E-ISSN:2456-3110

Case Report

Pakshaghata

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 4 APRIL
Publisherwww.maharshicharaka.in

Management of Pakshaghata through Ayurveda - A Case Series

Jayakumar P1*, Krishna A2
DOI:10.21760/jaims.10.4.43

1* Pallavy Jayakumar, Post Graduate Scholar, Department of Panchakarma, Government Ayurveda College, Thiruvananthapuram, Kerala, India.

2 Ambili Krishna, Assistant Professor, Department of Panchakarma, Government Ayurveda College, Thiruvananthapuram, Kerala, India.

Vata Dosha is considered to be the most important among Tridoshas in Ayurveda. Neither Pitta Dosha nor Kapha Dosha nor the Dhatus nor the Malas can move on their own. They are led by Vata Dosha just like the clouds which are driven by the wind.[1] Together with the other two Doshas, Vata plays a vital role in the causation of diseases. But there are some diseases where Vata alone gets vitiated and produce disease and they are generally termed as Vatavyadhis.[2] Pakshaghata is one among them which is characterized by loss of movement or disability of one side of the body. It may be correlated to hemiplegia caused due to cerebrovascular accident or stroke. This article is an attempt to analyse the case reports of five patients affected by Pakshaghata, who were admitted in our hospital IPD and to develop a general treatment protocol considering the site of lesion, Prakruti, age of the patient, chronicity of the disease etc.

Keywords: Pakshaghata, Panchakarma, Vatavyadhi, Stroke

Corresponding Author How to Cite this Article To Browse
Pallavy Jayakumar, Post Graduate Scholar, Department of Panchakarma, Government Ayurveda College, Thiruvananthapuram, Kerala, India.
Email: 		Jayakumar P, Krishna A, Management of Pakshaghata through Ayurveda - A Case Series. J Ayu Int Med Sci. 2025;10(4):282-288.
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https://jaims.in/jaims/article/view/4172/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-03-13 2025-03-27 2025-04-07 2025-04-17 2025-04-27
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© 2025 by Jayakumar P, Krishna A and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Download PDFBack To ArticleIntroductionCase ReportObservations and ResultsDiscussionConclusionReferences
Pallavy J et al. Management of Pakshaghata through Ayurveda

Introduction

Pakshaghata/Pakshavadha is a condition mentioned among the Vatavyadhis in Ayurveda classics. ‘Paksha’ means side/flank, ‘Aghata’/’Vadha’ means killing or destruction or paralysis.

Here, aggravated Vata gets localized in one half of the body and causes Shosha/atrophy of Sira and Snayu, thus debilitating the half, by loosening the joint connections. As a result, that side of the body experiences Akarmanyata (loss of motor functions) and Vichethanatwa (loss of movements).[3]

Vata can vitiate in two ways; either due to Dhatukshaya or due to Aavarana.[4] Due to indulgence in factors causing depletion of Dhatus, the Srothases or the channels become empty and Vata gets vitiated by filling up these. If other Doshas (which include Dhatus, Malas also) fills up these empty channels, then Vata gets vitiated by causing Aavarana or obstruction to these channels.

The vitiated Vata gets localized in various sites of the body during Sthaana Samsraya stage of Kriyaa Kaala and causes various diseases. In Pakshaghata, Sroto Vaigunya is at various parts of brain like basal ganglia, corona radiata, pons etc.

So vitiated Vata gets localized in these areas and results in presentations of stroke. Stroke is a common medical emergency with an annual incidence of between 180 and 300 per 100000.

The incidence rises with age. One fifth of patients with an acute stroke will die within a month of the event and at least half of those who survive will be left with physical disability. The common clinical stroke syndromes depend on which vascular territories are affected.[5]

Case Report

This case series includes participants who were admitted in the Panchakarma IPD of our institution with a primary history of weakness of one side of the body. Cases were evaluated initially by detailed history taking and physical examination.

Demographic data collected included age, gender and personal and medical history with duration since the onset of the condition and the radiological findings. Pre-post assessment done using Barthels index and SSQOL stroke assessment scale.

Case 1:

A 57-year-old male patient who was not a known case of diabetes mellitus or hypertension was admitted in the IPD with complaints of weakness of right side of the body since a year. He also had difficulty in recalling names and recent events. Delayed sensations of touch, pain, temperature etc on the affected side was also there. The patient has received medical management on the same day of occurrence of symptoms, within the golden hour. A course of physiotherapy was also done.

Clinical Examinations

  • Higher mental functions
  • Past memory intact, present affected.
  • Cranial nerves
  • Optic nerve: visual field-right side of both eyes affected.
  • Trigeminal nerve: pain, temperature, light touch sensations feeble on the right side of body.
  • Motor system
  • Muscle power:
RightLeft
UL4/55/5
LL4/55/5
  • Muscle Bulk:

Nearly 1 cm difference in right upper limb and lower limb when compared to left upper limb and lower limb.

Gait - hemiplegic

  • MRI findings:

Acute infarct in the left corona radiata, posterior limb of internal capsule extending to thalamus

Acute infarct on left occipital lobe and medial temporal lobe of left PCA territory. No haemorrhagic transformation.

Case 2:

A 62-year-old male patient with no K/H/O DM, HTN was admitted in the IPD of the hospital with complaints of weakness of right side of the body and difficulty in articulation of words. Duration of the complaints was 12 years and it had aggravated a month before visiting our OPD. He wasn’t taken to the hospital within the golden hour and hence medical management was delayed.


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Pallavy J et al. Management of Pakshaghata through Ayurveda

Clinical Examinations

  • Higher mental functions
  • Speech affected
  • Cranial nerves
  • Motor part of trigeminal nerve affected
  • Clenching of teeth and lateral movement of lower jaw affected.
  • Motor system
  • Muscle power:
RightLeft
UL3/54/5
LL3/54/5

Gait - hemiplegic

  • MRI findings:

Basal ganglia bleed.

Case 3:

A 46-year-old male patient with K/H/O T2 DM, HTN and CAD-dilated cardiomyopathy, was admitted in the IPD, with complaints of weakness of left side of the body and slight deviation of angle of mouth towards right for 2 months. He was given immediate medical management and was still under allopathic medications while he visited our OPD.

Clinical Examinations

  • Higher mental functions
  • Intact
  • Cranial nerves
  • Facial nerve - motor part affected
  • Blowing of cheeks not possible
  • Whistling movements not possible
  • Motor system
  • Muscle tone: Left upper limb hypertonic
  • Muscle power:
RightLeft
UL5/53/5
LL5/53/5

Gait - hemiplegic; walks only with support

  • MRI findings:

Acute infarct in right basal ganglia AMD corona radiata with haemorrhagic transformation.

Right MCA and ICA thrombotic occlusion.

Case 4

A 61-year-old female patient with K/H/O DLP and HTN, presented with weakness of right side of the body, deviation of angle of mouth towards left side and slurring of speech, was admitted in the IPD. All these complaints started before 8 months from the date of visiting our hospital. She was given immediate medical management and a course of physiotherapy too.

Clinical Examinations

  • Higher mental functions
  • Slurring of speech present
  • Cranial nerves
  • Trigeminal nerve - motor part affected;
  • Clenching of teeth - weakness on right side
  • Facial nerve - motor part affected;
  • Frowning, wrinkling, blinking- weakness on right side
  • Buccinator weakness on right side
  • Motor system
  • Muscle power:
RL
UL3/55/5
LL3/55/5

Gait - hemiplegic; walks only with support

  • MRI findings:

Acute infarct on left capsule-ganglionic region, left corona radiate

Acute ischemic stroke.

Case 5

A 74-year-old female patient with K/H/O HTN was admitted in the IPD, with presenting complaints of weakness of left side of the body associated with difficulty in walking. All these complaints started before 2 months from the date of visiting our hospital. She was not given medical management within the golden hour after the occurrence of stroke event.

Clinical examinations

  • Higher mental functions
  • Intact

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Pallavy J et al. Management of Pakshaghata through Ayurveda

  • Cranial nerves
  • Intact
  • Sensory system
  • Sensation of touch slightly reduced over left side of the body.
  • Motor system
  • Muscle bulk: Reduced by 2cm over left arm and left thigh
  • Muscle tone: normal
  • Muscle power:
RL
UL3/54/5
LL3/54/5

Gait - hemiplegic; walks only with support

  • MRI findings:

Old infarct with atrophy over left capsulo-ganglionic region.

Demographic Data of All Patients

PT.1PT.2PT.3PT.4PT.5
Age In Years5762466174
GenderMaleMaleMaleFemaleFemale
OccupationNRICentral Govt. StaffGovt. StaffHouse WifeHouse Maid
Side AffectedRightRightRightLeftRight
Brain LesionLeft Corona Radiata, Internal capsuleBasal GangliaBasal GangliaLeft Capsulo-Ganglionic Region, Corona RadiataLeft Capsulo-Ganglionic Region

General Treatment Principle

1. Deepana-Paachana

All patients were given Deepana-Paachana therapy as first line of treatment in Pakshaghata. Kashayas and Choornas were given for this purpose and commonly used combination was Gandarvahasthadi Kashaya[6] 60ml twice before food given along with 12gm Vaishwanara Choorna.[7]

2. Bahya Rukshana

Bahya Rukshana was the initial external therapy done for all the patients. The following procedures were adopted by considering the patient’s condition:

  • Ruksha Sweda
  • Dhanyamla Dhara and Pradeha

  • Udwarthanam
  • Kashaya Dhara

Out of the five patients, two were given Ruksha Sweda as the initial procedure and the medicine used was Kolakuklathadi Choorna.[8] For a patient complaining of numbness and paraesthesia, Dhaara using Dhanyamla was done. Dhaara using the Kashaya made of drugs of Vedanaasthapana Gana and Dashamoola Choorna was given as initial Rukshana for one patient. One case among the five was associated with flaccidity of limbs. So, he was given Udwarthana with Kolakulathadi Choorna. Two or three Rukshana therapies were administered to the patients till he/she was found suitable for Bahya Snehana or external oil therapies.

3. Bahya Snehana

Bahya Snehana was the procedure done after initial Rukshana. After assessing Nirama Lakshanas like removal of obstruction to channels, lightness of body, normal passage of Vata, free from fatigue, good appetite etc.[9]

suitable oil was selected for Abhyanga or external oil massage. The Taila Yoga selected for two patients was Chinchadi Taila.[10] Remaining three patients were administered Abhyanga with a combination of Mahanarayana Taila[11] and Prabhanjanam Kuzhambu.[12]

4. Swedana

After Abhyanga, different types of Swedana procedures were done, which included:

  • Patrapotala Sweda
  • Kaayaseka
  • Shashtika Pinda Sweda

Swedana Karma is contraindicated in Prameha.[13] So in diabetic patients, it was done in mild heat and with utmost care.

In Patrapotala Sweda, the same oil which was used for Abhyanga was used in four of the five cases.

For Kaayaseka, a combination of Prabhanjanam Vimardana Taila with either Chinchadi Taila or Dhanwantharam Taila[14] was used.

In all the five patients, there was wasting of muscles in varying grades. So, Shashtika Pinda Sweda was done. Here also the Taila used for Abhyanga was taken.


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5. Murdhni Taila

Among the four Murdhni Tailas, Shiropichu and Shirovasti were selected. Shirovasti was done towards the end of the treatment course, after Shashtika Pinda Sweda. The Taila used was Mahanarayana Taila. In two of the cases, Shiropichu was done before Shirovasti with the same Taila.

6. Main Panchakarma Procedures

A) Nasya- Marsha Nasya with Ksheerabala Taila(101 Aavarti)[15] was done in all cases, after Abhyanga and Ushma Sweda. The same Taila was used for Pratimarsha Nasya too, after

B) Basti- along with Patrapotala Sweda, Balaguloochyadi Yapana Basti was administered.[16]

C) Virechana- with suit. medicine as per Koshta was given at end of Patrapotala Sweda & Kaayaseka.

Observations and Results

There was gradual improvement in the patients’ condition with our treatment. After almost two months of IP management, they were discharged on oral medications. Follow up was done after a month. Effect of treatment was assessed based on physical symptoms, stroke scale quality of life index, Barthes index for stroke and improved quality of life.

BARTHES Index for Stroke

Patient 1Patient 2Patient 3Patient 4Patient 5
BTATBTATBTATBTATBTAT
Feeding0555050505
Grooming0555000005
Bathing5555050000
Dressing55510050505
Bowel0105100501005
Bladder51010100501005
Toilet use510510050505
Transfers (bed to chair and back)510101051005010
Mobility1015101051005510
Stairs0555050005

STROKE Scale Quality of Life Index

Before TreatmentAfter Treatment
Patient 189188
Patient 282181
Patient 376192
Patient 474178
Patient 586182

Discussion

All the five patients who were admitted in the IPD with the symptoms of basal ganglia stroke were managed through almost similar treatment protocol. Our internal medicines and external therapies along with the support of weekly physiotherapy sessions caused relevant improvement in the patients’ condition. Initial Deepana-Paachana and Rukshana helps in changing Doshas in Saama stage to Niraama stage, for their easy expulsion after bringing them to Koshta from Shaakhas. In Pakshaghata there is severe constriction of vessels, tendons and ligaments and emaciation of Dhatus also. Snehana, when done can immediately nourish the Dhatus and along with Swedana, it makes the body of the patient flexible just like a wooden stick, which can be easily bend after application of oleation and sudation.[17] Acharyas advise the use of Snehana and Swedana in Vatarogas, because in a Koshta which is well oleated Vata Dosha cannot cause any disease.[18] Among Swedana procedures, Patrapotala Sweda is found very effective as the leaves of Nirgundi, Eranda, Arka etc have analgesic and anti-inflammatory properties.[19] Murdhni Tailas play a vital role in the management of symptoms of Pakshaghata. Shirovasti with Mahanarayana Taila was done in all five cases and was found very effective. In Pakshaghata, the main pathology lies in the brain. So, Nasya was done using suitable formulation as it acts via the nasal cavity which is the gateway to Shiras.[20] Ksheerabala Taila was selected for Nasya in all the cases. It has the properties like rejuvenation, nourishment of senses etc.[15] For the alleviation of Vata disorders, Basti Karma is the main Shodhana treatment. Of all the diseases which are dependent on Shaakha (body tissues), Koshta(alimentary tract), Marmas (vital parts), Urdhvaanga(head and neck) and all other body parts, Vata dosha is main cause. It is also responsible for transit and localisation of faeces, Kapha, Pitta and other accumulated Malas. In mitigation of greatly increased Vata, there is no other treatment than Basti.[21] Balaguloochyadi Basti explained in Basti Kalpa of Ashtanga Hridaya Kalpasthaana was administered to all five patients and great improvement was noted. The above said Basti is said to have nourishing properties and cures all diseases.[16]The role of physiotherapy in management of cases is also appreciable.


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The patients attended weekly physiotherapy sessions which helped them to restore movements and functions, as it focused on both prevention and rehabilitation.

Conclusion

Among the five cases given above, the site of affliction of stroke was basal ganglia and corona radiata. A collection of cell bodies called the basal ganglia lies deep in the center of the brain. The basal ganglia serve as the message center for a range of bodily functions such as:

  • Movement control and learning
  • Behaviour
  • Emotions
  • Executive functions, the mental processes that enable people to do things, such as planning, focusing, remembering instructions, and multitasking.[22]

The patients had common symptoms like flattened emotions, apathy, memory problems etc.

Ayurvedic treatment along with physiotherapy proved to be beneficial in such cases for improving the quality of life of the patients.

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