Skanda (Bala Graha) and Cerebral Palsy – A Review

Among the Ashtanga Ayurveda, Kaumarbhritya focuses on child care in particular. Graharogais the most neglected portion due to excess mythological explanation, difficulty in clinical understanding, diagnosis, severity, complication, and treatment is entirely different from the routine disorder of children. Graharogas are those entities that attack and seize the body then affect the neonates and children very quickly with high mortality. Different acharyas describe Graha with their types, symptoms and treatment. Acharya Sushruta and Acharya Vagabhatta describe Skanda graha- commander-in-chief of the army of Devatas. The symptoms of the affected child resemble very much with Quadriplegic Cerebral Palsy. Cerebral palsy (CP) is the leading cause of childhood disability affecting function and development. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition communication, and behavior. Therefore, this paper aims to understand Balagraha with the modern aspect as well as its clinical application in day-to-day practice.


INTRODUCTION
Among the Ashtanga Ayurveda, Kaumarbhritya is the one focuses on child care in particular. There includes a detailed description of children's ailments, as well as information on how to prevent them and how to treat them. Graharoga is the most neglected portion due to excess mythological explanation, difficulty in clinical understanding, diagnosis, severity, complication, and treatment is entirely different to routine disorder of children. Graharogas of Kaumarbhrityaare different entities than Grahabadha. Graharogas are those entities which attack and seize the body. They affect a large number of neonates and pediatric age group. Their progression in the human body is quite quick, and they have a high fatality rate.In certain cases, they endanger the lives of the children who are impacted. Disease caused by unidentified factors are termed asidiopathic in modern science butBalagraha, Jataharnis, Matrikas, Adibalprivritta and Janambalprivritta, etc. Disorders are associated with goddesses, earlier birth sins, and evil deeds in our daily lives in our classics. Grahas afflict children for worship if the wet nurse and mother engaged in previously forbidden activities, are unhygienic, and do not behave in an auspicious manner, or if the children themselves are terrified, excited, terrorized, and beaten [1].
The oldest literature we have is the Vedas, which clearly describe grahaas a source of sickness. The Rig-veda first mentions bhutas as a threat to the fetus and infant [2]. The word grahi, according to Acharya Sayana, means "to hurt the infant." Mahabharata explained the morphology of the grahas with their physical character and symptoms of grahas. Varahamihira [6]. Vagbhata has clarified that Grahas an attack for three purposes Hinsa(to victimize) Archana (to get worshipped) Rati (to combat the sexual urges) [7].
Kashyap Samhita gives more importance to all Samhitas.
The first reference is in sutra sthana [8] [9]. They are fond of rakta, mamsa and ojas. These are night wanderers. These dwell at water tanks (Shitaputana), ruined houses (Putana), cowsheds (Mukhamandika) and bases of the trees (Pitrigraha). Jataharini which attacks pregnant and fetus is highly contagious. These vitiate the breast milk of dhatri too.
In modern medical sciences, these Grahasare correlated with infectious agents which may be viruses, bacteria, fungi, or other microbes. Microbes can easily be infected due to a lack of hygienic environment, low immunity in children, and psychological misconduct in both children and mothers.

ETIOLOGY OF GRAHAAVESHA
The main reason for grahaavesha is not to follow the principles of hygiene mention in swasthvritta. Unhygienic conduct of mother or frightening of the child or where benedictory rites have not performed the child is attacked by graha and child suffers from such imposed disease [10,11].

PATHOGENESIS
A Graha is said to enter the body unseen like an image in a mirror-like a transformation of heat, like the focusing of the rays in a lens or like the soul entering the body [12].
One relayed tounhygienic conditions, violation of rule and regulation of lifestyle of child or mothers such as feeding in an unclean and broken vessel with unhealthy condition of surrounding environment. These sound the susceptibility for the precipitation of unhygienic environment together with less immunity of the child which can easily invite the infliction of microbes. Other reason includes excessive indulgence of child's wet nurse or mother in eating, sex, sleep, exercise, harmful activities and other unreligious conducts etc.
Vagbhatta has clarified that the colonies of grahas are innumerable which wander around the world in various shapes to attack the people for threefold purposes viz. victimize, to combat the sexual urges and worship [13].

SAMANYA LAKSHAN
Whengraha attack with an evil motto, the child becomes frightened, cries, loses consciousness, grinds the teeth, hums, yawns, vomits froth or pus, passes loose motion with mucus and refuses to breastfeeds. He emits a fishy, bed bug-like or fleshy smell, thus producing various symptoms of infection of different systems of the body [15,16].

SAMANYA CHIKITSA SUTRA
The general line of management as mentioned earlier holds good for all graharogas by giving priority to absolute hygiene and immunity of baby, mother/dhatri, a physician is essential immunity besides symptomatic management.  [20] and oil preparation like Mahamasha oil, Jyotishmati oil. Symptomatic treatment according to developed signs and symptoms.

MATERIALS AND METHODS
Data and information regarding the GrahaRoga in children collected from different Ayurveda Samhita and related texts, modern pediatrics books, ebooks, health magazines, news papers, various research articles from different journals, websites and references from the different kinds of textbooks on pediatric practice.

SKAND GRAHA
Skanda garah has been explained by almost all the authors who had discussed the graharogas also holds another name 'kumara' [21]. He has been described as the one which is empowered with Taposhakti, Tejashwi, Yashshvi and Balaadhara.Skanda is the commander-in-chief of the army of Devataas and pierced with his weapon through the heart of Raakshasi Krouncha with a single shot. He has an effulgent red body decked with garlands and red flowers. His body is smeared with red sandal paste and he receives all the energies produced by austerities. Skanda Graha is having Teja, SwasthaShareera, Putra of Mahadeva, Agni & Ganga [22].

LASHAN ACCORDING TO DIFFERENT TEXTS
Following As said before in general line of treatment absolute hygiene and immunity of the child is most important in skandagraha affiliated child. It can be divided in daivvyapashraya and yuktivyapasrya chikitsa mentioned below.

 SADHYASADYATVA
If a child loses movement of eyes, develops an aversion to the breast, repeated attacks of unconsciousness throw-out the day and at night is incurable kind of possession as well as manifested of all the symptoms of affrication by evil spirits [23]. A child who is suffering from faking of the hair, hateredness of eatables, feeble voice, discoloration, crying , smell of vultures coming out of the body, round nodules appearing on the stomach, elimination of faces, depression in the middle of the tongue and the palate becoming black [24].

QUADRIPLEGIC CEREBRAL PALSY
Cerebral palsy [25] (CP) is a term used to describe a group of motor syndromes resulting from disorders of early brain development. It is caused by a broad group of developmental, genetic, metabolic, ischemic, infectious and other acquired aetiologias that produce a common group of neurologic phenotypes.Because of the substantial motor impairment of both extremities and the strong connection with mental retardation and seizures, spastic quadriplegia is the most severe form of CP. As a result of supranuclear bulbar palsies, swallowing difficulties are common, leading to aspiration pneumonia. Athetosis is common in children with spastic quadriparesis, and they may be classed as having mixed CP. Affected children are typically hypotonic, with poor head control and significant head lag, and over time develop greater variable tone, rigidity, and dystonia. Feeding may be challenging, and drooling and tongue thrust may be noticeable. Because the oropharyngeal muscle is implicated, speech is usually impacted. Speech may be nonexistent or slurred, and voice modulation may be poor.

DISCUSSION
Graharoga is well mentioned by different acharyas in their samhitas.Acharya charak, Sushruta, Vagbhatta, Harita,decribesgraha with its Purvarupa, samanyalakshan, samnyachikitsa. Acharya Sushruta and Acharya Vagbhatt both described well Skanda Graha based on their etiology factors, treatment and preventions than other acharyas. Their treatment protocol can be preventive prospectus [26] and rasayanabrihanchikitsa. According to Ayurveda, children can suffer from Graharogas due to unhygienic conditions. So, maintain hygiene of mother/dhatri and child during the antenatal, natal, postnatal period is main preventive aspect. Dhoopan karma can be used in Kumaragara [27] or in labour room to prevent bacterias which lead to infections [28]. As cerebral palsy has symptoms like poor head control, impaired all extremities, increased muscle tone and spasticity etc which has resemblance with the symptoms of sakandagraha. It can be treated with Daivavypashraya [29] and Yuktivyapashrya chikitsa mentioned by acharyas. In Daivavyapashrya chikitsa, main role is purity of mana which give happiness and stress-free life by various Japa, Bali, Homa, Rakshavidhana [30]. In all grahas, there are features of vatapredominancy (prakopa) that's why treatment protocal should be vaataghna [31] with various medicated ghee for abhyanga and parisechanatreatments reduces increased muscle tone, improves muscle bulk and power in CP children [32].

CONCLUSION
The study highlights the efficacy of "Ayurveda" which is an ancient tradition, used in some parts of India. This ancient concept should be carefully evaluated in the light of modern medical science and can be utilized partially if found suitable.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.