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2]

Case Report

One-and-a-Half Syndrome and its Management with Ayurvedic

Treatments: A Case Report

Abstract Manjusree
Introduction: One‑and‑a‑half syndrome is a condition characterized by horizontal gaze palsy and Radhakrishnan
internuclear ophthalmoplegia. Its risk factors include conditions that predispose to pontine lesions and Parappurathu,
demyelinating conditions. The symptoms include blurred vision, diplopia, and oscillopsia. Management
is addressing the underlying symptom and relieving the symptoms. The case of a 46‑year‑old Aravind Kumar1,
hypertensive male who was diagnosed with one‑and‑a‑half syndrome and who underwent inpatient Krishnendu
management at an allopathic hospital is presented here. He initially approached Sreedhareeyam’s Sukumaran1,
OP division and was prescribed medicine and inpatient management. Main Clinical Findings: Kavya Rama Varma1
On examination, he had blurred vision, diplopia, and one‑and‑a‑half syndrome. Intervention: He Senior Medical Officer,
underwent an inpatient Ayurvedic protocol comprising of oral medicines, external therapies, and eye Sreedhareeyam Ayurvedic
exercises. Outcome: Results at discharge and at three subsequent follow‑ups demonstrated gradually Eye Hospital and Research
improved ocular movements and relief of symptoms. Conclusion: This case illustrates that Ayurveda Center, 1Department of Clinical
treatments may be explored for this condition. Research, Sreedhareeyam
Ayurvedic Research and
Keywords: Ayurveda, case report, Kriyakalpa, ocular motility, ophthalmoplegia, Tarpana Development Institute,
Ernakulam, Kerala, India

Introduction distorted vision for 15, January 2021. At

3:30 pm on that day, the patient suddenly
One‑and‑a‑half syndrome presents with
developed numbness in his hands associated
a combination of ipsilateral conjugate
with weakness of the right side of his body,
horizontal gaze palsy (one) and ipsilateral
left‑sided facial deviation, and restricted
internuclear ophthalmoplegia (a
right eyeball movement. He immediately
half).[1] Causes include vascular, traumatic,
consulted a neurologist who diagnosed him
infiltrative, neoplastic, and inflammatory
with horizontal one‑and‑a‑half syndrome
conditions that predispose to pontine lesions,
and internuclear ophthalmoplegia.
demyelinating conditions, malignancies,
Computed tomography (CT) of the brain
and rarely infectious causes.[2] Common
showed acute hemorrhaging in the posterior
presentations are with diplopia, blurred
aspect of the pons. Electrocardiography
vision, and oscillopsia. Diagnostic parameters
showed normal sinus rhythms and no ST‑T
include ocular motility assessment,
changes, and an echocardiogram showed
differential diagnoses with ocular myasthenia
normal cardiac walls and chambers and
gravis, and neuroimaging, especially magnetic
good left ventricular systolic functions, and
resonance imaging (MRI) scanning, to rule
no regional wall motion abnormalities and
out brainstem lesions. Management entails Address for correspondence:
pulmonary arterial hypertension. He was Dr. Aravind Kumar,
targeting the underlying cause and employing
admitted in the Neurology department from Sreedhareeyam Ayurvedic
methods for ameliorating the symptoms. This
January 15, to January 27, 2021. Where Research and Development
report describes the Ayurvedic management Institute, Nelliakkattu
he was given symptomatic management.
of a case of one‑and‑a‑half syndrome. Mana, Kizhakombu,
An MRI brain taken on January 25, 2021 Ernakulam, Kerala, India.
Written informed consent was obtained
showed bleeding in the dorsal pons and E‑mail: clinicalresearch@
before documenting the case.
midbrain and a hypertension‑related sreedhareeyam.com

Case Report cavernoma [Figure 1]. On February 1, 2021,

the patient approached Sreedhareeyam
Patient information Hospital’s OP consultation center and
Access this article online

A 46‑year‑old hypertensive male presented started taking Ayurvedic medicines. He Website: www.journayu.in

with blurring of vision, double vision, and
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was advised admission the following DOI: 10.4103/joa.joa_263_21
Quick Response Code:
How to cite this article: Parappurathu MR, Kumar A,
Sukumaran K, Varma KR. One-and-a-half syndrome
and its management with Ayurvedic treatments: A
case report. J Ayurveda 2022;16:161-9.
Submitted: 13‑Aug‑2021 Revised: 22‑Dec‑2021
Accepted: 29‑Mar‑2022 Published: 04-Jul-2022

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Parappurathu, et al.: Ayurvedic management of one‑and‑a‑half syndrome
Figure 1: Discharge summary from neurology
month. His past history is significant for a cerebrovascular
accident (CVA) and hypertension, for which he is currently
under medication. His mother has had a history of both
hypertension and CVA. His personal history and social
history was normal. He was taking Biotor (1 tablet after
dinner), Nicardiaa (1 tablet twice a day after food),
Colihenz P (1 tablet after dinner), Rabican (1 tablet
after breakfast), Ciplox (1 tablet twice a day after food),
and Refresh Drops (1 drop in both eyes twice a day).
Cardiovascular, gastrointestinal, renal, and nervous systems
are all normal, and his vital signs were normal.
Clinical findings
Unaided distant visual acuity (DVA) was LogMAR 0.477
in both eyes (OU– oculus uterque) and near visual acuity
was N12 in his right eye (OD– oculus dexter) and N18 in
his left eye (OS– oculus sinister). Pinhole acuity was not
attempted here. A convex spherical lens measuring 0.75
diopters (D) and a cylinder of 0.5D with an axis of 90° was
able to correct the visual acuity to LogMAR 0.301 OD, and
a convex spherical lens of 0.75D corrected the visual acuity
to LogMAR 0.301 OS. A 1.75D convex spherical lens
corrected the NVA OU to N6. Ocular motility assessment
showed restriction in horizontal and vertical movements
OD and reduced adduction OS. Anterior segment
examination was normal OU. Normal responses to direct,
consensual, and near pupillary reflexes were observed OU.
Posterior segment examination showed normal media, optic
discs, background, and vasculature OU.
Dasavidha Pariksha (ten methods of examination)
showed a somatic constitution (Prakrti) of Vata
and Kapha; normal (Pravara) Sara (essence of
162
functional tissues (Dhatus), compactness (Samhanana),
measurement of body parts (Pramana), psyche (Sattva),
habits (Satmya) digestion (Ahara Sakti), and capacity
for exercise (Vyayama Sakti). He was categorized as
Yauvana (young) in age.
Time line
The patient reported for one outpatient consultation on
February 1, 2021. His inpatient management was from March
1 to 23, 2021. He reported for five follow‑up consultations
during the period of April– November 2021 [Table 1].
Diagnostic focus and assessment
A diagnosis of one‑and‑a‑half syndrome was made based on
the history and examinations. The condition was compared
with Vatavyadhi (nervous disease) and Vataja Timira (blurring
of vision due to Vata) as per Ayurveda. Routine hematological,
biochemical, and serological assessments were normal. The
patient submitted a negative result report of the COVID‑19
reverse transcriptase polymerase chain reaction test prior to
admission for therapy.
Therapeutic interventions
The patient was admitted for a course of inpatient Ayurvedic
management comprising of oral medicines [Table 2],
Sodhana Chikitsa (bio‑purification) [Table 3] and
local therapies for the eyes (Netra Kriyakalpa) and
head [Table 4]. He was advised adherence to a healthy diet
and lifestyle by the hospital’s in‑house dietician based on
his previous history of CVA and hypertension. He was also
trained in simple eye exercises (palming, throwing a ball,
and slow eye movements) from the hospital’s Yoga and
Naturopathy division.
All medicines, except Neurodiet, were manufactured in
Sreedhareeyam Farmherbs India, Pvt. Ltd., the hospital’s
GMP‑certified drug manufacturing unit. Neurodiet was
manufactured at The Diet Hub, based in Kochi, Kerala,
India.
Follow‑up and outcome
Unaided DVA at discharge improved to LogMAR 0.176
OD and 0.301 OS. A spherical lens of 0.75D with an
cylinder of 0.5D and an axis of 90° improved the DVA
to LogMAR 0 OU. NVA improved to N6 OU. Symptoms
also showed reduction. Extraocular motility assessment
demonstrated mild relief in eyeball movements OD
and mild improvement in adduction OS. He reported
for three follow‑ups, in which unaided DVA improved
to LogMAR 0.176 OU and eyeball movement OD and
adduction OS gradually increased. In addition, symptoms
gradually reduced. All findings were maintained at the
fourth and fifth follow‑ups. Posttherapeutic radiologic
exams were advised, but the patient could not obtain
them at present.
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Parappurathu, et al.: Ayurvedic management of one‑and‑a‑half syndrome

Table 1: Time line of events and therapeutic protocol

Date Relevant past history and interventions
January 15th, Patient develops numbness in his hands associated with weakness of the right side of his body, left‑sided facial deviation,
2021 and restricted movement of his right eyeball
Diagnosis of horizontal one‑and‑a‑half syndrome and internuclear ophthalmoplegia
CT brain: Acute hemorrhaging in the posterior aspect of the pons
Admitted for symptomatic management in neurology
January 25th, MRI brain: Bleeding in the dorsal aspect of pons and midbrain - Hypertension‑related cavernoma
2021 Discharge from hospital with medications
Past history significant for cerebrovascular accident and hypertension
Date Summaries from initial Diagnostic testing (including dates) Interventions
and follow‑up visits
February 1st, Patient reports for an Visual acuit Oral medicine: Dhanadarasnadi Kvatha
2021 outpatient consultation DVA: LogMAR 0.602 OD, LogMAR 0.301 OS External therapy: Ascyotana
NVA: N18 OU
Refraction: LogMAR 0.301 OU by a 0.75D
spherical lens with 0.75D cylinder and 40° axis
Extraocular motility: Restricted horizontal and
vertical movements OD, reduced adduction OS
March 1st, Patient is admitted for Visual acuity Oral medicines: Dhanadarasnadi Kvatha,
2021 inpatient management DVA: LogMAR 0.602 OD, LogMAR 0.301 OS Dhanvantaram 101 Avartana, Ananta
Ghrta*, Triphala Guggulu, Manasa
NVA: N18 OU
Mitra Vataka
Refraction: LogMAR 0.301 OU by a 0.75D
Sodhana chikitsa: Pratimarsa Nasya,
spherical lens with 0.75D cylinder and 40° axis
Gandusha
Extraocular motility: Restricted horizontal and
External therapies: Seka, Avaguntana,
vertical movements OD, reduced adduction OS
Ascyotana, Tarpana, Thala, Sirodhara
March 23rd, Patient feels comfortable Visual acuity Oral medicines: Dhanadarasnadi Kvatha,
2021 with treatment and is DVA: LogMAR 0.176 OD, LogMAR 0.301 OS Dhanvantaram 101 Avartana, Neurodiet^
discharged External therapies: Ascyotana, Siro
NVA: N6 OU
Abhyanga
Refraction: LogMAR 0 OU by a 0.75D spherical
lens with 0.75D cylinder and 40° axis
Extraocular motility: Mild improvement in ocular
movement OD, mild relief in adduction OS
April 24th, Patient reports for a Visual Acuity: Oral medicines: Dhanadarasnadi
2021 follow‑up consultation DVA: LogMAR 0.176 OD, LogMAR 0.301 OS Kvatha, Dhanvantaram 101 Avartana,
Asvagandha tablet
NVA: N6 OU
External therapy: Ascyotana
Refraction: LogMAR 0 OU by a 0.75D spherical
lens with 0.75D cylinder and 40° axis
Extraocular motility: Improvement in ocular
movement OD, mild relief in adduction OS
June 5th, 2021 Patient reports for a Visual acuity Oral medicines: Dhanadarasnadi Kvatha,
follow‑up consultation DVA: LogMAR 0.176 OD, LogMAR 0.301 OS Asvagandha tablet, Neurodiet^
NVA: N6 OU External therapies: Ascyotana, Abhyanga
Refraction: LogMAR 0 OU by a 0.75D spherical
lens with 0.75D cylinder and 40° axis
Extraocular motility: Improvement in ocular
movement OD, mild relief in adduction OS

Contd...

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Parappurathu, et al.: Ayurvedic management of one‑and‑a‑half syndrome

Table 1: Contd...
Date Summaries from initial Diagnostic testing (including dates) Interventions
and follow‑up visits
July 7th, 2021 Patient reports for a Visual acuity: Oral medicines: Dhanadarasnadi Kvatha,
follow‑up consultation DVA: LogMAR 0.176 OU Asvagandha tablet, Neurodiet^
NVA: N6 OU External therapies: Ascyotana, Abhyanga
Refraction: LogMAR 0 OU by a 0.75D spherical
lens with 0.75D cylinder and 40° axis
Extraocular motility: Improvement in ocular
movement OD, mild relief in adduction OS
September Patient reports for a Visual acuity Oral medicines: Rasna Dasamuladi
22nd, 2021 follow‑up consultation DVA: LogMAR 0.176 OU Ghrta, Dhanadarasnadi Kvatha,
Asvagandha tablet
NVA: N6 OU
External therapies: Ascyotana, Abhyanga
Refraction: LogMAR 0 OU by a 0.75D spherical
lens with 0.75D cylinder and 40° axis
Extraocular motility: Improvement in ocular
movement OD, mild relief in adduction OS
November 15th, Patient reports for a Visual acuity Oral medicines: Rasna Dasamuladi
2021 follow‑up consultation DVA: LogMAR 0.176 OU Ghrta, Asvagandha tablet, Neurodiet^
NVA: N6 OU External therapies: Ascyotana
Refraction: LogMAR 0 OU by a 0.75D spherical
lens with 0.75D cylinder and 40° axis
Extraocular motility: Improvement in ocular
movement OD, mild relief in adduction OS
* Proprietary medicines of Sreedhareeyam Farmherbs India Pvt. Ltd. ^Proprietary medicine of The Diet Hub, Cochin, Kerala. CT: Computed
tomography, MRI: Magnetic resonance imaging, DVA: Distant visual acuity, NVA: Near visual acuity, OU: Oculus uterque, OD: Oculus
dexter, OS: Oculus sinister, D: Diopters

Table 2: Oral medicines

Medicine Ingredients Dosage and time Anupana Rationale Duration
Dhanadarasnadi C. bonduc Linn., M. oleifera 30 mL, before Warm water Enhancing the activity Outpatient (1 month)
Kvatha* Lam., A. calamus Linn., P. longum breakfast and of Vata Dosha, Inpatient (March 01,
Linn., P. zeylanica Linn., etc., dinner stimulating the nerves 2021-March 23, 2021)
herbs of the body
2 months (discharge)
2 months (follow‑up 1)
2 months (follow‑up 2)
Follow‑up 4 (2 months)
Ananta Ghrta* Holostemma ada‑kodien Schult., 5 g, before Warm water Stimulating and 20 days (inpatient
T. chebula Retz., T. bellerica breakfast and enhancing the nerves course)
Linn., E. officinalis Gaertn., etc., dinner
herbs
Dhanvantaram S. cordifolia Linn., H. vulgare 30 mL, before Dhanadarasnadi Stimulating and Inpatient (March 01,
101 Avartana Linn., A. marmelos Corr., C. dinner Kvatha* enhancing the nerves 2021-March 23, 2021)
phlomidis Linn., R. cordifolia 2 months (discharge)
Linn., oil of S. indicum Linn., etc.,
2 months (follow‑up 1)
herbs
Asvagandha W. somnifera (Linn.) Dunal. 5 g, after breakfast Warm water Regulating neuronal 2 months (follow‑up 1)
Tablet and dinner activity, stimulating 2 months (follow‑up 2)
and enhancing the
2 months (follow‑up 3)
nerves
Follow‑up 4 (2 months)
Follow‑up 5 (2 months)

Contd...

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Parappurathu, et al.: Ayurvedic management of one‑and‑a‑half syndrome

Table 2: Contd...
Medicine Ingredients Dosage and time Anupana Rationale Duration
Triphala T. chebula Retz., T. bellerica 5 g, before Dhanadarasnadi Balancing out Kapha Inpatient (March 01,
Guggulu Linn., E. officinalis Gaertn., P. breakfast Kvatha* Dosha, resolving 2021-March 23, 2021)
longum Linn., C. mukul Linn. the growth in the
brain, abolishing the
Srotorodha (obstruction
of channels)
Neurodiet^ S. cordifolia Linn., A. sativum 5 g, before Warm water Enhancing the activity 2 months (discharge)
Linn., W. somnifera Linn., V. breakfast and of Vata Dosha, 1 month (follow‑up 2)
negundo Linn., etc., herbs and dinner stimulating the nerves
2 months (follow‑up 3)
minerals of the body
Vata Gajankusa Rasa: Purified Follow‑up 5 (2 months)
Hg, purified S, incinerated Fe,
incinerated Cu, incinerated FeS2,
purified Aconitum ferox Wall ex.
Ser., T. chebula Retz., etc., herbs
and minerals
Samira Pannaga Rasa: Purified
Hg, purified S, purified As2O,
purified realgar, purified As2S3
Maha Vata Vidhvansa Rasa:
Purified Hg, purified S,
calcified Pb, calcified Sn,
calcified Fe, incinerated
Na2[B4O5(OH)4]·8H2O, Z.
officinale Rosc., P. nigrum Linn.,
P. longum Linn., etc., herbs and
minerals
Sutasekhara Rasa: Purified
Hg, incinerated Au, incinerated
Na2[B4O5(OH)4]·8H2O, purified
Aconitum ferox Wall ex. Ser., Z.
officinale Rosc., P. nigrum Linn.,
P. longum Linn., etc., herbs and
minerals
Ekangaveera Rasa: Purified
Hg, purified S, incinerated Mn,
incinerated Sn, incinerated Pb,
incinerated Cu, Z. officinale
Rosc., P. nigrum Linn., P.
longum Linn., etc., herbs and
minerals
Manasa Mitra S. cordifolia Linn., A. 1 table, twice a Warm water Enhancing the activity Inpatient (March 01,
Vataka marmelos Corr., I. racemosa day after breakfast of Vata Dosha, 2021-March 16, 2021)
Hook., P. santalinus Linn., E. and dinner stimulating the nerves
cardamomum Maton., etc., herbs of the body
and minerals
Rasna A. galanga (Linn.) Willd., A. 5 g, twice a day, ‑ Enhancing the activity Follow‑up 4 (2 months)
Dasamuladi marmelos Corr., C. phlomidis after breakfast and of Vata Dosha, Follow‑up 5 (2 months)
Ghrta Linn., S. indicum Linn., T. dinner stimulating the nerves
terrestris Linn., etc., herbs of the body
C. bonduc: Cesalpinia bonduc, M. oleifera: Moringa oleifera, A. calamus: Acorus calamus, P. longum: Piper longum, S. indicum:
Sesamum indicum, P. zeylanica: Plumbago zeylanica, T. chebula: Terminalia chebula, T. bellerica: Terminalia bellerica, E. officinalis:
Emblica officinalis, S. cordifolia: Sida cordifolia, H. vulgare: Hordeum vulgare, A. marmelos: Aegle marmelos, C. phlomidis:
Clerodendrum phlomidis, R. cordifolia: Rubia cordifolia, W. somnifera: Withania somnifera, C. mukul: Commiphora mukul, A. sativum:
Alium sativum, V. negundo: Vitex negundo, Z. officinale: Zingiber officinale, P. nigrum: Piper nigrum, I. racemosa: Inula racemosa, P.
santalinus: Pterocarpus santalinus, E. cardamomum: Elettaria cardamomum, A. galangal: Alpinia galangal, S. indicum: Solanum indicum,
T. terrestris: Tribulus terrestris, *Proprietary Medicine of Sreedhareeyam Farmherbs India, Pvt Ltd. ^Proprietary Medicine of The Diet
Hub, Cochin, India

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Parappurathu, et al.: Ayurvedic management of one‑and‑a‑half syndrome

Table 3: Sodhana Chikitsa

Treatment Procedure Medicines Ingredients Rationale Dates of administration
Pratimarsa The patient lay supine and Karpasasthyadi S. cordifolia Linn., C. Reducing Kapha Dosha Inpatient (March 03,
Nasya two drops of the medicine Taila deodara Linn., S. lappa from the head, abolishing the 2021-March 11, 2021)
were instilled into each C. B. Clarke., oil of S. Srotorodha (obstruction of
nostril indicum Linn., etc., herbs channels) in the eyes and head
Gandusha The medicine was held in Tila Taila Oil of S. indicum Linn. Enhancing the activities Inpatient (March 02,
the mouth for a period of of Vata, enhancing and 2021-March 12, 2021)
time supporting the nerves Discharge (2 months)
S. cordifolia: Sida cordifolia, C. deodara: Cedrus deodara, S. lappa: Saussurea lappa, S. indicum: Sesamum indicum

Discussion at the fourth and fifth follow‑ups to further augment the

The patient’s condition was explored along the lines of
Vatavyadhi, specifically Indriyagata Vata as told by Caraka
Samhita[3] due to restricted eyeball movement. In addition,
the patient’s symptoms highlight the features observed
in Vataja Timira. His previous CVA was analyzed in line
with Avarana (occlusion) of Vata by Kapha. Some residual
Kapha remaining after the CVA may have increased Vata
and the resultant bleeding at the level of the pons and
midbrain, leading to the subsequent involvement of the
eyes. Thus, the treatment protocol (Cikitsa Krama) was
aimed at reducing Kapha and Rakta first, and subsequently
pacifying Vata.
Dhanadarasnadi Kvatha and Ananta Ghrta are proprietary
medicines of Sreedhareeyam Farmherbs, Pvt. Ltd., that
have the property of pacifying Vata, while at the same time
not being too nourishing. Excess nourishment was kept in
check by Triphala Guggulu,[4] which has the property to
cleanse the metabolic channels and keep Kapha balanced.
The Kvātha was administered with Dhānvantaram 101
Āvartana[5] as an adjuvant to further enhance the potency
of the medicine. Neurodiet, the proprietary medicine
of The Diet Hub, arrests neuronal degeneration and
restores normal neuromuscular activity through its careful
combination of potent herbo‑mineral formulations indicated
in Vātavyādhi. Vāta Gajāṅkuśa Rasa has the capacity to
penetrate and open micro‑channels and exert its activity
through cellular mechanisms.[6] Samīra Pannāga Rasa is
an arsenic‑mercurial compound that has neuro‑protective
effects, as evidenced by studies demonstrating its efficacy
in neurobehavioral and neuro‑inflammatory lesions.[7] Mahā
Vāta Vidhvansa Rasa has been shown to have a proclivity
for managing neuro‑degenerative conditions. Sūtaśekhara
Rasa, by virtue of its indication in gastric disorders,
increased digestion in this patient and caused nutrient‑rich
elements to reach the target tissues. Ekāṅgavīra Rasa
has been shown to relieve CVAs with antioxidant and
atherosclerotic properties of both itself and its processing
liquid (Bhāvana Dravya). Mānasa Mitra Vaṭaka, with the
presence of alkaloids, steroids, protein, tannins, phenols,
flavonoids, saponins, amino acids, and glycosides, has
been shown to prevent neurotoxicity and promote nerve
regeneration.[8] Rasna Dasamula Ghrta was prescribed
effects of the medicines.
Ocular irrigation (Seka) and pressing of boluses to the
eye (Avaguṇṭana) prepared the eye for receiving further
treatments by enhancing vascular dilatation, stimulating
peripheral nerves, and expelling obstructive toxins.[9]
Sterile medicines used for Āścyotana (eye drops) promoted
eyesight and relieved symptoms. Tarpaṇa was used for
improving eyesight and stimulating the nerves. The use
of lipid medicines for the head treatments was due to
their neuro‑protective and antioxidant properties, which
enabled more robust stimulation and protection of the
nerves. The use of a lipid medium to mix the paste was
to further enhance the absorption and bioavailability of the
medicines. Massage has been shown to increase serotonin
and dopamine, facilitate increased cellular exchange, and
enhance the elasticity of tissues, thus promoting nerve
regeneration.[10] Gargling optimizes the conductivity of
motor and sensory nerves, expels toxins, and improves
digestion.[11] The continuous dripping of oil over the head
may offer afferent inputs to the cerebral cortex, leading to
a tranquilizing effect.[12]
Eye exercises have been proven to improve ocular motility
and reduce ocular fatigue by improving accommodation and
vergence.[13] These may be referred to as dynamic/isotonic
exercises where both concentric and eccentric contractions
of the extraocular muscles occur.[14] Regular eye exercise
increases the amount of energy stores held in the muscle,
and increase the proteins that are required to use these
efficiently.[15]
Conclusion
The challenges faced in this case were improving
vision and relieving restricted ocular motility. The oral
medicines normalized the internal physiology, the external
treatments nourished and stimulated the nerves, and the
ocular exercises stimulated movement in the muscles.
Although positive results were obtained in this case, further
management incorporating bio‑purification (Śodhana)
would need to be planned to achieve better results. The
results obtained in this report may be validated using the
large scale sample trials.

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Parappurathu, et al.: Ayurvedic management of one‑and‑a‑half syndrome
Treatment Procedure
Seka 500 mL of lukewarm
Kvātha (decoction) or
Svarasa (juice) was taken and
poured in a thin stream over
the closed eyes
Avaguntana The medicine was placed in
two pieces of cotton gauze.
Boluses were prepared from
these. They were warmed
by dipping inside lukewarm
Kvātha and gently pressed
over the eyelids
Ascyotana The patient lay supine
and two drops of the
medicine was instilled in the
sub‑conjunctival sac
Tarpana Two circular cavities prepared Jatavedha
from gram flour were placed Ghrta*
around the orbital margins.
The lukewarm ghee was
poured into the cavities and
the patient was asked to
slowly blink
Tala The patient was asked to
approximate the location of
the bregma by touching the tip
of his thumb to the tip of his
nose and extending his index
finger to the head. The paste
was applied to that spot and
removed before it completely
dried
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Table 4: External therapies
Medicines Ingredients Rationale Dates of administration
Kasyapam T. chebula Retz., T. Irrigating obstructive Inpatient (March 01,
Kvatha* bellerica Linn., E. lesions and stimulating 2021-March 12, 2021)
officinalis Gaertn., G. peripheral nerves,
glabra Linn. performing a mild
sudation
Yava H. vulgare Linn. Abolishing the Inpatient (March 02,
Srotorodha (obstruction 2021-March 08, 2021)
of channels) at the
eyes, relieving excess
Kapha from the nerves
Netramrtam* KAl (SO4) 2, NaCl, H2O Balancing Kapha Outpatient (2 months)
and Pitta in the eyes, Inpatient (March 02,
promoting vision 2021-March 13, 2021)
Follow‑up 2 (2 months)
Follow‑up 3 (2 months)
Follow‑up 4 (2 months)
Follow‑up 5 (2 months)
Sunetra regular* C. sappan Linn., C. Balancing Kapha Discharge (2 months)
dactylon Linn., O. and Pitta in the eyes,
sanctum Linn., etc., promoting vision
herbs
Eye plus* N. nucifera Gaertn., Balancing Kapha Follow‑up 1 (2 months)
T. grandis (Linn.) f., and Pitta in the eyes, Follow‑up 3 (2 months)
O. sanctum Linn., promoting vision
Follow‑up 4 (2 months)
C6H5HgNO3, etc., herbs
Follow‑up 5 (2 months)
T. dioica Linn., A. indica Stimulating and Inpatient (March 14,
A. Juss., P. kurroa Royle enhancing the 2021-March 22, 2021)
ex. Benth., C.s rotundus nerve supply of the
Linn., etc., herbs extraocular muscles
Ananta Ghrta* Holostemma ada‑kodien and nerves, regulating
Schult., T. chebula the activity of Vata in
Retz., T. bellerica Linn., the eyes
E. officinalis Gaertn.,
etc., herbs
Kaccuradi C. zeodaria Rosc., E. Abolishing the Inpatient (March 02,
Curna officinalis Gaertn., R. Srotorodha (obstruction 2021-March 06, 2021)
cordifolia Linn., C. of channels) in the
deodara Linn., etc., nerves of the head,
herbs and minerals regulating the activity
Dhanvantaram S. cordifolia Linn., of Vata, and enhancing
101 Avartana H. vulgare Linn., A. and stimulating the
marmelos Corr., C. nerves
phlomidis Linn., T.
terrestris Linn., S. album
Linn., oil of S. indicum
Linn., etc., herbs
Contd...
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Parappurathu, et al.: Ayurvedic management of one‑and‑a‑half syndrome

Table 4: Contd...
Treatment Procedure Medicines Ingredients Rationale Dates of administration
Sirodhara The patient was instructed to Balasvagandhadi S. cordifolia Linn., Enhancing and Inpatient (March 07,
lay supine. A thin cloth band Taila W. somnifera (Linn.) stimulating the activity 2021-March 13, 2021)
was tied around the forehead. Dunal., L. lacca Kerr., of Vata in the head, Follow‑up 4 (2 months)
A pot with a hole measuring 8 S. album Linn., R. nourishing the nerves
mm was suspended above the cordifolia Linn., etc., and enhancing their
patient’s head. The lukewarm herbs activity
oil was poured into the pot and
was allowed to drain through
the hole onto the patient’s head
Abhyanga The medicated oil was made Karpasasthyadi S. cordifolia Linn., C. Enhancing and Discharge (2 months)
warm and applied over the Taila deodara Linn., S. lappa stimulating the activity Follow‑up 3 (2 months)
entire body ½ h before bath C. B. Clarke., oil of of Vata in the head,
Follow‑up 4 (2 months)
S. indicum Linn., etc., nourishing the nerves
Siro The bregma is approximated herbs and enhancing their Discharge (2 months)
Abhyanga by stretching the index finger activity Follow‑up 2 (2 months)
while touching the tip of the
Follow‑up 3 (2 months)
nose with the thumb. Oil is
applied to this spot first and
spread throughout the head
*Proprietary medicine of Sreedhareeyam Farmherbs India Pvt. Ltd. T. chebula: Terminalia chebula, T. bellerica: Terminalia bellerica, E.
officinalis: Emblica officinalis, G. glabra: Glycyrrhyza glabra, H. vulgare: Hordeum vulgare, C. sappan: Cesalpinia sappan, C. dactylon:
Cynodon dactylon, O. sanctum: Ocimum sanctum, N. nucifera: Nelumbo nucifera, T. grandis: Tectonia grandis, T. dioica: Tricosanthes
dioica, A. indica: Azadirachta indica, P. kurroa: Picorrhiza kurroa, C. rotundus: Cyperus rotundus, C. zeodaria: Cucurma zeodaria, R.
cordifolia: Rubia cordifolia, C. deodara: Cedrus deodara, S. cordifolia: Sida cordifolia, A. marmelos: Aegle marmelos, C. phlomidis:
Clerodendrum phlomidis, T. terrestris: Tribulus terrestris, S. album: Santalum album, S. indicum: Sesamum indicum, W. somnifera:
Withania somnifera, L. lacca: Laccifer lacca, S. lappa: Saussurea lappa

Declaration of patient consent Neurosurg Psychiatry 1967;30:383‑92.

The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient (s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal.
The patients understand that their names and initial s will
not be published and due efforts will be made to conceal
their identity, but anonymity cannot be guaranteed.
Acknowledgment
The authors thank Sreedhareeyam Ayurvedic Eye Hospital
and Research Center and Sreedhareeyam Farmherbs India,
Pvt. Ltd. for their help in preparing this review article.
The authors acknowledge the immense help received
from the scholars whose articles are cited and included in
references of this manuscript. The authors are also grateful
to the authors, editors, and publishers of all those articles,
journals, and books from where the literature for this article
has been reviewed and discussed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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सारांश

परिचय: डे ढ़ सिंड्रोम एक ऐसी स्थिति है जो क्षैतिज टकटकी पक्षाघात और इं टरन्यूक्लियर ऑप्थाल्मोप्लेजिया की विशेषता है । इसके
जोखिम कारकों में ऐसी स्थितियां शामिल हैं जो पोंटीन घावों और डिमाइलेटिंग स्थितियों की भविष्यवाणी करती हैं । लक्षणों में धुंधली
दृष्टि, डिप्लोपिया और ऑसिलोप्सिया शामिल हैं । प्रबंधन अंतर्निहित लक्षण को संबोधित कर रहा है और लक्षणों से राहत दे रहा है । एक
46 वर्षीय उच्च रक्तचाप से ग्रस्त पुरुष का मामला, जिसे डे ढ़ सिंड्रोम का निदान किया गया था और जिसने एलोपैथिक अस्पताल में
इनपेशेंट प्रबंधन किया था, यहां प्रस्तुत किया गया है । मुख्य नैदानिक लक्षण: जां च करने पर उसे धुंधली दृष्टि, डिप्लोपिया और डे ढ़
सिंड्रोम हो गया था। व्याधि विनिश्चय: उन्हें डे ढ़ सिंड्रोम का पता चला था। चिकित्सीय प्रयोग: उन्होंन�े मौखिक दवाओं, बाहरी उपचारों
और आं खों के व्यायाम सहित एक इनपेशेंट आयुर्वेद�िक प्रोटोकॉल से गुजरना शुरू किया। परिणाम और निष्कर्ष: डिस्चार्ज के
परिणाम और बाद के तीन फॉलो-अप में धीरे -धीरे बेहतर ओकुलर मूवमेंट और लक्षणों से राहत का प्रदर्शन किया गया। यह मामला
बताता है कि डे ढ़ सिंड्रोम के लिए आयुर्वेद उपचार की खोज की जा सकती है ।

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