A Clinical Approach to Ardita (Facial Palsy) through Ayurveda: A Single Case Study

Introduction

Vata is responsible for controlling all the functions as well as formation of body structures. It is the only motivating force in the body, having propulsive action, through which it moves things & expels waste products from the body [1]. It controls central nervous functions, neuro-muscular activities & mind. It is responsible for all movements in the body hence under the term “Nanatmaja Vyadhi” of Vata 80 disease have been included which covers wide range of symptoms like paresis, paralysis of muscles, monoplegia, diplegia, hemiplegia, facial paralysis, neuralgia, stiffness of muscles, sciatica, spondylitis, convulsions, tremors, atrophy of muscles & cramps[2]. Acharya Charak has explained Ardita as the contracture of mouth along with the involvement of forehead, eyebrow, eye, nasial fold on the affected side of face [3]. Acharya Charak opines that Ardita is localized in half face with or without involvement of body. Acharya Sushruta has considered the involvement of face only [4]. Ardita is also termed as Ekayaam [5].

On the basis of symptoms Ardita can be correlated with facial palsy. Facial palsy is a common neurological disorder in which seventh cranial nerve is affected. 7th cranial nerve also known as facial nerve, responsible for all voluntary movement of face, taste to the anterior 2/3 of tongue as well as control of lacrimal gland & salivary gland secretions. Facial palsy is defined as a temporary inability to control the facial muscles on affected side of face [6]. It can be characterized by weakness, muscle twitching, or total loss of ability to move on affected side along with drooping of eyelid, pain around the ear and change in taste [6]. Typical symptoms come on over 48 hours. Its cause is unknown. On the basis of lesions it can be divided into two types, UMN & LMN lesion. If patient involves paralysis of lower face on the opposite side, it comes under UMN. If involves upper as well as lower face on same side, it comes under LMN. Here the patient has come with symptoms involving left unilateral side of face with both quadrants upper & lower, so representing the symptoms of LMN lesion of facial nerve.

The incidence is around 23 per 1, 00,000 people per year, or about 1 in 60-70 people in a lifetime [7]. It affects men and women more or less equally, with a peak incidence between the age of 10-40. It occurs with equal frequency on the right & left sides of the face [8].

Case Study

A 44 years old female, housewife by occupation, belonging to the low middle class, came to Panchkarma OPD department of Rishikul campus, Haridwar, India with the following complaints from 1 week

• Weakness in the left side of face along with other body parts
• Numbness in the left half side of face
• Angle of mouth drooped down towards the left side of face
• Lacrimation from left eye
• Altered taste sensation & smell
• Slurred speech
• Inability to make facial expression like smile, frowning.

Results

After 7 days of therapy with internal medication, she got significant relief in complaints like lacrimation, numbness on left side of face, correction of facial symmetry, no difficulty in speaking.

Clinical assessments were made from the subjective symptoms & House-Brackmann’s grading of facial nerve VII. The result was seen after 7 days of treatment. There was no side effect observed during & after the treatment.

Discussion

Acharya Charak has mentioned Nasya for Ardita in Vata Vyadhi Chikitsa [10]. In Ayurveda Nasya is considered best to control the disease above neck [11]. The process by which the drug is administered through nostrils is called Nasya [12]. According to Ayurveda the drug administered through nostrils reaches Shrungataka Marma & distributed in Murdha ( brain), Siramukha (opening of the blood vessels of Netra (eye), Karna (ear), Kantha (throat) etc. finally scratches the morbid Dosha from supra clavicular region completely just like removing Munja grass from its stem [13]. According to modern science there is no direct route for pharmaco-dynamic consideration between nose & cranial organ because blood brain barrier is a strict security system of human brain. But the direct transportation can be possible through two pathways – Vascular & lymphatic. Vascular path transportation is possible through the pooling of nasal venous blood to the facial vein, which naturally occurs. Just at the opposite entrance, the inferior opthalamic vein also pool in the facial vein. As both facial & opthalamic vein have no veinal valves in between, so blood may drain on either side. That is to say the blood from facial vein can enter cavournus venous sinus of brain in reverse direction. Thus, such a pooling of blood from nasal vein to veinous sinuses of brain, is more likely in the head lowered position due to gravity. On these lines, the drug absorption into meninges & related parts of intracranial organs. Drug transportation by lymphatic path, can reach direct into the C.S.F. it is known that arachanoid matter sleeve is extended to the submucosal area of the nose along with olfactory nerve.

Here in this case the patient was given Sthanik Abhayanga & Swedana prior to the Nasya therapy. Sthanika Abhayanga was done with Go-Ghrita followed by Sthanik Dashmoola Kwath Naadi Sweda. It dilates the micro-blood vessels of face & enhances the blood circulation to that area. The increased blood flow to the peripheral arterioles accelerates the fast drug absorption & results in fast improvement.Improved blood supply to particular area of face result in nourishment of facial muscle & increases strength of facial muscle to work properly.

Mashbaladi Pachan Kashaya Nasya was given to the patient. It reaches to Shringataka Marma from where it spread into various Srotas (vessels & nerve) and controls the vitiated Vata Dosha. Not only have this drugs of Mashbaladi Panchan Kashaya also had additional property to pacify the vitiated Vata Dosha. They have anti-inflammatory and analgesic effect which gives relief in the symptoms. Kavala with luke warm water followed by Dhoompana after Nasya Karma removes the remaining Doshas which enhance the efficacy of treatment. Thus, helps to improve proper muscle functioning by pacifying the vitiated Vata Dosha & strengthening the muscles.

Conclusion

Here the patient is treated with Ayurvedic principles of Ardita & got marked improvement within one week without any side effect or recurrence. All the observation was done on the basis of clinical presentation & graded according to house- brookmans scale. Before the treatment the patient was unable to smile, had difficulty in speech, closure of eyelid, frowning, altered taste & smell. With the internal herbal preparation & Panchkarma therapy she got improvement in all the symptoms. After the completion two sitting of Nasya therapy & 60 days of internal herbal medication she got relief from all the symptoms successfully. From this study we can conclude that Ardita can be managed successfully by Ayurvedic principles. However, this is a single case study; similar studies are needed to be done on a large scale to establish statistical significance of the present line of treatment.