4th World Ayurveda Congress

4WAC , Bengaluru, 12th Dec 2010 4:30 pm

Guided by :Dr.Niranjan rao MD(Ayu)

Professor Dept of Panchakarma

SDMCA -Udupi

Presenter : Dr.Prakash paltye final year MD Scholar Dept of Panchakarma, SDMCA –Udupi

drprakash007paltye@gmail.comReF:No:4WAC/PA-780

INTRODUCTION: Pakshaghata is one among the Vatavyadhi consider

as mahagada mentioned by Acharyas and is tricky to restore to health. Pakshaghata may be correlated with the stroke phenomena, where in either left or right side of the body looses its functions in different degrees.

Paralysis is the total loss of voluntary motor function result from severe cortical or pyramidal tract damage, 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 is a leading cause of serious long term disability in the United states.

Stroke incidence and mortality rates found to be higher in developing than in developed countries for first time 2

New Data the World Congress of Cardiology BEIJING, 19 JUNE 2010.  There is evidence that stroke incidence rates in developing countries have increased by more than 100 per cent during the last four decades, while they have decreased by 42 per cent in developed countries over the same time period, according to new data presented today at the World Congress of Cardiology (WCC) Scientific Sessions in Beijing, China.  Over a four decade period, stroke incidence rates increased from 52 per 100,000 person-years (1970-1979) to 117 per 100,000 person-years (2000-2008) in developing countries. 

May 2007, The burden of stroke, Each year 16 million people experience a stroke and 5·7 million die. 87% of global stroke mortality occurs in low- and middle-income countries3.

Stroke is the third most common cause of death in developed countries, behind coronary heart disease (CHD) and cancer.

Basti is one of the superlative treatment modality in morbid vata dosha. 5 Niruha basti considered as one of the foremost treatment for pakshaghata.6 in which it is capable of eliminating doshas from the body and it sustains life, dosha, dhatu and mala.7 Niruhabasti serves purpose of ellimination of vitiated vata dosha. Among various types of Niruha basti dravyas, Dwi-panchamula Niruha basti dravya are also mentioned.8 so it is considered effective in Vatavyadhi and also provides additional benefits of shodhana, bruhmana, Rasayana .Here a sincere attempt is made to evaluate the efficacy of the same.

OBJECTIVES OF THE STUDY

To evaluate the efficacy of Dwi-panchamula Niruha

basti clinically. Conceptual study of Dwi-panchamula Niruha Basti

and pakshaghata will be taken up.

SELECTION OF PATIENTS AND METHODS

SOURCE OF DATA:

It is a single blind clinical study with a pre-test and post-test design where in a minimum of 20 cases but here attempt to made for present clinical study 60 patients suffering from Pakshaghata were selected.

Method of data collection: It is a clinical study to evaluate the efficacy of Dwi-

panchamula Niruha Basti as Yoga Basti procedure in 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 mentioned in our classics and allied sciences to confirm the diagnosis.

Patients will be analyzed & selected accordingly

Inclusion criteria : Patients suffering from pakshaghata. Patients who were fit for Niruha basti.

Age group between 30-70 yrs.

Exclusion criteria:Signs and symptoms of Pakshaghata with evidence

of cerebral infection, convulsive disorder, space occupying lesions and trauma.

Patients with T.I.A and IHD.Patients with signs and symptoms of Pakshaghata

above 6-months.

Assessment Criteria : Subjective parameters Symptoms of Pakshaghata. Symptoms of Samyak nirudha and anuvashita

Lakshanas.  Objective parameters It was assessed by Neurological mapping Interventions: Duration of treatment -8 days. Dosage of Dwi-panchmula Niruha basti dravya:  Shat-prasrutika matra i.e.576ml (Approxi:600ml) Dosage of Matra basti: 30 ml of Moorchita taila Mode of administration:- All the drugs will be

given perectum.

Poorvakarma: Sthanika Abhyanga with Moorchita tila taila & Nadi

sweda with ushna jala. Pradhana karma: In this study Dwi-Panchamula Niruha basti was

administered in Yoga basti course. Therefore, on 1st, 3rd, 5th, 7th, 8th, day Matra basti with Moorchita taila was given. And on 2nd, 4th, 6th, day Dwi-Panchamula Niruha basti was given.

Assessment will be done before administration of Basti Chikitsa (BT)

At the end of Yoga Basti course assessment will be done after 8 days (AT)

After 16 days followup will be done [pariharakala of basti] (FU)

Total duration of study will be maximum of 24 days.

Paschatakarma: Parihara kala of Niruha basti i.e 16 days.

Total 60 patients diagnosed as pakshaghata were randomly selected & studied

Distribution of patients according to age:Analysis of age incidence of 60 patients shown the more number of patients are in the group of 61 –70yers of age.

Marital status

Among 60 patients 58 patients in the study were married peoples and 2 patients were un married.

Diet

Maximum no of patients were of mixed diet (51).

Distribution of patients according to duration of illnessAnalysis of duration of illness incidence of 60 patients shown the, more number of patients are in the group of 10-20 days history of illness i.e-22 patients.

Distribution of patients according to religion

Analysis of religion incidence of 45 patients shown the more number of patients(75%) were in the group of Hindu.

Occupation

Analysis of occupation incidence of 60 patients shown the more number of patients(30%) housewife, were in the group moderate work group of occupation.

Distribution Of Patients According To Side Affected

Maximum numbers of patients56.66% of patients had right side affected while 43.33% had left side involvement.

EFFECTS OF DWI-PANCHAMULA NIRUHA BASTI ON DIFFERENT NEUROLOGICAL PARAMETERS

The analysis was done statistically using version SPSS statistics 17.0 software.

Paired t- test was used for comparing the results. BT- Before the initiation of Dwi-panchamula Niruha

Basti therapy. AT-Immediately after the completion of Dwi-

panchamula Niruha Basti therapy. AF- After the completion of follow up of 16 days.

•Over All Effect Of Treatment Analysis Of Subjective Criteria: Effect of treatment on Karma kshya

n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ testSD 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

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 :n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ testSD SE ‘t’ P

45 2.82

AT 2.24 0.58 20.56

0.449 ± 0.744

7.760 P<0.001

AF 1.84 0.98 34.75

0.583 ± 0.869

11.248

P<0.001

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 vak-stambha :n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ test

SD SE ‘t’ P

27 2.98

AT 2.39

0.59

19.79

0.242 ± 0.421

6.325 P<0.001

AF 1.96

1.02

34.22

0.358 ± 0.798

11.796

P<0.001

Statistical analysis revealed that there was 19.79% improvement in vak-stambha soon after treatment and was further increased to 34.22% after the follow up. This change that occurred with the treatment is statistically significant (P<0.001) with degree of freedom 26.

:

n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ testSD SE ‘t’ P

26 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

Effect of treatment on Sandhi bhandha vimoksha :

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

n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ test

SD SE ‘t’ P

33 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

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 Shotha

n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ test

SD SE ‘t’ P

33 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

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.

EFFECT OF TREATMENT ON DIFFERENT OBJECTIVE CRITERIA: Effect Of Treatment On Knee Reflex

n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ test

SD SE ‘t’ P

60 3.77

AT 3.08 0.69 18.30

0.469 ±0.61 11.733

P<0.001

AF 2.45 1.32 35.01

0.567 ±0.73 17.980

P<0.001

0

1

2

3

43.77

3.08

2.45

BT AT AF

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).

n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ testSD SE ‘t’ P

60 1.82

AT 1.60 0.22 12.08

0.415 ± 0.54 4.040 P<0.001

AF 0.82 1.00 54.94

0.487 ± 0.63 15.901

P<0.001

Effect of treatment on Finger nose test

Statistical analysis revealed that there was 12.08% improvement in Finger nose test soon after treatment and later on improvement was further increased to 54.94 % after the follow up. This change is statistically significant (P<0.001).

Effect of treatment on Finger movement of hand

n BT

Mean

Follow up Mean

Diff

“d”

% Paired ‘t’ test

SD SE ‘t’ P

60 1.83 AT 1.63 0.20 10.92

0.415 ± 0.54 4.040 P<0.001

AF 0.82 1.01 55.19

0.390 ± 0.50 29.182 P<0.001

Statistical analysis revealed that there was 10.92 % improvement in Finger movement hand soon after treatment and was further increased to 55.19 % after the follow up. This change that occurred with the treatment is statistically significant (P<0.001).

Maximum retention time for Dwi-panchamula niruha

basti was 48 min.

Minimum retention time for Dwi-panchamula niruha

basti was 5 min.

Maximum retention time for MATRA BASTI was

9hrs(540 min)

Minimum retention time for MATRA BASTI was 10min

MEAN RETENTION TIME OF BASTI FOR EACH DAY IS AS FOLLOWS

DAY 1st 3rd 5th 7th 8th

MEAN RETENTION

TIME FOR MATRA BASTI

150min 180min 240min 480min 540min

DAY 2nd 4th 6th

MEAN RETENTION

TIME FOR NIRUHA BASTI

8min 12min 18min

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 . Niruha Basti is one among the treatment modality for Pakshaghata.

Dwi-Panchamula Niruha basti has been selected for the study. While screening the literatures it can be found that this particular Basti pacifies the vitiated Vata dosha i.e.sarva anila vyadhihara and provides Bruhmana also.Reference: cha. si .3/35 and As.H.kalp: 4/4

DISCUSSION

PLAN OF STUDY:

The patients for the study were selected from the IPD section of SDMAH, Udupi. 80 patients fulfilling the inclusion criteria and presented with Prayatma Lakshana of Pakshaghatha were registered.

Total number of patients registered – 80 Completed Present clinical study – 60 Pilot study – 20 Reason for pilot – we tried basti with different

kalkas, as satapushpa kalka,ashwagandha kalka,and administrate basti in different dose with respect to beyond 70 yr age also. for further evaluation of retention time and benefits etc.. Hence the statistical data could not be done and put under the category of pilots study.

CLINICAL STUDY: A single blind clinical study was conducted on

Patients suffering from Pakshaghata. Patients were randomly selected. In this study Dwi-Panchamula Niruha basti was administered in Yoga basti course. Therefore, on 1st, 3rd, 5th, 7th, 8th, day Matra basti with Moorchita taila was given. And on 2nd, 4th, 6th, day Niruha basti was given. The following observations are made.

CONCEPTUAL STUDY Age and Moola chidra pramana relation is given in

Sushruta Samhita and in Astanga Sangraha, while Relation of Basti yantra pramana and Moola chidra pramana is given in Astanga hrudaya. From this one can draw relation between Age and Basti yantra pramana.

OBSERVATIONS AND RESULTS:

Age: This study describe maximum number of patients belonged to the age group of 61-70 yrs 40%, followed by 51-60years 28.33%, and then 21.66 % of patients belonged to the age group of 41 to 50 years ,and a minimum number 0f patients shown in the table 10% of the patients belonged to the age group of 30 to 40 years, After 40yrs up to 70yrs it is considered as Parihani state, which is characterized by Vataprakopa, Bhrishyamana Dhatu, Kshiyamana Dhatu awastha and because of the etiological factors when they indulging in vataprakopaka Ahara-Vihara led to morbid status of Vata, hence led to pakshaghata.

• Sex: In this study most of patients in the study were Males 66.66% and Female patients were 33.33%.However outstanding to exceptionally small sample it cannot be concluded that Male are more prone to Pakshaghata.

• Religion: Most of the patients included in the study were Hindus 75%, followed by Muslims 16.66% and Christians 8.33% This may be due to Hindu dominant population in this area.

• Desha: In the present study that 86.66 % patients hailed from Anupa desha and 13.33 % from sadharana desha,as most of patients are from areas near by udupi which is anupa desha.

• Duration: 18.33% 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 30% the history of 21-30 days and 36.66% Of the patient gave the history of 10-20 days were the maxim no: of cases observed in study. The patients in whom acute phase was over were more in the study.

EFFECT OF TREATMENT: ON CLINICAL PARAMETERS

•Effect on Reflexes:Statistical analysis revealed that there was improvement in all reflexes viz ‘Biceps’, ‘Triceps’, ‘Brachioradialis’, ‘Knee’ and ‘Ankle reflexes’ soon after the treatment which was further 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 reflex score soon after treatment, but further significant change in reflex score during fallowup period i.e basti parihara kala. so it can be concluded that Dwi-panchamula Niruha Basti is having more benefits in Karma kshya in addition to Karma hani.

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 lakshanas: absolute relief was seen in symptoms like

karmakshya, Vichetana , 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 24 days , may be more course of basti is needed to see result in this

lakshana.

DWI-PANCHAMULA NIRUHA BASTI IS BENEFICIAL IN PAKSHAGHATA BECAUSE OF THE FOLLOWING REASONS:•It pacifies Vitiated Vata Dosha.•It acts as Yapana as all its contents holds the qualities of Rasayana & Shodhana brumhana.•Improvement results seen after treatment and maintained further upto parihara kala •Reflexes : Lakshanas : Triceps reflexes Karma kshya Brachioradialis reflexes Ruja, Knee reflexes Vakastambha Ankle reflexes Toda, ShothaPower with respect to movement – Upper Limb — Shoulder, Elbow, Wrist. Lower Limb — Hip, Knee, Ankle,. Finger movement in Hand. Standing from Sittingposture Wrist drooping,Footdrooping

Loss of Speech Hand - grip power

Paper holding in Finger.

• Results seen after treatment were less improvement and later changed to significant during parihara kala:

Romberg’s test & Finger nose test Heel shin test Sitting from Lying down posture 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

CONCEPTUAL STUDY:  Dwi-Panchamula Niruha Basti can be considered

as Mridu Basti , Bruhmana Basti, Siddha Basti, Vataghana Basti, Shodhana Basti,Shamana Basti,Rasayana Basti, and On the basiss of Prasruta – yogiki Basti we can consider as shat prasrutika matra i.e. 576ml.

Ingredients of this Basti varies from usual Niruha Basti , were as in Dwi-panchamula Niruha basti, Makshikam, Lavanam, Trya-snehas i.e. Indukanta ghrita, Moorchita taila, ,Varaha vasa,and Ashwagandha kalka is added and Dasamulakwatha , chagala Mamsarasa, and Aamlakaanji is taken into consideration.

OBSERVATION: 28.33. % of patients in this study belonged to

Parihani awastha and 40% belonged to vrudha awastha , which is characterized by Vataprakopa, Bhrishyamana Dhatu, Kshiyamana Dhatu awastha.

Risk factors like Hypertension and Diabetes mellitus, Smoking, Tobacco Chewing.

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 restored very slowly and percentage of improvement is comparatively less to that of gross.

Speech and sensory aspects improved ,but it is not up to the mark of gross motor movements.

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

It has certain limitation in the treatment of chronic patients above age 70-90 yrs which is observed during pilot study.

The author is putting forward a combination of Shodhana, Rasayana, relevant shamana will yield, maximum benefit in the patients.

• References:• Tortora /Grabowski, Principles of Anatomy & Physiology ninth

edition pp: 1055 page no;479.• http:// www.worldcardiocongress.org/ 19.06.2010 08:30.• http://www.world-heart-federation.org/ 19.06.2010 08:30.• http://www.strokeassociation.org/ 19.06.2010 08:30.• Sushruta,Sushruta Samhita edited by Jadavji Trikamji Acharaya

reprint 2003 Chaukamba Sura Bharati prakashana Varanasi 2003 Pp:824page no:525.

• Agnivesha Charaka Samhita, edited by Jadavji Trikamji Acharya,5th edition Chaukamba publication Varanasi 2001.Pp :738 page no:619.

• Vagabhata, Ashtanga Hridaya edited by Kaviraj Atridev Gupta 14th edition Chaukamba Sanskrit Samsthan Varanasi Pp:616 page no:278

• http://www.enemakit.com/enema_history.html

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