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Line 139: − The cerebrovascular strokeis of two types considering its etio-pathology and manifestations. The principles of treatment vary based on etiopathology. Ayurveda also considers the cerebrovascular attacks in the same way.+ − + + + + + − I. Incomplete stroke − The clinical manifestation of ‘ardita’ is described as either half of the entire body or half of the face affected by aggravated vata dosha.[Cha. Sa. [[Chikitsa Sthana]] 28/42] So, ardita has a very similar clinical picture as that of pakshaghata (hemiplegia). However, a group of illnesses noted along with ‘ardita’ manifest in episodic form (vega). When the episodic event seizes, the patient is almost in normal state. Thus, a differential diagnosis between ardita and pakshaghata is chiefly relying on the transient nature of ardita [Chakrapani commentary, Cha. Sa. [[Chikitsa Sthana]] 28/38-42] − + + + + − + − + − + − + − + + + + + + + + − + − + − + − + − + + + + + + + + + +
→Diagnostic and Therapeutic approach in Ayurveda
== Diagnostic and Therapeutic approach in Ayurveda ==
== Diagnostic and Therapeutic approach in Ayurveda ==
=== Cerebrovascular accidents ===
=== Cerebrovascular accidents ===
<div style="text-align:justify;">
Cerebrovascular stroke is of two types considering its etio-pathology and manifestations. The principles of treatment vary based on etiopathology. Ayurveda also considers cerebrovascular attacks in the same way.
</div>
==== Incomplete stroke ====
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The clinical manifestation of ‘ardita’ is described as either half of the entire body or half of the face affected by aggravated [[vata]] [[dosha]].[Cha. Sa.[[Chikitsa Sthana]] 28/42] So, ardita has a very similar clinical picture as that of pakshaghata (hemiplegia). However, a group of illnesses noted along with ‘ardita’ manifest in episodic form (vega). When the episodic event seizes, the patient is almost in normal state. Thus, a differential diagnosis between ardita and pakshaghata is chiefly relying on the transient nature of ardita [Chakrapani commentary, Cha. Sa. [[Chikitsa Sthana]] 28/38-42]
So, ardita simulates a transient ischemic attack or incomplete stroke, and pakshaghata simulates the condition of complete stroke. The difference in line of treatment for ardita and pakshaghata apparantly reflect the difference in their etiopathological context.
So, ardita simulates a transient ischemic attack or incomplete stroke, and pakshaghata simulates the condition of complete stroke. The difference in line of treatment for ardita and pakshaghata apparantly reflect the difference in their etiopathological context.
Management of incomplete stroke
'''Management of incomplete stroke'''
In ardita, nasya therapy is the first choice of therapy or the recommended line of treatment. Various studies have demonstrated the effect of nasya therapy in transient ischemic attacks and postulated its direct impact on intracerebral space.
In ardita, nasya therapy is the first choice of therapy or the recommended line of treatment. Various studies have demonstrated the effect of nasya therapy in transient ischemic attacks and postulated its direct impact on intracerebral space.
There are three main hypotheses (as earlier proposed by the speaker) on the mode of action of nasya therapy on the brain and neurological diseases.
There are three main hypotheses (as earlier proposed by the speaker) on the mode of action of nasya therapy on the brain and neurological diseases.
a) Shringhataka Srotas: tiny vascular pathways giving entry to intracranial space.
b) Mastulunga factor: accessibility to cerebro spinal fluid through arachnoid sleeves.
'''a) Shringhataka Srotas''': tiny vascular pathways giving entry to intracranial space.
c) Ghreya prayoga: particular olfactory passage with chemo signalling.
Nasya therapy, if performed judicially in accordance to classical procedure can produce noticeable results in ischaemic conditions. Position of the head shall be lowered from the table. Person in supine sleeping position with hyper extended neck and head slightly hanging downward (head low position)]
'''b) Mastulunga factor:''' accessibility to cerebro spinal fluid through arachnoid sleeves.
Complete stroke
'''c) Ghreya prayoga:''' particular olfactory passage with chemo signaling.
[[Nasya]] therapy, if performed judicially in accordance with the classical procedure can produce noticeable results in ischaemic conditions. The position of the head shall be lowered from the table. Person in a supine sleeping position with hyper extended neck and head slightly hanging downward (head low position)]
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====Complete stroke====
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Stroke resulting from cerebrovascular hemorrhage can lead to hemiplegia or monoplegia or quadriplegia depending on the focal area. Acharya Charaka has also mentioned these different conditions as ekanga roga (monplegia), sarvanga vata(quadriplegia) and pakshavadha(hemiplegia). [Cha.Sa.[[Chikitsa Sthana]] 28/54-55]
Stroke resulting from cerebrovascular hemorrhage can lead to hemiplegia or monoplegia or quadriplegia depending on the focal area. Acharya Charaka has also mentioned these different conditions as ekanga roga (monplegia), sarvanga vata(quadriplegia) and pakshavadha(hemiplegia). [Cha.Sa.[[Chikitsa Sthana]] 28/54-55]
Acharya Sushruta has mentioned the involvement of the vascular system (dhamani) of the head in the pathology of stroke - Pakshaghata. [Su. Sa. Nidana Sthana 1/60]
Acharya Sushruta has mentioned the involvement of the vascular system (dhamani) of the head in the pathology of stroke - Pakshaghata. [Su. Sa. Nidana Sthana 1/60]
Management of complete stroke
Virechana therapy is the first line of treatment in pakshaghata (complete stroke). This line of treatment is most effective in the initial stage, i.e., within 2-6 weeks of the attack. After this period, it becomes a chronic condition, and then the general treatment protocols of disorders of vata are recommended.
'''Management of complete stroke'''
When the hemorrhage happens at the area of mostly ner internal capsules, near the circle of Willis, huge edema develops around the area in the brain which is usually referred as peri -hemorrhagic edema. Furthermore, when oedema recedes, there will be some improvements in the signs and symptoms of a stroke. So, at this stage of edema, [[virechana]] works well. It was found to contribute significantly in reducing peri-hemorrhage edema.
The recent research on the management of stroke reveals that due to rapid onset, the primary injury of ICH is challenging to treat. Primary injury is followed by secondary injury in the peri hemorrhagic region over several days to weeks and provides a longer treatment window than the primary injury. It is important to minimize the direct effect of clot-related hydrostatic pressure. Clot removal and/or hyperosmolar therapy by mannitol etc. is indicated for the purpose .
[[Virechana]] therapy is the first line of treatment in pakshaghata (complete stroke). This line of treatment is most effective in the initial stage, i.e., within 2-6 weeks of the attack. After this period, it becomes a chronic condition, and then the general treatment protocols of disorders of [[vata]] are recommended.
A collection of molecules called the ‘complement system’ plays a crucial role in the body’s frontline defense against pathogens. But after a stroke this system can trigger harmful inflammatory processes that damage the brain. Recent investigations in mice reveal that better outcomes can be achieved by addressing the immune response. It can be done by inhibiting its harmful effects immediately after stroke or promoting its ability to aid recovery.
When the hemorrhage happens at the area of mostly ner internal capsules, near the circle of Willis, huge edema develops around the area in the brain which is usually referred as peri -hemorrhagic edema. Furthermore, when oedema recedes, there will be some improvements in the signs and symptoms of a stroke. So, at this stage of edema, [[virechana]] works well. It was found to contribute significantly in reducing peri-hemorrhage edema.
The recent research on the management of stroke reveals that due to rapid onset, the primary injury of ICH is challenging to treat. Primary injury is followed by secondary injury in the peri hemorrhagic region over several days to weeks and provides a longer treatment window than the primary injury. It is important to minimize the direct effect of clot-related hydrostatic pressure. Clot removal and/or hyperosmolar therapy by mannitol etc. is indicated for the purpose.
A collection of molecules called the ‘complement system’ plays a crucial role in the body’s frontline defense against pathogens. But after a stroke, this system can trigger harmful inflammatory processes that damage the brain. Recent investigations in mice reveal that better outcomes can be achieved by addressing the immune response. It can be done by inhibiting its harmful effects immediately after stroke or promoting its ability to aid recovery.
So, [[Virechana]] could be a better supplement in Ayurveda clinics for steroids and diuretics to deal with cerebral inflammation. In addition, the mechanism of purification therapies(shodhana) could flush out untoward oxidant molecules generated during the phenomenon of stroke. This can set the immune mechanism to normalcy.
So, [[Virechana]] could be a better supplement in Ayurveda clinics for steroids and diuretics to deal with cerebral inflammation. In addition, the mechanism of purification therapies(shodhana) could flush out untoward oxidant molecules generated during the phenomenon of stroke. This can set the immune mechanism to normalcy.
When it is established that there is infarction and complete death of the nerve cells in complete stroke, it is usually treated as incurable. However, several patients with hemorrhagic stroke have got complete improvement in symptoms after Ayurvedic treatment. The slow auto-healing of neighboring tissues of infarcted focal area, the concept of neuronal plasticity, sensory-motor integration in the brain etc., can be the reasons behind these recoveries.
When it is established that there is infarction and complete death of the nerve cells in complete stroke, it is usually treated as incurable. However, several patients with hemorrhagic stroke have got complete improvement in symptoms after Ayurvedic treatment. The slow auto-healing of neighboring tissues of infarcted focal area, the concept of neuronal plasticity, sensory-motor integration in the brain etc., can be the reasons behind these recoveries.
</div>
== Concept of avarana of [[vata]] in neurological diseases==
== Concept of avarana of [[vata]] in neurological diseases==
“Avarana” pathologies are complex conditions having progressive nature and are difficult to diagnose and manage. Most of the progressive degenerative conditions of the brain do fall under the different kinds of Avarana.
“Avarana” pathologies are complex conditions having progressive nature and are difficult to diagnose and manage. Most of the progressive degenerative conditions of the brain do fall under the different kinds of Avarana.