Introduction

ALS is the most common progressive motor neuron disease. It is prime example of a neurodegenerative disease and is arguably the most devasting of the neurodegenerative disorder.^[1] Most of the cases are sporadic but 10% cases are familial.^[2] The prevalence of the disease is 4-5 per 100,000 population and in year 2016 alone it is estimated that 34,325 deaths occurred due to MND globally.^[3] Motor neurons affected by degeneration typically shrink and accumulate lipofuscin, a pigmented substance that naturally builds up in cells as a part of the aging process. As the nerve supply to muscles deteriorates (a process known as denervation), the affected muscles gradually waste away. This muscle wasting, identifiable through clinical examination and muscle biopsies, is referred to as amyotrophy. In the lateral columns of the spinal cord, the loss of nerve fibres triggers the formation of fibrillary gliosis - a process where supporting glial cells multiply and form scar-like tissue. This scarring increases the firmness of the spinal cord, a condition known as lateral sclerosis.^[4] There is only symptomatic treatment for this disease in modern science. No management protocol was given to prevent complication associated with the prognosis of this disease.

Pakshaghat, classified as a Vatapradhan Vyadhi in Ayurveda,^[5] refers to a condition where the human body becomes partially or completely paralyzed.^[6] This disorder is closely linked to the functioning of Pran Vayu and Vyan Vayu, two vital subtypes of Vata Dosha. Pran Vayu, located in the Shirpradesh (~head region), governs vital life functions,^[7] while Vyan Vayu, which moves throughout the entire body (Kritsnadehachar), controls all forms of physical movement.^[8]

In cases of Pranavritta Vyan, where Vyan Vayu is obstructed or impaired, the observed symptoms share similarities with certain types of Motor Neuron Disease (MND). These symptoms include Hata Paksha (~paraparesis or paralysis), Cheshta Nivritti (~restricted voluntary movements), Vakstambha (~slurred speech), Indriya Hani (~loss of sensory and motor functions),^[9] Bala Nash (~generalized weakness and reduced muscle strength), and Smriti Nash (~memory impairment).^[10] Such symptoms closely resemble the multifocal onset of Amyotrophic Lateral Sclerosis (ALS).

In the cardiovascular system (CVS) examination, S1 and S2 heart sounds were audible and normal. Examination of the gastrointestinal (GI) system revealed abdominal distension due to gas. In Central nervous system (CNS) examination patient was conscious and well-oriented, except for his hearing difficulties.

During the cranial nerve examination, Cranial Nerves I (Olfactory), II (Optic), III (Oculomotor), IV (Trochlear), and VI (Abducens) were found to be normal. The Trigeminal Nerve (V) was affected, suggesting motor and/or sensory dysfunction. The Facial Nerve (VII) showed a right-sided deviation of the mouth. The Vestibulocochlear Nerve (VIII) was also impaired, causing hearing loss in the right ear. Further abnormalities were observed in the Glossopharyngeal (IX), Vagus (X), Accessory (XI), and Hypoglossal (XII) nerves, indicating multi-cranial nerve involvement. Overall, the patient presented with significant neurological and systemic symptoms, including motor dysfunction, cranial nerve deficits.

Reflexes

Table 1: DTR before treatment

Table 4: Samsarjan Krama

Figure 1: Mustadi Yapan Basti

Figure 2: Shashtik Shali Pinda

Follow-up and outcomes:

The Patient was admitted in hospital so he was under observation. As therapy schedule was working patients’ assessment done weekly. Patient was doing well with help of treatment plan. After 2 months of discharge patient was not in contact for assessment of further progress & patient condition.

Table 6: Assessment outcomes

Improvement in Reflexes

Table 7: DTR after treatment

Table 8: Superficial reflexes after treatment

Discussion

ALS can be corelated with Vatavyadhi and Pran Arita Vyan due to its similar sign and symptoms and, primarily caused by an aggravated Vata Dosha.

In this case, it helps to alleviate muscle stiffness, weakness, and degeneration. It also enhances blood flow, supports cellular repair, and reduces Vata Dosha, thereby improved motor function and overall muscle health. Nasya^[16] works by directly stimulating the olfactory and trigeminal nerves, which have connections to the brain. This therapy enhances cerebral circulation, improves oxygenation, and helps to strengthen the nervous system. In this case Nasya may provide neuroprotective effects, reduce inflammation, and support cognitive and helps in motor functions.

Brihat Vata Chintamani Ras^[18] is a classical Ayurvedic formulation includes Suvarna, Rajat, Abhrak, Loha, Mukta, Praval which are known for its rejuvenating and neuroprotective properties. This compound, which contains purified minerals and herbs, helps in strengthening the nervous system, improving motor coordination, and enhancing nerve conductivity, it may support neuronal function and slow the progression of muscular atrophy.

Pathya Apathya plays major role in the management of Vatavyadhi. Emphasis on a Vata-pacifying diet which includes warm, unctuous (oily), easily digestible, and nourishing foods. Inclusion of healthy fats like ghee and sesame oil, which provide lubrication and support neuromuscular integrity. Consumption of nutrient-rich soups, stews, and cooked grains to nourish weakened tissues. Avoiding Vata aggravating foods, such as dry, cold, raw, processed, and excessively light items. Herbal infusions with digestive spices (ginger, cumin, fennel) were helps to enhance absorption and metabolic function.

Conclusion

Ayurvedic management of ALS is a holistic approach focused on balancing Vata Dosha, nourishing nervous system, and enhancing patient’s quality of life. Vatavyadhi is Yapya in nature, though not a complete cure, Ayurvedic therapies may offer supportive care by addressing muscle degeneration, nerve function, and overall well-being. Understanding correlation between Pranavritta Vyana and ALS allows Ayurvedic practitioners to provide targeted therapies that enhance nerve function and circulation. Further scientific studies and clinical trials are necessary to validate efficacy and safety of Ayurvedic interventions in ALS care.