19 Summary

Summary
SUMMARY
INTRODUCTION
There are 80 nanatmaj vyadhies which are caused by vata dosha.
Pakshaghata is one of them. Pakshaghata is a disabling disease which is
manifested as paralysis of one side of the body caused by vitiation of vata
dosha.
The etiological factors of underlying pathology according to the

classical book are the same as that of vata vyadhies i.e. Dhatukshya and
margavrodh. Clinically we can correlate Pakshaghata with hemiplegia.
The commonest cause of hemiplegia is CVA or stroke. The term literally
means effective interference in circulation of blood with in the brain.
In year 1969-71 the no of cases of stroke was 13/1 Lac. In the year
1990 the no. of cases of stroke were 73/ 1 Lac. from community surveys
from different regions of India. For hemiplegia of vascular origin indicate a
crude prevalence rate in the range of 200 per 1 Lac. persons. Currents
demographic trends suggest that a moderate percentage of Indian
population will suffer from this disease in the age group of 40-60 yrs which
is the most vulnerable period of life for this disease. The survivors after
stroke is having varying degree of residual disability which is a major
medical problem. Thus the anticipated cost of rehabilitation of stroke
victims will pose enormous socio-economic burden on our meagre health-
care resources, similar to what is now faced by developed nations in the
west. There fore early diagnosis, intensive treatment and prevention of
stroke at any age should be our main strategy in the national health
programmes. Pakshaghata is described in almost all texts as a vata
nanatmaja vyadhi, which means it gets manifested only due to vata dosha
involvement. The line of treatment of pakshaghata is described as
virechana in charaka samhita. It has been said that virechana is indicated
in that condition of vata where the vata is obstracted by pitta, rakta, kapha
1
Summary
and meda, Basti is considered most effective tool to curb vata vitiation. As
pakshaghata because of vitiation of vata, basti karma is of utmost
importance in this disorder and the combination of both i.e. virechana and
basti karma has been found very effective in the treatment of stroke. On
the basis of above facts. The present study has been carried out to study
the etio pathogenesis of pakshaghata due to cerebrovascular accidents
and established standard samprapti or pathogenesis for the same.
The present study has been carried out in two parts- 1) conceptual study
and 2) Clinical study.
Conceptual study includes diease review and drug review. Disease

review start with the classification of pakshaghata and all the aspects of
pakshaghata with respect to nidan, purvarupa, rupa, upashaya and
samprapti. This part also contain detail description of cerebro vascular
accidents with etiological risk factors, signs and symptoms and
etiopathogenesis. Drug review starts with the properties and indication of
virechana & basti in addition to the exhaustive descripition of guna karma
of all the drugs used for the study given in reference to different Ayurvedic
texts.
For clinical study 60 patients were registered and out of them 60

patients complete the trial they were classified in three groups.
 1st Groups – In 20 patients virechana karma with castor oil has

been given after samyaka snehana & swedana.
 2nd Groups – In 20 patients Basti karma Erandamuladi niruhan

basti and maha masha tail anuvashana basti in form of karma basti
have been given after samyaka snehana (external) and swedana.
 3rd Groups – In 20 patients both virechana and basti with

Erandamuladi niruhan & mahamasha tail anuvashana basti in the
form of karma basti have been given after smayaka snehana and
swedana.
2
Summary
 Group A –Results were satisfactory.
 Group B –Results were satisfactory and better than group A
 Group C –The combination of both karma showed remarkable

improvement in symptoms of disease or in other words group C
showed better results than group A and B.
Clinical research is the back bone of any medical science. It is the

most important among all other research because in clinical research
there is direct interaction with patients.
Pakshaghata is a most distressing disease among vatavyadhi. It is

a vata nanatmaja vyadhi. The pathological phenomena of vata playing
central role in the manifestation of Pakshaghata are Suddha vata prakopa,
Anyadosha Samsirsta vata prakopa and dhatukshayajanya vata prakopa.
Akin to pakshaghata, hemilegia also caused by a wide spectrum of

disease processes like vascular disorders, infective disorders of brain
tissue, tumors, trauma etc. among these vascular accident or stroke is the
commnest cause of hemiplegia.
1. AIM – To compare the effects of Virechana karma and Basti karma in

Pakshaghata.
2. OBJECTIVES
 To study the effect of virechana karma
 To study the effect of Basti karma
 To study critically about pakshaghata w.s.r. to CVA.
 To compare the effect of virechana karma and Basti karma in

managing pakshaghata.
3. MATERIAL AND METHODS
A. Subject – 60 subjects satisfying the selection criteria were

randomly considered for the present study. Three groups (Gr. A, B,
C) of 20 subjects each are made.
3
Summary
B. Source of Subject – Selection of the patients was made from the

OPD/ IPD of P.G. Department of Panchakarma of NIA, Jaipur, Raj.
C. Selection Criteria
i. Inclusion criteria
 Subjects with less than 2 year chronicity of disease.
 Subjects with age group 30-70 years.
 Only Hemiplegia due to C.V.A.
ii. Exclusion criteria
 Unconseious patients
 Patients of uncontrolled diabetes
 Age above 70 years
 Duration more than 2 years
 Hemiplegia due to trauma
 Hemiplegia due to Intracranial Infection and space
occupying lesion.
 Todd's paralysis
 Hysteria
 Associated cardiace disease like IHD and M.I
D. Study design – Randomised clinical trial
E. Duration of the Study
 Group A – Virechana 21 (Administered only once)
 Group B – 30 Days (Karma basti)
 Group C – 51 Days (Virechana and Basti karma)
Follow up – Three months after the treatment procedure
F. Drug Administration
 Group A - In 20 patients virechana karma with castor oil
(dose 50 ml) has been given after samyaka snehana and
swedana
4
Summary
 Group B - In 20 patients Basti karma with Erandmooladi

Niruhana Basti (dose 950 ml) and maha masha taila
Anuvasan Basti (dose 60 ml) in the form of karma basti
which has been given after smayaka snehana (external) and
swedana.
 Group C - In 20 patients both virechana and basti (with

Erandamooladi Niruhana Basti and Maha masha taila
Anuvasana basti in the form of karma basti) have been given
after smayaka snehana (external) and swedana.
4. Assessment Criteria
A thought clinical examination of the patient was done as per the

standard symptom scoring before and after treatment.
SUBJECTIVE PARAMETERS
1. Chesta Nivritti (Loss of Functional)
Lower extremities
i. Ability to sit on the bed.
 Able to site 0
 Able to sit with self support 1
 Able to sit with support from other 2
 Not able to sit at all 3
ii. Ability to stand from sitting position
 Able to perfrom 0
 Need self support 1
 Need support of other 2
 Cannot stand 3
iii. Ability to get down from bad
 Able to perform freely 0
 Need self support 1
 Need support of other 2
 Cannot do at all
5
Summary
iv. Ability to walk

 Can walk freely 0
 Can walk with self support 1

 Can walk with support from other 2
 Cannot walk at all 3

v. Time required to walk 10 mts.
 In 12 seconds 0
 In 15 seconds 1
 In 20 seconds 2
 > 20 seconds 3
Upper extremities
i. Strength of Grip
 Normal 0
 Moderate 1
 Mild 2
 No grip 3
ii. Pressing power (The cuff of Sphygmomanometer) is inflated upto 20

mmHg and pt. asked to put pressure.
 Normal pressing >10 mmHg 0
 Moderate pressing 5-10 mmHg 1
 Mild pressing 1-5 mmHg 2

 Unable to pressing 3
iii. Ability to wear dress

 Normal dressing 0
 Little difficulty in dressing one 1

 Considerable difficulty 2
 Cannot dress at all 3
6
Summary
iv. Ability to handle the book

 Normal handling 0
 Handling with little effort 1
 Handling with considerable effort 2
 Cannot handle at all 3
v. Ability to pick pain
 Normal picking 0
 Picking with little effort 1
 Picking with considerable effort 2
 Cannot at all 3
2. Rujam (Pain)
 No Pain 0
 Occasional Pain 1
 Continuous Pain 2
 Pain requiring analgesic 3
3. Vakstambha (Speech)
 Normal 0
 Difficulty in Speech with clear words 1
 Can speak but words are not clear 2
 Can not speak at all 3
4. Achetanta (Loss of sensation)
 Normal, feeling on pricking needle 0
 Mild, sensory loss patients feels pin prick is less sharp or is
dull on the affected side 1
 Moderate, sensory loss or there is a loss of superficial pain with
pin brick but pt. is aware that he/she is being touched 2
 Severe, to total sensory loss patient is not aware of being
touched on the effected side. 3
7
Summary
5. Gouravata (Heaviness)
 Normal, No Gouravata 0
 Mild Gouravata, Feeling of heaviness in his/her legs

and feet which is ignorable 1
 Moderate Gouravata, Feeling, heaviness which is distressing

enough for him/her and use some form of treatment 2
 Severe, which require acute treatment and is very distressing

for the patient 3
6. Shotha (Oedema)
 Normal 0
 Mild shotha, patients some times notice a little swelling in

his/her leg, ankle or feet which the patients ignores. 1
 Moderate shoth, noticable swelling with pitting in feet/ legs 2

 Severe shoth, severe and generalised swelling with pitting all
over body.
7. Vibandha (Constipation)
 Normal 0
 Mild, passes tight stool one daily with difficulty 1
 Moderate, passes stool once in 2 to 3 days 2

 Severe, Does not passes stool and need enema. 3
8. Daha (Burning sensation)

 Normal, No Daha 0
 Mild Daha, Ignorable 1

 Moderate Daha, may require some treatment 2
 Severe Daha, Daha is distressing and requires

immediate treatment 3
8
Summary
9. Shirahshula (Headache)
 Normal, No Shirahshula 0
 Mild Shirahshula , ignorable 1
 Moderate, Shirahshula may require some treatment 2
 Severe Shirahshula , shira shula is distressing and
requires immediate treatment 3
Muscle strength
 No movement 0
 Flicker with attempting movement 1
 Movement with gravity eliminated 2
 Movement against the gravity 3
 Diminish 4
 Normal 5
Reflex
 Absent 0
 Present 1
 Brisk 2
 Very brisk 3
 Clonus 4
Tone
 Hypotonia -1
 Normatonia 0
 Hypertonia +1
Objective Parameter
 CBC
 Lipid profile
 RBS
 CT/ MRI (Optional)
9
Summary
Total effect of therapy
 Complete Remission ≥ 75%
 Marked Improvement ≥ 50%
 Moderate Improvement ≥ 25%
 No improvement < 25%
Statistical Analysis
To analysis the effect of therapy of therapy statistically mean,

percentage, S.D., S.E., t and P values were calculated by using paired 't'
test.
Consideration of Probability (p) value for stastical analysis -
 P> 0.05 Insignificant
 P<0.05 Significant
 P<0.01 Highly Significant
Niruha basti preparation
Erandamuladi Niruha basti
,j.Mewya f=iya --------------------- 'ke;sr iz;qDr%AA

(Ch. Si. 3/38-42)
S.No. Kwatha Dravya S.No. Kalka Dravya
1. Erand moola 3 Pal 1. Soya beej 1 Karsha
2. Palash (shati) 1 Pal 2. Hauber 1 Karsha
3. Shalparni 1 Pal 3. Priyanguphala 1 Karsha
4. Priushnaparni 1 Pal 4. Pippali 1 Karsha
5. Chhotikateri 1 Pal 5. Mulehthi 1 Karsha
6. Badi kateri 1 Pal 6. Bala 1 Karsha
10
Summary
7. Gokshura 1 Pal 7. Rasota 1 Karsha
8. Rasna 1 Pal 8. Nagarmotha 1 Karsha
9. Ashwagandha 1 Pal 9. Saindhav lavan 1 Karsha
10. Atibala 1 Pal
11. Giloya 1 Pal 1. Madhu 2 Prashrit
12. Punnarnava 1 Pal 2. Til taila 2 Prashrit
13. Amalatas 1 Pal 3. Gomutra 2 Prashrit
14. Devdaru 1 Pal 4.
15. Madan phala No. 8 5.
PREPARATION OF KWATH
Determination of quantities of Basti ingredients
nÙok··nkS lSU/koL;k{ka e/kqu% izl`r};e~---

-----------------------
ofLrnkZn'kizl`rks Hkosr AA
(Chakradatta Niruh adhikar 5-7)
 Madhu – 2 Prasharat 160 gm
 Sandhav – 1 Aksha 10 gm
 Sneha – 2 Prasharat 160 gm
 Kalka – 1 Prasharat 80 gm
 Kwath – 5 Prasharat 400 ml
 Prakshepa – 2 Prasharat 160gm
Total Niruhana Basti matra 12 Prasharat (960 ml)
Method of preparation
ekf{kda yo.ka Lusgaa dYda DokFkfefr

Øekr~ A
11
Summary
vkoisr fu:gk.kkes"k la;kstus fof/k AA (A.H.

Basti vidhi 19/45)
As a first step in the preparation of Niruha basti madhu and saidhav

lavan should be grinded thoroughly followed by the addition of sneha (Tila
taila), kalka and kwatha in that order to this preparation. Gomutra is added
in the required quantity. All the contents should be properly admixed and
churned in order to make a proportionate Niruha Dravya.
Erand Muladi Niruhan Basti (Ch. Si. 3/38-42)
1st Madhu 2 Prasharat 160 gram

Sandhav lavan 1 Aksha 10 gram
nd
2 Sneha (tila taila) 2 Prasharat 160 gram
rd
3 Kalka 1 Prasharat 80 gram
th
4 kwatha 5 Prasharat 400 ml
 Kwatha dravya – 680 gram
 2 kansa water = 512 tola = 5120 ml
 1/8 (Ashtamansha) = 640 ml
 Aavap / prakshepa = 2 Prasharat – 160 ml

(As per disease)
Anuvasan Basti (Mahamash tail)
Anuvasan basti which forms apart of karma basti is performed with
Mahamasha taila taking reference from a comprehensive text chakradutta.
Anuvasana Basti preparation
Mahamasha taila is considered for Anuvasan Basti-
f}i×pewyha fu%DokF; -----------------------

Ekk"k rSy fena Ekâr~ AA
oLR;H;×tuikus"kq ukous iz;kst;sr
i{kk?kkrs guqLrEHks vfnZrs lkirU=ds
Method
12
Summary
n'kewyk<da nzks.ks fu%DokF; ikfndks

Hkosr~ A
DokFk'p
prqxqZ.kLrSykUEkk"kDokFks·O;;a fof/k AA
(Charkra dutta vata vyadhi Chi. P. 192-196)
RESULTS
Table No. 1 Status of 76 patients of Pakshaghata
Total 76 patients were registered for the present study. Among

them 60 patients completed their treatment and 16 patients left against
medical advise (LAMA). In Group A, 20 patients had completed the
treatment and 8 patients left against medical advise and in Group B 20
patients had completed the treatment and 2 patients left against medical
advise, in group C, 20 patients had completed the treatment and 6
patients left against medical advise.
Table No. 2 Age wise distribution of 76 patients of Pakshaghata
Patients between the age group of 30-70 years were selected for
the present clinical study. The data reveals that majority of the patients
39.48% were reported in the age group of 51-60 years followed by 28.94%
in the age group of 41-50 years,19.74% in the age group of 30-40 and
11.84% in the age group 61-70 years.
Table No. 3 Sex wise distribution of 76 patients of Pakshaghata
In the present study, maximum number of patients i.e. 88.16%

were of male sex and remaining 11.84% patients were female.
Table No. 4 Religion wise distribution of 76 patients of Pakshaghata
The religion wise distribution showed that 76.32% of patients were

belonging to Hindu religion while 23.68% of patients were from other
religion.
13
Summary
Table No. 5 Marital status wise distribution of 76 patients of

Pakshaghata
In this study 96.06% of patients were married and remaining 3.94%

patients were unmarried.
14
Summary
Table No. 6 Education wise distribution of 76 patients of

Pakshaghata
As shown in table, maximum number of patients i.e. 36.84% were

having the education upto graduation followed by 27.63% patients. having
education to marticutation, 14.47% of patients. Were post graduation
11.84% patients were uneducated and 9.22% patients were having
education upto primary.
Table No. 7 Occupation wise distribution of 76 patients of

Pakshaghata
In this study businessmen were more in number i.e. 40.79%

followed by service man (35.53%), Labourer (15.78%) and household
(7.90%).
Table No. 8 Socio-economical status wise distribution of 76 patients

of Pakshaghata
The present study shows that maximum number of patients 68.42

were from middle class, while 19.74% from upper class and 11.84 patients
from lower class.
Table No. 9 Habitat wise distribution of 76 patients of Pakshaghata
The present study shows that majority of the patients i.e. 60.52%
were belonging to Urban habitat while rest of the patients i.e. 39.48% were
from Rural habitat.
Table No. 10 Family history wise distribution of 76 patients of

Pakshaghata
This present study shows that 90.79% of patients were having

Negative family history followed by 9.21% of patients having Positive
family history.
15
Summary
Table No. 11 Desha wise distribution of 76 patients of Pakshaghata
In the present study, 82.89% patients were belonging to sodharam

desha followed by 14.47% belonging to jangal desha and 2.64%
belonging to Aanup desha.
Table No. 12 Chronicity wise distribution of 76 patients of

Pakshaghata
The present clinical study shows that majority of the patients i.e.
48.69% were reported having chronicity of 1-2 years followed by 23.68%
having chronicity of 6-12 months , 18.42% having chronicity 3-6 months,
and 9.21% patients were having chronicity of 0-3 months.
Table No. 13 Dietary Habit wise distribution of 76 patients of

Pakshaghata
In this study, maximum number of patients i.e. 67.10% were having

Habit of Adhyasana followed by habit of Samasana in 32.90% patients.
Table No. 14 Type of Diet wise distribution of 76 patients of

Pakshaghata
The present study reveals that maximum patients 65.78% were

Vegetarian while 34.22% patients were having Mixed diet.
Table No. 15 Dominance of rasa in diet wise distribution of 76

patients of Pakshaghata
In this series Dominancy of katu rasa in diet was present in 31.58%

of patients. Dominancy of Madhura Rasa was present in 23.68% and
dominancy of lavan rasa in diet was present in 11.84 of patients 32.90% of
patients were having Normal Diet without Dominancy on any specific
Rasa in Diet.
16
Summary
Table No. 16 Kostha wise distribution of 76 patients of Pakshaghata
The present study reveals that maximum numbers of patients i.e.

52.64& were having Krura Kostha while 28.94% patients were having
Madhyama Kostha and 18.42% patients having Mridu Kostha.
Table No. 17 Agni wise distribution of 76 patients of Pakshaghata
In this study, Maximum number of patients 42.11% were having

Mandaagni followed by 38.16% of patients were having vishamagni
15.79% patients having Samagni and 3.94% patients were having
Tikshagni.
Table No. 18 Bowel Habit wise distribution of 76 patients of

Pakshaghata
In the present study maximum number of patients 61.84% were

having Irregular Bowel Habit while 38.16% patients were having Regular
Bowel habit.
Table No. 19 Addiction wise distribution of 76 patients of

Pakshaghata
In the present study, the available data depicts that 39.47%

patients were having Addiction of Tea/Coffee, 28.94% patients were
having Addiction of Smoking, 17.11% patients were having Addiction of
Tabacco, 13.15% patients were having Addiction of Alcohal and 1.32
patients was having Addiction of Opium / Connobis.
Table No. 20 Emotional status wise distribution of 76 patients of

Pakshaghata
In the present study the available data depicts that 39.47% patients
passed a Tensive emotional status, 30.26% passed anxious and
remaining same percentage of patients had depressive emotional status.
17
Summary
Table No. 21 Nidra wise distribution of 76 patients of Pakshaghata
In the present study shows that 44.73% patients were found to be

having irregular sleep, 30.26% were having Alpa Nidra and remaining
25% patients were having regular sleep.
Table No. 22 Sharirika prakriti wise distribution of 76 patients of

Pakshaghata
The present study show that 43.42% patients were of Pitta kaphaja
Deha Prakriti, 36.84% were of Vata Kaphaja Prakriti and remaining
19.73% patients were having Vata Pittaja Deha Prakriti.
Table No. 23 Manasa prakriti wise distribution of 76 patients of

Pakshaghata
The present study shows that 75% patients passed Rajas Prakriti,
while rest 25% patients passed Tamas Prakriti.
Table No. 28 Vyayama shakti wise distribution of 76 patients of

Pakshaghata
68.42% patients passed avara vyayaam shakti 18.42% patients

passed madhyama vyayama shakti and remaining 11.84% patients were
having pravara vyayama shakti.
Table No. 29 Abhayavaharana shakti wise distribution of 76 patients

of Pakshaghata
The present study shows that maximum number of patients 69.73

were from Madhyama Abyavaharan shakti while 17.10% were from Avara
Abhayavaharan shakti and 13.15% were from Pravara Abhyavaharan
shakti.
Table No. 30 Jarana shakti wise distribution of 76 patients of

Pakshaghata
The present study shows that maximum number of patients 71.05%

were from Madhama Jarana Shakti while 18.42% were from Avara Jarana
Shakti and 10.52% were from Pravara Jarana Shakti.
18
Summary
Table No. 31 Onset wise distribution of 76 patients of Pakshaghata
In the present study 82.89% patients were having sudden onset of

symptoms while remaining 17.11% patients reported gradual onset of
symptoms.
Table No. 32 Nature of lesion wise distribution of 76 patients of

Pakshaghata
On observation of nature of lesion 84.21% patients have Infaraction

and 15.79% patients have Hemorrhage this data this data is based on the
CT scan or MRI carried out by modern physician in these patients.
Table No. 33 Doshanubandha wise distribution of 76 patients of

Pakshaghata
On observation of Doshanubandha in Pakshaghata 68.42%

patients showed kaphanubandha lakshana and remaining 31.58%
patients showed pittanubandha lakshana.
Table No. 34 Dushya wise distribution of 76 patients of Pakshaghata
All the patients of Pakshaghata manifest Majja Dushti Lakshana

71.05% patients shows Rakta, Meda Dushti, Lakshana and 26.31%
patient shows Asthi Dusti Lakshana.
Table No. 35 : Cardinal symptoms wise distribution of 76 patients of

Pakshaghata
In this study, all the patients (100%) were having Chesta nivritti,
Ruja in 73.68%, Vakstambha were present in 76.31% patients, Achetanta
was present in 60.52% patents, Guruta was present in 64.47% patients,
vibandha was present in 68.42% patients, Sotha was present in 52.63%
patients, Daha was present in 75% patients and Shirashula was present in
78.94% patients.
19
Summary
COMPARATIVE EFFECT OF THERAPIES ON CHESTA NIVRITTI

Loss of function
Lower
1. Comparative effect of therapies on Ability to sit on the bed.
Group C showed significant results with P value <0.05 and

percentage of relief 58.52% when compared to group A & B which
showed insignificant results with >0.05 and percentage of relief 16.67%
and 15.79% respectively.
2. Comparative effect of therapies on Ability to stand from sitting

position
Group A showed insignificant results with P value >0.05 and

percentage of relief 15% compared to group B & C which showed
significant results with <0.05 and percentage of relief 23.81% and 30.43%
respectively.
3. Comparative effect of therapies on Ability to get down from bed

percentage of relief 13.04% Group B showed significant results with P
value <0.05 and percentage of relief 21.74% and group C showed highly
significant results with P value <0.01.
4. Comparative effect of therapies on Ability to walk

percentage of relief 25.53% compared to group A and B which showed
insignificant results with >0.05 and percentage of relief 13.04% and
13.04%.
5. Comparative effect of therapies on Time required to walk 10 mtr

Group A showed insignificant results with P value <0.05 and
percentage of relief 13.64% compared to group B and C which showed
respectively.
20
Summary
COMPARATIVE EFFECT OF THERAPIES ON CHESTA NIVRITTI

Loss of function
Upper
6. Comparative effect of therapies on strength of grip

respectively.
7. Comparative effect of therapies on pressing power

Group A, B and C showed significant results with P value <0.05 and
percentage of relief 17.86%, 18.52% and 19.35% respectively.
8. Comparative effect of therapies on Ability to wear dress
Group A, B and C showed insignificant results with P value >0.05 and

percentage of relief 11.54%, 11.11% and 12.12% respectively.
9. Comparative effect of therapies on Ability to Handle the book

Group A showed insignificant results with P value >0.05 and percentage of
relief 16.67% compared to group B and C which showed significant results
with <0.05 and percentage of relief 17.86% and 17.86% respectively.
10. Comparative effect of therapies on Ability to pick pin

Group A, B and C showed insignificant results with P value >0.05
and percentage of relief 10.71%, 10.71% and 11.11% respectively.
COMPARATIVE EFFECT OF THERAPIES
Comparative effect of therapies on Ruja

1. Group C showed Highly significant results with P value (<0.01) and
percentage of relief 23.08% when compared to Group A & B which
showed significant results with <0.05 and percentage of relief 20% and
22.22% respectively.
21
Summary
Comparative effect of therapies on Vakstambha

2. Group A showed insignificant results with P value >0.05 and
percentage of relief 16.67% when compared to Group B and C which
showed significant results with <0.05 and percentage of relief 17.24%
& 20% respectively.
Comparative effect of therapies on Achetanta
3. Group C showed highly significant results with P value <0.01 and

showed significant results with P value <0.05 and percentage of relief
28.57% and 31.25% respectively.
Comparative effect of therapies on Guruta

4. Group A, B, and C showed significant results with P value <0.05 and
percentage of relief 23.53%, 25% and 25% respectively.
Comparative effect of therapies on Vibandha

percentage of relief 21.88% when compared to Group A & Group B
which showed significant results with <0.05 of percentage of relief 20%
& 20.83% respectively.
Comparative effect of therapies on Shotha

6. Group B showed insignificant results with P value >0.05 and
percentage of relief 15% compared to group A & C which showed
significant results <0.05 and percentage of relief 17.39% and 26.32%
respectively.
Comparative effect of therapies on Daha

showed significant results with <0.05 and percentage of relief 58.52%
and 20% respectively.
22
Summary
Comparative effect of therapies on Shirahshula

8. Group A showed insignificant results with P value >0.05 and
significant results with <0.05 and percentage of relief 13.13% and 30%
respectively.
COMPARATIVE EFFECT OF THERAPIES ON POWER (UPPER
AND LOWER)
1. Comparative effect of therapies on shoulder

percentage of relief 4.84% when compared to group B and Group C which
showed significant results with <0.05 and percentage of relief 8.45% and
9.72% respectively.
2. Comparative effect of therapies on Elbow

10% respectively.
3. Comparative effect of therapies on Wrist

8.45% respectively.
4. Comparative effect of therapies on McP & IP

5. Comparative effect of therapies on Hip

7.14% respectively.
23
Summary
6. Comparative effect of therapies on Knee

9.86% respectively.
7. Comparative effect of therapies on Ankle

8. Comparative effect of therapies on Metatarsals

COMPARATIVE EFFECT OF THERAPIES ON REFLEX

1. Comparative effect of therapies on Knee

percentage of relief 11.11% when compared to group B and Group C
which showed significant results with <0.05 and percentage of relief
2. Comparative effect of therapies on Ankle

and percentage of relief 12%, 17.24% and 19.35% respectively.
3. Comparative effect of therapies on Triceps

4. Comparative effect of therapies on Biceps

which showed significant results with <0.05 and percentage of relief 20%
24
Summary
COMPARATIVE EFFECT OF THERAPIES ON TONE

1. Comparative effect of therapies on Tone (Hand)
Group B showed highly significant results with P value <0.01 and

percentage of relief 50% when compared to group A & C which showed
respectively.
2. Comparative effect of therapies on Tone (Leg)

which showed significant results with <0.05 and percentage of relief
COMPARATIVE EFFECT OF THERAPIES ON SEROLOGICAL
INVESTIGATIONS
1. Comparative effect of therapies on Se. cholesterol levels
Group C showed highly significant results with P value <0.01 and

percentage change of 3.82% when compared to group A & B which
showed significant results with <0.05 and percentage change of 3.51%
2. Comparative effect of therapies on HDL levels

percentage change of 1% when compared to group A and Group B which
showed insignificant results with >0.05 and percentage change of 0.70%
3. Comparative effect of therapies on LDL levels

percentage change of 3.64%, 4.90% and 6.34% respectively.
4. Comparative effect of therapies on VLDL levels

Group C showed Highly significant results with P value <0.01 and
percentage change of 4.74% when compared to group A and Group B
25
Summary
which showed insignificant results with >0.05 and percentage change of

5. Comparative effect of therapies on Triglyceride levels

percentage change of 4.89%, 5.36% and 5.62% respectively.
6. Comparative effect of therapies on Random Blood Sugar

and percentage change of 0.51%, 0.68% and 1.19% respectively.
OVER ALL EFFECT OF THERAPIES IN PERCENTAGE

 Complete Remission in Group -A is 0% in Group -B is 5% and in
Group- C is 10%.
 Marked improvement in Group -A is 20%, in Group- B is 20% and
in Group -C is 50%.
 Moderate improvement in Group- A is 45%, in Group- B is 55% and
In Group- C 30%.
 No improvement in Group -A is 35%, in Group -B is 20% and in
Group- C is 10%.
DISCUSSION & CONCLUSION

The thesis entitled-
"The comparative study of virechana karma and Basti karma in

the management of Pakshaghata W.R.S. to C.V.A.
Comprises of five parts viz conceptual study, Drug Review, Clinical

study, Discussion, Summary and Conclusion.
EFFECT OF THEREPIES
In the clinical study 76 patients were registered in three groups

randomly. Patients in Group A were treated with Virechana with castor oil
26
Summary
after samyak snehan and Swedana. Patients in Group B were treated with
basti karma (Erandmooladi Niruhan and Mahamasha tail Anuvasan) in
Group C Virechan followed by basti karma and out of 76 patients 60
completed the trial.
EFFECT ON CHESHTA NIVRITTI (LOSS OF FUNCTION)
Effect of therapy on the cardinal symptom of Pakshaaghaata

Cheshtaa Nivritti was assessed by assessing the following mentioned
parameters like, Distal motor function, Motor function of arm, Motor
function of leg, Muscle power and assessing the improvement in activities
of daily living like Sitting from lying down, Standing from sitting, Increase in
walking capacity, Hand grip power. In all the above mentioned symptoms
the better result was observed in group C as compared to Group B and
Group A. It may be inferred from the above results that virechan followed
by basti karma played a significant role in alleviating Cheshtaa Nivritti This
proves the efficacy of Virechana followed by basti karma in this disease by
its Srotovishuddhi and Indriya-Prasaadana properties. The improvement in
above symptoms is may be due to the relief of the Aavarana of Vaayu
leading to the normal function of Vaayu.
EFFECT ON RUJA (PAIN)
Patients of Group A and group B showed statistically

significant(<0.05) results with percentage relief of 20% and 22.22%
respectively but group C showed statistically Highly significant (<0.01)
results with percentage relief of 23.08%. Ruja might have been checked
due to the fact that the Vaata gets pacified due to the removal of Aavarana
by basti karma and virechan & basti karma combined.
EFFECT ON VAKSTAMBHA (SPEECH)
The relief observed in Group B and in Group C were statistically

significant (<0.05) with percentage relief of 17.24% and 20% in Group A it
was statistically insignificant (>0.05) with percentage relief of 16.67%.
27
Summary
Basti karma and virechan followed by basti karma by its Srotoshodhana

property might have relieved the Aavarana of Udaana by Kapha and also
might have reduced the Praana Vaayu Dushti which is controller of Vaak
Indriya Moola.
EFFECT ON GURUTAA (HEAVINESS)
The relief observed in Group A, B & C were significant (<0.05) with

percentage relief of 23.53%, 25% & 25% respectively. Hence Gurutaa
might have been checked better by Virechana owing to its Srotosodhana
properties and may be potentiated by the Teekshna, Sookshma, Ushna
and Vata- Kapha Shaamaka properties of the basti karma.
EFFECT ON SHOTHA (OEDEMA)
The relief observed in Group A & C were statistically significant

(<0.05) with percentage relief of 17.39% and 26.32% respectively and in
Group B it was statistically insignificant (>0.05) with percentage relief of
15%. Virechana checks the derangement of Tridosha along with Rakta,
and this property might have enabled it to function more efficiently in
resolving Shotha.
EFFECT ON DAAHA (BURNING SENSATION)
The relief observed in group A was statistically significant (<0.05)

with percentage relief of 18.52% and Highly significant in group C with
percentage of relief 22.22%. Result bestowed in Group A was significant
because virechan is considered as best treatment for pittaj vikar & pitta
avaran is removed and daha is alleviated. In group C Basti is also given
after virechana. It pacifies vata and residual pitta dosha. There for the
result was highly significant in this group.
EFFECT ON SIRAHSHULA (HEADACHE)
Patients of Group B & C showed statistically significant (<0.05)

results with percentage relief of 13.33% and 20% respectively and in
28
Summary
group A it was statistically insignificant (>0.05) with percentage relief of

9.38%. Significant results were obtained in group B and C vata vitiation is
responsible for headache with the use of basti karma morbid vata is
pacified and it reduces headache
EFFECT ON VIBANDHA (CONSTIPATON)
Group A and in Group B were evaluated to be having significant

(<0.05) results with percentage relief of 20% and 20.83% respectively and
in group C it was statistically Highly significant (<0.01) with percentage
relief of 21.88%.
All the therapies were evaluated to be having significant result in

relieving the constipation but group C showed highly significant result This
shows the Anulomaka property of therapies and supports the action of
therapies on Apaana Kshetra and their role in Apaana Vaayu Dushti.
EFFECT ON SANKOCHA (MUSCLE TONE)
Rigidity or increased muscle tone is relieved significantly (<0.05) by

41.67% in upper limb and 42.86% in lower limb in group A ;by 50% in
upper limbs & 57.14% in lower limbs in group B and by 53.85% in upper
limb and 45.45% in lower limb in group C. The therapeutic interventions by
virechana and Basti might have regulated the aavrita vata by clearing the
aavaran and thus strengthening the functional aspect of vata .The
cumulative effect of virechan and basti are better seen in group C.
EFFECT ON REFLEXES
The effect of virechan in group A is insignificant (>0.05) in knee,

ankle, triceps & biceps reflexes. The effect of basti in group B showed
significant (<0.05) results in knee and biceps reflexes and showed
insignificant (>0.05) result in ankle and triceps reflexes.
29
Summary
The cumulative effect of virechan and basti has shown significant

results in knee and biceps reflexes and insignificant results in ankle and
triceps reflexes.
The aggravation of reflexes, which is the manifestation of chalguna

of vitiated vata is regulated and significantly normalized as the treatment
modalities subdued the vata and controlled the vitiation.
INVESTIGATIONS ON LIPID PROFILE & RANDOM BLOOD SUGAR

Serum cholesterol level was reduced significantly in Group A &
Group B but better recovery was reported in Group C.
In group A virechana was given which might have caused cleansing
of intestine (Srotosuddhi) there by reducing cholesterol.
In Group B basti was given which might have improved the
intestinal flora with subsequent obsorption and assimilation of fats
reducing Serum cholesterol.
In Group C virechana karma was followed by Basti karma the
combined action of both by doing srotosuddhi, removing obstruction in
channels and maintaining flora of intestine showed Highly significant
results in Serum cholesterol.
HDL level was insignificant in group A & B i.e. virechana & Basti
karma.
HDL level was significant in group C i.e. virechana karma followed
by Basti karma it is also due to improvement in fat, metabolism.
LDL & Triglyceride level were lowered significantly in Group A i.e.
virechana karma. It is supposed to be due to Srotosuddhi and cleansing of
alimentary gut.
LDL & Triglyceride was lowered significantly in Group B, Basti
karma also it is supposed to be due to maintenance of flora and
improvement in Dhatwagni & Bhutagni.
LDL & Triglyceride were improved significantly in Group C due to
combined effect of virechana and Basti karma.
30
Summary
VLDL showed significant changes in Group C due to combined

effect of virechana and Basti karma which might have improve the fat
metabolism at cellular level.
Blood sugar level showed insignificant change in their value in all
the group i.e. A virechana, Group B Basti karma & Group C i.e. virechana
followed by Basti karma.
CBC (Complete blood count) level showed insignificant changes in
all the groups i.e. A virechana, Group B Basti karma & Group C i.e.
virechana followed by Basti karma.
TOTAL EFFECT OF THERAPIES
In Group A, complete remission found in 0.0% patients marked
improvement found in 20.00% patients, moderate improvement found in
45.00% patients while no improvement was observed in 35.00% of
patients.
In Group B, complete remission found in 5.00% patients, marked
improvement found in 20.00% patients, moderate, improvement found in
55.00% patients while no improvement was observed in 20.00% of
patients.
In Group C, complete remission found in 10.00% patients, marked
improvement found in 50.00% patients, moderate improvement found in
30.00% patients, while no improvement was observed in 10.00% patients.
So the total effect of therapies shows that in comparision to Group A, B &
C shows better results which could be due to the cumulative effect of
virechan & Basti karma.
So, the Total effect of therapies shows that in comparison to Group
A and Group B, Group C shows better results which could be due to the
cumulative effect of Virechana & Basti karma.
31

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Summary

The etiological factors of underlying pathology according to the

Conceptual study includes diease review and drug review. Disease

For clinical study 60 patients were registered and out of them 60

 1st Groups – In 20 patients virechana karma with castor oil has

 2nd Groups – In 20 patients Basti karma Erandamuladi niruhan

 3rd Groups – In 20 patients both virechana and basti with

 Group A –Results were satisfactory.

 Group B –Results were satisfactory and better than group A

 Group C –The combination of both karma showed remarkable

Clinical research is the back bone of any medical science. It is the

Pakshaghata is a most distressing disease among vatavyadhi. It is

Akin to pakshaghata, hemilegia also caused by a wide spectrum of

1. AIM – To compare the effects of Virechana karma and Basti karma in

 To study the effect of virechana karma

 To study the effect of Basti karma

 To study critically about pakshaghata w.s.r. to CVA.

 To compare the effect of virechana karma and Basti karma in

3. MATERIAL AND METHODS

A. Subject – 60 subjects satisfying the selection criteria were

B. Source of Subject – Selection of the patients was made from the

 Group B - In 20 patients Basti karma with Erandmooladi

 Group C - In 20 patients both virechana and basti (with

A thought clinical examination of the patient was done as per the

iv. Ability to walk

 Can walk with self support 1

 Cannot walk at all 3

ii. Pressing power (The cuff of Sphygmomanometer) is inflated upto 20

 Mild pressing 1-5 mmHg 2

iii. Ability to wear dress

 Little difficulty in dressing one 1

iv. Ability to handle the book

 Mild Gouravata, Feeling of heaviness in his/her legs

 Moderate Gouravata, Feeling, heaviness which is distressing

 Severe, which require acute treatment and is very distressing

 Mild shotha, patients some times notice a little swelling in

 Moderate shoth, noticable swelling with pitting in feet/ legs 2

 Moderate, passes stool once in 2 to 3 days 2

8. Daha (Burning sensation)

 Mild Daha, Ignorable 1

 Severe Daha, Daha is distressing and requires

Total effect of therapy

 Complete Remission ≥ 75%

 Marked Improvement ≥ 50%

 Moderate Improvement ≥ 25%

 No improvement < 25%

To analysis the effect of therapy of therapy statistically mean,

Consideration of Probability (p) value for stastical analysis -

 P> 0.05 Insignificant

 P<0.01 Highly Significant

Niruha basti preparation

Erandamuladi Niruha basti

,j.Mewya f=iya --------------------- 'ke;sr iz;qDr%AA

S.No. Kwatha Dravya S.No. Kalka Dravya

1. Erand moola 3 Pal 1. Soya beej 1 Karsha

2. Palash (shati) 1 Pal 2. Hauber 1 Karsha

3. Shalparni 1 Pal 3. Priyanguphala 1 Karsha

4. Priushnaparni 1 Pal 4. Pippali 1 Karsha

5. Chhotikateri 1 Pal 5. Mulehthi 1 Karsha

6. Badi kateri 1 Pal 6. Bala 1 Karsha

7. Gokshura 1 Pal 7. Rasota 1 Karsha

8. Rasna 1 Pal 8. Nagarmotha 1 Karsha

9. Ashwagandha 1 Pal 9. Saindhav lavan 1 Karsha