---

Pakshghata - Chikitsa (चिकित्सा)

परिचय (Introduction)

---

चिकित्सा क्रम (Treatment Protocol)

1. पूर्वकर्म (Purvakarma - Preparatory Procedures)

• Abhyantara Snehana (Internal oleation): Medicated ghee for 3-7 days
  • Ashwagandha Ghrita
  • Panchatikta Ghrita
• Bahya Snehana (External oleation):
  • Sarvanga Abhyanga (full-body oil massage) with:
    • Mahanarayana Taila
    • Bala Taila
    • Dhanwantaram Taila
  • Anu Taila - considered the best for Abhyanga in Pakshghata [Su.Sa. Chikitsa Sthana 5/19]
  • Shirobasti (retention of medicated oil over the scalp) - one of the most effective external therapies

• Sarvanga Swedana (whole-body steam) following Abhyanga
• Patra Pinda Swedana - bolus fomentation with medicated leaves; combines heat with anti-Vata herbal penetration
• Shashtika Shali Pinda Sweda - bolus of shastika rice cooked in milk + Bala decoction; nourishes and strengthens
• Nadi Swedana - directed steam for specific joints and muscles

---

2. संशोधन (Samshodhana - Main Panchakarma Procedures)

A. विरेचन (Virechana - Therapeutic Purgation)

• Mridu Virechana (mild purgation) is preferred
• Indicated for clearing Pitta-Kapha avarana over Vata
• Clinical study of 31 Pakshghata patients: Virechana group showed better improvement than Kostha Shuddhi group alone
• Preparations: Eranda Taila (castor oil), Trivrit Lehya

B. बस्ति (Basti - Medicated Enema) - MOST IMPORTANT

• Alternating pattern: starts with Anuvasana, alternates with Niruha, ends with Anuvasana
• Rajayapana Basti - specifically documented in Pakshghata clinical studies with significant improvement in slurred speech, spasticity, and movement
• Asthapana Basti: administered when Shodhana is required prior to Vata Shamana [Su.Sa. Chikitsa Sthana 5/19]

C. नस्य (Nasya - Nasal Medication)

• Ksheera Bala Taila avartita (repeatedly processed)
• Dhanwantara Taila avartita
• Karpasasthyadi Taila
• Nasya acts on space-occupying CNS pathology and nourishes Prana Vayu channels
• When accompanied by visual disturbances (Drishti Dosha): Akshitarpana with Triphala Ghrita

D. वमन (Vamana) - used selectively when Kapha avarana is predominant

---

3. शमन औषधि (Shamana Aushadhi - Internal Medicines)

Kwatha (Decoctions):

• Dashamoola Kwatha - foundational Vata-pacifying decoction
• Rasnasaptaka Kwatha
• Maharasnadi Kwatha
• Mashabaladi Kwatha [Bhaishajya Ratnavali, Vatavyadhi adhikara 62-63]
• Erandamuladi Kwatha

Ksheerapaka (Milk Decoctions):

• Lasuna Ksheerapaka - garlic in milk [Ca.Sa. Chikitsa Sthana 5/94-95]
• Prasarinyadi Ksheera Kashaya [Sahasrayoga 1/59(1)]
• Masha Atmagupta adi Ksheera (for Nasapana) [Chakradatta, Vatavyadi 27]

Churna (Powders):

• Ashwagandha Churna
• Bala Churna
• Shatavari Churna

Ghrita (Medicated Ghee):

• Ashwagandha Ghrita
• Panchatikta Ghrita

Leha (Electuaries/Linctus):

• Kalyana Leha - especially effective for post-stroke aphasia (speech loss); shown more effective than speech therapy alone in a study of 40 patients

Taila (Medicated Oils) for internal use:

• Sahacharadi Taila
• Bala Taila

---

4. बाह्य प्रयोग (Bahya Prayoga - External Therapies)

---

5. चिकित्सा क्रम सारांश (Treatment Sequence in Practice)

1. Dhanyamladhara
2. Abhyanga
3. Shashtika Shali Pinda Sweda
4. Matra Basti
5. Nasya
6. Tailadhara
7. Shamana Aushadhis (oral medicines)

---

6. पथ्यापथ्य (Dietary & Lifestyle)

• Masha (black gram) - considered highly Vatahara
• Sesame (til), garlic (lasuna), Saindhava Lavana
• Warm, unctuous, easily digestible food
• Milk, ghee
• Rest and protection from cold/wind

• Vata-aggravating diet (dry, cold, light food)
• Excessive physical exertion
• Suppression of natural urges
• Stress and exposure to cold

---

7. आधुनिक दृष्टिकोण (Modern Integration)

• Physiotherapy and occupational therapy
• Speech therapy (for aphasia accompanying Pakshghata)
• Neurological rehabilitation

---

---

पक्षघात - प्रकारानुसार शमन योग (Type-based Samshamana Yoga)

---

प्रकार / Types of Pakshghata

1. शुद्ध वातज पक्षघात (Shuddha Vataja Pakshaghata)

• Shula (pain), Stambha (stiffness), Kampa (tremors)
• Shosha (wasting/atrophy) of the affected limbs
• Dry, rough skin on the affected side
• Loss of voluntary motor function

• Snehana (unctuous therapies) + Snehayukta Virechana [A.H. Chi 21/44]
• Basti is Purna Chikitsa here

---

2. अन्यदोष संसृष्ट पक्षघात (Anyadosha Samsrishta Pakshaghata)

अ. पित्तानुबंध (Pittanubandha - Vata + Pitta)

• Daha (burning sensation), Jwara (fever), Sweating
• Redness/discoloration of affected parts
• Bhrama (giddiness), Trishna (thirst)
• Moha (delusion/confusion), slurred speech

ब. कफानुबंध (Kaphanubandha - Vata + Kapha)

• Gaurava (heaviness), Tandra (drowsiness/somnolence)
• Sheetata (coldness of the affected part)
• Shotha (swelling/edema)
• Praseka (hypersalivation), Aruchi (anorexia)
• Stiffness with heaviness

---

3. क्षयहेतुज पक्षघात (Kshayahetuja Pakshaghata)

• A. Sonitaatisritikrita - due to excessive blood loss
• B. Balavadvigrahadita - due to injury from a powerful person/trauma

• Extreme Shosha (emaciation/wasting)
• Daurbalya (profound weakness)
• Kampa (tremors)
• Indriya Daurbalya (weakness of sense organs)
• Poor prognosis (Krichrasadhya or Asadhya)

---

एकसार सारणी (Summary Table)

---

• Acute stage - Samjna Prabodhaka (Hridya Rasaushadhi): Yogendra Rasa, Trailokya Chintamani Rasa, Akika Pishti, Pravala Pishti
• Sub-acute stage - Shodhana followed by type-specific Shamana
• Chronic stage - Ekangavira Rasa, Brihat Vatachintamani Rasa, Smriti Sagara Rasa, Ardhangavatari Rasa

---

पक्षघात - प्रकारानुसार शमन योग

(Pakshghata - Type-based Samshamana Yoga)

---

TYPE 1 — शुद्ध वातज पक्षघात (Shuddha Vataja)

---

TYPE 2 — अन्यदोष संसृष्ट पक्षघात (Anyadosha Samsrishta)

उप-प्रकार अ — पित्तानुबंध (Pittanubandha)

---

उप-प्रकार ब — कफानुबंध (Kaphanubandha)

---

TYPE 3 — क्षयहेतुज पक्षघात (Kshayahetuja)

• Sonitaatisritikrita - from excessive hemorrhage/blood loss
• Balavadvigrahadita - from trauma by powerful force

---

सारांश सारणी (Summary Table)

---

• Acute - Samjna Prabodhaka: Yogendra Rasa, Trailokya Chintamani Rasa, Pravala/Akika Pishti
• Sub-acute - Type-specific Shodhana + Shamana
• Chronic - Ekangavira Rasa, Brihat Vatachintamani Rasa, Smriti Sagara Rasa, Ardhangavatari Rasa

---

पक्षघात - आद्रित चिकित्सा सूत्र और प्रकारानुसार चिकित्सा

(Pakshghata - Chikitsa Sutra with Type-based Chikitsa & Samshamana Yoga)

---

आद्रित चिकित्सा सूत्र (Chikitsa Sutra - by each Acharya)

---

1. आचार्य चरक का चिकित्सा सूत्र

"स्वेदनं स्नेहियुक्तं पक्षाघाते विरेचनम्" Swedanam Snehiyuktam Pakshaghate Virechanam

• Acharya Jejjata interprets: Snehayukta Swedan + Snehayukta Virechan दोनों अलग-अलग क्रियाएं हैं
• Acharya Gangadhara का मत भी Jejjata के समान ही है
• Acharya Chakrapani ने इस verse पर कोई commentary नहीं दी

1. Snehana
2. Swedana
3. Mridu Virechana (with Snehayukta dravya)
4. Basti
5. Samshamana Aushadhi

---

2. आचार्य सुश्रुत का चिकित्सा सूत्र

अणुतैलमभ्यंगार्थे, सैन्धवमुपनाहार्थे, बलातैलमनुवासनार्थे; एतिमतन्धितस्तीस्त्रो दश मासान् वक्रयापरथमुपिएयेत

• Anu Taila - Abhyanga (massage) के लिए
• Saindhava (rock salt) - Upanaha (poultice) के लिए
• Bala Taila - Anuvasana Basti के लिए

• अति कृश (अत्यंत कमज़ोर) न हो
• प्रभावित अंग में पीड़ा हो (संवेदना शेष हो)
• आहार-विहार नियमों का पालन करता हो
• चिकित्सा की सामग्री जुटाने में सक्षम हो

1. Snehana + Swedana
2. Mridu Vamana (mild emesis)
3. Virechana
4. Basti (Anuvasana + Asthapana)
5. Nasya
6. Samshamana Aushadhi

---

3. आचार्य वाग्भट का चिकित्सा सूत्र

"स्नेहनं स्नेहियुक्तं पक्षाघाते विरेचनम्" Snehanam Snehiyuktam Pakshaghate Virechanam

---

4. आचार्य चक्रदत्त का योगदान

• Mashatmaguptadi Kwatha
• Mashabaladi Kwatha
• Swalparasonapinda
• Masha Taila / Maha Masha Taila

---

चिकित्सा सूत्र का सार (Common Chikitsa Sutra)

---

प्रकारानुसार चिकित्सा एवं शमन योग

(Type-based Chikitsa + Samshamana Yoga)

---

प्रकार 1 — शुद्ध वातज पक्षघात (Shuddha Vataja)

वातहर + बल्य + बृंहण

1. स्नेहन - Abhyanga with Anu Taila / Bala Taila / Maha Masha Taila
2. स्वेदन - Patra Pinda Sweda, Shashtika Shali Pinda Sweda
3. स्नेहयुक्त विरेचन - Eranda Taila + Trivrit (mild)
4. बस्ति - Basti = Purna Chikitsa for this type
   • Anuvasana: Bala Taila, Masha Taila
   • Niruha: Dashamoola Kwatha + Saindhava
5. नस्य - Ksheera Bala Taila avartita

---

प्रकार 2अ — पित्तानुबंध पक्षघात (Pittanubandha)

पित्त-वातहर + विरेचन (मुख्य शोधन) + सञ्ज्ञाप्रबोधन

1. Mridu Snehana (Pitta shamak ghrita)
2. Mridu Swedana
3. विरेचन - PRIMARY (Pitta का प्रधान शोधन)
   • Trivrit Lehya / Avipattikar Churna / Eranda Taila with ksheera
4. Basti - Dashamoola Kwatha Niruha
5. Shirodhara - Ksheera dhara / Chandanadi Taila
6. Nasya - Dhanwantara Taila avartita

📌 Clinical Evidence: Comparative study of 31 Pakshghata patients - Virechana group showed better improvement than Kostha Shuddhi group alone (Carakasamhitaonline).

---

प्रकार 2ब — कफानुबंध पक्षघात (Kaphanubandha)

कफ-वातहर + वमन (मुख्य शोधन) + दीपन-पाचन

1. Ruksha Swedana (dry fomentation) - Patra Pinda, Nadi Sweda
2. वमन - PRIMARY (Kapha का प्रधान शोधन)
   • Madanaphala, Yashtimadhu, Saindhava
3. Virechana (following Vamana)
4. Basti - Dashamoola + Trikatu Niruha Basti
5. Nasya - Shadbindu Taila

---

प्रकार 3 — क्षयहेतुज पक्षघात (Kshayahetuja)

• Sonitaatisritikrita (excessive bleeding) → Asadhya
• Balavadvigrahadita (trauma) → Krichra Sadhya [Su.Ni. 1/63; Gayadas commentary]

केवल बृंहण + रसायन — शोधन सर्वथा निषिद्ध (Shodhana absolutely contraindicated)

1. Snigdha Snehana only - Ashwagandha Ghrita, Shatavari Ghrita
2. Mridu Snigdha Swedana
3. Brimhana Basti - Narayana Taila Anuvasana Basti
4. Rasayana Aushadhi
5. Pathya Ahara - Masha, Ksheera, Ghrita, Raktashali

---

सम्पूर्ण सारांश (Master Summary Table)

---

• तीव्र - Samjna Prabodhaka: Yogendra Rasa, Trailokya Chintamani Rasa, Akika/Pravala Pishti
• मध्य - Type-specific Shodhana → Samshamana
• जीर्ण - Ekangavira Rasa, Brihat Vatachintamani Rasa, Ardhangavatari Rasa, Smriti Sagara Rasa