Post-concussion syndrome(PCS) is defined as the persistence of concussion symptoms such as headache, dizziness, fatigue, and difficulty in concentrating beyond the acute recovery phase, typically lasting more than 4 weeks in adults and children. It’s considered a form of chronic sequelae of a mild traumatic brain injury.

In Ayurveda, this condition can be correlated to Abhighathaja Vyadhi, which refers to conditions or disorders caused by an external trauma or injury(Abhighatha). These may result from physical accidents, falls, blows, or overexertion, leading to conditions such as contusions, concussions, fractures, dislocation etc. Trauma disrupts the harmony of doshas (vata, pitta, and kapha), causing localized or systemic effects depending on the severity and nature of the injury.

Dosha involvement and Lakshanas:

1. Vata dosha: Dominantly aggravated due to its role in movement, pain, and sensory function.

• Symptoms: Severe pain, dizziness and tremors.

2. Pitta dosha: Aggravated in cases of inflammation, bleeding, or burning sensation.

• Symptoms: Redness, heat, and irritability.

3. Kapha dosha: Imbalance due to swelling, heaviness, and sluggishness.

• Symptoms: Lethargy, confusion, or unconsciousness.

ETIOLOGY OF POST CONCUSSION SYNDROME(PCS):

The exact cause of PCS is not fully understood, but it’s believed to be a combination of physical, psychological, and neurological factors. PCS typically occurs after a mild traumatic brain injury(TBI) such as a concussion, when the brain experiences direct or indirect trauma.

1. Structural and Neurological Damage:

• Concussions involve physical changes to the brain, even if they are not visible on standard imaging techniques like CT or MRI  scans. These changes may contribute to PCS.

a)Axonal Shearing:

• Cause: The brain rushes inside the skull during impact, leading to stretching, and damaging axons(nerve fibers that transmit signals).
• Impact: This disrupts communication between neurons adding to cognitive and sensory symptoms such as memory issues, headaches, and dizziness.

b)Neurochemical imbalance:

• Cause: Trauma causes a sudden release of neurotransmitters (chemical messengers in the brain) leading to energy imbalances.
• Impact: The brain’s demand for energy increases, but the ability to deliver oxygen and glucose is impaired, prolonging recovery and causing symptoms like fatigue and mental fog.

c)Inflammation

• Cause: Trauma can trigger an inflammatory response in the brain.
• Impact: Persistent inflammation can lead to chronic symptoms such as headaches, mood changes, and cognitive difficulties.

d)Blood flow disruption:

• Cause: Altered cerebral blood flow due to vascular damage,  or autoregulatory dysfunction.
• Impact: Impaired blood flow can cause dizziness, headaches, and concentration problems.

2. Psychological and Emotional factors:

• In some cases, psychological components contribute to the development or persistence of PCS symptoms.
• Impact: These conditions can amplify symptoms like fatigue, headaches, and sleep disturbances.

b) Post-traumatic stress disorder(PTSD):

• Cause: PCS is more likely in individuals who have experienced emotional trauma during or after the injury, especially in accidents or assaults.
• Impact: PTSD symptoms such as hyperarousal, flashbacks, and irritability may overlap with or worsen symptoms.

c)Somatization:

• Cause: Individuals with heightened health anxiety may focus on minor symptoms, perceiving them as more severe.

3. Vestibular and sensory system dysfunction:

Trauma to the head can affect the vestibular system(responsible for balance)and sensory processing.

a)Vestibular dysfunction:

• Cause: Damage to inner ear structures or their connection to the brain.
• Impact: Causes symptoms like dizziness, vertigo, and balance problems, usually in PCS.

b)Oculomotor dysfunction:

• Cause: Trauma can impair eye movements and coordination.
• Impact: Results in symptoms like blurred vision, double vision, and difficulty focusing.

c)Auditory disturbances:

• Cause: Concussion-related trauma to the auditory system.
• Impact: can result in tinnitus(ringing in the ears)or hypersensitivity to noise.

4.Genetic and biological predispositions:

Certain individuals may be genetically or biologically predisposed to develop PCS.

a)Gender:

• Observation: Studies suggest women may be more likely to develop PCS.
• Reason: This may be due to hormonal influences or differences in neck muscle strength and brain structure.

b)Age:

• Observation: Older adults are at higher risk of prolonged recovery.
• Reason: Age-related changes in the brain, plasticity,  and vascular health may delay healing.

c)Pre-existing conditions:

• Observation: Conditions like migraines, ADHD, or mental health disorders increase susceptibility.
• Reason: These conditions may overlap or amplify PCS symptoms.

5)Repeated Concussions

• Experiencing multiple concussions increases the likelihood of PCS.

a)Cumulative damage

• Cause: Repeated injuries may lead to more extensive axonal damage and prolonged inflammation.
• Impact: This can lead to severe, sometimes permanent brain damage, making PCS more likely.

b)Second Impact Syndrome:

• Cause: A second concussion, occurs before the first one has healed.
• Impact: This can lead to severe sometimes permanent brain damage, making PCS more likely.

5. Psychological stress and external forces:

• The recovery process itself may contribute to PCS in some cases.

a)Overexertion:

• Cause: Returning to work, or sports too early can strain the brain.
• Impact: Symptoms like headaches and fatigue may persist or worsen. 

b)Lack of support:

• Cause: Social, financial, or occupational pressures after an injury can increase stress.
• Impact: Emotional stress may exacerbate symptoms.

c)Misdiagnosis or poor management:

• Cause: Delayed or inadequate treatment for the initial concussion.
• Impact: Prolongs healing and increases the likelihood of persistent symptoms.

CLINICAL SYMPTOMS OF POST CONCUSSION SYNDROME(PCS):

The clinical symptoms can vary for each patient. Here are the clinical signs:

1. Physical Symptoms:

These are the most common and often the first to appear. They include:

• Headache: A persistent tension or migraine-type headache is the hallmark symptom.
• Dizziness: Feeling lightheaded or experiencing vertigo, especially when standing up quickly.
• Fatigue: Constant tiredness and lack of energy.
• Sleep disturbances: Includes insomnia, difficulty falling asleep, or excessive sleepiness.
• Sensitivity to light and noise: Difficulty tolerating bright lights or loud environments.
• Visual disturbances: Blurred vision, double vision, or difficulty focusing.
• Tinnitus: Ringing or buzzing sounds in ears.
• Nausea: Sometimes accompanied by dizziness or vomiting.

2.Cognitive Symptoms:

These are related to mental functioning and may be subtle but impactful:

• Memory problems: Difficulty recalling recent events or new information.
• Attention and concentration issues: Trouble focusing on tasks or conversations.
• Executive dysfunction: Impaired decision-making, planning, or problem-solving abilities.
• Processing speed: Slower thinking or response times.

3. Emotional and behavioral symptoms:

Concussions can disrupt emotional regulation, leading to:

• Irritability: Increased frustration or anger over minor issues.
• Depression: Feelings of sadness, hopelessness, or a loss of interest in activities.
• Anxiety: Excessive worry, tension, or fear.
• Emotional liability: Rapid mood swings or heightened emotional responses.

4. Autonomic Dysregulation symptoms:

Post-concussion syndrome affects the autonomic nervous system, leading to:

• Heart rate and blood pressure variability: Palpitations or dizziness during positional changes.
• Thermoregulation issues: Feeling excessively hot or cold without external triggers.
• Exercise intolerance: Feeling faint or unwell during physical activity.

5. Neurological symptoms:

Some patients may report additional neurological complaints:

• Balance problems: Feeling unsteady or having difficulty walking.
• Seizures: Rare, but possible in severe cases(post-traumatic epilepsy).
• Paresthesia: Tingling or numbness, especially in the extremities.

6. Social and functional impairments:

Persistent symptoms can lead to significant challenges in daily life, such as:

• Work or academic difficulties: Poor performances due to cognitive or emotional struggles.
• Social withdrawal: Avoiding people because of irritability, fatigue, or emotional stress.
• Reduced quality of life: General dissatisfaction due to limitations caused by PCS.

DIAGNOSIS OF POST CONCUSSION SYNDROME(PCS):

Diagnosing PCS can be challenging as there are no definitive diagnostic tests. It often requires clinical evaluation, history taking, and exclusion of other conditions.

A few challenges in the diagnosis of PCS are:

• Subjectivity of symptoms: Many PCS symptoms are subjective making them hard to quantify.
• Overlap with psychological conditions: Symptoms like fatigue, irritability, and concentration difficulties are seen in depression and anxiety.
• Lack of biomarkers: No specific lab tests or imaging studies can definitively diagnose PCS.
• Cultural and individual variations: Symptom reporting may vary based on personal and cultural factors.

Here’s a detailed breakdown of the diagnostic process:

1. Analyzing clinical history:

The cornerstone of PCS diagnosis is a thorough patient history and symptom assessment:

• Trauma history: Establish if there was a head injury, even if it’s a minor injury. Look for events like falls, motor vehicle accidents, or sports injuries.
• Symptoms following injury: Document the onset of symptoms immediately or shortly after the injury.
• The clinical symptoms comprise of: Headache, dizziness, fatigue, sleep disturbances, memory issues, concentration problems, irritability or mood swings, sensitivity to light or noise, and blurred vision.
• Symptom persistence: For PCS, these symptoms must persist for several weeks or months, typically beyond the expected recovery period(3-6 months).

2. Symptom-based diagnostic criteria:

Diagnostic criteria from sources like the International Classification of Diseases(ICD-11) or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)can guide evaluation:

ICD-11 criteria for PCS:

• Symptoms lasting at least 3 months after the head injury.
• Symptoms must include at least any of the 3 : headache, dizziness, fatigue, irritability, insomnia, difficulty concentrating, or memory issues.
• No clear alternative explanation for the symptoms.

DSM-5 criteria for major/mild neurocognitive disorder due to TBI:

• Evidence of cognitive decline in one or more domains.
• Symptoms must interfere with independence in everyday activities.
• A history of TBI associated with loss of consciousness, post-traumatic amnesia, or neurological deficits.

3. Physical and neurological examination:

A comprehensive examination is crucial to identify any residual neurological deficits or exclude other conditions:

• Balance and gait testing: To evaluate dizziness or vestibular dysfunction.
• Vision and eye movements: Issues like blurred vision or convergence insufficiency are common.
• Cranial nerve testing: To rule out damage to cranial nerves.
• Cognitive assessment: Assess memory, attention, and executive function.

4. Neuropsychological Testing:

Formal neuropsychological assessments are often used for:

• Cognitive testing: Evaluating deficits in memory, attention, problem-solving, and language.
• Emotional and psychological symptoms: Screening for mood disorders like depression or anxiety, which are common in PCS.

5. Imaging and laboratory tests:

While PCS cannot be confirmed through imaging, tests may rule out other conditions.

• CT or MRI: To rule out structural damage, hemorrhages, or other abnormalities.
• Advanced imaging(if available): Functional MRI(fMRI), diffusion tensor imaging(DTI), or PET scans may show subtle brain changes, but these are not routinely used.
• Blood tests: To rule out metabolic or systemic issues, such as thyroid dysfunction or anemia, that could mimic PCS symptoms.

6. Exclusion of other diagnosis:

PCS symptoms can overlap with other medical or psychological conditions. It’s essential to exclude:

• Migraines or other headache disorders.
• Vestibular disorders. Eg: benign paroxysmal positional vertigo, labyrinthitis.
• Psychiatric disorders. Eg: depression, PTSD, anxiety.
• Neurological conditions, Eg: multiple sclerosis, epilepsy.
• Chronic pain syndrome.

TREATMENT OF POST CONCUSSION SYNDROME (PCS) IN MAURYA AYURVEDA HOSPITAL:

The symptoms of Post-Concussion Syndrome(PCS) can last for weeks or even months. While the treatment progress may be slow, a consistent and appropriate approach can lead to gradual improvement. Our hospital focuses on holistic strategy to address the symptoms, ensuring noticeable enhancements overtime. We provide integrated care for PCS by collaborating Ayurveda, acupuncture and  physiotherapy.
The treatment modalities offered at our hospital are outlined below:

ROLE OF AYURVEDA IN POST CONCUSSION SYNDROME(PCS):

EXTERNAL TREATMENTS IN POST CONCUSSION SYNDROME:

1)SHIRO DHARA:

The regular, rhythmic application of heated medicinal oil, herbal concoctions, or other therapeutic liquids to the forehead is known as Shirodhara. This therapy is well known for its ability to soothe the nervous system. Here, KSHEERABALA TAILA is normally used for the same objective.

TAKRADHARA:

 

Takradhara is a procedure in which medicated buttermilk is poured in a continuous stream over the forehead(Shirodhara) or entire body(Sarvanga dhara). This treatment(Shirodhara) is particularly effective for managing stress, neurological conditions, etc.

• Buttermilk is prepared by churning curd(yogurt) with water and removing butter content.
• To enhance their therapeutic properties, herbal decoctions of Amalaki (Indian gooseberry) or musta(Cyperus rotundus) are added.
• The duration typically ranges from 30-60 minutes.

Benefits:

• The cooling effect of medicated buttermilk reduces pitta-related inflammation and relieves chronic headaches.
• The rhythmic pouring of buttermilk has a calming effect on the brain and central nervous system, reducing mood swings, irritability, anxiety, and restlessness.
• It also improves sleep quality and relaxation by balancing vata.
• Balancing vata and pitta also helps address dizziness, balance issues, etc.
• Since amalaki and musta provide neuroprotective effects, they support neurological healing.
• The anti-inflammatory properties of the herbs used in Takradhara reduce swelling and inflammation of the head region, aiding recovery from trauma.

2)SHIRO VASTHI:

Shiro means head and Vasthi refers to container or holding. This treatment involves the retention of warm medicated oils on the scalp within a specially designed cap or container for a prescribed duration(for about 30-60 minutes). A dough made of black gram flour is used to seal edges. Normally Ksheerbala taila is warmed and used. After the procedure oil is removed, head is gently massaged to ensure relaxation and better absorption.

Benefits of Shiro Vasthi:

• The warm medicated oils used in Shiro Vasthi have anti-inflammatory and analgesic properties, soothing the nerves and reducing pain.
• Shiro Vasthi induces relaxation, calms the mind, and regulates sleep cycles by harmonizing the hypothalamic pituitary adrenal axis.
• Medicated oils like Ksheerabala help to rejuvenate brain cells, enhance neural repair, and reduce oxidative stress in the brain tissue.
• It also supports healing and recovery, by increasing blood flow to the brain.

3)SHIRO PICHU:

Placing a cotton cloth or pad dipped in warm medicated oil on the crown of the head is known as shiro pichu. Ksheerabala taila is used for the same. It’s usually done about 20 minutes.

Benefits:

• It promotes mental relaxation.
• It helps in reducing stress and anxiety.
• It calms down the nervous system.
• It’s good to manage headaches and tension.
• It improves the quality of sleep.

4)THALAM:

Applying a medicinal paste to the center of the head  in Ayurveda is known as thalam. The medicinal paste helps to lessen and treat illness by stimulating and acting upon nerve endings. Its benefits include: 

• Helps with sleep issues.
• Stimulates senses and sensory channels.
• Managing elevated blood pressure.
• Reducing the prevalence of headaches, including migraines, and other ENT-related conditions.

KACHOORADI THALAM produces the best outcomes in this case.

5)THALAPOTHICHIL:

Thalapothichil is also called shiro lepa, where the scalp of a patient is applied with medicinal herbs for various neurological and mental disorders. Here the patient is initially applied with medicinal herb paste( which is covered through the entire scalp and is normally covered using banana leaf. Then medicinal oils like Ksheerabala, Chandanadi, or Valiya Chandanadi are applied as Thalam.

The medicinal herb paste is made with 

• Amala(Indian gooseberry,Phyllanthus emblica).
• Mustha(Nut Grass,Cyperus rotundus).
• Usheera(Ramacham,Vetiveria zizanioides,).
• Kachuram(Kachuram,Curcuma zedoaria).
• Rasnadi choornam.
• Curd.

Benefits of Thalapothichil :

• Extremely good at improving cognitive functions.
• Improvement of sensory integration that leads to better coordination and awareness.
• Good for better sleep and relaxation.

6)NASYAM:

Nasyam (Nasya) comes under one of the five purifying treatments (panchakarma) in ayurveda. For treating various diseases medicinal oils, powders, or medications are administered via the nostrils. Nasyam works especially well for conditions affecting the head, neck, and shoulders.

Types of Nasyam:
Marsha Nasya: The therapeutic oil or powder is administered in higher doses. The goal of the process is to keep the nasal pathways and associated structures healthy by lubricating, nourishing, and maintaining them. Ksheerabala(101) is typically utilized for this.
Pratimarsha Nasya: The mildest type of nasya in Ayurveda, Pratimarsha Nasya is a daily preventive form of nasya therapy. Pratimarsha Nasyam is typically done using Anu Taila.

Benefits of Post Concussion syndrome in PCS:

• Enhancement in neurological activity.
• It encourages cleansing and improves blood circulation.
• It relieves symptoms like headaches, lightheadedness and congestion of the nose.
• It improves motor and sensory abilities.
• It helps the nervous system to relax.
• It encourages recovery.

ROLE OF PHYSIOTHERAPY IN POST-CONCUSSION SYNDROME(PCS):

1. Stretching exercises:

Techniques of stretches:

• Neck stretches.
• Upper trapezius stretch.
• Levator scapulae stretch.
• Chest opener stretch.
• Cat-cow stretch.
• Scalene stretch.

Goals attained with stretching:

• It relieves tension in the neck, shoulders, and upper back.
• It enhances blood circulation to the affected area.
• It enhances flexibility.
• It reduces stress and promotes relaxation.

2. Strengthening exercises:

Key techniques in strengthening are:

• Deep neck flexor strengthening.
• Scapular retraction.
• Chin tucks with resistance.
• Isometric neck strengthening.
• Wall angles.
• Shoulder blade push-ups.
• Resistance band rows.
• Dead bug core exercise.

Benefits of strengthening exercises:

• It improves neck stability.
• It supports posture.
• It helps to manage symptoms.
• It enhances overall functions.
• It restores balance.

3. Frenkel exercises:

These are done slowly, and in repetitive patterns to improve balance, coordination, and proprioception.

a) Lying position:

• Heel slide: It improves coordination of the lower limb.
• Alternate heel touch: It aids in the coordinated leg movements of both legs. 
• These are given as beginner-level exercises.

b) Sitting position:

• Marching in place: It develops rhythmic leg movements.
• Ankle circles: It develops coordination of the ankle and foot.
• These are given as intermediate levels.

c)Standing position;

• Sidestep: It helps to attain balance and lateral coordination.
• Toe-to-heel walking: It improves balance and gait control.
• These are given as advanced-level exercises.

d)Advanced coordination(Dynamic movements):

• Balancing on one leg: It helps to enhance proprioception and stability.
• Tracing shapes: It usually supports visual and motor coordination.

3. Gaze stabilization Exercises:

These are designed to improve the vestibulo-ocular reflex(VOR), which helps stabilize the vision during head movements.

• Focus on stationary targets while moving the head.
• Move the head and target in opposite directions while keeping the target in focus.
• Progressions: Increase speed or complexity using different backgrounds, distances, or dual-tasking.

4. Balance and postural Training:

Address deficits in static and dynamic balance, that are common in vestibular disorders.

a)Static balance:

• Standing on one leg.
• Tandem stance(heel to toe).
• Standing on foam or unstable surfaces.

b)Dynamic balance:

• Walking with head turns(horizontal/vertical).
• Obstacle courses.
• Walking on uneven surfaces or slopes.

5.Gait Training:

Improves walking stability by incorporating exercises like:

• Walking with varied speeds or directions.
• Dual-task walking (eg: walking while holding an object or counting).
• Walking on narrow paths or uneven surfaces.

5. Relaxation techniques:

Addresses associated anxiety or stress, which may exacerbate symptoms:

• Breathing exercises.
• Progressive muscle relaxation.
• Yoga-inspired balance postures.

6. Functional and cognitive training:

Enhances real-life adaptability.

• Stimulated activities of daily living(eg: picking objects, climbing stairs).
• Cognitive challenges during balance tasks.

Benefits:

• Improves balance and spatial orientation.
• Reduces dizziness and vertigo.
• Enhances gaze stability, preventing nausea and visual disturbances during head movements.

7. Oculomotor Therapy:

Techniques:

• Saccadic eye movements: Exercises to improve rapid shifting of gaze between targets.
• Smooth pursuit training: Tracking a moving object to improve eye movement coordination.
• Convergence training: Exercises to reduce symptoms like double vision and difficulty focusing.

Benefits:

• Alleviates eye strain, blurred vision, and headaches.
• Enhances visual coordination and reading ability.

8. Cervical Spine Therapy:

Techniques:

• Manual Therapy: Gentle mobilizations and manipulations address joint restrictions.
• Soft Tissue Techniques: Massage, myofascial release, and trigger point therapy for neck muscles.
• Postural Training Exercises: To correct forward head posture and neck alignment.
• Stretching and strengthening exercises: To improve flexibility and endurance of cervical muscles.

Benefits:

• Reduces neck pain and associated headaches.
• Improves posture and spinal alignment.
• Restores cervical mobility and muscle balance.

9. Neuromuscular Re-education:

Techniques:

• Proprioceptive training: Exercises to enhance body awareness and joint position sense.
• Dynamic balance training: Challenging tasks that require coordination of multiple systems, such as single leg stance or agility drills.
• Gait training: Addressing abnormalities in walking patterns caused by dizziness or imbalance.

Benefits:

• Reduces pain and muscle tension.
• Promotes relaxation and recovery.

10.Pain management techniques:

Techniques:

• Electrical Stimulation: Transcutaneous Electrical Nerve Stimulation(TENS) for pain relief.
• Heat or Cold Therapy: For muscle tension and inflammation.

 Benefits:

• Reduces pain and muscle tension.
• Promotes relaxation and recovery.

11. Cognitive and breathing exercises:

Techniques:

• Diaphragmatic Breathing: To reduce stress and enhance oxygenation.
• Mindfulness training: Combining relaxation techniques with body awareness.
• Dual-task exercises: Performing motor tasks alongside cognitive challenges to improve mental focus.

Benefits:

• Reduces anxiety and mental fog.
• Enhances cognitive function and multitasking abilities.
• Promotes relaxation and mental clarity.

12. Patient Education:

Techniques:

• Teaching proper sleep hygiene.
• Guidance on activity pacing to avoid symptom exacerbation.
• Ergonomic advice for work and daily tasks.

Benefits:

• Empowers patients with tools to manage symptoms independently.
• Reduce risk of re-injury.
• Enhances overall quality of life.

ROLE OF ACUPUNCTURE IN POST-CONCUSSION SYNDROME(PCS):

Acupuncture, an ancient Chinese medical practice, plays a supportive role in managing PCS particularly in alleviating symptoms and aiding recovery.

Techniques of Acupuncture:

1. Needling

Targeted points:

• GV20(Baihui): Enhances circulation to the brain and promotes neurological repair.
• GB20(Fengchi): Relieves headaches, dizziness, and neurological symptoms.
• ST36(Zusanil): Strengthens the immune system and boosts energy levels.
• L14(Hegu): Used together to balance the nervous system and reduce inflammation.

2. Electroacupuncture:

Mild electrical stimulation applied to needles may enhance therapeutic effects, especially for neurological recovery.

Benefits of Acupuncture in Encephalitis:

• Pain relief: Reduces headaches and discomfort without relying heavily on medication.
• Reduced dependence on medication: Alleviates symptoms, minimizing side effects from drugs.
• Enhanced recovery: May speed up recovery by improving circulation, reducing inflammation, and promoting neural repair.
• Support for mental health: Improves mood and reduces stress, which are critical during recovery.

3. Benefits of yoga and pranayama:

Yoga and pranayama play a significant role in the management of Post- Concussion Syndrome(PCS).

• It enhances neurological recovery by improving blood flow to the brain.
• It enhances neural repair and reduces symptoms like dizziness, headaches, and mental fog.
• Many PCS patients experience anxiety and depression. Both yoga and pranayama activate the parasympathetic nervous system, reducing hormones, and cortisol and promoting relaxation.
• It also enhances focus, memory, and mental clarity by increasing brain function and calming an overactive brain.
• Gentle yoga stretches, release tension in the neck, shoulders, and head which can alleviate tension headaches and improve posture.
• Deep breathing exercises regulate the sleep-wake cycle and improve the quality of sleep, which is often disturbed in PCS.
• Pranayama improves oxygenation of tissues, revitalizing the body and reducing fatigue, a common symptom of PCS.

THE GENERAL DIET GUIDELINES SUGGESTED IN OUR HOSPITAL ARE:

• Avoid physically demanding activities.
• Drink between 2.5 and 3 liters of water.

The following foods are recommended:

• Meals that are steamed, like chapati, put, idiyappam, and unfermented appam.
• Vegetables that have been boiled.
• Hot kanji.

Foods that are discouraged include 

• Dosa, idli, and fermented appam.
• Tubers include potatoes, tapioca, and sweet potatoes.
• Non-vegetarian meat, fish, and eggs (may be eaten in curry, if required).
• Fast food, greasy and fried foods, cold food, pickles, fruits, dry fruits, nuts, milk, and milk products.

DISCLAIMER: The information provided in this article is intended solely for educational  purposes. Treatment decisions should be made exclusively by a well-qualified Ayurvedic physician. Self-medication is strongly discouraged.

Maurya Ayurveda Hospital, opposite to Sabine Hospital, Pezhakkapilly P.O,Muvattupuzha,Ernakulam;PIN:686673,Contact no:9947183000

Email: [email protected]

Maurya Ayurveda Ortho & Neuro Rehabilitation Centre ( Ayurveda Hospital )