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| CASE REPORT |
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| Year : 2022 | Volume
: 16
| Issue : 1 | Page : 80-84 |
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A progressive revival of semivegetative patient of head injury with ayurvedic treatment
Yogesh Chandrakant Kale1, Yashashree V Joshi2, Barakha V Kulkarni2
1 Department of Medicine, Punarvasu Chikitsalaya, Pune, Maharashtra, India
2 Autonomous Institute Affiliated with Brahma Ayurved Services Private Limited, Pune, India
| Date of Submission | 03-Jun-2021 |
| Date of Decision | 09-Jul-2021 |
| Date of Acceptance | 31-Dec-2021 |
| Date of Web Publication | 19-Mar-2022 |
Correspondence Address:
Yogesh Chandrakant Kale
Punarvasu Chikitsalaya, 1123/B, Shivajinagar, Model Colony, Near Lalit Mahal Hotel, Pune - 411 016, Maharashtra
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/joa.joa_154_21
Introduction: The presented case report depicts gradual revival of a patient with head trauma from semivegetative state with complete Ayurvedic treatment. Main Clinical Findings: The patient was in semivegetative state with least mobility, due to partial motor function loss, drowsiness, speech and memory loss, no sensation or control over micturition and defecation, and need of PEG tube for feeding. Diagnosis: Shirobhighatajanya Vatavyadhi and Sannyasa. Interventions: Complete Ayurvedic treatment was administered focusing on Vatashamana, Raktaprasadana, Agnideepana, Marmaparipalana, and Indriyaprabodhana. Outcome: Mobility, speech and memory improvement, oral solid food intake by herself, and proper sensation and control over micturition and defecation are the main satisfactory outcomes. Conclusions: Timely and complete Ayurvedic diagnosis and Ayurvedic treatment along with Chatushpada Sampatchikitsalaya are the key factors in treating chronic and critical conditions of Marmabhighata.
Keywords: Head trauma, Marma, Shirasabhighata, vegetative
How to cite this article:
Kale YC, Joshi YV, Kulkarni BV. A progressive revival of semivegetative patient of head injury with ayurvedic treatment. J Ayurveda 2022;16:80-4 |
How to cite this URL:
Kale YC, Joshi YV, Kulkarni BV. A progressive revival of semivegetative patient of head injury with ayurvedic treatment. J Ayurveda [serial online] 2022 [cited 2022 May 16];16:80-4. Available from: http://www.journayu.in/text.asp?2022/16/1/80/339979 |
| Introduction | |  |
Head injury is always considered as a serious issue and needs emergency treatment. Head region (Shiras) is one of the “three-main” Marmas.[1] Trauma on head mainly leads to major sensory/motor function loss or even death.
In this case, the patient had suffered from partial motor function loss, but she was revived up to the stage of the removal of PEG tube and catheter and mobility to some extent with complete Ayurvedic treatment.
| Case Report | | |
A 59-year-old woman fell from two-wheeler on August 2, 2020; immediately, she was hospitalized in nearby allopathic hospital.
She was in the state of deep coma for 3 days. Then slowly, she became conscious. During hospitalization, the patient received all essential investigations, treatment, and supportive care along with chest limb physiotherapy and music therapy. PEG tube was inserted on August 19, 2020. She was discharged from that hospital on August 21, 2020, with following notes.
- Final diagnosis - Diffuse subarachnoid hemorrhage, right parietal thin subdural hemorrhage suggestive of diffuse axonal injury. Grade III right maxilla fracture. Right greater tubercle of humerus cortical fracture
- Condition on discharge - State not responsive, Foley's catheter, and PEG tube in situ
- Treatment at discharge - Tablet augmentin - DUO, tablet eptoin, tablet rablet, tablet emeset, tablet dolo, tablet ganaton, syrup cremaffin, tablet mucomelt-A
- Advice on discharge - Maintain general hygiene, back care, continue PEG feeds, “position change” 2 hourly, wheelchair ambulation, oral care, PEG care, Foley's care, eye care, PEG feeds 200 ml/2 hourly in sitting position, music therapy. Chest limbs physiotherapy as taught.
She was maintained at home in such semivegetative state for 7 weeks and presented at our hospital by her family on October 8, 2020.
Patient's condition at the time of admission at our hospital [Figure 1]
- Immobile (on stature)
- Drowsy [Figure 2]
- PEG tube and Foley's catheter in situ
- Responding to painful stimulation only
- Not talking since a month but sometimes responding to call by eye blinking
- Unable to swallow, to move on her own, and to recognize family members
- Uncontrolled limb movements
- Accidental wounds – healed, dry, and clean
- Past 2 days – vomiting 4–5 times/day and passing liquid fecal matter (no sensation/control)
- Abdomen – tenderness
- Restlessness
- Nadi-Vata, 73/min
- Blood pressure – 136/90 mm of Hg
- Temperature – 97.8°F
- SPO2 – 93%
- Varna-Panduta
- Sparsh-sarvangroukshya
- Nidana-Shiromarmabhighatajanya Sannyasa, Vatavyadhi
Treatment plan
This was a case of Shiromarmabhighata leading to severe vitiation of Vata-Dosha and Rakta-Dhatu.[2],[3] Patient's condition showed involvement of asthi, majja, indriya, smruti, dhi, ojas, and agni [Table 1].[4]
Considering abnormalities developed in all these factors, treatment was chalked out as Vatashamana, Raktaprasadana, Agnideepana, Indriybodhana, Smruti-dhi-Vardhana, and Rasayana [Table 2].
Snehana is the main treatment in this case. Snehana pacifies Vata, counters dhatukshaya, ojakshay, indriybalahani, and smrutikshaya, and activates agni.[5] Basti is the main treatment for marmaparipalana.[6] Therefore, different snehas were used through various routes of drug administration with mrudu-nadisvedana. Sarvanga-snehana was partially used for keeping the patient away from bed sores.
Initially, the patient was drowsy, nonresponsive to verbal/physical command. Physiotherapist had advised “position-change/2 h” and intensive chest/limb patting to awaken and check her status, which resulted in incomplete rest. This was stopped as such trasana was not advisable in this condition of severe dhatukshaya + ojakshaya. Further, the only continued medicine tablet eptoin was stopped after the admission it being the cause of patient's drowsiness. It helped patient in gaining consciousness and responses were improved.
Diet
The patient was previously advised to feed 200 ml/2 h in day–night which constituted almost 2200 ml in 24 h. However, vomiting, liquid feces, and abdominal tenderness are the indications of much depletion of agni. Here, tarpana, pachana, and laghana were needed to increase agni gradually. Hence, five feedings/during only daytime were decided, not exceeding 900 ml/day; starting from lajamand then peya, mudgayusha, dadimswarasa, amrutaSuvarna siddha kshirpak, shalipayas, and kushmandswaras.[7],[8]
It was given through PEG tube initially. When the patient came out of drowsiness, her favorite liquid items were given orally in minimal quantities to improve mental status and ruche (indiry-tarpana) [Table 3].[9]
The patient was discharged after 12 days with essential medication and was called for follow-up after 2 weeks and then after 4 weeks.
Second admission of the patient was done on February 25, 2021, for Sarvangadhara with Himasagara Taila and Narayana Taila for 7 days. Her follow-up after a month (April, 2021) reveals her progress in doing day-to-day activities. The patient is able to walk with support [Figure 5], eat solid food [Figure 6] by herself, and perform her daily activities. Bala, varna, utasaha, and kshudha show remarkable progress [Figure 7].
| Discussion | | |
In this case, head injury affected patient's motor and sensory functions partially, leading to dependency on others. PEG tube, catheterization, and self-hygiene issues are troublesome to patient and her family members too. Ayurvedic treatment helped reduce these troubles and pulled out patient from this completely dependent status to partial independency and offered the quality life to certain extent.
Here “Ayurvedic treatment with Ayurvedic diagnosis” is the key of success! For which, chatushpadasampad-chikitsalaya is must.[10] In the present era, Ayurvedic hospitals with these criteria are must. We have achieved similar results in many cases in the last 20 years with cohesive and persistent effort. In this case, the patient opted for Ayurvedic chikitsa after 2 months. We have achieved much better results in patient which have opted for Ayurveda as the first option immediately after the trauma.
Satisfaction of the patient herself and her family members is rewarding for us.
Author is sure that this case report will prove to be a good guideline to Ayurveda fraternity in clinical practices.
Acknowledgment
We are truly thankful to the Team Punarvasu Chikitsalaya for all the help provided regarding this case and report.
Informed consent
Informed written consent of patient is taken regarding revealing the facial identity of the patient.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Punarvasu Chikitsalaya, Pune, supported the study.
Conflicts of interest
There are no conflicts of interest.
| References | | |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3]
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