E-ISSN:2456-3110

Case Report

Parkinson’s Disease

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 1 January
Publisherwww.maharshicharaka.in

Ayurvedic management of Parkinson’s disease - A Case Study

Suraksha S.1*, Lolashri S.2, M Goud K.3
DOI:

1* S Suraksha, Post Graduate Scholar, Department of Panchakarma, Sri Kalabyraveshwaraswamy Ayurvedic Medical College, Hospital and Research Centre, Bengaluru, Karnataka, India.

2 S J Lolashri, Associate Professor, Department of Panchakarma, Sri Kalabyraveshwaraswamy Ayurvedic Medical College, Hospital and Research Centre, Bengaluru, Karnataka, India.

3 Kiran M Goud, Professor and Principal, Department of Panchakarma, Sri Kalabyraveshwaraswamy Ayurvedic Medical College, Hospital and Research Centre, Bengaluru, Karnataka, India.

Parkinson’s disease is defined as Chronic, progressive neurodegenerative disease characterized by both motor and non-motor features. The most important signs and symptoms of Parkinson’s disease occur when the nerve cells in basal ganglia, an area of brain that controls the movement become impaired or die. When these neurons die or get impaired, they tend to produce less amount of important chemical in the brain called as Dopamine which causes various symptoms like Tremors, Rigidity in muscles, Akinesia and postural disability associated with various Cognitive, Behavioural and other Psychological symptoms. In Ayurveda presentations of this disease can be corelated with the Kampavata in which both Sarvanga Kampa and Shiro Kampa are important Lakshanas that are seen. The Vata that is responsible for controlling the various functions of the body is responsible for causing the disease Kampavata and hence Kampavata is also mentioned in 80 types of Nanatmaja Vikaras. The Chala Guna of the Vata is pathologically increased leading to the Kampa. Treatment mainly aims at reversing the imbalance of Vata Dushti through various Shamana and Shodhana Chikitsa, Here a case of 58 year old female presenting with the symptoms of Severe Tremors, Postural instability and difficulty in performing daily activities who was provisionally diagnosed as Kampavata was successfully treated with Snehana and Brihmana line of management in the form of Sarvanga Abhyanga, Shali Pinda Swedana and Rajayapana Basti.

Keywords: Parkinson’s Disease, Kampavata, Snehana, Swedana, Rajayapana Basti

Corresponding Author How to Cite this Article To Browse
S Suraksha, Post Graduate Scholar, Department of Panchakarma, Sri Kalabyraveshwaraswamy Ayurvedic Medical College, Hospital and Research Centre, Bengaluru, Karnataka, India.
Email: 		S Suraksha, S J Lolashri, Kiran M Goud, Ayurvedic management of Parkinson’s disease - A Case Study. J Ayu Int Med Sci. 2023;8(1):194-200.
Available From
https://jaims.in/jaims/article/view/2175

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-11-28 2022-11-30 2022-12-07 2022-12-14 2022-12-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2023by S Suraksha, S J Lolashri, Kiran M Goudand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Suraksha S et al: Ayurvedic management of Parkinson’s disease A Case Study

Introduction

Parkinson’s disease is a chronic progressive disease of the nervous system characterized by the cardinal features of Rigidity, Bradykinesia, Tremor and Postural Instability.[1] The exact cause of the Parkinson’s disease is not exactly known. But the factors such as Genetic predisposition, infections such as Encephalitis, Prolonged use of Antipsychotic drugs, Arteriosclerosis, Neurotoxins etc. can affect the substantia nigra in the basal ganglia leading to the destruction of Dopamine producing neurons. The Vagus nerve may play a crucial role in pathogenesis of Parkinson’s Disease which has been hypothesized that Alpha-synuclein aggregates form in the enteric nervous system, and spread via the autonomic system to the Central Nervous System.[2] The incidence of Parkinson’s disease increases with age, but an estimated 4 percent of people with Parkinson’s disease are diagnosed before the age of 50.[3]

Kampavata manifestations have the similarities in presentations with Parkinson’s disease. Kampavata is one among the Vataja Nanatmaja Vyadhi explained in Charaka Samhita[4] and same is explained as Vepathu by various other Acharyas. In Madhava Nidana, Vepathu is explained in a separate chapter which is characterized by Sarvanga Kampa and Shiro Kampa.[5]

In Basavarajeeyam, the symptoms of Kampavata provides the diagnostic clue regarding the disease Parkinson’s presented by symptoms such as Karapadatale kampa, Deha Bhramana, Nidrabhanga and Ksheenamati.[6] Kampavata being one of the Vatavyadhi, general line of management of the Vatavyadhi can be adopted considering the specific nidanas. As Snehana and Swedana are first line of management that are told and Basti chikitsa helps in treating the Vata dushti, A 58 year old lady with Kampavata was adopted here with Sarvanga Abhyanga, Shashtika Shali Pinda Swedana and Rajayapana Yoga Basti followed by Shamanoushadhi’s which has given maximum improvements in both physical and mental parameters after the treatment.

Case Report

Female patient of age 58yrs who is not a k/c/o Hypertension / Diabetes Mellitus / Thyroid dysfunction was apparently normal 5 years back.

One day patient started complaining of pain in lower limbs and patient found difficulty in walking due to stiffness in lower limbs. The pain also started radiating to bilateral upper limb within span of 1 day. Gradually patient started presenting with forward bending of the body, difficulty in maintaining posture and difficulty in holding the objects for which patient became dependent on others for performing the house hold work, taking bath and combing hair. For all these complains patient took Siddha and Ayurvedic treatment in her hometown and details of the medicines are not Known. Patient also started experiencing delusions, difficulty falling asleep and always thinking in subconscious mind. Next, patient started having the complaints of slow and reduced speech, reduced facial expression and blinking of the eyes since 2 years for which patient took medicines but didn’t get relief. Gradually patient started difficulty in passing stools (once in 2 days) along with tremors in both hands since 1 year. Patient also complains of lockjaw 1 year back for which patient visited the nearby hospital and took treatment and found great relief. Now patient complains of Severe Tremors in upper and lower limbs, difficulty in walking, performing the daily activities, pain in the shoulder joint and involuntary movements in upper limbs which got aggravated since 6 months for which patient visited SKAMCH&RC for further management.

Past History

Nothing contributory.

No H/o Hypertension / Diabetes Mellitus / Thyroid dysfunction / Trauma or any other major medical illness.

Medical history: 1)Syndopa Plus 1-0-1 2) Pacitane 2mg 1-0-1

Surgical history: Hysterectomy 7 years back.

Family History: No similar complaints seen in the family.

Personal History

Appetite: Reduced since 1 year.

Bowel: Constipated since 1 year (2 days once).

Micturition: 4-5times/day, 2-3 times at night.

Sleep: Disturbed and Delayed.

Habits: Tea-coffee 2-3 times/day.


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Suraksha S et al: Ayurvedic management of Parkinson’s disease A Case Study

General Examination

On the day of examination patient was found to be Moderately nourished, Moderately built, Afebrile, Other parameters like Pallor was present, Icterus, Clubbing, Cyanosis, Lymphdenopathy, Edema was absent with Stooped posture and Festinant gait.

Systemic Examination

CVS: S1 S2 Heard, No murmur.

GIT: P/A Soft, non-tender, no organomegaly.

RS: NVBS heard, No added sounds.

CNS:

Higher Motor Function

Consciousness - Conscious

Orientation to time - Intact

Orientation to place - Intact

Orientation to person - Intact

Memory immediate - Intact

Memory recent - Intact

Memory remote - Intact

  • Intelligence - Moderate
  • Hallucination - Absent
  • Delusion - Present
  • Emotional disturbance - Present
  • Speech Disturbance - Present

Dysarthria: slow speech, difficult in articulation.

  • Handedness - Right

Cranial Nerve Examination

All the Cranial nerves are intact except Facial nerve where frowning of forehead is reduced and Spinal Accessory where Shrugging of shoulder with and without resistance is not possible.

Sensory System Examination

Superficial  Deep Cortical
Touch - Intact Touch - Intact Tactile localization - Present
Temperature - Intact Temperature - Intact Tactile discrimination - Present
Pain - Intact Pressure sense - Intact  Stereognosis - Present
    Graphesthesia - Present



Motor System Examination

Muscle Bulk Right (in inches) Left (in inches)
 Upper limb
 Arm  9.5  9
 Forearm  7.5  7.5
 Lower limb
 Thigh  16  16.5
 Calf  10  9.5

Tone
Rigidity seen in Upper limb and Lower limbs.

Co-ordination

Romberg Sign - positive

Upper limb: Finger to nose test - possible

Finger to finger test - possible

Rapid alternate movements - B/L upper limb - difficult to perform

Lower limb: Heel shin test - not possible

Tandem walking - not possible

Involuntary movements - Present in B/L upper limb

Gait - Festinating gait

Superficial reflexes

Corneal reflex - positive

Abdominal reflex - positive

Plantar reflex - positive

Deep reflexes

Biceps jerk : 2+

Triceps jerk : 2+

Supinator jerk : 2+

Knee jerk : 2+

Ankle jerk : 2+

Clonus - Patella - Absent

Clonus - Ankle - Absent

Jaw jerk : 2+

Locomotor System Examination

Cervical spine

Inspection:

Spine curvature - Stooped posture


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Suraksha S et al: Ayurvedic management of Parkinson’s disease A Case Study

Palpation: Tenderness - absent

Range of movements:

Flexion: mild painful

Extension: mild painful.

Left lateral bending: mild painful.

Right lateral bending: mild painful

Left rotation: mild painful.

Right rotation: mild painful.

Lumbar spine

Inspection : normal

Palpation : tenderness absent

Range of movements :

Flexion - unable to perform

Extension - unable to perform

Left lateral bending - unable to perform

Right lateral bending - unable to perform

Left rotation - unable to perform

Right rotation - unable to perform

All Joints are normal with no swelling, no tenderness, no deformity.

Except - Movements of flexion and extension of Bilateral knee joint is painful, All the movements of Shoulder joint is painful, Internal and External rotation of Hip Joint is painful.

Ashta Sthana Pareeksha

Nadi : 76 per minute

Mala : 2 days once

Mutra : 4-5 times/day

Jihwa : Lipta

Shabdha : Prakruta

Sparsha : Anushna Sheeta

Drik : Prakruta

Akriti : Madhyama

Diagnosis: Majority of the symptoms correlated with the Kampavata which can be considered as Parkinson’s Disease in Contemporary science.

It fulfills the following criteria’s :

  • Tremor
  • Bradykinasea
  • Rigidity
  • Postural Instability

Intervention

Table 1: Showing the treatment given in 2 Phases.

Date Treatment Given Observations and Results
31/07/2021 to 07/08/2021 [8 days] PHASE 1 §   Shirobasti with Moorchita Taila. §   Sarvanga Abhyanga with Moorchita Taila. §   Sarvanga Shastika Shali Pinda Sweda. Orally §   Gandharva Hastadi Taila 20ml with milk in empty stomach. §   Zandopa powder 1tsp TID. §   Stiffness in hands reduced comparatively. §   Pain in shoulder joint persists. §   Patient feels lightness and has become active.  
8/08/2021 to 14/08/2021 [7 days] PHASE 2 §     Shiro Basti with Moorchita Taila. §     Sarvanga Abhyanga with Moorchita Taila. §     Sarvanga Shastika Shali Pinda Sweda. §     Rajayapana Basti. Orally §     Zandopa powder 1tsp TID §   C/O tremors in B/L upper limbs persists. §   Improvement in sitting, standing and patient try to walk by herself with assistance.
14/08/2021 to 16/08/2021 [3 days] §   Shiro Basti with Moorchita Taila. §   Sarvanga Abhyanga with Moorchita Taila. §   Sarvanga Shastika Shali Pinda Sweda. §   Anuvasana Basti with Mahanarayana Taila. Orally §   Zandopa powder 1tsp TID §   Chaturbhuja Rasa 1-0-1 (A/F) §   C/O tremors in B/L upper limbs slightly reduced. §   Patient is able to sit for longer duration and tries to walk comparitively better. §   Pain over the shoulder joint reduces. §   Slurred speech reduced and patient is able to balance herself.
17/08/2021 to 21/08/2021 [5 days]     §   Shiro Basti with Moorchita Taila. §   Sarvanga Abhyanga with Moorchita Taila. §   Sarvanga Shastika Shali Pinda Sweda. Orally §   Zandopa powder 1tsp TID §   Chaturbhuja Rasa 1-0-1 (A/F) §   Balarishta §   Ashwagandharishta 6tsp TID §   C/O of tremors in B/L upper limb reduced. §   Patient’s response is better and attempt to stand by herself from chair. §   Patient is able to stand straight and walk without support for certain distance.

Table 2: Showing the chart of Rajayapana Basti given for 8 days.

Days 1 2 3 4 5 6 7 8
Basti A N A N A N A A

A - Anuvasana Basti - Mahanarayana Taila - 80ml

N - Niruha Basti - Following ingredients are added.


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Suraksha S et al: Ayurvedic management of Parkinson’s disease A Case Study

1. Madhu = 60ml

2. Saindhava Lavana = 6 grams

3. Mahanarayana Taila = 80ml

4. Rajayapana Kalka = 30grams

5. Rajayapana Kwatha = 300ml

6. Aja Mamsa Rasa = 200ml

Follow Up Medications

1. Balarishta - 6tsp TID with 6tsp of warm water (After Food)

Ashwagandharishta - 6tsp TID with 6tsp of warm water (After Food)

Dashamoolarishta - 6tsp TID with 6tsp of warm water (After Food)

2. Zandopa powder - 1stp-0-1tsp for 1 month.

Observation and Result

Significant reduction in the symptoms after treatment in Tremor, Bradykinesia, Rigidity, speech. The tremors reduced from grade 4 to grade 2 after the treatment. There was an improvement in speech from grade 3 to about grade 1. Rigidity got relieved from grade 3 to grade 1, Bradykinesia also reduced from grade 4 to grade 1.[7]

SN Results Before Treatment  After Treatment
1. Tremor  4 2
2. Bradykinesia  4 1
3. Rigidity  3 1
4. Speech  3 1

Discussion

The Majority of the symptoms of Parkinson’s Disease can be correlated with the classical symptoms of Kampavata told in Ayurvedic literature. The main pathology involved here is due to Dhatukshayajanya Vata Vyadhi and line of management should be adopted based on Nirupasthambita Vata Vyadhi Chikitsa.[8] Therefore, it becomes very much necessary to adopt the Brihmana line of management to relieve the symptoms caused due to Apatarpana pathology.

So, the first line of management that was given was Sarvanga Abhyanga with Moorchita Taila. Sarvanga Abhyanga helps in Vatashamana and Jara Vyadhi Nashana. Parkinson’s disease is usually seen

in older age and Sarvanga Abhyanga helps in regulating the functions of Vata and Kapha. The patient’s body also attains Dridata by adopting Abhyanga.[9]

Shashtika Shali Pinda Swedana provides Brihmana effect along with the Swedana effect. The Dashamoola Kwatha, Balamoola Kwatha along with Ksheera and Shali helps in nourishing the muscle tissues and also prevents the further chances of muscle weakness.[10]

Swedana makes the skin more permeable by vasodilatation of blood vessels and helps in absorption of medicines. The important quality of Shashtika is Snigdha, Guru, Sheeta and Tridoshahara along with Ksheera which is amphipathic in nature that helps in greater absorption of the medicine through the skin. In this way, Shashtika Shali Pinda Swedana helped in providing Brihmana effect along with controlling the vitiated Vata in the patient.

Shirobasti is one among the Murdhni Taila procedure where large quantity of Sneha is retained on the head for longer duration. In case of Parkinson’s Disease where both psycho somatic functions are hampered, Shiro Basti helps in relaxing and revitalizing the Central Nervous System by balancing the hormonal functions that regulates the emotional behaviours and sleep disturbances.

Yapana Basti is given prime importance in Siddhisthana as it can be given in both Swastha and Atura and Sarva Kala. Yapana Basti having the properties of Mamsa Balajanana, Shulahara, Janu Uru Jangha Graham, Sadyobalajanana, Rasayana etc. helps in strengthen the muscles and has neuroprotective action.[11]

Basti Chikitsa is adopted in this case as it has a special mode of action to control all 5 Doshas in the sequential order of Apana Vayu, Samana Vayu, Vyana Vayu, Udana and Prana Vayu later corrects vitiated Kapha and Pitta Doshas finally bringing equilibrium in the various systems of the body.[12]

Basti has a special property to stimulate Enteric Nervous System and also acts on Central Nervous System by sending the afferent impulses via different Chemoreceptors and Baro Receptors. Yapana Basti in this way shows both Shodhana and Rasayana action, thus helps in Parkinson’s Disease.


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Suraksha S et al: Ayurvedic management of Parkinson’s disease A Case Study

Conclusion

Kampavata and its treatment principles has been adopted in this case as majority of the symptoms are similar to that of Parkinson’s disease. Bahya Chikitsa along with the Panchakarma modalities can create wonders and miracles in treating various Vata Vyadhi. After proper assessment and diagnosis Sarvanga Abhyanga, Shashtika Shali Pinda Swedana and Rajayapana Basti which was adopted helped in bringing back the vitiated Vata Dosha to normalcy and Brihmana nature of Yapana Basti helped in rejuvenation of body and strengthening the neurological functions of the body. Shamana Oushadhi’s that were adopted like Arishtas in the form of Ashwagandha, Bala, Dashamoola along with combined effects of Kapikachu are useful in improving the day to day activities of patient as it balances Vata Dosha and Kapikachu in Zandopa powder acts as the supplementation of the L-DOPA which makes it special in the management of Parkinson’s Disease.[13]

As the Parkinson’s disease is neuro degenerative this study paves a way for further research in larger samples to understand the various other Panchakarma procedures in treating this condition.

Reference

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2. https://www.frontiersin.org/articles/10.3389/fneur.2021.681413/full

3. https://www.parkinson.org/understanding-parkinsons/statistics

4. Agnivesha, Charaka, Chakrapanidatta, Sootrasthana, Chapter Maharogadhyaya, Verse 11 In:YT Acharya (Edi.). Reprint Edition 2015, Varanasi, Chaukambha Orientalia. p.113.

5. Madhavakara. Madhava Nidanam edited by Yadunandana Upadhyaya, Vol-1. Chukhambha Prakashana, Varanasi. Pg-494.


6. Vaidyavarashree Basavaraj,

Basavarajeeyam, Sri Govardhana Sharma, editor.1st ed. Vatavyadhi Nidana Lakshana Chikitsa, Chapter 6. Nagpur: Gorakshana Yantralaya Publication; 1978p. 100-101.

7. Vinay Choudhary, Shaizi Layeek, Mayank Bhatkoti,. Clinical Evaluation of Rajayapana Basti administered by Classical Putaka method and Drip method in Parkinson’s disease. Journal of Ayurveda and Hol Med (JAHM). 2016; 4(2):3-15.

8. Agnivesha, Charaka, Chakrapanidatta, Chikitsasthana, Chapter Vatavyadhi Chikitsitam, Verse 75, In:YT Acharya (Edi.). Reprint Edition 2015, Varanasi Chaukambha Orientalia, p 620.

9. Vagbhata, Arunadatta, Hemadri, Dinacharya Vidhi Adhyaya, Verse 08, In:Harisadashiva shastry Paradkar bhishagacharya (Edi.) Ashtanga hrudaya with Sarvanga Sundara and Ayurveda Rasayana Commentary, Reprint Edition 2019, Varanasi Chaukambha surabharathi prakashana, p.26.

10. Swamy, V. K., M. Goud, K., Deshpande, S., M J, S., & K.N, V. (2017). Role of Panchakarma in Parkinson’s disease - a case study. International Journal of Ayurveda and Pharma Research, 5(8). Retrieved fromhttps://ijapr.in/index.php/ijapr/article/view/731

11. Agnivesha, Charaka, Chakrapanidatta, Siddisthana, Chapter Uttarabasti Siddi Adhyaya, Verse 16, In:YT Acharya (Edi.). Reprint Edition 2015, Varanasi Chaukambha Orientalia, p.731.

12. Vrddha Vagbhata, Shashilekha, Siddisthana, Siddi Basti Kalpa Adhyaya, Verse 24 In: Acharya Astanga samgraha samhita with Shashilekha Sanskrit commentary. Reprint Edition: 2019. Varanasi: Choukambha Sanskrit Series office p.605.

13. J.L.N.Sastry; Dravyaguna Vijnana Foreword by Prof K.C.Chunekar. volume II; Chaukhambha Orientalia, Varanasi, 2012; Pg.176.


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