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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 80-84

A progressive revival of semivegetative patient of head injury with ayurvedic treatment


1 Department of Medicine, Punarvasu Chikitsalaya, Pune, Maharashtra, India
2 Autonomous Institute Affiliated with Brahma Ayurved Services Private Limited, Pune, India

Date of Submission03-Jun-2021
Date of Decision09-Jul-2021
Date of Acceptance31-Dec-2021
Date of Web Publication19-Mar-2022

Correspondence Address:
Yogesh Chandrakant Kale
Punarvasu Chikitsalaya, 1123/B, Shivajinagar, Model Colony, Near Lalit Mahal Hotel, Pune - 411 016, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_154_21

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  Abstract 


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 Top


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 Top


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]
Figure 1: Condition of patient at the time of admission

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  • 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
Figure 2: Drowsy condition

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Figure 3: Patient able to swallow semisolid food

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Figure 4: Patient able to hold sitting position

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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]
Table 1: Samprapti-ghataka

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Considering abnormalities developed in all these factors, treatment was chalked out as Vatashamana, Raktaprasadana, Agnideepana, Indriybodhana, Smruti-dhi-Vardhana, and Rasayana [Table 2].
Table 2: External and internal treatment

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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]
Table 3: Progression during admission period and subsequent follow-ups

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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].
Figure 5: Patient able to stand by herself and walk with support

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Figure 6: Patient able to eat solid food by herself

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Figure 7: Increased Varna-Utsaha

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  Discussion Top


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 Top

1.
CharakSamhita, Siddhisthana, Trimarmiya Siddhi Adhyaya, 9/9-10. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 1
    
2.
CharakSamhita, Chikitsasthana, Vatavyadhichikitsitam Adhyaya, 28/18. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 2
    
3.
CharakSamhita, Sutrasthana, Vidhishonitiya Adhyaya, 24/10. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 3
    
4.
CharakSamhita, Sutrasthana, Vatakalakaliya Adhyaya, 12/8. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 4
    
5.
CharakSamhita, Chikitsasthana, Vatavyadhichikitsitam Adhyaya, 28/81-82. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 5
    
6.
CharakSamhita, Siddhisthana, Kalpanasiddhi Adhyaya, 1/38-39. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 6
    
7.
CharakSamhita, Chikitsasthana, Grahanichikitsitam Adhyaya, 15/243. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 7
    
8.
CharakSamhita, Siddhisthana, Kalpanasiddhi Adhyaya, 1/12. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 8
    
9.
CharakSamhita, Chikitsasthana, Yonivyapadchikitsitam Adhyaya, 30/331-332. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 9
    
10.
CharakSamhita, Sutrasthana, Khuddakchatushpada Adhyaya, 9/3. Available from: https://niimh.nic.in/ebooks/ecaraka. [Last accessed on 2021 May 10].  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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