Evaluation of rakta dushti in Pakshaghata with specialreference to Cerebrovascular accident

Introduction

The term Pakshaghata literally means loss of function in one half of the body. It is a Vatavyadhi of Nanatmaja variety¹ and is considered as Mahavatavyadhi. Mithya Ahara Vihara along with specific Nidanas like Shiromarma Abhigata and Ati Raktasrava are the important causative factors of the disease. Ardita and Pakshaghata are two similar clinical entities with respect to Lakshana. The vitiation of Rakta Dhatu is the root cause of Shiroroga including Ardita² , which also plays a key role in the genesis of Pakshaghata. The symptoms of Pakshaghata³ in Ayurvedic classics mimic the features of Cerebrovascular accident. Acharyas identified the role of Rakta Dhatu in the genesis of Pakshaghata; hence the present study is carried out to evaluate the involvement of Rakta in the development of Pakshaghata.

OBJECTIVES

1. To study the role of Rakta Dushti in the Etiopathogenesis of Pakshaghata.

2. To study the Clinical incidence of Rakta Dushti in genesis of Pakshaghata.

METHODS

A special proforma was prepared with all points of history taking, physical examinations as mentioned in Ayurveda and allied sciences, along with the laboratory investigations. Accordingly patients were selected for clinical evaluation.

RESULTS AND DISCUSSION

Rakta Pradooshana occurs due to vitiation of Tridosha by Aharaja, Viharaja and Agantuja Nidana. Different etiological factors are mentioned in literature for the vitiation of Rakta among which some of the factors like Atisevana of Katu, Kshara Rasa, Laghu Guna and Ahaara Dravya like Masha (black gram), Kulatha (horse gram) Nishpava (legumes), Sheetambu Sevana and Vihara like Ratri Jagarana, Uchabhashana, Shrama are also the vitiating factors for Vata.⁴ The vitiated Vata influences Rakta, causing increase of Vishada Guna, Tanu, Rukshata in the Rakta leading to Dhatu Shoshana and the pathology will be of Cerebral atrophy and the presentation of this condition is Kevala Vatajanya Pakshghata which is Krichra Sadhya in nature.

Amla, Lavana, Katu, Rasa Pradhana and Ushna Veerya Pradhana Ahara , excessive use of Tila Taila (sesamum oil) Moolaka, Amla Mastu (sour curd water), Anupa Mamsa, Jalaja Mamsa (Ushna Virya) and Vihara such as Atapa Sevana, Anala Sevana and Manasika Nidana like Ati Krodha are the causative factors for vitiation of Pitta.⁵ Dushita pitta influences Rakta by the increase of Ushna, Oushnya, results in delayed clotting time (Cheerath Syayathe).⁶ This results in Rakta Srava from the Srotus leading to Dhatukshaya, because of which Vata increases and leads to development of clinical features such as Glani, Indriya Dourbalaya, Trushna, Murcha, Kriyakshayam. This pathology can be correlated to Dhatukshayajanya Pakshaghata. It may be due to increasing capillary permeability of the vessels and the pathology resembles cerebral hemorrhage.

Excessive intake of Madhura Rasa, Snigda Guna Ahara , Dadhi (Curd), Jalaja Mamsa (Guru Guna) and Divaswapna after intake of food vitiate Kapha Dosha.⁷

The Dushta Kapha, influences Rakta by increasing the Pichila and Sneha Guna in Rakta Dhatu leading to Dhamani Pratichaya or Margavarodha to Vata. The clinical presentations include Cheshta Pranasha, Vaksanga and Murccha. This pathology can be correlated to Margavarodhajanya Pakshaghata. It may occur due to increased lipids in the blood. Further pathogenesis is manifested as atherosclerosis which leads to ischemic cerebral disease or as fat embolism related Cerebro Vascular Disease.

Rakta Dushti Lakshanas observed in the patients were Indriya Bramsha 80%, Ajeerna 43.4%, Murcha 20%, Cheshta Nasha 100%, Ardita 80%, Vadana Jihmata 80%, Gadgada 60%, Lala srava 50%, Hanu Graha 43.3%, Mooka 40%, Moha 33.3%, Chakshu Vibhrama 16.7%, Kasa, Shwasa 16.7%, Udveshtana 6.6%, Akshi Nimeelana 6.6% were found.

Shiro Marma is one among the Trimarma.⁸ It is the Sthana of Prana Vata and Indriyas.⁹ When Shiras is affected by Bahya Karanas like Abhighata and Abhyantara Karanas like Doshas, it can produce many Lakshana such as Ardita, Cheshta Nasha, Moha, Hanugraha, Mooka, Gadgada, Lalasrava, Vadanajihmata.¹⁰ These Lakshanas which are mentioned by Acharya Charaka gives a similarity between both Ardita and Pakshaghata.

Hence, Pakshaghata is one of the presentations of Shiro Abhighata. Spontaneous internal bleeding leading to Cerebrovascular disease may also be considered as Abhyantara Marmabhighata Janya Pakshaghata. The most prominent symptoms of Shiro Abhighata observed in this study include Cheshta Nasha (100%), Ardita (80%), Vadana Jihmata (80%), Gadgada (50%), Lala Srava (50%), Hanugraha (43.3%), Mooka (40%) and Moha (33.3%).

Pakshaghata is commonly seen in people above 60 years of age which is due to the predominance of Vata in Vridhavastha.

Associated diseases like Hypertension and Diabetes Mellitus were present in 86.6% and 46.6% of the samples respectively.

In the sample patients, 83.3% were taking mixed food and 16.7% were vegetarians. Also the habit of cigarette smoking was found in 60% and alcohol intake in 56.6% of the patients, which shows the relevance of Rakta Dushti due to Ahara and Vihara mentioned by the Acharyas.

Among the 50 patients, 36.7% were exposed to Pittaja Rakta Dushti Nidana, 26.6% were Vataja Rakta Dushti Nidana, 16.6% Kaphaja Rakta Dushti Nidana and the remaining 20% had Abhighata as a Nidana for Pakshaghata. Hence, significant number of Rakta Dushti Nidanas was observed to produce Pakshaghata. Inter alliance between Rakta Dushti and Pakshaghata is inevitable.

CONCLUSION:

Out of 50 patients, 26.6% were exposed to Vataja Rakta Dushti Nidana, 36.7% were exposed to Pittaja Rakta Dushti Nidana, 16.6% were exposed to Kaphaja Rakta Dushti Nidana and 20% had Marmabhighata. In this study a significant number of Rakta Dushti Nidanas were observed to produce Pakshaghata.