A review of Parkinson???s vis-??-vis kampa vata and a sample time study of the e
A review of Parkinson???s vis-??-vis kampa vata and a sample time study of the efficacy of Parkino, an Ayurvedic Formulation in the treatment
of Parkinson's disease
By
Baidyanath Research Institute
Done under the guidance of Prof R.H.Singh. Presented by Dr.K.G.Newton
Department of Kayachikitsa Shree Baidyanath Ayurved Bhawan
Institute of Medical Sciences Naini, Allahabad - 211008
Banaras Hindu University Phone- 0532-695220,697209.
Varanasi, India Email : query@baidyanath.org
Abstract
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Parkinson's disease is a chronic progressive disease of Extra-pyramidal system where voluntary movement is disturbed with appearance of involuntary movements and altered muscle tone. Parkinsonism is a syndrome characterized by hypokinesis, rigidity and tremor, the incidence rising along with increasing age. Though the aetiopathogeneis of this disease is not precisely known but it is understood to be caused by lesions in the basal ganglia and is associated especially with damage to the interconnecting system between substantia Nigra and Corpus stratum. Parkinsonism is associated with Dopamine deficiency. It is prevalent all over the world and has no definitive treatment except the palliative prescription of anti-cholinergics together with Levodopa and dopadecarboxylase inhibitor.
Ayurveda considers such movement disorders under Vata-Vyadhi. and in common practice, the term Kampa Vata is used to describe the syndrome. The strategy is to combat Vata Dosa and to sustain neuronutrition by Rasayana remedies.
This paper deals with the literature review of parkinson???s disease vis-??-vis kampa vata and also the present communication is based on a lead case study on Kampa Vata treated with the compound Parkino 20 ml. twice a day for 8 weeks. The response was assessed symptomatically in terms of subjective feelings of the patient, degree of involuntary movements and facial expressions. All the patients exhibited highly significant improvement in symptoms during first 2 to 4 weeks of treatment but during subsequent intervals no further improvement was noted. It is suggested to continue the trial for further observations on the efficacy of this drug.
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Introduction:
Parkinson's Disease is a slowly progressive disorder of the central nervous system that affects movement, muscle control and balance. Although the exact cause of Parkinson's Disease is unknown, research has concentrated on genetics, environmental toxins, endogenous toxins and viral infection.
In Parkinson's, cells are destroyed in part of the brain stem - the substantia nigra, which sends out fibers to the corpus stratia, gray and white bands of tissue in both sides of the brain. Cells there release dopamine, one of three major neurotransmitters (chemical messengers) which help the body respond to stress. By the time symptoms develop, patients have lost 80 to 90 percent of their dopamine-producing cells.
Symptoms include tremors, slowed movement and postural instability. Other features include rigidity, flexed posture, freezing phenomenon and loss of postural reflexes. Patients can experience depression, sleep disturbances, dizziness and problems with speech, swallowing and sexual functioning.
Since medications and other conditions can cause Parkinson's-like neurologic symptoms, diagnosis is critical and misdiagnosis is frequent. Medical science lacks an accurate blood or imaging diagnostic test for Parkinson's, though tests can exclude other conditions. Diagnosis is based on an evaluation of symptoms.
The progression of the disease varies from individual to individual, so treatment is also individualized. Treatment in modern science focuses on relieving disabilities. While there is no cure, therapies can minimize symptoms and maximize function and quality of life.
The usual treatment is a combination of levodopa and carbidopa (Sinemet). Levodopa, which treats neurochemical abnormality. However, over the years, its effectiveness can decline and its side effects, such as motor complications, can increase. Adjusted dosage can help but additional medications may be required. Because of levodopa's complexities, young people with Parkinson's often start with other treatments, reserving levodopa for later in the disease. Patients have other treatment options, including surgery. Transcranial magnetic stimulation is also being studied.
Parkinson's can impair quality and length of life, so its diagnosis and symptoms can devastate an individual and family, and patients often face depression. However, excellent physical therapies, and educational and support resources are available. Research is steadily improving quality of life and symptom control.
Incidence:
Parkinson's disease has been reported to affect approximately 1 percent of Americans over 50 years of age, but unrecognized early symptoms of the disease may be present in as many as 10 percent of those over 60 years of age.
Early-onset Parkinson's disease, which often affects persons in their 20???s, is receiving more attention because of its impact on employability. Epidemiological studies conducted in the United States have found that Parkinson's disease is more prevalent in men than in women (approximate ratio: 3:2).
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Clinical Presentation
The first step in evaluating a patient with problems suggestive of Parkinson's disease is to determine which components of motor control are affected. The patient's signs and symptoms are then clustered to determine whether the diagnosis is Parkinson's disease or another movement disorder.
Like some other CNS degenerative disorders, Parkinson's disease begins insidiously. Persons close to the patient may notice the problem before the patient does. The patient's facial expression may appear "depressed" or "apathetic," and the voice may become softer in volume and monotonous in tone. The patient may complain of muscular "weakness" or "stiffness." Involuntary movements, such as tremor or the turning in of a foot (dystonia), may become a problem. The symptoms may be noticed during routine activities, or they may be present only at certain times, such as when the patient is walking or writing.
In the initial stages of Parkinson's disease, many patients do not have movement problems. Instead, they may complain of anxiety and difficulty sleeping. However, signs of motor system dysfunction become apparent on neurologic and physical examination.
The clinical examination of a patient with possible Parkinson's disease should include a detailed evaluation of mental status, cranial nerves, motor tone, muscular strength, reflexes, coordination and sensation. Kinesis, posture, gait and habitual activities must be observed using physical examination maneuvers that best bring out the patient's motor dysfunction.
The hallmark physical signs of Parkinson's disease are tremor, rigidity and bradykinesia. Poor postural reflexes are sometimes included as the fourth hallmark sign. When postural reflexes are inadequate, patients may fall if they are pushed even slightly forward or backward, or if they are standing in a moving vehicle such as a bus or train
In Parkinson's disease, tremor typically occurs at rest but may also be present when the arms are raised (postural tremor). Tremor is not a pathognomonic sign because it can also occur with other movement disorders. Conversely, not all patients with Parkinson's disease manifest tremor, so the absence of tremor does not rule out the diagnosis.
"Cogwheel rigidity" refers to increased tone that is felt by the examiner as a ratchet-like resistance during passive range of motion. This sign may be present with or without tremor.
"Bradykinesia" means slowed movement and includes both non-volitional and volitional movements. The "masked facies" of Parkinson's disease is an example of slowed non-volitional movement. Because adjustments of posture to maintain balance require rapid activation of agonist-antagonist muscle groups, bradykinesia may be the underlying reason for poor postural reflexes in Parkinson's disease.
Stage-wise Development of PD.
Stage I Unilateral involvement only, minimum or no function impairment.
Stage II Bilateral involvement, without impairment of balance.
Stage III First sign of impaired righting reflexes, unsteadiness, functionally restricted but physically capable of leading an independent life.
Stage IV Fully developed, severely disabling disease, still able to walk and stand un-helped, but marked impairment is visible.
Stage V Confined to bed or wheel chair.
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Parkinson???s in Ayurved
Paralysis agitans. Described by James Parkinson in 1817, is independent re description of Kampa vata (Kampa;tremor, Vata metabolic derangement Predisposing to neurological and mental diseases) described in Ayurveda centuries ago. Various signs and symptoms associated with the disease such as akinesia, drooling, reptilian stare, tremor, constant somnolence, rigidity, and dementia were described in Caraka Samhita. A more clear definition. 'tremors of hands and feet, difficulty with body movements is described by Charak Samhita similar to Kampavata) '' is found in Basavarajiyam (1400AD). Several preparations containing Mucuna pruriens (Atmagupta) were described for treatment of patients with Kampavata. The major active compound present in Mucuna pruriens is levodopa. Levodopa is the major drug used in the treatment of Parkinson's disease. The evidence suggests that Parkinson's disease existed in ancient India under the name Kampavata and herbal preparations containing levodopa were administered to alleviate the symptoms of the disease centuries before such a drug came into modern medicine.
Ateio pathogenesis in Ayurved:
Kampa vata has been described in Ayurved under Vat Rogas.
Susruta defined this word Vata as ???Va gati gandhanyohu??? Su.Sutra 21 -5 .The meanings of the word "gati" are movement, moving, going etc. and of "gandhana" are intimation, information, hint etc. It is therefore clear from the definition that Vata is involved in two important functions
1)Movement 2) Information, also known as knowledge.
A reference from Charaka clearly indicates that Vata is responsible for all
activities of the body ??? ???Sarva hi chesta vatena sa pranaha praninam smrita???.
Vata is responsible for all activities of the body and in fact it constitutes the very life of
living beings.
A few of the important qualities of Vata described in Ayurvedic texts are
1. AMURTATVA :
This is explained by Chakrapani as Adrishyata i.e. invisibility (Chakrapani on Cha. Su.20-1 2). This particular quality is due to the predominance of the Akasa and Vayu Bhutas in its composition. (ASam.Su.20-3). Therefore Vata does not possess any corporeal form. Vata is also stated as Asamghata (Cha.Su. 1 2-3), indicating the absence of a corporeal form like pitta and kapha.
It is to be clearly understood that Vata cannot be perceived by the sense organs whose "Artha" is developed from either Agni, or Ap or Pridhvi Bhutas, indicating that Vata does not possess colour, taste and odour.
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2. ANAVASTHITA :-
Another important quality is Anavasthita (unstability) which is also qualified as Chalasvabhava" (mobility as a natural quality) (Chakrapani on Cha. Su 12-3). It is also stated that Vata moves very swiftly (Shigratvat-Cha. Vi. 8-98); as mentioned in Vataprakriti lakshanas
This quality of chalatva is directional in character. The word "Gati" also indicates the directional movement. In the chestavaha srotas (motor fibres), the Vata moves from Buddhi and Manas towards the muscles of Karmendriyas, Where as in Sanjnavahasrotas (sensory fibres) the movement is towards the Maras and Buddhi from the Jnanendriyas (sense organs). (In a living animal, impulses normally pass in one direction only from the cell body along the axon its termination). Due to its swift movement, Vata is instantaneous in action and radiates through the body in repetitive currents (Repetitive
discharges or rhythmicity occur normally in many of the neurons of the central nervous system).
For the maintenance of physiological function, Vata, should have Avyahatgati i.e., movement without any obstruction (Cha.Chi 28-4) indicating that any obstruction in its movement will lead to a pathological condition.
According to Ayurveda the main location of Vata is in the moordhini (Seat of Prana vata --- Sthanam pranasya moordho ) which is considered the life of human beings and it can be conclusively established that functional seat of Vata is the Mastishka (brain, central nervous system)
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NATURE OF MASTISHKA
Since it is known that the seat of Vata is Mastishka, it is important to understand its nature. The following points are pertinent to arrive at a conclusion.
The Siras contains Mastishka or Mastulunga and it is snigdha in nature.
The Mastulunga resembles the partly melted ghee.
Therefore the qualities of Mastishka should be snigdha, slakshna, guru, , picchilla, sandra etc. similar to those of a snigdha dravya. The snehaguna is the special quality of Ap bhuta and Apya dravya.
A sneha dravya possesses predominant qualities of both prithvi and Ap (Su. Su. 41-11). It may be-noticed that mastiska, the important seat of Vata possesses opposite qualities of Vata. It is a fact that the brain is rich in lipids and proteins, the former being relatively more in quantity. As between the gray matter and white matter, the latter contains more of lipids because of the presence of a large number of myelinated fibers in it. If the physical characteristics of nerve proteins especially the mucoproteins and lipids are to be described in Ayurvedic phraseology, they are basically snigdha, guru, slakshna, picchila and sandra.
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ASRAYASRAYEE BHAVA :
The Asrayee is Vata with the predominance of Akasa and Vaya Bhutas and the Asraya (brain) contains substances with the physico-chemical properties which reflect those of Pridhvi and Ap bhutas, It is therefore but natural that the constant use of Ahara, vihara and aushadhas possessing the Rukshadi gunas causes abnormal functioning of Vata by perhaps very minute alteration in the composition of its Asraya and thus creating an imbalance in the relationship between the Asraya and its Asrayee.
On the same analogy, the qualities of Mastishka should be opposite to those of Vata.
The similarities between the phenomenon of Vata and nerve impulse can be noticed from the following table.
VATA NERVE IMPULSE
1. Amurta ??? invisible 1. Invisible; not perceived by sense
no corporeal form. It is energy. Organs.
2. Anavasthita/chalatwa 2. It is conducted in one direction from
it is mobile from the neuron through axon to its
termination.
3. Swayambhu 3. self origination in the neurons of
self originated and self- CNS and self propagated
propagated in nerve fibre.
4. Sukshma ??? capable of passing 4. Passes through a nerve fibre of even
through smallest channels of one micron in diameter.
5. Sheeghragati ??? swift movement 5. Moves in a nerve fibre some times
at a velocity of 100 metres/sec.
6. Avyahatagati 6. Obstruction in its movement leads
to pathological condition.
7. Functions of gati and 7. Motor and sensory functions.
Gandhana
A nerve impulse is possible only with the help of neurotransmitters released at the neuronal junctions. The release of neurotransmitters at the junctions help the smooth transition of nerve impulse.
Thus, Parkinson???s where there is a loss of cells producing these neurotransmitters can be compared to kampa vata, which is characterized by the disorder of Gati (movement).
Thus, in Kampa vata, the main place affected is the seat of vata, which is located in the brain and influences the whole body.
Formulation of Parkino :
1. Sahajan mool- Moringo pterygosperma
2. Bala panchang- Sida cordifolia
3. Aswagandha mool Withania somnifeta
4.Satavari mool Asparagus racemosus
5.Brahmi panchang Bacopa moniera
6.Shodit kupilu Strychnos nuxvomica
Pharmaco-dynamics ??? Mode of Action ??? treatment:
Kampa vata, being a disorder of Vata, therapy is aimed at the following levels
1. Vata samana
2. Rasayan
3. Medhya dravyas. Herbs having nootropic effects
As its already known that kampa vata is due to the derangement of vata and also that its prevalence is more in above 50 year subjects and that the main seat of involvement is the mastishka- it is clear that the therapy should be aimed at these three levels.
1. Pacifying the vitiated vata
2. Providing neuro-nourishment by rasayana dravyas
3. Nootropic effect of Medhyas
The formulation of Parkino is well balanced enough to deliver the above three functions.
The herbs like Sahajan mool, Shodit kupilu pacify the vitiated vata, where as aswagandha, satavari and bala are known for their Rasayan properties and brahmi is the well known medhya which has the nootropic action.
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Other therapies, which are useful in Parkinson???s, would be Sarvanga Abhyanga with mahamasha taila, Sastishali pindasweda, yapan vasti and physiotherapy along with counseling.
Short sample time study and conclusion:
Keeping this in view, a short sample time study was conducted under the guidance of Prof.R.H.Singh at BHU to evaluate the efficacy of the product Parkino. The initial observations in this study were remarkably significant. The effect of the formulation has been observed on a sample of 6 over a period of two months and the following three parameters were observed.
1. Involuntary movements
2. General sense of well being
3. Parkinson???s face.
These three parameters showed an improvement of 25-30 % by the end of first month and by the end of the second month all these three parameters have remained static and neither showed further improvement nor were deteriorating.
The following table in short records the result
Grade scores BT D- 15 D- 30 D- 45 D- 60
Involuntary
Movements 02 01 01 1.5 1.5
Patients feelings 02 01 01 01 01
Parkinson???s face 02 01 01 01 01
Thus it has been concluded that this significant improvement observed in these cases without any side effects is a remarkable achievement and would be the lead results for further clinical trials.
It has been advised that this medicine Parkino should be subjected to further randomized clinical trials to establish the efficacy of the product.
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Bibliography;
1. Agnivesa 1977 Charak samhita 5th Ed.Su Sthana ???5- Commentary by Kasinath
Shastry, Published by chowkamba ,Varanasi.
2.Ibid 1977 Su Sthana ???6,Verse 9-48
3.Ibid 1977 Su Sthan ??? 12 ,verse 8
4.Andrew P wickens 1982 The causes of Aging , United Kingdom
5.Bhava Mishra 1974 Bhavaprakash, Ed 8th .Commentary by Vishvanath shastry ,
Published by Motilal Banarsi Das, N. Delhi
6.Caleb E Finechew 1982 The biology of Aging
7. V.V.S.Shastry 1990 Tridosha and the phenomenon of Vata
8.Dwarakanath C 1986 Introduction to Kayachikitsa ,2nd Ed Pg.63-69 Published
by Chowkamba Orientalia, Varanasi
9.Elsiever 1979 The Biology of Senesence
10.Kart S Cary 1986 Aging and health, Biological and Social Perspective
11.Nicholas coni 1974 Lecture notes on Geriatrics,4th Ed Published by Blackwell
Scientific Publications
12. Oxford University
press 1984 Aging ??? The Facts ,Oxford
13.Singh R H 1998 Holistic principles of Ayurvedic medicne ,1st Ed .Published
by Chowkamba Sanskrit Prathistan ,Varanasi.
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