- The patient, a 58-year-old male, presented with left-sided hemiplegia and speech difficulties for 5 years. He experienced a stroke 5 years ago after a domestic quarrel caused mental stress. - On examination, he had spastic weakness and sensory deficits on the left side of the body. Investigations revealed a past left ventricular hemorrhage. He was diagnosed with a cerebrovascular accident manifesting as left hemiplegia. - Treatment included herbal Kashayams, Choorna, Abhyanga, Pinda Sweda, and Nasya aimed at reducing pain, improving strength and speech.

1. -Dr. Divya K S
2nd Year PG Scholar,
Dept of PG Studies in Kayachikitsa,
SKAMCH&RC,
Bangalore.

2. Name : Mr. Channigarayappa
Age : 58 years
Sex :Male
Religion :Hindu
Socio-Economic status :Lower middle class
Marital status :Married since 32 years
Education : 7th class
Occupation : Security at Doddana Vidhya
Samastha

3. Date of Admission :22/04/2015
Ward :MGW
Source of History :Patient, Relative of patient
Case taken on :4/05/2015
Consultant Doctor :Dr. Byresh
OP No :10656
IP No :1601/15
Address : Mudden palya,
Magadi Road,
Banglore.

4.  C/o Balakshaya and Karmakshaya in
Vamabhaga of shareera since 5 years.
 C/o Vak aspashtatha since 5 years.

5.  C/o Dakshina parshva shoola since 5 years.
 c/o Vama bahu shoola since 5 years.
 C/o Mala baddhata since 5 years.
 C/o Moothratheetha since 5 years.

6. Patient was not a k/c/o hypertension or diabetes mellitus. Two
days prior to the onset of symptoms the patient is said to have
had a domestic quarrel due to which the pt was under
enormous mental stress. When patient didn’t come back from
work after his usual time( 9 pm ) the patient’s family members
went to school in search for the patient and he was found
conscious but was not responding or speaking, his face was
deviated to the right side with saliva dribbling and had passed
urine in his pants.

7. There was no episodes of vomitting or headache or
seizures according to the patient’s relatives. When
they enquired with the other securities they were told
he fell unconscious from his chair at around 8.30pm
that evening. The patient was taken back to the house
and from there later to Ashraya Hospital Sunkatha
katte at around mid night. From the hospital he was
diagnosed with raised blood pressure and was given
medicines(details not known).By next day(15/6/2009)
morning patient regained consciousness and was
diagnosed with stroke of the left side of the body.

8. Later that morning the patient was shifted to Adharsha
Nursing home in Madduru on the advise of friends and
relatives, during which time the patient was having loss of
strength of lt hand and leg with flexion and rigidity of left
hand, deviation of face towards the right side and was not
able to speak. The patient was admitted for 12 days and
investigations was done and medicines was given. He didn’t
get any relief after the treatment for 1 month and due to
feeling nausea the patient stopped taking medicines.

9. For the next 9-10 months the patient didn’t take any
treatment. Later he went to various folklore practioner
with little or no improvement in the symptoms except
one where he was able to move his fingers but the
condition relapsed after the finishing of the 5 day
course treatment. 2years prior he went to a folklore
practioner in Maganahalli and was given with tablets
and oil for massage and the treatment continued for 6
months.

10. The patient got mild improvement , he was able to walk
with support of others and the stiffness in his lt hand
was reduced. After 6 months the patient stopped taking
medicine due to nausea. After that for 1 and1/2 years
no treatment was taken. He came to SKAMCH and
RC for further treatment.

11.  N/k/c/o DM or dyslipidaemia.
 K/c/o HTN since 5 years.

12. Previous medications details not known
Current medication:
Tab. Amcard 1-0-0 A/f

13.  Patient has 1 sibling
 Patient is married and has 2 children.
 No one in the family is said to have
similar complaints
His Cousin passed away due to stroke 1 year back

14.  Diet - Mixed, Nonveg – once/week
 Appetite - Moderate
 Sleep - Normal( 7-8 hrs/ day)
 Micturation - 5-6 times per day
2 times/ night, incontinence present
 Bowel - once in 3-4 days, hard stools

15.  Habits - Alcohol intake since 10 years
reduced since last 5 years, 1-2 times in
1 or 2 months
- no smoking
coffee- 2 cups/day

16.  Built - Moderate
 Nourishment - Moderate
 Pallor - Absent
 Icterus - Absent
 Cyanosis - Absent
 Clubbing - Absent
 Lymphadenopathy - Absent
 Edema - Absent
 Tongue - not coated

17.  Pulse - 80 BPM
 B.P - 120/80 mm of Hg
 Temp - 98.6° F
 Respiratory - 20 Times/min
 Height -167cm
 Weight - 70 kg
 BMI - 25

18.  CVS
On auscultation; S1 S2 heard, No murmurs
 RS
Inspection
 Shape of chest - bilaterally symmetrical
 Respiratory rate – 20 times/min

19. Palpation
Trachea - centrally placed
Auscultation
Normal vesicular breath sounds heard

20.  PA
Inspection:
 No distension
 Umbilicus- inverted , centrally placed
 No visible peristalsis, no scars or discoloration
Palpation:
 Soft,
 Tenderness in the epigastric region & lumbar region
 No organomegaly

21. Percussion:
• Dullness heard over right hypochondrium.
• Tympanic sound heard in the remaining quadrants of
the abdomen
Auscultation:
• Bowel sounds heard

22. CNS
1)HMF
 Consciousness – Fully conscious
 Orientation to -time
-place Intact
-person
 Memory -immediate
-recent Intact
-remote
 Intelligence- Not able to elicit
 Hallucination & Delusion- Absent

23.  Speech disturbance- present, unable to speak
 Handedness-Right
2)Cranial Nerve Examination
 Olfactory- Smell sensation-intact
 Optic-a) Visual acuity
-b)Colour vision
-c)Visual field NAD
-d)Light reflex
-e)Accomodation

24.  Occulomotor,Troclear & Abducent Nerve
-Eyeball movement-Possible in all directions
-Pupil-position
-shape
-size NAD
-symmetry
-Ptosis-Absent
 Trigeminal
Sensory-Touch, pain and pressure sensation- Intact
-corneal reflex-present( lt diminished)
Motor-clenching of teeth -possible
-lateral movement of jaw- not possible

25. Reflex-corneal-present( lt- diminished)
- jaw jerk-present
 Facial
A)Forehead frowning -possible, equal in both sides
b)Eyebrow raising - possible, equal in both sides
c)Eye closure - possible, equal in both sides
d)Teeth showing -deviation of angle of
mouth towards right
e)Blowing of cheek -not possible
f)Naso labial fold - deviation towards right

26.  Vestibulo-cochlear Rt Lt
-Rinne’s test- bone conduction present present
Air conduction absent present
-Weber’s test- lateralisation towards right
 Glossopharyngeal and Vagus
Position of uvula- centrally placed
Taste sensation -intact
Gag reflex - normal
 Spinal accessory
Shrugging shoulder- weakness in the left side
Neck movement -possible against resistance

27.  Hypoglossal
Protrusion of tongue -complete protrusion not possible
deviation towards right
Tongue movements - restricted movements

28. Motor System
1)Involuntary movements – Absent
2)Muscle bulk – Rt Lt
Biceps 28.5cm 26.5cm
forearm 23.5cm 22.5cm
mid thigh 45.5cm 44.5cm
calf muscles 30.5cm 28.5cm
3)Muscle tone
Right hand - Normal
Left hand - Spastic
Right leg - Normal
Left leg - Spastic

29. 4)Muscle strength Rt Lt
 a)Elbow -flexion 5/5 1/5
-extension 5/5 0/5
 b)Wrist -flexion 5/5 1/5
-extension 5/5 0/5
 c) Finger abduction 4/5 0/5
 d)Opposition of thumb 5/5 1/5
 e) Test of grip 5/5 0/5

30. Rt Lt
Lower limb
Hip -adduction 5/5 4/5
-abduction 5/5 4/5
-flexion 5/5 3/5
-extension 5/5 3/5
Knee -flexion 5/5 2/5
-extension 5/5 3/5
Ankle -dorsiflexion 5/5 1/5
-plantarflexion 5/5 1/5

31. 5)Coordination
UL-Finger nose test Co-ordination present
LL-Knee heel test
6)Gait- Hemiplegic gait
7)Reflexes
Superficial
a)Corneal -present (diminished at lt side)
b)Abdominal - Absent

32. Rt Lt
Deep (2 + indicates normal)
a)Biceps jerk ++ +++
b)Triceps jerk ++ +++
c)Knee jerk ++ +++
d)Ankle jerk ++ +++
(2 + indicates normal)
e)Clonus-patella absent absent
-ankle absent absent
Babinski reflex - positive
Abdominal reflex- absent

33. 8)Sensory system
1)Superficial:
a)Touch -Intact
b)Temperature -Intact
c)Pain - present
2)Deep:
a)Crude touch -present
b)Vibration - present
c)Position sense -present
d)Pressure sense -present

34. The CNS examination results points towards an
uppermotor lesion since
 Reflexes were brisk on the affected side
 Muscle wasting absent
 Spastic tone present
 Babinski reflex was present
 Clonus was absent

35. Report of MRI
- Left ventricular heamorrhage
- No space occupying lesions
- No mass effect

36.  Prakruti - vata-pitta
 Vikruti :-
Hetu - Krodha, Chintha
Dosha -Vata, pitta pradhana tridosha
Dushya -Rakta, meda,
snayu, sira
Prakruti - Chirakari
Desha -Saadharana
Kaala - Varsha ritu
Bala -Madhyama

37.  Sara -Madhyama
 Samhanana -Madhyama
 Pramana - Ht-167 cm
-Wt- 70 kgs
 Satmya - Madhyama (mamsa rasa, katu,
amla, lavana rasa satmya)
 Satva -Avara
 Ahara sakthi-
Abvyaharana sakthi -madhyama
Jarana sakthi -madhyama
 Vyayama sakthi - Avara
 Vaya -Yuva

38. Nidana sevana- katu, amla,
lavana rasa, madhya
sevana, chintha, kopa
Vata, Pitta dusti occurs
Reaches hridhaya and
combines with raktha
38
SAMPRAPTHI

39. Reaches masthiska
/uttamanga
Sthanasamsraya in
dhamanis and siras
Causes avarana
39

40. Leads to obstruction of
movement of vata by raktha
Shiromarma abhighata
Karmakshaya
Pakshaghata
40

41. Samprapthi ghataka
 Dosha -Vata, pitta pradhana tridosha
 Dooshya -Rasa, rakta,
sira, snayu
 Agni -Jataragni, dhatvagni
 Srothas -Rakthavaha,
medhovaha
 Srotho dushti prakara –Sanga, Athi pravruthi
 Udbava sthana -Pakvashaya
 Vyaktha sthana - Ardhakaya
 Adhishtana - Masthishkaghata siras
 Marga - Madhyama
 Sadhyasadhyatha - Kruchra sadhya

42.  Pakshaghata
 Sarvanga roga(padam sankochayati hastam va)
 Asthimajjagata vata
 Ardhita vata

43. Disease Lakshanas Inclusion Exclusion
Sarvanga roga Vata prakopa in
sarva deha
leading to
sankocha of hasta
and pada
Sankocha of
hasta and pada of
right side of body
is present
All the 4 limbs
are not effected
Asthi majjagata
vata
Bheda of asthi
and parvas
Santhi shoola
Mamsa bala
kshaya
Aswapna
Santata ruk
Mamsa
balakshaya
Complete loss of
movements of lt
hasta and pada
and vak graha

44. Disease Lakshana Inclusion Exclusion
Ardita Ardha mukha
sankocha,
vakrata of
nasa,bhru,lalata,
akshi, hanu,
stabda netrata, deena,
samutkshipta, kalaa
vaak, danta chalana,
shravana badha,
pada,hasta,akshi,
janga,uru,shankha,
shravana,ganda ruk
Deviation of asya
to left side,vaak
aspashta
All other
symptoms absent.
Pakshagata Chesta nivrutti of
ardha shareera, ruja,
vakstambha ,
Chesta nivrutti of
ardha shareera,
vakstabdhata ,
present

45. Vamabhaga pakshaghata

46.  Heamorrhagic stroke
 Ishcemic stroke
 Transient ishcemic attack

47.  CVA(Cerebero Vascular Accident-
heamorrhage) manifested as with Left
Hemiplegia.

48. Date Treatment given Observation
22/4/15-255/15 1. Bhadra darvyadi
kashyam- 3tsp with
9tsp water at 7 am
2. Gandharvahastyadi
kashayam- 3tsp
with 9tsp water at
6pm
3. Vacha choorna – ¼
tsp powder with ½
tsp honey for
rubbing over
tongue- once daily
4. Agni lepa for 5 days
( 15 gms agnilepa
kalka internally
with warm water
twice daily before
food
•Loss of strength of lt
side of body
•Difficulty to speak
•Difficulty in walking
• Dakshina parshva
shoola
•Pain in lt shoulder
•Sleep- disturbed
•Appetite- good
•Bowel- irregular, hard
stools, constipation
•Bladder- Incontinence
present

49. Date Treatment Observation
26/4/15- Stop Agnilepa
•Start sarvanga
abhyanga with
karpasasthyadi taila
followed by patrapinda
sweda
•Mukhabhyanga with
karpasthyadi taila
followed by Nasya with
anu taila 15 drops into
each nostril
Sleep improved, other
complaints persisting
C/o b/l pedal
odema(pitting on
examination)
27/4/15 Continue above
medicines
•Gandharvahastyadi
taila – 2 tsp oil with ½
cup hot milk after food
at bed time
C/o not passed bowels
since 2 days

50. Date Treatment Observation
28/4/15 Continue same
treatment
Pedal oedema reduced
Parshva shoola reduced
Bowel passed
29/4/15- 2/5/15 Continue same
treatment
Stopped Nasya on
2/5/15
Pain over left shoulder
reduced
Bowel- Irregular
3/5/15- 5/5/15 Sarvanga Abhyanga
with Dhanwanthram
taila followed by
Shashtika shali pinda
sweda
Pratimarsha nasya with
101 2drps into each
nostrils 3-4 times/ day
C/o pain in lt shoulder
reduced
C/o pain in rt parshva
relieved
Patient able to walk
with support
Pedal odema reduced
Bowel- Irregular

51. Date Treatment Observation
6/5/15 Continue same
treatment
•Dashamoola kwatha
with Gandharvahastyadi
taila- Basti stat
c/o pain in lt upper and
lower limb
Gait- Improved
Bowel not passed since
4 days
After basti- 1
evacuation
7/5/15 Continue same
treatment
8/5/15-11/5/15 Continue same
treatment
Started yoga basti
Anuvasana with
Ksheerabala taila and
sukumaram ghritha
Erandamoola kwatha
niruha basti

52. Date Treatment Observation
12/5/15- 14/5/15 Continue same
treatment
Added
Tab Sallaki plus 1-1-1
after food
on 12/5/5
Pt fell down while
sitting, C/o pain in rt
knee joint
15/5/15 Pt Discharged
Continue all oral
medications
Added
•Prasarani taila- warm
and apply to body
before bath
Condition of Patient on
discharge
Pain in left upper limb
reduced by 30%
Movements improved
Able to walk with
support

53. 1.Ashtavarga kashaya 15ml-o-15ml b/f
2. Vaishwanara churna 6gm-0-6gm b/f
3. Snehapana with Guggulutiktaka ghritha
4. Sarvanga abhyanga with Ksheerabala taila
5. Virechana with Gandharvahastadi Eranda with hot
milk as anupana
6. Sarvanga abhyanga followed by shashtika shali
pinda sweda
7. Madhu tailika vasti
8. Ksheerabala taila 101- 10 drops Bd
9. Marsha nasya with anutaila
10.Mahayogaraja guggulu 2-2-2 Bd A/f

54. Thank you

55. 1st stage
1.Ashtavarga kashaya 15ml-o-15ml b/f
2. Vaishwanara churna 6gm-0-6gm b/f
3. Snehapana with Guggulutiktaka ghritha
4. Sarvanga abhyanga with Ksheerabala taila
5. Virechana with Gandharvahastyadi Eranda with
hot milk as anupana

56. 2nd stage
1. Sarvanga abhyanga followed by shashtika shali pinda
sweda
2. Madhu tailika vasti
3. Ksheerabala taila 101- 10 drops Bd
3rd stage
1. Marsha nasya with anutaila
2. Chandraprabha vati
3. Balamoola ksheerapaka

57.  4th stage
1. Mahayogaraja guggulu
3. Ksheerabala taila- 10 drops bd bf
4. Dhanwantharam ksheerapaka
5. Prathimarsha nasya with Ksheerabala taila 101
6. Nitya abhyanga with Dhanwanharam taila