E-ISSN:2456-3110

Review Article

Parkinson's Disease

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 6 JUNE
Publisherwww.maharshicharaka.in

Ayurvedic management for Parkinson's Disease : A comprehensive case report on Kampavata

Pankaj S1*, V Balendu Krishnan2, Hari G3
DOI:10.21760/jaims.9.6.59

1* Pankaj Sharma, Post Graduate Scholar, Department of Kayachikitsa Rasayana Evam Vajikarana Tantra, Belagavi, Karnataka, India.

2 V Balendu Krishnan, Assistant Professor, Department of Kayachikitsa, Shiva Ayurvedic Medical College and Hospital, Bilaspur, Himachal Pradesh, India.

3 Hari G, Professor, Department of Kayachikitsa, Shiva Ayurvedic Medical College and Hospital, Bilaspur, Himachal Pradesh, India.

Parkinson’s Disease (PD) is a progressive neurodegenerative disorder characterized by symptoms such as bradykinesia, tremors, impaired posture, balance, and muscle rigidity. This case report discusses a 57-year-old male with a decade-long history of PD, presenting with tremors, slurred speech, and neck rigidity, who sought Ayurvedic treatment after finding no relief from conventional biomedical approaches. The patient was assessed using Ayurvedic principles of Rogi-Roga Pareeksha as Kampavata, and accordingly, the treatment plan combining Rookshana (drying) and Snehana (oleation) therapies were adopted. The intervention included external therapies like Udvartanam (powder massage), Sarvanga Abhyanga (full body oil massage), Swedana (fomentation), and Vaitarana Basti (medicated enema). Internal medications included Maharasnayogaraja Guggulu Kashayam, Saraswatarishtam, Ashtavarga Kashayam and Brihatvatachintamani Rasa. Over a two-week treatment period, significant improvements were observed in tremors, bradykinesia, rigidity, gait, and speech, with the patient reporting enhanced quality of life and reduced stress. This case highlights the potential efficacy of Ayurvedic treatment modalities in managing neurodegenerative disorders like PD, particularly when conventional treatments fail to provide relief.

Keywords: Ayurveda, Kampavata, Parkinson’s Disease, Rookshana, Snehana

Corresponding Author How to Cite this Article To Browse
Pankaj Sharma, Post Graduate Scholar, Department of Kayachikitsa Rasayana Evam Vajikarana Tantra, , Belagavi, Karnataka, India.
Email: 		Pankaj S, V Balendu Krishnan, Hari G, Ayurvedic management for Parkinson's Disease : A comprehensive case report on Kampavata. J Ayu Int Med Sci. 2024;9(6):357-362.
Available From
https://jaims.in/jaims/article/view/3307

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-04-10 2024-04-15 2024-04-26 2024-05-13 2024-05-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Authors state no conflict of interest. Non Funded. The conducted research is not related to either human or animals use. 11.12 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Pankaj S, V Balendu Krishnan, Hari Gand 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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Introduction

Parkinson’s Disease (PD) is a progressive disorder that is caused by degeneration of nerve cells in the part of the brain called the substantia nigra, which controls movement.[1] The cause of Parkinson’s Disease is unknown but factors such as genetic history, and certain environmental factors are known to cause the disease. There are bradykinesia, tremors, impaired posture and balance, muscle rigidity etc. as symptoms of PD. The prevalence of Parkinson's disease varies by nation. West Africa and Asia have lower rates of Parkinson's disease than Europe and North America. India has the lowest global generalised incidence of Parkinson's disease (70 per 100,000 normal persons). Nonetheless, the Parsi community in Mumbai has the highest incidence of Parkinson's disease (PD) in the world (328 per 100,000 people).[2]

Understanding the disease in Ayurveda is based on Nidana Panchaka, Roga-Rogi Pareeksha, which further helps in understanding medication protocol i.e., Shamana (pacifying) and Shodhana (purifying) Chikitsa (treatment). According to Ashtanga Hridayam, Kampa (tremor) is a sign of Sarvanga Vata and Vata Prakopa, or the vitiation of Vata. Numerous medications for the treatment of Kampavata are described in texts like Bhaishajya Ratnavali, Chakradutta, and Vangasena. A more thorough diagnostic technique that mentions the disease's symptoms and the management has been mentioned in Basavarajeeyam under the heading Kampavata.[3] Being a pre-diagnosed case of Parkinson’s Disease, this report is primarily focused on the management of a PD case using Ayurvedic parameters and treatment modalities.

Case History

A 57-year-old male patient visited the Out Patient Department with complaints of tremors, slurred speech and neck rigidity for ten years. As per the patient, he was asymptomatic ten years back, when he gradually developed difficulty in speaking, tremors and rigidity in the neck. On further inquiry, he revealed being diagnosed with Parkinson’s Disease by the bio-medical medicine and taken previous consultations for the same but found no relief in the complaints. Hence, the patient approached OPD of Kayachikitsa, Shiva Ayurvedic Medical College and Hospital for exploring potentials of Ayurveda in Parkinson’s Disease.

Personal History

Ahara (Diet) - Mixed (vegetarian and non-vegetarian)

Nidra (Sleep) - Sound: Diwaswapna (day sleep) - Not Elicited

Mala (Bowel) - Samanya 1time/day

Mutra (Micturition) - 4 to 5 times/day

Vyasana (Addiction) - Not Elicited

The patient leads a stressful life due to a hectic work schedule.

Family History: There is a history of Parkinson’s disease in the family (Grandfather).

History of Past Illness: History of Hypertension (since 1992), Amlapitta (since 1993)

History of Past Medication: History of intake of Asomex-TM (Telmisartan 40 mg and Amlodipine 5 mg), Ciplar C-A (Propanolol) 20mg (later up to 40 mg), Pantoprazole 40 mg (regularly)

History of Mansika Bhavas: Chinta - increased thought process, Bhaya - fear (+)

Methodology

The Nidana-Panchaka examination of the patient as per Ayurveda principles was adopted. Rogi-Roga Pareeksha (Examination) followed by eliciting Lakshana, Nidana, Poorvaroopa, Dosha and Dooshya respectively, formulating the possible Samprapti, defining the disease condition and its stage and finally the treatment protocol was followed.

Samprapti (Etiopathogenesis)

Nidana Sevana → Kapha Vitiation → Srotosanga → Vata Prakopa → Continues Nidana Sevana → Vata and Kapha Vitiation → Sthana Samshraya → Udana Vayu Vaigunya → Kampavata

Roga Pareeksha (Assessment of the disease)

Eliciting the Lakshanas (signs):

Tremors (Kampa)

1. Bradykinesia (Cheshtahani)

2. Rigidity (Stambha)

3. Gait impairment (Skhalita Gati)


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4. Speech Changes (slurred) (Vak Vikriti-Baddhata)

5. Difficulty in writing

6. Postural deformity (Avanamana)

Amongst these Kmapa, Cheshta Hani and gait impairment are the signs of most diagnostic importance.

Eliciting the Nidana (Etiological factors)

1. Chinta, Prapatana, Sheeta, Ruksha Bhojana

2. Beejadosha (genetics and familial history)

3. Shiro Abhighata (head injury in childhood)

4.Long use of Proton Pump Inhibitors (Pantoprazole 40 mg)

Rogi Pareeksha (Assessment of the diseased)

  • Prakriti-Kapha Vata Dominant
  • Vikriti-Kaphavrita Vata
  • Satva-Madhyama
  • Sara-Madhyama
  • Ahara Shakti- +
  • Samhanana - Susamhita
  • Vyayam Shakti - Avara
  • Vaya - Madhyama, Pittakala

Final Diagnosis: Kampavata

Vyadhi Swaroopa: Chirkari, Jeerna

Prognosis: Kricchra Sadhya/Yapya (difficult to treat or manageable)

The patient was recommended for IPDadmission on August 16, 2022, following a thorough evaluation of Vyadhi and Rogi. At admission, the patient's general state was well, although slightly stressed. Blood pressure was 118/86 mm Hg, pulse rate was 68 bpm, and SpO2 was 98%.

Therapeutic intervention

Chikitsa in Ayurveda is based on three principles: Yuktivyapashraya, Daivavyapashraya and Sattvaavajaya. Here primarily Yuktivyapashraya Chikitsa was adopted. The following treatment principles were adopted:

1. Rookshana Chikitsa (Udvartanam, Swedana, Dhanyamla Dhara, Vaitarana Basti with Gomutra) for Kapha Avrita Dosha.

2. Snehana Chikitsa (Abhyanga, Matra Basti, Vaitarana Basti with Ksheera) for Vata Dosha

Bahiparimarjana Chikitsa (External therapeutics)
1. Udvartanam (powder massage) with Kolakulatthadi Choornam (for initial five days)

2. Sarvanga Abhyanga (full body oil massage) with Mahanarayana Taila following Udvartanam

3. Dhanyamla Pinda Swedana and Nadi Swedana (fomentation procedures with Kolakulatthadi Choorna Pottali and Dhanyamla)

4. Sarvanga Dhara with Dhanyamla (pouring medicated liquid over the body)

5. Matra Basti (enema) with Sahacharadi Taila (50 ml) added with pinch of Saindhava Lavana.

6. Vaitarana Basti (a type of medicated enema) with Gomutra (fresh cow’s urine) and Ksheera (cow’s milk) as Prakshepa, The Ingredients and plan of Basti have been mentioned in Table no. 1 and Table no. 2.

Table 1: Vaitarana Basti ingredients

Gomutra Vaitarana BastiKsheera Vaitarana Basti
1.  Saindhava Lavana - 15 gm
2.  Guda - 50 gm
3.  Ksheerabala Taila - 100 ml
4.  Chincha - 100 ml
5.  Gomutra - 200 ml
6.  Balamoola Kwatha - 200 ml		1.  Saindhava Lavana - 15 gm
2.  Guda - 50 gm
3.  Ksheerabala Taila - 100 ml
4.  Chincha - 100 ml
5.  Balamoola Ksheerapaka - 300 ml

Table 2: Plan of Vaitarana Basti and Matra Basti

Day123456789
Niruha Basti (Before Food)-gVBgVBgVBkVBkVBkVBkVB-
Matra Basti (After Food)sMBsMBsMBsMBsMBsMBsMBsMBsMB

gVB: Gomutra Vaitarana Basti; kVB: Ksheera Vaitarana Basti; sMB: Sahacharadi Taila Matra Basti)

Antahaparimarjana Chikitsa (Internal Medication)
1. Maharasnayogaraja Guggulu Kashayam 15 ml mixed with 60 ml water before food, twice daily.

2. Saraswatarishtam and Ashtavargam Kashayam (mixed 20 ml) added with Brihatchagalayadi Ghrita 5 ml, one hour after food twice daily.

3. Brihatvatachintamani Rasa for 5 days followed by a gap of 2-3 days. Then again continued for 5 days, then advised for ten days, twice daily.


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4. Shilajatu one capsule once daily, with milk.

The above said treatments were adopted from 16.08.2022 to 31.08.2022. On Discharge, medicines were continued adding Kauncha Paka 10 grams with milk at bedtime, and Murivenna Taila, before bath for Abhyanga was advised as a daily regimen.

Follow-up

It was recommended to the patient to follow up in three months. The patient was given a suitable diet and exercise regimen up until that point.

Summary of Outcomes

Poor (5); Fair (4); Good (3); Very Good (2); Excellent (1)

Lakshanas (Notable Signs and Symptoms)Before Treatment (At Time of Admission)After Treatment (At Time of Discharge)
Kampa (Tremors)52
Chestasanga (Bradykinesia)41
Stambha (Rigidity)31
Gati (Gait)41
Vakstambha (Speech)41
Writing41
Posture31

Result

A notable improvement in the complaints was reported. The impairment of Kampa, Stambha, Cheshtasanga, gait, speech, and posture were greatly diminished. In addition, the patient's quality of life increased and stress levels was greatly lowered.

Discussion

Vata Vyadhi addresses a number of serious health issues pertaining to the joints, bones, degenerative diseases, etc. In biomedical medicine, levodopa, dopamine agonists, MAO inhibition, anticholinergics, and other medications are used to manage bradykinesia, tremors, and other symptoms in order to lessen their severity. With the use of Nidana Panchaka, Hetu, and Vyadhi Vipreeta Chikitsa, Ayurveda takes a holistic approach to treat Rogi and Vyadhi, thereby improving the patient's quality of life and reducing symptoms. Since, the aforementioned case was a pre-diagnosed case of Parkinson's disease, it was understood using the principles of Ayurveda, specifically Kampavata.

Despite having a family history, the patient has taken 40 mg of pantoprazole for a very long time. Although the precise role of proton pump inhibitors (PPIs) in Parkinson's disease (PD) is still unknown, research suggests that using PPIs increases the risk of developing neurodegenerative diseases.[4]

However, in terms of Ayurveda, managing the symptoms was made tricky because this case involved both Kevala Vata Lakshanas and Kapha Avrita Vata Lakshanas. While the Kevala Vata needs more Snehana line of modalities, the Kaphavrita Vata may benefit from the Rookshana line of treatment.

Hence, incorporating both, the dual (Vyatyasyata) modalities were incorporated in Bahiparimarjana and Antahparimarnjana Chikitsa. Udvartanam (powder massage) with Kolakulatthadi Choornam, Dhanyamla Pinda Swedana (fomentation procedures with Kolakulatthadi Choornam Pottali and Dhanyamla), Sarvanga Dhara with Dhanyamla (pouring medicated liquid over the body) and the Vaitarana Basti (decoction enema) with Gomutra (fresh cow’s urine) followed the line of Rooksha Chikitsa; while the Sarvanga Abhyanga (full body oil massage) with Mahanarayana Taila, Vaitarana Basti (medicated enema) with Ksheera (cow’s milk) and Matra Basti (enema) with Sahacharadi Taila (50 ml) added with pinch of Saindhava Lavana were based on line of principle of Snehana Chikitsa.

Despite Kapha Aavarana being the main presentation, the Snehana Chikitsa was advised after Rookshana. Udvartanam aids in Kapha depletion, Meda Pravilayana (Meda removal from the Srotas), and organ strengthening. Kolakulatthadi Choornam was used in the condition because of its Ushna and Vata pacifying qualities.[5]

As Bhedi, Teekshna, and Ushna, Dhanyamla Dhara and Dhanyamla Pinda Sweda are the Rooksha Swedana (fomentation) that aid in the removal of Avarana and the combat Kapha-Vata vitiation. Assessing the Vata dominant Lakshanas, typically referred to as Kevala Vata, full body massage with Mahanarayana Taila was advised.

Mahanarayana Taila alleviates theVata Vriddhi and is recommended in Shakhagata and Koshthagata Vata pathologies. Furthermore, it is stated that Mahanarayana Taila is Brimhana and advised for Snayu strengthening (the neuro-muscular structures).[6]


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Since Basti is regarded as the most effective method of treating Vata Vyadhi. Even though the Kapha affliction was also observed, two variations of the Vaitarana Basti - with Gomutra and with Ksheera, from the Chakradutta Amavata Chiktisa were adopted. Gomutra was used primarily to address theKapha dominant conditions because of itsmore Rooksha, Teekshna, and Sookshma Gunas. In the second type ofVaitarana Basti, Balamoola (Sida cordifolia) Ksheerapaka was used in place of Gomutra because, in order to pacify Vata, more Madhura, Snigdha Guna was needed. After having themeal, it was suggested to have a Matra Basti with 50 ml of Sahacharadi Taila. Sahacharadi Taila is used in conjunction with Kapha to counteract Vata, and it is especially recommended in Kampa (tremors) Lakshanas.[7]

Arya Vaidya Pharmacy in Coimbatore offers a proprietary medication called Maharasnayogaraja Guggulu Kashayam, which combines the ingredients of Maharasnadi Kashayam and Yogaraja Guggulu. With its Kapha and Vata pacifying qualities, Maharasnadi Kashayam is Brimhana Kashaya and is directed towards the Marma-Asthi-Sandhis. However, in addition to strengthening the Agni, balancing, and alleviating the Sandhi-Majja Gata Vata Rogas, Yogaraja Guggulu also aids in Vata Vyadhi.[8]

Being a Medhya formulation, Saraswatarishtam is good for Medha (intellect) and aids in Ksheenasmriti, whereas Ashtavargam Kashayam takes a different approach to alleviate Vata. Being Balya and Agni potentiating Ghrita, Brihatchagalayadi Ghrita aids in Rasayana activity to achieve copious forms of Dhatus in this patient. Brihatvatachintamani Rasa is a herbo-mineral preparation that contains gold and is considered a Rasayana Aushadha. It is also a Vyadhi-Pratyaneeka Chikitsa for Vata-dominant Vyadhi. Shilajatu is used in Kapha and Vata dominant conditions as Tikta, Ushna, and Katupaka Rasayana. Even though it functions in the higher mental functions, the aforementioned situation can still use it.[9] It was recommended as a daily regimen to take 10 grams of Kauncha Paka with milk before bed and Murivenna Taila massagebefore bathing. In the treatment of Parkinson's disease, mucuna (Kauncha) seeds have demonstrated comparable effectiveness to pure levodopa or carbidopa. Levodopa is a direct precursor of the neurotransmitter dopamine.

For the long-term treatment of Parkinson's disease, this powdered mucuna seed formulation is preferable to traditional L-dopa preparations.[10] Thus, by applying these various modalities of Rooksha and Snigdha Chikitsa, a noteworthy improvement in the patient's complaints was observed.

Conclusion

In the context of Kampavata, it can be said that Ayurvedic intervention in neurodegenerative disorders like Parkinson's disease is very successful. Utilizing distinct methodologies from Kapha Avarana and Rookshana Chikitsa, the outcomes documented were exemplary. Moreover, there were documented no side effects from the Ayurvedic treatment.

Informed consent

The written informed consent has been taken from patient for treatment as well as publication purpose, without disclosure of the identity, solely meant for the medical education and learning.

Acknowledgements

Thanks are due to Dr. Harsha NM, Principal and Medical Superintendent, Shiva Ayurvedic Medical College and Hospital, Chandpur, Bilaspur Himachal Pradesh, for his unsurmountable support and guidance in carrying out the aforesaid work.

References

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