Objectives: To manage the acute cerebral hemorrhagic stroke with midline shift through panchakarma and Ayurvedic oral medications. Methods: The present case deals with a diagnosed case of hemorrhagic stroke presented as right sided hemiplegia with midline shift of 7mm towards right side. The Ayurvedic diagnosis of Pakshaghata was made and Nasya and Kaala basti procedures were done. Assessment were taken before and after treatment on National Institute of Health Stroke Scale (NIH-SS), and Barthel Index. Results: On NIH-SS, maximum relief was noticed in level of consciousness, motor movement of all four limbs, sensory function, level of recognition , change is noticed in facial palsy and language .On Barthel index , significant improvement in daily routine of patient was seen. Conclusion: Ayurvedic panchakarma therapy along with internal medication provided an evidence for the absence of midline shift in present case.