Pakshaghata (also called Pakshavadha or Ardhangavata) is described as a Vata Nanatmaja Vyadhi (disease caused solely by aggravated Vata). It manifests as paralysis of one side of the body (hemiplegia) due to either dhatukshaya (tissue depletion) or avarana (obstruction of Vata by Kapha, Pitta, Rakta, Meda). Classical descriptions are found in Charaka Samhita (Chikitsa 28), Sushruta Samhita (Chikitsa 3), Ashtanga Hridaya, Madhava Nidana (22), and Yoga Ratnakara.

"मज्जामेदशुक्रक्षये वा पक्षाघातः प्रवर्तते । आवृतेनापि वातेन पक्षवधोऽपि जायते ॥"
(सुश्रुत चिकित्सा ३/२)

Pakshaghata occurs when aggravated Vata afflicts snayu (nerves), dhamani (arteries), and sira (channels), resulting in loss of function of one side of the body. Ayurveda recognizes two pathogenic mechanisms: dhatukshaya (depletion of dhatus like mamsa, majja, shukra) and avarana (occlusion of Vata by Kapha, Pitta, Rakta, Meda). This correlates with ischemic and hemorrhagic stroke in modern medicine.

Dietary causes:

• Ruksha, Sheeta, Laghu ahara (dry, cold, light food)

  "रूक्षशीतललघ्वन्नं वातं कुर्वन्ति तात्कालम्"
  (चरक सूत्रस्थान २५/४०)

• Alpa ahara (undernourishment, fasting)

  "अल्पाहारोपवासेन वातो दूष्यति देहम्"
  (सुश्रुत सूत्रस्थान १५/८)

• Excess dry pulses (kulattha, masura), bitter and pungent foods aggravate Vata.
• Viruddha ahara (incompatible diet) weakens agni, aggravates Vata.

Lifestyle causes:

• Ati-vyayama (excessive exertion)

  "अतिव्यायामाच्च वातः प्रकोपं लभते ध्रुवम्"
  (अष्टाङ्गहृदय सूत्रस्थान १२/४)

• Ratrijagarana (night vigil)

  "रात्रिजागरणं वातकरं"
  (चरक सूत्रस्थान २१)

• Ativata-sevana (excess exposure to wind, cold) aggravates Vata.
• Vegavidharana (suppression of natural urges) causes Vata dushti.
• Manasika hetu — stress, anger, grief aggravate Vata (Madhava, Kashyapa).

Pathogenesis: Vata is aggravated due to dhatukshaya (depletion of mamsa, meda, majja, shukra) or avarana (obstruction by Kapha, Pitta, Rakta, Meda). Vitiated Vata lodges in snayu, sira, dhamani of one paksha (side of body) → paralysis, slurred speech, rigidity.

"मज्जामेदशुक्रक्षये वा पक्षाघातः प्रवर्तते । आवृतेनापि वातेन पक्षवधोऽपि जायते ॥"
(सुश्रुत चिकित्सा ३/२)

Diagnosis: Clinical features — hemiplegia, slurred speech, Vata-predominant nadi. Assessment of bala, indriya, agni, satva, srotas. Modern correlation: CT/MRI for ischemic/hemorrhagic stroke.

• Stiffness of limbs
• Tingling sensation
• Heaviness on one side
• Difficulty in speech

• Hemiplegia — loss of voluntary movement on one side (Akarmanyatā)
• Hemiparesis / weakness of limbs (Daurbalya of pakṣa)
• Loss or impairment of sensation (Achetanā/Doṣa-ātaṅkta indriyāḥ)
• Facial deviation / facial paresis (Mukha vakra / Anaghātata of mukha)
• Speech impairment — Vakstambha / slurring (Aphasia / dysarthria)
• Gait disturbance / inability to walk (Chalanā-aviṣamata)
• Autonomic / sphincter disturbance — urinary or fecal incontinence / retention

• Paralysis of one side (hemiplegia)
• Loss or slurring of speech
• Tremors, contractures
• Drooping of face

"गात्रैकदेशवैकल्यं पक्षाघाते लक्षणम्"
(माधवनिदान २२/३)

• Dhatukshaya-janya Pakshaghata — due to tissue depletion (mamsa, majja, shukra)
• Avarana-janya Pakshaghata — obstruction of Vata by Kapha, Pitta, Rakta, Meda

• Apasmara (epilepsy)
• Hritshoola (cardiac disorders)
• Prameha
• Kampavata (Parkinsonism-like features)

Acute, mild cases without loss of consciousness are sadhya. Chronic, recurrent, or severe cases are krichrasadhya/asadhya.

• Principles: Brimhana, Snehana, Svedana, Basti, Nasya, Shirodhara

  "स्नेहस्वेदनबस्तीनां पक्षाघाते प्रयोचनम्"
  (सुश्रुत चिकित्सा ३/१०)

• Panchakarma:
  • Snehapana — ghrita, taila preparations
  • Abhyanga + Svedana — Mahanarayana taila, Bala taila
  • Basti — primary line

    "बस्तिर्वातहरः श्रेष्ठः"
    (चरक सिद्धिस्थान १/३९)

  • Nasya — anutaila, ksheerabala taila
• Herbal medicines: Ashwagandha, Bala, Shatavari, Kapikacchu, Yogaraj Guggulu, Mahayogaraj Guggulu, Brahmi vati
• External therapies: Pizhichil, Shirodhara, Shiroabhyanga, Pichu
• Pathya: Warm, unctuous brimhana diet (ksheerapaka, ghrita, yavaghu); daily abhyanga; gentle exercise
• Apathya: Dry, cold, ruksha ahara; over-exertion; night vigil; excess wind exposure

• Warm, unctuous diet (milk, ghrita, yava)
• Daily abhyanga
• Gentle vyayama

• Dry, cold food
• Over-exertion
• Night vigil
• Excess exposure to wind

Stroke is a sudden neurological deficit due to cerebrovascular accident (ischemia/hemorrhage). Ayurveda correlates it with Pakshaghata, a Vata vyadhi, managed with Panchakarma (Basti, Snehana, Swedana, Nasya), nourishing therapies, yoga, physiotherapy, and rasayana.

• Nadi pariksha (Vata predominance)
• Neurological exam
• CT/MRI brain
• Blood sugar, lipid profile