Issue : 01 DOI : INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCHVolume : 02
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 81
Abstract
Pakshaghata is made up of two words Paksha (half part of body) and Aghat (loss of function). Ayurved
literature is full of textual references where Pakshaghata is described extensively. It is considered as Vata
Dosha predominant Vyadhi [1]. Pakshaghata described in Ayurveda occurs due to Sira-Snayu-Vishoshoshya
leading to Sandhibandhan Vimokshayan, Hasta-Pada Sankocha, Vaakstambha and Vichetana. Prognosis
depends on many factors including Vaya, Bala, Dosha involvement etc. In modern science all the motor
activities are controlled by brain. Cerebrovascular accidents are mainly responsible for loss of function in
body and due to maximal similarity they can be correlated with Pakshaghata [2].CT Brain evaluation
provides an objective tool to identify site, extent and severity of cerebral involvement. In clinical practice,
gradation of Sandhibandhan Vimokshayan can be established through gait examination, which reflects the
degree of joint instability, muscular weakness, and neurological deficit. By correlating Ayurvedic
lakshanas with CT Brain findings, an integrated approach emerges to assess progression and prognosis.
This study aims to grade Sandhibandhan Vimokshayan by linking gait abnormalities in Pakshaghata with
radiological evidence, thereby creating a bridge between Ayurvedic clinical parameters and modern
diagnostic imaging. Such correlation not only validates traditional observations but also enhances clinical
understanding, rehabilitation strategies, and patient outcomes in stroke management.
Keywords: Pakshaghata , Vyadhi , Sira- Snayu Vishoshya , Sandhibandhan Vimokshayan , Hasta – Pada
Sankoch , Vaaksthambha , Vichetana
P
ISSN No. : 2584-2757
Volume : 03
Issue : 01
Publisher
ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION
FOR PATHOLOGY AND RADIODIGNOSIS
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 5 9 4 6 3
Reg. No. : MAHA-703/16(NAG) Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding author: Dr. Deepali Amale Article Info: Published on : 15/10/2025
Impact Factor : 1.013
Gradation Of Sandhibandhan Vimokshayan As A Gait Examination In
Pakshaghata By Evaluating CT Brain.
Dr. Deepali Amale1, Dr. Vaishnavi Sanjay Biradar 2
1Professor, Guide & H.O.D. of Rognidan Evum Vikruti Vigyan. C.S.M.S.S. Ayurveda Mahavidyalaya and
Rugnalaya, Kanchanwadi, Chh. Sambhajinagar.
2PG Scholar, Rognidan Evum Vikruti Vigyan. C.S.M.S.S. Ayurveda Mahavidyalaya and Rugnalaya,
Kanchanwadi, Chh. Sambhajinagar.
Cite this article as: - Dr. Deepali Amale (2025) ; Gradation Of Sandhibandhan Vimokshayan As A Gait Examination In
Pakshaghata By Evaluating CT Brain. ;Inter .J. Dignostics and Research 3 (1) 81-89 , DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 5 9 4 6 3
G AR V
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 81
Abstract
Pakshaghata is made up of two words Paksha (half part of body) and Aghat (loss of function). Ayurved
literature is full of textual references where Pakshaghata is described extensively. It is considered as Vata
Dosha predominant Vyadhi [1]. Pakshaghata described in Ayurveda occurs due to Sira-Snayu-Vishoshoshya
leading to Sandhibandhan Vimokshayan, Hasta-Pada Sankocha, Vaakstambha and Vichetana. Prognosis
depends on many factors including Vaya, Bala, Dosha involvement etc. In modern science all the motor
activities are controlled by brain. Cerebrovascular accidents are mainly responsible for loss of function in
body and due to maximal similarity they can be correlated with Pakshaghata [2].CT Brain evaluation
provides an objective tool to identify site, extent and severity of cerebral involvement. In clinical practice,
gradation of Sandhibandhan Vimokshayan can be established through gait examination, which reflects the
degree of joint instability, muscular weakness, and neurological deficit. By correlating Ayurvedic
lakshanas with CT Brain findings, an integrated approach emerges to assess progression and prognosis.
This study aims to grade Sandhibandhan Vimokshayan by linking gait abnormalities in Pakshaghata with
radiological evidence, thereby creating a bridge between Ayurvedic clinical parameters and modern
diagnostic imaging. Such correlation not only validates traditional observations but also enhances clinical
understanding, rehabilitation strategies, and patient outcomes in stroke management.
Keywords: Pakshaghata , Vyadhi , Sira- Snayu Vishoshya , Sandhibandhan Vimokshayan , Hasta – Pada
Sankoch , Vaaksthambha , Vichetana
P
ISSN No. : 2584-2757
Volume : 03
Issue : 01
Publisher
ROGANIDAN VIKRUTIVIGYAN PG ASSOCIATION
FOR PATHOLOGY AND RADIODIGNOSIS
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 5 9 4 6 3
Reg. No. : MAHA-703/16(NAG) Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding author: Dr. Deepali Amale Article Info: Published on : 15/10/2025
Impact Factor : 1.013
Gradation Of Sandhibandhan Vimokshayan As A Gait Examination In
Pakshaghata By Evaluating CT Brain.
Dr. Deepali Amale1, Dr. Vaishnavi Sanjay Biradar 2
1Professor, Guide & H.O.D. of Rognidan Evum Vikruti Vigyan. C.S.M.S.S. Ayurveda Mahavidyalaya and
Rugnalaya, Kanchanwadi, Chh. Sambhajinagar.
2PG Scholar, Rognidan Evum Vikruti Vigyan. C.S.M.S.S. Ayurveda Mahavidyalaya and Rugnalaya,
Kanchanwadi, Chh. Sambhajinagar.
Cite this article as: - Dr. Deepali Amale (2025) ; Gradation Of Sandhibandhan Vimokshayan As A Gait Examination In
Pakshaghata By Evaluating CT Brain. ;Inter .J. Dignostics and Research 3 (1) 81-89 , DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 5 9 4 6 3
G AR V
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 82
Introduction :
The term Pakshaghata means loss of function of
one half of the body. [3] Is defined by an
impairment of either the motor or sensory
systems, or both, in one side of the body.
Acharya Sushruta, mentioned this disease as Maha
Vatavyadhi, states that Dhatu kshaya or
Margavarana can cause manifestation[4].Etiological
factors for Pakshaghata are - Virudha Aahara ,
Atijagarana , Ativyavaya , Vicheshta , Shoka,
Dhatu-Kashya, Divaswapna , Chinta , Vegan
Dhahran & Marmabhigata , Excessive intake of
Ruksha , Laghu, Shita gunatmaka aahara dravya
sevan leads to vitiation of Vata by Margavrodha [5]
. Acharya Charaka says that Vayu beholds either
side right or left of the body, dries up the Sira and
Snayu of that part and produces loss of movements,
contraction of hand or leg along with Ruja and
Vaakstambha [6] . Sushrutacharya quotes that,
aggravated Vata traverses through the Urdhvaga,
Adhoga and Tiryaka Dhamanis, lossens the Sandhi
Bandha, and leads to Vaam or Dakshin Paksha
Hanan. Here patients half of body become
inoperative and loses sensibility, suddenly falls
down or expires [7] . Vagbhatacharya says that
Vayu hold half of the body, dries up Sira and
Snayu, loosens Sandhi Bandha and leaves either
half of the body dead and leads to Ardhakaya
Akarmanyata and Vichetana [8,9] .In Pakshaghata
there is impairment of Karmendriyas and they are
considered as part of the motor system [10] . The
disease affects the Madhyama Roga Marga (Marma
and Asthi Sandhi) and disrupts the functions of Sira
(blood vessels), Snayu (ligaments) Kandara
(tendon). It leads to Vishoshana of Sira-Snayu on
one half side of the body, Vichetana as Cheshta
Nivrutti on either vama or dakshina paksha along
with other symptoms such as Sandhi Bandhan
Vimokshayan as inability to maintain proper gait,
hemiplegic or dragging gait pattern , stiff or
circumductory leg movement , loss of smooth
coordination; in upper & lower limbs this
manifests as: Weakness or flaccidity of joints, Lack
of voluntary control in movement, Instability in gait
and posture, Difficulty in coordinating limbs,
Vaakstambha, Hasta-Pada Sankoch, Akarmanyata,
Hasta-Pada Kriyahani Pakshahanan of Either
Paksha etc. Due to vitiation of Vata dosha, the
natural stability and strength of Sandhi (joints) and
Bandhana (supportive structures, nerves, muscles)
gets disturbed. Symptoms of Pakshaghata can be
correlated with Hemiplegia which is most
commonly caused by Cerebrovascular Accident [11]
.Risk Factors of Stroke are :- Old age , High BP,
Previous Stroke or Transient Ischemic Attack (TIA)
Diabetes, High cholesterol , Smoking , Tobacco
consumption , AFI etc.[12] A stroke is referred to as
Cerebrovascular Accident. It is an interruption in
the flow of blood to cells in the brain. A stroke
occurs when a blockage in an artery prevents blood
from reaching cells in the brain or an artery
ruptures inside or outside the brain causing
hemorrhage [13] i.e. it may be due to - Thrombosis,
Embolism & Hemorrhage. Synonyms for CVA
include stroke, brain attack, and cerebral apoplexy
[14] .Stroke is the clinical designation applied to all
these conditions. Clinical features of stroke are :-
Sudden numbness or weakness of the face, arm, or
leg (especially on one side of the body), Sudden
confusion, trouble speaking, or
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 82
Introduction :
The term Pakshaghata means loss of function of
one half of the body. [3] Is defined by an
impairment of either the motor or sensory
systems, or both, in one side of the body.
Acharya Sushruta, mentioned this disease as Maha
Vatavyadhi, states that Dhatu kshaya or
Margavarana can cause manifestation[4].Etiological
factors for Pakshaghata are - Virudha Aahara ,
Atijagarana , Ativyavaya , Vicheshta , Shoka,
Dhatu-Kashya, Divaswapna , Chinta , Vegan
Dhahran & Marmabhigata , Excessive intake of
Ruksha , Laghu, Shita gunatmaka aahara dravya
sevan leads to vitiation of Vata by Margavrodha [5]
. Acharya Charaka says that Vayu beholds either
side right or left of the body, dries up the Sira and
Snayu of that part and produces loss of movements,
contraction of hand or leg along with Ruja and
Vaakstambha [6] . Sushrutacharya quotes that,
aggravated Vata traverses through the Urdhvaga,
Adhoga and Tiryaka Dhamanis, lossens the Sandhi
Bandha, and leads to Vaam or Dakshin Paksha
Hanan. Here patients half of body become
inoperative and loses sensibility, suddenly falls
down or expires [7] . Vagbhatacharya says that
Vayu hold half of the body, dries up Sira and
Snayu, loosens Sandhi Bandha and leaves either
half of the body dead and leads to Ardhakaya
Akarmanyata and Vichetana [8,9] .In Pakshaghata
there is impairment of Karmendriyas and they are
considered as part of the motor system [10] . The
disease affects the Madhyama Roga Marga (Marma
and Asthi Sandhi) and disrupts the functions of Sira
(blood vessels), Snayu (ligaments) Kandara
(tendon). It leads to Vishoshana of Sira-Snayu on
one half side of the body, Vichetana as Cheshta
Nivrutti on either vama or dakshina paksha along
with other symptoms such as Sandhi Bandhan
Vimokshayan as inability to maintain proper gait,
hemiplegic or dragging gait pattern , stiff or
circumductory leg movement , loss of smooth
coordination; in upper & lower limbs this
manifests as: Weakness or flaccidity of joints, Lack
of voluntary control in movement, Instability in gait
and posture, Difficulty in coordinating limbs,
Vaakstambha, Hasta-Pada Sankoch, Akarmanyata,
Hasta-Pada Kriyahani Pakshahanan of Either
Paksha etc. Due to vitiation of Vata dosha, the
natural stability and strength of Sandhi (joints) and
Bandhana (supportive structures, nerves, muscles)
gets disturbed. Symptoms of Pakshaghata can be
correlated with Hemiplegia which is most
commonly caused by Cerebrovascular Accident [11]
.Risk Factors of Stroke are :- Old age , High BP,
Previous Stroke or Transient Ischemic Attack (TIA)
Diabetes, High cholesterol , Smoking , Tobacco
consumption , AFI etc.[12] A stroke is referred to as
Cerebrovascular Accident. It is an interruption in
the flow of blood to cells in the brain. A stroke
occurs when a blockage in an artery prevents blood
from reaching cells in the brain or an artery
ruptures inside or outside the brain causing
hemorrhage [13] i.e. it may be due to - Thrombosis,
Embolism & Hemorrhage. Synonyms for CVA
include stroke, brain attack, and cerebral apoplexy
[14] .Stroke is the clinical designation applied to all
these conditions. Clinical features of stroke are :-
Sudden numbness or weakness of the face, arm, or
leg (especially on one side of the body), Sudden
confusion, trouble speaking, or
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 83
understanding speech, Sudden trouble seeing in one
or both eyes, Sudden dizziness, loss of balance or
coordination [15] .CVA or Stroke is the third leading
cause of death after heart diseases & cancer; which
occurs in the late middle age & in old age. Stroke
incidence rises exponentially with age about a
quarter occurs below 60 yrs & half below the age of
75 yrs [16] .Stroke is sudden onset of neurological
deficit from vascular mechanism 85% are ischemic
& 15% are primary hemorrhages [17] . The
prevalence of stroke in our country ranges from 40-
270 per 100000 population [18] .
CT scan (Computed Tomography Scan) is an
imaging technique that uses X-rays and computer
processing to create detailed cross-sectional images
of internal body structures. CT Brain (Computed
Tomography of Brain) plays a pivotal role in the
diagnosis and evaluation of CVA. It helps
differentiate ischemic from hemorrhagic stroke,
localizes the site of lesion, and determines the
extent of brain damage. CT Brain Findings like
Ischemic or hemorrhagic infarct → Shows exact
site and extent of neuronal damage. , Lesion in
internal capsule, basal ganglia, cortex → Strongly
linked with motor weakness and gait impairment
while Edema, midline shift, or diffuse atrophy →
Indicates severity of neurological dysfunction. CT
imaging is essential for timely decision-making in
acute stroke management, as it provides structural
correlation to the clinical deficits observed. In the
context of Pakshaghata, CT Brain allows objective
assessment of the brain pathology underlying the
Ayurvedic clinical features such as Sandhibandhan
Vimokshayan.
Aim:
To establish the gradation of Sandhibandhan
Vimokshayan as a Gait Examination in
Pakshaghata by correlating with CT Brain
evaluation.
Objectives:
1) To define and standardize the gradation
criteria for Sandhibandhan Vimokshayan in
Pakshaghata as Gait Examination.
2) To assess CT Brain findings in patient
presenting with Gait Disturbances.
3) To Co-relate CT Brain findings with the
gradation levels of Sandhibandhan
Vimokshayan.
4) To determine the clinical Significance of
Sandhibandhan Vimokshayan gradation as a
diagnostic tool for neurological gait
abnormalities.
5) To explore the potential of integrating
Ayurvedic Diagnostic Concepts with
modern neuroimaging for comprehensive
gait assessment & To study Pakshaghata
Vyadhi in detail.
Methodology:
Study Type: An Observational Study
Study Design:
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 83
understanding speech, Sudden trouble seeing in one
or both eyes, Sudden dizziness, loss of balance or
coordination [15] .CVA or Stroke is the third leading
cause of death after heart diseases & cancer; which
occurs in the late middle age & in old age. Stroke
incidence rises exponentially with age about a
quarter occurs below 60 yrs & half below the age of
75 yrs [16] .Stroke is sudden onset of neurological
deficit from vascular mechanism 85% are ischemic
& 15% are primary hemorrhages [17] . The
prevalence of stroke in our country ranges from 40-
270 per 100000 population [18] .
CT scan (Computed Tomography Scan) is an
imaging technique that uses X-rays and computer
processing to create detailed cross-sectional images
of internal body structures. CT Brain (Computed
Tomography of Brain) plays a pivotal role in the
diagnosis and evaluation of CVA. It helps
differentiate ischemic from hemorrhagic stroke,
localizes the site of lesion, and determines the
extent of brain damage. CT Brain Findings like
Ischemic or hemorrhagic infarct → Shows exact
site and extent of neuronal damage. , Lesion in
internal capsule, basal ganglia, cortex → Strongly
linked with motor weakness and gait impairment
while Edema, midline shift, or diffuse atrophy →
Indicates severity of neurological dysfunction. CT
imaging is essential for timely decision-making in
acute stroke management, as it provides structural
correlation to the clinical deficits observed. In the
context of Pakshaghata, CT Brain allows objective
assessment of the brain pathology underlying the
Ayurvedic clinical features such as Sandhibandhan
Vimokshayan.
Aim:
To establish the gradation of Sandhibandhan
Vimokshayan as a Gait Examination in
Pakshaghata by correlating with CT Brain
evaluation.
Objectives:
1) To define and standardize the gradation
criteria for Sandhibandhan Vimokshayan in
Pakshaghata as Gait Examination.
2) To assess CT Brain findings in patient
presenting with Gait Disturbances.
3) To Co-relate CT Brain findings with the
gradation levels of Sandhibandhan
Vimokshayan.
4) To determine the clinical Significance of
Sandhibandhan Vimokshayan gradation as a
diagnostic tool for neurological gait
abnormalities.
5) To explore the potential of integrating
Ayurvedic Diagnostic Concepts with
modern neuroimaging for comprehensive
gait assessment & To study Pakshaghata
Vyadhi in detail.
Methodology:
Study Type: An Observational Study
Study Design:
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 84
Diagnosed patient of Pakshaghata having any 3/4
Lakshanas :
Sira-Snayu Vishoshya, Sandhibandhan
Vimokshayan , Vichetana , Hasta-Pada Kriyahani
Pakshahanan of Either Paksha, Vaakstambha, Sira
– Snayu Vishoshya , Vichetana, Hasta –Pad
Sankoch etc.
⇓
Enrollment of patient in study with written
informed consent.
⇓
Patient was assessed for subjective and objective
criteria
⇓
Correlation & Gradation between Sandhibandhan
Vimokshayan (Gait) will be done.
⇓
Obtained data was analyzed
⇓
Discussion
⇓
Conclusion
Study Design
Inclusion Criteria:
1. Diagnosed patient of Pakshaghata having
any 3 or 4 Lakshanas: - Sira-Snayu
Vishoshya, Sandhibandhan Vimokshayan,
Vichetana, Hasta-Pada Kriyahani
Pakshahanan of Either Paksha,
Vaakstambha, Ruja, Hast-Pad Sankoch etc.
Exclusion Criteria:-
1. Diagnosed patient Of Paraplegia,
Quadriplegia, Meningitis, Glioma, Guillain-
Barre Syndrome, Bell’s palsy and Epilepsy.
2. Unconscious, Disoriented, Unco-operative
Patients.
3. Known case of HIV, Hepatitis -B, Any
Malignancies, Tuberculosis, Severe
Systemic Disorders etc.
Subjective Criteria:-
1. Hasta-Pada Kriyahani Pakshahanan of
Either Paksha (Loss of movements of either
side)
2. Hasta-Pada Sankoch ( Muscle Atrophy)
3. Sandhi Bandhan Vimokshayan ( Gait)
4. Vaakstambha ( Aphasia )
5. Sira -Snayu Vishoshya ( Muscle Power &
Muscle tone)
6. Vichetana (Reflexes)
Objective Criteria:
1. CT Brain Gradation
Assessment Of Subjective Criteria :
1 .Hasta-Pada Kriyahani Pakshahanan of Either
Paksha (Loss of movements of either side)
Grade
Hasta-Pada Kriyahani Pakshahanan of
Either Paksha (Loss of movements of
either side)
1 Loss of movement of either side of arm &
leg but can walk without support
2 Loss of movement of either side of arm &
leg but can walk with support
3 Loss of movement of either side of arm &
leg ; unable to walk
2.Hasta-Pada Sankoch ( Muscle Atrophy)
Grade Hasta-Pada Sankoch ( Muscle Atrophy)
1 Measurable reduction in the mass of muscle
of affected side
2 Moderate reduction in the mass of muscle
with partial wasting of affected side
3 Complete muscle wasting of affected side
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 84
Diagnosed patient of Pakshaghata having any 3/4
Lakshanas :
Sira-Snayu Vishoshya, Sandhibandhan
Vimokshayan , Vichetana , Hasta-Pada Kriyahani
Pakshahanan of Either Paksha, Vaakstambha, Sira
– Snayu Vishoshya , Vichetana, Hasta –Pad
Sankoch etc.
⇓
Enrollment of patient in study with written
informed consent.
⇓
Patient was assessed for subjective and objective
criteria
⇓
Correlation & Gradation between Sandhibandhan
Vimokshayan (Gait) will be done.
⇓
Obtained data was analyzed
⇓
Discussion
⇓
Conclusion
Study Design
Inclusion Criteria:
1. Diagnosed patient of Pakshaghata having
any 3 or 4 Lakshanas: - Sira-Snayu
Vishoshya, Sandhibandhan Vimokshayan,
Vichetana, Hasta-Pada Kriyahani
Pakshahanan of Either Paksha,
Vaakstambha, Ruja, Hast-Pad Sankoch etc.
Exclusion Criteria:-
1. Diagnosed patient Of Paraplegia,
Quadriplegia, Meningitis, Glioma, Guillain-
Barre Syndrome, Bell’s palsy and Epilepsy.
2. Unconscious, Disoriented, Unco-operative
Patients.
3. Known case of HIV, Hepatitis -B, Any
Malignancies, Tuberculosis, Severe
Systemic Disorders etc.
Subjective Criteria:-
1. Hasta-Pada Kriyahani Pakshahanan of
Either Paksha (Loss of movements of either
side)
2. Hasta-Pada Sankoch ( Muscle Atrophy)
3. Sandhi Bandhan Vimokshayan ( Gait)
4. Vaakstambha ( Aphasia )
5. Sira -Snayu Vishoshya ( Muscle Power &
Muscle tone)
6. Vichetana (Reflexes)
Objective Criteria:
1. CT Brain Gradation
Assessment Of Subjective Criteria :
1 .Hasta-Pada Kriyahani Pakshahanan of Either
Paksha (Loss of movements of either side)
Grade
Hasta-Pada Kriyahani Pakshahanan of
Either Paksha (Loss of movements of
either side)
1 Loss of movement of either side of arm &
leg but can walk without support
2 Loss of movement of either side of arm &
leg but can walk with support
3 Loss of movement of either side of arm &
leg ; unable to walk
2.Hasta-Pada Sankoch ( Muscle Atrophy)
Grade Hasta-Pada Sankoch ( Muscle Atrophy)
1 Measurable reduction in the mass of muscle
of affected side
2 Moderate reduction in the mass of muscle
with partial wasting of affected side
3 Complete muscle wasting of affected side
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 85
3. Sandhi Bandhan Vimokshayan ( Gait)
Grade sSandhi Bandhan Vimokshayan ( Gait)
Hemiplegic Gait
1
Slight Asymmetry, Minimal impact on gait.
Slight reduction in step length ( but
functional)
Occasional foot drop & toe drop with
minimal tripping.
Slight knee Hyperextension.
Hip Circumduction – slight outward swing
of leg.
Arm swing – slight reduction or
asymmetry.
2
Noticeable asymmetry, affects gait pattern.
Step length- noticeable reduction, more
effortful steps.
Foot drop & Toe drop – frequent (trips or
stumbles)
Knee Hyperextension – Regular (affects
stability)
Hip Circumduction – Noticeable outward
swing, laborious gait.
Arm swing– noticeable reduction affects
balance.
3
Significant Asymmetry, major gait
disruption.
Step length – severe reduction , greatly
affects mobility
Foot drop & Toe drop – Significant &
constant with difficulty in walking
Knee Hyperextension – Constant , major
instability
Hip Circumduction – Significantly outward
swing ( highly insufficient)
Arm Swing – Severe reduction or absence
4. Vaakstambha ( Aphasia )
Grade Vaakstambha ( Aphasia )
1 Able to pronounce simple word but unable
to pronounce compound words
2 Slurred Speech
3 Aphasia
5. Sira -Snayu Vishoshya ( Muscle Power )
Grade Sira -Snayu Vishoshya ( Muscle Power )
1 Movement against gravity, but not against
resistance
2 Movement at the joint , but not against gravity
3 Muscle flicker, but no movement at the
joint.
6. Sira -Snayu Vishoshya ( Muscle Tone )
Grade Sira -Snayu Vishoshya (Muscle tone)
1
Slight Increase In Tone
Catch / Release at end Rom(Range of
Motion / Movement)
2 More marked increased in tone through
ROM but affected part move easily
3 Considerable increase in tone
Passive movement difficult
7.Vichetana (Reflexes)
a.Vichetana (Deep Tendon Reflex)
Grade Vichetana (Reflexes)
Deep Tendon Reflex
1 Slightly Increased
2 Exaggerated (brisk)
3 Sustained Clonus
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 85
3. Sandhi Bandhan Vimokshayan ( Gait)
Grade sSandhi Bandhan Vimokshayan ( Gait)
Hemiplegic Gait
1
Slight Asymmetry, Minimal impact on gait.
Slight reduction in step length ( but
functional)
Occasional foot drop & toe drop with
minimal tripping.
Slight knee Hyperextension.
Hip Circumduction – slight outward swing
of leg.
Arm swing – slight reduction or
asymmetry.
2
Noticeable asymmetry, affects gait pattern.
Step length- noticeable reduction, more
effortful steps.
Foot drop & Toe drop – frequent (trips or
stumbles)
Knee Hyperextension – Regular (affects
stability)
Hip Circumduction – Noticeable outward
swing, laborious gait.
Arm swing– noticeable reduction affects
balance.
3
Significant Asymmetry, major gait
disruption.
Step length – severe reduction , greatly
affects mobility
Foot drop & Toe drop – Significant &
constant with difficulty in walking
Knee Hyperextension – Constant , major
instability
Hip Circumduction – Significantly outward
swing ( highly insufficient)
Arm Swing – Severe reduction or absence
4. Vaakstambha ( Aphasia )
Grade Vaakstambha ( Aphasia )
1 Able to pronounce simple word but unable
to pronounce compound words
2 Slurred Speech
3 Aphasia
5. Sira -Snayu Vishoshya ( Muscle Power )
Grade Sira -Snayu Vishoshya ( Muscle Power )
1 Movement against gravity, but not against
resistance
2 Movement at the joint , but not against gravity
3 Muscle flicker, but no movement at the
joint.
6. Sira -Snayu Vishoshya ( Muscle Tone )
Grade Sira -Snayu Vishoshya (Muscle tone)
1
Slight Increase In Tone
Catch / Release at end Rom(Range of
Motion / Movement)
2 More marked increased in tone through
ROM but affected part move easily
3 Considerable increase in tone
Passive movement difficult
7.Vichetana (Reflexes)
a.Vichetana (Deep Tendon Reflex)
Grade Vichetana (Reflexes)
Deep Tendon Reflex
1 Slightly Increased
2 Exaggerated (brisk)
3 Sustained Clonus
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 86
b.Vichetana (Superficial Reflex Grades
Babinski Sign)
Grade Vichetana (Reflexes)
Deep Tendon Reflex
1 Present
c.Vichetana (Abdominal Reflexes)
Grade Vichetana( Abdominal Reflexes)
1 Absent
Objective Criteria:
1.CT Brain Gradation :
Grade CT BRAIN
1
Small ischemic focus (< 1.5 cm)
or minimal hemorrhage.
Small focal infarct (<1.5 cm)
or lacunar infarct.
2
Moderate-sized infarct in MCA territory
or small intracerebral bleed. (1.5-3 cm).
Localized cerebral edema with mild
compression of ventricles.
No/Minimal midline shift (< 5 mm).
3
Large infarct/hemorrhage (> 3 cm).
Significant cerebral edema with mass
effect.
Midline shift > 5 mm.
Ventricular compression/hydrocephalus
may be present.
Case Study:
A 52year male patient brought by relatives in
conscious and oriented state with complaints of left
sided weakness, difficulty in movement & slight
slurred speech since last 9 months .
• K/C/O HTN since 7-8 years (On Rx. Tab
TAZLOC-AM OD)
• Patient on irregular medications.
• No any drug or food allergy
• No any surgical history
• Addiction: Chronic alcoholic, tobacco
chewer, bidi smoker since 20 yrs.
O/E :
➢ Temp - Afebrile
➢ P - 80/ min
➢ BP - 130/80 mmHg
➢ RS - B/L clear
➢ CVS - S1S2 Normal
➢ CNS - Conscious oriented
Central nervous system: Higher functions
Consciousness - fully conscious to time place and
person. Memory Intact, Behavior friendly,
Orientation - fully oriented to time, place and
person.
Cranial nervous: Facial nerve (symptoms present)
Asymmetry of face,
O/E: Eye closure normal, whistling not present,
blowing not present
CT Scan Findings:
Acute ischemic infarct noted in the right internal
capsule and corona radiata, measuring
approximately 27 × 8 mm. The lesion is associated
with mild perilesional edema.No evidence of
hemorrhage, mass effect, or midline shift is seen.
Findings are consistent with acute infarct in the
right MCA territory, correlating with contralateral
(left-sided) hemiparesis.
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 86
b.Vichetana (Superficial Reflex Grades
Babinski Sign)
Grade Vichetana (Reflexes)
Deep Tendon Reflex
1 Present
c.Vichetana (Abdominal Reflexes)
Grade Vichetana( Abdominal Reflexes)
1 Absent
Objective Criteria:
1.CT Brain Gradation :
Grade CT BRAIN
1
Small ischemic focus (< 1.5 cm)
or minimal hemorrhage.
Small focal infarct (<1.5 cm)
or lacunar infarct.
2
Moderate-sized infarct in MCA territory
or small intracerebral bleed. (1.5-3 cm).
Localized cerebral edema with mild
compression of ventricles.
No/Minimal midline shift (< 5 mm).
3
Large infarct/hemorrhage (> 3 cm).
Significant cerebral edema with mass
effect.
Midline shift > 5 mm.
Ventricular compression/hydrocephalus
may be present.
Case Study:
A 52year male patient brought by relatives in
conscious and oriented state with complaints of left
sided weakness, difficulty in movement & slight
slurred speech since last 9 months .
• K/C/O HTN since 7-8 years (On Rx. Tab
TAZLOC-AM OD)
• Patient on irregular medications.
• No any drug or food allergy
• No any surgical history
• Addiction: Chronic alcoholic, tobacco
chewer, bidi smoker since 20 yrs.
O/E :
➢ Temp - Afebrile
➢ P - 80/ min
➢ BP - 130/80 mmHg
➢ RS - B/L clear
➢ CVS - S1S2 Normal
➢ CNS - Conscious oriented
Central nervous system: Higher functions
Consciousness - fully conscious to time place and
person. Memory Intact, Behavior friendly,
Orientation - fully oriented to time, place and
person.
Cranial nervous: Facial nerve (symptoms present)
Asymmetry of face,
O/E: Eye closure normal, whistling not present,
blowing not present
CT Scan Findings:
Acute ischemic infarct noted in the right internal
capsule and corona radiata, measuring
approximately 27 × 8 mm. The lesion is associated
with mild perilesional edema.No evidence of
hemorrhage, mass effect, or midline shift is seen.
Findings are consistent with acute infarct in the
right MCA territory, correlating with contralateral
(left-sided) hemiparesis.
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 87
CT Brain
Observations :
Muscle power :
Right Left
Upper Limb 0 Grade 3
Lower Limb 0 Grade 3
Reflexes :
Right Left
Bicep N (Grade-2)
Exaggerated
Tricep N (Grade-2)
Exaggerated
Brachioradial N (Grade-2)
Exaggerated
Knee N (Grade-2)
Exaggerated
Achill’s
tendon N (Grade-2)
Exaggerated
Abdominal
Reflex N Absent
Planter N Babinski sign
Present
Muscle Tone :
Right Left
Upper limb Normal Rigidity
Lower limb Normal Rigidity
Discussion :
In the present case, a 52-year-old hypertensive male
presented with acute onset weakness of the left
upper and lower limb, along with deviation of the
mouth angle and difficulty in performing routine
movements. Clinically, these features correlate with
Pakshaghat lakshanas described in Ayurveda,
namely Hasta-Pada Kriyahani (loss of motor
function of limbs), Sandhibandhan Vimokshayan
(loosening of joint stability and disturbed gait),
Vakstambha (speech disturbance), and Sira-Snayu
Vishoshana (degeneration of neural and muscular
structures). These manifestations are equivalent to
the modern diagnosis of Cerebrovascular Accident
(CVA) or ischemic stroke. On CT Brain, the
findings revealed an acute ischemic infarct in the
right internal capsule and corona radiata, measuring
approximately 27 x 8 mm, with mild perilesional
edema and no significant midline shift. This infarct
lies in the right MCA territory, which explains the
contralateral left-sided weakness due to
involvement of descending corticospinal fibers. The
absence of mass effect or midline shift corresponds
to a moderate-grade infarct (CT gradation Grade
2).When correlated clinically, the patient exhibited
Grade 2 Hasta-Pada Kriyahani with partial but
significant motor impairment, walking possible
only with support, and an unstable gait pattern. The
characteristic Sandhibandhan Vimokshayan
(loosening of stability in gait) was observed as
reduced step length, imbalance, and asymmetry of
movements. Reflex examination showed
Hypereflexia with positive Babinski sign,
corresponding to Vichetana Grade 2. Mild facial
deviation was present without severe speech deficit,
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 87
CT Brain
Observations :
Muscle power :
Right Left
Upper Limb 0 Grade 3
Lower Limb 0 Grade 3
Reflexes :
Right Left
Bicep N (Grade-2)
Exaggerated
Tricep N (Grade-2)
Exaggerated
Brachioradial N (Grade-2)
Exaggerated
Knee N (Grade-2)
Exaggerated
Achill’s
tendon N (Grade-2)
Exaggerated
Abdominal
Reflex N Absent
Planter N Babinski sign
Present
Muscle Tone :
Right Left
Upper limb Normal Rigidity
Lower limb Normal Rigidity
Discussion :
In the present case, a 52-year-old hypertensive male
presented with acute onset weakness of the left
upper and lower limb, along with deviation of the
mouth angle and difficulty in performing routine
movements. Clinically, these features correlate with
Pakshaghat lakshanas described in Ayurveda,
namely Hasta-Pada Kriyahani (loss of motor
function of limbs), Sandhibandhan Vimokshayan
(loosening of joint stability and disturbed gait),
Vakstambha (speech disturbance), and Sira-Snayu
Vishoshana (degeneration of neural and muscular
structures). These manifestations are equivalent to
the modern diagnosis of Cerebrovascular Accident
(CVA) or ischemic stroke. On CT Brain, the
findings revealed an acute ischemic infarct in the
right internal capsule and corona radiata, measuring
approximately 27 x 8 mm, with mild perilesional
edema and no significant midline shift. This infarct
lies in the right MCA territory, which explains the
contralateral left-sided weakness due to
involvement of descending corticospinal fibers. The
absence of mass effect or midline shift corresponds
to a moderate-grade infarct (CT gradation Grade
2).When correlated clinically, the patient exhibited
Grade 2 Hasta-Pada Kriyahani with partial but
significant motor impairment, walking possible
only with support, and an unstable gait pattern. The
characteristic Sandhibandhan Vimokshayan
(loosening of stability in gait) was observed as
reduced step length, imbalance, and asymmetry of
movements. Reflex examination showed
Hypereflexia with positive Babinski sign,
corresponding to Vichetana Grade 2. Mild facial
deviation was present without severe speech deficit,
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 88
indicating Vakstambha Grade 1.The gradation of
Sandhibandhan Vimokshayan was thus consistent
with the CT Brain findings. A moderate-sized
infarct (Grade 2 on CT) produced a Grade 2 clinical
gait disturbance, thereby demonstrating a direct
correlation between radiological severity and
Ayurvedic functional gradation. This proves that
Sandhibandhan Vimokshayan, as described in
classical texts, can be objectively validated by
modern neuroimaging.
Therefore, the present case highlights that
Ayurvedic lakshanas such as Sandhibandhan
Vimokshayan are not only clinically observable but
also radio logically explainable, making them
valuable parameters for assessing severity and
prognosis in Pakshaghata. This integrative
approach bridges classical Ayurvedic description
with modern CT Brain evaluation, offering a
comprehensive understanding of disease
progression and patient management.
Conclusion:
The present case demonstrates that Sandhibandhan
Vimokshayan (gait disturbance) in Pakshaghata can
be effectively graded and correlated with modern
radiological evidence. The moderate infarct in the
right internal capsule and corona radiata (CT Brain
Grade 2) produced a corresponding Grade 2 gait
disturbance. Hence, by evaluating CT Brain
findings and correlating them with clinical
manifestations, we can establish that
Sandhibandhan Vimoksanam lakshana in
Pakshaghata can be correlated with gait
examination, as both reflect the degree of
neurological deficit and functional disability in
CVA patient.
References:
1. View of Management of Pakshaghata in
Ayurveda - A Case Study | Journal of
Ayurveda and Integrated Medical Sciences
https://share.google/9HfpHTiYDIL19jvjg
2. https://share.google/9HfpHTiYDIL19jvjg
3. Pakshaghata – Samprapti & Chikitsa
Vivechana Europeon Journal of Biomedical &
Pharmaceutical Sciences. By – Vasantha
Lakshmi & Dr. Abdul Khader. ( An ISO 9001:
2015 Certified International Journal )
https://www.ejbps.com
4. View of A Conceptual Review on Insights of
Pakshaghat (Hemiplegia) in Ayurveda
https://share.google/0bD2vZ3Z1zbeKxC03
5. A Review Article on Pakshaghata W.S.R. to
Stroke BY- Dr. Shaikh Akhil Shaikh Chand &
Dr. Tabassum Kauser Iqbal Ahmed Khan .Vol.
11, Issue 13, 2022. ISO 9001: 2015 Certified
Journal www.wjpr.net
6. Charak Samhita Chikitsa Sthan 28/53-55. By-
H.S. Kushwaha, Publisher - Chaukhamba
Orientalia - 2011.
7. Sushrut Samhita Nidan Sthan 1/60-62. By-
Trivikram Yadav, Publisher - Chaukhamba
Prakashan - 2010.
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 88
indicating Vakstambha Grade 1.The gradation of
Sandhibandhan Vimokshayan was thus consistent
with the CT Brain findings. A moderate-sized
infarct (Grade 2 on CT) produced a Grade 2 clinical
gait disturbance, thereby demonstrating a direct
correlation between radiological severity and
Ayurvedic functional gradation. This proves that
Sandhibandhan Vimokshayan, as described in
classical texts, can be objectively validated by
modern neuroimaging.
Therefore, the present case highlights that
Ayurvedic lakshanas such as Sandhibandhan
Vimokshayan are not only clinically observable but
also radio logically explainable, making them
valuable parameters for assessing severity and
prognosis in Pakshaghata. This integrative
approach bridges classical Ayurvedic description
with modern CT Brain evaluation, offering a
comprehensive understanding of disease
progression and patient management.
Conclusion:
The present case demonstrates that Sandhibandhan
Vimokshayan (gait disturbance) in Pakshaghata can
be effectively graded and correlated with modern
radiological evidence. The moderate infarct in the
right internal capsule and corona radiata (CT Brain
Grade 2) produced a corresponding Grade 2 gait
disturbance. Hence, by evaluating CT Brain
findings and correlating them with clinical
manifestations, we can establish that
Sandhibandhan Vimoksanam lakshana in
Pakshaghata can be correlated with gait
examination, as both reflect the degree of
neurological deficit and functional disability in
CVA patient.
References:
1. View of Management of Pakshaghata in
Ayurveda - A Case Study | Journal of
Ayurveda and Integrated Medical Sciences
https://share.google/9HfpHTiYDIL19jvjg
2. https://share.google/9HfpHTiYDIL19jvjg
3. Pakshaghata – Samprapti & Chikitsa
Vivechana Europeon Journal of Biomedical &
Pharmaceutical Sciences. By – Vasantha
Lakshmi & Dr. Abdul Khader. ( An ISO 9001:
2015 Certified International Journal )
https://www.ejbps.com
4. View of A Conceptual Review on Insights of
Pakshaghat (Hemiplegia) in Ayurveda
https://share.google/0bD2vZ3Z1zbeKxC03
5. A Review Article on Pakshaghata W.S.R. to
Stroke BY- Dr. Shaikh Akhil Shaikh Chand &
Dr. Tabassum Kauser Iqbal Ahmed Khan .Vol.
11, Issue 13, 2022. ISO 9001: 2015 Certified
Journal www.wjpr.net
6. Charak Samhita Chikitsa Sthan 28/53-55. By-
H.S. Kushwaha, Publisher - Chaukhamba
Orientalia - 2011.
7. Sushrut Samhita Nidan Sthan 1/60-62. By-
Trivikram Yadav, Publisher - Chaukhamba
Prakashan - 2010.
Issue : 01 INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]Volume : 03
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 89
8. Ashtang Sangraha Nidansthana 15/26. By- Dr.
Jyotirmitra, Publisher -Chaukhamba Prakashan
- 2010.
9. Ashta ng Hridaya Nidansthana 15/38-39. By -
Dr. A.M.Kunte, Publisher - Chaukhamba
Prakshan -2010.
10. Conceptual Study on Nidana of Pakshaghata.
Journal of Ayurveda & Integrated Medical
Sciences. BY Urooj Fatima Shashikala Patil,
Shubhangi, Seema Shinde. Volume 4 ,Issue 6
,NOV-DEC 2019 www.jaims.in
11. Pakshaghata (Hemiplegia) – A disease Review
International Ayurvedic Medical Journal
(ISSN: 23205091) (SEP. 2017) 5(9) By- Pranit
Hanumantrao Patil. https://www.iamj.in
12. https://www.cdc.gov/stroke/about/index.html
13. Understanding Stroke www.gwhospital.com
14. Stroke An Overview , Science Direct Sedation
(sixth Edition) 2018 Pages 529-559
www.sciencedirect.com
15. Stroke www.medlineplus.gov/stroke
16. Dr. Sindhu M. -A Study on etiopathogenesis
of Pakshaghata W.S.R. to Cerebrovascular
Disease.S.D.M. College of Ayurveda,
Kuthpady, Udupi 2007.
17. Harrisons Principles of Internal Medicine.
Chapter 17 By -Fauci & others 18th edition
2009.
18. (PDF) Pakshaghat and its Management through
Panchakarma: A Case Study
https://share.google/6LqoX3gsNNRXrtePg
Conflict of Interest : None
ISSN: 2584-2757
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 5 9 4 6 3
Dr. Deepali Amale Inter. J.Digno. and Research
This work is licensed under Creative
Commons Attribution 4.0 License
Submission Link : http://www.ijdrindia.com
Benefits of Publishing with us
Fast peer review process
Global archiving of the articles
Unrestricted open online access
Author retains copyright
Unique DOI for all articles
https://ijdrindia.com
Copyright @ : - Dr.Deepali Amale Inter. J.Digno. and Research IJDRMSID00077 |ISSN :2584-2757 89
8. Ashtang Sangraha Nidansthana 15/26. By- Dr.
Jyotirmitra, Publisher -Chaukhamba Prakashan
- 2010.
9. Ashta ng Hridaya Nidansthana 15/38-39. By -
Dr. A.M.Kunte, Publisher - Chaukhamba
Prakshan -2010.
10. Conceptual Study on Nidana of Pakshaghata.
Journal of Ayurveda & Integrated Medical
Sciences. BY Urooj Fatima Shashikala Patil,
Shubhangi, Seema Shinde. Volume 4 ,Issue 6
,NOV-DEC 2019 www.jaims.in
11. Pakshaghata (Hemiplegia) – A disease Review
International Ayurvedic Medical Journal
(ISSN: 23205091) (SEP. 2017) 5(9) By- Pranit
Hanumantrao Patil. https://www.iamj.in
12. https://www.cdc.gov/stroke/about/index.html
13. Understanding Stroke www.gwhospital.com
14. Stroke An Overview , Science Direct Sedation
(sixth Edition) 2018 Pages 529-559
www.sciencedirect.com
15. Stroke www.medlineplus.gov/stroke
16. Dr. Sindhu M. -A Study on etiopathogenesis
of Pakshaghata W.S.R. to Cerebrovascular
Disease.S.D.M. College of Ayurveda,
Kuthpady, Udupi 2007.
17. Harrisons Principles of Internal Medicine.
Chapter 17 By -Fauci & others 18th edition
2009.
18. (PDF) Pakshaghat and its Management through
Panchakarma: A Case Study
https://share.google/6LqoX3gsNNRXrtePg
Conflict of Interest : None
ISSN: 2584-2757
DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 7 3 5 9 4 6 3
Dr. Deepali Amale Inter. J.Digno. and Research
This work is licensed under Creative
Commons Attribution 4.0 License
Submission Link : http://www.ijdrindia.com
Benefits of Publishing with us
Fast peer review process
Global archiving of the articles
Unrestricted open online access
Author retains copyright
Unique DOI for all articles
https://ijdrindia.com