Case-presentation- धमनीकाठिन्य एवं उच्चरक्तचापजनित मस्तिष्कगत-रक्तस्रावोत्तर ग्रथितरक्त/पक्षवध की आयुर्वेद चिकित्सा (Ayurvedic Management of An Atherosclerosis originated Hypertensive post-haemorrhagic Hematoma with presentation of Hemiplegia)

 

Case study- 

 धमनीकाठिन्य एवं उच्चरक्तचापजनित मस्तिष्कगत-रक्तस्रावोत्तर ग्रथितरक्त/पक्षवध की आयुर्वेद चिकित्सा                                                                                                                                                                                     Ayurvedic  Management of An Atherosclerosis originated Post-hemorrhagic Hematoma with presentation of Hemiplegia.

 

Vd. SURENDRA A. SONI, 

M.D., PhD (KC), 

Professor & Head, 

Vd. ANAMIKA S. SONI, 

M.D., Associate Professor,

Vd. NIRALI S. THACKER, 

Final year P.G. 

Upgraded P.G. Dept. of Kayachikitsa, Govt. Akhndanand Ayurveda College, Ahmedabad, Gujarat, India. 

 

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ABSTRACT

 An Atherosclerosis originated Hypertensive post Hemorrhagic Hematoma case of a chronic smoker with presentation of hemiplegia was treated successfully with classical line of treatment of 'Kapha-Vatanubandhi Pakshavadha & Grathita Rakta Chikitsa'. Treatment includes the use of Matrabasti, Deepana, Pachana, Anulomana, Srotosodhana, Brihana, Rakta-Vilayana, Katu and Kshara etc. targeting to the basic site of pathology along with main site of Vata Dosha ( Pakwashaya ).

 

 

KEYWORDS : Atherosclerosis, Hypertensive,  Hemorrhagic, Hematoma, Hemiplegia, Kapha-Vatanubandhi, Pakshavadha, Grathita Rakta, Matrabasti, Deepana, Pachana, Anulomana, Srotosodhana, Brihana, Rakta-Vilayana, Katu, Kshara,Vata Dosha, Pakwashaya.

 

 INTRODUCTION

An intracerebral hemorrhage (ICH) is a type of stroke. Its name refers to the bleeding (hemorrhaging) within the cerebrum caused by a blood vessel ruptures and creates pool of blood called a hematoma in the brain. As the bleeding continuous the hematoma gets larger, increasing the pressure inside the brain. compression on the brain can cause damage to the brain and lead to neurological deficits, unconsciousness or death.

Spontaneous intracerebral hemorrhage accounts of 10-15% of all strokes. Worldwide, the prevalence of stroke is 9 cases/1000 in the global population. In India is approximately 200 per 100,000 persons and 9.94% of total deaths.  Cerebro vascular accidents are the second leading cause of death and the third leading cause of disability.

In Ayurveda, according to Acharya Charaka, all Shiroroga are caused by Dustha Rakta (ch.su.17/11). The vitiated Doshas with Rajasa and Tamasa also, individual or in combination reside and obstruct the channels that carry Rakta, Rasa and consciousness. This leads to various disease such as Mada (intoxication), Murchchha (syncope) and Sanyasa (coma) which are etiologically and therapeutically progressive. Vitiated doshas distress the mind and alter the sensorium leading to further impairment of consciousness.

Injury/bleeding in the Shiras  is one type of Siro Raktapitta if it is due to internal or 'Nija_hetu.'. It leads to Ardita (hemiplegia with facial palsy), Moha (a state of confusion), Udveshtana (twisting pain in the head), Chestanasha (loss of body functions), Hanugraha (stiffness of jaw), Mooka (dumpness), Lalasrava (dribbling of saliva), Vadana Jimhatva (deviation of face) etc.

             The term Pakshaghata means paralysis of one half of the body. Aghata denotes the impairment of Karmendriyas, Gyanendriyas and Manasa. Gyanendriyas are considered a part of the sensory system and Karmendriyas are considered a part of the motor system. The Manasa is supposed to control and guide both. Pakshaghata is a Vatavyadhi. The features of Pakshaghata are Chestahani, Ruja, Vakstambha, Hasta Pada Samkocha, Sandhi Bandhvimoksha, Mukhavakrata, Sphoorana of Jihva 

 

PRELIMINARY DATA OF PATIENT

Age- 60 yr

Sex- male

Date of admission – 01/01/2020

Date of discharge – 22/03/2020

 

CASE DESCRIPTION

A 60 years old male came to our Hospital in Kayachikitsa OPD on 1/1/2020 with complaints of weakness of the left side of his body, abnormal speech, unable to walk, difficulty in eating and drooling from left angle of mouth since 7 days. He was a previously diagnosed case of a Cerebro vascular accident (An Atherosclerosis originated Hypertensive post Hemorrhagic   Hematoma  with presentation  of  Hemiplegia).

PAST HISTORY

H/O tobacco chewing since 40 years

 k/c/o hypertension since 5 years 

 

History of present illness-

On 23/12/2020, during midnight patient went for urination and suddenly  fell down around 2.30 am. He was unable to walk and speak. Then he was admitted at allopathic hospital and was diagnosed as CVA. He was discharged from there in 3 days but still he had same signs & symptoms. On 1/1/2020 he was admitted in government Akhndanand Ayurveda College Hospital, Ahmedabad.

 

ON EXAMINATION

B.P. – 160/100 mm Hg

P.R.-102 /min

R.R.- 20/min

Weight- 56 kg

 

Personal history
Diet	Non-vegetarian
Addiction	Tobacco since 40 years
Appetite	Normal
Bowel	1 time/day
Sleep	Normal
Micturition	5-6 time/day, 2-3 time/nt

 

Astha vidha pariksha
Nadi	Vata-pitta
Mootra	Samayak
Mala	Samayak
Jihwa	Nirama
Shabda	Vikkruta
Sparsha	Anushnashita, Ruksha
Drik	Samayak
Aakruti	Udvigna

 

Dashvidha pariksha
Prakriti	Vatapradhan pitta
Vikruti	Lakshna nimmitta
Sara	Ras-sara
Samhanana	Madhyama
Pramana	Madhyama
Satmaya	Madhyama
Satva	Madhyama
Aaharashkti	Abhyavarana shakti :  madhyama  Jaran shakti : madhyama
Vyayamshkti	Madhyama
Vaya	Vriddha

 

CLINICAL FINDINGS:-

OBJECTIVE FINDING:

Before Treatment-

 CT scan of Brain (23/12/2019)

SUBJECTIVE FINDINGS

No.	Symptoms of Pakshaghata
1	Vamasandhibandhan vimokshyana	Present
2	Dakshinsandhibandhan vimokshayana	Absent
3	Cheshta nivritti	Present
4	Ruja	Present
5	Vakastambha	Present
6	Akarmanyata	Present
7	Achetana	Absent

 

Cerebro vascular accident (An Atherosclerosis originated Hypertensive post Hemorrhagic Hematoma) was diagnosed by history, reports and clinical examination.

 

Samprapti

                  Patient had started smoking before 40 years. He was chronic smoker and taking 15-20 bidis/ day. He had habit of Atichankramana after retirement of his service. He was suffering from tension as his wife is expired and he is feeling very lonely. Patient has Vata-Pittaj Prakruti and also k/c/o hypertension. All Nidan Sevana leads to Vataprakopa. This aggravated Vata get enter into Siras through Raktavaha Srotasa (Sthanshamshrya). This leads to Mada and Murchha. Patient ate biryani (heavy meal) on dated 22/12/2019 at night. He was going for urination at 2:30 a.m. due to poor consciousness he felt down. He had Shiromarmabhighata. It leads to Abhyantara Raktapitta (An Atherosclerosis originated Hypertensive hemorrhagic hematoma). 

 

Samprapti Ghataka

Dosha	Vata pitta rakta
Dushya	Rasa, Rakta, Mamsa, Majja
Adhisthan	Sharirardha
Srotasa	Rasa, Rakta, Mamsa, Majja
Rogamarga	Madhyama
Srotodustiprakara	Sanga
Sama/nirama	Nirama
Vyadhiprakara	Chirakari

 

 

Treatment

Date 1/1/2020	•  1. Before meal Avipattikar churna- 6 gm Navayasloha- 500 mg Sarjikakshara-250 mg 1 tsf bd with cow’s ghee   •  2. After meal Shankhavati 2 tab bd Ashwagandharista 20 ml bd with water   •  3. Kshirapaka Ashwagandha churna – 5 gm Sunthi churna – 3 gm BD   •  4. Sinhnadaguggulu – 3 tab bd Punarnava Mandur – 2 tab bd Tribhuvankirtirasa- 1 tab bd   •  5. Dashmulakwatha 100 ml with Madhu- 2 tsf BD   •  6. Panchkarma  Sarvang Abhyanga with Nirgundi Taila and Nadi-Swedana Matrabasti with Bala-Aswagandhatail Tail.
Date 8/1/2020	Rep. 1,2,3,4,5,6. 7. Goksuradi guggulu 2 tds Chandraprbhavati 2 tds
Date 27/1/2020	Stop 6
Date29/1/2020	Rep. 1,2,3,4,5,7 8. Erand taila 4 tsf + Shunthi Churna 3 gm for 3 days
Date 15/2/2020	Rep. 1,2,3,4,5,7. 9. Yastimadhu Ghanavati 1 tds for Kasapravruti
Date 16/3/2020	Rep. 1,2,3,4,6
Date  22/3/2020	Rep. 1,2,3,4.

 

Observation 

No.	Symptoms of Pkshaghata	BT	AT
1	Vama sandhi bandhan Vimokshayana	8	1
2	Dakshin sandhi bandhan vimokshayana	0	0
3	Cheshta nivritti	8	2
4	Ruja	9	1
5	Vakastambha	10	1
6	Akarmanyata	7	1
7	Achetana	0	0

 

0 = no difficulty, 1-3 = mild , 4-5 = moderate , 6-7 = severe , 8-10 = very severe .

 

DATE	B.P. (mm Hg)	GRIP POWER (mm Hg)		10 METER WALKING TIME
		Lt hand	Rt hand
1/1/2020	160/100	0	120	Unable to walking
11/1/2020	144/90	30	120	In 10 sec. with support
14/1/2020	140/90	30	130	In 10 sec. without support
26/1/2020	136/90	80	160	In 10 sec. without support
10/2/2020	134/92	100	160	In 10 sec. without support
25/2/2020	132/90	120	160	In 10 sec. without support
11/3/2020	134/90	140	160	In 9 sec. without support
22/3/2020	130/90	140	160	In 8 sec. without support

 

Post-treatment CT Brain-

CT scan of Brain (14/03/2020)

Hypodencity (HD – 17-20 ) noted in right cephaloganglionic region, p/o infarct.

Age related cerebral cortical atrophy is seen. No hematoma.

 

RESULT

Patient did not take any contemporary medicine and he got completely relief through ayurvedic treatment. After 3^rd day of treatment, improvement was seen in abnormal speech, eating and drooling from left angle of mouth. After 10 days, also improved in swallowing and loss of sensation in left upper and lower limb. He could able to walk with support. After 14 days, he was able to walk without support. After 26 days he was able for wearing slippers and walk without support. At the time of discharge patient was happy as he was able to walk, stand and do his regular activities without support. 

 

DISCUSSION

Stroke is the sudden death of some brain cells due to lack of oxygen when the blood flow to the brain is lost by blockage or rupture of an artery to the brain. In Ayurveda stroke is described by Pkshaghata/Siragat-vat. Pakshaghata is a Nanatmaj Vatavyadhi according to Charaka. Due to the intake of various diet and regimen, Vatadosha gets vitiated and occupies the Rikta Strotasa in the body. Patient was also chronic smoker and he was taking 15-20 bidis/day. Due to excessive Dhumasevana, Ruksha and Khara Guna of Vata increased in vessels, which is responsible for Dhamnikathinya. Patient was also k/c/o hypertension(Vatanubandhi) as a result of atherosclerosis. These all causes led to intracerebral hemorrhage and hematoma that is a condition of Grathit-rakta mentioned in Ayurveda.

Specific treatment plan was designed as per condition of Atherosclerosis originated Hypertensive post Hemorrhagic Hematoma with presentation of Hemiplegia.

As per complex  pathology, the treatment plan was started with priority given to Koshta mainly Pakwashaya. Avipattikara Churna combination designed to pre-existing irritation, blotting, flatulence and treat incomplete evacuation. Sarjikakshara (soda-bi-carb) was added to break/dissolve the hematoma/Grathita-rakta. Navayasa Loha was added to strengthen the body. Shatavari and Aswagandha was selected to give Vata-shaman and Brihana effects.

                     Guggulu mainly planned as per Vatadosha and Punarnava Mandur was selected for cerebral oedema. Tribhuvanakirti rasa was given in small dose to check seasonal cough and cold and Grathita Rakta. Dashmoola Kwatha with Madhu(honey) as Ubhaya-prtyanika specially Rakta-vilayaka (thrombolytic agent). Minor changes in drugs was made as per the condition of patient, disease and season etc. Above plan work tremendously and patient started responding on third day and within a month all complaints cured completely. After that he was kept in IPD for Brihana and Rasayana Chikitsa for next 45 days up to the lockdown announced. Patient showed overall improvement in all parameters.

 

                      

CONCLUSION 

                       An Atherosclerosis originated Hypertensive post Hemorrhagic Hematoma can be managed very well applying the line of treatment of Vatavyadhi, Grathia Rakta-Pitta. While modern science recommends Brain Surgery to remove such hematoma, which has various risk factors and very high cost of surgery. While Ayurveda can manage such cases effectively avoiding the surgery with nominal cost. Such multiple pathological cases are increasing day by day in society. So the treatment plan must be targeted individually as per case/patient in closed observation. “पुरुषं पुरुषं वीक्ष्य

” means individual approach has been instructed in Ayurveda.

 

 

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