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| CASE REPORT |
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| Year : 2021 | Volume
: 9
| Issue : 4 | Page : 272-277 |
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A chronic case of Bell’s palsy and its management through Ayurveda: case study
Preeti Patel, Swarnakant Jena, Santosh K Bhatted, Prasanth Dharmarajan
Department of Panchakarma, AIIA, New Delhi, India
| Date of Submission | 02-Jun-2021 |
| Date of Decision | 30-Oct-2021 |
| Date of Acceptance | 24-Sep-2021 |
| Date of Web Publication | 29-Dec-2021 |
Correspondence Address:
Dr. Preeti Patel
Department of Panchakarma, AIIA, New Delhi 110076.
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jism.jism_52_21
Background: Bell’s palsy is an acute idiopathic condition that develops due to peripheral facial nerve paralysis of sudden onset, usually affecting the face by temporary weakness or paralysis of the face. With various aetiologies (infection, trauma, ischemia, or inflammation) affecting the seventh cranial nerve are the pathogenesis to originating the symptoms of Bells’s palsy. According to Ayurveda, this condition can be correlated with Ardita Vata, which is described under the umbrella of Vatavyadhi Chikitsa. Aim and Objectives: The study has been documented to evaluate the efficacy of Panchakarma procedures along with Shamana Aushadhi (oral medication) in the management of a patient with chronic Bell’s palsy. Settings: A 1-year-old chronic case of Bell’s palsy was managed in out patient department-based Panchakarma treatment at AIIA, New Delhi, and the patient was assessed both before and after the given treatment. Treatment Plan: The patient was administered Mukhabhyanga (massage on face) with Asana Bilwadi Taila, Nadi Sweda (sudation) with Dashamoola Ksheer Dhooma, Nasya (transnasal medication) with Avartita Ksheerbala Taila in Arohana Matra (increasing dose), and Kavala (Gargling) with Saindhavadi Taila and Irimedadi Taila for 14 days along with Shamana medication for one month. Result: Marked improvement was observed on the basis of House–Brackmann scale; continuous teardrops from the eye were completely stopped. After 15 days of treatment, the scale was reduced from IV to III, and then II, I, respectively after the 30th day and 60th day during the follow-up. Conclusion: This case showed promising and quick results of Ayurveda treatment by considering aspects of Vatavyadhi, specifically Ardita Vata, even after 1 year of chronicity without showing any complications. Keywords: Ardita Vata, Avartita Ksheerbala Taila, chronic Bell’s palsy, Ksheer Dhooma, Nasya
How to cite this article:
Patel P, Jena S, Bhatted SK, Dharmarajan P. A chronic case of Bell’s palsy and its management through Ayurveda: case study. J Indian Sys Medicine 2021;9:272-7 |
How to cite this URL:
Patel P, Jena S, Bhatted SK, Dharmarajan P. A chronic case of Bell’s palsy and its management through Ayurveda: case study. J Indian Sys Medicine [serial online] 2021 [cited 2022 Aug 13];9:272-7. Available from: https://www.joinsysmed.com/text.asp?2021/9/4/272/334258 |
| Introduction | |  |
Bell’s palsy is the most common form among all facial paralysis, and it is of an abrupt onset in nature. The patient attains maximal weakness within 48 h in this condition. The incidence of this disease is approximately 25 per 100,000 annually. Diabetes mellitus and pregnancy are the major risk factors. The paralysis of one side of the face has a complete interruption of the facial nerve, but there might be a possibility of bilateral facial nerve paralysis. Initially, the presence of incomplete paralysis is the most favorable prognostic sign.[1] Usually, most of the patients are cured within six to eight weeks of developing symptoms but 7% of the patients with a history of Bell’s palsy may experience either recurrence or no improvement in symptoms if they had not got any treatment or avoid this condition.[2]
In Ayurveda classics, Ardita Vata has been described as a condition that affects half of the face only with or without the involvement of half of the body. According to Acharya Sushruta, pregnant women, during the postdelivery period, children, aged people, weak and emaciated people, anemic and bleeding conditions, excessive yawning, laughing, eating hard foodstuff, excessive laughing, carrying heavy loads on head, and sleeping in uncomfortable postures are the most common causes of the Ardita Vata.[3] According to the prognosis of Vatavyadhi dealing with the various factors in Ayurveda, such as Doshabala, Rogibala, Dhatubala, etc. for Ardita Vata, it is mentioned that these groups can be untreatable after three years of origin. So, this study has been documented to evaluate the efficacy of Panchakarma procedures along with Shamana Aushadhi (oral medication) in the management of a patient with chronic Bell’s palsy.
| Materials and Methods | | |
Case Report
A 39-year-old male patient visited the Panchakarma out patient department of AIIA, New Delhi with a complaint of weakness of left half of the face, mouth deviated to the right side. The patient was having difficulty in closing the left eye, differences in the nasolabial fold, and watering from the left eye for one year; the patient also presented with an associated complaint of pain in the head. This was a case diagnosed with chronic Bell’s palsy. Informed consent of the patient was taken before treatment was given.
History
The patient denied any type of facial trauma or exposure to any sick contact of contagious diseases. The patient also did not report any recent or long-term fever, nausea, vomiting, and other systemic illness.
Clinical Examination
General examination and systemic examination of the patient were done as per Ayurveda and contemporary methods.
Ayurveda methods: Aaturbala Pramana Pariksha is done by Dashvidha Pariksha (10-fold examination); [Table 1] and [Table 2] depict an examination of the patient with the help of Asthavidha Pariksha (eight-fold examination).
General and systemic examination of the patient was done and is shown in [Table 3].
Local Examination
After the local examination of the patient, asymmetry of the face was observed as well as difficulty in closing the left eye, flattened nasolabial fold of the left side, watering from the left eye, and puffed cheeks with expiration; the patient also showed Bell’s phenomenon, but wrinkling of the forehead was present. Findings during the local examination of the patient are mentioned in [Figure 1]. | Figure 1: Before treatment. (A) Eyeball turns up and out (Bell’s phenomenon). (B) Frontal wrinkling present. (C) Cheek puffs out with expiration. (D) Deviation of mouth to normal side
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Treatment Administered
Before undergoing the Panchakarma procedures, Mridu Virechana (mild purgation) with Eranda Taila 40 mL was given to the patient and then advised to follow the Samsarjana Karma (dietic regimen) for one day. Both procedural and medicinal treatment was given to the patient, and details are shown in [Table 4] and [Table 5].
Observation
Observations were made on the basis of Ayurveda symptoms mentioned in the classical text as well as based on the House–Brackmann grading scale of facial nerve weakness. There were some Samvata Lakshnas observed in the patient that were improved after treatment. The patient was observed both before the treatment and after the treatment on the basis of the House–Brackmann grading scale.[4] The patient reported with Grade IV before the treatment; these details are mentioned in [Table 6]. | Table 6: Showing grading of the signs and symptoms of the patient before treatment
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The patient reported with Grade IV before the treatment; after a period of 14 days of Panchakarma procedures, it was reduced to Grade III. Oral medication was given to the patient, and the patient was assessed after a period of 15 days; grading was reduced to Grade II. After a follow-up of 30 days, the patient was found to have no signs and symptoms along with a reduced grading to I. Improvement of the patient according to the House–Brackmann grading scale is shown in [Figure 2]. | Figure 2: Showing improvement of patient according to House–Brackmann grading scale
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| Result | | |
In this case study, there were four assessment periods; the result is made on the basis of them. The first assessment was done before the treatment, the second assessment was done on the 15th day after the Panchakarma procedures, the third assessment was done on the 30th day after the completion of oral medication, and the last assessment was done after the follow-up period of 30 days. A significant improvement was observed in the signs and symptoms of the patient after the completion of both procedural and medicinal treatment, which are shown in [Figure 3]. | Figure 3: After treatment: (A) Complete closing of eyes. (B) Frontal wrinkling present. (C) Puffing out of the cheeks. (D) Mild improvement in deviation of mouth
Click here to view |
| Discussion | | |
In Ardita Vata, there is an involvement of the face only as described by Acharya Sushruta.[3] On the basis of symptomatology, it can be correlated with Bell’s palsy. It is a self-limiting condition as the patient will recover without taking any form of medicine but this case is a chronic case, so here an attempt was made to establish a treatment protocol for chronic Ardita Vata. Acharya Sushruta mentioned that Ardita Vata should be treated as Vatavyadhi treatment modality, preferably Nasya, Nadisweda, shirobasti, and Basti along with Ksheerataila by using Pana, Abhyanga, Tarpana, etc.[5] Here in this case as the patient was experiencing one year of chronicity, therefore, Sama and Nirama Lakshana were assessed and it was found that there is an involvement of Samavata. Therefore, treatment was planned for Srotosuddhi followed by Brimhana Karma for Vata. There are four types of Srotodusthi,[6] and Sanga is one of them. Ardita Vata is a condition where Sanga type of Srotodushti is present. In Ardita Vata, the main culprit is Vata. In this condition, Vata Sanga is present so mainly Shrotoshodhana and Vatahara treatment modality was adopted here. For the normalization of the Vata Dosha, the first of all, Mridu Sneha Virechana,[7] mild purgation with Eranda Taila (castor oil) was given to the patient for the elimination of vitiated Dosha, Mala, and Dhatus. Overall, 30 mL Eranda Taila for one day was given and five Vegas were noted. The patient was then advised to follow a one-day Samsarjana Karma (dietic regimen). As this condition was a chronic Vatavyadhi, so after the cleaning of channels through castor oil a treatment modality was adopted that brings rejuvenation in the body (Brimhana). Snehana, Ksheerdhooma, Nasya, and Kavala were adopted to mitigate vitiated Vata in these particular areas.
Probable Mode of Action
Abhyanga, Swedana, and Nasya showed good results in many cases of Ardita Vata.[8] Acharya Charaka[9] and Sushruta[10] described that Nasya and Nadi Sweda are the prime treatment procedures for Ardita Vata. After the completion of Samsarjana Karma, for the normalization of the Vata Dosha, Sthanik Abhyanga (local massage of face) with Asana Bilwadi Taila,[11] followed by Mridu Nadi Swedana (mild sudation) was done with the Ksheer Dhooma and Dashmoola Kwatha (decoction of Dashmoola),[12] until the Samyak Swinna Lakshanas was attained.
Ksheer Dhooma is a form of Swedana that comes under the Nadi Swedana. These therapies pacify the Vata Dosha. The combination of both procedures helps to alleviate many Vata disorders.
Nasya Karma is done by Avartita Ksheerbala Taila (101) in Arohana Matra 4-6-8-10-12-10-8-6 drops. Avartita Ksheerbala Taila (101)[13] ingredients are Bala, Ksheer[14] (milk), and sesame oil.[15]Bala has Balya Karma, which helps in alleviating Vata Dosha and promoting strength as well as providing nourishment to the nerves.[16] It has Madhura (sweet) Rasa, Guru (heavy), Snigdha (unctuous) Guna, Sheeta Veerya (cold potency), and Madhura Vipaka.[17] It also possesses analgesic and anti-inflammatory properties,[18] which protect the nerve. All the Dravya of Ksheerbala Taila has Madhura Rasa and Madhura Vipaka that pacifies the Vata Dosha, and Tila Taila (sesamum oil) provides the base for the Nasya Dravya as it plays a significant role in the absorption of the substances through the nasal mucosa.[19]
Milk has Rasayana properties and Brimhana karma as mentioned in Ayurveda classics, which helps in alleviating Vata as well as signs and symptoms of the patient.
Kavalagraha (Gargling) is an effective therapeutic oral cleansing procedure that is usually performed after the Nasya Karma. Kavalagraha was done with the Saindhavadi Taila and Irimedadi Taila.[20]
In oral medication, the Avipattikar Choorna[21] is used mainly for the Deepana-Pachana purpose; it normalizes the Vata and Pitta Dosha due to its Saraka Guna. Dhanadhanyadi Kashayam and it is indicated in the treatment of Ardita Vata in Sahasrayogam Kashaya Prakaranam as “Arditakshepaka Vatahara Kashaya,” having most of the ingredients such as Ushna Virya (hot potency), Katu (pungent), and Kashaya Rasa (astringent taste), thus probably aiding in reducing Vata.[22] Cap palsineuron (ingredients such as Mahavatavidhwansana, Sameerapannaga, etc. are potent Vatahara, Shulahara, and Rasayana) might help to reduce Vata symptoms, as these formulations are mostly used in chronic Vata disorders.[23]Abhyarishta was used here to maintain Agni (digestion) as well as to evacuate Malas (excretory functions) properly; it acts through its main ingredient Abhaya (Terminalia chebula).[24]
| Conclusion | | |
In Ayurveda classics, Ardita Vata (Bell’s palsy) was described in the chapter titled Vatavyadhi, so in Ardita Vata the main culprit is Vata. That is why here mainly Vatahara treatment protocol was adopted. It is managed with the Panchakarma procedures such as Mukhabhayanga, Nadi swedana, Nasya, and Kavala along with oral medications. After completion of the treatment, significant improvement was noticed in the signs and symptoms of the patient. As all the procedures were done on an out patient department basis, they did not require any hospitalization. This present study protocol seems promising and very effective, less time-consuming, as well as easy to perform and worth documenting.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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