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“EVALUATION OF EFFICACY OF DHANWANTARAM TAILA IN THE MANAGEMENT OF ARDITA

A COMPARITIVE CLINICAL STUDY” By

RATNA KUMAR K. Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fu

Ayurved

KayUnde

Dr. K. ShM.D. (A

DepartmPost Graduate St

D.G. MELMALAGI AYURV

lfillment of the degree of

a Vachaspati M.D. In

achikitsa r the Guidance of iva Rama Prasad

yu) (Osm), C.O.P (German), M.A., Ph.D. (Jyotish)

ent of Kayachikitsa udies & Research Center EDIC MEDICAL COLLEGE, GADAG 2003-2006

Ayurmitra

TAyComprehended

Declaration by the candidate

I here by declare that this dissertation / thesis entitled “EVALUATION OF

EFFICACY OF DHANWANTARAM TAILA IN THE MANAGEMENT OF ARDITA A

COMPARITIVE CLINICAL STUDY” is a bonafide and genuine research work carried out

by me under the guidance of Dr. SHIVA RAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm),

C.O.P (German), M.A., Ph.D.(Jyotish), Professor, Department of Kayachikitsa, PGSRC, DGMAMC,

Gadag.

Date

Place

RATNA KUMAR K.

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER

Department of Kayachikitsa GADAG, 582 103

This is to certify that the dissertation entitled “EVALUATION OF EFFICACY OF

DHANWANTARAM TAILA IN THE MANAGEMENT OF ARDITA A COMPARITIVE

CLINICAL STUDY” is a bonafide research work done by RATNA KUMAR K. in partial

fulfillment of the requirement for the post graduation degree of “Ayurveda Vachaspati M.D.

(Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences, Bangalore,

Karnataka.

Dr. SHIVA RAMA PRASAD KETHAMAKKAM.D. (Ayu) (Osm), C.O.P (German),M.A., Ph.D. (Jyotish)

GuideProfessor

Dept. of Kayachikitsa

PGS&RC

Date:

Place: Gadag

J.S.V.V. SAMSTHE’S

D.G.M.AYURVEDIC MEDICAL COLLEGE

POST GRADUATE STUDIES AND RESEARCH CENTER GADAG, 582 103

Endorsement by the H.O.D, principal/ head of the institution

This is to certify that the dissertation entitled “EVALUATION OF EFFICACY OF

DHANWANTARAM TAILA IN THE MANAGEMENT OF ARDITA A COMPARITIVE

CLINICAL STUDY” is a bonafide research work done by RATNA KUMAR K. under the

guidance of Dr. SHIVA RAMA PRASAD KETHAMAKKA, M.D. (Ayu) (Osm), C.O.P

(German), M.A., Ph.D.(Jyotish), Professor, Department of Kayachikitsa, PGSRC, DGMAMC,

Gadag, in partial fulfillment of the requirement for the post graduation degree of “Ayurveda

Vachaspati M.D. (Kayachikitsa)” Under Rajeev Gandhi University of Health Sciences,

Bangalore, Karnataka.

. DP

(Dr. G. B. Patil) Principal,

DGM Ayurvedic Medical College, Gadag

Date: Place:

(Dr. V. Varadacharyulu) Professor & HOD

Dept. of Kayachikitsa PGS&RC

ate: lace: Gadag

Copy right

Declaration by the candidate

I here by declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation/ thesis in print or

electronic format for the academic / research purpose.

Date

Place

RATNA KUMAR K.

© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgment

It might be . . Alm ghty . . . i

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Asha (Desire) is the reason of success either achieved or not. Desire is the first

step of the process, “The Beginning.” It guides us to the contentment, is under the

influence of God, Parents and Elders who guides us towards wisdom. I would like to

mention the Personalities who guided me during my course of study.

I express my gratitude to my guide Dr. Shiva Rama Prasad Kethamakka, M.D.

(Ayu), M.A. Ph.D., professor, department of Kayachikitsa, for his guidance and timely

help.

I express my gratitude to Dr. V.V.Varadacharyulu M.D. (Ayu), Goldmedalist,

professor and H.O.D of Kayachikitsa for his advice and encouragement in every s ep of

this work.

I express my obligation to my princ pal Dr.G.B.Patil, for his encouragement and

providing all necessary facilities for this research work.

I extend my gratitude to Dr.P. Shivaramudu, Dr. G.Purushottamacharyulu,

Dr.M.C.Patil, Dr. G.Danappagouda, Dr.S.H.Doddamani, Dr.S.N.Belawadi,

Dr.Nedugundi, Dr.Samudri, Dr, Kubersankh. Dr.Mulgund, Dr. R.V.Shettar, Dr.J.Mitti,

Dr.Mulki Patil, Professor Nandakumar, Dr. Ravikrishna, Dr.Prashant.

I express my immense gratitude to my U.G. Lecturers, Dr.Vasudeva Reddy,

Dr.Narahari Reddy, Dr.Karunakaran, Dr.Muttu Swamy, Dr.Janardhan, Dr.Ramdas,

Dr.Anuradha, Dr.Nandakumar, Dr.Rajashekar, Dr.Sai Prasad, Dr.Bharati,

Dr.Nagaprasoona, Dr.Prameela, Dr.Venugopal, Dr.Shanti, Dr.Savitri, Dr.Geeta,

Dr.Swam nathan, Dr.P.R.Swam nathan, Dr.Shiva Subramanyam, Dr.Jayakrishna,

Dr.Murlidharan, Shankaran Kutty, Dr.J.L.N.Shastri, Dr.Vasu, Dr.Sudheer,

Dr.Purshottman, Dr.Panda.

I express my deep gratitude to Dr.U.V.Purad and family who gave support and

inspiration during my course of study.

I would like to mention some of my friends who supported me throughout my

career are J Kalyan Srinivas, Kural, Mahantesh Hugar, A.A.N.Uday kumar, Godwin,

Rajesh, P.Chandramouleeswaran, Jeeva, Deva, Krishna, Aravind, Kumaran,

Late.Dr.Praveena, D.Radhika, Sirisha, Padmaja, Rekha, Sreena, Pavitra, Deepti, Deepa,

Nageshwari, Maheshwari, Kokila, Kamakshi, Premjita, Vijayanti, Gayatri, Nivedita,

Vasu anna, Praveen anna,I.Kalyanchakravarti, Seshukumar, Mahesh kumar, Rajaravi

Kiran, Vamsi Krishna, Sharma, Harita Naidu, Bhuvaneshwari, Sudha, Mani anna,

Jayashanka , Kawas, Srijit, Vijit, Shivakumar, Chinnavamshi, Sreekant, Kishore,

.

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If Ayurveda represents Agni then Kayachikitsa is its Adhya Dhatu thus I would

like to start with my friends of Kayachikitsa, Kalmath, Venkareddivar, Umesh Kumbar,

Jigalur, Sarvi, Ashok M.G, Gavi Patil, Shivaleelakalyani, Kamalakshi, Sulochana, Shekar

Sharma, Ashok Akki, Meenakshi,

I extend my sincere thanks to my friends Ganti, Pradeep, Sobagin, Shakuntala,

Hiremath, Sharanu, Suvarna, Anita, Anand, Shambu, Jayshree, Kattimani, Rudrakshi,

Suma, Amneesh, Vijay Hiremath, Manjunath Akki, Suresh Akkandi, Lingareddy Biradar,

Ashwini Dev, Shiba Prasad, Prasannakumar, Kalmesh, Madhusree, Devendrappa Budi,

Jayaraj, Shaila, Swami, Ashok Bingi, Sajjanar, Sunita, Anand, Jagadish, Inamadar,

Gangoor, Kataraki, Ashwini, Shalini, Shivaleela Kudiri, Ronad, Ramkumar, Harun, Arun

Biradar, Mounesh, Shabbir, Avinash, Naveen, Sunil, Ravi, Subhash, Sameer, Sanjay,

Anil, Obeyah, Prabhu, Gourav, Niel, Ravi Joshi, Jay kumar, Kiran, Prashant, Sandeep,

Firoz, Sharat, Abhishek, Rahul, K.M.Krishna, Anjay.

I express my deep gratitude to Shri.Vishwanath Rao.K, K.Gururaj, K.Seema and

family for their love and affection.

I extend my gratitude to Ioholli s r (Engg), J.Jnan kumar, P.B.Vastrad, Siddhu,

Gopi, Chaitrakumar, Venkatesh for their love and affection.

I would like to recall my seniors Srinivas Reddy, Kotesh, Shankar Gouda,

Hanumanth Gouda, Joshi, Shyju, Shajil, Renjit, Mangala Patil, Vanita, Yasmeen, Pathan

Shetty, Jaggal, Santosh, Hiremath, Subin, Febin, Varsha, Kashi, Veena, Bani, Santoji.

I extend my Sincere Thanks to Shri.Habib Katib sir and family members

for their support during my stay at Gadag.

I bow my head in front of my Great grand Parents Late.K.Chenchaiah,

Late.K.Ratamma, Late.D.Laxmi Vilasam and Grand parents Late.K.Kotaiah,

Late.K.Venkata Subbamma, Late.D.Bhagya Rao, D.Prameela.

I express my deep gratitude to Uncle D.Venkateswarlu(BA.Bed), Aunts

K.Suryam, Baby Sarojini for their love and affection.

I express my affection to my Uncle K.Madan Mohan Rao, Aunt Padmavati,

Brothers Sridhar, Sai, Sister Laxmi.

I express my love and affection to brothers in law Dr.K.Siva Prasad (M.D),

(Obstetrics & Gynecology), K.Srinivasa Rao (M.Sc), D.Maruti Murali (BSc BEd),

Dr.D.Ramalinga Varaprasad (M.D) (Anesthesiology), and family membe s for their love

and affection.

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I extend my affection to my elder brother Dr.C.H.Phanindra Babu (M.B.B.S.

D.G.O) aunt Maruti and family members.

My affection is towards my Brother K.Vijaya Bhaskar, Mrs.K.Vijaya Bhaskar,

and Kids, Jitendra, Lohita, and my sister Sowmya Damu and Johny and family members.

I acknowledge my patients for their wholehearted consent. I express my thanks to

all the persons who have helped me directly and indirectly with apologies for my inability

to identify them individually.

Above all, I owe and dedicate this work to my Parents Shri.Koppolu.

Subrahmanyam (BA.Bed) (Rtd. Head Master) and Smt.K.Radha (Praveena Pracharak)

(Hindi Pandit) who gave me confidence and inspiration are with me at critica Situa ions

are the Sole responsibilities for my success.

Dr.K.Ratna Kumar

Ardita a Vataja Nanatmaja Vyadhi that afflicts the face is in association with

Pakshagata or manifests as a sole entity. It is considered as Shiroroga as its Adhistana is

Shiras and Pranavata vitiation too generates A dita. Bhela elucidated Ardita amongst

Asthi Majjagata Vata. Based on Dosha involvement Ardita types also have been

mentioned. Increased glucose tolerance, hypertension, qualitative and quantitative

disfigurements in Rakta Dhatu, emboli, thrombus, vascular alterations, viral infections,

hypoxias, receptor stimulations, nerve injury, hormonal and thermoregulatory

phenomenon etc will account for its genesis. In short, a disease with wide ranges of

etiology from metabolic to idiopathic.

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Ardita resembles facial paralysis a nervous disorder either U.M.N or L.M.N

lesion. Starts as a physical morbidity and terminates at psychological level, as face is the

index of m nd and this entity deflects the m nd i.e., it will change the behavioral and

psychological attitudes of the diseased.

Vata vitiation penultimate in Rakta Soshana moves to Shiras and presents Ardita.

Thus the present study is under taken 1) To evaluate the efficacy of Avartita

Dhanwantarm Taila (101) caps in Ardita (internally) and the 2) To evaluate the efficacy

of Dhanwantaram Taila as Shirovasthi in Ardita (externally).

In total 30 patients were selec ed equally distributed in two groups and the

assessment is carried out under three categories i.e., Marked Restoration, Moderate

Restoration and Poor Restoration.

The compound medicine took care of the Ardita by virtue of its qualities and

accounted for rem ssion of symptom otology with P value (<0.001) in both groups. But

the results of Group– 1 are impressive than that of Group- 2 In group-1, out of 15 patients

observed 8 patients (53.33%) are of marked restoration where in group-2, out of 15

patients 3 fall under marked restoration but the psychological factors came down

remarkably in group-2 than that of group-1 which is indicative of a combined approach,

which may account for better rem ssion of Ardita.

Key words: Ardita, Facial paralysis, UMN, LMN, Vataja Nanatmaja Vyadhi, Majjagata

Vata, Avartita Taila, Dhanwantaram Taila, Shirovasthi, etc.

Contents of

“EVALUATION OF EFFICACY OF DHANWANTARAM TAILA IN

THE MANAGEMENT OF ARDITA A COMPARITIVE CLINICAL

STUDY”

By

RATNA KUMAR K.

Chapter Content Pages

1 Introduction 1 to 4

2 Objectives 5 to 8

3 Review of literature 9 to 56

4 Methodology 57 to 70

5 Results 71 to 108

6 Discussion 109 to 153

7 Conclusion 154 to 156

8 Summary 157 to 160

9 Bibliographic References i To xii

10 Annex-1: Case sheet 1 to 9

11 Annex-2 : Cumulative Master Charts 1 to 12

Dhanwantaram Taila in Ardita A comparative clinical study –Contents

1

Tables of

“EVALUATION OF EFFICACY OF DHANWANTARAM

TAILA IN THE MANAGEMENT OF ARDITA A

COMPARITIVE CLINICAL STUDY”

By

RATNA KUMAR K.

SN Title of Table Page

Number1 Showing the Samanya Vatavyadhi Nidana 13-15

2 Showing Ardita Nidana by Various Acharyas 16

3 Showing Dhatukshayakara Nidana 16

4 Showing the Ardita Lakshanas Mentioned in Different Texts 20-21

5 Muscles innervated by the Facial Nerve w.s.r. to Upanga 36

6 Showing the symptoms relation to CNS 43

7 Depicting the pharmacological qualities of the Kashaya dravya ingredients

(Dashamoola)

54

8 Depicting the pharmacological qualities of the ingredients of Prakshepa

dravyain Dhanwantaram Taila

55-56

9 Demographic Data of Dhanwantaram Taila in Ardita of Group-1 71

10 Demographic Data of Dhanwantaram Taila in Ardita of Group-2 72

11 Distribution of patients by Age- gender of Dhanwantaram Taila in Ardita

of Group-1

73

12 Distribution of patients by Age- gender of Dhanwantaram Taila in Ardita

of Group-2

73

13 Results of patients by Gender in Dhanwantaram Taila in Ardita Group-1 74

14 Results of patients by Gender in Dhanwantaram Taila in Ardita Group-2 75

15 Distribution of patients by Religion of Dhanwantaram Taila in Ardita

Group-1

77


2

16 Distribution of patients by Religion of Dhanwantaram Taila in Ardita

Group-2

77

17 Distribution of patients by occupation of Dhanwantaram Taila in Ardita

Group-1

79

18 Distribution of patients by occupation of Dhanwantaram Taila in Ardita

Group-2

80

19 Distribution of patients by economical status of Dhanwantaram Taila in

Ardita Group-1

82

20 Distribution of patients by economical status of Dhanwantaram Taila in

Ardita Group-2

82

21 Data of patients by presenting complaints in Ardita Vata 84

22 Distribution of patients by associated complaints in Ardita Vata 85

23 Distribution of patients by diet of Dhanwantaram Taila in Ardita Group-1

& 2

86

24 Distribution of patients by Ahara Nidana in Ardita Vata 87

25 Distribution of patients by Anya Nidana in Ardita Vata 88

26 Distribution of patients in accordance to onset in Ardita Vata 89

27 Distribution of patients in accordance to side effected in Ardita Vata 90

28 Distribution of patients in accordance to Vyasana in Ardita Vata 91

29 Distribution of patients by Dosha vruddhi lakshana in Ardita Vata 92

30 Distribution of patients by according to Dosha Kshaya lakshana in Ardita

Vata

93

31 Distribution of patients by prakruti of Dhanwantaram Taila in Ardita

Group-1

93

32 Distribution of patients by Prakruti of Dhanwantaram Taila in Ardita

Group-2

94

33 Distribution of patients by Sroto Lakshana in Ardita Vata 95

34 Assessment of Subjective parameters in Ardita Vata (Facial Paralysis) –

Group-1

97

35 Assessment of Subjective parameters in Ardita Vata (Facial Paralysis) –

Group-2(Shirovasthi)

98


3

36 Assessment of Objective parameters in Ardita Vata (Facial Paralysis) –

Group-1 (Dhanwantaram Taila 101 Avartita caps internally)

99

37 Assessment of Objective parameters in Ardita Vata (Facial Paralysis) –

Group-2 (Shirovasthi)

100

38 Results of Dhanwantaram Taila in Ardita Vata in Group-1 100

39 Results of Dhanwantaram Taila Shirovasthi in Ardita Vata in Group-2 101

40 Statistical analysis of Subjective parameters in Ardita Vata (Facial

Paralysis) – Group-1 (Dhanwantaram Taila 101 Avartita caps internally)

103


Paralysis) – Group-2 (Dhanwantaram Taila Shirovasthi)

104



& Group-2 (Dhanwantaram Taila Shirovasthi) comparison

105

43 Statistical analysis Objective parameters in Ardita Vata (Facial Paralysis)

– Group-1 (Dhanwantaram Taila 101 Avartita caps internally)

106

44 Statistical analysis of Objective parameters in Ardita Vata (Facial

Paralysis) – Group-2 (Dhanwantaram Taila Shirovasthi)

107

45 Statistical analysis of Objective parameters in Ardita Vata (Facial


& Group-2 (Dhanwantaram Taila Shirovasthi) comparison

107


4

Figures and Photos of “EVALUATION OF EFFICACY OF DHANWANTARAM

TAILA IN THE MANAGEMENT OF ARDITA A COMPARITIVE CLINICAL STUDY”

By RATNA KUMAR K.

SN Title of Figures and photos Page Number

1 Ingredients of Dhanwantaram Taila 48

2 Procedure of shiro vasti 70

3 Distribution of patients (Group 1 & 2) by Age – Gender of Dhanwantaram Taila in Ardita

74

4 Over all Distribution of patients by Gender in Ardita Vata 76

5 Result of patients by Gender in Ardita Vata 76

6 Distribution of patients by religion in Ardita Vata 78

7 Result of patients by religion in Ardita Vata 79

8 Distribution of patients by Occupation 80

9 Result of patients by occupation in Ardita Vata 81

10 Distribution of patients by Economic status 83

11 Distribution of patients by diet in Ardita Vata 86

12 Distribution of patients by onset in Ardita Vata 89

13 Distribution of patients by side effected in Ardita Vata

90

14 Distribution of patients by Vyasana in Ardita Vata 91

15 Distribution of patients by Prakruti in Ardita Vata – Group-1 94

16 Distribution of patients by Dosha prakruti lakshana in Ardita Vata – Group-2

95

17 Distribution of patients by Srotas Lakshana in Ardita Vata Group-1 96

18 Distribution of patients by Srotas Lakshana in Ardita Vata Group-2 96

19 Results of (Dhanwantaram Taila 101 Avartita caps internally) in Ardita Vata

101

20 Results of (Dhanwantaram Taila Shirovasthi Externally) in Ardita Vata 102


5

Chapter – 1

Introduction

Man is identified well with his deeds and capacity of interaction with the language.

Out of the expression most important are the mouth to deliver speech and face to show

the expression. The disability of the both is seen in Ardita, a Vata Vyadhi that is a target

disease at present era, as the human is much exposed to the cold and causes of the Vata

and Ardita.

Face is the index of the mind; which is not to be ignored. The activity of the most

intelligent animal among Gods creation is similarly co-coordinated and controlled from

an epicenter the head, which is an “Uttamanga” 1. Ardita not only to be considered as a

Vata Vyadhi even though told in 80 Vata Vyadhi but also as a “Shiro Roga” as the Shiras

is the Adhistana. Hence Ardita is also considered as Shiro roga. It is even considered

under Asthi Majjagata Vata 2.

Movement characteristically qualifies the living, achieved by the grace of

Amoortha and Vibhu Vata 3. The human body fails to function or becomes crippled and

even ceases functions to death when the Vata is vitiated 4. Ardita, a Vata Vyadhi, where

the Indriyas which differentiates living and non-living are impaired and responsible for

the interaction between the living and its environment is ceased. Vata employs all sense

organs in their activity and carries all sense objects 5. The functions of senses are

hampered and impaired in Ardita, thus the Ardita is an Indriya vikara also, which are

controlled by Vata.

Dhanwantaram Taila in Ardita A comparative clinical study - Introduction

1

So, Ardita 6 vis-à-vis Facial Paralysis 7, is a disease in which the most important

characteristic of a human being viz. Facial and verbal expressions are lost in a way that

the patient loses the essential human characteristic feature, the communication. This

disease affects all ages and it’s sufficiently high enough to warrant an effective treatment.

In contemporary systems of medicine there are no clear-cut curative aspects for this

disease. In this regard Ayurveda through its holistic approach makes the ailment to restore

to normalcy or it will limit to normal successfully without any side effects.

The need of the hour is a treatment, which not only relieves a person from his

disability and dependency but also improves the quality of life by improving a

catastrophic consequence, Ardita is a fatal, crippling disorder, which renders the human a

handicap and brings about dependency for his lifetime.

Ardita being a Vataja-nanaatmaja Vyadhis is counted among the list of

Mahagadas, by nature itself these are difficult to treat as the mobility and minimizing the

disability is not possible. Ardita Vata is a disease in which some of the Jnanendriyas and

Karmendriyas, located in the head are affected, particularly in their function.

Neurologic disorders are common and costly in contemporary medicinal practice.

According to one recent estimate at US, which is said as developed country, 180 million

Americans suffer from a nervous system disorder, resulting in annual cost of 634 billion

dollars. In India where the people are exposed to extreme cold climate with bare or half

covered cloths and strong cold winds are having much higher incidences which may not

be on the records. Most patients with neurologic symptoms seek care from internists and

other generalists rather than from neurologists, and this situation is likely to continue as

primary care-based health care systems become increasingly prevalent and access to


2

specialists is reduced. Because useful therapies now exist for many neurologic disorders,

a skillful approach to their diagnosis is important. Many errors result from an over-

reliance on neuro-imaging and other laboratory tests at the expense of a primary focus on

the history and examination.

These errors can be avoided by adherence to an approach in which the patient's

illness is defined first in anatomic and then in patho-physiologic terms; only then should

a specific diagnosis be entertained. Arrival at a diagnosis permits the physician to

institute therapy and to inform and counsel patients and their families about the expected

disease course 8.

In India, where Ayurvedic practices with herbal and herbo-mineral compounds

are practiced is cheaper and effective. Apart from the medicines of the general practice,

“Panchakarma” is an eliminative therapy which is practiced along with the pacifying

methods too. Shirovasti even though not an eliminative therapy is one of the procedures

administered in Ayurveda for pacifying the Vata. At present the “Dhanwantara Taila

(101 Avartita)” capsule internally and Dhanwantara Taila for the Shirovasti are

undertaken for the clinical trail.

Incidence

Facial paralysis of acute onset presumed to be due to non-suppurative

inflammation (of unknown aetiology) of the Facial nerve within its canal above the

stylomastoid foramen. The condition may occur at any time from infancy to old age.

The incidence rate is 23 numbers per 100000, or about 1 in 60 to 70 with the

lowest incidence rates in children and increasing incidence with age to the fourth decade,


3

after which it remains steady. It is found epidemics of infective aetiology do have a role

to play in the incidence.

Age i.e. above 40, Diabetes Mellitus, Hypertension, Otitis media, pregnancy,

herpes zoster, Ramsay hunt syndrome, multiple sclerosis especially in young adults are

vulnerable to facial paralysis.

As per the observation made from this present clinical study it can be presumed

that, facial paralysis is occurring to the entire man kind irrespective of age & sex and is

having a relevance with the season in particular damp weather (cold / winter / fog /mist).

The aetiological factors are such a common entities to which most of the individuals are

exposed.

At this juncture it is relevant to mention some of the recent Ayurveda Researches,

claim worthy in Ardita. They are -

Dr.R.V. Shettar, Role of nasya karma in Ardita with special reference to

Ksheerabala taila (avartita) D.G.M. Ayurvedic medical college, Gadag – 1999.

Dr.Prashanth G.S, Clinical study on the effect of mahamasha taila nasya karma in

Ardita (Umn lesion palsy) S.D.M College of Ayurveda Udupi – 2003

Dr.D.Venkata Ravi Krishna, Effect of Mashabaladinasya with and without

balaksheeradhooma in the management of Ardita., N.K.J. Ayurvedic medical

college & P.G center, Bidar - 2005


4

Chapter – 2 Objectives

The objectives of the present study are undertaken with disease oriented and to

evaluate the trail drug “Dhanwantaram Taila” internally and externally. As the disease is

common and easily available at the geographical area of the present study, the efficacy of

the trail drug is tested in terms of the internal medicine and as procedure – Shirovasthi.

To evaluate the efficacy of Dhanwantaram Taila capsule in Ardita

Generally the disease manifestation is either from Amashaya or Pakwashaya 9.

Ardita is a disease of Vata; its genesis is from Pakwashaya, as it is the primary seat of the

Vata 10 and even justifies the statement of Bhela 11. Always the Vata diseases are

manifested because of two reasons. The former being Dhatu Kshaya and the later is

Margavarana 12.

Vata is a force, which moves to its functions all the incapable Pitta, Kapha, Dhatu

and Mala which are lame 13 individually. Vata is not only powerful but also having the

control over all the functional, cognitional aspects of the body and is capable of quick

traversing through all the minute channels of the body 14. Thus Vata vitiation interferes

with the normal functions of Indriyas 15.

Ardita is a Vata Vyadhi and is one out of 80 Vataja nanatmaja vyadhis.

Bhavamishra has defined Ardita into three types, based on the Dosha predominance 16.

Vagbhata has stated that Ardita results by the vitiation of Pranavata 17. Susruta has given

an authentic statement about Rakta Kshaya leading to Ardita in some individuals 18. And

even charka considered Ardita is a Shiroroga 19.

Dhanwantaram Taila in Ardita A comparative clinical study –Objectives

5

Ardita as understood with the contemporary medical knowledge is developed

from the 7th cranial nerve impairment. Watching the muscles of facial expression or

asking the person to perform particular facial movements checks the facial nerve (N-VII).

Wrinkling the forehead, raising the eyebrows, pursing the lips, and smiling are controlled

by the facial nerve. If a branch of N-VII has been damaged, there will be muscle

weakness or drooping on the affected side. For example, the corner of the mouth may sag

and fail to curve upward when the person smiles. Placing solutions known to stimulate

taste receptors on the anterior third of the tongue can check special sensory components

of N-VII.

In Ardita all the above symptoms are witnessed. The management of Ardita stated

in classics that are to be applied at the Dosha vitiation is Moordhni Taila Chikitsa along

with Vata pacifying modalities. Out of the many medicaments, Dhanwantaram Taila

internally administered at present clinical study may act directly at the level of

Pakwashaya, which is the site of vitiation of Vata.

Dhanwantaram Taila by virtue of its sukshma, snigdha, vatahara gunas will take

care of its vitiation there by restores the Vata to its normal functions, which are under the

control of nervous system in parlance. The Herbs that are used in the preparation are

extensively Vata shamaka and having Rasayana properties even. So, it is conveniently

concluded as the best treatment for Dhatu Kshaya and also of Avarana Chikitsa.

To evaluate the efficacy of Dhanwantaram Taila as Shirovasthi in Ardita

Bhavamishra affirmed that the Shiras is the Adhyamangam indicating, is the first

organ and also an important one. Mastulunga is embedded in it and there are Upangas of

Shiras even elaborated 20.


6

Shiras is the seat 21 of Pranavata and is considered as the life 22 of the human

beings. Charaka stated that, the Shiras occupies the prime place amongst the vital organs

of the body and it is the seat of the vital centers and all the sense faculties 23. As per

Artharvaveda, Vata is located in the upper portion of Mastishka 24.

“Manas” is enclosed between Shiras and Talu 25 is controlled by Vata 26. There by

the actions of Manas are under the control of Vata. The functions of “Manas” such as

control and direction of all Indriyas 27 are directly governed by Vata only. Chesta as

represented by vocal or physical movements’ decisive cognition of Indriyartha by the

Indriya buddhi 28 is conducted by Vata.

The dooshyas like sapta dhatus, three malas, Ama, sira, kandara, snayu may be

getting involved in different Vata Vyadhis. There is affliction of the chestavaha srotases

which conduct the motor function; the specific direction for the requisite motor function

is transmitted from the Buddhi only, in close association of the Manas 29 Samjnavaha

srotoses (sensory system) in the manifestation of Vata Vyadhis. In short, Vata vaha

srotoses is involved in the genesis of Vata Vyadhi 30.

Ardita is a malady, which is stated as Shiroroga apart from the Vata Vyadhi, as

Shiras is the adhistana for this ailment. Vagbhata opines that vitiation of Pranavata can

lead to Ardita 31. Rakta Kshaya can even manifest Ardita 32.

Disease Ardita afflicts the face and other closely associated organs i.e. Upangas of

Shiras 33. In Ardita Vata there is affliction of both Jnanendriyas and Karmendriyas.

Shirovasthi, one among the Moordhni Taila Chikitsa, is an important treatment

modality explained by Susruta as the first line of treatment for Ardita 34. It is considered

the most effective, as it is Vata shamaka and is nearer to the site affected 35. "Oil in the


7

crown overcomes the falling, graying and other discoloration and cracking of the hair and

all Vata ailments of the head; it also bestows liveliness to the organs, a clear voice and

firm jaws and strength to the head 36."

Dhanwantaram Taila 37 is an excellent Vata shamaka for both external and internal

applications. The drugs used in the preparation are extremely Vata shamaka and have

Rasayana properties even.

As it is directly in contact with the effected site, it will bring down derangement in

Pranavata and can act on vitiated Vata and will bring it back to normal. The medicines of

the preparation are assumed to act on Dhatu Kshaya, Avarana and Margavarodha even.

Any disease entity results in stress and in its course can affect the psychological

and behavioral attitudes of the diseased in short; the ailment can cause psychological

disturbances. Shirovasthi when given to the affected can even act over the stress and can

maintain the equilibrium state of both physical and mental attitudes of the diseased.

Principle oriented approach to the treatment of Ardita with Dhanwantaram Taila

can yield better results alone but as per Susruta 38 Shirovasthi is the first line of treatment

implicated as a treatment modality even though gives positive result is compared here in

the study, for the evidences to establish for the scientific community.


8

Chapter – 3

Literature

Historical review of Ardita

Among the three Dosha, Vata was given the high importance as it is with immense

power and movement. It is also called Deva, Bhagavan. In Vedic medicine terms like

shirasaamaya, shirasaanya roga have been used. According to Sayana’s interpretation

Shirasaamaya may be other disease of head and Shirasaanya roga is a wider term covering

the disorders of the organs such as eyes, ears etc. situated in head 39.

Epics and Puranas dealt physiological and pathological conditions caused by Dosha

and clearly defined commonly known contemporary disease conditions. In Ramayana,

pathological effects caused by aggravated Vata are allegorically described. At the end the

importance of Vata in maintenance of health and life is elucidated.

Banabatta a courtier in the court of king Harsha vardhana has named some of the

common prevailing diseases like Ardita along with Pandu, Svayathu, Medoroga, Akshepa.

Agni Purana defines Pathya to the patient of Vata Vyadhi 40. In Garuda purana Vata

prakopa Nidana are mentioned 41. But no specific reference regarding Ardita is available.

In Rkveda and Atharvaveda there are details of Vata bheda, sandhivyadhi, and

medicines used in Vata Vyadhi. One hymn in Atharvaveda quotes the importance of Vata

and it’s relation towards the functional aspects 42.

Most of the Samhita have mentioned Ardita and affirmed Nidana, Poorvaroopa,

Roopa, etc., pertaining to Ardita. Exclusive involvement of Vata Dosha in its Samprapti is

unique and hence it belongs to the category of Vataja nanatmaja Vyadhi.

Dhanwantaram Taila in Ardita A comparative clinical study – Literary Review

9

Etymology of Ardita

The word Ardita generally indicates a person afflicted or distressed. But in

Ayurveda it explains a specific disease afflicting the Urdhavanga (Jatrordhwa) particularly

the face 43. Ardita is a type of Vataja nanatmaja Vyadhi 44, expresses itself with the loss of

movement involving one half of the face or half of the body with half of the face.

The word Ardita is derived from the root "Ard" which means to move, be moved

or scattered. According to Amarakosha a Sanskrit dictionary 45 and also in Sanskrit-

English dictionary by M. Monier-Williams 46 meanings like asked, requested, begged,

injured, pained has been given even the word Ardita is used with the meaning to hurt, to

destroy, to cause injury.

Definitions of Ardita

All most all authors indicated that the face is the afflicted part in Ardita which is a

Vata Vyadhi.

Charaka states that this disease is localized in half of the body 47

According to Susruta, the Vata vitiated by its own causes, afflicts the half of the

mouth (and other regions of the head) 48. Gayadasa comments that the Vata is

vitiated in the Ardita. Madhavakara has followed Susruta 49.

Vagbhata accepts the opinion of Susruta, that half of the vaktra is afflicted by the

vitiated Vata causing a curling in that region 50.

Arunadatta is clearer in defining that Ardita is a state that the upper portion of the

body particularly the half of the Vaktra is afflicted 51.

Adhamalla commenting over Sharangadhara Samhita 52 has clearly stated that the

Ardita is a disease afflicting one half of the face.


10

The word "paralysis" indicates an abnormal condition characterized by the loss of

muscle functions or the loss of sensation or both. It is defined as the loss of the ability to

move all or parts of body or feel things in it or state of being unable to take action, make

decisions, or operate normally 53.

Paralysis is impairment or loss of especially the motor function of the nerves,

causing immobility or powerlessness 54.

Stedman’s Electronic Medical dictionary defines paralysis as Loss of power of

voluntary movement in a muscle through injury to or disease of its nerve supply or Loss of

any function, as sensation, secretion, or mental ability.

Facial Paralysis is Paresis or paralysis of the facial muscles, usually unilateral, due

to either –

1) A lesion involving either the nucleus or the facial nerve peripheral to the nucleus

(peripheral facial paralysis) or

2) A supra-nuclear lesion in the cerebrum or upper brainstem (central facial

paralysis); with the latter, facial weakness is usually partial and the upper portion of the

face is relatively spared, due to bilateral cortical connections.

Bell's palsy (peripheral facial paralysis) is paresis or paralysis, usually unilateral, of

the facial muscles, caused by dysfunction of the 7th cranial nerve; probably due to a viral

infection; usually demyelinating in type.

Synonyms of Facial Paralysis are –

Facial palsy

Facioplegia

Fallopian neuritis

Prosopoplegia.


11

Synonyms of Ardita

1) Ardita Vata:

Ardita is with the loss of movement involving one half of the face or half of the

body with half of the face. Ardita is also known as Facial paralysis or Facial hemiplegia

(Paralysis of one side of the body) indicating the paralysis of the muscles of one side of

the face with the rest of the body not being afflicted.

2) Ekayama:

According to some authors Ardita is also known as Ekayama. Vagbhata in

Astanga Hridaya uses the word Ekayama for the Ardita 55.

Nidana of Ardita

Nidana in the form of ahita ahaara, vihaara and manasika vitiate the Dosha and

Dushya bringing about morbid state in the body. For Ardita Charaka has mentioned

Nidana as of Vata Vyadhi. He has 56 mentioned some specific Nidana at Shiroroga chapter

which is also considered as Ardita Nidana as the Shiras is the Adhistana of Ardita. In the

context of Navegandharaneeya adhyaya 57 Charaka has mentioned Ardita as one among

the complications arising due to suppression of sneeze. Even this can be considered as

Nidana of Ardita.

Susruta 58 and Vagbhata 59 also explained Ardita Nidana vividly. Vata samanya

Nidana and Ardita Nidana according to different authors are given in the tabular form as

below.


12

Table No 1.

Showing the Samanya Vatavyadhi Nidana

Sl Vataprakopaka Nidanas C.S SS Va. MN YR BP. HS

I AHARAJA

Guna Pradhana

1. Rooksha + + + + + + +

2. Sheeta + + - + + + +

3. Alpa + - + + + + -

4. Laghu + - - + + + -

Rasa Pradhana

5. Kashaya - + + - - + +

6. Katu - + - - - + +

7. Tikta - + + - - + -

Dhanya Varga

8. Masoora - + - - - - +

9. Kalaya - + - - - - +

10. Nishpava - + - - - - +

11. Rajamasha - + - - - - +

12. Krishnakanya - + - - - - +

13. Kangu - + - - - - +

14. Neevara - + - - - - +

15. Raktashali - + - - - - +

16. Koradoosha - + - - - - +

17. Shyama - + - - - - +

18. Yavagu - - - - - - +

19. Mudga - + - - - - +

20. Aadaki - + - - - - +

21. Harenu - + - - - - +

Harita Varga

22. Kalinga - - - - - - +

23. Vastuka - - - - - - +

24. Palandu - - - - - - +

25. Gunjana - - - - - - +

26. Kandashaka - - - - - - +

27. Shushkashaka - - - - - - +

28. Vallura - + - - - - -

29. Varaka - + - - - - -


13

II VIHARAJA

Sl Vataprakopaka Nidanas C.S SS Va. MN YR BP. HS

30. Vishamasana + + - + + - -

31. Atibhukta - - - - - - +

32. Kshara - - - - - - +

33. Abhojana - - + - - - -

34. Langhana + - - - + - -

35. Adhovatarodha - + - - - - +

36. Mutrarodha - + - - - - +

37. Pureesharodha - + - - - - +

38. Nisha Jagarana + - + + + + +

39. Ativyavaya + + + + + - +

40. Ativyayama + + + + + - +

41. Atiadwa + + - + + - +

42. Atibhashana - - + - - - +

43. Ashwayana + - - + + - +

44. Ushtrayana + - - + + - +

45. Rathayana - - - - - - +

46. Gajayana + - - + + - -

47. Plavana + - - + + + -

48. Atichesta + - - + + - -

49. Vegadharana + + + + + - -

50. Sheegrayana + - - + + - -

51. Apatamsana + + - + + - -

52. Abhighata + + - + + + -

53. Balavadvidgraha - + - - - - -

54. Shayyasana + - - - + - -

III MANASIKA

55. Shokha + - + + + + -

56. Chinta + - + + + + -

57. Duhkha + - - - - - -

58. Krodha + - - - + - -

59. Bhaya + - - - - - +

IV PANCHAKARMA APACHARAJA

60. Vishama Upachara + - - + - + -

61. Asamyak Vamana - - - - + - -

62. Asmyak Virechana - - - - + - -

63. Kriyatiyoga - - + - - - -


14

V KALAJA

Sl. Vataprakopaka Nidanas C.S. S.S. Va. M.N. Y.R. B.P. H.S.

64. Sheeta dine - - - - - - +

65. Durdine - - - - - - +

66. Snanapeete - - - - - - +

67. Aparahne - - - - - - +

68. Varsharitu - - - - + - -

69. Payodasamaye - - - - + - -

70. Jara + - - - + - -

71. Greeshma ritu - + - - - - -

72. Aahoratri - + - - - - -

73. Nishante + - - - - - -

74. Divasante + - - - - - -

75. Varshante + - - - - - -

VI ANYA

76. Dosha Sravana + - - + - + -

77. Asrik Sravana + - - + + + -

78. Dhatu Kshaya + - - + + + -

79. Marmaghate + - - + - + -

80. Ama Dosha + - - + + + -

81. Rogati Karshana + - - + + + - (CS = Charaka Samhita 60, SS = Susruta Samhita 61, Va = Astanga Hridaya 62,

MN = Madhava Nidana 63, YR = Yoga Ratnakara 64,

BP = Bhava Prakasha 65, HS = Hareeta Samhita 66)


15

Table No.2

Showing Ardita Nidana by Various Acharyas

NIDANA CS 67 SS 68 AH 69 MN70 BP 71 YR 72 KK 73

Ucchairbhasya - + + + + + +

Atihasa - + + + + + -

Atibhashana - + + + + + -

Atijhrumbhana - + + + + + +

Kathina padartha sevana - + + + + + -

Ati bhara harana/vahana on shiras

- + + + + + -

Vishama asana + + + + + + -

Vishama shayana + + + + + + -

Ati jihwa nirlekhana - - - - - + -

Netra,Nasa,Karna vigharshana

- - - - - + -

Pravata sevana + - - - - - -

Vegadharana + + + + + + +

Vyadhikarshana - - - - - + +

Diwaswapna - - - - - + -

Table No.3

Showing Dhatukshayakara Nidana

NIDANA C.S S.S A.H M.N B.P Y.R K.K

Abhighata - - - - - + -

Marmabhighata + + + + + + -

Vranapaka - - - - - + -

Raktakshaya - + - + + - -

Ati madyapana - - - - - + -

Ativyavaya - - - - - + -

Ativyayama - - - - - + -

Ati langhana + - - - - - -

Siravyadha - - - - - + -


16

Charaka 74 has included Ardita in the diseases caused by the vitiated Vata in the

head. Hence the following general causes of Shiroroga are even considered under

Ardita Nidana 75.

Sandharana - Suppression of natural urges

Diwaswapna - Sleep during the day time

Ratrijagarana - Vigil during night

Mada - Intoxication

Uchha bhashana - Speaking loudly

Exposure to frost and easterly wind

Atimaidhuna - excessive indulgence in sex

Asatmya gandha - Inhalation of undesirable smell

Rajodhumahima atapa - exposure to the dust, smoke, snowfall and sun.

Ati seeta-Ambusevana - excessive intake of cold water (beverages)

Abhighata to siras - injury to head

Dushta Ama - vitiation by ama

Rodana - lamentation

Bashpa nigraha - Suppression of tears

Manastapa - anxiety and other mental stresses

Doshakala viparyaya - regimen contrary to those prescribed for the locality

and season.

Excessive intake of guru, Amla and harita (greens) diets.

Due to the above causes, the Doshas get aggravated resulting in the

vitiation of Rakta Dhatu in the head and leads to morbidity.


17

These causes are relevant to all diseases that afflict the head, where Ardita is also

included. In the causation of the diseases of head, it should be noted that apart from the

doshas Rakta Dhatu is having a major role in the disease process.

Both Susruta 76 and Vagbhata 77 have enumerated the causes of Ardita 78.

1) Speaking loudly

2) Churning hard food stuffs.

3) Excessive laughter, yawning and also sneezing

4) Carrying heavy loads on head

5) Sudden movement of head and neck

6) Sleeping in an uncomfortable posture.

7) Use of pillows in wrong posture.

Susruta adds further that, in the event of Rakta Kshaya, the following will

be afflicted by Ardita:

1) Pregnant lady

2) Recently delivered lady

3) Children

4) Old people

5) Emaciated persons

Vagbhata explained Ardita is a disease, resultant of the vitiation of

Pranavata 79. Thus causes of the vitiation of Pranavata are even included under the Nidana

are as follows:

1. Excessive indulgence in the Ruksha Ahara and Vihara

2. Excessive physical exercise


18

3. Fasting

4. Over eating

5. Trauma

6. Excessive indulgence of walking

7. Suppression of natural urges

8. Trying to stimulate for excretion when natural urges not ready for

Yogaratnakara 80 further contributed some more verses are as follows.

i) Sitting on an uneven place

ii) Excessive use of tongue cleaning

iii) Injury to the cheeks

iv) Wrong use of Siravyadhana (in the head)

v) Injury to the Marma (in the head)

vi) Excessive rubbing of the eyes, ears and nose.

All the causes stated above are of different categories are relevant to the

present context.

Poorvaroopa / Pre disease syndrome

Lakshanas indicative of the forth-coming disease are called poorva roopa. By seeing

these features the disease can be ascertained. In parlance with the shadkriyakala this stage

denotes the sthaanasamshraya avastha.

Charaka 81 has mentioned avyakta lakshana as poorva roopa of all Vata vyadhis.

Yogaratnakara 82 has followed Susruta in naming the poorva roopa.

The poorvarupa of Ardita Vata as described by Susruta 83 is as follows :

1) Romaharsha (horripilation)


19

2) Vepanam (Trembling)

3) Avila Netrata (eye not being clear)

4) Vayuroordhwa (upward movement of Vata)

5) Twachi swapa (loss of sensation of skin)

6) Toda (pain)

7) Manya sthamba (stiffness of the neck)

8) Hanugraha (stiffness of the jaw)

All the symptoms of Ardita in a mild form are also considered as poorvarupa.

Roopa / Lakshana / symptomatology

Roopa of a disease is the stage of Vyakta in the Kriyakalas and manifests the full

fledged disease. More or less all the authors opine that Mukha vakrata and netra stabdata

associated with Vaksanga in the disease of Ardita. The signs and symptoms of Ardita as

mentioned in different Ayurvedic classics are tabulated as follows.

Table No. 4

Showing the Ardita Lakshanas Mentioned in Different Texts

LAKSHANAS C.S

S.S

A.S

A.H

M.N

B.P

Y.R

H.S

G.N

1. Mukhavakrata + + + + + + + + + 2. Nasavakrata + + - - + + + + - 3. Bhruvakrata + + - - + + + + - 4. Lalatavakrata + + - - + + + + - 5. Akshivakrata + + - - + + + + - 6. Aharavakradarshanata + - - - - - - - - 7. Ekakshinimeelana - - + + - - - - - 8. Netrasthabdhata + - + + - - - - - 9. Kshavathunigraha + - + + - - - - - 10. Dantachala + - + + - - - - - 11. Vaksthabhdata/Sanga - + + + + + + - + 12. Nisteeva

parshvaagamana - - + + - - - - -

13. Shrutihani + - + + - - - - - 14. Gandha ajnana - - + + - - - - - 15. Swara bhramsha + - + + - - - - - 16. Shankha ruja + - - - - - - - -


20

LAKSHANAS C.S

S.S

A.S

A.H

M.N

B.P

Y.R

H.S

G.N

17. Netra ruja + - - - - - - - - 18. Shravana ruk + - - - - - - - - 19. Ganda ruk + - - - - - - + - 20. Moordha kampa - + + + - - + - + 21. Hasita vakrata + - + + - - - - - 22. Pada ruk + - - - - - - - - 23. Hasta ruk + - - - - - - - - 24. Jangha ruk + - - - - - - - - 25. Uru ruk + - - - - - - - - 26. Greeva ruk - + - - + + - + + 27. Chibuka vedana - + - - + + + + + 28. Danta vedana - + - - + + + + + 29. Jatroordhva ruja - - + + - - - - - 30. Adhah shareerardha

vedana - - + + - - - - -

31. Hanu vakrata + - - - - - - - - 32. Mukha sankocha + - - - - - - - - 33. Bhaadyete sravanav + - - - - - - - - 34. Deena vak + - - - - - - - - 35. Jihma vak + - - - - - - - - 36. Samukshipta vak + - - - - - - - - 37. Kala vak + - - - - - - - - 38. Sajjati vak + - - - - - - - - 39. Bahu sosha + - - - - - - - - 40. Jaanu sosha + - - - - - - - - 41. Shareerardha + - - - - - - - - 42. Ukte vakrata - - + + - - - - - 43. Eeekshita vakrata - - + + - - - - - 44. Smruti moha - - + + - - - - - 45. Traasaha suptasya - - + + - - - - - 46. Greeva vakrata - + - - - - - + + 47. Netraadi vikruti - + - - - - - + + 48. Visangna - - - - - - - + - 49. Vedanaatura - - - - - - - + -

(CS = Charaka Samhita 84, SS = Susruta Samhita 85, AS = Astanga Sangraha 86,

AH = Astanga Hridaya 87, MN = Madhava Nidana 88, BP = Bhava Prakasha 89,

YR = Yoga Ratnakara 90, HS = Hareeta Samhita 91, GN = Gadanigraha 92)


21

The following are the list of sign and symptoms mentioned in different Ayurvedic

classics.

1) Distortion of the affected side of the face (the mouth angle is drawn over to

the opposite side)

2) If the patient tries to laugh, the mouth angle is drawn to the normal side.

3) There is also pulling of neck toward normal side.

4) Tremors or Shaking of the head and also teeth.

5) Rigid and winkles of the eyes, closing of the affected eye is difficult.

6) Distortion of the nose

7) Difficulty in speech and hoarseness

8) Loss of hearing and smell sensation and pain in the ear also.

9) The spitting is effected to one side only.

10) Sneeze gets suppressed

11) Severe pain in neck, chin, teeth, on the affected side

12) Frightened during sleep

13) Loss of memory.

Since Charaka described a combined state of Ardita and Pakshaghata 93, only those

symptoms expressed due to the Ardita are given below.

i) The food instead of going straight goes into one side of the mouth.

ii) While speaking nose gets curved

iii) The eye remains rigid and winkles

iv) The sneeze gets suppressed.


22

v) Speech is faint, distorted, stutters, indistinct and thick and hoarseness of

voice.

vi) Loosening of Teeth

vii) Pain in the gums

viii) There is distortion /asymmetry of the nose, eyebrows, forehead, eye and

jaw.

Bhavamishra, yogaratnakara, has classified the Ardita roga into three types, based

on the predominance of the doshas involved in Samprapti. Are listed below:

I) Vataja Type

1) Excessive salivation

2) Pain

3) Shaking of the head.

4) Throbbing pain

5) Stiffness of the neck and jaws.

6) Difficulty in speech.

7) Oedema of the lips.

II) PITTAJA TYPE

1) Fever

2) Thirst

3) Loss of consciousness

4) Burning sensation.

III) KAPHAJA TYPE

1) Oedema of the cheek, neck etc.

2) Stiffness of the above regions or paralysis.


23

Episodic nature of Ardita:

Charaka says Ardita features are seen in one half of face, trunk, extremities or they

may be restricted only to face and is episodic in nature 94. Gadanigraha has also mentioned

the episodic nature of Ardita. Ardita involves one lateral of face only, sparing trunk and

extremities and is non-episodic in nature is the opinion of Susruta 95. Where as Vagbhata

states Ardita as non-episodic, either left or right lateral or upper or lower half of body is

affected. Ekaayaama is used to indicate the same.

From the above information it is very much evident that difference of opinion

regarding the area of involvement of Ardita does exist.

• Dosha pradaanata in Ardita 96 - Charaka has not mentioned the types of

Ardita depending on dosha pradhaanata. But accepts involvement of other

doshas

• Yogaratnakara 97 and Gadanigraha 98 mention three types of Ardita - Vataja,

Pittaja, Kaphaja.

Facial paralysis-

Facial paralysis is due to a lesion of the pyramidal tract between the cortex and the

middle of the Pons (upper motor neuron paralysis), the nucleus and the seventh cranial

nerve (lower motor neuron paralysis) and facial muscles (myopathy).

Facial paralysis can occur by two kinds of lesions viz. Supra-nuclear and infra-

nuclear type. The signs and symptoms vary according to the nature of the fiber paths

involved.


24

Facial weakness/paralysis may be due to:

A supra-nuclear lesion involving the corticospinal fibers concerned involuntary

facial movements;

A supra-nuclear lesion involving the fibers concerned in emotional movement of

the face - mimic paralysis.

Nuclear and infra-nuclear lesions involving the lower motor neurons; and

Primary degeneration or disorder of function of facial muscles

1) Facial paralysis due to a supra-nuclear cortico-spinal lesion is distinguished by the

fact that movements of the lower face are affected more severily than those of the

upper.

2) A pathway controlling emotional movements as distinct from voluntary movement

of the opposite side of the face, the most important originates in the frontal lobe. A

lesion, above the internal capsule may paralyse voluntary movement of the lower

face on the opposite side. Leaving emotional movement, as in spontaneous smiling

intact, very rarely, a frontal or thalamic lesion may abolish contra-lateral emotional

movement leaving voluntary movement unimpaired (Mimic Paralysis).

3) Lesions involving the lower motor neurons destroy the final common path; affect

equally all forms of facial movements. The facial lower motor neurons may be

involved by a lesion:

a) Pontine lesion (within the Pons)

Lesions in this region, facial paralysis is usually associated with

conjugate ocular deviation, often with paralysis of the ispilateral jaw

muscles and some times with the contralateral hemiplegia. Involvement of


25

trigeminal nucleus may lead to sensory loss also. Bilateral facial paralysis

occasionally occurs as a congenital abnormality (Mobius' Syndrome).

b) Lesion within the posterior fossa, between the pons and the internal

acoustic meatus may cause deafness and loss of taste in the anterior two

third of the tongue as well as facial paralysis. The commonest of such

lesions are acoustic neuroma.

c) Within the temporal bone the facial nerve may be involved in skull

fracture or be involved in infections of the middle ear and mastoid. Herpes

zoster of the geniculate ganglion usually causes facial paralysis through

secondary involvement of the motor fibers of the nerve, so called Ramsay -

Hunt syndrome. Lesions within the middle ear is usually associated with

loss of taste in the anterior two third of the tongue, due to interruption of

the fibers of the chorda tympani.

d) After emergence of the nerve from the skull the fibers of the facial nerve

may be involved in many inflammatory or malignant processes causing

unilateral or bilateral facial palsy. Facial palsy of bilateral or unilateral with

recurrent episodes of facial oedema occur in patients with deeply furrowed

tongue i.e. Melkersson's syndrome.

4) Primary dysfunction of the facial muscles is seen in myasthenia gravis, muscular

dystrophy and dystrophy mytonica.

Among the above terms of lower motor neuron lesions, Bell's palsy is a

commonest form of facial paralysis.


26

Causes of facial paralysis-

1. Upper motor neuron lesions-

(Lesions of pyramidal tract between cortex and middle of pons)

• Vascular-cerebral thrombosis, embolism and hemorrhage

• Traumatic-cerebral contusion

• Neoplastic-glioma, secondaries

• Infective

2. Lower motor neuron lesions- (Peripheral)

3. Muscular diseases-

• muscular dystrophy

• myasthenia gravis

Bell's palsy:

Bell's palsy is defined as the facial paralysis of acute onset presumed to be due to

non-suppurative inflammation of the facial nerve within its canal above the stylomastoid

foramen.

The features of Bell's palsy are:

1. Usually unilateral, rarely bilateral.

2. Pain within ear or mastoid region or around the angle of jaw.

3. Onset is sudden - often patient awaken to find the face paralyzed.

4. Paralysis of the muscles of facial expression. The upper and lower facial muscles

are equally affected and voluntary emotional & associated movements are

involved.


27

5. Eyebrow droops, wrinkles smoothed out, frowning and rising of eyebrow is

impossible.

6. The palpebral fissure becomes wider on affected side and closure of the eye is

impossible.

7. When the patient attempts to close the eye, the globe rolls upwards and slightly

inwards - Bell's phenomenon.

8. Eversion of the lower lid impairs absorption of tears, tends to overflow.

9. Nasolabial fold is smoothed out.

10. Mouth becomes drawn to sound side and the patient cannot retract the angle of the

mouth or purse the lips as in whistling.

11. Paralysis of the buccinator causes cheek a puffed out appearance in respiration.

12. Food accumulates between the cheek and the teeth.

13. The tongue deviates to the sound side when protruded.

14. Loss of taste in anterior 2 / 3 of the tongue may occur when the inflammatory

process extends to the chorda tympani.

15. The patient may complain of hypercusis, an intensification of loud noises in the

affected ear, when the branches to the stapedius are involved.

The features of Ardita as per Ayurveda in modern parlance suggest the

involvement of all cranial nerves as one or the other feature of their damage is present as a

lakshana in Ardita. Also, the involvement of facial nerve is very obvious as it manifests

with more number of symptoms than any other cranial nerve. This is the reason why the

Ardita is frequently compared to facial nerve palsy even though unilateral involvement of

all the cranial nerves is seen.


28

Samprapti of Ardita

The Vata vitiated by the earlier stated causative factors, settles in the regions of

head, nose, chin, forehead and the eyes and produces the disease called Ardita 99-100 Vata.

The symptom of vaksanga indicates that the vitiated Vata 101-104 affects the tongue also

Vagbhata has indicated the affliction of the ear on the affected side 105.

As per Charaka, the vitiated Vata while settling in the above stated regions in the

head accounts for the "Soshana" of the "Rakta" Dhatu resulting in Ardita 106. Here the

soshana may be understood as a reduced supply of Rakta to that particular region affecting

the normal physiological functions (jeevanakriya).

The pranavata is located in the head 107. According to Vagbhata Ardita roga is out

of the vitiation of Pranavata 108 and as one of the functions of the Pranavata is "Dhamani

dhrik" i.e. sustaining and protecting the dhamanis (arteries) 109, Therefore the Rakta

Shodhana or reduction in the blood supply may result due to its vitiation.

The dhamanis may also be affected by the disease dhamani pratichaya

(atherosclerosis) which is one of the important aetiology of Rakta Soshana to that region in

the head, which controls the voluntary movements of the facial muscles.

Udbhavasthana of Ardita

In Ayurveda, from the point of origin, all the diseases are classified under two

categories i.e. Amashaya samutha and Pakwashaya samutha.

The normal Vata Dosha, which sustains the body, is present in the Kosta

(Pakwashaya), and in case of Vata Vyadhis the symptoms located in other parts of the

body become allayed on eradicating morbid Vata remaining in Pakwashaya by means of

Vasti or any other treatments. It is clear from this point that, most of Vata Vyadhis are


29

from Pakwashaya only. Hence Pakwashaya is the udbhavasthana of Ardita. Even it fulfils

the illustration of Bhela 110, who considered Ardita one among the Asthi Majjagata Vata.

Sanchara stana of Ardita

This term signifies the circulation of vitiated Dosha all over body, with special

reference to the sroto vaigunya that occurred by etiological factors. This spreading takes

place through the media/vehicle i.e. rasayani 111.

The Rasa vikshepana in body is by Vyanavata through rasayani. Vitiated doshas also

travel through these rasayani. Therefore rasayani may contain any Dosha irrespectively.

With regards to Vata Vyadhi, the rasayani may be considered as Vata vahini, through

which the Vata predominantly pervades. Aruna siras are considered as same type; hence

they are the media of Ardita. Dhamanis may also be considered as circulatory or sanchara

sthana of the said disease.

Adhistana of Ardita

Vitiated doshas lodge at the place of srotovaigunya during the circulation of Rasa by

Vyanavata. The doshas thus may account for structural or functional impairment.

Adhistana of Ardita is considered as shiras which is an indriyayatana (brain) i.e. abode of

all indriyas. Ayatana means the place where sense organs and the channels carrying

sensory vital impulses are set as the rays in the sun. The head injury leads to the disorders

like Ardita 112. The doshas if provoked in the seats of indriya they cause either upaghata

(impairment) or upatapa (irritation) of concern indriya. Here Upaghata means destruction

(vinasha) and upatapa is impairment. (kinchit vaikalya) 113.

Deformity or destruction in a particular center or area results in to either

disturbance or cessation of the functions corresponding to that area. Cortex, internal


30

capsule, mid brain, medulla all these are considered as indriyayatana because indriyas

dwell here.

Dosha in Ardita

Vata vitiation is having the prime role, in the disease manifestation.

Pranavata

Murdha (brain) is the dwelling place of Pranavata and it controls the functional

aspects of indriya and manas. In this disease the functions of hasta, paada, muka are

affected, as it is bound to instigate subtle indriyas to execute their appropriate

functions. So involvement of Pranavata is considered. Vagbhata 114 said indriya

vikaras are due to vikruti of Pranavata and the above said explanation even denotes

the same.

Vyanavata

Indriya dharana functions are attributed to Pranavata but reflexes, co-

ordination requires the assistance of Vyanavata. Vyanavata possessed with Chala

guna predominantly. Hence all the movements of the body specifically of indriyas

are governed by Pranavata are sustained by Vyanavata even. In classics five distinct

movements of Vyanavata are said - prasarana, akunchana, utkshepa, unmesha,

nimesha 115.

All the voluntary movements of dhamani, khandara, maamsadhara kala are

under the control Vyanavata, as it is the controller and performer. The main

symptomatology of Ardita is reduction or loss of motor functions. So Vyanavata do

have an important role in this disease.


31

Samanavata

Samanavata resides near Agni 116 and it is possessed with ruksha guna. Due

to its guna, it causes shosha (atrophy) of snayu and sira. Samanavata is responsible

for digestion, absorption and assimilation of ingested food.

Udanavata

Bala of the Shareera rely on Udanavata 117 indriyas. Any loss of bala as

witnessed in vak-stamba etc the role of Udanavata is appreciated.

Tarpakakapha

Tarpakakapha dwells in shiras and nourishes the indriyas. All the sense organs

are present in head 118, except organ of touch, which is distributed through out the

body including head. Tarpana karma too affected here. Thus its role is considered

here. This tarpaka kapha is having direct relation with indriyayatana and indriya.

Dushyas in Ardita

1) Rasa

2) Rakta (asrujah sirakandara)

3) Mamsa

4) Majja

• Loss of voluntary movement in half of the face or half of the body, inability to

express emotions like laughing, etc., inability to masticate properly, inability to

pronounce properly due to impaired articulation, all these are suggestive of snayu

and sira involvement. These two are the upadhatus of meda and Rakta respectively.


32

• Vak is the karma of vak-indriya. In Ardita features pertaining to vak like deena

jihwa, aphala jihwa, etc. will be present indicating the affliction of vak-

karmendriya.

• Jnanendriya are also involved in Ardita. The same is indicated by lakshanas like

vaksanga, netra vaikruti, jihwa sankoca, shravana bhadirya, etc. hence respective

affected Jnanendriya may be included as dushya in Ardita.

• Ardita is considered as a Shiroroga. Charaka in Shiroroga Samprapti says that, due

to Nidana sevana the prakupita vatadi doshas vitiate asruk. So Rakta Dhatu may be

included as dushyas in Ardita.

• Bones are filled with Majja and Dalhana supported this. He says mastulunga is like

solid mass of ghee. By Majja Kshaya Vata roga may manifest. Among the sthanas

of Vata, Majja is considered as one of the place 119, 120.

Srotas in Ardita

Depending upon the functional aspects Vata vaha srotases are classified under two

headings i.e. motor (Gati) or sensory (Gandhana).

• Chestavaha srotases 121 which conduct the motor function. The specific direction

for the requisite motor function is transmitted from the Buddhi only, in close

association of the "Manas" 122. Therefore it is assumed that, these chestavaha

srotases originate in Buddhi (higher cortical centers) and with a relay in the mind,

terminate in the cognitive organ or other muscles.

• Samjnavaha srotases which conduct the sensory function. These originate in the

respective cognitive organs and after relaying in the region of manas, terminate in

the connected Indriya buddhi.


33

The Vata vaha srotases are of two types based on their structure:

Samvrita : Well covered or concealed. These are the myelinated nerve fibers.

Asamvrita : not covered or open. These are the nonmyelinated variety.

Pranavaha Srotas:

As Pranavata vitiation manifests Ardita, the role of these Srotas has to be

considered.

Rasavaha Srotas:

In many diseases doshas are dragged with Rasa Dhatu thus Rasa vaha Srotas too

has a role to play in this disease.

Roga marga in Ardita

Ardita is a disease of Madhyama roga marga 123 due to its involvement of shiro

marma and snayu. As it is explained by Bhela, the disease Ardita falls under Asthi Majja

gata Vata Vyadhi. Asthi 124 is said as Madhyama roga marga. Ardita even falls under this

catogery.

Applied Anatomy of the disease concern

It is clear that this disease Ardita afflicts the face and other closely associated

organs. All authorities mentioned that the afflicted region is the half of the face.

Synonyms of Mukham

'Vaktram', 'Asyam', 'Vadanam', 'Tundam', 'Ananam', 'Lepanam', and 'Mukham', are

the synonyms of the face and also the mouth 125.

On this regard, branches of facial nerve and its innervations with respect to the

muscles of the, Upangas as explained by Bhavamishra of Shiras to whom it is supplying,

are tabulated below 126.


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Branches of Facial Nerve

1) From the geniculum of the facial nerve -

i) The greater petrosal nerve

ii) A small branch passes through temporal bone to join the tympanic plexus

of the glossopharyngeal nerve.

iii) A minute, inconstant branch to the sympathetic plexus on the middle

meningeal artery

2) In the descending part of the canal

i) The small stapedial nerve passes fowards to supply the stapedus muscle.

ii) The chorda tympani

iii) Auricular branch of the vagus.

3) In the neck

i. Descending digastric branch

ii. Posterior auricular nerve

4) In the parotid gland

i) Temporal branches

ii) Zygomatic branches

iii) Buccal branches

iv) marginal mandibular branch

v) Cervical branches

Table – 5

Muscles innervated by the Facial Nerve w.s.r. to Upanga


35

S.No Upanga Muscle

1 Lalata Occipito frontlis (Epicranius)

2 Bhruyugma Corrugator supercili Procerus

3 Netradvayam Orbicularis oculi

4 Karnam Stapedius, Auricularis anterior, Auricularis Posterior,

Auricularis Superior

5 Kapola Buccinator

6 Nasika Procerus, Nasalis, Dilator naris, Depressor Septi,

Compressor naris

7 Ostha Orbicularis oris

8 Srikvinyam Depressor angularis

9 Mukha Depressor labii inferioris, Levator angularis, Levator labii

superioris, Risorius, Zygomaticus major, Zygomaticus

minor

10 Hanu Platysma

11 Jihwa Stylohyoidus, Platysma

12 Chibuka Mentalis

13 Gala Platysma

14 Talu ---

15 Danta ---

16 Danta veshtha ---

17 Shankam ---

The above stated organs and sub organs of the Shiras have different functions.

Majority of them join to reflect the facial expression through the action of different

muscles. There are four sense organs viz., Netra, Karna, Nasika and Jihwa. Of these the

actual perception of Shabda, Roopa and Gandha belong to different cranial nerves,

whereas the Rasa perception is closely associated with the facial nerve, which is also

controlling the movements of the muscles of the face. It may be noticed from the above


36

tabular statement that the affliction of the facial nerve is capable of paralyzing many

muscles of the face.

Applied Physiology of the Ardita Vata

The most important functions of the organs/sub-organs of Shiras enlisted above

are:

Facial Expression:

• Due to emotions like happiness, fear, dislike etc.

• Closure and opening of the eyes.

• The movement of the pinnae of the ears which are not very evident in the

human beings.

• Respiratory Act: inhalation and expiration through the nose.

• Deglutition of the food after proper mastication, prevention of the food

falling out of the mouth.

• Various stages of laughter.

• Verbal expression through the movements of tongue, lips, cheeks etc.

To conduct all the above said functions different groups of muscles play an

articulated part. The facial expression is dependent on the mood of the mind which acts in

two different ways.

i) In association with the sense organs depending on the

information received from them.

ii) Without association of the sense organs 127.

The Vata is stated to control the mind 128 and also the Arthas (objects) of the mind.

“Manas” is the cause of different modes of functions of Buddhi 129. Therefore it is


37

understood that the Manas is capable of modifying the instruction of Buddhi for an action.

There are two sub-divisions of Vata which can modify the functions of Manas.

Pranavata 130

Udanavata 131

A critical analysis of the functions of both Pranavata and Udanavata

indicates the following areas in CNS, related to them.

Pranavata:

Reticular formation is from the brain stem to medulla oblangata with connection to

higher centers.

Udanavata:

Reticular formation is from the lower part of the Pons to the spinal cord up to C3,

C4, C5, and T2 to T6. The motor nuclei of the cranial nerves 7, 9, 10, 11 and 12 are

included.

Vaktra:

This word vaktra has two meanings one is Face and another is the Mouth.

The face has many Upangas as explained already. The vaktra or mouth is the upper

opening of the Annavaha Srotas. The food ingested is chewed well for mixing with the

saliva and also for softening and passes through the gala (throat) and Annanadi

(oesophagus) into the Amashaya for the process of digestion.

Oshtha: (lips)

The lips are made up of muscles covered by skin. They prevent the food from

falling out of the mouth. They protect the teeth and gums and also take part in two

important functions.


38

i. Verbal expression and

ii. Facial expression

Jihva: (tongue)

Tongue is a muscular structure and it is voluntary. It is placed on the floor of the

mouth with a front portion free. It is capable of all types of movements. The

"Rasanendriya" is located in the epithelium covering it. The sensation of the taste is

carried by the chorda tympani branch of the facial nerve (anterior two third of the tongue)

and the posterior one third by the glossopharyngeal nerve. The muscles of tongue are

supplied by the hypoglossal nerve.

The tongue serves the following functions:

i. Mastication : it helps in the act of chewing

ii. Deglutition

iii. Taste

iv. Speech

v. Secretion of mucous and of serous fluid with which it keeps moist.

Vyavachedaka Nidana of Ardita

Charaka has differentiated Ardita from Pakshaghata. Firstly, Ardita affects one

lateral side of the face with or without the involvement of one lateral side of body where

as Pakshaghata involves only one lateral side of body sparing the face, secondly Ardita is

episodic in nature where as Pakshaghata is non-episodic in nature. Thirdly both these have

different associated signs and symptoms i.e. all the features of Ardita are not seen in

Pakshaghata and all the features of Pakshaghata are not seen in Ardita 132.


39

Aphasia

Aphasia is a disorder affecting the ability to speak or read. Global aphasia, results

from extensive damage to the general interpretive area or to the associated sensory tracts.

There are several other forms of aphasia. Major motor aphasia may develop in an

individual after a brief period of global aphasia.

This condition is extremely frustrating for the individual, who can understand

language and knows how to respond but lacks the motor control necessary to produce the

right combinations of sounds. It is also known as nonfluent, or expressive, aphasia. In

fluent, or receptive, aphasia, the person does not understand what is heard or make sense

while speaking. The individual words and sounds come easily, but they convey no

meaning.

Lesser degrees of aphasia commonly follow a minor stroke. There is no initial

period of global aphasia, and the individual can understand spoken and written words. The

problems encountered with speaking or writing gradually fades. Many individuals with

minor aphasia recover completely.

Facial paralysis is seen in three clinical forms for the differential diagnosis 133

1. Upper motor neuron paralysis (U.M.N. lesion)

2. Lower motor neuron paralysis (L.M.N. lesion)

3. Myopathy

1. Upper motor neuron paralysis-

• In U.M.N. paralysis the eye can be closed and the fore head wrinkled, but

the teeth cannot be bared on the affected side and there is weakness of lips

and buccinator muscles.


40

• In bilateral pyramidal lesions the upper part of the face is paralyzed as well

as the lower, and emotional movements are also involved.

2. Lower motor neuron paralysis-

• Here the upper and lower halves of the face are affected equally; emotional

movements are lost. If there is no recovery contractures may occur,

fasciculation may be seen.

3. Myopathy-

• Myopathy may cause facial weakness. This occurs in the heredofamilial

dystrophies and myotonic dystrophy, but in these conditions the affection is

not limited to the face, weakness is bilateral and confusion is unlikely to

occur.

• Myasthenia gravis with its ptosis, diplopia, and characteristic aggravation by

exercise (ready response to Tensilon) is usually easy to recognise.

• Facial -hemi-atrophy may, superficially resemble uni-lateral facial paralysis,

but it is differentiated by the fact that the weakness is associated with an

atrophy of all the tissues-skin, muscle, bone, nasal cartilage and even the

eyes.

Other diseases affecting the face and facial nerve-

Ramsay- Hunt syndrome 134

Herpes zoster affecting the geniculate ganglion produces a severe

facial paralysis that is associated with a painful facial eruption with

in the external ear canal. This affection may also involve auditory

nerve.


41

Chronic facial hemispasm- It is characterized by spontaneous

unilateral frequent sudden strong brief contractions of a part or all

of the facial musculature. The condition usually begins in the

orbicularis oculi muscle and over many years' spreads to involve

more of the face. In a few instances the disorder follows Bell's

palsy. Cause is not known but compression of the facial nerve by

adjacent structures in the posterior fossa has been postulated.

Alcohol injection or intra cranial surgical freeing of the facial nerve

from adjacent structures can obtain relief.

Facial myokymia 135

Multiple sclerosis - A constant, brief, synchronized worm like

contraction of facial muscle fibers characterizes it. Intra-pontine

lesions such as tumors and multiple sclerosis manifest it.

Bilateral facial paralysis (facial diplegia) occurs in acute

inflammatory poly-radiculo-neurities (Gullian-Barre syndrome) and

in variety of sarcoidosis known as uveoparotid fever.

An attempt is made to compare Ardita with respect to cranial nerves and the

information is suggestive of involvement of other cranial nerves.


42

Table – 6 Showing the symptoms relation to CNS

Symptoms as explained in Ayurvedic texts 136 to 143

With relation to the cranial nerve

Distortion of half of the face, curvature of the nose, eyebrow, fore head and mandible, ingested food moves tortuously to one side, dribbling of saliva from the angle of mouth, 144 closure of eye

Facial nerve 145-146

Pain in ear Lesion of Facial nerve involves vestibulocochlear 147

Cessation of function of ears. Lesion involving Facial, auditory and vestibular nerves. 148

Speech becomes faint, distorted, imperceptible, interrupted and hoarseness of voice

Vocal cord involvement / vagus nerve 149

Pain in the eye Optic nerve 150

Eye remains fixed Occulomotor, trochlear, Abducent 151

Abnormality of eye Occulomotor/Abducent 152

Distortion of eye Abducent / trochlear 153 Area 8 of Frontal Cortex 154

Mistiness of vision (Yogaratnakara) Adie’s syndrome optic nerve 155 lesion of Mid Brain 156

Loss of sense of smell Olfactory nerve 157

Contracture / spasm / abnormalities of tongue

Hypoglossal 158 Abducent 159

Spasm of one half of the face Facial nerve 160

Lid becomes fixed while speaking Occulomotor161

Pain above supraclavicular region Trigeminal 162

Pain and distortion of neck Accessory nerve 163

Contraction of arm, foot knee. Half of the body.

UMN lesion of Facial nerve is with hemipegia.

Half of the face Lesion which is either UMN / or LMN Patient get’s frightened and awakes from sleep. (Traasah suptasya) 164

Trigeminal nerve 165

Alterations in consciousness (Moha / visangna) 166-167

Occulomotor 168

Alteration’s in memory (Smruti moha), tremor’s / shaking ( Kampa)

Lesions of Basal ganglia (imbalance in cholinergic and dopaminergic neurons. 169

Throbbing, fasciculation (Sphurana), continuous throbbing (Vyatha)

Facial nerve (synkinetic movements / facial myokymia). 170


43

Chikitsa of Ardita

There are slight differences in the treatment advocated by the Bruhatrayee

1) Charaka Samhita 171

Tailabhyanaga to the head

Nasyakarma

Tarpana Kriya with medicated oil to the eyes and ears.

Nadi Sweda

Upanaha Sweda

Both these swedana kriyas are to be administered with the flesh of aquatic animals.

2) Susruta Samhita 172

Mastishkyam: Application of sneha or kalka with sneha etc. on the

vertex of the head.

Shirovasti

Nasyakarma

Dhoomapana

Upanaha Sweda

Snehana-according to the Dosha

Nadisweda.

3) Astanga Hridaya 173 followed Charaka.

Nasya Karma

Application of oil to head

Tarpana Kriya with medicated oil to eyes and ears.


44

In addition he recommended two more methods of treatments based on the

accompanying Dosha.

Kapha - If there is oedema, Vamana has to be administered.

Pitta - If there is redness and burning sensation, siravyadha is

recommended.

4) Bhavamishra 174

Snehapana according to Dosha

Nasya karma

Upanaha Sweda

Shirovasthi

Diet with the articles which alleviate Vata.

It is evident as per above explanations that, snehana plays an important role in the

management of Ardita. Vagbhata listed Ardita under the diseases arising out of Pranavata

vitiation. Shirovasthi is a bahya snehana procedure which is a treatment of choice in

Ardita, as it acts directly at the level of murdha which is stated as adhistana of Pranavata

175. This approach even fulfills the general rule i.e. Pranavata should be guarded first while

approaching any Vata Vyadhi 176.

Sadhya-Asadhyata of Ardita

This indicates the curability or incurability of a disease, which carries an inherent

meaning to that of prognosis. Certain features suggestive of asadyata are mentioned in our

classics. Presences of such features are indicative of incurability.

The features of incurability of Ardita are ksheena (debilitated), animeshaksha(unable

to close the eyes), avyakta bhashina(whose speech gets obstructed constantly), trivarsha


45

and vepana (tremors). Trivarsha is suggestive of two things either the disease is 3 years old

or discharge from mouth, eyes and nose 177-178-179. Kalyanakaaraka explained trivarsha,

aschira-bhashini, vepamaana shira (tremors), animisha aksha (unable to close the eyes) as

features indicative of asadyata 180.

In general, among all Vata Vyadhis Ardita, Hanustamba, Kubjata, Pakshaghata,

Anga shosha, Panguta and Khuda Vata are incurable due to their deep-seated nature. Even

on rigorous treatment also they may or may not get cured. If the patient is balawan, disease

is recent in onset and with out any upadravas then they may be curable 181.

Pathya – Ahara 182

1. Rasas – madhura – amla – lavana

2. Shukadanya – navagodhuma, navashali, raktasali, sashtikashali

3. Shaka varga – patola, shigru, vartaka, lashuna,

4. Mamsa varga – ushtra, go, varaha, mahisha, mayura, bheka,

nakula, chataka, kukkuta, tithira, kurma

5. Jala varga – ushnajala, shrita sheetajala, narikela jala

6. Dugdha varga – go, aja, dadhi, ghritha, kilata, kurchika

7. Mutra varga – go mutra

8. Madya varga – dhanyamla, sura

9. Sneha varga – tilaja, ghrita, vasa, majja.

Among present day food stuffs and activities

♦ can be taken – orange juice, carrot all fibrous fruits,

♦ should do – facial exercises – as advised, steam bath etc.,

♦ soft bland diet

♦ Supplementations which can regulate Vata


46

Apathya – Ahara 183

rasa – katu, tikta, kashaya

shimivarga – rajamasha, nishpava, mudga, kalaya,

shukavarga – truna, kangu, koradusha, neevara, shyamaka

mamsa varga – shushka mamsa, kapota, paravata

jala varga – sheeta jala

ksheera varga – gardabha

Among present day food stuffs and activities -

Avoid cold hard foods

Avoid nuts

Cannot be taken – fast food, cold beverages, liquor

Should be avoided – long standing sitting, driving, staying in A.C etc.,

Pathya Vihara

1. Veshtana – application of gauze to the effected part, usage of Muffler

2. Tarpana – the eye is moistened regularly to facilitate blinking

3. Mardana – regular pressure by massaging facial muscles

4. Bhushayya - The patient should lie down at intervals through out the day

to restore the affects of gravity on the paralyzed muscles

Apathya vihara –

1. Avoid cold winds

2. Manasika – Krodhaa, Chinta, Shoka, Bhaya, Duhkha

3. Shareerika – jagarana, shrama, vyayama, vyavaya, chankramana, vegadharana,

etc.,


47

Drug

Review

Explanation of composition of Dhanwantaram Taila is as follows.

S.No Name of the ingredient Quantity of proportion

1 Balamoola Kashaya (Sida cordifolia) 6 Parts

2 Dasamoola ( Bilva, Agnimantha, Kashmari etc)

Yava(Barley)

Kola (Zizyphus jujuba)

Kulatha (Dolichos biflorus) Kashaya of all

1 Part All together

3 Cows milk 6 Parts

4 Tilathaila 1 Part

5 Kalka dravyas - Meda, Mahameda, Devadaru,

Manjishta, Ksheerakakoli, Kakoli, Chandana, Sariba,

Kushta, Tagara,Jeevaka, Rushabhaka, Saindhava,

Kalaanusaari, Shaileya, Vacha, Agaru, Punarnava,

Aswagandha, Shathavari, Ksheerashukla,

Madhuyashti, Hareethaki, Bibheethaki, Amalaki,

Rasa, Shathahva, Shurpaparnya, Ela, Twak, Pathram

(Abhava pratinidhi dravyas are considered)

Each half tola

All these ingredients are discussed with their pharmacological and therapeutic

importance as under.


48

1) Bala - Sida cordifolia linn - Family: Malvaceae

Charaka included Bala in “Bhrimhaniya", "Balya" Prajasthapana 182 Vargas, and in

madhuraskandha 183 and stated that it is best in producing astringent, promoting strength

and alleviates Vata 184. Susruta included this drug in Vata samshamana varga 185.

According to Vagbhata it belongs to madhuraskandha 186 Bhavamishra described Bala

chatustaya in Guduchayadi varga 187. In Dhanwantari nighantu also it is mentioned in

Guduchayadi varga.

Parts used - the entire plant is used in medicine

Properties

Rasa - Madhura

Virya - Sheeta

Vipaka - Madhura

Guna - Snigdha, guru

Medicinal properties: Alleviates the three doshas, vrishya, tejovardhana, balyam, grahi,

vatanulomani, rasayani, brimhani

Uses: Indicated in Raktapitta, Rakta Dosha, Vatahara, Pradara, Jwara, Shoola Prameha,

Mootrakricchra etc. The powder of the bark of the Bala root if taken with milk and sugar

relieves polyurea.

Chemistry: Whole plant contains an alkaloid probably identical with ephedrine. Seeds

contain much larger quantities i.e., 0.32 percentage of alkaloid than other parts. Fatty oil,

mucins, phytosterol, potassium nitrate, resin, acids etc. are present but no tannin or

glycoside.


49

2) Godugdha – (Cows milk)

Varga Dugdha Varga

Synonyms Gavya, Payaha

Rasa Madhura

Guna Mridu, Snigdha, Bahala, Slakshna, Pichila, Guru, Manda

Prasanna, Rasayana, Jeevaneeya

Veerya Sheetha

Vipaka Madhura

Doshakarmas Rakta-Pitta hara, Vata-Pittaghna

3) Yava (Barley) - Hordeum vulgare

Rasa - Kashaya, Madhura

Guna - Mrudu, Rooksha, Guru, Picchila

Veerya - Sheeta

Vipaka - Katu

Karma - Lekhana, Medhya, Agnideepana, Swarya, Balya, Bahushleshma

Pitta-medoharam, Urustambhahara,

4) Kola -Zizyphus jujuba lamk - Rhamnaceae

Rasa - Madhura, Amla

Guna - Guru, Snigdha

Veerya - Sheeta

Vipaka - Madhura / Amla

Karma - Vata Pitta hara, Hrudyam, Grahi, Ruchyam, Kaphapittakaram,


50

5) Kulatha - Dolichos biflorus linn - Fabaceae

Rasa - Kashaya

Guna - Laghu, Rooksha and Sara

Veerya - Ushna

Vipaka - Katu

Karma - Kapha Vatahara, provokes Pitta Dosha, Medohara, Vidahi

6) Tilathaila -Sesamum indicum linn. - Pedaliaceae

English - Gingelly oil, sesamum oil

Sanskrit - synonyms of tila taila phala are snehaphala, hemadhanya,

pavitra, pitrutarpana, papaghani, jatila etc.

Properties of Tila Taila 188-189-190

Rasa - Madhura, Tikta and accompanying Kashaya

Virya - ushna

Vipaka - Madhura 191

Gunas - sukshma, vyavayi, vishada, guru, sara, vikasi, tikshna, himasparsha.

All Ayurvedic authorities advocated the use of sneha dravyas (fats or lipids) both

for dietary purposes 192-193 and for the purpose of treatment as medicated oil and or the

pure fats both internally or externally in sneha kriyas 194. Of all the varieties, Tila taila is

the most efficacious for the purpose of strength and oleation 195.

Actions: Vataghni, aggravates Pitta, does not aggravate Kapha, Susruta states that it

alleviates kapha, deepana, pachana, brimhanam, balyam, preenanam, vrishyam lekhanam,

promotes skin health, intellect digestive fire, health of eyes, complexion, strength and


51

stability of mamsadhatu, krimighna, causes constipation and reduces the quantity of urine,

good for the hair, cleanses the Garbhashya and yoni helps in overcoming aging process

and fatigue, causes Rakta Pitta.

Indications: Vrana, prameha, pain in ears; yoni and head, all kinds of injuries are relived

with Tila taila. It is used for alleviation of Vata, in vasti, nasya for internal administration,

to be used in ears and eyes and in dietary articles.

Composition of Tila Taila: Saturated fatty acids: Palmitic acid - 9.1%, Stearic acid - 4.3 %,

Arachidic acid - 0.8 %, unsaturated fatty acids, Oleic acid 45.4 % and Linoleic acid -

40.4%

Avartita Taila 196

Oil which is subjected to repeat processing with the prescribed ingredients in order

to attain medicated oil Par excellence is Avartita Taila and even it fulfils the literary

meaning Avartita i.e. to rotate or to repeat. There are ample references with regards to this

procedure.

In alchemy the samskara, bhavana and mardana (mardanam gunavardhanam) are

the superior aspects, by means of these procedures fixation of active principles from the

herbs is possible and the volatile oils can be preserved in a better way. Avartita procedure

potentiates the drug action.

Method of preparation of Dhanwantaram Taila 197:

1. Preparation of Bala moola kwatha- Course powder of Bala moola is boiled with 8

parts of water and reduced to ¼ quantities.

• Bala moola – 60 kg

• Water - 480 liters

• End product - 120 liters


52

2. Preparation of kwatha –

Coarse powder of dashamoola, yava, kola and kulattha i.e. 4 all together is

boiled with 80 liters of water and reduced to ¼ quantities.

• 4 drugs all together - 10 kg.

• Water - 80 liters.

• End product - 20 liters

Preparation of kalka 198

Drugs from table-8 are collected from the sources, powdered, mixed with water

and converted into kalka. Abhava prathinidhi drayas are considered when ever the original

is not available.

• Kalka drugs all together - 5 kg

• Water - quantity sufficient.

Procedure of sneha paka –

Kwatha, taila, kalka and milk are boiled together until the attainment of sneha

siddhi lakshana’s i.e madhyama paka 199. Prepared Taila can be used for vasti, abhyanga,

paana, and nasya karma.

Indications of Dhanwantaram Taila 200–

Dhanwantaram Taila is useful in all vata vyadhi, sutika (peurperium), bala, marma

hata (injury to vital spots), Asthi hata (injury to bones), ksheena (emaciated), jwara,

gulma, grahonmada, mootraaghata, aantravruddhi, yoni roga and Kshaya.

Procurement

For the present clinical study the Avartita Dhanwantaram Taila (101) capsules are

procured from Swadeshi Pharmaceuticals, Udupi.

Contents of yoga along with their respective Rasa, Guna, Veerya, Vipaka, Dosha

karma are tabulated in the following tables.


53

Table - 7

Depicting the pharmacological qualities of the Kashaya dravya ingredients (Dashamoola)

Sl. no

Dravyanama with Latin Name

Rasa Guna Veerya Vipaka Doshaghnata Karma

1. Bilwa (Aegle marmelos)

Katu-Tikta-Kashaya

Snigdha Teekshna Ushna Katu Kapha Vatahara

Grahi, Agnikrit, Pachaka, Shothahara,balya and vedanastapaka

2. Agnimantha (Premna Mucronata)

Tikta-Katu Kashaya

Laghu-Ruksha Ushna Katu KaphaVatahara

Shothahara, Pandunashana, Agnikrit, Vibandha nashana

3. Shyonaka (Oroxylum indicum)

Madhura Tikta Kashaya

Laghu-Ruksha Ushna Katu KaphaVatahara

Vedana nashaka, Shothahara, Aruchinashaka, Grahi, Basthi rogahara

4. Patala (Stereospermum Suaveoleus)

Tikta-Kashaya Laghu-Ruksha Ushna Katu Tridosha hara Vedana Sthapaka, Chardi-Shwasa-Atisara nashaka, Sthothahara, Vranaropaka

5. Kashmari (Gmelia arborea)

Tikta-Madhura-Kashaya

Guru Ushna Katu Tridosha hara Deepaka, Pachaka, Medhya, Shothahara, Amashoolahara, Jwara-Visha-Trishnashamaka,bhramanashini.

6. Shaliparni (Desmodium Gangeticum)

Madhura-Tikta Guru-Snigdha Ushna Madhura Tridoshanashaka

Vedana Sthapaka, Vranaropaka, Shothahara, Chardi-shwasa-Atisaranashaka,vrsya,rasayani, Brumhana

7. Prishniparni (Urariapicta)

Madhura-Tikta Laghu-Snigdha Ushna Madhura Tridoshanashaka

Daha, Jwara, Shothahara, Vrishya Raktatisara nashaka

8. Gokshura (Tribulus terrestris)

Madhura Guru-Snigdha Sheeta Madhura Vata-Pittashamaka

Balya, Mutrala, Vrishya, Ashmari hara, Vatarogahara,brumhana,sulahara,pustikaraka,srotovishodaka

9. Brihati (Solanum indicum)

Katu-Tikta Laghu-Ruksha,Teekshna

Ushna Katu Kapha-Vatahara

Kushta, shwasa, Jwara, Shula-Kasa-Agnimandya nashaka

10. Kanthakari (Solanum xanthocarpum)

Tikta-Katu Laghu-Ruksha-Teekshna

Ushna Katu Kapha-Vatahara

Vedana sthapaka, Shotha hara, Krimighna, Kasahara, Hikkanashaka,parswa peedahara


54

Table - 8

Depicting the pharmacological qualities of the ingredients of Prakshepa dravyain Dhanwantaram Taila

Sl. no

Dravyanama with Latin Name

Rasa Guna Veerya Vipaka DoshaghnataKarma

1 Meda Shatavari moola (P.D.)

Madhura, Tikta Guru Shīta Madhura Vāta, Pitta Shāmaka

2 Mahāmeda Ashwagandha moola (P. D.)

Tikta, Katu, Madhura

Laghu, Snigdha Ushna Madhura Kapha, Vāta Shāmaka

3 Devadāru Cedrus deodara (Roxb.) Loud.

Tikta, katu, Kashaya

Laghu, Snigdha Ushna Katu Kapha Vāta Shāmaka, Deepana, Kasahara

4 ManjishtaRubia cardifolia

Tikta, Kashaya, Madhura

Guru, Rooksha Ushna Katu Sleshma Pitta hara, Sothahara, Akshi Karna rukhara,

5 Amalaki Emblica officinalis

Amla Madhura, Tikta, Katu, Kashaya,

Guru, Ruksha, Sheeta

Sheeta Madhura TridoshaharamVrushyam, Rasayanam, Vayastapana, Chakshushya ,bhagna sandanakruth,keshya

6 HareethakiTerminalia chebula

Kashaya, Tikta, Katu, Amla, Madhura

Laghu, Rooksha Ushna Madhura Tridoshahara Rasayana, Chakshushya, Anulomana, Prajastapana, Hrudya, Lekhana,brumhana,shoola prasamani

7 VibheethakiTerminalia bellerica

Kashaya Rooksha, Laghu Ushna Madhura Kapha Pitta hara hakshushya, Bhedana, Keshya

8 Kshīra kākoli Ashwagandha moola (P. D.)


Laghu, Snigdha Ushna Madhura Kapha, Vāta Shāmaka

9 Chandana Santalum album

Tikta, Madhura Laghu, Rooksha Sheeta Katu Kapha Pitta hara, Daha prashamana, Varnya

10 Kalanusari (Sariba)Hemidesmus indicus

Madhura, Tikta Snigdha, Guru Sheeta madhura Agnimandya hara, Grahi, Tridoshaharam, Vishanashaka

11 Kushta Saussuria lappa, C.B.Clarke


Laghu, Rūksha Tīkshna

Ushna Katu Kapha, Vāta Shāmaka Vrushya, Lekhana

12 Tagara Valeriana wallichii

Tikta, Katu, Kashaya

Snigdha, laghu Ushna Katu Tridoshaharam, shoolahara, Vishaghnam, akshiroga haram

13 Jeevaka Vidarikanda (P.D.)

Madhura Guru, Snigdha Shīta Madhura Vāta Pitta Shāmaka


55

14 RushabhakaShatavari moola (P.D.)

Madhura, Tikta Guru Shīta Madhura Vāta, Pitta Shāmaka

15 Saindhava Sodium chloride

Lavana, madhura Laghu, Snigdha, Sookshma

Sheeta Netryam, Vrushyam, Tridoshaharam, Deepana, Pachana, Ruchyam

16 Shaileya Parmelia perlata

Tikta, Kashaya Laghu, Snigdha Sheeta Katu Hrudyam, Vishahara, Kapha Pitta hara

17 Vacha Acorus calamus

Katu, Tikta Laghu, Teekshna Ushna Katu Bhutajanita kapha Vatahara, lekhanam, Medhyam,

18 Agaru Aquilaria agallocha

Tikta, Katu Teekshna, laghu Ushna Katu Karna Akshi rogaharam Vatakapha haram, Rasayana

19 Punarnava Boerhaavia diffusa Linn.

Madhura, Tikta, Kashāya

Laghu, Rūksha Ushna Madhura Tridoshahara, Vayastapana, Deepana, Sothahara

20 Aswagandha Withania somnifera Dunal


Laghu, Snigdha Ushna Madhura Kapha Vāta Shāmaka, Balya, Rasayana

21 ShathavariAsparagus racemosis Willd.

Madhura, Tikta Guru, Snigdha Shīta Madhura Vāta, Pitta Shāmaka, Vrushya, Rasayana

22 Ksheerashukla (Vidāri kanda) Pueraria tuberosa DC.

Madhura Guru, Snigdha Shīta Madhura Vāta, Pitta Shāmaka, Balya, Brumhana, Varnaya, Sukralam

23 Madhuyashti Glycyrrhizaglabra Linn.

Madhura Guru, Snigdha Shīta Madhura Tridosha Shāmaka, Rasayana, Vrushya, Chakshushya

24 Rasa (Bola)Commiphora myrrha

Tikta,Katu, Kashaya

Laghu, Rūksha Ushna Katu Kapha Pitta haram,

25 Shathahva Auethum sowa Kurz.

Katu, Tikta Laghu, Rūksha Teekshn

Ushna Katu Kapha, Vāta Shāmaka, Deepana

26 Shurpaparnya(Mandukaparni)

Centella asiatica

Tikta Laghu Sheeta Madhura Kapha Pitta hara, Medhya, Vayastapana

27 Ela Eletteria cardomum

Katu, Madhura Laghu, Rooksha Sheeta Katu Kapha Vatahara Deepana, Rochana, Hrudya

28 Twak Ciannamomum zeylanica

Madhura, katu, Tikta

Laghu, Rooksha, Teekshna

Ushna Katu Vatapittaghnam, Twachyam, Peenasaharam, Balya, Grahi,sukrala

29 Patram Abes webbiana

Tikta, Madura Laghu, Teekshna Ushna Katu Kapaha Vata hara, Deepana, Hrudya


56

Chapter -4 Methodology

Methodological approach is the fundamental aspect of research. Utmost care is

taken in designing a methodology for conducting a research. Clinical research involves

the experimentation of a drug / therapy on a population and recording the feed back based

on which postulations are made regarding the usefulness of the drug/therapy in the

disease. Hence in this section, researchers put forward the systemic procedures, which are

followed by the researcher’s right from the identification of the problem to the final

conclusion.

Research approach

In the present study, the investigators objective was “EVALUATION OF

EFFICACY OF DHANWANTARAM TAILA IN THE MANAGEMENT OF ARDITA

A COMPARITIVE CLINICAL STUDY”. The efficacy was determined by finding out

the difference between the baseline data of the parameters to the after treatment data in

comparision.

I) Study design

The study design selected for the present study was a comparative clinical trial.

Demographic data and disease specific data are collected according to the case record

form given in the appendix.

Dhanwantaram Taila in Ardita A comparative clinical study –Methodology

57

II) Source of data

Patients suffering from Ardita Vata were selected from the post graduate studies

and research center, Department of Kayachikitsa, OPD and IPD of Shri D.G. Melmalgi

Ayurvedic medical college and hospital, Gadag, Karnataka.

III) Sample size

The sample size for the present study planned for 50 patients in each group

suffering from Ardita Vata as per the selection criteria is the proposal.

The study was conducted as a comparative study between two groups. A

minimum of 100 patients equally distributed in two groups.

1) Group-1: 50 patients will receive Dhanwantaram Taila capsules internally.

2) Group-2: 50 patients will receive Shirovasthi with Dhanwantaram Taila

externally.

Even though as many as 110 patients are scrutinized only a minimum of 15 patients in

each group are at the end of the study.

IV) Selection criteria

The cases were selected as per the pre set inclusion and exclusion criteria.

A) Inclusion criteria

The following symptoms are observed for inclusion as they are the

symptoms told for the Ardita Vata in the classics. As this disease is on parlance

with facial paralysis, the individuals presenting with those symptom’s too

considered for this present clinical study. The parameters considered are

enlisted below.


58

1. Patients above 15 to 65 years of age groups irrespective of sex.

2. Patients fit for Shirovasthi karma

3. Patients with Bell's palsy 201

4. Patients with clinical features of Ardita - such as -

a) Vaktra Vakrata

b) Netra Vakrata

c) Hasita Vakrata

d) Shirah (Moordha) Kampa

e) Vaksanga

f) Netra Avilata

g) Netra Stabdhata

h) Manya Graha

i) Hanu Graha

j) Vaktra parswa Vedana

k) Srutihani

l) Nisteevaparwshato yayat

m) Ekasakshi nimilanam

B) Exclusion criteria 202, 203, 204

1. Extremely emaciated

2. Duration of more than 3 years

3. Trauma 205 and other Asadhya lakshanas

4. Other systemic disorders

5. Pregnant women and lactating mothers

6. Patients associated with Pakshaghata 206.


59

The above listed exclusion criteria are explained in detail as under.

1) Extremely emaciated: Extremely emaciated (ksheena) individuals are

excluded, as they are possessed with Dhatu Kshaya i.e. even Rakta Kshaya and

are with vitiated Vata similar to that of Pathogenesis of Ardita, thus excluded

for this study.

2) Duration more than 3 years: With increase in duration, the pathogenesis

deepens i.e. the superficial states of affliction deepens and are always associated

with complications. With respect to facial nerve, damage management is

difficult to regenerate the nerve to its capacity of nervous tissue which is not

pronounced, hence it is excluded.

3) Trauma: As the condition of trauma is considered as an emergency which

needs sophisticated treatment and utmost care for the internal bleeding, and

even considering the extent of nervous tissue damage, these individuals are not

considered for this study.

4) Asadhya Lakshana’s:

a) Animishakshasya: As the condition is related to the extensive

involvement of ophthalmic nerve and even the fixed eye as a symptom

can be appreciated in endocrinal disorders, Swasa, dhanurvatha etc.

Thus it is excluded.

b) Other systemic disorders: As it is evident from the contemporary

system revels that the individuals with increased glucose tolerance or

extensive hypertension are prone to get Ardita, hence such patients are

not included.


60

5) Pregnant women and Lactating Mothers: As the placental / lactating barrier

components may be there in the compound which may be harmful, even though

Ayurvedic herbals are safe in this part as a routine Pregnant and lactating

women are excluded from the study.

6) Pakshagata : Though charka explained Ardita with Pakshagata, as the latter is

having an immense pathogenesis and is presumed to be associated with diabetes

mellitus, hypertension, Atherosclerosis, Hemorrhagic tendencies were excluded,

as these individuals are access towards Ardita.

7) Prasakta and sakta Bhashinah: As it is said as an Arista Lakshana 207 and

always too feeble phonation is the resultant of paralysis of vocal cords which

needs an expert guidance, thus excluded in this study.

C) Criteria of diagnosis:

The clinical features of Ardita (Facial paralysis) mentioned in texts will

be the basis of diagnosis.

V) Posology of Dhanwantaram Taila

a. Internal: Dhanwantaram Taila capsules –2 gms / 24 hours in divided

doses (Each capsule 300 mg. of Taila) for 14 days or 2 caps TID.

b. External: Dhanwantaram Taila Q.S. Shirovasthi for 7 days.

c. Study duration :

Group-1: 14 days and Group-2: 7 days

d. Follow up:

Group-1: 7 days and Group-2: 7 days


61

VI) Examination of patient:

Patient selected is observed for the symptoms affirmed from the classical texts

and also in the contemporary parlance. The different symptoms enlisted in the study are

awarded the grades for the study and evaluation. The individual symptoms even though

are self explanatory are discussed one by one along with the grades granted for it.

1) Mouth angle deviation: Distance from the philtrum to the angle of the mouth

is measured with tape. The grades are -

0 = Normal

1 = 0.1mm – 5mm

2 = more than 5mm

2) Deviation of jaw: With reference to deviation and its interference with

mastication the deviation of the jaw is measured. The grades are -

0 = Normal

1 = jaw slightly deviates towards the sound side when, the patient opens

the mouth later, it is normal on closure and doesn’t interfere with

mastication i.e. solids.

2 = jaw gets deviated even when the patient is with closed mouth and

interferes with mastication.

3 = severe deviation which totally interfere with mastication i.e even for

liquids so that, food intake is a prime concern.

3) Closure of the eye effected

0 = Normal

1 = 0.1mm – 5mm (3/4th closure of the eye)

2 = 5.1mm – 10mm ( ½ closure of the eye)

3 = 10.1mm – 15mm (1/4th closure of the eye)

4 = more than 15mm (inability to close the eye)


62

4) Wrinkles on forehead

0 = Normal

1 = not perfectly formed but with superficial lining’s of folds.

2 = not perfectly formed with smoothed out edges.

3 = no formation of folds with complete smoothed out edges.

5) Vak sanga

0 = Normal speech/ pronunciation

1 = inadequate clarity of speech/unable to pronounce the vowels.

2 = poor clarity of speech / simple words cannot be pronounced

3 = no speech / complete absence of pronunciation based on the clarity

and pronunciation

6) Lala srava and Asru srava: Based on the involvement of nerve damage,

(strength of muscles in the case of Lala srava) as these are indicative of

prognosis.

O = Normal

1 = Moderate quantity with low frequency.

2 = Moderate quantity with high frequency.

3 = Continuous +3 / diminished - 3

7) Facial expression: Based on the extent of involvement of facial muscles i.e.

voluntary, emotional and associated functions.

O = Normal expression to that of normal side.

1 = Mild but is clear.

2 = Unable to differentiate the mood’s of the patient.

3 = Complete loss of expression.


63

8) Mouth inflation: Based on the strength and withholding capacity of facial

muscles.

O = Normal

1 = Inflates but, air will escape slowly.

3 = Unable to inflate.

9) Whistling: Capacity of whistling is based on the movement of tongue and

orbicularis ori.

O = Normal

1 = Patient can purse the lips / retract the angle of mouth but is unable to

blow the air completely with pressure.

2 = Occasional and is unclear.

3 = Absence / Impossible to whistle.

10) Ability to masticate: Based on the ability to masticate, collection of food

with respect to normal side.

O = Normal chew without any collection between teeth and gums.

1 = Mild difficulty in chewing with mild collection of food.

2 = Difficulty to chew with more collection of food.

3 = severe, with slipping of food from the affected side.

11) Nisteevah Parshwato yayat: In order to check the strength, force in relation

to the severity of paralysis, the patient is asked to spit and findings were noted.

O = Normal ejectile force and direction.

1 = Sputum moves to one side but with force when, patient split’s.

2 = Sputum falls in front of the patient/on patient itself and is with

minimal force.

3 = Unable to spit / when the patient tries to do so, the sputum drools

down like saliva from the corner of the affected side.


64

12) Tongue deviation on protrusion: Based on the tonicity, strength of the

muscles and associations with other cranial nerves.

O = Normal

1 = Normal protrusion of the tongue with mild deviation to the sound side.

2 = Mild protrusion with deviation.

3 = Inability to protrude the tongue.

13) Hearing: Based on the extent of paralysis and other cranial nerve

involvement.

O = Normal

1 = Audibility with disturbance

2 = Mild audible loss / mild hearing loss.

3 = No conduction hearing.

14) Vertigo: based on the involvement of other cranial nerves / infection i.e. of

middle ear.

O = Normal

1 = Occasionally

2 = Postural

3 = Always

15) Taste in the anterior two third of the tongue: Based on the extent of lesion of

facial nerve / infection.

O = Normal

1 = Mild disturbance in taste perception.

2 = Unable to differentiate the taste.

3 = Complete i.e. total taste loss.


65

16) Hyperacusis

O = Normal

1 = Mild intensification of sound in the affected ear.

2 = Moderate intensification of sound but is tolerable.

3 = Severe intensification which is intolerable.

17) Bhru vakrata

O = Normal to that of normal side.

1 = Eye brow droops, but frowning and raising are slightly possible and

the wrinkles of the brow are with superficial lining’s of folds.

2 = Eye brow droops, frowning and raising are impossible and the

wrinkles of the brow are with complete smoothed out edges.

18) Vakra Nasika

O = Normal

1 = Slight deviation towards the sound side when patient tries to speak,

laugh. Etc, but regains its position when the pt is quite.

2 = Slight deviation towards the sound side even when the patient is

quite i.e. not doing any facial expression.

3 = Severe deviation which interferes with breathing.

19) The subjective parameters viz. Shula, Sravana ruk, Shanka ruk, Ganda ruk,

Danta parshwa vedana, Chibuka parshwa vedana, Greeva parshwa vedana are

valued with the following grades.

O = Normal

1 = Mild pain generally brought to the attention, after inquiry.

2 = Patient frequently complains.

3 = Excruciating condition.


66

20) Manasika Karana: Ardita, a grave situation, as it doesn’t spare the

expressions too, the diseased is anguish, anxious, frustrated, gloomy and is

miserable, which is evident from the posture of the patient i.e. sitting with the

hand over the side of the face is suggestive of their psyche.

It is a challenging task to judge the emotions, in the cases of lower

motor neuron paralysis further the inability of the afflicted to communicate as

the phonation is also affected hence the information is gathered from family

member’s serves as an essential information in order to evaluate the extent of

psychological involvement.

As per the present day scenario for the better evaluation of the

psychosomatic concern’s the maanasika factors are drawn under one umbrella

and are evaluated as follows.

1. As an etiology leading to disease manifestation.

2. Change in psychological attitudes with special reference to Ardita i.e. after

the latter’s manifestation.

a) Krodha:

O = which is normal by birth.

1 = State of being an introvert i.e. controls everything without

expressing his/her displeasure’s out.

2 = Shows off displeasure through heated arguments / shouting /

screaming but doesn’t use any foul language.

3 = Throw’s objects near by out of rage and uses foul language but is

unintentional i.e. repents / apologies after the incident.


67

4 = doesn’t repent for the misbehavior instead it becomes a prestige

and are proud of their misdeeds.

5 = Extreme condition where, the inflicted goes for anti social

activities i.e. murder, kidnap etc.

b) Bhaya:


1 = Occasional fear by thinking of their ailment.

2 = Fear leading to the disturbances in routine activities and are

associated with irregularities in food intake and sleep etc.

3 = Fear leading to, severe disturbances in sleep and patient awakes

suddenly and is restless.

4 = Visits number of doctors and is not convinced with their

prescription. Finally, the extreme fear results either in psychosis

or anxiety neurosis etc.

c) Chinta:


1 = patient is not anxious about the ailment.

2 = patient is anxious but is with a belief that, the ailment will be

cured.

3 = patient is highly anxious about the ailment and tend to avoid

society, relatives etc. and doesn’t like to interact with people due

to the cosmetic concern.


68

4 = Extreme anxiety, where the patient feels totally dejected and

even relations with the family members are at a stake.

d) Shoka:


1 = Patient withstands the in convenience / hurdle by their mere

willpower and food intake, sleep are normal.

2 = Always looking gloomy and tends to lament on & off thinking

about the ailment / hurdle.

3 = physically, psychologically the patient is exhausted with severe

disturbances in sleep and intake of food.

4 = Extreme condition where, the patient even develops wasting /

emaciation.

e) Dhukka:


1 = Occasional alteration in concentration, but doesn’t interfere with their

working abilities, sleep, intake of food and routine activities.

2 = Pays attention to the ailment and with disturbances in sleep, intake of

food and routine activities.

3 = Patient will not cope up with the stress / colleagues. Doesn’t pay

attention towards day to day activities / family members are always in

misery with grave disturbances in sleep and food habits.

4 = Extreme condition where, the patient tries for suicide / hurt themselves

and are difficult to convince / counsel these category.


69

VII) Procedure of Shirovasthi

Shirovasthi is one among the moordhnitaila and is superior amongst all 208, and

is one of the bahya shamana in accordance to dalhana. The word vasti is used here to

indicate “to stagnate” thus in Shirovasthi medicated oil is made to stand over the scalp

till the appearance of Samyak Lakshanas 209-210 or till vedanopashamana 211-212, or for a

prescribed amount of time 213 Adhamalla comments over the samyak lakshanas and

says the srava which is happening during the procedure is nothing but tanmala srava.

In this present clinical study Shirovasthi is administered as per the illustrations

laid in the text 214, the procedure is carried out for 7 days i.e. up to the maximum 215

days as advocated in the text.


70

CHAPTER-5 RESULTS

Present study registers 30 patients in two groups, out of 110 approached patients.

The percentage of patients undertaken from the scrutinised is 27.27%. Out of 110

patients, 30 who were in the study are fulfilled the criteria of inclusion. All the patients

were examined before and after the trail, according to the case sheet format given in the

annex. Both the subjective and objective criteria were recorded. The data recorded is

presented under the following headings.

A. Demographic data

B. Evaluating disease Data

C. Result of the Dhanwantaram Taila in Ardita vis-à-vis Facial Paralysis

D. Parameter analysis (subjective & objective)

Table – 9 Demographic Data of Dhanwantaram Taila in Ardita of Group-1

SN OPD Age Gender Religion Occupation Economical status

Food habits

Result

1 2737 65 F H SED MID Mx Moderate 2 3226 57 F H SED HMID Mx Moderate

3 3299 46 M H LABR POOR V Marked

4 3525 56 M H ACT MID Mx Marked 5 3571 40 F H SED MID V Moderate 6 3978 20 M H ACT MID V Marked

7 4807 26 F H ACT MID V Marked

8 4826 27 M H LABR POOR Mx Moderate 9 170 34 M H LABR POOR Mx Marked

10 260 38 F H SED HMID V Moderate 11 1125 24 M H LABR POOR V Marked 12 2590 18 F H ACT MID V Marked

13 3294 64 M H LABR POOR V Moderate 14 3421 44 F H ACT MID V Moderate

15 3558 30 F Mu LABR POOR Mx Marked

Dhanwantaram Taila in Ardita A comparative clinical study –Results

71


72

Table – 10

Demographic Data of Dhanwantaram Taila in Ardita of Group-2

SN OPD Age Gender Religion Occupation Economical status

Food habits

Result

1 2996 60 M H LABR POOR V Moderate 2 3193 65 M H LABR POOR V Moderate

3 3918 26 F H ACT MID V Marked

4 35558 58 M H SED MID Mx Moderate 5 3584 34 M H ACT MID Mx Moderate 6 4267 20 F H ACT MID V Moderate

7 4348 61 M H ACT MID V Moderate

8 4799 31 M H LABR POOR V Marked 9 101 40 M H ACT MID V Moderate

10 269 17 F H ACT MID V Moderate 11 996 48 M H LABR POOR Mx Moderate 12 2284 27 M H ACT MID Mx Poor

13 3765 20 F H ACT HMID V Moderate 14 3393 40 M H LABR POOR Mx Marked

15 3643 65 M H LABR POOR Mx Moderate

M = Male, F = Female, H = Hindu, Mu = Muslim, LABR = Labour, ACT = Active, SED = sedentary, POOR = Poor economical class, MID = Middle economical class,

HMID = Higher Middle economical class, ARS = Aristocrat, V = Vegetarian, Mx = Mixed diet,

A) Demographic data:

The details of Age, Gender, Religion, and Occupation etc. discussion of the 30

patients in two groups is as follows.

A1) Distribution of patients by Age

An interval of 10 has considered from the ages 15 to 65 as discussed in the

methods. In the study it is revealed that Ardita, a Vata roga can effect any ages

irrespective of gender. At the older age group of 55-65, 4 (26.66%) patients in G1 and 5

(33.33%) patients in G2 are reported, where in 45-55 age group, 1 (6.66%) patient in

each group G1 and G2 are reported. And 35-45 age group reported with 3 (20%) in G1

and 2 (13.33%) patients in G2 respectively. 25-35 age group reported with the each 4


73

(26.66%) patients in G1 and G2 with the symptoms of Ardita. The 15-25 age group

reports 3 (20%) in each group respectively. The tabulations are depicted as under.

Table- 11

Distribution of patients by Age- gender of Dhanwantaram Taila in Ardita of Group-1

Male patients Female patients Total patients Age

Number % Number % Number %

15-25 2 13.33 1 6.66 3 20.01

25-35 2 13.33 2 13.33 4 26.66

35-45 0 0 3 20 3 20.01

45-55 1 6.66 0 0 1 6.66

55-65 2 13.33 2 13.33 4 26.66

Total 7 8 15 100

Table- 12

Distribution of patients by Age- gender of Dhanwantaram Taila in Ardita of Group-2

Male patients Female patients Total patients Age

Number % Number % Number %

15-25 0 0 3 20 3 20.01

25-35 3 20 1 6.66 4 26.67

35-45 2 13.33 0 0 2 13.33

45-55 1 6.66 0 0 1 6.66

55-65 5 33.33 0 0 5 33.33

Total 11 4 15 100

Figure – 3

Distribution of patients (Group 1 & 2) by Age – Gender of Dhanwantaram Taila in Ardita

The ob

which is a ge

exposed to th

above.

A2) Distribut

Resu

Gender

Female

Male

Total

servation of this study suggests that the Ardita Vata effects to that of 55-65

riatric group and also to that of 25-35 ages where the patients are actively

e external cold windy climate. The pictorial representation is as shown

ion of patients by Gender

Table- 13 lts of patients by Gender in Dhanwantaram Taila in Ardita Group-1

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

8 53.33 3 37.5 5 62.5 0 0

7 46.66 5 71.42 2 28.57 0 0

15 8 7 0

210

322

310

3201

010 22

50

0 1 2 3 4 5

15-25

25-35

35-45

45-55

55-65

DISTRIBUTION OF PATIENTS BY AGE - GENDER

G2 Female

G2 Male

G1 Female

G1 Male

Dhanwantaram Taila in Ardita A comparative clinical study –Results 74


75

Table- 14

Results of patients by Gender in Dhanwantaram Taila in Ardita Group-2

Gender

T

otal

no

of

pati

ents

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Female 4 26.66 1 25 3 75 0 0

Male 11 73.34 2 18.18 8 72.72 1 9.09

Total 15 3 11 1

The male female ratio in the study is 3:2 patients. The percentage of the

distribution does not show any gender differentiation to get this Vata disease, except a

small lean towards male population. The observations are 18 Patients in both groups i.e. 7

in G1 and 11 in G2 male patients and 12 patients i.e. 8 in G1 and 4 in G2 were female.

As the results observed, out of Group-1 male patients 5 (71.42%) marked

restoration and 2 (28.57%) patients with moderate restoration are observed. Where in

Group-1 female patients responded to the treatment are 3 (37.5%) marked restoration and

5 (62.5%) patients with moderate restoration are observed. No patients of either gender

expressed the Poor restoration. Out of Group-2 male patients 2 (18.18%) with marked

restoration, 8 (72.72%) patients with moderate restoration are observed and 1 patient

(9.09%) show poor restoration. Where in Group-2 female patients responded to the

treatment are 1 (25%) with marked restoration and 3 (75%) patients with moderate

restoration are observed. No patients of female gender expressed the Poor restoration.

The pectoral expression is as under.

Figure - 4

Over all Distribution of patients by Gender in Ardita Vata

Distribution of patients by Gender in Asthigata vata

Male60.00%

Female 40.00%

Figure - 5

Result of patients by Gender in Ardita Vata

Result of patients by Gender in Ardita vata

5

2

3

1

2

8

5

3

0

1

0

0

0 1 2 3 4 5 6 7 8 9

G1-Male

G2-Male

G1-Female

G2-Female Poor

Moderate

Marked



77

A3) Distribution of patients by Religion

Table- 15

Distribution of patients by Religion of Dhanwantaram Taila in Ardita Group-1

Religion

T

otal

no

of

pati

ents

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Hindu 14 93.33 7 50 7 50 0 0

Muslim 1 6.66 1 100 0 0 0 0

Christian 0 0 0 0 0 0 0 0

Others 0 0 0 0 0 0 0 0

Total 15 8 7 0

Table- 16

Distribution of patients by Religion of Dhanwantaram Taila in Ardita Group-2

Religion

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Hindu 15 100 3 20 11 73.33 1 6.66

Muslim 0 0 0 0 0 0 0 0

Christian 0 0 0 0 0 0 0 0

Others 0 0 0 0 0 0 0 0

Total 15 3 11 1

For the convenience of the study, the religion groups are noted as Hindu, Muslim,

Christian and Others. The maximum numbers of patients are noticed from the Hindu

community as the ratio of community at the study area is more i.e. 14 in group-1 and 15

in group-2, along with only one Muslim patient reported in group-1.

As the results are observed, out of 14 (93.33%) of Hindu patients in group-1, 7

(50%) patients marked restoration and the rest 7 (50%) are at moderate restoration. The

Muslim patient reported in this group show marked response. On the other hand in group-

2 all patients are of Hindu community. The results are 11 (73.33%) of moderate

restoration and 3 (20%) with marked restoration along with one (6.66%) of poor

restoration. The graphical representation is as under.

Figure – 6

Distribution of patients by religion in Ardita Vata


Distribution of patients by religion in Ardita Vata

Hindu, Group-1,

14

Hindu,Group-2,

15

Muslim, 0

Muslim, 1

Christian , 0

Christian , 0

Others, 0

Others, 0

0

2

4

6

8

10

12

14

16

Group-1 Group-2

Figure – 7

Result of patients by religion in Ardita Vata

A4) Dis

Dist

Occupa

Sedenta

Active

Labour

Total

Result of patients by religion in Ardita Vata

7

1

0

0

0

0

0

11

0

0

0

0

0

0

0

1

0

0

0

0

0

0

3 7

0 2 4 6 8 10 12

G1-Hindu

G2-Hindu

G1-Muslim

G2-Muslim

G1-Christian

G2-Christian

G1-Others

G2-Others

Poor

Moderate

Marked

tribution of patients by Occupation

Table- 17

ribution of patients by Occupation of Dhanwantaram Taila in Ardita Group-1

tion

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

ry 4 26.66 0 0 4 100 0 0

5 33.33 4 80 1 20 0 0

6 40 4 66.66 2 33.33 0 0

15 8 7 0


Table- 18

Distribution of patients by Occupation of Dhanwantaram Taila in Ardita Group-2

Occupation

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Sedentary 1 6.66 0 0 1 100 0 0

Active 8 53.33 1 12.5 6 75 1 12.5

Labour 6 40 2 33.33 4 66.66 0 0

Total 15 3 11 1

Figure – 8 Distribution of patients by Occupation

A

4 (100%)

(80%) pa

Distribution of patients by Occupation in Ardita Vata

Sedentary, 4

Sedentary, 1

Active, 8

Active, 5

Labour, 6

Labour, 6

0 1 2 3 4 5 6 7 8 9

Group-1

Group-2

t the results are observed in Group-1, out of 4 (26.66%) of sedentary patients, all

patients moderately restored. At the active group, out of 5 (33.33%) patients, 4

tients markedly restored and one (20%) moderately restored. As the results are


observed in labour class, out of 6 (40%) patients 4 (66.66%) markedly restored and 2

(33.33%) patients moderately restored. No patients of any group are in the poorly

restored category of the clinical trail with Dhanwantaram Taila on Ardita in group-1.

At the results observed in Group-2, out of 1 (6.66%) of sedentary patient reported

moderately restored in the trail. At the active group, out of 8 (53.33%) patients, 1

(12.5%) patient markedly restored, 6 (75%) moderately restored and one (12.5%) poorly

restored in the clinical trail. As the results are observed in labour class, out of 6 (40%)

patients, 2 (33.33%) markedly restored and 4 (66.66%) patients moderately restored. No

patients of sedentary and labour groups are in the poorly restored category of the clinical

trail with Dhanwantaram Taila Shirovasthi on Ardita in group-2. The responses of these

are expressed in the figure below.

Figure – 9

Result of patients by occupation in Ardita Vata

Result of patients by occupation in Ardita Vata

4

4

4

1

6

42

1

0

0

1

2

0

0

1

0

0

0

0 1 2 3 4 5 6 7

G1- Sedentary

G2- Sedentary

G1-Active

G2-Active

G1-Labour

G2-Labour

Poor

Moderate

Marked



82

A5) Distribution of patients by economic status

Table- 19

Distribution of patients by Economic Status of Dhanwantaram Taila in Ardita Group-1

Economic Status

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Poor 6 40 4 66.66 2 33.33 0 0

Middle 7 46.66 4 57.14 3 42.85 0 0

Higher Middle

2 13.33 0 0 2 100 0 0

Higher 0 0 0 0 0 0 0 0

Total 15 8 7 0

Table- 20

Distribution of patients by Economic Status of Dhanwantaram Taila in Ardita Group-2

Economic Status

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Poor 6 40 2 33.33 4 66.66 0 0

Middle 8 53.33 1 12.5 6 75 1 12.5

Higher Middle

1 6.66 0 0 1 100 0 0

Higher 0 0 0 0 0 0 0 0

Total 15 3 11 1

At the results observed in group-1, out of 6 (40%) of poor patients, 4 (66.66%)

patients are markedly restored and 2 (33.33%) patients are moderately restored. Out of 7

(46.66%) of Middle class patients, 4 (57.14%) patients are markedly restored and 3

(42.85%) patients moderately restored. From higher middle class 2 (13.33%) patients all

patients are moderately restored. No patients are reported from the higher class of

classification.

At the results observed in group-2, out of 6 (40%) of poor patients, 2 (33.33%)

patients are markedly restored and 4 (66.66%) patients are moderately restored. Out of 8

(53.33%) of Middle class patients, 1 (12.5%) patients are markedly restored and 6 (75%)

patients moderately restored along with one patient (12.5%) with poor restoration. From

higher middle class 1 (6.66%) patient restored moderately. No patients are reported from

the higher class of classification.

The pictorial graph is expressed below.

Figure - 10

Distribution of patients by Economic status

Distribution of patients by Economic status

Poor, 6

Poor, 6

Middle, 8

Middle, 7

Higher Middle, 1

Higher Middle, 2

Higher, 0

Higher, 0

0 1 2 3 4 5 6 7 8 9

Group-1

Group-2



84

B) Data related to the disease.

B1) Distribution of patients by presenting complaints in Ardita Vata

Table-21

Data of patients by presenting complaints in Ardita Vata

Group-1 Group-2 Presenting complaints

Patients % Patients %

Vaktra (Hasita) Vakrata 15 100 15 100

Ukte Vakrata 15 100 15 100

Hasita Vakrata 15 100 15 100

Netra (Ekshita) Vakrata 15 100 15 100

Shirah (Moordha) Kampa 0 0 0 0

Vaksanga 15 100 15 100

Netra Stabdhata 15 100 15 100

Swara Bhramsha 0 0 0 0

Srutihani 5 33.33 4 26.67

Kshavagraha 0 0 0 0

Gandhajnanam 0 0 0 0

Smrutimoha 0 0 0 0

Trasasuptasya jayate 1 6.67 2 13.33

Nisteevaparshwato yayat 15 100 15 100

Ekasya Aksha nimilanam 15 100 15 100

Vaktra (Hasita) Vakrata, Ukte Vakrata, Hasita Vakrata, Netra (Ekshita) Vakrata

Vaksanga, Netra Stabdhata, Nisteevaparwshato yayat and Ekasya Aksha nimilanam

lakshanas are observed 100% in both groups. Srutihani is observed as 5 (33.33%) and 4


85

(26.67%) in the group 1 & 2 respectively. In the same way Trasasuptasya jayate is

observed as 1 (6.67%) and 2 (13.33%) in the group 1 & 2 respectively. All other

symptoms listed as presenting complaint according to classical texts are not witnessed in

the study.

B2) Distribution of patients by associated complaints in Ardita Vata

Table- 22

Group-1 Group-2 Associated diseases in Ardita Vata


1. Greeva parshwa vedana 7 46.67 3 20

2. Chibuka parshwa vedana 2 13.33 2 13.33

3. Danta parshwa vedana 3 20 4 26.67

4. Shravana Ruk 13 86.67 11 73.33

5. Akshi Ruk 6 40 7 46.67

6. Shankha Ruk 3 20 2 13.33

7. Ganda Ruk 4 26.67 6 40

The major associative complaint found here in the study is Shravana Ruk with 13

(86.67%) and 11 (73.33%) in group 1 & 2 respectively. Next major symptoms are Greeva

parshwa vedana and Akshi Ruk. The rest of the symptoms associated are expressed in the

table above.

B3) Distribution of patients by diet in Ardita Vata

Table- 23

Distribution of patients by diet of Dhanwantaram Taila in Ardita Group-1 & 2

Diet consumption

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Vegetarian 9 60 5 55.55 4 44.44 0 0

Mixed diet 6 40 3 50 3 50 0 0

Gro

up-1

Total 15 8 7 0

Vegetarian 9 60 2 22.22 7 77.78 0 0

Mixed diet 6 40 1 16.67 4 66.66 1 16.67

Gro

up-2

Total 15 3 11 1

Figure –11

Distribution of patients by diet in Ardita Vata

The die

out of 9 (60%

(44.44%) patien

PATIENTS BY DIET CONSUMPTION

Vegetarian , 9

Vegetarian , 9

Mixed diet, 6

Mixed diet, 6

0 1 2 3 4 5 6 7 8 9 10

Group-1

Group-2


t variances in the Ardita Vata results observed are as under. In group-1,

) of vegetarian patients, 5 (55.55%) patients are markedly restored, 4

ts are moderately restored. Out of 6 (40%) of mixed diet practitioners, 3


87

(50%) patients are markedly restored and 3 (50%) patients are moderately restored to the

treatment. And no patients are with poor restored group of result in the vegetarians or

mixed dieticians.

In group-2, out of 9 (60%) of vegetarian patients, 2 (22.22%) patients are

markedly restored, 7 (77.78%) patients are moderately restored and no patients of poorly

restored in this group. Out of 6 (40%) of mixed diet practitioners, 1 (16.67%) patient are

markedly restored and 4 (66.66%) patients are moderately restored to the treatment and

one (16.67%) patient is poorly restored. The table and graph are as shown above.

B4) Distribution of patients by according to Ahara Nidana in Ardita Vata

Table- 24

Distribution of patients by Ahara Nidana in Ardita Vata

Ahara Nidana Patients %

Rookshanna 22 73.33

Sheetanna 14 46.66

Laghwanna 5 16.66

Langhana 1 3.33

Abhojana 1 3.33

Katina Ahara 23 76.66

Atyahara 4 13.33

The Nidana observed in the Ardita Vata are as above. Out of the patients it is

observed that the Rookshanna (73.33%), Sheetanna 14 (46.66%) and Katinaahara 23

(76.66%) for causing the disease Ardita. But still the causes like Abhojana (1), Langhana

(1), Atyahara (4) and Laghwanna (5) found in this study revels that these told causes to

develop Ardita exists.


88

B5) Distribution of patients by according to Anya Nidana in Ardita Vata

Table- 25

Distribution of patients by Anya Nidana in Ardita Vata

Anya Nidana Total no of patients %

Dhatu kshaya 6 20

Ama sanchaya 12 40

Prajagara 6 20

Vega dharana 11 36.66

Vega Udeerana 7 23.33

Untrasa Vaktra 1 3.33

Vichestita 4 13.33

Nasa Vigharshana 0 0

Ati Prabhashanam 3 10

Ati Hasya 2 6.66

Jrumbha 0 0

Kshavatu 0 0

Jihva Nirlekhana 0 0

Netravigharshana 0 0

Vishamopachara 5 16.66

Shiro Bharaharana 1 3.33

Vishama shayanam 9 30

Diwaswapna 6 20

Vyavaya 2 6.66

KarnaVigharshana 0 0

Adhwagamana 4 13.33

Yanat Patanam 0 0

Plavana 24 80

Vyayama 14 46.67

Manasika Nidana 30 100

Out of many Anya Nidana told by Acharyas when enumerated, Plavana (24),

Vyayama (14), Amasanchaya (12) Vegadharana (11) and Vishama Shayana (9) are the

major causatives found. Out of these lists some are found little as shown in table and

some were not found at all, which doesn’t mean still they do not exist as cause. When the

manasika Nidana is assessed it is found that all the patients are subjected for it.

B6) Distribution of patients in accordance to onset in Ardita Vata

Table- 26 Distribution of patients in accordance to onset in Ardita Vata

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Acute/ sudden 23 76.66 10 43.47 13 56.52 0 0

Gradual 2 6.66 1 50 1 50 0 0

Chronic or below 3 years

5 16.66 0 0 4 80 1 20

Total 30 11 18 1

Figure –12

Distribution of patients by onset in Ardita Vata

Distribution of the Patients by Onset in Ardita Vata

Chronic or below 3 years, 5

Acute/ sudden, 23

Gradual, 2


In this study out of 30 patients listed a maximum i.e. 23 patients are of acute onset

in which 13 (56.52) moderately restored along with 10(43.47%) markedly restored. And

5 patients are chronic or below 3 years of disease development show moderately

restoration for 4 (80%) patients along with 1 patient of poor restoration. 2 patients are

reported at the gradual onset express one each of marked and moderate restoration. The

tabulation and graph is expressed above.

B7) Distribution of patients in accordance to side effected in Ardita Vata effect

Table- 27 Distribution of patients in accordance to side effected in Ardita Vata

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Right 19 63.33 7 36.86 11 57.89 1 5.26

Left 11 36.67 4 36.36 7 63.64 0 0

Total 30 11 18 1

Figure –13 Distribution of patients by side effected in Ardita Vata

Right, 19 Left, 11

0

5

10

15

20

Right Left

Distribution of the Patients Side effected in Ardita Vata


It is necessary to understand the importance of the disease appearance side to

facilitate the relationship with the Vaksanga. When observed in the distributions of the

diseases appearing side 19 Right and 11 Left sides are found. The poor restoration

observed in the patients of Right side affected. Other than this observation rest of patients

are well restored and responded to the treatment.

B8) Distribution of patients in accordance to Vyasana in Ardita Vata

Table- 28 Distribution of patients in accordance to Vyasana in Ardita Vata

Vyasana

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Madyapana 8 26.66 2 25 6 75 0 0

Dhooma pana 12 40 5 41.66 6 50 1 8.33

Tobacco chewing 10 33.33 3 30 7 70 0 0

Betel nut usage 26 86.66 6 23.07 19 73.06 1 3.84

No habits 4 13.33 2 50 2 50 0

Figure –14 Distribution of patients by Vyasana in Ardita Vata

Madyapana , 8

Dhooma pana, 12

Tobacco chewing , 10

Betel nut usage, 26

No habits, 4

0

5

10

15

20

25

30

Distribution of the Patients Vyasana in Ardita Vata



92

Out of observations it is very specific that the cracking the hard nuts such as Betel

Nut is found at the maximum of 26 patients irrespective of gender. The oral habits such

as tobacco chewing are also observed here for 10 patients along with Dhoomapana 12

patients. The alcohol consumers are listed as 8 here and miraculously no habit people

also recorded here are 4 patients.

B9) Distribution of patients by according to Dosha Vruddhi lakshana in Ardita Vata Table- 29

Distribution of patients by Dosha vruddhi lakshana in Ardita Vata

Vata Pts % Pitta Pts % Kapha Pts % Karshya 7 23.3 Adhikshudha 0 0 Praseka 30 100

Ushna kamitwa 8 26.6 Adhidaha 0 0 Gowrava 9 30

Anaha 10 33.3 Atinidra 7 23.3

Shakrudgraha 24 80

Balabhrmsha 30 100

Nidrabhramsha 23 76.6

Pralapa 4 13.3

Bhrama 6 20

The Vata Vruddhi lakshana are powerfully enrolled here as this disease is one of

the Vataja nanatmaja Vyadhi. All patients reported Bala bhramsha here. Maximum of

Shakrut graham (24), Nidrabhramsha (23) and Anaha (10) along with Ushna Kamitwa (8)

are reported. No Pitta Vruddhi lakshana are found. Even Gowrava (9) and Atinidra (7)

found in the study along with Praseka (lalasrava) in all patients which are Kapha

lakshana. The Dosha vruddi lakshanas which are enumerated in general but specific to

that of a Vata Vyadhi naturally show significance of Vata vruddhi here in this study.


93

B10) Distribution of patients according to Dosha Kshaya lakshana in Ardita Vata Table- 30

Distribution of patients according to Dosha Kshaya lakshana in Ardita Vata Vata Pts % Pitta Pts % Kapha Pts %

Alpa chesta 30 100 Mandagni 16 53.3 Bhrama 6 20

Sleshma Vruddi 4 13.3 Prabha hani 0 0 Sandhi saidhilya

6 20

The Dosha Kshaya lakshana when enumerated it is clearly evidential that the

Dosha dooshaya sammurchana and disease manifestation occurring at the individual relay

the Kshaya lakshana very specifically. Here Alpa chesta with reference to Facial muscle

activity is understood and found in all cases. The anubandha Dosha Kshaya lakshana also

found in 16 cases of Mandagni (Pitta) and 6 each of Bhrama and Sandhi saithilya

(Kapha),.

B11) Distribution of patients according to Prakruti in Ardita Vata

Table- 31

Distribution of patients prakruti of Dhanwantaram Taila in Ardita Group-1

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

Vata Pitta 8 53.3 4 50 4 50 0 0

Pitta Kapha 2 13.33 1 50 1 50 0 0

Vata Kapha 5 33.33 3 60 2 40 0 0

Total 15 8 7 0

Figure –15

Distribution of patients by Prakruti in Ardita Vata – Group-1

Vata Kapha

Distributi

Prakruti

Vata Pitta

Pitta Kapha

Vata Kapha

Total

In both

of these group p

the prakruti im

relation to the t


Distribution of the Patients by Prakruti in Ardita Vata

33.33%

Vata Pitta53.33%

Pitta Kapha 13.33%

Table- 32

on of patients by Prakruti of Dhanwantaram Taila in Ardita Group-2

Tot

al n

o of

pa

tien

ts

%

Mar

ked

Res

tora

tion

%

Mod

erat

e R

esto

rati

on

% P

oor

R

esto

rati

on

%

9 60 1 11.11 7 77.8 1 11.11

3 20 2 66.67 1 33.33 0 0

3 20 0 0 3 100 0 0

15 3 11 1

the groups it is found that the Vata Pitta prakruti people are more. Many

atients are moderately restored to the management. It may be said as that

portance is there in disease manifestation and prognosis but not a direct

reatment is identified here in the study.

Figure – 16

Distribution of patients by Dosha prakruti lakshana in Ardita Vata – Group-2

B12) Distrib

Bhrama (P

Trushna (U

Praseka (R

Toda (Asth

Shoola (As

Invo

importance.

Patients by Dosha Prakruti Lakshana

Vata Kapha20.00%

Pitta Kapha 20.00%

Vata Pitta60.00%

ution of patients by srota Lakshana in Ardita Vata

Table- 33 Distribution of patients by Sroto Lakshana in Ardita Vata

Group-1 Group-2 Lakshana


ranavaha & Majjavaha) 3 20 3 20

dakavaha) 2 13.33 0 0

asavaha) 15 100 15 100

ivaha) 4 26.67 2 20

thivaha) 15 100 15 100

lvement of the Srotas in the manifestation of the disease has a vast

As observed here the group-1 & 2 patients show Praseka (Rasavaha) and


Shoola (Asthivaha) lakshanas every where. The rest are of significant but not observed

for many patients. The pectoral graph is as below.

Figure –17

Distribution of patients by Srotas Lakshana in Ardita Vata – Group-1

D

Figure –18

Bhrama , 3Trushna, 2

Praseka, 15

Toda , 4

Shoola , 15

0

2

4

6

8

10

12

14

16

Distribution of the Patients Sroto Lakshana in Ardita Vata-Group-1

istribution of patients by Srotas Lakshana in Ardita Vata – Group-2


Distribution of the Patients Sroto Lakshana in Ardita Vata-Group-2

3

0

15

2

15

0 2 4 6 8 10 12 14 16

Bhrama

Trushna

Praseka

Toda

Shoola


97

C) Result of the Dhanwantaram Taila in Ardita Vata

C1) Assessment of Subjective parameters in Ardita Vata (Facial Paralysis) – Group-1 (Dhanwantaram Taila 101 Avartita caps internally)

Table- 34

Presenting complaints Patients Before

Patients After

Patients Improved

%

Vaktra (Hasita) Vakrata (Mouth angle deviation)

15 7 8 53.33

Netra Stabdata (closure of the eye affected) 15 7 8 53.33

Hanu Vakrata (Deviation of jaw) 15 7 8 53.33

Vakra Nasika (distortion of Nose) 15 7 8 53.33

Bhru Vakrata (distortion of eye brow) 15 6 9 60

Lalata Vali Nasha (wrinkles on forehead) 15 6 9 60

Vaksanga (ability to speak) 15 6 9 60

Lalasrava (salivation) 15 5 10 66.66

Asrusrava (lacrimation) 15 3 12 80

Facial expression 15 6 9 60

Mouth inflation 15 7 8 53.33

Whistling 15 6 9 60

Ability to masticate 15 7 8 53.33

Ability to spit 15 7 8 53.33

Tongue deviation on protrusion 15 8 7 46.66

Srutihani (loss of hearing) 5 1 4 80

Bhrama (vertigo) 3 0 3 100

Taste in the anterior 2/3rd of tongue 5 0 5 100

Hyperacusis 2 0 2 100

Manasika karana 15 8 7 46.6


98

C2) Assessment of Subjective parameters in Ardita Vata (Facial Paralysis) – Group-2 (Dhanwantaram Taila Shirovasthi)

Table- 35

Presenting complaints Patients Before

Patients After

Patients Improved

%

Vaktra (Hasita) Vakrata (Mouth angle deviation)

15 12 3 20

Netra Stabdata (closure of the eye affected) 15 12 3 20

Hanu Vakrata (Deviation of jaw) 15 12 3 20

Vakra Nasika (distortion of Nose) 15 12 3 20

Bhru Vakrata (distortion of eye brow) 15 11 4 26.66

Lalata Vali Nasha (wrinkles on forehead) 15 11 4 26.66

Vaksanga (ability to speak) 15 11 4 26.66

Lalasrava (salivation) 15 9 6 40

Asrusrava (lacrimation) 15 10 5 33.33

Facial expression 15 10 5 33.33

Mouth inflation 15 11 4 26.66

Whistling 15 11 4 26.66

Ability to masticate 15 12 3 20

Ability to spit 15 10 5 33.33

Tongue deviation on protrusion 15 10 5 33.33

Srutihani (loss of hearing) 4 1 3 75

Bhrama (vertigo) 3 0 3 100

Taste in the anterior 2/3rd of tongue 5 1 4 80

Hyperacusis 1 0 1 100

Manasika Karana 15 6 9 60


99

The above declared subjective parameters are assessed thoroughly on parlance

with the contemporary medical system and put forth here. As it is observed that almost all

the parameters are found in all patients. In the Group-1, Vaktra (Hasita) Vakrata (Mouth

angle deviation), Netra Stabdata (closure of the eye affected), Hanu Vakrata (Deviation

of jaw), Vakra Nasika (distortion of Nose), Mouth inflation, Ability to masticate, Ability

to spit are observed for the all 15 patients initially later only in 7 patients, i.e. 8 (53.33%)

of over all relief is visualized. Bhru Vakrata (distortion of eye brow), Lalata Vali Nasha

(wrinkles on forehead), Vaksanga (ability to speak), Facial expression and Whistling are

observed for 15 patients initially in due course of treatment the number came down to 6

which relay the relief as 9 (60%) patients. Hyperacusis and Bhrama show the 100% relief

for the patients those who have them. The rest of the parameters also found effective at

the end of the treatment including manasika karana with 46.6% and 60% of improvement

in group 1 and 2 respectively is depicted as in the table.

On the contrary the group-2 patients even though show all parameters initially not

show any significant results as total relief. But many patients are expressed the progress

in terms of grade differences as discussed in the methodology.

C3) Assessment of Objective parameters in Ardita Vata (Facial Paralysis) – Group-1 (Dhanwantaram Taila 101 Avartita caps internally)

Table -36

Objective parameter Mean Before Mean After Mean Difference

Mouth angle Deviation 1.533 0.46 1.07

Closure of eye effected 2.33 0.6 1.73

Deviation of Jaw on affected side þ 1.6 0.46 1.14

Erythrocyte Sedimentation Rate 17.933 13.33 4.6

Hemoglobin % 10.26 10.41 0.15


100

C4) Assessment of Objective parameters in Ardita Vata (Facial Paralysis) – Group-2

(Dhanwantaram Taila Shirovasthi)

Table -37

Objective parameter Mean Before Mean After Mean Difference

Mouth angle Deviation 1.86 0.9 0.96

Closure of eye effected 2.2 1.2 1

Deviation of Jaw on affected side þ 1.66 0.93 0.73

Erythrocyte Sedimentation Rate 16.53 14.06 2.46

Hemoglobin % 10.26 10.33 0.073

The above two tables expressed for the variances of the objective parameters

show significant differences in both groups. The data is furnished at the above tables are

the means and the master charts annexed show a detail picture of the objectives

considered.

C5) Results of Dhanwantaram Taila in Ardita Vata

Table-38 Results of Dhanwantaram Taila in Ardita Vata in Group-1

Result Number of patients Percentage

Marked Restoration 8 53.3

Moderate Restoration 7 46.67

Poor Restoration 0 0

Total 15 100

The group-1 (Dhanwantaram Taila 101 Avartita caps internally) results expressed

here after the through exercise on the subjective and objective parameters cumulated. The

results at the end found are – 8 (53.33%) of marked restoration and 7 (46.67%) of

moderate restoration. No patients are in the category of poor restoration. The graphical

expression is as under.

Figure – 19 Results of (Dhanwantaram Taila 101 Avartita caps internally) in Ardita Vata

Re

Marke

Modera

Poor

The

through exe

end found a

One patient

under.

Results of (Dhanwantaram Taila 101 Avartita caps internally) in Ardita Vata

Moderate Restoration

46.67%

Marked Restoration

53.33%Poor Restoration

0.00%

Table-39 sults of Dhanwantaram Taila Shirovasthi in Ardita Vata in Group-2Result Number of patients Percentage

d Restoration 3 20

te Restoration 11 73.33

Restoration 1 6.67

Total 15 100

group-2 (Dhanwantaram Taila Shirovasthi) results expressed here after the

rcise on the subjective and objective parameters cumulated. The results at the

re – 3 (20%) of marked restoration and 11 (73.33%) of moderate restoration.

(6.67%) is in the category of poor restoration. The graphical expression is as


Figure – 20 Results of (Dhanwantaram Taila Shirovasthi Externally) in Ardita Vata

D) StatisticaD1) StatisticGroup-1 (D

The

efficacy of t

In gr

(by compar

parameters (

The

shows most

wrinkles on

values). The

more variati

(by compari

Results of (Dhanwantaram Taila Shirovasthi Externally) in Ardita Vata

Moderate Restoration

73.33%

Marked Restoration

20.00%

Poor Restoration6.67%

l analysis of the clinical and objective parameters al analysis of Subjective parameters in Ardita Vata (Facial Paralysis) –

hanwantaram Taila 101 Avartita caps internally)

statistical analysis was done by applying paired t-test in order to know the

he drug both internally and externally before and after treatment.

oup1 except the parameters vertigo and hyperacusis shows highly significant

ing p-values) the parameter HB% shows less highly significant than other

by comparing p-values).

parameter Ayurvedic Health Assessment criteria and mouth angle deviation

highly significant, where as the parameters closure of the eye effected,

forehead and asru srava shows equally highly significant (by comparing t-

parameter Ayurvedic Health Assessment shows more net mean effect with

on, where as the parameter HB% shows less mean effect with less variation

ng mean and S.D).



103

Table -40 Statistical analysis of Subjective parameters in Ardita Vata (Facial Paralysis) – Group-1

(Dhanwantaram Taila 101 Avartita caps internally)

Subjective parameters Mean SD SE t-Value p-Value Remark

Wrinkles on forehead 1.2 0.414 0.106 11.32 <0.001 H.S

Vaksanga 1.2 0.414 0.106 11.32 <0.001 H.S

Lalasrava 1.4 0.507 0.13 10.76 <0.001 H.S

Asrusrava 1.2 0.414 0.106 11.32 <0.001 H.S

Facial Expression 1.066 0.593 0.153 6.96 <0.001 H.S

Ability to inflate 1.266 0.457 0.118 10.72 <0.001 H.S

Ability to Whistle 1.066 0.258 0.066 16.15 <0.001 H.S

Ability to masticate 1.2 0.414 0.106 11.32 <0.001 H.S

Ability to spit 1 0.377 0.097 10.25 <0.001 H.S

Tongue deviation on protrusion

1.066 0.258 0.066 16.15 <0.001 H.S

Bhru vakrata 0.866 0.351 0.09 9.53 <0.001 H.S

Vakra nasika 0.866 0.351 0.09 9.53 <0.001 H.S

Hearing 0.266 0.457 0.118 2.25 <0.05 H.S

Vertigo 0.2 0.414 0.106 1.88 >0.05 N.S

Taste in anterior 2/3rd of tongue

0.33 0.487 0.125 2.66 <0.05 H.S

Hyperacusis 0.133 0.351 0.09 1.46 >0.05 N.S

Krodha 0.6 0.507 0.13 4.61 <0.001 H.S

Bhaya 0.8 0.414 0.106 7.54 <0.001 H.S

Dhukka 0.666 0.487 0.125 5.328 <0.001 H.S

Shoka 0.733 0.457 0.118 6.21 <0.001 H.S

Chinta 0.66 0.617 0.159 4.188 <0.001 H.S

AHA 9.533 2.099 0.542 17.58 <0.001 H.S

HS = Highly Significant, NS = Non significant, AHA = Ayurvedic Health Assessment


104

D2) Statistical analysis of Subjective parameters in Ardita Vata (Facial Paralysis) – Group-2 (Dhanwantaram Taila Shirovasthi)

Table -41

Subjective parameters Mean SD SE t-Value p-Value Remark

Wrinkles on forehead 0.933 0.593 0.153 6.098 <0.001 H.S

Vaksanga 0.933 0.457 0.118 7.906 <0.001 H.S

Lalasrava 0.733 0.703 0.181 4.04 <0.01 H.S

Asrusrava 1.066 0.457 0.118 9.033 <0.001 H.S

Facial Expression 0.533 0.516 0.133 4 <0.01 H.S

Ability to inflate 1.133 0.516 0.133 8.518 <0.001 H.S

Ability to Whistle 0.733 0.457 0.118 6.211 <0.001 H.S

Ability to masticate 0.66 0.487 0.125 5.328 <0.001 H.S

Ability to spit 0.733 0.457 0.118 6.21 <0.001 H.S

Tongue deviation on protrusion

1 0.534 0.138 7.24 <0.001 H.S

Bhru vakrata 0.66 0.487 0.125 5.328 <0.001 H.S

Vakra nasika 0.6 0.507 0.1309 4.58 <0.001 H.S

Hearing 0.2 0.414 0.106 1.88 >0.05 N.S

Vertigo 0.2 0.414 0.106 1.88 >0.05 N.S

Taste in anterior 2/3rd of tongue

0.266 0.457 0.118 2.25 <0.05 H.S

Hyperacusis 0.066 0.258 0.0666 1 >0.05 N.S

Kroda 0.733 0.457 0.118 6.21 <0.001 H.S

Bhaya 1 0 0 0 - -

Dhukka 1 0.377 0.097 10.309 <0.001 H.S

Shoka 1.066 0.258 0.066 16.15 <0.001 H.S

Chinta 1.2 0.414 0.106 11.32 <0.001 H.S

AHA 11.4 1.594 0.4117 27.69 <0.001 H.S

HS = Highly Significant, NS = Non significant, AHA = Ayurvedic Health Assessment


105

D3) Statistical analysis of Subjective parameters in Ardita Vata (Facial Paralysis) – Group-1 (Dhanwantaram Taila 101 Avartita caps internally) & Group-2 (Dhanwantaram Taila Shirovasthi) comparison – Table -42 Subjective parameters

Gr Mean SD SE PSE t-value p-value Remark

1 0.4 0.507 0.1309 0.176 1.89 >0.05 NS Wrinkles on forehead 2 0.733 0.457 0.118

1 0.4 0.507 0.1309 0.21 2.21 <0.05 HS Vaksanga 2 0.866 0.639 0.165 1 0.333 0.487 0.125 0.219 1.89 >0.05 NS Lalasrava 2 0.733 0.703 0.181 1 0.2 0.414 0.106 0.163 2.858 <0.01 HS Asrusrava 2 0.666 0.487 0.125 1 0.4 0.507 0.13 0.243 2.19 <0.05 HS Facial Expression 2 0.933 0.798 0.206 1 0.466 0.516 0.133 0.196 1.7 >0.05 NS Ability to inflate 2 0.8 0.56 0.144 1 0.4 0.507 0.13 0.194 2.06 <0.05 HS Ability to Whistle 2 0.8 0.56 0.144 1 0.466 0.516 0.133 0.215 2.48 <0.05 HS Ability to masticate 2 1 0.654 0.169 1 0.466 0.516 0.133 0.245 1.906 >0.05 NS Ability to spit 2 0.933 0.798 0.206 1 0.533 0.516 0.133 0.232 1.435 >0.05 NS Tongue deviation on

protrusion 2 0.866 0.743 0.191 1 0.4 0.507 0.13 0.175 1.9 >0.05 NS Bhru vakrata 2 0.733 0.457 0.118 1 0.466 0.516 0.133 0.202 2.31 <0.05 HS Vakra nasika 2 0.933 0.593 0.153 1 0.06 0.258 0.06 0.084 - - - Hearing 2 0.06 0.258 0.06 1 0 0 0 0.06 1.0 >0.05 NS Taste in anterior 2/3rd

of tongue 2 0.06 0.258 0.06 1 0.533 0.516 0.133 Kroda 2 0.333 0.487 0.125

0.182 1.098 >0.05 NS

1 0.6 0.736 0.1902 Bhaya 2 0.266 0.457 0.118

0.223 1.497 >0.05 NS

1 0.666 0.816 0.21 0.244 1.35 >0.05 NS Dhukka 2 0.333 0.487 0.125 1 0.466 0.639 0.165 0.188 1.77 >0.05 NS Shoka 2 0.133 0.351 0.09 1 0.533 0.639 0.165 0.21 0.633 >0.05 NS Chinta 2 0.4 0.507 0.13 1 4.33 4.923 1.271 1.612 1.61 >0.05 NS AHA 2 6.933 3.844 0.992


106

In group2 except the parameters HB%, hearing and vertigo all the parameters

shows highly significant (by comparing P-value) except in parameter vertigo all other

parameters shows most highly significant (by comparing p-values).

The parameter Ayurvedic Health Assessment, shoka and chinta shows most

highly significant (by comparing t-values). The parameter Ayurvedic Health Assessment

shows more net mean effect, the ability to spit with more variation. The parameter HB%

shows less net mean effect with less variation. There is a zero variation parameter bhaya

(by comparing mean and S.D).

In group2 the parameters Ayurvedic Health Assessment, shoka, chinta, dhukka

and krodha shows more highly significant than group 1 (by comparing t-value and p-

value).

D4) Statistical analysis Objective parameters in Ardita Vata (Facial Paralysis) – Group-1 (Dhanwantaram Taila 101 Avartita caps internally)

Table -43

Objective parameters Mean SD SE t-Value p-Value

Rem

ark

Mouth angle Deviation 1.066 0.258 0.066 16.15 <0.001 HS

Closure of eye effected 1.733 0.593 0.153 11.326 <0.001 H.S

Deviation of Jaw on affected side þ

1.133 0.516 0.133 8.51 <0.001 H.S

Erythrocyte

Sedimentation Rate

4.6 1.502 0.387 11.8 <0.001 H.S

Hemoglobin % 0.146 0.1407 0.036 4.05 <0.01 H.S

HS = Highly Significant


107

D5) Statistical analysis of Objective parameters in Ardita Vata (Facial Paralysis) – Group-2 (Dhanwantaram Taila Shirovasthi)

Table -44

Objective parameters Mean SD SE t-Value p-Value

Rem

ark

Mouth angle Deviation 0.933 0.593 0.153 6.09 <0.001 HS

Closure of eye effected 1 0.654 0.169 5.917 <0.001 H.S

Deviation of Jaw on affected side þ

0.733 0.457 0.118 6.21 <0.001 H.S

Erythrocyte Sedimentation Rate

2.466 1.187 0.306 8.05 <0.001 H.S

Hemoglobin % 0.066 0.144 0.037 1.78 >0.05 N.S

D6) Statistical analysis of Objective parameters in Ardita Vata (Facial Paralysis) – Group-1 (Dhanwantaram Taila 101 Avartita caps internally) & Group-2 (Dhanwantaram Taila Shirovasthi) comparison

Table -45 Objective parameters

Gro

up Mean SD SE PSE t-value p-value

Rem

ark

1 0.466 0.516 0.133 Mouth angle Deviation

2 0.933 0.593 0.153 0.202 2.31 <0.05 HS

1 0.6 0.736 0.190 Closure of eye effected 2 1.2 0.77 0.2

0.275 2.181 <0.05 HS

1 0.466 0.516 0.133 Deviation of Jaw on affected side þ 2 0.933 0.593 0.153

0.202 2.31 <0.05 HS

1 13.33 2.41 0.622 Erythrocyte Sedimentation Rate

2 14.06 3.326 0.858 1.059 0.689 >0.05 NS

1 10.413 0.315 0.0815 Hemoglobin %

2 10.33 0.351 0.09 0.121 0.685 >0.05 NS


108

Inter group comparison of Statistical analysis in Group 1and Group 2

To compare mean effect of two groups the analysis is carried out by using

unpaired t- test. The respective parametric analysis is as follows. Here except the

parameters mouth angle deviation , closure of the eye effected , deviation of the jaw,

vaksanga, asru srava, facial expression, whistling, ability to masticate and nasa vakrata

shows not significant i.e., the mean effect of the two groups is not same in the above

mentioned parameters (by comparing p-value). The mean effect of parameter Ayurvedic

Health Assessment is more in group 2 than in group1, but group 1 shows more variation

after the treatment.

In the group1 the parameter taste in the anterior 2/3 of the tongue zero mean

effect after the treatment. In the group2, the parameters mouth angle deviation, deviation

of the jaw, wrinkles on forehead, vaksanga, lalasrava, asrusrava, facial expression, mouth

inflation, whistling, ability to spit and tounge deviation onm protrution shows more mean

effect than group 1 but the parameter ability to masticate shown more mean effect in

group 1 than group 2 after the treatment ( by comparing mean ).

Among the maanasika factors, the parameters krodha, bhaya, dhukka, shoka and

chinta shows more mean effect in group1 after the treatment.In the parameters bhru

vakrata and vakra nasika shows more mean effect in group 2 after the treatment.

CHAPTER-6 DISCUSSION

Healthy discussion paves a way to the generation of thoughts that guides us in a

new dimension for the better evaluation of the problem. At this juncture some of the

aspects of the present disease are discussed.

Face is the index of mind; Ardita a Vataja nanatmaja Vyadhi affects the face,

which reflects the psyche i.e., a major psychological concern for the diseased. This entity

affects the uttamanga (shiras). Acharya Bhela elucidated this entity under one among the

ailments of Asthi Majjagata Vata, which is indicative of its prognosis.

If we glance over the symptoms viz. loss of facial expression, drooping of the eye

lid, eye brow and sagging of corner of the mouth, closure of the eye is difficult,

mastication is difficult and fluids too seep out of the corner of the mouth. Speaking,

whistling and drinking of fluids too get impaired.

A patient tends to sit with the hand over the side of the face, which is indicative of

the extent of stress impact over the afflicted. As the patient is unable to register the

pleasure, laughter, surprise, interest or worry the non-verbal communication even gets

ceased.

It is a serious handicap within the society and some people become withdrawn,

depressed and feels dejected. As it is difficult to run a business or perform a work that

demands inter-personal relationships, communication, devastating for television

presenters, stage and film actors, IT professionals and even the lay man as it is a basic

cosmetic concern.

Dhanwantaram Taila in Ardita A comparative clinical study –Discussion

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In short, Ardita is a crippling malady deprives the Indriyas from their cognitional

and functional aspects which penultimate in physical, psychological and behavioural

attitudes. The disease Ardita should be perceived in a multi-dimensional view in order to

tackle the situation. Hence is discussed in the fore coming pages with comparison with

contemporary system of medicine.

Discussion is carried out under following headings.

1) Discussion on disease

2) Discussion on probable mode of action and efficacy of the drug.

3) Discussion on Demographic Data.

4) Discussion on statistical Result.

1. DISCUSSION ON DISEASE-

Ardita is a disease with multi faceted aetiology, pathology, symptomatology with due

regard to this, comparative discussion is done under the following headings.

a) Discussion on etiology

b) Discussion on Pathogen tic aspects.

c) Discussion on Symptomatology & prognosis.

d) Conclusion on Discussion.

The primitive structure of nervous system is neuron and thus discussion is with

neuron and its relations-

Neurons-

These are the cells that are specialized for the reception, integration, interpretation

and transmission of information.


110

Nerve cell-

Nerve cells convert information obtained from the environment into codes that

can be transmitted along their axons. By such coding the same neuron can transmit

different kinds of information. Some of the aspects are discussed below, as Ardita is a

disease of Vatavaha srotas.

Schwann cells-

These cells envelope all nerve fibers of peripheral nervous system and extend

from their attachment to (entry or exit from) the spinal cord and brain stem almost to their

termination.

Astrocytes- These are small star shaped cells that surround the neurons partly by their

processor and separate them with other neurons. Astrocytes communicate with each other

through calcium channels and this plays a role in the regulation of synaptic activity.

Microglia- These cells are with relation to capillaries and are numerous in gray matter

than in white matter. Any damage to nervous tissue by trauma or disease activates these

cells and these cells act as phagocytes. They serve as insulators, helps the neuronal

activity by maintaining a suitable metabolic environment, terminates the action of

neurotransmitters, probably play a role in maintaining the blood brain barrier.

Repairs the damaged areas of neurons, ependymal cells are concerned in

exchanges of material between the brain and cerebrospinal fluid and oligodendrocytes

provide myelin sheaths to nerve fibers within in the central nervous system.

Myelin-

Those nerves in our body, which, for the sake of our survival, should conduct

very fast, are all myelinated.


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Myelin Relation to Dauhrudavasta-

Myelination- begins at the 4th month of intrauterine life and is completed after a

few years after birth. It may be due to this myelination the foetus expresses its

longings through the synaptic impulses, ultimately appreciated by mother. It is at

this juncture mother is called as dauhrudini.

Importance of Myelin- propagation of action potential is fast in myelinated nerve

fibers and energy expenditure is minimal in myelinated nerve fibers.

Composition of Myelin- myelin contains lipids, protein and water. It is made up of

specific phospholipid i.e. sphingomyelin.

Schwann cells- Are responsible for myelination and are in the form of segments,

which forms a gap, with respective segment is nodes of Ranvier.

Chalaguna of Vata- when an impulse travels down a nerve fiber it doesn’t proceeds

uniformly along the axis cylinder gut, jumps from one node to the next is called

salutatory conduction. This jumping of impulses may be assumed to that of “Chala

guna” of Vata.

Gap substance- Gap substance plays a role in regulating the flow of the nerve impulse, by

influencing the passage of ions into, and out of the axon.

Applied aspects- In disorders of lipid metabolism, myelination can be seriously impaired,

various proteins are identified in myelin sheaths and any abnormality in them can be the

basis of some neuropathies.

Rogatikarshana, Ahara Nidana, Madhyapana, Vyasana may have a role to play

over the myelination, generation of impulses and deposition of unwanted products.


112

Receptors- Receptors are the structures, which receive the sensory stimulus. The apparent

sensory nerves arises from these structures and reaches the C.N.S. thus, receptors is the

first structure in the sensory pathway.

Impulse- When a receptor is stimulated, it develops a local current, called generator

potential if the generator potential is sufficiently strong, an action potential develops in

the emerging nerve and later conveyed to the respective site.

Synapse- Synapses are sites of junction between neurons. They are of various types

depending upon the parts of the neurons that come in contact. They constitute the

pathways for the impulse propagation.

Within central nervous system (C.N.S) axon or its branches terminates with

another neuron by means of intimate relationship

Out side the C.N.S they may end in relation to an affecter organ (muscle or

gland) or may end by synapsing with neurons in a peripheral ganglion.

Neurotransmission- This is a process through which a substance released at pre-synaptic

terminal acts upon receptors on a contiguous postsynaptic neuron, directly affecting the

electrical resistance of the plasma membrane within milliseconds.

Entry of calcium ions during depolarization of the terminal membrane is an

essential prerequisite for the liberation of the neurotransmitter.

Important aspects of neurotransmitters with relation to sympathetic and Parasympathetic

nerve endings:

Axon terminal contain vesicles rich in acetylcholine.

In sympathetic terminals vesicles contain catecholamine (nor adrenaline etc.,) and

are excitatory in nature.


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Monoamines present in relation to the sympathetic endings destroy catecholamine

and regulate sympathetic activity.

Parasympathetic terminals contain a purine and are inhibitory.

Apart from the muscle, effector endings are present in relation to glands. (eg.

Facial nerve – salivary glands.)

Neuromediation- Repeated synaptic activity can have long lasting effects. These effects

produced under the chemical influences are described as neuro-mediation.

Neuromodulators- Some chemical substances associated with synapses influences the

effects of transmitters or of neuromediators indirectly, are called neuromodulators.

Functional relationship between impulse and Schwann cells-

Signals traveling along the axons probably influence the differentiation of

Schwann cells and determine the proliferation and their existence.

Myelination from Schwann cell is also under the influence of the impulses.

Signals those arising from these influences the growth of the axon and diameter.

These cells are essential for the repair of damaged peripheral nerves.

a) Discussion on etiology

Receptor modulations to stimulus- Depending on the rate of provision of information the

receptors are categorized into the following headings.

Fast adopting receptors

Slow adopting receptors.

These provide information to the C.N.S. about the extent of changes in length of

the muscle i.e. stretch or contraction etc.


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Table showing comparison of the Nidana told in Samhita is compared here with the

receptors of contemporary system.

Nidana Receptors

Plawana, adhwagamana,

Shirobharaharana, Vishamashayana

Cutaneous receptors: are concerned with

touch, pain, temperature and pressure.

Vyayama, Vyavaya,

Shirobharaharana, Yanat Patanam,

Untrasavaktra, Vishamopachara,

Vichestita, Adhwagamana,

Proprioceptivereceptors: provide the

information about the state of

contraction

of muscles, and of joint movements and

Position. Information thus attained is

necessary for precise control of

movement and maintenance of posture.

Organs

of Golgi / Type III

Adhika asruk / Dosha srava,

sira vyadhana, marma sanchedhana,

Rakta Kshaya, garbhini

Interoceptive receptors: are located in the

thoracic and abdominal viscera and in

blood vessels. These include specialized

structure like the carotid sinus and the

carotid body.

AtiPrabhashanam/hasya,

katinaAhara,karadhi,

jrumbha,shirobharaharanauntrasavaktra,

kshavathu,vyayama,vichestita,karma,

vigharshana

Mechanoreceptors: these are stimulated

by mechanical deformation include the

receptors of touch, pressure, stretch and

end organs of internal ear. Based on the

adoption of stimulus

Teekshana madya /asava, jihwa

nirlekhana

Chemo receptors: these are stimulated by

chemical influences. Eg. Receptors in

taste buds, or in carotid bodies.

Plavana,prajagara,yanatpatanam,Adhwa

gamana, vishamashayana,Diwaswapna,

vyayama,vyavay,Amasanchay,vranapak

Thermoreceptors : these respond to the

alterations in temperature


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Nidana

r

,

Receptors

Atiasruk/Doshasrava, garbhini, sutika,

RaktaKshaya, ma masanchedhana,

siravyadhana

Osmoreceptors: These respond to the

changes in the osmotic pressure.

Vrana paka, siravyadhana, Shiro

bharaharana, yanat patanam ati

vyayama, ati Dosha srava, Dhatu

Kshaya, abhighata,rogati karshana, ati

asruk srava, garbhini, sutika, ksheena

Nociceptors: the above categories

include

receptors that are stimulated by

damaging influences which are

perceived as pain, discomfort or

irritation.

Shirobharaharana, vishama

shayana, divaswapna, plavana,

vishamopachara, vyavaya.

Free nerve endings: Terminals of these

nerves doesn’t show specialized

structure hence the name, found in

connective tissue, epithelial lining of the

skin, cornea, Alimentary canal. They are

numerous in relation to the hair follicles

and are fast adopting mechanoreceptors/

Type IV: probably responsible for pain.

Adhwagamana, (karma,

nasa, netra vigharshana i.e,

with the palm of the hand)

Tactile corpuscles: seen in relation to

dermal papillae in the hand, foot and in

other situations are responsible for touch

and are slow adopting mechanoreceptors.

Lamellated corpuscles: are found in

subcutaneous tissue of the palm and sole,

& are sensitive to vibration and pressure.

They are of fast adapting in nature.

Atihasya, ati prabhashanam

Pacinian corpuscles: lie deep to skin in

dermis or in tissue deep to skin and are

sensitive to vibration. Type II: these are

fast adapting mechanoreceptors, supplied

by myelinated nerve fibers


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Vyayama, vyavaya,

shirobharaharana

Ruffini endings: present in the hairy

skin/ non hairy skin, are also found in

relation to the joints, in the gums and in

the glans penis and are slow adopting

mechano receptors responsive to stresses

in dermal collagen. Apart from their

sensoryfunctions afferent nerve fibers

may play a role in inflammation and

repair of the tissues.

Type I: these are slow adapting

mechanoreceptors are responsible for the

sense of joint position and movement.

Critical analysis of nerve damage with reference to Nidana-

The pressure on a nerve can be brief, prolonged or intermittent which will after

its structural and functional aspects.

Neuropraxia – Brief intermittent or possible longer pressure, which causes minimal or no

structural damage. Recovery is possible within a few weeks. 216

Axonotmesis- Prolonged or chronic recurrent pressure may cause degeneration of the

nerve. Recovery will take considerably longer as the nerve fibre has to grow.

Neurotmesis- When the axon, Schwann cell and myelin sheath are severed, the

degeneration takes place in the following manner.

Anterograde- degeneration: the changes in the part of the axon distal to the injury are

referred as anterograde degeneration or wallerian degeneration, which takes place in the

entire length of the injured neuron.

A series of events with neurofibril, myelin sheath break down in association with

chemical changes and phagolyte invasion. The substances secreted by macrophages


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probably, causes proliferation of schwann cells, which increase in size and large series of

membranes generated helps to form numerous tubes. These tubes play vital role in the

regeneration of nerve fibers.

Retrograde degeneration- degenerative changes in the neuron proximal to the injury are

referred to as retrograble degeneration. This phenomenon occurs in the cell body and in

the axon procimal to injury with chromatolysis may or may not associate with cell death.

Transneural degeneration- The changes resulting from axonal injury are not confirmed to

the injured neuron only, but can extend to other neurons with which the injured neuron is

associated or synapsed is referred to as transneuronal degeneration and it can extend

through several synapses.

Changes are confined to a short segment near the site of injury; changes are same

to that of distal part of the axon. Further the tip of the surviving part gives off a number

of branches, which innervate the connective tissue at the site of injury.

The tubes which are formed out of proliferation of the distal part comes in close

approximation to that of regenerating axonal branches and if succeeds in reaching such

tube, the branch grows rapidly and establishes contact with an appropriate peripheral end

organ, if not undergoes degeneration. The new axon formed is thin and is devoid of

myelin progressively increases in thickness with myelin sheath formation.

Regeneration of the severed nerve is considerable increased

If the cut ends are in close approximation (not more than 3 mm)

If the scar tissue doesn’t intervene between the tubes and also absence of neuroma.

Any disease entity may result in peripheral nerve fiber degeneration say, leprosy,

diabetic neuropathy, poliomyelitis etc.

Regeneration capacity of C.N.S is inversely proportional to that of peripheral nerves.


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Nidana With Special Reference to nerve injury

Naasa, Netra, karna vigharsana,

kathina aachara, vichestita,

vishamopachara

Neuropraxia (Loss of conduction is

due to ischaemia)

Shirobhaaraharanam, vishama

shayanam, ati prabhaashanam, ati

hasya, vega dharana, adhwagamana,

vega udeerana

Axonotmesis, (mechanical

displacement of nodes of Ranvier

with stretching of paranodal

myelin)

Jrumbha, kshavathu, untraasa

vaktra, jihwa nirlekhana, vyayama,

atihasya, ati prabhashana, vyavaya,

vishamopachara, vichestita.

Stretching, (mechanical

displacement of nodes of Raniver

with stretching of paranodal

myelin)

Marma sanchedhana, marmaghata,

abhighata, yanatpatanam,

karaadhyascha.

Neurotmesis, Wallerian

degeneration which is with

chromatolysis

It is evident from the above information that, the Nidana aspects, which were elaborated

in our classics, can fall under degenerative phenomenon too.

The etiology is indicative of vascular, metabolic, neuronal, thermoregulatory,

hormonal, electrolyte, hypoxia, and psychological variances and hence discussed with

apparent physiology as it is an essential tool to understand the disease in a better way.

The discussion is as follows.


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Circadian Rhythm-

Diurnal fluctuations of plasma hormonal levels are called circadian rhythm.

Gluco-corticosteroid secretion is maximal in the morning and least in the early part of

night or midnight. The neurotransmitter dopamine might be involved in the causation of

circadian rhythm. It depends on day night cycle and supra-chiasmatic nucleus of

hypothalamus. At this moment it may be of relevance to consider circadian rhythm as

Dosha dominations with reference to diurnal variations.

Homeostasis-

Our body has an internal environment and the internal environment is almost

constant. The cells are bathed by ECF and temperature, pH concentrations of various

solutes in it like the glucose, sodium and potassium, urea etc and are almost constant.

And even the ICF does have the same constants. This phenomenon, that the internal

environment is practically constant is homeostasis.

b) Discussion on Pathogen tic aspects.

Samprapti is suggestive of extensive involvement of Rakta Dhatu in the genesis of

Ardita. With regards to this some of the aspects of Blood are dealt here.

Blood (Rakta Dhatu)-

Respiration synchronizes life which rely on blood is the factor behind mortality.

Deprivation of blood to the tissues by any means is an alarming factor for the medical

intervention as blood is the vital requirement of every aspects of our body. Quantitative

and qualitative disfigurements of it pose a threat to the life; in short, Rakta is the sole

entity which governs the physical soul.


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Role of Blood in Homeostasis-

Respiratory, excretory, nutritional functions and is the chief factor which regulates

the homeostasis.

As the enzymatic reactions can only be effective at a narrow range of pH, increase in

that alarms for an intervention i.e., of chronic or acute changes.

Blood contains so many buffers thus nullifies the pH.

It constitutes the defense mechanism by means of its effective functional aspects.

Emboli, thrombus, atherosclerosis, arteriosclerosis, neuropathies and vascular

diseases deprive the functional capabilities of blood.

Vitamin C, calcium, iron, folic acid and vitamin B12 are of significant value for its

genesis.

Coagulatory factors are effective with the norms of blood vitamin K and vitamins C

are having an important role in this regard.

Anemia (pernicious / megaloblastic / nutritional/ haemolytic) has an influence over

the functions of blood.

pH and its relation with vital functions-

The pH of the arterial blood must remain in a narrow range because many vital

proteins are strongly dependent of it, for their functions.

If pH falls thus it deteriorates the enzymatic actions resulting in loss of myocardial

contractility, loss of vascular tone and devastating deterioration of functions of central

nervous system.

It accounts either for acidosis i.e., H+ ion concentration decreases or alkalosis where

H+ ion concentration increases.


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Ill effects of pH over the internal environment-

Catabolism of many organic compounds leads to the generation of phosphoric acid

and sulphuric acid and the H+ ions of these acids must be cleared off from the body.

Continuous operation of Kreb’s cycle accounts for the gain of H+ ions in the blood.

After severe excessive exercise blood lactic acid concentration increases this is

known as physiological acidosis.

During exercise re-synthesis of high energy phosphate bonds may be incomplete and

for the recovery it needs oxygen (as hemoglobin is the carrier of oxygen).

Chronic alcoholism can also influence the pH variations.

Acidosis– Acidosis may develop due to the accumulation of fixed acids (metabolic

acidosis), volatile acids (respiratory acidosis), Diabetic acidosis, renal acidosis, lactic

acidosis and severe diarrhoea (due to loss of bicarbonate ions).

Alkalosis– severe vomiting (hydrogen ion excess), powerful diuretics leading to

excessive loss of chlorides.

The Nidana aspects and Vatavyadhi are in association with external

environmental factors it is of relevance to discuss some of the regulatory phenomenon at

this instance-

Thermoregulation- The water loss through skin is of two kinds, viz; sweating and

insensible perspiration. Sweating occurs when the environmental temperature is high or

when there is sympathetic stimulation or during physical exercise where as insensible

perspiration is independent of these conditions and occurs even in very cold environment

and at rest.


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Exposure to cold triggers hypothalamus and produces cutaneous vasoconstriction,

shivering, horripulation and minimal adipose tissue lysis.

Vasoconstriction at the level of skin and cutaneous tissue is of thermal insulator in

nature. Where as vasodilatation is of thermal conductor in nature.

The whole process is under the influence of receptors (peripheral and central) –

hypothalamus sympathetic stimulation – vasoconstriction/vasodilatation in a

succeeding order.

It can happen in case of Plavana, Vyayama, Adhwagamana, Vyavaaya, Prajagara,

Hima sevana, Atapa sevana, Shirobharaharana, Ucchairbhashana and Ati-haasya.

Aaharaja Nidana-

Balanced diet is the invigorator of life that is health. This entity is doctrine by our

sages from the ages. They advocated sarvarasabhagasa, saatvika aahara, saatmyaahara,

hitaahara etc., it is said as one amongst the 3 pillars of life which sustains the body

indicating its supremacy.

Ahara Rasa the resultant of digestion is nourishing all the micro and macro-

entities saatvikaahara, sarvarasabhyasa, nitya ksheera ghrita bhojana were elaborated for

the promotion of healthy life.

Essence of tissues i.e., Ojus is in direct relation to Ahara as the tissues are from

Ahara, Ojus is considered as strength and is with an eye over the immunity. Kapha Dosha

maintains the structural integrity by its snigdha properties Ojus do possess most of the

qualities akin to Kapha.

Thus quality snigdha have a note over the structural and functional entities that

are in particular to Vata Dosha. Vata Dosha imparts catabolic phenomena to the internal


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environment and is vitiated by properties/etiological factors and manifests its

pathogenesis either by means of Dhatu Kshaya or Maargavarana.

Many factors, like the composition of the chyme entering the duodenum, volume

of gastric content, duodenal distention, stimulation or inhibition of extrinsic nerves etc,

influences the gastro-duodenal pump and hence gastric emptying.

Abhojana (with reference to fasting)-

Fasting reduces gastric secretion and leads to vagal stimulation, which directs to

gastric secretion, increased HCl secretion and increased gastric motility. The HCl

constitutes of H+ ion and Cl- ion. Excess increase of chloride ions may pose a threat to

the pH by means of acidosis.

The effect can be produced by acetylcholine the neurotransmitter for

parasympathetic nerves. Here Abhojana is similar to that of fasting and may have similar

effect over the nervous system.

Tonicity (with reference to quantity of food intake)-

Food in the stomach

Afferent impulses via vagus

Vagal nucleus at medulla

Efferent path via vagus

Target cells in stomach the food acts as a stimuli by means of distention.

It is evident from above that, quantity of food has a say over the digestion and it is

true in the case of Laghwanna, Langhana, and Abhojana.


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If the chyme is very acidic, the gastric motility and emptying are inhibited due to the

neural and GI hormonal signals. It can happen with respect to laghwanna, Langhana, and

Abhojana.

Atyahara (with reference to quantity and fat content of food intake)-

Excess fat in the chyme (reaching the duodenum) reduces gastric emptying cause

enterogastrone to be liberated from the upper small intestine is absorbed and circulates in

the blood later reappears in the gastrointestinal tract. In stomach HCl secretion and

gastric motility are suppressed. Excess carbohydrate may cause fermentation,

microorganism invasion followed by the non-release of intrinsic factor.

Atyahara may cause alkalosis i.e., excess production of hydrogen ions due to the

huge amount of food intake, excess chloride ions may be lost and in the case of teekshana

Madhya/teekshana asava there will be change in pH levels.

Role of Osmosis w.s.r.to extent of liquidity consumed-

Osmoreceptors-

Mucosa of both duodenum and jejunum contain osmo-receptors. Hyperosmolar

chyme causes shrinkage of these receptors where as hypo-osmolarity produces swelling

and is under the influence of neural mechanism (afferent fibers) a gastrointestinal

mechanism i.e., altered volume leads to their stimulation.

Osmolarity-

If the chyme reaching the duodenum and jejunum is hyper-osmolar, the gastric

peristalsis is reduced and emptying gets delayed. If the chyme is hypo-osmolar, the

peristalsis and emptying of stomach increases. It can happen in the Nidana like

rookshaahara, sheetanna, laghwanna.


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Hypo or Hyper reflexes (Vega Udeerana, Vegadharana and Maanasika factors)-

Here some of the physiological aspects of intestines are discussed with special

reference to above mentioned factors.

Parasympathetic stimulation increases intestinal motility and sympathetic inhibits

it. Anxiety, resentment, hostility cause increase in colonic motility and dejection, sorrow

inhibits it.

Large intestine can absorb water, sodium chloride, glucose and aminoacids and

proteins. Potassium, which is responsible for resting membrane potential, is secreted by

colon.

The bacterial flora of small and large intestines synthesize vitamin K and also

some members of vitamin B complex. Hemorrhagic disease of the newborn is due to the

deficiency of vitamin K because the intestinal flora is sterile (no bacterial flora). This

may be the reason that ‘Bala’ category is prone to Ardita as per Sushruta because of the

disfigurements in the qualitative and quantitative aspects of blood.

Excess bacterial Population in the small intestine can lead to steateorrhea and

hence retards fat absorption. Excess utilization of Vitamin B can result in Anemia.

Vegaudeerana, Vegadharana and Maanasika factors influences the intestinal

motility and hence the bacterial flora. Amino acids, proteins, Vitamin B are essentials of

myelination, thus deficiency of this factors may happen during the hypo/hyper reflexes,

Vitamin K deficiency leads to Hemorrhagic tendencies and even the calcium absorption

which is responsible for healthy activity of nervous system and get hampered and may

results in Ardita.


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Excess exercise and excess indulge in sex-

There will be either Pratiloma or Vilomakshaya that manifests Rakta kshaya,

leading to pathogeneses and thus Ardita.

Vyasana–

Madya and Kramuka with their vyavayi and vikashi properties may influence the

blood and nervous system and hence develop Ardita. Cigarette smoking, Tobacco

chewing are the major factors that leads to cerebral vascular accidents irrespective of sex.

They may generate vascular changes (Atherosclerosis / Arteriosclerosis) and these factors

may also influence neurotransmitter release and produces ill effects.

Excess loss of tissues, decrease of Rakta-

“Sheeryate iti Shareeram” and “Dahyate iti Deham” are indicative of the

degenerative phenomenon of the tissues. Sharangadhara elaborated this aspect with

relation to the age. The catabolic process is under the influences of Vata Dosha in other

words it imparts Rookshata to the tissues thus disintegrating the harmony of Homeostasis

– Vata Dosha facilitates Dhatukhaya and these people thus afflicted by this are vulnerable

for any disease process. Sushruta emphasized this category under the aetiology, which is

unquestionable as Dhatu Kshaya includes the Rakta Kshaya and hence the Ardita.

Circadian rhythm w.s.r.to Nidana-

There is hyper excitation in the impulse propagation due to excess production of

neurotransmitters. Apart from this is a condition association with stress. Excess cortisol

level can change Homeostasis. Diwaswapna, Vyavaya, Adhwagamana,

Shirobharaharana, Teekshna madhya, Ativyayama, Prajagara and even we can consider

hypo or hyper states of hormones.


127

Role of emboli/thrombus/hemorrhage w.s.r.to Nidana-

Rakta Soshana results in deprivation of vascularity to the tissues and vital centers

that results in damage of the specific structures and deranges their integrity and

functional aspects and thus produces so many morbid states in our body. As evident from

the descriptions, Rakta Soshana is of significant value in the genesis of Ardita hence

some of the aspects of Rakta discussed below with special reference to Nidana.

Emboli- If the emboli migrates to the vital organs ceases the blood flow to the

respective organs and causes irreversible damage i.e., necrosis (cell death). If enters

the brain, deprivation of blood to the brain tissue leads to the necrosis and hence the

higher centers are affected produces paralytic stroke. If enters the lungs, the

capillaries surrounding alveoli (i.e., emboli leading to a block) interferes with the

gaseous exchange and poses threat to life.

Thrombus- May block the respective arteries and it leads to cessation of blood supply

to finer arterioles and hence vital centers. Aneurisms, varicosities and injury

(Abhighata) may also produce their ill effects over the vital centers.

Hemorrhage- Hypertension may lead to cerebral hemorrhage Absence of coagulatory

factors, vitamin C and Hagemen factor, Haemophilia, haemolytic aneamias,

leukaemia. Arteriosclerosis, atherosclerosis, where the deposition of calcium and

lipids thickens the walls of the arterioles. The major complication is

emboli/thrombus/hemorrhage in the case of Siravyadhana, Adhika asruksrava,

garbhini, sutika and Abhighata hence deserves attention.

Garbhini, sutika- In order to supply requirements to foetus the blood gets diluted and

there is excess haemo-dilution. Reduced levels of oxy-hemoglobin carriage may hamper


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O2 supply to higher centers thus producing paralytic stroke. Pregnant women may have

pre-eclamptic/eclamptic changes and the entities: Placenta praevia and abruptio placenta

are with hemorrhagic tendencies. Rh incompatibility does have a note over garbhini as it

may lead to haemolysis.

Sutika- During the third stage of labour if care is not taken there is a possibility of air

{Emboli} bubbles escaping into the circulation. Emboli may reach brain/alveoli/heart

tissue/finer ends of arterioles, which result in necrosis. If enters brain can cause paralytic

stroke. There is also a sudden variation in the haematocrit and Rh incompatibility

shouldn’t be over looked. As these people have already crossed the exhaustion which

may produce excess cortisol which drains away the calcium. Thus, these people are in

association with change in the haemo-dynamics may be prone to Ardita.

Role of calcium in Defense mechanism (w.r.s.t. Vranapaka & Rogati Karshna)-

Neutrophil gets sensitized after the injury and by means of vasodilatation,

margination, and emigration phagocytoze the bacteria. For the movement of actomycin a

filament of neutrophils (pseudopodial throwing) needs entry of calcium from extra

cellular fluid, to move inside the neutrophil.

For phagocytosis neutrophil needs IgG which stains the bacteria with opsonin

thus phagocytoze the bacteria. Extensive involvement of vrana may cause the excess loss

of ionic calcium and in the case of Rogati karshana there may be also over activity of

immune mechanism. Immune system if continuously provoked may lead to immuno-

suppression for eg in Tuberculosis, Leukaemia, Diabetes etc.

Prolonged cortisol levels can cause immuno-suppression. Diabetes as it is

associated with neuropathy, nephropathy and retinopathy. Alterations in the vascular


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mechanisms is pronounced in this category and are even susceptible for infection as

excess sugar levels in these individuals act as culture media are vulnerable to stress. HIV

and Tuberculosis are Immunosuppressive disorders. Alcohol abuses may interfere with

calcium absorption, Decrease in the ionic calcium levels may happen in Rogati karshana,

Vranapaka and Dhatu kshaya.

Density of the inspired air (w.r.s.to Raja, Dhuma, Asatmya gandha)-

If the density of the inspired air is high, the resistance to flow increases.

The buffering ability of C.S.F is very low than that of blood due to its less protein

content. Entry of small amount of CO2 can cause fall of pH of C.S.F and onset of

respiratory stimulation is relevant, in the case of Dhuma, Raja, Asatmya gandha.

Hyper ventilation- Severe voluntary hyperventilation can lead to temporary apnea, the

drive for respiration disappears i.e., and CO2 is a stimulant to respiration. It may happen

in the case of Uchhairbhashana, Ati hasya, Vyayama, Adhwagamana, Vyavaya, which

may account for hyper-sensitization of nervous system, is indicative of hypoxia may

bring ill effects.

Lung Perfusion (w.s.r.to Posture)-

In the erect posture, the apex of the lung has a poor blood supply, that is,

perfusion in the apex is poor, and where as perfusion in the basal region of lung is

excellent. It may happen in the case of Adhwagamana, Shirobharaharana prajagara.

Lung irritant receptors (Hering Breuer Reflex) w.s.r to Nidana-

Lung irritant receptors are those that response to the stretches in the bronchus

accounts for alteration of respiration. The afferent impulses from these receptors are

carried by vagal afferent fibers.


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In the initial phase of cough, there is a catch (an inspiratory catch) followed by

violent expiratory effort with the glottis closed. At this phase the intra-pleural pressure

raises tremendously and the alveoli have to with stand tremendous pressure. This is

followed by actual expiration of the air with a very high velocity.

During cough, owing to great rise of intra-pleural pressure veins are severely

compressed leads to cessation of blood flow through them, no cardiac inflow, no cardiac

out put leads to cerebral ischemia the brain cannot with stand prolonged attack of assaults

of anoxia/ischemia for say more than 20 seconds.

It may be of relevance in the case of Kshawathu, Jrumbha as sneezing is also due

to the irritation of lung irritant receptors, which carries afferent impulses via vagus.

Dhatu Kshaya/Rogati karshana (w.s.r.to Fat of epineurium)-

The epineurium contains fat, which cushions nerve fibers; loss of this fat in

bedridden patients can lead to pressure on nerve fibers and paralysis.

Electrolyte imbalance (w.s.r.to Adhika Dosha sravana) –

Severe diarrhoea and severe vomiting are going to cause the pH variations.

• In diarrhoea :

Huge amount of bicarbonate rich fluid is lost and there is no time for the

absorption of pancreatic juice and ultimately results in acidosis.

• In vomiting :

Severe vomiting is always with excess loss of hydrogen ions from the gastric

juice and may cause alkalosis. It may be true with respect to “Adhika Dosha

sravana.”


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Limbic system & Stress (w.s.r. to Manasika factors) –

Maanasika Factors / Ailment

Stress

Hypothalamo – Pitutary – Adrenal axis

A.C.T.H, A.D.H and Thyroxine

Absorption of Calcium from gut

Cortisol – Sodium retention

Renal absorption of Calcium

Expansion of E.C. F

Hyper Voluemia

Hypertension

It helps adrenaline and nor adrenaline

Vasospasm

Decreased blood supply to vital organs

May result in Ardita

Cortisol even affects mood and behavior and produces other systemic effects also.

Calcium is responsible for propagation of impulses by influencing Neurotransmitters.

A.C.T.H. = Adreno corticotropic Hormone, A.D.H. = Anti Diuretic Hormone.

E.C.F. = Extra cellular Fluid.


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Limbic system is the areas of the brain whose activities produce various

emotional changes. Deep-seated anger, bitterness, which is common in modern life,

stimulates gastric secretion. Anxieties do have the similar note. Excitement causes faster

rate of emptying but fear inhibits it. Sobbing (Rodana) which is associated with a typical

respiratory pattern occurs during grief. Kama, Krodha, Chinta, Dhukka and Bhaya may

also influence the Limbic system and change the healthy neuronal activities.

Stress-

Acute stress is associated with excess secretion of cortisol from adrenal cortex

and may disturb internal environment

Ama in the pathogenesis of Ardita-

The prime entity for the disease genesis i.e., Ama is the resultant of hypo

functioning of Agni. This can be related to that of Xenobiotics, free radicals, toxins

produced out of metabolism i.e., cellular toxins which may lead to the derangements in

the healthy cellular structural and functional integrations thus disturbs the harmony of the

homeostatic mechanism and brings out morbidity.

Ama w.s.r to nervous system

Folic acid, vitamin B12 and calcium absorption is at the level of gastrointestinal tract.

(G.I.T) Intrinsic factor is responsible for the absorption B12. Cell division is under the

influence of vitamin B12.

The amino acids, which constitute the muscle tissue, are also derived from G.I.T.

healthy muscles maintain the better vesicles at the axonal end plates which in turn

lodges the calcium and neurotransmitter.


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Abnormal collection of various proteins and fat droplets commonly seen in

perikaryon either represent reserve material or are a product of normal or pathological

metabolism.

Ageing neurons contain a pigment lipofusin (made up of residual bodies derived from

lysosomes).

A spiral space through which perineural space communicates with periaxonal space,

which provides a path for passage of substances into the myelin sheath and axon,

from the space around the nerve fiber, is called Incisures of Schmidt Lanterman.

Further the gap between neurilemma and axolemma communicates with extra cellular

fluid.

Any interference to the above structures, which diminishes the functional and

structural aspects, can be considered as Ama. Action potentials are generated from the

initial segment i.e., axon hillock, which is rich in voltage sensitive channels. Any

deviations from normalcy may be considered as Ama.

Role of Pakwashaya in Ardita-

The basic factor responsible for myelination, sphingomyelin a phospholipids is

derived from the G.I.T.

Chemically erythropoietin is a glycoprotein hormone and depends on G.I.T. for its

synthesis.

Vitamin K, which is responsible for coagulation is synthesized from the gut that

plays a vital role in the haemostatic phenomenon.


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The oxyntric cells of the gastric glands secrete intrinsic factor. It combines with

extrinsic factor vitamin B12 and the combined material is absorbed, from the

lower part of small intestine.

Vitamin B12 is essential for cell division and erythropoiesis.

Folic acid, iron, vitamin B12, vitamin C and calcium are the prerequisites for an

effective erythropoiesis that in turn potentiates the functional aspects of blood are

derived from G.I.T. only.

Primitive factors essential for bone and marrow formation are also dependent on

G.I.T.

Amino acids constitute muscles can provide abundant vesicles over their axon end

plates which can accommodate calcium and neurotransmitters in their norms

which is the basic requirement for healthy conductivity.

Mal-absorption, Ama and other barriers hamper the production of basic essentials

of life.

Osmolarity, tonicity, pH variances, nature of food, quantity, quality and emotional

factors do play an effective part over the G.I.T. i.e., change in the homeostatic

mechanisms interfere with the functional and physiological aspects of G.I.T.

Anxiety, depression and other psychological factors do have a note over the G.I.T.

vago-vagal reflex is the indicative of inter-relationship between gut and nervous

system.


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Role of Asthi as seat of Vata in Ardita-

Calcium plays a vital role in the neuronal conductivity i.e., the impulse

propagation is under the influences of calcium, which is in turn dependent on

Asthi, for its synthesis, which governs the movement.

A chief source of calcium is bone and hence is the important factor, which

maintains the normal serum calcium levels. Vitamin D, have a role in this process.

Dry leafy vegetables are the poor sources of calcium hence Acharyas illustrated

Rookshahara under aetiological factors.

Role of Majja as seat of Vata in Ardita-

Bone marrow is the source of erythropoiesis, which is also having a control over

the immunity as it is generating W.B.C.

Vitamin B12 stimulates erythropoiesis

In severe intensity of hypoxia, the yellow bone marrow gets converted into red

bone marrow and starts generating R.B.C i.e., erythropoiesis. This is indicative of

connection between Pranavata and blood. Further, if the erythropoiesis is

inadequate spleen and liver starts generating R.B.C which are in turn dependent

on G.I.T. for their primitive requirements.

Liver contains about 2mg of vitamin B12 another 2 mg of vitamin B12 present in

the rest of the body chiefly bone marrow. The requirement of vitamin B12 and

folic acid rises sharply in pregnancy and deficiency produces a block of

metabolism of folic acid, which reflects in erythropoiesis.

Increased erythropoiesis may occur during Garbhini, Vyayama, Adhwagamana,

Adhika Rakta srava, Raka Kshaya, Vranapaka, Rogati karshana and Sutika.


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c) Discussion on Symptomotology & prognosis-

Ardita (Facial Paralysis) is a Vataja Nanamataja Vyadhi elaborated in the texts.

As per Charaka it is in association with Pakhaghata whereas other Acharyas are of the

opinion that Ardita afflicts Mukhardha (half of the face). Bhela illustrated Asthi Majja

gata vata, which includes Apasmara, Unmada, Hanugraha, Kuni, Kubja, Pangutwa,

Sandhi vichyuti, Kampa, Gatra sosha and Ardita. Here Ardita, Apasmara, Unmada should

not be merely considered as the diseases of the cranial Vault (i.e. brain considered as

Majja present within the skull). The pathogenesis of any vyadhi i.e., Nija is either from

Amashaya or pakwashaya Hence, Ardita though it’s Adhistana is Shiras originates from

pakwashaya as per the rule, Vata Vyadhi genesis is from Pakwashaya as per Acharya

Charaka. The treatment principle of Unmada and Apasmara is also suggestive of this.

Thus, the disease Ardita needs a multi dimensional approach for its better understanding

and evaluation in order to proceed for the management.

Upper motor neuron lesions and lower motor neuron lesions can lead to facial

paralysis. Bell’s palsy, which is the commonest form of facial paralysis, is due to non-

suppurative inflammation of facial nerve within its canal i.e., peripheral facial paralysis is

of unknown etiology.

Thrombosis, embolism and hemorrhage can result in a paralytic shock, which

results in Ardita in association with Pakshaghata. Multiple sclerosis, hemi facial spasm

and facial myokymia do have a relevance to the context.

Hypertension, increased glucose tolerance can manifest facial paralysis due to

their atherotic changes and in case of neuropathies the vascular concern can even pose a

threat of facial paralysis. Bilateral facial palsy is of minimal incidence.


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Horripulation– it is a very important tool of thermoregulation, which is the resultant of

posterior hypothalamus stimulation. This mechanism helps to preserve the body

temperature by reinforcing the thermal insulation of the shell (internal structures), when

the temperature is about 23° C shivering manifests.

Vepanam, Romaharsha, Twachiswapa, Vayuroordhwa may be indicative of

thermoregulatory changes. Apart from this even internal structures are under the

modulations of temperatures. Sheetaanna, teekshana Madhya, Ama sanchaya may does

some thermomodulation. Vranapaka may be associated with hyperemia and with

vasodilation, which may cause variations in temperature. Ati Dosha sravana, ati asruk

sravana, siravyadhana, rogati karshana may be in associations with thermal changes.

Transmigrations of sensations or impulses may be assumed as vayururdhwam.

Thirst (Trushna) is because of the hyper-osmolarity of the plasma and mental confusion

(Smruti Moha) is out of shrinkage of intracellular fluid of brain cells. This may be due to

the thermal modulation or due to adhika rookshahara Vihara Nidana and fewer intakes of

liquids.

Transneuronal degeneration- The degenerative change is not confined to the injured

neuron only but extends to other neurons too. The etiological factors may lead to the

trans-neuronal degeneration and ultimately affecting the higher centers.

Smrutimoha (memory loss/amnesia) - Mechanism of memory is through the development

of new neuronal circuits i.e., formation of new synapses. Specific or concerned

neurotransmitter is repeatedly secreted which ultimately results in consolidation. If the

synapse stays for long time, then it is long-term memory. If the synapse disappears within


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a short time, then it is called short-term memory. As Smruti Moha the symptom of Ardita

is indicative of disturbances in the neuronal activity.

Comparison between Trigeminal neuralgia in contemporary system (Brains

Pg106) with special reference to Ardita-

In an attack of trigeminal neuralgia pain is usually confined to part of the region

supplied by the affected division. Thus it may be most marked in the fore head, cheek,

the upper or lower jaw, or the tongue. A striking feature of it are the attacks tend to be

precipitated by chill, by touching the face as in washing and shaving, by talking,

mastication and swallowing.

Many patients describe trigger zones touching of which invariably excites an

attack. The attacks are always brief and do not last longer than one or two minutes. The

pain is very severe and the patient is in agony. The pain often evokes a reflex spasm of

the facial muscles on the affected side, hence the term ‘tic douloureux’.

Flushing of the skin, lacrimation and salivation may also occur. In trigeminal

neuralgia there is usually no reduction of sensibility but minimal blunting of touch or a

diminished corneal reflex is rarely found. The attacks may interfere with eating, and the

recurrence of severe pain over a long period may cause loss of weight, depression and

even suicide.

Fortunately the attacks usually cease at night, though they some times awaken the

patient from sleep. Long remissions of pain, lasting weeks or months, are the rule in early

stages. 217

A comparison is made from the above information out of academic interest with

relation to the aetiology and symptomatology of Ardita (various authors).


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Etiology– Jihwa nirlekhana, karma, netra, nasa vigharashana, karadi, atiprabhashana, ati

hasya, katina Ahara, jrumbha, vishamopachara, vishama shayana, plavana, untrasavaktra,

kshavathu, vyayama, vyavaya, vichestita and abhighata are suggestive, of ‘trigger zones’.

Symptomatology– Vagbhata – smrutimoha, trasahasuptasya, nisthevaha parshwa yana

(salivation), teevra jatrurdhwa ruja may fall under above category.

Yogaratnakara – Lalasrava, vyatha, sphuranam, ostaswayathu, shula, moha, dhoopathe,

may be suggestive of facial palsy in association with trigeminal neuralgia.

Susruta– Chibuka parshwa vedana, danta parswavedana, greeva parshwa vedana, netradi

vikriti (may be diminished corneal reflex)

Hareeta– Vedanatura, Visanjna, Greeva parshwa vedana, Danta parshwa vedana,

Gandayoh vedana.

Charaka– Ardha mukha sankocha, gandaruk, shankha ruk

Episodic nature of facial paralysis– Recurrent idiopathic facial palsy is rare. It may occur

first on one side and a year or two later on the other, and very occasionally develops

simultaneously on the two sides.

A recurrent form of facial palsy associated with paroxysmal headache is termed as

facioplegic migraine.

Sadhya – Asadhyata-

Lesions of neurapraxial type account for rapid recovery. More than 50% of cases

of Bell’s palsy recover completely and may take months. Factors associated with poorer

prognosis than average include hyperacusis, diminished lacrimation, and an age greater

than 60 years, diabetes mellitus and hypertension.


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If, at the end of three weeks from the onset there is some return of voluntary

power in the face, recovery is rapid.

As observed in accordance with contemporary medicine, the Ayurvedic sadhya –

asadhya lakshanas, which were illustrated, are of relevance i.e., duration more than 3

years and ksheena (debilitated) in general vata rogas in vardhakya are difficult to cure.

2) Discussion on probable mode of action and efficacy of the drug.

Mode of action of Shirovasthi-

Dhanwantaram Taila as shirovasthi will penentrate the skin and by virtue of its

Medicinal properties corrects the vitiated Pranavata, thus nullifies the Samprapti and

account for remission of Ardita. It acts as vatahara, balya, santarpana and nourishes the

exhausted tissues. It is presumed to instigate the reflex stimulation of branches of facial

nerve and leads to better neuronal activity.

Temperature effect of Shirovasthi- Internal environment acclimatizes to the external

environment by means of various regulatory mechanisms, which accounts for the

homeostasis. The uniform temperature of this procedure may stimulate the receptors and

brings out vasodilatation by the release of bradykinin a neurotransmitter from the

cutaneous parasympathetic nerve endings.

The hyperemia, out come of Vaso-dilation will improve the peripheral circulation

by which, it may even nourish the tissues, which are deprived of it, hence directly

activates the respected branches of facial nerve. The neurotransmitters released during

this period improve the afferent and efferent pathways and eventually the tonicity of

muscles affected get improved.


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Astrocytes– Inflammatory mechanism can be better counteracted as the vasodilation may

hasten the phagocytosis of the diseased tissue and brings out regenerative changes by

stimulating astrocytes.

Schwann cells – Healthy synaptic impulses can get activated which influence the

Schwann cells and thus, remyelination.

Medicinal properties– As the Dhanwantaram Taila is a rich source of lipids and is having

anabolic activity can account for the regeneration of nerve fibres (remyelination as nerve

fibers contain myelin which is out of protein and lipid base).

Electrophoresis (w.s.r.to Kala & sodium absorption) - The saindhava lavana present in

the compound can instigate the sodium potassium A.T.Pase which is responsible for the

generation potential thus improving the neurotransmitter pathway.

It is presumed that, superior saggital sinus of cerebro vascular system has an

advantage of epiploic arteries Trans-dermal entry of the contents of Shirovasthi will enter

these arteries and later into circulation. On saturation and after crossing the Blood Brain

Barier the trans-membranal and transcranial exudation, diffusion or, and passage of

snigdha, sookshma Shirovasthi dravya may be possible.

Gap substance– Shirovasthi may enhance the proper conduction of nutrients and ions by

instigating gap substance can even influence axon hillock for generation of impulses.

Centrifugal flow– By the flow of protein i.e., through axonal flow the regeneration of the

nerve fiber is possible. The axonal flow is slow in nature, this may be the reason

shirovasti is advocated for 7 days in order to facilitate the proper nourishment to the

injure nerve.


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Salivation– The salivary nucleus (superior and inferior) is close to the vomiting and

respiratory centres. As per the lala srava is concerned Shirovasthi may activate electrical

or chemical impulses in higher centers by virtue of its receptor stimulation and maintains

the proper firing i.e., salivary nucleus is supplied by facial nerve and its stimulation

through Shirovasthi will produce salivation.

Generation of New synapses – Neural activity provides a stimulus for the development of

new synapses and for increase in their size as evident from the experiments, especially

true in areas like the hippocampus and is associated with memory. Hence, the symptom

smruti moha can be better managed by this procedure.

Pressure effect (threshold) – When a threshold stimulus is applied to a nerve fiber, the

fiber develops an action potential, which propagates onwards without any reduction of its

amplitude until it reaches the end of the fiber. Thus, Shirovasthi may act as a threshold in

the genesis of impulse.

Circadian rhythm with relation to Procedural effect– As the procedure do carry an affect

is evident from the previous works may account for regression of the symptomatology

and Shirovasthi may reduce the influences of glucocorticoids and thus regulates the

circadian rhythm which may nullify the Pathology.

Pineal gland– It can initiate the pineal gland and thus maintains the neurotransmitter

levels in a normal range.

Limbic system– As the emotions and moods of individuals are under the influence of

limbic system. The procedure Shirovasthi may counteract the ill effects of these

psychological factors.

Stress - It can even win over cortisol by effectively managing the stress.


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“Manas” is under the influence of Vata and is responsible for proper cognition

and providing conducive environment through Shirovasthi can effectively control

function of indriyas. Repeated synoptic activity can have long lasting effects on the

receptor neuron including the structural changes by the formation of new synapses.

Discussion on Avarthita Dhanwantaram Taila (101)-

Mode of action–

The major component of the cell membrane is phospholipids and acts as a

selectively permeable membrane, any substance which is a lipid soluble can pass through

the membrane, thus the Avartita caps when given internally gets digested in the stomach

and by virtue of its sukshma guna the medicated oil can enter even the subtle structures as

it is lipid soluble. Act at the levels of astrocytes, schwann cells, axon hillock and

Incisures of Schmidt Lanterman, by disintegrating the Ama thus facilitates the drug

action.

As the sphingomyelin is the primitive phospholipids for myelin formation, the

present drug that is of lipid base may even bring out remyelination. It may govern the

healthy generation of impulses with conducive release of neurotransmitters thus may

maintain the neuronal activity. The anabolic ingredients of this preparation may win over

the Samprapti. It can act by means of facilitated diffusion, active transport and transport

of proteins.

Tila Taila is having unique property of nourishing the emaciated and depleting the

obese. Cow’s milk that is another major ingredient is having qualities similar to that of

Ojus. It is also a rich source of calcium and having the Jeevaniya and Rasayana

properties.


144

Rakta Dhatu denotes life and cow’s milk is also termed as life (jeevana) hence,

can fulfil the requirements needed for the soshita Rakta Dhatu. It also contains vitamin C,

Iron, folic acid and vitamin B12 the essential factors for erythropoiesis. Thus the drug as a

whole may take control over the disease Ardita and results for its regression.

Drug efficacy over symptoms-

It is a challenging task to evaluate the efficacy of a compound preparation it

should be affirmed by subjecting it to repeated clinical trails or we should rely on “Phala

Sruti” of the preparation, as it is the confirmation of our Aptas.

As per the rule a drug acts either by virtue of its Rasa /Guna / Veerya/ Vipaka/

Prabhava and some drugs are Vichitra Pratyarbdha thus; it becomes a difficult task to

judge the exact mode of action. Hence the probable mode of action is postulated here.

Tila Taila is having a unique property of inheriting the qualities of drugs and thus

acquires the qualities of drugs and thus potentates the drug action. Further Taila is a rich

source of amino acids thus takes care of myelin, which is out of amino acids

(Sphingomyelin). Taila is the drug of choice for Vata ailments as it depletes the obese

and nourishes the emaciated.

Bilva is stated as panduhara. Go-Dugdha is also having a say over erythropoesis

by virtue of its essential factors. Thus a better erythropoesis which takes care of other

tissues as Raktha is stated as Jeevana i.e. it will supply essential requirements O2,

nutrients etc to all the vital tissues.

Drug Bala is indicated in Rakta Pitta, Rakta dosha, pradara etc is indicative of its

action over Rakta Dhatu. And is the prime factor i.e Rakta Sosha is the prime factor

which is responsible for samprapti.


145

Tila Taila, gokshura, kulathha may bring out srotoshodhana thus regulates vata.

Dashamoola possess vedanastapaka properties apart from their Vata hara qualities, which

takes care of the symptoms.

Yava, Agaru by virtue of their Lekhana properties may drain away the unwanted

depositions in myelin. Kola by its guru, snigdha properties may take care of Dhatu

Kshaya.

Amalaki is stated as Bhagnasandanakrit, here it may be considered as the

regeneration of the neuron i.e. union of injured ends. Further Amalaki is a rich source of

Vitamin C, which is responsible for erythropoiesis and bestows the immunity too.

Saindhava lavana is Netryam and it can penentrate through cell membranes level

(Kala) and may help for the generation of healthy impulses. Madhuyasti, Shurpaparnya

are Medhya indicative of its action over higher centers i.e. memory is related with

hippocampus etc. thus it may instigate healthy neuronal activity.

Agaru, Tagara, Madhuyasti, Amalaki, Manjista are having effect over Akshi and

Karna Vikara which are afflicted in Ardita.

Vrishya drugs are indicative of their capability to bring out cell division i.e. they

generate the healthier tissues i.e. nothing but regeneration. Here these may account for

generation of healthy Vascular and nervous tissues and erythropoeises by means of their

ability to regenerate.

Further the drugs of this compound preparation are having Dhatu Vardhaka,

Rasayana, Vedanashamaka, Balya, Vrysa, Deepana, Vatahara, Shoolahara properties may

take care of Ardita.


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3) Discussion on Demographic Data-

Role of Age and Gender-

The Physiological variation of Dosha with age is of significant value as it is

indicative of prognosis Relevancy of age and gender is discussed here by both groups.

Maximum numbers of patients are in 55to65 age group, which is suggestive of influence

of Vatadosha and the disease being age related as evident from the explanations in

Brain’s Diseases of the Nervous system. Probability of this incidence may be the

deposition of unwanted lipids and proteins in the ageing neurons and the regeneration

capacity of nerves are also dependent on age and there may be Arteriosclerotic

/Atherosclerotic changes that deprive the tissues off nutrition in this trail out of 30

patients 60% are male and 40% are female. Both age groups and gender is indicative of

the extent of exposure to the etiological factors also.

Role of Religion-

Increased dominance of Hindus in this particular area is the reason for maximum

number of Hindu patient in this study.

Role of Occupation-

Out of 30 patients 43.33% were active and 40% were labor and 16.66% are of

sedentary. As the manual workers and active group are with vitiations of Vata and are

frequently exposed to the etiological factors thus susceptible for Ardita. Peripheral facial

paralysis i.e. Bell’s palsy is under the climatic influences.

Role of Economical status-

As poor people tend to have imbalanced diet they are prone to diseases as diet do

have a note over disease progression and regression. In this study 40% patients fall under


147

poor category that is indicative of the importance of balanced diet as it maintains the

healthy status of all the tissues, in particular blood and nervous tissue.

Role of Diet-

Out of 30 patients observed 60% patients were vegetarians and 40% patients were

of mixed diet habits. At the observation it is noted that the vegetarians restoration is more

in comparison to that of mixed diet people. The probable reason for this may be drug

action is dependent on pH levels, as mixed diet category may be with pH variations

because of their high protein diet and thus the drug action.

Role of Ahara Nidana-

Most of the patients are exposed to the Ahara and Vihara Nidana which is

indicative of the extent of Vata vitiation and deprivation of nutrients to the vital tissues

and myelination as the Nidana influences the formation of primitive factor’s essential for

the formation of respective Dhatu. This disease afflicts the face, which represents

external beauty, thus the afflicted with draws from duties i.e. is a major cosmetic and

Psychological concern and prolonged stress by thinking of the ailment may change

Homeostasis of the diseased and terminates as a Psychosomatic entity too.

Role of Onset-

Most of the afflicted fall under acute on set i.e. 23 (76.67%), which is suggestive

of the disease relation towards season as more number of patients witnessed during

winter season.


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Side effected-

In this study it was observed with respect to side affected 63.33% are right and

36.67% are left. It may be due to Adhomukha Kurma Nadi situated right side in males

and the cases enrolled do shows more number of males affliction.

Role of Vyasana-

In this trail betel nut usage, Cigarette smoking and tobacco chewing along with

alcohol abuses are noticed as they are not good for bone, heart, lungs and blood vessels.

It is indicative of the extent of vascular, neuronal changes and their impact over healthy

tissues.

Role of Prakruti-

Prakruti is of significance as it is in association with prognosis and effectiveness

of the treatment adopted. 17 (56.67%) patients fall under Vatapitta category. As the

catabolic phenomenon is pronounced in these individuals there may be Dhatu Kshaya in

turn Rakta Kshaya, which is the reason for Ardita. Vyadhi Kshamatwa is also under the

influences of Prakruti.

4) Discussion on statistical Result-

i) Statistical analysis of Subjective parameters in Ardita Vata (Facial Paralysis) – Group-

1 (Dhanwantaram Taila 101 Avartita caps internally)

The statistical analysis was done by applying paired t-test in order to know the

efficacy of the drug both internally and externally before and after treatment.


149

In group1 except the parameters vertigo and hyperacusis shows highly significant

(by comparing p-values) the parameter HB% shows less highly significant than other

parameters (by comparing p-values).

The parameter Ayurvedic Health Assessment criteria and mouth angle deviation

shows most highly significant, where as the parameters closure of the eye effected,

wrinkles on forehead and asru srava shows equally highly significant (by comparing t-

values). The parameter Ayurvedic Health Assessment shows more net mean effect with

more variation, where as the parameter HB% shows less mean effect with less variation

(by comparing mean and S.D).

ii) Statistical analysis of Subjective parameters in Ardita Vata (Facial Paralysis) – Group-

2 (Dhanwantaram Taila Shirovasthi)

In group2 except the parameters HB%, hearing and vertigo all the parameters

shows highly significant (by comparing P-value) except in parameter vertigo all other

parameters shows most highly significant (by comparing p-values).

The parameter Ayurvedic Health Assessment, shoka and chinta shows most

highly significant (by comparing t-values). The parameter Ayurvedic Health Assessment

shows more net mean effect, the ability to spit with more variation. The parameter HB%

shows less net mean effect with less variation. There is a zero variation parameter bhaya

(by comparing mean and S.D). In group2 the parameters Ayurvedic Health Assessment,

shoka, chinta, dhukka and krodha shows more highly significant than group 1 (by

comparing t-value and p-value).


150

iii) Inter group comparison of Statistical analysis in Group 1and Group 2

To compare mean effect of two groups using unpaired t- test carries out the

analysis. The respective parametric analysis is as follows. Here except the parameters

mouth angle deviation, closure of the eye effected, deviation of the jaw, vaksanga, asru

srava, facial expression, whistling, ability to masticate and nasa vakrata shows not

significant i.e., the mean effect of the two groups is not same in the above mentioned

parameters (by comparing p-value). The mean effect of parameter Ayurvedic Health

Assessment is more in-group 2 than in group1, but group 1 shows more variation after the

treatment.






group 1 than group 2 after the treatment (by comparing mean).




d) Conclusion on Discussion

• All the primitive factors are derived from the chief source i.e., food.

• A healthy environment of G.I.T is necessary for a better tissue growth.


151

• The etiology is indicative of involvement of metabolic, vascular, neuronal,

thermoregulatory, hormonal, coagulatory, qualititative and quantitive aspects of

blood, and its applied aspects. (Emboli/ thrombus/haemorrage etc.)

• Blood is the life, as it carries out vital functions.

• Nervous system is responsible for a conducive environment by their neuronal

activities.

• Manasika factors are in direct association with limbic system and can influence

the internal environment.

• Stress is the important entity that should not be neglected.

• Homeostasis is the mechanism that influences the acclimatization to external

stress and strain.

• Immuno-suppression and coagulatory factors should not be overlooked.

• It is evident as per the discussion that Ardita a Vata nanatmaja Vyadhi originates

from Pakwashaya.

• Shiro mundana should be done prior to the procedure Shirovasti. As it is a

cosmetic concern patient may not cooperate.

• A skilled physician always should conduct Shirovasti procedure.

• Bhela considered Ardita amongst Asthi Majja gata Vata, is also having relevance.


152

Limitations of the study

• The sample size was small

• The study period of study was limited.

• Do not have the facility of C.T. Scan and M.R.I. to Asses the extent of vascular

impairments.

• Do not have the facility of electro myography and Nerve conduction test.

Future scope for the further study

Same study can be repeated by taking a large number of samples and for longer

duration with a combined approach along with nerve conduction and electro

myography.

Rakta Vasti (as it is of ethical concern blood should be collected from

slaughterhouses. No animal should be sacrificed for the sake of study) along with

Dadimadi gharita internally.

Haematenic preparations internally along with medicated Vata hara gritha and

Dashamoola as a Ksheeravasti can be studied.

Madhu Tailika Vasti/ Raja Yapana Vasti /Medicated ghrita as Vasti and with

haematenic preparations with navaneeta internally can be studied.

MahaNarayana / Mahamasha / Dhanwantaram Taila as Vasti and Drakshavalekhya /

Ayaskruti / Navayasa Loha internally can be studied.


153

Chapter – 7 Conclusion

Ardita, a Vataja Nanatmaja Vyadhi having its adhistana in Shiras affects the

Indriyas depriving their functional aspects and makes the afflicted crippled and disabled

thus the healthier years of life are lost leaving the diseased in agony and affects the inter-

personal relationships, there by economical condition of a family and lastly having a note

over economy of country. It is considered one between the Asthi Majja gata Vata and

Pranavata vitiation do manifests Ardita.

Ardita resembles in close proximity with the pathology of the 7th cranial nerve i.e.

facial nerve. It is of multi faceted etiology ranging from metabolic to idiopathic. Cerebro-

vascular diseases, trauma, infections, space occupying lesions are some of the factors

which should not be neglected. Apart from this thermoregulatory, excess receptor

instigation, hypoxial tendencies, pH variations, Emboli, Thrombus and Hemorrhage and

quantitative and qualitative disfigurements of blood, absence of coagulatory factors,

Vitamin deficiencies etc are of relevance towards this entity. It is evident from Samprapti

which stresses on role of Vata and Rakta Dhatu i.e. Rakta Soshana in the genesis of

Ardita.

“Vatam Snehena Mitravat” is the quotation that reminds us about the supremacy

of sneha Dravya in the treatment aspects of Vata Vyadhi and is true in Ardita too.

Depending on adhistana various modes of administration of Sneha is explained in our

classics. Shirovasthi, which is superior amongst Moordhini Taila, suits Ardita as per its

adhistana.

Dhanwantaram Taila in Ardita A comparative clinical study –Conclusion

154

Dhanwantaram Taila, which is elaborated in Astanga Hrudya, Shareerastana, is

the pick in this study as it is indicated in all the Vata Vyadhi. The trail drug is studied as

an internal mediaction and as well as a procedure over 30 patients of Ardita equally

distributed in two groups.

For internal use Avartita Dhanwantaram Taila (101) cap’s i.e. 2 T.D.S. for 14

days (Gr-1) and for external use Dhanwantaram Taila as shirovasthi i.e. for 7 days (Gr-2)

are selected.

The results are grouped under three categories viz. “Marked Restoration”,

“Moderate Restoration” and “Poor Restoration” depending on the remission of the

symptomatology. The result declaration is based on the norms and conditions of the

inclusion criteria and study of the subjective parameters in association with objective

parameters. After thorough study of entire parameters available for the assessment, result

was drawn. And the results of Group-1 are 53.3% markedly restored and 46.67% are

Moderately Restored. In Group-2 20% falls under Marked Restoration, 73.33% are

Moderately Restored and 6.67% is of Poor Restoration.

To compare mean effect of two groups using unpaired t- test carries out the

analysis. The respective parametric analysis is as follows. Here except the parameters

mouth angle deviation, closure of the eye effected, deviation of the jaw, vaksanga, asru

srava, facial expression, whistling, ability to masticate and nasa vakrata shows not

significant i.e., the mean effect of the two groups is not same in the above mentioned

parameters (by comparing p-value). The mean effect of parameter Ayurvedic Health

Assessment is more in-group 2 than in group1, but group 1 shows more variation after the

treatment.


155






group 1 than group 2 after the treatment (by comparing mean).




This is fairly concluded in the evaluation of the Dhanwantaram Taila capsules

(Group-1) is that the medicament chosen for the study yields a better result to pacify the

Ardita Vata in a stipulated fourteen days period is a chance of 53.33%, which is in record

as marked restoration.

On the other hand where a procedure with the Dhanwantaram Taila (Group-2) is

evaluated with chosen procedure for the study yields a better result to pacify the Ardita

Vata in a stipulated seven days period is a chance of 20%, which is in record as marked

restoration.

When a comparative study is made for the inter group it is revealed that the mouth

angle deviation, closure of the eye effected and the deviation of the jaw, which are

symptoms of the Ardita have high significance of statistical evaluation. Where as the

Ardita is not having any significance for the chosen objective parameters such as E.S.R.

and Hb%. The over all significance of the study as par statistical purview is high

significant p value.


156

Chapter – 8 Summary

Vata is the prime entity, which is the governor of motor and sensory functions, is

involved in the Pathogenesis of Ardita (close proximity to that of 7th cranial

nerve affliction i.e. facial paralysis).

Though Ardita is a vataja nanatmaja vyadhi, the involvement of other two doshas

is even evident. Vata-Pitta, Vata-Kapha, and Vata prakruti individuals are

vulnerable to this ailment. Though Adhistana of Ardita is Shiras its origin is from

Pakwashaya as all the primitive factors responsible for blood and Nervous tissue

are derived from it.

Pranavata and Udanavata are presumed as higher centers and motor nuclei of

cranial nerves respectively.

Rakta Kshaya is the factor that accounts for decreased blood supply to the tissues

and deprivation of its supply poses an irreversible damage to the vital tissues.

Dhatu Kshaya can be compared as a demylenating entity with special reference

to nervous tissue. Dhanwantaram Taila is having a telling effect over the Ardita

as it acts as a foster i.e. presumed as a remyelenating entity.

Ama can be considered as xenobiotics, free radicals metabolic or cellular toxins

that harm the healthy tissues.

Seasons, Diabetes Mellitus, Hypertension, and Atherosclerosis are having a

reason towards Ardita.

Dhanwantaram Taila in Ardita A comparative clinical study –Summary

157

Nervous tissue is of minimal regeneration capacity that is dependent on

approximation of injured nerves, extent of injury and on age.

As there is evidence of inflammation of facial nerve, the hyperemia, which is an

out come of Shirovasthi, will take care of infection and inflammation as the

increase in neutrophilic activity can speed up recovery.

As per present day scenario, stress is directly proportional to the disease. And

Shirovasthi is inversely proportional to both stress and disease.

Shirovasthi acts as a vasodilator by virtue of its receptor stimulation there by

maintains adequate circulation through which nervous tissues are benefited from

the long deprivation of nutrients.

Shirovasthi, by means of its reflex stimulation of facial nerve increases its

activity, thus restores the tone and strength of facial nerve.

Shirovasthi may stimulate the pineal body and it may keep melatonin and

seratonin levels in their norms. It may regulate the dopaminergic activity there by

brings mental tranquility.

Role of Shirovasthi a procedure par excellence i.e. Uttama to the structure par

excellence Shiras i.e. Uttamanga is having a say over Ardita. It may act as a

neuro-guard (i.e. protector of nerves) as well as a stress guard (i.e. protects

individuals from the ill effects of stress).

Bhela elucidated Ardita under Asthi Majja gata Vata which is indicative of it’s

inter relation with Pakwashaya and hence it should not be merely considered as

an entity of cranial vault (i.e., Brain is considered as Majja)


158

Most of the drugs of Dhanwantaram Taila are anabolic by their qualities. Thus,

can oppose the catabolic effects of vitiated Vata and may bring homeostasis, by

means of which an equilibrium state is attained i.e. health.

A fair conclusion in the evaluation of the Dhanwantaram Taila capsules (Group-

1) in Ardita Vata in a stipulated fourteen days period is a chance of 53.33%,

which is in record as marked restoration.

On the other hand where a procedure with the Dhanwantaram Taila (Group-2) in

the Ardita Vata in a stipulated seven days period is a chance of 20%, which is in

record as marked restoration.

When a comparative study is made for the inter group it is revealed that the

mouth angle deviation, closure of the eye effected and the deviation of the jaw,

which are symptoms of the Ardita have high significance of statistical evaluation.

Where as the Ardita is not having any significance for the chosen objective

parameters such as E.S.R. and Hb%. The over all significance of the study as par

statistical purview is high significant p value.

Statistical analysis is carried out by using unpaired t- test. The respective

parametric analysis is as subjective high significance and objective parametric

non significance in the study.

To compare mean effect of two groups the analysis is carried out by using

unpaired t- test. The respective parametric analysis is as follows. Here except the

parameters mouth angle deviation , closure of the eye effected , deviation of the

jaw, vaksanga, asru srava, facial expression, whistling, ability to masticate and

nasa vakrata shows not significant i.e., the mean effect of the two groups is not


159

same in the above mentioned parameters (by comparing p-value). The mean

effect of parameter Ayurvedic Health Assessment is more in group 2 than in

group1, but group 1 shows more variation after the treatment.


effect after the treatment. In the group2, the parameters mouth angle deviation,

deviation of the jaw, wrinkles on forehead, vaksanga, lalasrava, asrusrava, facial

expression, mouth inflation, whistling, ability to spit and tounge deviation onm

protrution shows more mean effect than group 1 but the parameter ability to

masticate shown more mean effect in group 1 than group 2 after the treatment

(by comparing mean ).


chinta shows more mean effect in group1 after the treatment.In the parameters

bhru vakrata and vakra nasika shows more mean effect in group 2 after the

treatment.


160

Bibliographic References

1) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita sutra, 17/12, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, p.p 99.

2) Girirajadayal Shukla, Bhela Samhita Chikitsa, 24/44-99, 1st ed, 1959, Choukumbha

Vidyabhavan, Varanasi, pp

3) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Sutra, 13/8, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 79to80.

4) Ibid, 13/8, pp 79

5) Priyavat Sharma ed, Charaka Samhita, Sutra 12/8, Vol-1, 1st ed, Chaukhambha

Orientalia, Varanasi, 1981, pp 82. 6) Yadavji Trikamji Acharya, Susruta Samhita, Nidana1/68-72, 4th edition, Choukhamba

Orientalia, Varanasi, 1980, pp 267. 7) Michael Swash ed, Hutchison's Clinical Methods, Nervous System – 11th chapter; 21st

Edition, Harcourt publishers Ltd, London, 2002, pp 250. 8) Braun Wald et. Al. edited Harrison’s principles of internal medicine vol. 2 Mc Graw hill,

UK, 15th edition, 2003, pp-2326. 9) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita

Vimana, 6/3, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 252.

10) K.R. Shastri Navre, Astanga Hridaya Sutra, 12/1, edited by Hari Sadashiva Shastri Paradakara, Choukumbha Surabharati Prakashan, Varanasi, 2002, pp 192.

11) Girirajadayal Shukla, Bhela Samhita Chikitsa, 24/44-99, 1st ed, 1959, Choukumbha

Vidyabhavan, Varanasi, pp,

12) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Chikitsa, 28/59, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp.619.

13) Brahma Shankara Shastri, Yogaratnakara, Vata Vyadhi prakarna, Purvardha, shloka 1-5,

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15) Ibid, sutra, 11/6, pp 183

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ii

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iii

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iv

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v

86) Vagbhata, Rudra Prasada ed, Astanga Sangraha (Sashilekha) Nidana 15/34-38, Trichur: Mangalodaya publications; 1913. (Krishnadas Academic series 4) p. 246.



88) Yadunandan Upadhyaya edited, Madhava Nidana $/45-46, Madhukosha commentary, Kashi Sanskrit series –158, published by Chaukhambha Sanskrit Sansthan, Varanasi, 26th edition 1996, pp 431.

89) Brahma Samkar Misra ed, Bhavaprakasha madhyama khanda Vatavyadhi, chapter 2/62-

64, 5th edition, Chowkhambha orientalia, varanasi, 1988, p233.

90) Lakshmipathi Sastri, Yogaratnakara, Poorvardha, Vata Vyadhi Chikitsa, 57-59 sloka, Chowkhambha Sanskrit samstan, Varanasi, 1988, pp 515 and 518.

91) Ramavalamba Shastri ed, Hareeta, Hareeta Samhita, Truteeya sthan, 1st ed, 1985,

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92) Gangasahay Pande ed, Gadanigraha, sl 49-51, 1st ed, 1969, Chowkhambha Orientalia, Varanasi, pp 483.


Chikitsa, 28/40-41, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 618.

94) Ibid, 28/52, pp619.




97) Lakshmipathi Sastri, Yogaratnakara, Vata Vyadhi Chikitsa, 57-59 sloka, Chowkhambha Sanskrit samstan, Varanasi, 1988, pp 515 and 518.

98) Gangasahay Pande ed, Gadanigraha, sl 52, 1st ed, 1969, Chowkhambha Orientalia,

Varanasi, pp 483.

99) Yadunandan Upadhyaya edited, Madhava Nidana 22/45, Madhukosha commentary, Kashi Sanskrit series –158, published by Chaukhambha Sanskrit Sansthan, Varanasi, 26th edition 1996, pp 431.

100) Yadavji Trikamji Acharya, Susruta Samhita Nidana 1/69, 4th edition, 2000, Choukhamba



102) Yadavji Trikamji Acharya, Susruta Samhita, Nidana1/70, 4th edition, Choukhamba



vi


104) Yadunandan Upadhyaya edited, Madhava Nidana 22/47, Madhukosha commentary,





107) K.R. Shastri Navre, Astanga Hridaya, Sutra, 12/4, edited by Hari Sadashiva Shastri


108) Ibid, Nidana 16/20, pp 537.

109) Ibid, sutra, 12/4, pp 193.

110) Girirajadayal Shukla, Bhela Samhita Chikitsa, 24/44-99, 1st ed, 1959, Choukumbha Vidyabhavan, Varanasi, pp ,

111) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 1/23, 2nd ed, 1996, Krishnadas

Academy, Varanasi, pp 446.


113) Ibid, 20/15, pp 115.



115) Ashtangasangraha Suthrasthana chapter 20 sloka 2. Prof.K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 368.

116) K.R. Shastri Navre, Astanga Hridaya Sutra, 12/8, edited by Hari Sadashiva Shastri


117) Ibid, 12/15, pp 193.

118) Ibid, 12/17, pp 195.


120) K.R. Shastri Navre, Astanga Hridaya, Sutra, 12/1, edited by Hari Sadashiva Shastri



vii

121) Dr.V.V.S.Sastry, Essentials of Basic Ayurveda concepts, 2000, Publication Division, DGM Ayurvedic Medical College, Gadag, p 200.

122) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka

Samhita Shareera, 1/21to23, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 288to289.

123) K.R. Shastri Navre, Astanga Hridaya Sutra, 12/44, edited by Hari Sadashiva

Shastri Paradakara, Choukumbha Surabharati Prakashan, Varanasi, 2002, pp 200.

124) Ibid, 12/47, pp 198.

125) Amarakosha Sanskrit English dictionary, 2/349.

126) Brahma Samkar Misra ed, Bhavaprakasha Poorva khanda chapter 2/71-74, 5th edition, Chowkhambha orientalia, varanasi, 1988, p 33.


Shareera, 1/21, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 288.

128) Ibid, sutra, 12/8, pp 100.

129) Girirajadayal Shukla, Bhela Samhita Chikitsa, 8/4, 1st ed, 1959, Choukumbha Vidyabhavan, Varanasi, pp 158.




132) Ibid, 28/52, pp 619.

133) Michael Swash ed, Hutchuinson’s clinical methods, 21st ed, W.B. Saunders, Philadelphia,

pp 249-50.

134) John Walton ed, Brains diseases of the nervous system, 10th ed, 1993, Oxford University press, Oxford, pp 108.

135) Braun Wald et. Al. edited Harrison’s principles of internal medicine vol. 2 Mc Graw hill,

UK, 15th edition, 2003, pp-2378.

136) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Chikitsa, 28/38-42, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 618.

137) Yadavji Trikamji Acharya, Susruta Samhita Nidana 1/68, 4th edition, 1980, Choukumbha

Orientalia, Varnasi, p 267.

138) Vagbhata, Rudra Prasada ed, Astanga Sangraha (Sashilekha) sutra 15/34-38, Trichur: Mangalodaya publications; 1913. (Krishnadas Academic series 4) p. 618.


viii

139) K.R. Sriknta Murty ed, Astanga Hridaya Nidana, 15/36, 2nd ed, 1996, Krishnadas Academy, Varanasi, pp 533.

140) Ramavalamba Shastri ed, Hareeta, Hareeta Samhita, Truteeya sthan, 1st ed, 1985, 20/1,

Prachya Prakashan, Vranasi, pp 308.

141) Brahma Shankara Shastri, Yogaratnakara, Vata Vyadhi Prakarna, 5th ed, 1993, Choukumbha Sanskrit samsthan, Varanasi, pp506.

142) Yadunandan Upadhyaya edited, Madhava Nidana 22/45-46, Madhukosha commentary,


143) Gangasahay Pande ed, Gadanigraha, sl 49-51, 1st ed, 1969, Chowkhambha Orientalia,

Varanasi, pp 483.

144) Braun Wald et. Al. edited Harrison’s principles of internal medicine vol. 2 Mc Graw hill, UK, 15th edition, 2003, pp-2154.

145) Michael Swash ed, Hutchuinson’s clinical methods, 21st ed, W.B. Saunders, Philadelphia,

pp 249-50.

146) John Walton ed, Brains diseases of the nervous system, 10th ed, 1993, Oxford University press, Oxford, pp 108-9.

147) Ibid, pp,108-109.

148) Braun Wald et. Al. edited Harrison’s principles of internal medicine vol. 2 Mc Graw hill,

UK, 15th edition, 2003, pp-2378.


150) Ibid, pp 85.

151) Ibid, pp 98-100.

152) Ibid, pp 98-99.

153) Ibid, pp 99-100.

154) Ibid, pp 35.

155) Ibid, pp 91.

156) Ibid, pp 38.

157) Ibid, pp 76.

158) Ibid, pp 125.

159) Ibid, pp 100.

160) Ibid, pp 109.

161) Ibid, pp 99.


ix

162) Ibid, pp 104.

163) Ibid, pp 125.


Paradakara, Choukumbha Surabharati Prakashan, Varanasi, 2002, pp 533. 165) John Walton ed, Brains diseases of the nervous system, 10th ed, 1993, Oxford University

press, Oxford, pp 104.


167) Brahma Shankara Shastri, Yogaratnakara, Vata Vyadhi Prakarna,, 5th ed, 1993,

Choukumbha Sanskrit samsthan, Varanasi, pp 506.


169) Ibid, pp 21.

170) Ibid, pp 109-110.



172) Yadavji Trikamji Acharya, Susruta Samhita, Chikitsa, 5/22, 4th edition, Choukhamba Orientalia, Varanasi, 1980, pp 428.

173) K.R. Sriknta Murty ed, Astanga Hridaya Chikitsa, 21/43, 2nd ed, 1996, Krishnadas

Academy, Varanasi, pp 725.

174) Brahma Shankara Mishra, Bhavaprakasha, Madhayama khanda, ch/68, 5th ed, 1980, Choukumbha oriental, Varanasi, pp 234.



176) Ibid, Chikitsa, 22/69, pp 734.

177) Yadavji Trikamji Acharya, Susruta Samhita, Nidana, 1/73, 4th edition, Choukhamba Orientalia, Varanasi, 1980, pp 267.

178) Gangasahay Pande ed, Gadanigraha, sl -55, 1st ed, 1969, Chowkhambha Orientalia,

Varanasi, pp 484.

179) Brahma Shankara Mishra, Bhavaprakasha, Madhayama khanda, ch/67, 5th ed, 1980, Choukumbha oriental, Varanasi, pp 234.

180) Kalyana karaka, Vata Vyadhi, 1/3.



182) Ibid, sutra, 4/9-18, pp 32.


x

183) Ibid, Vimana, 8/139, pp 284.

184) Ibid, 25/40, pp 132.

185) Yadavji Trikamji Acharya, Susruta Samhita, Sutra 39/7, 4th edition, Choukhamba



187) Brahma Shankara Mishra, Bhavaprakasha, Madhyamakhanda Vatavyadhi Prakarna,

shloka 67, 5th ed, 1980, Choukumbha oriental, Varanasi, pp 234.

188) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita sutra, 13/15, 1sted, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 82.

189) Ibid, 27/284-286, pp 163.

190) Yadavji Trikamji Acharya, Susruta Samhita, Sutra, 45/113-114, 4th edition, Choukhamba


191) Ibid, 45/113, pp 204.

192) Yadavji Trikamji Acharya, Chakrapani Dutta, Ayurveda Deepika Charaka Samhita Vimana, 1/13, 1st ed, 2000, Choukumbha Surabharati Prakashan, Varanasi, pp 233.

193) Ibid, sutra, 27/286, pp 163.

194) Ibid, 13/9, pp 81.

195) Ibid, 13/12, pp 82.

196) Yadavji Trikamji Acharya, Susruta Samhita, Chikitsa, 4/29, 4th edition, Choukhamba

Orientalia, Varanasi, 1980, pp,423.

197) K.R. Shastri Navre, Astanga Hridaya Shareera, 2/47-52, edited by Hari Sadashiva Shastri Paradakara, Choukumbha Surabharati Prakashan, Varanasi, 2002, pp 383.

198) Sailaja srivatsava, Sharangadhara Samhita, Madhyamakhanda, 5/1, 2nd ed, 1998,

Choukumbha Orientalia, Varanasi, pp 81.

199) Ibid, 9/12-14, pp 117.

200) K.R. Shastri Navre, Astanga Hridaya Shareera, 2/47-52, edited by Hari Sadashiva Shastri Paradakara, Choukumbha Surabharati Prakashan, Varanasi, 2002, pp 383.

201) John Walton ed, Brains diseases of the nervous system, 10th ed, 1993, Oxford University

press, Oxford, pp 108-109.


xi

202) Yadavji Trikamji Acharya, Susruta Samhita, Nidana 1/73, 4th edition, Choukhamba Orientalia, Varanasi, 1980, pp 267.

203) K. R Shrikanta Murthy, Madhava Nidana, 22/47, Choukhamba Orientalia, Varanasi,

1995ed, pp85.

204) Brahma Shankara Shastri, Yogaratnakara, Vata Vyadhi Prakarna, Tasya Asadhaya Lakshana, 5th ed, 1993, Choukumbha Sanskrit samsthan, Varanasi, pp510.

205) T. R. Harrisons. Harrison.s; Principles of Internal Medicine, Editor-T . R. Harrisons,

Chapter 95, International edition-2003, 15th edition. P, no-2435.


207) Ashtangasangraha Suthrasthana chapter 11/27. Prof. K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 253.

208) Yadavji Trikamji Acharya, Susruta Samhita, Chikistha 5/19-22, 4th edition, Choukhamba Orientalia, Varanasi, 1980, pp 427-428. 209) Ashtangasangraha Suthrasthana chapter 31/16. Prof. K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 537. 210) K.R. Shastri Navre, Astanga Hridaya Sutra, 22/30, edited by Hari Sadashiva Shastri Paradakara, Choukumbha Surabharati Prakashan, Varanasi, 2002, pp 302. 211) K.R. Shastri Navre, Astanga Hridaya Sutra, 22/30, edited by Hari Sadashiva Shastri Paradakara, Choukumbha Surabharati Prakashan, Varanasi, 2002, pp 302. 212) Ashtangasangraha Suthrasthana chapter 31/16. Prof. K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 537. 213) Ibid, 31/16, pp537. 214) Ashtangasangraha Suthrasthana chapter 31/16-17. Prof. K.R.Shrikhantamurthy, editor. Varanasi: Chaukhambha Orientalia; 1996. p. 537. 215) Ibid, 31/16-17.pp 537. 216) Ann Thomson et, all, ed. Tidys Physiotherapy, 21chapter, 12th edition, Publication Varghese Publishing House, 1996, pp.349. 217) John Walton ed, Brains diseases of the nervous system, 10th ed, 1993, Oxford University press, Oxford, pp 104-105..


xii

Sri D.G.M.AYURVEDIC MEDICAL COLLEGE, GADAG

Department of postgraduate studies and research center (Kayachikitsa),

Special case sheet for evaluation of efficacy of Dhanwantaram taila in the management of Ardita Guide: Dr. K. Shiva Rama Prasad

Scholar: K. Ratna Kumar

1) Name of the Patient Sl.No

2) Sex Male Female OPD No

3) Age Years IPD No

4) Religion Hindu Muslim Christian Other

5) Occupation Sedentary Active Labor

6) Economical status Poor Middle Higher middle Higher class

7) Address

Pin

8) Birth data Place of Birth

AM Date Month Year Time

Hours Minutes PM

9) Selection Included Excluded

10) Schedule Initiation completion

11) Result Responded Not responded Discontinued

INFORMED CONSENT

I Son/Daughter/Wife of

am exercising my free will, to participate in above study as a subject. I have been informed to

my satisfaction, by the attending physician the purpose of the clinical evaluation and nature of

the drug treatment. I am also aware of my right to opt out of the treatment schedule, at any

time during the course of the treatment.

Patient's Signature

1

12) CHIEF COMPLAINTS WITH DURATION

Complaints Duration Before After

1 Vaktra (Hasita) Vakrata

2 Ukte Vakrata

3 Hasita Vakrata

4 Netra (Ekshita) Vakrata

5 Shirah (Moordha) Kampa

6 Vaksanga

7 Netra Stabdhata

8 Swara Bhramsha

9 Srutihani

10 Kshavagraha

11 Gandhajnam

12 Smrutimoha

13 Trasasuptasya jayate

14 Nisteevaparwshato yayat

15 Ekasya Aksha nimilanam

13) ASSOCIATED COMPLAINTS

Associated Complaints Duration Before After

1. Greeva parshwa vedana

2. Chibuka parshwa vedana

3. Danta parshwa vedana

4. Shravana Ruk

5. Akshi Ruk

6. Shankha Ruk

7. Ganda Ruk

2

14) HISTORY OF PRESENT ILLNESS (a) How it was noticed? Self / told by others

(b) Mode of onset - sudden / Gradual

(c) Mode of progress Typical / Rapid / Longtime non progressive

15) HISTORY OF PAST ILLNESS 16) TREATMENT HISTORY 17) FAMILY HISTORY 18) PERSONAL HISTORY

Food habits Vegetarian Mixed diet

Taste preferred Sweet Sour Salty Pungent Bitter Astringent

Agni Sama Vishama Manda Teekshna

Kosta Mrudu Madhyama Krura

Sleep Day Night Sound Disturbed

Addictions Tobacco Alcohol Drugs

Bowel habits Normal Loose Constipated

Menstrual History Regular Irregular Amenorrhea Menopause

19) Ardhita Nidana Rookshanna Laghwanna Abhojana Atyahara

Ah

ara

Sheetanna Langhana Katina Ahara Madya (tikshna) Prajagara Ati Prabhashanam Vishamopachara Adhwagamana Vega Dharana Ati Hasya Shiro Bharaharana Yanat Patanam Vega Udeerana Jrumbha Vishama shayanam Plavana Untrasa Vaktra Kshavatu Diwaswapna Vyayama Vichestita Jihva Nirlekhana Vyavaya Vi

hara

Nasa Vigharshana NetraVigharshana KarnaVigharshana Shoka Dhukka Krodham Manasika Chinta Bhaya

Ati Dosha sravana Dhatu kshaya Garbhini/ sutika Abhighata Ati Asruk sravana Rakta kshaya Rogati karshana Marma ghatha

Ama sanchaya Ksheena Vranapaka Marma sanchedhana

Any

a

Karadhyaschya Sira vyadhana

3

20) Ardhita Poorvaroopa BT AT BT AT

1. Romaharsha 2. Twachiswapa 3. Vepathu 4. Toda 5. Avilanetrata 6. Manyagraha 7. Vayururdhvam 8. Hanugraha

21) Ardhita Lakshana (Charaka) Lakshana BT AT BT AT 1. Uru Ruk 2. Bahu sosha 3. Pada sosha 4. Janu sosha 5. Ardha mukha sankocha 6. Mukhardha 7. Nasa vakrata 8. Bhru vakrata 9. Lalata vakrata 10. Akshi vakrata 11. Hanu vakrata 12. Vakram vrajatyasya bhojanam 13. Kathayataha vakranasikam 14. Kathayataha stabdhanetram 15. Kshavathu nigraham 16. Deena vak 17. Jihma vak 18. Samukshipta vak 19. Kala vak 20. Sajjati vak 21. Danta chalana 22. Bhodhyete sravanav 23. Swara bheda 24. Pada ruk 25. Hasta ruk 26. Akshi ruk 27. Jangha ruk 28. Shankha ruk 29. Sravana ruk 30. Ganda ruk 31. Shareerardha 32.

Ardhita Lakshana (Susruta and others) Lakshana BT AT BT AT

Vaktravakrata (ardha) Netrasthabdhata Greevavakrata Dantachala Shiraschalana Swarabhramsha Vaksanga Sruthihani Netravikriti Kshavagraha Greeva parshwa vedana Gandhaagnanam Chibuka parshwa vedana Smruthimoha Danta parshwa vedana Trasahasupthasya Ukte Vakrata Nisteevahaparshvathoyayath Hasithameekshitam Ekasyakshnonemilanam Moordhakampa Jatrurdhvaruja Visanjna Vedanatura Gandayoh vedana Shareera Ardha Adhastat

22) Ardhita Vikalpa Samprapti

Vataja Pittaja Kaphaja 1. Lalasrava 1. Peetaasyata 1. Gandashotha 2. Vyatha 2. Jwara 2. Shirasishotha 3. Kampha 3. Trushna 3. Manyashotha 4. Sphuranam 4. Moha 4. Sthambha 5. Hanugraha 5. Dhoopathe 6. Vaggraha 7. Osthaswayathu 8. Shula

4

23) EXAMINATION (a) Dosha Examination

Desham (Deha) Bhumi Jangala Anupa Sadharana Vata B A Pitta B A Kapha B A

Karshya Peeta mootrata Agni sadana

Karshnya Peetanetra Praseka

Ushna kamitwa Peetavi t Alasya

Kampa Peetatwak Swetangata

Anaha Adhikshudha Sheetangata

Shakrudgraha Adhidaha Gowrava

Balabhrmsha Slathangata

Nidrabhramsha Swasa

Pralapa Kasa

(a) Dosha Vruddhi

Bhrama At in idra

Vata B A Pitta B A Kapha B A

Angasada Mandagni Bhrama Alpabhashite

ahitam Shareera sheetatwam Urah

shoonyata

Chesta heenata Prabha hani Shira soonyata

Vyamoha Hridrava

(b) Dosha Kshaya

Sleshma vruddhi Sandhi saidhi lya

Nadi V P K VP VK PK VPK

Prakruti V P K VP VK PK VPK

Sara Pravara Avara Madhyama Samhanana Susamhita Asamhita Madhyma samhita Pramana Height in Cms Weight in Kgs Satmya Ekarasa Sarvarasa Ruksha Sneha Satwa Pravara Avara Madhyama Ahara Shakti Abhyavaharana Jarana Vyayam Shakti Pravara Avara Madhyama Vaya Balya Yauvana Vardhakya

Nadi Dosha Pravrutti

Gati Varna

Purnata Gandha

Spandana Kathinya

Mutra

Jihwa Ardra Sushka Sama Nirama Lepa Nirlepa

Mala

Shabda Sparsha Sheeta Ushna

Ast

asth

ana

Drik Akruti

5

(b) Cranial Nerves affected BT AT BT AT

Prominence of temporal Muscle

Prominence of Massater Muscle

Trigeminal

Corneal reflex Deviation of Jaw on affected side (In mm)

Inability to close the eye________

Mouth angle deviation ( In mm)

Inability of eye brow rising (Presence of wrinkles on forehead)

Sense of taste in anterior 2/3 of the tongue

Facial

Mouth inflation test

Whistling

Power of hearing Abnormal sensation

Auditory

Vertigo Glasso - pharyngeal

Sense of taste in posterior 1/3 of the tongue

Olfactory Gandhajnanam

Tongue protrusion Tongue movements

Deviation Atrophy

Hypoglossal

Tremor (c) Ama Lakshana

Vata B A Pitta B A Kapha B A

Vibandha Durgandha swasa Avi lam

Agnisada Durgandha udgara Tantumat

Tandra Harita shyava

shtevana Sandra

Antrakujana Ghana (Guru)

shtevana Kantopal ipta

m

Kat i parshwa Vedana Amlodgara Durgandha

shteevana

Shodha Kanta daha Kshutvighata

Toda Hrit daha Udgarav ighata

Vicharet Snigdhopakrama

vr iddhi

(d) Sama Dosha

Nishi vr iddhi

6

Agnimandya Hri l lasa Jwara

Aruchi Tandra /Tama Pandu

Rasa

Angamarda Akala val ipal i ta Klaibya

Asyapaka Medhrapaka Yakri t roga Rakta

Guda paka Twak vikara Pleharoga

Galaroga Jihwaroga Mamsa vikara Mamsa

Kielam Arshas Ostaprakopa

Medograndhi Atisweda Padapanidaha Medas

Sthoulyam Dantadimalam Chikkanadeha Asti Astishula Astibheda Keshadi

vikara

Majja Parwaruk Netrabhi shyandam Bhrama

Aharshana Sukrameha Klaibya

(e)

Sam

a D

hatu

Sukra

Apraja Garbhanasha Virupapraja

Aruchi Tandra Suptata

Apakti Nisteeva Stambha

Klama Hridayavisuddhi Ani la

mudhata

Alasya Guru udara Vyakulamutra

(f) Ama lakshana

Balabhramsha Gourava Malasanga (g) Sama mutra Mutra roga Meha

Apsu avasedana Durgandha Prustakati

graha

Ghana/Bhrusha Pichchila Sadana

(h) Sama Pureesha

Vichchinna Vistambham Shiroruk (a) Vitals

Temperature ºF Pulse / min Respiration rate / min

Height Cms Weight Kg Blood pressure mmHg

(b) Srotas Srotas B A B A Pranavaha Vepana (S) Bhrama (S) Udakavaha Trushna (Y) Rasavaha Praseka (Y) Sosha (C) Raktavaha Jwara (Y/B) Asthivaha Toda (S) Shoola (Y/B) Majjavaha Moha (V) Bhrama (S)

7

25) INVESTIGATIONS (parameters)

Investigations for screening Before After Random Blood Sugar for exclusion mg/dlTridot Objective parameters Mouth angle Deviation mm mmClosure of eye effected mm mmDeviation of Jaw on affected side þ mm mmErythrocyte Sedimentation Rate mm/1st Hour mm/1st HourHemoglobin % gm/dl gm/dlPresenting complaints Vakra Nasika (distortion of Nose) Bhru Vakrata (distortion of eye brow) Lalata Vali Nasha (wrinkles on forehead) Vaksanga (ability to speak) Lalasrava (salivation) Asrusrava (lacrimation) Facial expression Mouth inflation Whistling Ability to masticate Ability to spit Tongue deviation on protrusion Srutihani (loss of hearing) Bhrama (vertigo) Taste in the anterior 2/3r d of tongue Hyperacusis Manasika karana 26) Treatment schedule (Distribution of Medicine)

Internal medication (Gr_A) Shiro Vasti (Gr_B)

Day 1 Day 1

Day 3 Day 2

Day 5 Day 3

Day 7 Day 4

Day 9 Day 5

Day 11 Day 6

Day 14 Day 7

8

Worksheet

1) Ayurvedic Health Assessment: - (AHA Criteria) Symptoms Before After Difference 1 Annabhilasha 2. Bhuktasya paripakam

Vit 3 Srishta

Mootra

4 Sareera laghavam

5 Suprasennendriyam

swapnam 6

Sukha prabotanam

7 Balam

8 Varnam

9 Saumanasyam

10 Samagnita

Total score

O =Normal, 1= Mild, 2 =Moderate, 3= Severe, 4= Extreme. (Final Follow up) 21st day / 14th Day Investigators Note:

Signature of Guide

(Dr. K. Shiva Rama Prasad)

Signature of Scholar

(K. Ratna Kumar)

9

Cumulative Chart Group - 1 O.P MD CE DJ ES HB WF VS LS AS S FE MI W M NP TD SR BV VN KR BH DH SH CH TL RT

2737 1 1 1 0 0 1 1 2 2 1 0 1 1 1 1 1 1 1 1 0 1 1 0 0 20 Mor

3226 0 1 0 0 0 1 1 1 1 2 1 1 1 1 1 1 2 1 1 0 0 0 0 0 17 Mor

3299 2 2 2 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 44 Mar

3525 2 2 2 1 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 0 2 2 2 2 43 Mar

3571 1 1 1 1 0 1 2 1 1 2 1 1 1 1 1 1 2 1 1 0 1 1 1 0 24 Mor

3978 2 2 2 1 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 45 Mar

4807 2 2 2 2 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 46 Mar

4826 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 1 1 0 0 1 0 0 1 0 17 Mor

170 2 2 2 0 0 2 2 2 2 2 2 2 2 2 2 2 - 2 2 2 2 2 2 2 42 Mar

260 1 1 1 0 0 2 2 2 2 2 2 2 2 1 1 1 2 2 1 0 1 0 2 0 30 Mor

1125 2 2 2 1 0 2 2 2 2 2 2 1 2 2 2 1 - 2 2 2 2 2 2 2 41 Mar

2590 2 2 2 1 0 2 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 43 Mar

3294 1 1 1 0 0 1 1 2 2 1 0 1 1 1 1 1 1 1 0 0 0 0 0 1 18 Mor

3421 1 1 1 0 0 1 1 1 2 1 1 1 1 1 1 1 1 0 1 1 1 0 0 0 19 Mor

3558 2 2 2 1 0 2 2 2 2 2 2 2 2 2 0 2 2 2 2 2 2 2 2 2 43 Mar

O = No change, 1 = Improved, 2 = Cured. Mar = Marked Restoration, Mor = Moderate Restoration, Pr = Poor Restoration,

MD = Mouth angle deviation, CE = Closure of the eye, DJ = Deviation of Jaw, ES = Erythrocyte sedimentation ratio, HB = Hemoglobin percentage, WF = Wrinkles on Forehead, VS = Vak sanga, LS = Lala srava, AS = Asru srava, S = Shula, FE = Facial expression, MI = Mouth inflation, W = Whistle, AM = Ability to masticate, NP = Nisteevah Parshawato yayat,

TD = Tongue deviation on protrusion, SR = Sravan ruk, BV = Bhru vakrata, VN = Vakra Naasika, KR = Krodha, BH = Bhaya, DH = Dhukka, SH = Shoka, CH = Chinta.

- 1 -

Cumulative Chart Group - 2

O.P MD CE DJ ES HB WF VS LS AS S FE MI W AM NP TD SR BV VN KR BH DH SH CH TL RT

2996 1 0 1 0 0 0 2 2 2 2 0 1 1 0 2 2 - 0 0 1 1 1 2 1 22 Mor

3193 0 1 1 0 0 2 2 1 1 1 0 1 0 1 2 2 2 2 0 2 2 0 2 1 26 Mor

3918 2 2 2 0 0 2 2 2 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 43 Mar

3558 1 1 1 0 0 1 0 0 1 1 0 1 1 1 1 1 - 1 1 0 1 1 2 1 18 Mor

3584 1 1 0 0 0 1 1 0 1 2 2 1 1 0 1 1 2 1 1 2 2 2 2 2 27 Mor

4267 0 0 0 0 0 0 1 2 2 2 0 1 1 0 2 2 2 0 0 2 2 2 2 2 25 Mor

4348 1 1 1 0 0 1 1 0 0 1 0 1 0 1 0 1 2 0 1 0 2 1 2 1 18 Mor

4799 2 2 2 0 0 2 2 2 2 1 2 2 2 2 1 1 2 2 2 2 2 2 2 2 41 Mar

101 1 1 1 0 0 1 1 0 1 1 1 1 0 1 1 1 - 0 1 2 2 2 2 2 23 Mor

269 1 1 1 0 0 1 1 1 1 2 1 2 2 1 0 0 2 1 1 2 2 2 2 2 29 Mor

996 1 1 0 0 0 1 1 1 1 1 2 1 1 0 1 1 1 1 0 2 2 2 2 2 25 Mor

2284 0 1 0 0 0 1 1 0 1 1 0 0 0 0 0 1 - 1 0 0 1 1 1 1 11 Pr

3765 1 1 1 0 0 0 1 2 2 2 2 1 1 1 2 2 2 0 0 0 1 2 1 1 26 Mor

3393 2 2 2 0 0 2 1 2 2 1 1 2 2 2 0 0 2 2 2 2 2 2 2 2 37 Mar

3643 1 0 1 0 0 1 0 0 1 1 0 1 1 1 1 1 0 1 1 2 2 2 2 2 22 Mor

O = No change, 1 = Improved, 2 = Cured. Mar = Marked Restoration, Mor = Moderate Restoration, Pr = Poor Restoration,

MD = Mouth angle deviation, CE = Closure of the eye, DJ = Deviation of Jaw, ES = Erythrocyte sedimentation ratio, HB = Hemoglobin percentage, WF = Wrinkles on Forehead, VS = Vak sanga, LS = Lala srava, AS = Asru srava, S = Shula, FE = Facial expression, MI = Mouth inflation, W = Whistle, AM = Ability to masticate, NP = Nisteevah Parshawato yayat,

TD = Tongue deviation on protrusion, SR = Sravan ruk, BV = Bhru vakrata, VN = Vakra Naasika, KR = Krodha, BH = Bhaya, DH = Dhukka, SH = Shoka, CH = Chinta.

- 2 -

Annexure-2 AHA Group 1 AHA Group 2

OPDNo BT AT difference OPDNo BT AT difference2737 22 9 13 2996 20 10 10 3226 21 13 8 3193 20 9 11 3299 10 0 10 3918 10 0 10 3525 10 1 9 3558 20 11 9 3571 17 6 11 3584 13 2 11 3978 9 0 9 4267 16 2 14 4807 13 0 13 4348 17 7 10 4826 18 7 11 4799 15 4 11 170 8 0 8 101 22 10 12 260 19 11 8 269 20 10 10 1125 12 0 12 996 22 10 12 2590 7 0 7 2284 25 11 14 3294 17 10 7 3765 19 8 11 3421 15 8 7 3393 16 2 14 3558 10 0 10 3643 20 8 12

Mouth angle deviation Group 1 Group 2

OPDNo BT DT AT OPDNo BT DT AT 2737 2 2 1 2996 2 1 1 3226 2 2 1 3193 1 1 1 3299 1 0 0 3918 1 0 0 3525 1 0 0 3558 2 2 1 3571 2 1 1 3584 2 1 1 3978 1 1 0 4267 2 2 2 4807 1 0 0 4348 2 2 1 4826 2 1 1 4799 2 1 0 170 1 0 0 101 2 2 1 260 2 1 1 269 2 1 1 1125 1 1 0 996 2 1 1 2590 2 1 0 2284 2 2 2 3294 2 2 1 3765 2 1 1 3421 2 2 1 3393 2 1 0 3558 1 0 0 3643 2 2 1

closure of the eye affected OPDNo BT DT AT OPDNo BT DT AT

2737 3 2 2 2996 1 1 1 3226 3 2 1 3193 2 1 1 3299 1 1 0 3918 1 0 0 3525 1 1 0 3558 3 2 2 3571 3 2 1 3584 2 2 1 3978 2 1 0 4267 2 2 2 4807 1 0 0 4348 2 2 1 4826 3 2 1 4799 2 1 0 170 2 1 0 101 3 2 2 260 3 2 1 269 3 2 2 1125 2 1 0 996 2 2 1 2590 3 2 0 2284 3 3 2 3294 3 3 2 3765 3 2 1 3421 3 2 1 3393 2 1 0 3558 2 1 0 3643 2 2 2

- 3 -

Deviation of the jaw OPDNo BT DT AT OPDNo BT DT AT

2737 2 1 1 2996 2 2 1 3226 1 1 1 3193 2 2 1 3299 1 0 0 3918 1 0 0 3525 1 0 0 3558 2 1 1 3571 2 1 1 3584 1 1 1 3978 2 1 0 4267 2 2 2 4807 1 0 0 4348 2 2 1 4826 2 1 1 4799 1 0 0 170 1 0 0 101 2 1 1 260 2 1 1 269 2 1 1 1125 2 1 0 996 1 1 1 2590 2 1 0 2284 2 2 2 3294 2 1 1 3765 2 2 1 3421 2 1 1 3393 1 1 0 3558 1 0 0 3643 2 2 1

ESR OPDNo BT AT OPDNo BT AT

2737 15 12 2996 19 16 3226 18 15 3193 25 21 3299 17 13 3918 18 15 3525 19 14 3558 13 11 3571 20 15 3584 10 10 3978 15 10 4267 14 11 4807 25 17 4348 16 13 4826 20 15 4799 18 15 170 16 12 101 10 10 260 15 11 269 20 18 1125 19 12 996 16 14 2590 22 17 2284 19 16 3294 18 16 3765 15 12 3421 15 11 3393 15 11 3558 15 10 3643 20 18

Hb% OPDNo BT AT2 OPDNo BT AT2

2737 10.2 10.6 2996 10 10.4 3226 10 10 3193 10.2 10.2 3299 10 10.4 3918 10.6 10.8 3525 10 10 3558 11 11 3571 10.4 10.4 3584 10 10 3978 10.2 10.4 4267 10.2 10.2 4807 10 10 4348 10 10 4826 10.6 10.6 4799 10.4 10.8 170 10.4 10.6 101 10 10 260 10.2 10.4 269 10.2 10.2 1125 11 11 996 10.4 10.4 2590 10.8 11 2284 10.2 10.2 3294 10 10.2 3765 10 10 3421 10.2 10.4 3393 10.8 10.8 3558 10 10.2 3643 10 10

BT = Before Treatment, DT= During Treatment, AT= After Treatment

- 4 -

Wrinkles on the fore head OPDNo BT DT AT OPDNo BT DT AT

2737 2 2 1 2996 1 1 1 3226 2 2 1 3193 1 0 0 3299 1 0 0 3918 1 1 0 3525 1 1 0 3558 2 2 1 3571 2 1 1 3584 2 1 1 3978 2 1 0 4267 1 1 1 4807 1 0 0 4348 2 2 1 4826 2 1 1 4799 2 1 0 170 1 0 0 101 2 1 1 260 2 1 0 269 2 2 1 1125 2 1 0 996 2 2 1 2590 1 1 0 2284 2 2 1 3294 2 2 1 3765 1 1 1 3421 2 1 1 3393 2 1 0 3558 1 0 0 3643 2 2 1

Vak sanga OPDNo BT DT AT OPDNo BT DT AT

2737 2 2 1 2996 1 0 0 3226 2 2 1 3193 1 1 0 3299 1 1 0 3918 1 1 0 3525 1 1 0 3558 2 2 2 3571 2 1 0 3584 2 2 1 3978 2 1 0 4267 2 1 1 4807 1 0 0 4348 2 2 1 4826 2 1 1 4799 2 1 0 170 1 0 0 101 2 2 1 260 2 1 0 269 2 2 1 1125 1 1 0 996 2 2 1 2590 2 1 1 2284 2 2 1 3294 2 2 1 3765 2 2 1 3421 2 1 1 3393 2 1 1 3558 1 0 0 3643 2 2 2

Lala srava OPDNo BT DT AT OPDNo BT DT AT

2737 1 1 0 2996 1 0 0 3226 3 2 1 3193 2 1 1 3299 1 0 0 3918 2 1 0 3525 2 1 0 3558 1 1 1 3571 3 2 1 3584 1 1 1 3978 2 1 0 4267 1 0 0 4807 1 1 0 4348 1 1 1 4826 2 1 1 4799 1 1 0 170 1 0 0 101 2 2 2 260 2 1 0 269 3 2 1 1125 2 1 0 996 2 2 1 2590 2 1 1 2284 1 1 1 3294 1 1 0 3765 1 0 0 3421 2 1 1 3393 1 1 0 3558 1 0 0 3643 2 2 2

- 5 -

Asru srava OPDNo BT DT AT OPDNo BT DT AT

2737 1 1 0 2996 1 1 0 3226 2 1 1 3193 2 2 1 3299 1 1 0 3918 2 2 1 3525 1 1 0 3558 2 1 1 3571 2 1 1 3584 2 2 1 3978 1 1 0 4267 1 1 0 4807 1 0 0 4348 1 1 1 4826 2 2 1 4799 1 0 0 170 1 0 0 101 3 3 1 260 1 1 0 269 2 2 1 1125 2 1 0 996 2 1 1 2590 2 1 0 2284 2 2 1 3294 1 1 0 3765 1 1 0 3421 2 1 0 3393 1 0 0 3558 1 1 0 3643 3 3 1

Facial expression


Shula OPDNo BT DT AT OPDNo BT DT AT

2737 2 2 1 2996 1 0 0 3226 1 0 0 3193 2 1 1 3299 1 0 0 3918 1 1 0 3525 2 1 0 3558 2 1 1 3571 1 1 0 3584 2 1 0 3978 1 1 0 4267 1 0 0 4807 2 1 0 4348 2 2 1 4826 2 1 1 4799 2 1 1 170 1 1 0 101 2 2 1 260 1 1 0 269 2 1 0 1125 1 0 0 996 2 1 1 2590 2 1 0 2284 2 2 1 3294 2 2 1 3765 1 0 0 3421 2 1 1 3393 2 1 1 3558 1 0 0 3643 2 1 1

- 6 -

Abilitty to inflate the mouth OPDNo BT DT AT OPDNo BT DT AT

2737 2 2 1 2996 2 2 1 3226 2 1 1 3193 2 1 1 3299 1 0 0 3918 2 1 0 3525 1 0 0 3558 2 1 1 3571 2 2 1 3584 2 2 1 3978 2 1 0 4267 2 2 1 4807 1 0 0 4348 2 1 1 4826 2 2 1 4799 2 1 0 170 2 1 0 101 2 1 1 260 2 1 0 269 1 0 0 1125 2 1 1 996 2 1 1 2590 1 0 0 2284 2 2 2 3294 2 2 1 3765 2 2 1 3421 2 1 1 3393 2 1 0 3558 2 1 0 3643 2 2 1

Ability to whistle


Ability to masticate


- 7 -

Ability to spit OPDNo BT DT AT OPDNo BT DT AT

2737 2 2 1 2996 1 1 0 3226 2 1 1 3193 1 0 0 3299 1 0 0 3918 1 0 0 3525 1 0 0 3558 3 3 2 3571 2 1 1 3584 2 1 1 3978 1 1 0 4267 1 1 0 4807 1 0 0 4348 2 2 2 4826 1 1 1 4799 2 1 1 170 1 0 0 101 2 2 1 260 2 2 1 269 2 2 2 1125 2 1 0 996 2 2 1 2590 1 1 0 2284 2 2 2 3294 2 2 1 3765 1 1 0 3421 2 1 1 3393 1 1 1 3558 1 0 0 3643 2 1 1

Sravana Ruk OPDNo BT DT AT OPDNo BT DT AT

2737 2 1 1 2996 - - - 3226 1 0 0 3193 2 1 0 3299 1 1 0 3918 1 0 0 3525 2 1 0 3558 - - - 3571 1 1 0 3584 1 1 0 3978 1 0 0 4267 1 0 0 4807 2 1 0 4348 2 1 0 4826 2 2 1 4799 1 0 0 170 - - - 101 - - - 260 1 1 0 269 2 1 0 1125 - - - 996 2 1 1 2590 2 1 0 2284 - - - 3294 2 1 1 3765 1 1 0 3421 2 1 1 3393 1 1 0 3558 1 0 0 3643 1 1 1

Evaluation and assessment of sravana ruk is on reduction in severity i.e. subjective not on statistical evaluation.

Tounge deviation on protrusion OPDNo BT DT AT OPDNo BT DT AT

2737 2 2 1 2996 1 1 0 3226 2 1 1 3193 1 0 0 3299 2 1 0 3918 1 0 0 3525 1 0 0 3558 3 2 2 3571 2 1 1 3584 2 1 1 3978 1 1 0 4267 2 1 0 4807 1 0 0 4348 2 2 1 4826 2 1 1 4799 2 1 1 170 1 1 0 101 2 2 1 260 2 2 1 269 2 2 2 1125 2 1 1 996 2 2 1 2590 1 0 0 2284 3 2 2 3294 2 2 1 3765 2 1 0 3421 2 1 1 3393 1 1 1 3558 1 1 0 3643 2 2 1

- 8 -

Bhru vakrata OPDNo BT DT AT OPDNo BT DT AT

2737 2 1 1 2996 1 1 1 3226 2 1 1 3193 1 0 0 3299 1 0 0 3918 1 1 0 3525 1 1 0 3558 2 2 1 3571 2 2 1 3584 2 1 1 3978 1 0 0 4267 1 1 1 4807 1 0 0 4348 1 1 1 4826 1 1 1 4799 1 0 0 170 1 0 0 101 1 1 1 260 1 1 0 269 2 1 1 1125 1 1 0 996 2 2 1 2590 1 1 0 2284 2 2 1 3294 2 2 1 3765 1 1 1 3421 1 1 1 3393 1 1 0 3558 1 0 0 3643 2 2 1

Vakra naasika


Hearing OPDNo BT DT AT OPDNo BT DT AT

2737 1 1 0 2996 3226 3193 3299 3918 3525 1 0 0 3558 3571 3584 1 1 0 3978 4267 4807 4348 1 1 1 4826 1 1 1 4799 170 101 260 269 1 1 0 1125 996 2590 2284 3294 1 1 0 3765 3421 1 0 0 3393 3558 3643 1 1 0


- 9 -

Vertigo

OPDNo BT DT AT OPDNo BT DT AT 2737 1 0 0 2996 3226 3193 3299 3918 3525 3558 3571 3584 1 0 0 3978 4267 4807 4348 1 1 0 4826 1 0 0 4799 170 101 260 269 1 0 0 1125 996 2590 2284 3294 1 0 0 3765 3421 3393 3558 3643

Taste in anterior 2/3 of tongue OPDNo BT DT AT OPDNo BT DT AT

2737 1 1 0 2996 1 1 0 3226 3193 1 1 1 3299 1 0 0 3918 3525 3558 3571 3584 3978 4267 1 0 0 4807 1 0 0 4348 4826 4799 170 101 260 269 1125 996 1 0 0 2590 2284 3294 1 1 0 3765 1 1 0 3421 3393 3558 1 0 0 3643

Abnormal sensation of sound (Hyperacusis) OPDNo BT DT AT OPDNo BT DT AT

2737 1 1 0 2996 3226 3193 1 0 0 3299 1 0 0 3918 3525 3558 3571 3584 3978 4267 4807 4348 4826 4799 170 101 260 269 1125 996 2590 2284 3294 3765 3421 3393 3558 3643


- 10 -

Krodha OPDNo BT DT AT OPDNo BT DT AT

2737 1 1 1 2996 2 1 1 3226 1 1 1 3193 1 1 0 3299 1 1 0 3918 1 0 0 3525 1 1 1 3558 1 1 1 3571 1 1 1 3584 1 1 0 3978 1 1 0 4267 1 1 0 4807 1 0 0 4348 1 1 1 4826 2 2 1 4799 1 0 0 170 1 0 0 101 1 1 0 260 1 1 1 269 1 0 0 1125 1 1 0 996 1 0 0 2590 1 1 0 2284 1 1 1 3294 1 1 1 3765 1 1 1 3421 2 2 1 3393 1 1 0 3558 1 1 0 3643 1 1 0

Bhaya OPDNo BT DT AT OPDNo BT DT AT

2737 2 1 1 2996 2 1 1 3226 2 2 2 3193 1 1 0 3299 1 1 0 3918 1 0 0 3525 1 1 0 3558 2 1 1 3571 2 1 1 3584 1 1 0 3978 1 0 0 4267 1 1 0 4807 1 0 0 4348 1 1 0 4826 2 2 2 4799 1 0 0 170 1 1 0 101 1 1 0 260 2 2 1 269 1 0 0 1125 1 1 0 996 1 0 0 2590 1 1 0 2284 2 1 1 3294 1 1 1 3765 2 1 1 3421 2 2 1 3393 1 1 0 3558 1 1 0 3643 1 0 0

Dhulkka OPDNo BT DT AT OPDNo BT DT AT

2737 2 2 1 2996 2 1 1 3226 2 2 2 3193 1 1 1 3299 1 1 0 3918 1 0 0 3525 1 0 0 3558 2 1 1 3571 2 2 1 3584 1 1 0 3978 1 0 0 4267 2 1 0 4807 1 0 0 4348 2 1 1 4826 2 2 2 4799 1 0 0 170 1 1 0 101 1 1 0 260 1 1 1 269 1 0 0 1125 1 0 0 996 1 0 0 2590 1 0 0 2284 2 1 1 3294 1 1 1 3765 1 1 0 3421 2 2 2 3393 1 0 0 3558 1 1 0 3643 1 1 0


- 11 -

Shoka OPDNo BT DT AT OPDNo BT DT AT

2737 1 1 1 2996 2 1 0 3226 2 2 2 3193 1 1 0 3299 1 1 0 3918 1 0 0 3525 1 0 0 3558 1 1 0 3571 2 2 1 3584 1 1 0 3978 1 0 0 4267 1 1 0 4807 1 0 0 4348 1 1 0 4826 2 2 1 4799 1 0 0 170 1 0 0 101 1 1 0 260 1 1 0 269 1 0 0 1125 1 0 0 996 1 0 0 2590 1 0 0 2284 2 1 1 3294 1 1 1 3765 2 1 1 3421 1 1 1 3393 1 1 0 3558 1 1 0 3643 1 0 0

Chinta OPDNo BT DT AT OPDNo BT DT AT

2737 1 1 1 2996 2 1 1 3226 1 1 1 3193 2 1 1 3299 2 1 0 3918 1 0 0 3525 1 1 0 3558 2 1 1 3571 1 1 1 3584 1 1 0 3978 1 1 0 4267 2 1 0 4807 1 1 0 4348 2 1 1 4826 1 1 1 4799 1 1 0 170 1 1 0 101 2 1 0 260 1 1 1 269 1 1 0 1125 1 1 0 996 1 1 0 2590 1 1 0 2284 2 1 1 3294 2 1 1 3765 2 1 1 3421 2 2 2 3393 2 1 0 3558 1 1 0 3643 1 1 0

BT = Before Treatment, DT= During Treatment, AT= After Treatment Danta/ Chibuka/ Greeva /parshwa vedana, Jatrurdhwa vedana are considered under shula

assessment is done on reduction in severity i.e. subjective not on statistical evaluation. BT = Before Treatment, DT= During Treatment, AT= After Treatment

- 12 -

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA

BANGALORE

Proforma for registration of subject for dissertation

1) Name of the candidate and

address (in block letters)

: RATNA KUMAR K.

NEAR SARASWATI SISU MANDIR

BOSE NAGAR, CHIRALA,

PRAKASHAM (DT.) A.P. PIN : 523155.

2) Name of the institute : Sri D.G. Melmalagi Ayurvedic Medical College,

Post graduation & Research Centre,

Gadag - 582103

3) Course of study and subject : AYURVEDAVACHASPATHI (M.D.)

KAYACHIKITSA

4) Date of admission : October 2003

5) Title of the topic : “EVALUATION OF EFFICACY OF

DHANWANTARAM TAILA IN THE

MANAGEMENT OF ARDITA A COMPARITIVE

CLINICAL STUDY”

6) Brief Review of Intended work:

6.1) Need for the study:

Ardhita 1 (Facial paralysis) 2 is a disease in which the most important characteristic of

a human being viz. Facial and verbal expressions are lost in a way that the patient loses

the essential human characteristic feature, the communication. This disease affects all

ages and it’s sufficiently high to warrant an effective treatment.

In the management of Ardhita, Ayurveda gives importance to the Moordhini taila 3-5

applications. Among this Shirovasti 6-7 is considered as superior and effective

1

management modality and Dhanwantara tailam 8 is considered as the best Vatahara

medication when used both internally and externally.

In contemporary systems of medicine there is no clear-cut curative aspects for this

disease. In this regard Ayurveda through its holistic approach makes the ailment to restore

to normalcy or it will limit to normal successfully without any side effects.

6.2) Review of Literature:

Ardhita is one out of 80 disease 9 explained as Vataja nanatmaja vyadhis in classics.

The Samhita's affirm Ardhita as one of the Mahavatavyadhi. There are apt and authentic

references of Ayurveda and the symptomology directly resembles to the facial paralysis,

which is a CNS disorder. The common symptoms are distortion of either half of the face,

speech disturbances, shaking of head, spitting and laughing to the affected side, transient

loss of hearing 10-11, etc.

In the management of Ardhita Ayurveda advised Nasya, moordhini taila and

srotrakshi tarpana. Shirovasthi is the important procedure among moordhni taila, which is

considered as Vata shamaka and also applied directly on the affected site 12-14.

Dhanwantara taila, is explained in Ashtanga Hridaya Shareera Sthana 2nd chapter, is

known as the best Vatahara medicine both for internal and external usage. In this study

Dhanwantara taila is administered internally as capsule and externally as Shirovasthi.

6.3) Objective of the study:

a. To evaluate the efficacy of Dhanwantara taila capsule in Ardhita.

b. To evaluate the efficacy of Dhanwantara taila as Shirovasthi in Ardhita.

7) Materials and methods: 7.1) Source of data:

a. Patients suffering from Ardita are selected from Dept. of K.C., P.G.S. & R.C.,

O.P.D. of Shree D.G.M.A.M.C. & H., Gadag by preset inclusion criteria and

exclusion criteria.

2

b. Literary aspect of the study will be collected from classical Ayurvedic and modern

texts and updated with recent medical journals.

c. Trail Drug: Dhanwantara taila 8 – The composition and properties of

Dhanwantara taila yoga is as follows 15–

1. Balamoola Kashaya (Sida cordifolia) : 6 Parts

2. Cows milk : 6 Parts

3. Yava(Barley)

Kola (Zizyphus jujuba) KASHAYA

Kulatha (Dolichos biflorus) : 1 Part All together

4. Tilathaila : 1 Part

5. Kalka dravyas

6. Dasamoola ( Bilva, Agnimantha, Kashmari etc) Meda, Mahameda, Devadaru,

Manjishta, Ksheerakakoli, Kakoli, Chandana, Sariba, Kushta, Tagara,Jeevaka,

Rushabhaka, Saindhava, Kalaanusaari, Shaileya, Vacha, Agaru, Punarnava,

Aswagandha, Shathavari, Ksheerashukla, Madhuyashti, Hareethaki,

Bibheethaki, Amalaki, Rasa, Shathahva, Shurpaparnya, Ela, Twak,

Pathram (Abhava pratinidhi dravyas are considered) : Each half tola

d. Preparation of Medicine: Dhanwantara taila ingredients are well identified and

collected from local areas. Good manufacturing practice will be followed for the

preparation of Dhanwantara taila.

7.2) Method of collection of Data: a. Study design: Comparative clinical trial. b. Sample size and grouping: A minimum of 100 patients equally distributed in

three groups.

1) Group A: 50 patients will receive Dhanwantara taila capsules internally.

2) Group B: 50 patients will receive Shirovasthi with Dhanwantara taila

externally.

c. Exclusion criteria 16-17 : 1) Extremely emaciated.

2) Duration of more than 3 years.

3) Trauma 18 and other Asadhya lakshanas.

4) Other systemic disorders.

5) Pregnant women and lactating mothers.

6) Patients associated with Pakshaghata 19.

3

d. Inclusion criteria : 1) Patients above 15 to 65 years of age groups irrespective of sex.

2) Patients fit for Shirovasthi karma

3) Patients with Bell's palsy 20

4) Patients with clinical features of Ardhita - such as -

a) Vaktra (Hasita) Vakrata ¥ÌEwÌ (·þÍ²ÌtÌ) ¥ÌFêòtÌ

b) Netra (Ekshita) Vakrata �ÌâwÌ (<ÊÍKÌtÌ) ¥ÌFêòtÌ

c) Shirah (Moordha) Kampa Í¨Ìœú (˜ÌÜŒÌÊ) FÉò�Ì

d) Vaksanga ¥ÌÌE²ÌÉOÌ

e) Netra Avilata �ÌâwÌÌÍ¥Ì¡ôtÌ

f) Netra Stabdhata �ÌâwÌ ²yÌ–ŒÌtÌ

g) Manya Graha ˜Ì�™ÌÌOÌë·

h) Hanu Graha þ ·þ�ÌÙOÌë·þ

i) Vaktra parswa Vedana ¥ÌEwÌ�ÌÌ«ÌÊ¥Ìâzù�Ì

j) Srutihani ¨ÌßÍtÌ·þÌÍ�Ì

k) Kshavagraha KÌ¥ÌOÌë·þ

l) Gandhajnam OÌÉŒÌÌ%bÌÌ�ÌÉ

m) Smrutimoha ¨˜ÌßÍtÌ˜ÌÌâ·þ

n) Nisteevaparwshato yayat Í�Ì¯öÕ¥Ì:�ÌÌ«ÌÊtÌÌâ™ÌÌ™ÌÌtÌÆ o) Ekasya Aksha nimilanam DFò²™ÌÌKÌÌâÍ�Ì˜ÌÕ¡ô�ÌÉ

e. Criteria of diagnosis : 1) The clinical features of Ardhita (Facial paralysis) mentioned in texts will

be the basis of diagnosis.

f. Posology : 1) Internal: Dhanwantara taila capsules –2 gms / 24 hours in divided doses

(Each capsule 300 mg. of taila) for 14 days or 2 caps tid.

2) External: Dhanwantara taila Q.S. Shirovasthi for 7 days.

g. Study duration : Group A: 14 days

Group B: 7 days

4

h. Follow up:

Group A: 7 days

Group B: 7 days

i. Assessment of results : Subjective and objective parameters of base line data to after treatment data

comparison will be done for the assessment of results. Statistical assessments

are done by large sample test in the evaluation of DHANWANTARAM TAILA

IN THE MANAGEMENT OF ARDHITA.

j. Subjective parameters : As designed in the classical Ayurvedic and contemporary texts. And

1) Examination of trigeminal nerve.

2) Examination of Facial nerve.

3) Examination of Auditory nerve.

4) Examination of Glossopharyngeal nerve.

5) Examination of hypoglossal nerve.

k. Objective parameters : 1. Deviation of mouth angle in millimeters

2. Inability of the closure of the eye in millimeters (Right & Left eye)

7.3) Ethical clearance obtained: Yes, certificate enclosed

8. List of References:-

1. Priyavat Sharma ed., Susruta Samhita, Nidana1/68-72, 4th edition, Choukhamba

Orientalia, Varanasi, 1980, pp 267

2. Michael Swash ed, Hutchison's Clinical Methods, Nervous System – 11th chapter;

21st Edition, Harcourt publishers Ltd, London, 2002, pp 250

3. Priyavat Sharma ed, Susruta Samhita, Chikitsa 24/27-28, 4th edition, Choukhamba


4. Priyavat Sharma ed., Ashtanga Hridayam sutra 22/23, Choukhamba Orientalia,

Varanasi, 1978, pp 236

5. Yadavji Trikamji Acharya ed, Charaka Samhita, Chikitsa 28/99-100, 5th edition,

Choukhamba Samskruta Samstan, Varanasi, 2004, pp 621

6. Priyavat Sharma ed., Susruta Samhita, Chikitsa 5/19-22, 4th edition, Choukhamba

Orientalia, Varanasi, 1980, pp 427-28 5

7. Yadavji Trikamji Acharya ed, Charaka Samhita, Chikitsa 28/99-100, 5th edition,


8. Hari Shastri Paradkarvaidya ed., Astanga Hridaya Shareera 2/47, 7th edition,

Choukhamba Orientalia, Varanasi, 1982, pp 383

9. Pandit Sri Brahma Shankara Mishra ed., Bhavaprakasha Dwiteeya Khanda 24/5, 5th

Edition, Choukhambha Sanskrit samsthan, Vidya vilas press, Vranasi, 1988, pp 227

10. Priyavat Sharma ed., Susruta Samhita, Nidana1/68-72, 4th edition, Choukhamba


11. Christopher R.W. Edward et.al. Davidson’s Principles of Practice of Medicine,

Diseases of Nervous System 14, 18th edition, Churchill Livingstone, London, 1999;

pp 996-997

12. Priyavat Sharma ed., Susruta Samhita, Chikitsa 4/19, 4th edition, Choukhamba


13. Shankar laalji Jain ed., Shaligramji vaishya commented, Vangasena Vata vyadhi

Adhikara/94 Khemaraja SriKrishanadasa Prakashana, Bombay, 1996, pp 330

14. Ganga Sahaya Pandey & Indra Deva Tripathi ed., Gadanigraha 19/24-25,

Choukhamba Sanskrit series, Varanasi, 1969, pp 474

15. K.M.Nadkarni, Indian Meteria medica, 3rd Edition, Popular Prakashan Pvt Ltd,

Bombay, 1982 – pp 1134, 1316, 458, 45, 353, 584, 1168, 876, 1149, 1156, 1255,

612, 1229, 595, 738, 295, 1075, 596, 596, 1098, 619, 1108, 1189, 108, 557, 35, 120,

202, 1292, 153, 686,582, 1205, 1202, 480, 374, 113, 940, 475, 328, 3

16. Yadunandana Upadhyaya ed, Madhava Nidana 22 /46-7, 15th edition, Choukhambha

sanskrit samsthan, Varanasi, 1985, pp 433

17. Indradeva Tripathi & Daya Shankar ed, Yogaratnakara Vata Vyadhi Nidana/60, 1st

edition, Krishnadasa Academy, Choukhambha Press, Varanasi, 1998, pp 406

18. Eugene Braunwald et.al., Harison’s Principles of internal medicine, volume I, 15th

ed. India: McGraw Hill, U.S, 2001, pp2435

19. Yadavji Trikamji Acharya ed, Charaka Samhita, Sutra 20/11, 5th edition,


20. Christopher R.W. Edward et.al. Davidson’s Principles of Practice of Medicine,

Diseases of Nervous System 14, 18th edition, Churchill Livingstone, London, 1999;

pp 996-997

6

9. Signature of the candidate :

(Ratna Kumar. K.) 10. Remarks of Guide :

This dissertation topic and chosen

medicament for the research will certainly help the

ailing society and can contribute good values for

the Ayurvedic research.

11.Name and Designation (in Block letters) :

11.1. Guide : Dr.SHIVA RAMA PRASAD KETHAMAKKA M.D.(K.C)(Osm), M.A.(Jyo)

READER IN KAYACHIKITSA DGMAMC, PGS&RC, Gadag

11.2. Signature :

11.3. Co-Guide : -

11.4. Signature : -

11.5. Head of the department :

11.6. Signature :

Dr. V. VARADA CHARYULU M.D. (Ayu)

PROFESSOR & H.O.D., DGMAMC PGS&RC, Gadag

12.1. Remarks of Chairman and Principal :

7

ardhita kc030 gdg

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