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Cover page of the Journal of Health Sciences


 
 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 12  |  Issue : 3  |  Page : 251-256

An unusual case of Bell's palsy (Ardita vata) managed through Ayurveda


Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India

Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. Swarnima Mishra
Department of Kayachikitsa, All India Institute of Ayurveda, Gautam Puri, Sarita Vihar, New Delhi - 110 076
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kleuhsj.kleuhsj_40_19

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  Abstract 


Ardita vata presenting with palsy of one side of the face is akin to Bell's palsy or acute idiopathic lower motor neuron facial palsy. This is characterized by sudden-onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. Bell's palsy is an idiopathic, presumed immune-mediated phenomenon, possibly with an infection as the inciting event. In contemporary science, administration of steroids is the treatment of choice for complete facial palsy. A 17-year-old boy diagnosed with Ardita vata due to chronic ear infection was treated with Karpasasthyadi taila Nasya and oral Ayurvedic medicines along with two sittings of the Panchakarma procedure. The total duration of the treatment was 4 months; however, significant results observed after 1 month of treatment shown almost complete recovery without any concurrent medications. The patient suffers from the same complaint 5 years ago in the right side of his face, and for that, he took 2 years of allopathic treatment and got complete relief. This case is evidence to demonstrate the effectiveness of Ayurveda treatment in case of Ardita vata (Bell's palsy) and as a proposition for further research on a greater number of patients.

Keywords: Ardita, Bell's palsy, Karpasasthyadi taila, Nasya, ksheerdhooma


How to cite this article:
Mishra S, Prajapati AK, Huddar VG. An unusual case of Bell's palsy (Ardita vata) managed through Ayurveda. Indian J Health Sci Biomed Res 2019;12:251-6

How to cite this URL:
Mishra S, Prajapati AK, Huddar VG. An unusual case of Bell's palsy (Ardita vata) managed through Ayurveda. Indian J Health Sci Biomed Res [serial online] 2019 [cited 2019 Nov 21];12:251-6. Available from: http://www.ijournalhs.org/text.asp?2019/12/3/251/269204




  Introduction Top


Facial nerve dysfunction can seriously influence a patient's personal satisfaction. The human face is a point of convergence for correspondence and appearance. The facial nerve conveys motor, sensory, and parasympathetic fibers, and hence facial palsy results in both functional and cosmetic impairments. Facial nerve paralysis is determined on clinical introduction to have shortcoming of the facial muscles. There are numerous reasons for one-sided facial paralysis that ought to be considered, including idiopathic, traumatic, infective, neoplastic, innate, and immune system. The early impact of Bell's paralysis is powerlessness to completely close the mouth and eye on the influenced side of the face, causing troubles in eating and talking, corneal drying, and disintegration. Later indications can incorporate agony around the ear sometimes and then reaching out to the back of the head or neck, modified taste, synkinesis, facial spasm, facial contractures, dysfunctional lacrimation, and voice intolerance.[1] The subsequent disability of oral fitness, verbal correspondence, and social connection can add to critical significant emotional distress during Bell's palsy.[2]

About 71% of patients with Bell's paralysis have motor work recuperation totally inside a half year without treatment.[3],[4] About 33% of patients may have inadequate recuperation and leftover impact. Among the remaining impacts incorporate postincapacitated hemifacial spasm, co-contracting muscles, synkinesis, and perspiring while at the same time eating or during physical effort. The two most basic unusual regeneration patterns are lacrimation of the ipsilateral eye during chewing (crocodile tears) and closure of the ipsilateral eyelid when the jaw opens (jaw-winking). In view of symptomatology, this indication can be contrasted as Ardita Vata in Ayurveda [Table 1].
Table 1: Comparison of Bell's palsy with Ardita vata

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As per the literature, it is episodic and takes 6 months to recover without any intervention.[7] Here is a case where almost complete recovery observed at 4 months of the treatment.


  Case Report Top


A 17-year-old, moderately built male, belonging to the middle class household student, diagnosed with recurrent Bell's palsy presented to Kayachikitsa outpatient department (OPD) in AIIA with complaints of deviation of the mouth toward the left side (Vakreekaroti nasa bhru lalata akshi hanustatha), watering (Netramaavilam), unable to blink (Stabdha netram, Ekasya aksho nemeelanam), and difficulty in chewing food on the right jaw (Bhojanamiti na samam mukhena khadati) for 2 months [Figure 1].[8],[9],[10],[11] Associated complaints – itching in the right ear since childhood and pus discharge in the right ear since childhood (on and off).
Figure 1: Deviation of the mouth towards Rt, BT

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The patient did not take any medicine for ear complaint. According to the patient, he was asymptomatic 5 years ago, 1 day he felt deviation of his face toward left side, with mild difficulty in speech, eating, and drinking. Patient took 2 years of allopathic treatment along with physiotherapy and improved completely. no any this type of complaint found in next 5 years. In March 2018, 1 day when he was woke up from the bed, while he was brushing teeth, he noticed deviation of the mouth toward left (Samutkshipteti atitwaritah), inactivity of eyelid movement of the right eye, difficulty in speech (Vaak sanga),[12] and escaping water from the mouth. There was no any history of diabetes mellitus, hypertension, dengue, malaria, or any other infectious disorder. There was a history of mild perforation of the tympanic membrane (right) with fungal infection, as per the patient's report treatment was started with steroids for 5 days and advised to continue for another 5 days. As satisfactory results were not observed, the patient stopped the use of steroids against medical advice before 1 month of consultation for Ayurvedic treatment and consulted for Ayurvedic management.

On physical examination

The physical examination at the time of hospital visit of the patient revealed a body temperature of 98.8°F, pulse rate – 80 beats/min, respiratory rate of 19 times/min, blood pressure of 100/70 mmHg, and normal oxygen saturation. Auscultation of the lungs detected bilateral chest clear, and there was no added sound. A cardiac examination showed a nondisplaced point of maximal impulse with regular tachycardia. There were no murmurs, rubs, or gallops. The abdomen was soft and nontender with no any organomegaly. At the time of the first visit, all routine investigations were normal. Higher mental functions were intact with motor functions of the affected facial nerve. Deviation of mouth towards left side was observed during clenching of teeth and while puff out cheeks, air found to be escaped through the left angle of mouth with drooping of mouth in the left side. Complete closure of the right eye was not possible and unable to raise the right eyebrow with absent wrinkles on the right side of the forehead, indicating the affected motor function of the facial nerve; however, the sensory functions were unaffected [Table 2].
Table 2: Findings before and after treatment

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Assessment criteria

Using the House–Brackmann scale of facial nerve weakness showed that there is grade IV of facial paralysis (weak with incomplete eye closure).[13]

Samprapti (Pathogenesis)

Due to the excessive exposure to cold wind, vitiated Vata with Kapha is involved in the genesis of the disease. Prakupita vata (aggravated vata) along with Kapha settles in Sandhi's (joints of above clavicle) of Sira (head), Nasa (Nose), Hanu (Mandible), Lalata (forehead), and Netra (eye). Snayu (ligaments) and Kandara (tendons) are affected by the Doshas and presented symptoms on the right half of the face with all the features of Ardita vata. This condition is akin to Bell's palsy in contemporary science, where the facial nerve palsy presenting with the above symptoms is seen.

Management

Step 1st management of tympanic membrane perforation along with fungal infection

As the patient was suffered from recurrent fungal infection in the ear, leads to ear perforation (mild) along with pus discharge and itching, and we know that the facial nerve is prone to transtympanic penetrating trauma as it courses through the tympanic segment of the facial canal. Here, only the thin lateral wall of the facial canal separates the facial nerve from the tympanic cavity of the middle ear.[14] For that, patients referred in ear, nose, and throat OPD, where ear complaint managed by mopping for the removal of pus, karna pichu by jatyadi taila, along with oral medication sarivadi vati 2 tablet B.D (twice a day), Gandhak vati 2 tablet B.D for 2 months.[15]

Step 2nd management of fascial paralysis

Treatment of facial paralysis was started, as the patient admitted in Kayachikitsa OPD along with the ear complaint. The patient took following Ayurvedic medication [16] for 4 months [Table 3].
Table 3: Treatment administered

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Total duration of the treatment with admission was 4 months. During the treatment and follow-up (4 months), the patient was advised to avoid the exposure to wind, sunlight, dust, etc., as Vataprakopaka nidanas.


  Observations and Results Top


Clinical parameters

Images

After 4 months of treatment, there were complete improvements of symptoms such as closing of the eye (95%), speech (100%), and difficulty in eating and drinking. After the 30th day of the treatment, the improvement was seen in reduction of deviation of the mouth, watering of eyes, and pricking pain in the eye. After 2 months, remission was observed in all the symptoms [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]. For shaman of Doshas, the same medications were continued for the next 4 months. The patient was totally free from all the symptoms, [Videos 1 and 2] and the treatment was aborted.
Figure 2: Half opened eye BT

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Figure 3: Complete eye closure AT

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Figure 4: Absent folds BT

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Figure 5: Normal folds AT

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Figure 6: No deviation AT

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  Discussion Top


Bell's paralysis can be corresponded to Ardita vata in Ayurveda. Despite the fact that this condition is steadily settling after some time, needs the proper and timely organization of mediation to avoid irreversible changes. Subsequently, in conventional treatment, steroid organization as early as possible is considered as the line of treatment. In the present case, treating Bell's paralysis without proceeding with steroid treatment yielded total recuperation inside 7 days of treatment. While examining the causative elements for Vata vyadhi (Vata Dosh – predominant disorders – Ardita Vata in the present setting), extreme presentation to cold air is considered as one of the causative factors in the vitiation of Vata that was proved in the present case.

Treatment principle and rationale of treatment adopted

As there is relationship of Vata with Kapha, the Vata Kaphahara chikitsa is to be embraced. Navana Nasya (putting cured oil drops in the nostrils), Moordhni taila (distinctive modalities of treatment of putting sedated oil over the head), Nadisweda (fomentations to face through the tubular structures), and Upanaha (utilization of the paste prepared of medications to head is the line of treatment referenced for Ardita. In light of this, the Karpasasthyadi Navana Nasya and Sthanika Nadisweda have been received to evacuate Urdhwajatrugata doshas. To subside the remaining Doshas, oral medications fighting Vata and Kapha dosha have been chosen. Abhyanga with ksheerbala taila (Bala – Sida cardifolia incorporated into Balya Mahakashya by Acharya Charaka and because of its substance ephedrine, it has psychostimulant property following up on the central nervous system [18] and Tila taila which give lipophilic base to better retention) and Swedana with Ksheerdhoom (A decoction arranged by Vatahara drugs with Cow's milk). The drugs chose here not only serve the purpose of Vata alleviation as well as help in the management of symptoms before Nasya for expanding blood flow to the peripheral arterioles which help for quick medication assimilation. In Nasya treatment, medicated oil is administrated in nostrils, this drug is compassed to Shringataka marma and spreads into all Srotas (vessels, nerves) and dispense with the vitiated Dosha.[19] Nasya supports the sensory system by vascular pathway. Talama invigorate the sense organs and nerves and decrease mental exhaustion, decline mental weariness, and control the expanded or Dosha Vrudhi in the head. Ekangaveera rasa utilized orally act as Rasayan, Brihan, and Vishaghna.[20] Ksheerabala capsule smothers nerve inflammation because of its Sheeta property and advances nerve recovery and offers strength to muscles due to Balya and Brimhana properties of medications present in it. It precludes wear and tear of nervous and muscular tissues. Possibly, a combination of all these formulations helped in breaking the pathology at different level.


  Conclusion Top


Navana nasya with Karpasasthyadi taila followed by the oral medicines in the treatment of Bell's palsy (Ardita vata) has provided complete improvement in this case. No conventional drugs were used during the course of treatment. The whole of Ayurvedic treatment modality opts in these cases has shown anti-inflammatory, acts as a nervine potion, stimulant for nerve ending, and neurodegenerative property.

Declaration of patient consent

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 initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study was financially supported by All India Institute of Ayurveda, Sarita Vihar, Gautampuri.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Stew B, MRCS, DOHNS, ENT ST5 All Wales Rotation and Huw Williams, FRCS, ENT Consultant, Modern management of facial palsy: A review of current literature. Br J Gen Pract 2013;63:109-110.  Back to cited text no. 12
    
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Schaefer N, O'Donohue P, French H, Griffin A, Elliott D, Gochee P, et al. Transtympanic facial nerve paralysis: A review of the literature. Plast Reconstr Surg Glob Open 2015;3:e388.  Back to cited text no. 14
    
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Motalib Momin MA, Bellah SF, Raussel Rahman SM, Rahman AA, Monjur Murshid GM, et al. Phytopharmacological evaluation of ethanol extract of Sida cordifolia L. Asian Pac J Trop Biomed 2014;4:18–24.  Back to cited text no. 18
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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