Ayurvedic Management of Hemiplegia (Pakshaghata) Following Stroke | AVCRI | Since 1957

Pakshagatha and Ayurveda 

Hemiplegia (paralysis or hemiparesis) is a common medical condition that  can happen at any time and is the third leading cause of death worldwide. It is known as ‘pakshaghata’ in Ayurveda. It is classified under nanatmaja vata vyadhi and is characterised by  a  complete or partial paralysis of the arm, leg, and trunk on one side of the body.

The main  cause of hemiplegia is cerebrovascular accident (the sudden death of some brain cells due to a lack of oxygen when the blood flow to the brain is lost by blockage of an artery to the brain), affecting the corticospinal tract.

As per Ayurveda pathophysiology, the vitiated vata dosha affects half of the body by causing drying  of nerves or blood vessels, and muscles. Where Rehabilitation is the primary treatment of hemiplegia to regain maximum function  of physical condition, Ayurveda can manage and improve motor functions by vatanulomana  and balya  forms of medicines

Symptoms of Paralysis

·      Loss of motor function and pain on either side of the body (right or left) can be indicative of an ischemic stroke.

·      Sudden  weakness in the face, arm, or leg, especially on one side of the body

·      Slurring or loss of speech

·      Difficulty in  seeing in one or both eyes.

·      Difficulty in walking, dizziness, loss of balance, or lack of coordination.

·      Severe headache with no reason

·      fatigue, light-headedness, or vertigo

·      numbness or weakness

·      pins and needles or reduced sensation of touch

·      muscle weakness or numbness

·      Contractions (spasticity) on the legs and hands on either side.

·      Pricking pain or sharp pain in the body

·      Loss of activity (akarmanyata) and loss of sensation (achetana) of the affected side.

The common causes include 

Aharajanya /Dietary Factors  like

·        Excessive intake of tikta, (katu) (pungent) and (kashaya) (astringent) tastes.

·        Consuming less quantity of food

·        Excess intake of food items that are dry and rough in  quality.

·        Untimely  food consumption

Viharajanya /Lifestyle Factors like

·        Suppression of natural urges.

·        Keeping awake at night

·        Talking in a high pitch 

·        Excessive application of purificatory therapies

·        Injury to vital parts

 Manasa /Psychological Factors like

·        Fear, grief, and overthinking 

Abhighataja/External  Factors like

·        Untreated chronic inflammations or infections

Samprapthi /Pathogenesis of Pakshagatha 

These two causes provide a background for the pathogenesis of vata-dominant diseases.

Either due to the Depletion of body constituents (dhatu kshaya) or by Obstruction or covering of vata dosha by body constituents (dhatu, mala), the vata gets aggravated. The aggravated vata is lodged in vacant channels (sroto vaigunya). Due to obstruction in its path, vata dosha affects the indriya (sensory and motor organs) and leads to impairment of either side of the body. It also causes the dryness  of siras (nerves) and snayus (tendons), producing contractions of legs and hands on either side.

Investigations includes

·        past medical history

·        Neurological examination.

·        Imaging technique ( CT or MRI )

·        Blood tests (complete blood count, Erythrocyte sedimentation rate, hemoglobin level, platelet count, etc

Principles of management

·        Vata shamana (pacification of vata dosha) by snehana (therapeutic oleation) and swedana (therapeutic sudation)

·        Vatanulomana (proper functioning of vayu) by mridu samshodhana (Therapeutic purgation using drugs with mild potency)

·        Balya (strengthening) and regenerative therapies (rasayana) by therapeutic enemas.

Therapies advised in Pakshaghata

·      Snehana (therapeutic oleation):

Snehana is administered  both externally and  internally. Internal can be used for shamana (pacification) and shodhana (purification) purposes, whereas external application is used only for shamana (pacification) purposes.

·      Abhyangam: 

Abhyanga helps the body  to get strong and stable. By the medicated oil, which acts on vitiated Vata, the body becomes capable of withstanding fatigue. It balances the Vata Doshas and provides Pushti Prasada (food for the dhatus). When Abhyanga is performed for a longer period, oil helps to  nourish the depleted dhatus

·      Swedana (therapeutic sudation):

Swedana can be used for pacification and purification purposes. Upanaha sweda (poultice) and bashpa sweda are commonly advised in pakshaghata. Sweda helps to clear the body of impurities. Swedana medicines by Ushna and Tikshna guna can penetrate the microcirculatory channels (Srotas) and trigger the sweat glands, causing them to produce more sweat. After dilatation of the micro channels, Laghu and Snigdhadosha enter the channels and lead them to go towards Kostha or excrete them through the skin's micropores as sweat

·      Virechana (therapeutic purgation):

Virechana is the principal purificatory procedure mentioned in Pakshaghata management. Virechana with unctuous drug is especially mentioned in classics because vata shamana (pacification of vata dosha) and vatanulomana (proper functioning of vayu). Virechana is the line of treatment for Vata Vyaadhi condition, where Vata is associated with Kapha, Pitta, Rakta, and Meda

·      Anuvasana basti (therapeutic unctuous enema):

Anuvasana with bala taila is indicated in pakshaghata. Anuvasana basti can pacify vata dosha to rejuvenate the tissues, which may be helpful.

·      Asthapana basti (therapeutic decoction enema):

Asthapana basti can be administered when shodhana (purification) is required before vata shamana (pacification of vata dosha).

Role of Basti Dravya in Pakshaghata: 

When the body's functioning is disrupted by the imbalanced  Vata, it results  in numerous imbalances. Basti pacifies Vata dosha and eliminates waste materials from the body. The large intestine is the focal point of the Vata area, which is cleansed by Basti. Basti gives throughout action in the body in case of Pakvashaya, the Basti provides its effects below the Nabhi and through the Srotas. The morbid Doshas are forcibly thrown out of the body under the influence of Basti therapy. Basti therapy offers two actions; it expels out Dosha and also nourishes the body.

·      Nasya (nasal medication):

Nasya has an effect on the space-occupying lesion. Nasyaaushadhi spans to mind by means of the nasal route and follows up on the higher centre of the cerebrum, controlling different endocrinal, neurological, and circulatory health issues. Drug administered in this way in Nasya therapy reaches the brain & pacifies Doshas. The drug reaches Shringhataka, which is described as the inner side of the middle head. The drug, through this route, spreads in the Marma, Netra, Shrotra, Siramukha, and Kantha, etc., and pacifies morbid Dosha. This therapy clears Uttamanga in supra supraclavicular region

·      Siro abhyangam :It is generally accepted that there are around 107 Marma points throughout the body, where 12 are classified as Padu Marmas (vital life centers), many of which are located in the head and neck region. Shiro Abhyanga essentially means a complete massage of the head, neck, and shoulders using Ayurvedic herbal oils. These are the areas that are most affected by stress, which is why Shiro Abhyanga is beneficial in reducing pain and stress in these regions.

·      Siro dhara :

When medicated kwatha, or  Taila, is poured on the forehead, it is called Taila Dhara. It improves speech, stabilizes the mind, and increases physical strength. Dhatus are nourished, increases virility, excessive body temperature is reduced, and the patient can get good sleep. 

Some of the herbal formulations used

Dhanadanayanadi kashayam, dhanwantharam kashayam,ashtavargam kashayam, dasamoolam kashyam, sahacharadi kashyam,prasarinyadi kashayam, rasonadi kashyam, gandharvahasthadi kashayam, rasnadi kashayam, saraswatharistam, aswagandharistam, kallyanaka ghritham, saraswatha ghritham, Balarista, Dashmoola Arista,

Thailam that are useful in Pakshaghata (Stroke):

Ksheerabala taila, Prabhanjana vimardana taila, Bala-aswagandhadi taila, Sahacharadi taila, Bala taila, Prasarini taila, Gandharvahastadi erandataila, Dhanwantharam thailam are used 

Diet and Lifestyle in Stroke 

·      Avoid excessive use of spicy, astringent, and/ or salty, oily/ fatty food and incompatible diet.

·      Use black gram, horse gram, onion, garlic, ginger, radish, ash gourd, green gram, etc in regular diet.

·      Consume a high fibre diet 

·      Control the treatable risk factors like Diabetes mellitus, hypertension, and heart disease.

·      Practice regular exercises or physiotherapy. 

·      Avoid excessive starvation, excessive exercise, and suppressing of natural urges. 

·      Avoid alcohol consumption, smoking.

·      Avoid discontinuation of any regular medication without medical advice.

What is hemiplegia, and how is it related to stroke?

Hemiplegia refers to paralysis on one side of the body and is commonly associated with stroke, which is a sudden interruption in blood flow to the brain, leading to neurological symptoms.

How does Ayurveda approach the management of hemiplegia (Pakshaghata)?

Ayurveda focuses on a holistic approach involving lifestyle modifications, specific diet recommendations, herbal medicines, and therapies to manage hemiplegia.

Can you explain the Ayurvedic treatment options for managing Pakshaghata?

Ayurvedic treatments for Pakshaghata may include procedures like Virechana (therapeutic purgation), Nasya (nasal administration of medicines), and specific Panchakarma therapies to address the root cause of the condition.

What are the key principles of Ayurvedic management of stroke symptoms?

Ayurvedic management of stroke symptoms involves understanding the individual's constitution, balancing the doshas (bio-energies), improving circulation, and addressing the nidana (causative factors) of the disease.

Are there any published studies on the Ayurvedic management of hemiplegia with stroke symptoms?

Yes, there are research studies published in reputable journals like the International Journal of Ayurvedic and Health Sciences, PMC, and other platforms discussing the effectiveness of Ayurvedic treatments for hemiplegia.

How does Ayurvedic treatment aim at improving motor function and reducing disability in stroke patients?

Ayurvedic treatments focus on improving blood circulation, strengthening neurological pathways, enhancing muscle tone, and reducing disability through a combination of herbal medicines and therapies.

Can you explain the role of specific Ayurvedic protocols like NDT, TST, MRE, and MIL in managing hemiplegia?

Specific protocols like Neuro-Developmental Therapy (NDT), Task-Specific Training (TST), Motor Relearning (MRE), and Movement-Initiation Learning (MIL) are used in Ayurvedic management to address different aspects of hemiplegia and improve functional outcomes.

What are the complications of Pakshaghata?

Physical dependency, mental instability result in complications further

What is the chief complaint of Pakshaghata?

Sudden  weakness in the face, arm, or leg, especially on one side of the body

Slurring or loss of speech

Difficulty in seeing in one or both eyes.

Difficulty in walking, dizziness, loss of balance, or lack of coordination.

Severe headache with no reason

fatigue, light-headedness, or vertigo

numbness or weakness

pins and needles or reduced sensation of touch

muscle weakness or numbness

Contractions (spasticity) on the legs and hands on either side.

Pricking pain or sharp pain in the body

Loss of activity (akarmanyata) and loss of sensation (achetana) of the affected side.

Which dosha is involved in pakshaghata?

Vata in a prime role.

How do you treat pakshaghata?

Various treatment modalities like vasthy,abhyangam,sirodhara, and kaya seka help in supporting the post complications.

What is the cause of Pakshaghata?

Ahara ,vihara ,manasika and abhigathaja hetus.

Which Ayurvedic medicine is best for platelets?

Kashayams like drakshadi kashayam, karimbirumbadi kashayam, kooshmanda rasayanam with proper advises are often included in the clinical management of neurological disorders. 

Which medicine is good for pitta dosha?

Drakshai kashyam, guduchyadi kasyam, etc 

What is the Pakshaghata gait?

A limping or a dragging gait

What is the golden treatment for a stroke?

Vasti is the prime treatment for controlling the complications

How to test and find a Stroke?

MRI and CT to rule out the reasons for the condition

What are the different types of Stroke?

Three types of major strokes are now recognised. These are ischaemic, haemorrhagic, and lacunar strokes. Ischaemic variety with cerebral infarction results from atherothrombosis or brain embolism to cerebral vessels. Haemorrhagic stroke with bleeding within the central nervous tissue occurs due to a ruptured cerebral aneurysm in the young and hypertensive intra-cerebral bleeding in the elderly. Lacunar strokes are deep, small cerebral infarcts located in the basal ganglia or deep white matter, resulting from diseases of small penetrating vessels