INTRODUCTION:

Ayurveda the science of life considers a person healthy when there is a balance of three doshas i.e Vata, Pitta and Kapha.^[1,2] Vata is considered as motivator and controller of other two doshas.^[3] Major Neurological disorders comes under Vatavyadhis. Charakacharya mentioned 80 types of Nanatmaja Vata Vikaras and Kampavata is considered as one among them.^[4] As it is mentioned in Shabda Kalpadruma that “Na Kampo Vayuna vina” so it is considered under Vatavyadhi.^[5]

Based on the symptom of Kampavata it can be compared with Parkinson’s disease in Modern Science in which tremors is a cardinal feature^[6].

In Ayurvedic literature various names for tremors are available like Kampavata, Vepathu, Shirakampa, Kampana etc. Parkinson's disease is the second commonest neurological disorder affecting 1 million patients in United States and 5 million persons in the world. It affects men, women of all races, all occupations and all countries. The mean age of onset is about 60 years but can be seen in patients in their 20’s and even younger age. The frequency of Parkinson’s disease increases with ageing^[7]. If we see the western medical literature, the famous physician Galen first described this condition under the name "Shaking Palsy”. Then in 1817 the physician James Parkinson published detailed description of the condition and thus, as the tradition in the West, the disease was named after him. Parkinson’s disease is characterised by tremors, rigidity, bradykinesia and gait impairment called cardinal features. Other associated features like speech difficulty, autonomic disturbances, sensory alteration, mood disorders, sleep dysfunction, cognitive impairment, dementia etc. may present.^[8,9,10,11] In Ayurveda, for the treatment of Kampavata along with many internal medicines, Snehana, Swedana, Basti (Niruha and Anuvasana), Virechana, Nasya, Mastiskya (Shirobasti, Shirodhara, Shiropichu and Shiroabhyanga) has been indicated^[12,13].

Case Report:

A 62 years non hypertensive and non-diabetic male patient with an attendant was approached to Clinical Section (OPD) of RARIMD, Bengaluru on 29^th May 2020 with the Chief complain of tremors on both hands, difficulty in speech (slurred speech), difficulty in walking (initiation of walking), salivation, weakness in the body and with mild memory loss since 5-6 years. Patient was on Tab. Syndopa (Levodopa 100mg + Carbidopa 25mg).

On examination:

Physical examination:

B.P- 130/90 mm of Hg, Pulse - 84/min

RR – 26/min, Pallor- Nil, Oedema – Nil

Systemic Examination:

Resp. System - Chest is clear, CVS – S1 and S2 normal

CNS- Conscious and Orientation was normal

P/A- Soft, no tenderness, bowel sounds were present

Diagnosis:

He was diagnosed as Kampavata (Parkinson’s disease) on the basis of clinical signs and symptoms after the thorough examination.

Plan of treatment:

The following medications were given to the patient for a period of 3 months. Patient reported to the OPD in every 15 days for taking of medicines.

1. Tab. Aswagandha (500mg) - 1 Tab three times a day after food with water

2. Tab. Vallari (500mg) - 1 Tab three times a day after food with water

3. Pratimarsha nasya as nasal instillation 2drops in each nostril with Dhanwantaram tail (101) once daily in the morning in empty stomach.

4. Shiropichu (anointing with medicated oil over head) at night with Dhanwantaram taila

Assessment Criteria:

The symptoms of Parkinson’s disease were assessed based on Unified Parkinson’s Disease Rating Scale (UPDRS) at base line (before treatment), after one month, after two months and at the completion of the treatment (after 3 months).

RESULTS:

The result showed good improvement in maximum signs and symptoms which showed in the table below.

Sl. No.	Symptoms	BT	After 1^st Month (29.05.2020)	After 2^nd Month (30.06.2020)		AT (After 3^rd Month) (28.07.2020)	% of Improvement (25.08.2020)
I. Mentation, Behavior and Mood
1.	Intellectual Impairment	1	1	1		1	00
2.	Thought Disorder	0	0	0		0	00
3.	Depression	2	2	1		1	50
4.	Motivation/Initiative	2	2	1		1	50
II. Activities of Daily Living
5.	Speech	2	2	2		1	50
6.	Salivation	3	3	2		2	33.3
7.	Swallowing	2	2	2		2	00
8.	Handwriting	2	2	2		1	50
9.	Cutting Food and Handling Utensils	2	2	1		1	50
10.	Dressing	1	1	1		1	00
11.	Hygiene	1	1	1		1	00
12.	Turning in Bed and Adjusting Bed Clothes	1	1	1		1	00
13.	Falling (Unrelated to Freezing)	0	0	0		0	00
14.	Freezing when Walking	3	3	2		2	33.3
15.	Walking	2	2	2		1	50
16.	Tremor	2	2	2		1	50
17.	Sensory Complaints Related to Parkinsonism	1	1	1		1	00
III. Motor Examination
18.	Speech	2	2	2	1		50
19.	Facial Expression	1	1	1	1		00
20.	Tremor at Rest	3	3	2	2		33.3
21.	Action or Postural Tremor of Hands	2	2	2	2		00
22.	Rigidity	2	2	1	1		50
23.	Finger Taps	2	2	2	1		50
24.	Hand Movements	2	2	2	1		50
25.	Rapid Alternating Movements of Hands	1	1	1	1		00
26.	Leg Agility	1	1	1	1		00
27.	Arising from Chair	1	1	1	1		00
28.	Posture	1	1	1	1		00
29.	Gait	1	1	1	1		00
30.	Postural Stability	1	1	1	1		00
31.	Body Bradykinesia and Hypokinesia	2	2	2	1		50
	Total	49	49	42	34		30.61

DISCUSSION:

Kampavata considered among 80 types of nanatmaja vatavyadhis. The symptoms in Kampavata are mainly related to neurological, intellectual and behavioural impairments. The treatment in this case was planned to improve the neurological, intellectual and behavioural symptoms.

Aswagandha is considered as best neuro tonic which gives strength to the nerves. According to Ayurveda Aswagandha is considered as vatashamaka, balya, vrishya, rasayana and mastiskashamaka (mental wellbeing)^[14]. As per New Look to Phytomedicine, 2019 (24.12.5.4) the clinical trials and animal research support the use of withania somnifera for the conditions such as anxiety, cognitive and neurological disorders, senile dementia, neuro protective effects against 6-OHDA - induced Parkinsonism in rats^[15]. Study also showed that the extract of withania somnifera root (Aswagandha Root) at the dose of 100mg\kg shows significant improvement in Parkinson’s disease, Motor neurons function, catecholamines, potential antioxidant levels and prevent lipid peroxidation ie. Reduced elevated level of TBARS^[16].

Vallari which consists of mainly Brahmi is a well-known memory boaster in Ayurveda.Because of its katu rasa, ushmavirya it alleviates vata and kapha. Because of its medhyaprabhava it is used in many manasika vikaras like unmada, apasmara, smriti dourvalya etc.^[17] As per modern science the alcoholic extract of Bacopa monnieri improves the cognitive functions, memory, learning abilities etc. It was also found that the alcoholic extrct of bacopa treatment for three weeks showed a neuroprotective effect in the 6 – OHDA rat model of Parkinsonism.^[18]

Nose (Nasa) is considered as the gate way of Brain. ^[19] So when we put some medicated oil, ghee or decoctions, it goes in to the cranial cavity, reach the Shringatakamarma and spread through the openings of siras of eye, ear and throat etc. and to the brain. So Nasya will helpful in many Neurological and Psychiatric disorders. Dhanwantaram (101) drop contains more Vatanashaka dravyas and nutritional properties which helps in controlling of vitiated Vata^[20] and ultimately useful in Kampavata.

Shropichu is considered as one among 4 procedures of Mastiskya^[21] where medicated oil/ghee poured on a cotton pad/cloth pad and kept over head (over Brahmarandra) and after covering with a leaf/plastic, it will be tied with a cloth and kept for whole night. The potency of the drug may enter to the brain and helps to alleviate the doshas. Dhanwantaram taila contains more vatanashaka dravyas^[22]. So it helps to control the vitiated Vata by which it can be used in many Neurological disorders including Kampavata.

CONCLUSION:

It is therefore evident that the multiple treatment approaches based on Ayurvedic principles can produce effective results in the management of Kampavata (Parkinson’s disease) not only in improving the signs and symptoms but also in quality of life.

REFERENCES:

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2. Agnivesha of Charaka Samhita with Vidyotini Commentry by Pt. Kashinatha Shastri and Dr. Gorakh Nath Chaturvedi, Published by Chowkhamba Vidyabhavan, Varanasi, 1970, Ch. Su 12/13, Page-179.

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4. Agnivesha of Charaka Samhita with Vidyotini Commentry by Pt. Kashinatha Shastri and Dr. Gorakh Nath Chaturvedi, Published by Chowkhamba Vidyabhavan, Varanasi, 1970, Ch. Su 20/11Page- 269.

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8. Harrison, Principle of Internal Medicine, Vol.-II, 18^th Edition, Page3317

9. Jhakeshwar Prasad et. all, Therapeutic Approaches for the Management of Parkinson’s Disease, RJPPD, Vol.-XI, Issue-1, Year-2019

10. Rajesh Kumar Reddy et. all, Evaluation of Neuroprotective Activity of Melissa officinalis in MPTP Model of Parkinson’s Disease in Mice, RJPT, Vol. – XII, Issue-5, Year-2019.

11. Rahul S Solunkeet.all, Formulation and Development of Enteric Coated Tablet for Parkinson’s disease, Published in RJPT, Vol. XIII, Issue-2, Year-2020

12. Nirmal Saxena edited Vangasena Samhita, Vol. -I, 28/155 Edition, Published by Chaukhamba Krishnadas Academy, Varanasi, 2004, Page - 409.

13. Pathak Shrikrishna Lalagaj Dattaram, Ras Raj Sundar, Uttarakhand (Uttarabhag), Kamala Prakash, Mathura, Edition- 1888, Vatavyadhi Chikitsa Adhyaya, Page -549-550

14. P.V. Sharma, Dravyaguna Vijnana, Part-II, Choukhamba Bharati Academi, Varanasi, 17^th Edition-1996, Page -764-765.

15. A. Srivastava, …A.B. Pant in New Look to Phytomedicine, 2019 (24.12.5.4)

16. V. Nimitha et. all, Medicinal Plants used for the Treatment of Parkinson’s Disease, Published in RJPDFT, Vol.-XI, Issue-2, Year-2019

17. P.V. Sharma, Dravyaguna Vijnana, Part-II, Choukhamba Bharati Academi, Varanasi, 17^th Edition-1996, Page-7-8.

18. Neelima B. Chauhan, Jogender Mehla, in Bioactive Nutraceuticals and Dietary Supplements in Neurological and Brain Disease, 2015

19. Vagbhata of Astanga Hridaya with Sarvanga Sundar commentary by Aruna Dutta and Ayurveda Rasayana commentary by Hemadri, Published by Choukhamba Surabharati Prakashana, Varanasi, Edition-2018, A.H, Su.20/1, Page-287.

20. Shahasra Yoga, Sanskrit- Hindi Version, Published by CCRAS-1990 Page-261

21. Vagbhata of Astanga Hridaya with Sarvanga Sundar commentary by Aruna Dutta and Ayurveda Rasayana commentary by Hemadri, Published by Choukhamba Surabharati Prakashana, Varanasi, Edition-2018, A.H.Su.22/23, Page-301

22. Shahasra Yoga, Sanskrit – Hindi Version, Published by CCRAS - 1990, Page – 261

Received on 01.10.2020 Modified on 19.10.2020

Res. J. Pharmacology and Pharmacodynamics.2020; 12(4):147-150.

DOI: 10.5958/2321-5836.2020.00027.0