normal power 5

Diminished 4

Movement against gravity 3

Annexure


Drooping of Wrist/Foot

Paper holding

ANY OTHER FEATURES:

SIGNATURE OF GUIDE SIGNATURE OF CO-GUIDE

SIGNATURE OF SCHOLAR

Movement with gravity eliminated 2

Flicker with attempting movement 1

No movement 0

Drooping of Wrist/Foot Score

Full 0

Moderate 1

Slight 2

No 3 Paper holding Score

Normal 2

Patient holds gently 1

Patient fails to hold paper 0

Neurological Mapping

“A Clinical Study to Evaluate the Efficacy of Virechana Karma in Pakshaghata Page 207

ROUTINE

NEUROLOGICAL

EXAMINATION

Build

General Appearance

Temperature

Pulse Rate

Body Weight

PSYCHIAL FUNCTIONS

Intelligence

Attentiveness

Memory

Orientation

Emotional State_Phobias,

Hallucinations.

Delusions

Sleep

Delirium

Coma

SPEECH AND

ARTICULATION

Right Handed or Left Handed

Aphasia

Apraxia

Articulation

CRANIAL NERVES

Smell

Visual Acuity

Optic Discs and Fundi_Pupil

External Occular Movements

Nystagmus

Corneal Reflexes

Sensation Over Face

Massetters, Temporals

Facial Movements and

Symmetry of Face

Palate

Tongue Sternomastoids

Trapezius

MOTOR FUNCTIONS

Power

Co_Ordination

Tone

Wasting and Fasciculations

Hypertrophy of muscles

Involuntary Movements and

Fits

EXAMINATION OF GAIT

Sensory Functions

Cutaneous Sensibility

Touch (Cotton_Wool)

Pain (Pin Prick)

Temperature

Deep Sensibility

Joint Sense

Vibration

Sensibility of Muscles and

Tendons To deep

Pressure

Stereognosis

Tactile Localisation

Compass Tests

REFLEX FUNCTIONS

Tendon Reflexes

Biceps

Triceps

Supinator

Kneejerk

Anklejerk

Presence of Clonus

Cutaneous Reflexes

Epigastric Reflexes

Upper And Lower

Abdominal Reflexe

Plantar reflexes

Visceral Reflexes

Micturation

Defaecation

Tonic Reflexes

Kernig’s Sign

Neck Stiffness

SPINE AND CRANIUM

Deformaties or Tenderness

Presence of Bruit on

auscultation of Skull

TROPHIC CHANGES

Skin ----Bed Sores,

Perforating Ulcers, Naevi

Pigmented patches.

Bones and Joints –

Arthropathies, Pes Cavus.

SPECIAL

EXAMINATIONS

C. S. F – Dynamics, Cells,

Total Protiens, Globulins,

Sugar, Chlorides, Culture.

Blood – blood Counts, E.S.R.

X- Ray Examination

including Contrast

Radiography.

E.E.G., Electrical And Other

Eploratory

Examinations of Nerve And

muscles

Electromyography.,Muscles

or Cerebral Biopsy.

NEUROLOGICAL MAPPING

A CLINICAL STUDY TO EVALUATE THE EFFICACY OF VIRECHANA ...

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Transcript of A CLINICAL STUDY TO EVALUATE THE EFFICACY OF VIRECHANA ...