E-ISSN:2456-3110

Case Report

Parkinson’s Disease

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Ayurvedic management of Parkinson’s Disease - A Case Study

Anush N1*, Gopan Y2, Jadhav LL3
DOI:10.21760/jaims.9.7.48

1* Anush N, Post Graduate Scholar, Dept of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Yadu Gopan, Assistant professor, Dept of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 Lakshmiprasad L Jadhav, Professor, Dept of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India.

Parkinson's disease is a movement disorder characterized by the degeneration of neurons in the nigrostriatal dopaminergic system, with its etiology remaining unknown. An imbalance between dopamine and acetylcholine neurotransmitters, involving either an increase in acetylcholine or a decrease in dopamine levels, is observed. Clinical features of Parkinson's disease are an expressionless face with a staring look and infrequent blinking, along with characteristics such as greasy skin, soft and rapid monotonous speech, and a flexed posture known as universal flexion. The gait of individuals with Parkinson's disease is characterized by walking with short steps, a tendency to run, delayed initiation of walking, shortened stride, rapid small steps, and a phenomenon known as festination. Other gait-related issues include reduced arm swinging, impaired balance during turning, propulsion and retropulsion, as well as lateropulsion and kinesia paradox. Resting tremors, rigidity and hypokinesia are common symptoms experienced by patients with Parkinson's disease. In a case study involving a 54-year-old male diagnosed with Parkinson's disease, treatment included Basti, Abyanga, Swedana, and Shamanaoushadi. Significant improvement in symptoms was observed, highlighting the beneficial effects of Shodana and Shamana therapies in enhancing the patient's quality of life.

Keywords: Abyanga, Basti, Parkinson’s disease, Swedhana, Shamana

Corresponding Author How to Cite this Article To Browse
Anush N, Post Graduate Scholar, Dept of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Anush N, Gopan Y, Jadhav LL, Ayurvedic management of Parkinson’s Disease - A Case Study. J Ayu Int Med Sci. 2024;9(7):309-313.
Available From
https://jaims.in/jaims/article/view/3351

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-13 2024-05-27 2024-06-07 2024-06-17 2024-06-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.31

© 2024by Anush N, Gopan Y, Jadhav LLand 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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Anush N et al. Ayurvedic management of Parkinson’s Disease

Introduction

Parkinson’s disease (PD) is a long term progressive degenerative neurological disorder that mainly affects motor system. The mean age of onset of this disease is 60 years. It is estimated that, there are 5 million people all over the world suffering from this disease.[1]

The clinical features are resting tremors, cog wheel rigidity, bradykinesia and postural instability. Most PD cases occur sporadically and are of unknown cause. Degeneration of pigmented pars compacta neurons of the substantia nigra in the midbrain resulting in lack of dopaminergic input to striatum; accumulation of cytoplasmic intraneural inclusion granules (Lewy bodies).

Cause of cell death is unknown, but it may result from generation of free radicals and oxidative stress, inflammation, or mitochondrial dysfunction; no environmental factor has yet been conclusively determined to cause typical PD. Rare genetic forms of parkinsonism exist (~5% of cases); most common are mutations in glucocerebrosidase, LRRK2, α-synuclein or parkin gen.[2]

In early stages the symptoms like tremors, postural imbalance, bradykinesia, rigidity are seen. In advanced stages dementia, sleep disturbance, speech impairment, dysphagia, urge incontinence and nocturia are seen.

In Ayurveda due to the similar clinical presentation Parkinson’s disease has close similarity with Kampavata. Kampavata has been described under Vataja Nanatmaja Vyadhi in Ayurveda literature[3]

It is described with symptoms like Karapadatalakampa (upper and lower limbs tremors), Stambha (rigidity), Chestasangha (bradykinesia and akinesia), Vakvikruthi (disturbance of speech).[4]

Case Report

A 54-year-old male, employed as a farmer, sought medical attention at the Kayachikitsa Outpatient Department of Sri Dharmasthala Manjunatheshwara Ayurveda Hospital in Hassan.

He presented with concerns of tremors in both hands, postural instability, stiffness in both upper limbs, and overall weakness persisting for the past six months.

The patient has a documented history of hypertension spanning eight years and has been consistently taking prescribed medications for the condition. Despite prior treatment with allopathic medications for his current complaints, he did not experience significant relief in symptoms.

Table 1: Timeline of the Case

October 2022Healthy and asymptomatic
November 2022Observed mild tremors in left hand
December 2022Observed generalised weakness and tremors in both hands
February 2023Underwent conservative allopathic management
April 2023Admission to SDMCAH, Hassan

Clinical Findings

General examination

The general condition of the patient was fair and his vital signs were found to be normal. He has moderate built. He had normal appetite and bowel-bladder habits. His sleep was sound.

Vital signs and Physical Examination:

Table 2: Vital signs

Blood Pressure130/90 mmHg
Heart Rate70/min
Height170 cm
Weight70 kg
BMI24.2 kg/m2

Table 3: Physical Examination

Gastro intestinal systemSoft Abdomen, Non-Tender and No Organomegaly
Respiratory systemSymmetrical Chest, No added sound
Cardio vascular examinationS1, S2 heard, No Murmurs

Table 4: CNS Examination

Higher mental functionIntact
Muscle movements CoordinationPoor
Tandem walkingNormal
Romberg’s signNormal
Knee heel testNormal
Finger to nose testNegative, patient was unable to do it with precision due to tremors
Involuntary movementsResting tremors in right upper limb
ToneBoth Upper Limb - Rigid
PowerBoth Upper Limb and Lower Limb - 4/5
ReflexesBoth triceps, biceps - + Both knees - ++

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Assessment Criteria

Table 5: Hoehn & Yahrscale: Stage III

StagesDescription
Stage IUnilateral involvement only with minimal or no functional disability
Stage IIBilateral or midline involvement without impairment of balance
Stage IIIBilateral disease: mild to moderate disability with impaired postural reflexes; physically dependent.
Stage IVSeverely disabling disease; still able to walk or stand unassisted
Stage VConfinement to bed or wheelchair unless aided

Diagnostic assessment

Table 6: MRI Brain

Dated 31/04/2023Diffuse age-related cerebral atrophyNormal study

Diagnosis: Kampavata, Parkinson’s disease stage 2

Therapeutic Interventions

Initially, the patient underwent Shodhana Chikitsa, followed by subsequent Shamana Chikitsa. The treatment plan was devised, considering the etiology, clinical features, outcomes of clinical examination, and laboratory findings.

Table 7:

DateTreatment
01/05/2023Admitted
01/05/2023 - 02/05/20231. Saravnga Udwartana + Dashamoola Kwatha Parisheka
2. Cap Balamoola 4-0-4 before food with warm milk
3. Ekangaveera Rasa 1-0-1 after food with warm water
03/05/2023Sadyovirechana with Gandharvahastadi Erandataila - 60ml + warm water No of Vegas: 7
04/05/2023 To 09/05/20231. Saravnga Abhyanga with Mahanarayana Taila + Shashtika Shali Pinda Sweda
2. Veshtana with Mahanarayana Taila to all four limbs
3. Niruha Basti with Yeshtimadhu Ksheerapaka 300ml
4. Anuvasana Basti with Ashwagandha Bala Lakshadi Taila - 70ml
5. Cap Balamoola 4-0-4 before food with warm milk
6. Ekangaveera Rasa 1-0-1 after food with warm water

Result

The condition of the patient improved with gradual course of treatment.

Table 8:

Before treatmentAfter Treatment
Hoehn and Yahr scale: Stage II with B/L involvementHoehn and Yahr scale: Stage I with no Functional disability

Discussion

Initially, the patient was treated using the Mrudu Langhana approach. This involved Rukshana and Swedana therapies, specifically Sarvanga Udvartana and Sarvanga Parisheka, respectively. Mrudu Langhana is recommended for patients who will later undergo Brimhana treatment.[5]

In this patient, Brimhana was administered through various types of Snehana. Consequently, the patient first underwent Mrudu Langhana using Udvartana and Parisheka Sweda. Mrudu Langhana helped to increase Agni, thereby enhancing the absorption of Brimhana Dravyas. Later, the patient received Sadyovirechana with Gandharvahastadi Eranda Taila. Mruduvirechana or Snigdhavirechana with Eranda Taila is recommended for Vatavyadhi, as it aids in Vatanulomana and Koshtashuddhi.[6]

Following Sadyovirechana, various forms of Snehana Chikitsa were initiated. Mahanarayana Taila was used for Veshtana on all four limbs as well as for Sarvanga Abhyanga. Veshtana is one of the treatments recommended for Vataprakopa, particularly effective in conditions characterized by increased Chala Guna (tremors) of Vata.[7]

Abhyanga pacifies Vata and is beneficial for age-related disorders. It offers Pushti (nourishment) and Ayu (longevity).[8] Mahanarayana Taila contains Brimhana-Pradhana Vatahara Dravyas and is indicated for all types of Vata Vyadhis. It enhances the Shareera Dridhata (stability of the body).[9]

Abhyanga was followed by Shashtika Shali Pinda Sweda, a Brimhana Sweda particularly effective for Dhatukshaya (degenerative conditions) and Stambha (stiffness). Basti is the best treatment for Vatavyadhi, and since the present case involves Dhatukshayajanya Vatavyadhi, the Basti should be Brimhana and Dhatuposhaka in nature.

Therefore, Anuvasana Basti was administered using Ashwagandha Bala Lakshadi Taila, which is Pushtikara (nourishing) and specifically indicated for Kshaya and various types of Vatavyadhi. Yashtimadhu Ksheerabasti was given as Niruha Basti, selected for managing Majjadhatu Kshaya, which correlates with neurodegeneration, as Madhura Ksheerabasti is indicated for such conditions. Oral medications prescribed included Cap. Balamoola and Ekangaveera Rasa.


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Bala is a Rasayana Dravya and Vatahara that nourishes Dhatu and Oja and promotes Ayu (longevity). It is indicated for Kshaya. Ekangaveera Rasa is recommended for all types of Vatavyadhi, particularly neurological disorders. With collective actions such as Vatahara, Balya, Brimhana, and Rasayana, the aforementioned treatment procedures and oral medications helped alleviate the symptoms of Parkinson’s disease, resulting in significant improvement in the patient's condition.

Conclusion

The integrated approach of Shodhana and Shamana therapies in this case study shows promising results in Parkinson's disease. The combination helped in pacification of Vata and improvement of Deha-Dhatu Bala contributes to symptomatic relief and improved quality of life for the patient. Long-term management and follow-up are essential to monitor the progression of the disease and make necessary adjustments to the treatment plan. Additionally, lifestyle modifications, dietary recommendations, and stress management strategies can complement the Ayurvedic interventions for a comprehensive approach to Parkinson's disease. This case study provides valuable insights into the potential benefits of Ayurvedic interventions, emphasizing the importance of a personalized treatment approach in chronic neurological disorders like Parkinson's disease. Further research and clinical studies are required to validate and refine Ayurvedic protocols for the management of such conditions.

References

1. Kasper, Fauci, Hauser, Longo, Jameson, Loscalzo, Harrisons Principle of Internal Medicine, 19th Edition, page no. 996

2. Kasper, Fauci, Hauser, Longo, Jameson, Loscalzo, Harrisons Principle of Internal Medicine, 19th Edition, page no. 997

3. Agnivesha, Charaka Samhita, revised by Charaka & Dridhabala, Ayurveda Dipika commentary Chakrapani Dutta, edited by Yadav ji Trikam ji, Chaukhamba Academy, Varanasi, reprint 2010, page no. 738

4. Yogaratnakar, vidyothini hindi commentary by Vaidya lakshmipathi shastri edited by Bhishagratna Brahma Shankar Shastri, Chaukhambha Sanskrit Sansthan, Varanasi, 2014, page no. 540.

5. Vagbhata, Sutrastana 14th Chapter, Astanga Hridaya. Edited by Pandit Harisadhashiva Paradakara Bhisagacharya with commentaries, Sarvanga Sundari of Arunadatta and Ayurveda Rasayana of Hemadri.Chaukhamba Varanasi: Sanskrit Sansthan: Verse 15

6. Agnivesha, Chikitsastana 28th chapter Charaka Samhita, revised by charaka & Dridhabala, Ayurveda Dipika commentary Chakrapani Dutta, edited by Yadav ji Trikam ji, Chaukhamba Academy, Varanasi, reprint 2010, Verse 84

7. Vagbhata, Sutrastana 13th Chapter, Astanga Hridaya.Edited by Pandit Harisadhashiva Paradakara Bhisagacharya with commentaries, Sarvanga Sundari of Arunadatta and Ayurveda Rasayana of Hemadri.Chaukhamba Varanasi: Sanskrit Sansthan: Verse 2

8. Vagbhata, Sutrastana 2nd Chapter, Astanga Hridaya. Edited by Pandit Harisadhashiva Paradakara Bhisagacharya with commentaries, Sarvanga Sundari of Arunadatta and Ayurveda Rasayana of Hemadri. Chaukhamba Varanasi: Sanskrit Sansthan: Verse 8

9. K R Shrikantha Murthy, Bhavaprakasha of bhavamishra; Vatavyadi Adikara vol 2. 3rd Varanasi: Chaukamba Krishnadas Academy; 2005 verse 151-162


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