A A M J Anveshana Ayurveda Medical Journal

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1 A A M J Anveshana Ayurveda Medical Journal ISSN: Research Article A Case Report on Parkinson s Disease Remya. E 1 N. Subhash Babu 2 Mandip Goyal 3 A b s t r a c t Parkinson s disease is one of the most common extra pyramidal disorders seen in clinical practice. Presence of bradykinesia along with any of the 3 cardinal signs i.e. rest tremor, rigidity and postural instability suggests PD. If untreated, progress of the disease is steady and relentless and at present, there is no permanent cure for PD. Rāsnā Daśamūla Ghrita, mentioned in the treatment of Vātika Kāsa was also found to be effective for neurological disorders like Sarvāngaroga, Ekāngaroga, Śirakampa etc. Efficacy of Rāsnā Daśamūla Ghrita in the management of Parkinson s disease was evaluated on the basis of a case study which was conducted in Inpatient Department of Kayachikitsa, Govt. Ayurveda College; Thiruvananthapuram. Snehapāna, Virechana and Śamana Snehana were the treatment methods adopted here. Symptoms were analyzed before and after the treatment and during follow up after 2 weeks. Differences were evaluated using Unified Parkinson s Disease Rating Scale. The results of the study were encouraging. Relief of bradykinesia & tremor during Snehapāna & aggravation of complaints during Śodhana were observed. Different concepts of Ayurveda about the disease & rationale of selection of the drug were also discussed. Key words: Parkinson s disease, Rāsnā Daśamūla Ghrita, Unified Parkinson s Disease Rating Scale 1 Phd Scholar, 2 Professor, Department. of Kayachikitsa, Govt.Ayurveda College, Thiruvananthapuram, 3 Associate Professor, Department of Kayachikitsa, Institute of Post Graduate Training and Research Institute in Ayurveda, Gujarat Ayurved University, Jamnagar CORRESPONDING AUTHOR Dr. REMYA E Ph.D. scholar, Department of Kayachikitsa IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat, India drremyaenair@gmail.com AAMJ / Vol. 2 / Issue 3 / May June 2016

2 INTRODUCTION Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported ; with a propensity to bend the trunk forward and to pass from a walking to a running place ; the senses and intellect being uninjured. - The first description about shaking palsy by Dr. James Parkinson in 1817, which became famous as Parkinson s disease in later life i. Parkinsonism is a syndrome consisting of a variable combination of tremor, rigidity, bradykinesia and a characteristic disturbance of gait & posture. Parkinson s disease is a chronic, progressive, neuro-degenerative movement disorder in which idiopathic Parkinsonism occurs without evidence of more widespread neurologic involvement. Parkinson s disease (PD) generally commences in middle or late life and leads to progressive disability with time. Disease affects approximately 2 of every 1000 people & 2 per 100 among people older than 65 years. The disease is more prevalent in age group of years. Clinical diagnosis of PD is made from history and clinical examination. The natural course of this disease is steady progression over years. It is also associated with an increased risk of death, usually from complications such as immobility, pneumonia, vascular diseases or neoplasm. PD reduces life expectancy by an average of 3-9 years. This disease is now turned as the 14 th leading cause of death in US. As far as modern medicine is concerned, there is no known cure for PD. None of the currently available treatment can halt or even slow the loss of neurons in PD. The side-effects of available treatment as well as its financial burden are not at all satisfactory. Nowadays more PD patients are opting for Ayurvedic management due to dissatisfaction in modern regimes at the level of cure & complications. Even though many Ayurvedic treatment modalities were in practice, data is scattered here and there due to lack of proper documentation. In Inpatient Department of Kayachikitsa, Govt. Ayurveda College, Thiruvananthapuram, an alternative drug Rāsnā Daśamūla ghrita was used for Snehana (Oleation) at various levels to study its efficacy in the management of PD and the results were encouraging.. This article aims at analyzing the effects with the help of modern symptomatology & also to throw light to the probable mode of action of the drug within the concepts of Ayurveda. MATERIALS AND METHOD Place of Study: Department of Kayachikitsa, Govt. Ayurveda College, Thiruvananthapuram, Kerala Case study A 48 year old male patient, was admitted to the Inpatient Department., Department of Kayachikitsa, Govt. Ayurveda College, Thiruvananthapuram, Kerala with chief complaints of 1. Slowness of all activities 2. Tremor on action 3. Rigidity 4. Generalized body ache and discomfort Patient has been suffering from above complaints since 3 years. History of Present illness The patient was apparently normal 3 years back. After that he had developed pain and tremor over left upper limb which increases on activities. Gradually his right upper limb was also affected and he had difficulty in performing day to day activities like brushing, bathing, combing hair etc. Later on he has developed resting tremor, pain and stiffness of whole body. All activities became slowed and he couldn t roll over bed too. Drug History He was under Syndopa plus for 2 ½ years & stopped 3 months before the hospital admission due to dyspepsia. Examination findings T Tremor (Pill-rolling trmor) R Rigidity (Cog-wheel rigidity) A Akinesia/ bradykinesia P Postural instability Masked facial expression (Hypomimia) Low volume, monotonous speech (Hypophonia) Short rapid steps in shuffling manner with decreased arm swinging (Festinant gait) Disturbed fine motor control Micrographia Drenching sweats AAMJ / Vol. 2 / Issue 3 / May June

3 Personal History Appetite : Moderate Bowel : Constipated Micturition : Normal Sleep : Disturbed Height : 172 cm Weight : 78kg Pulse Rate : 84/min BP : 130/80 mmhg Diagnosis : Parkinson s disease Assessment Criteria : UPDRS UPDRS is a rating scale, consisting of 42 points with 0-4 scoring pattern under four headings I. Mentation, Behaviour and Mood II. III. IV. Activities of Daily Living Motor examination Complications of Therapy Conceptualisation of PD in terms of Ayurveda (i) Kaphāvritha Vyāna ii : Vāta Esp: VyānaVāta in its natural state is responsible for all the activities of body. When Vyāna becomes Āvrita (Occlusion) by Kapha, it fails to perform its functions & thereby slows down the bodily activities. Features of this condition is similar to Parkinson s disease like Parva Asthi Vāk Graha ( Stiffness of joints, dysarthria), Anga Guruta ( Heaviness of body), Skhalitha Gati (Gait instability) (ii) Kampavāta iii : Basavarājiyam has given complete symptomatology of Kampavāta which is nearer to Parkinson s disease such as Kara pāda tala kampa (Tremor of hands and feet), Deha bhramana dukha (Difficulty in locomotion), Kshīna mathi (Cognitive impairment). Stambha & Kampa together seen as a symptom of (iii) Hīna Pitta & Vridha Vāta Kapha iv (iv) Sarvānga Vāta v (v) Snāyu Gatha Vāta vi Treatment Protocol The treatment protocol assigned for this patient was Snehapāna and Śamana Snehana with Rāsnā Daśamūla Ghrita and Virechana Table 1. Treatment Protocol Treatment Drug of Choice Dose Duration Dīpana and Pāchana Gandharvahasthādi Kaśāya, Vaiśwānara Chūrna 3 days Snehapāna Rāsnā Daśamūla Ghrita Started with a dose of 50ml & increased upto 250ml 7 days Swedana Abhyanga with Balātaila and Ūśmasweda 3 days Virechana Gandharveranda Taila 40ml Peyādi Krama 7 days Śamana Snehana Rāsnā Daśamūla Ghrita 25ml Twice daily for14 days AAMJ / Vol. 2 / Issue 3 / May June

4 OBSERVATIONS AND RESULTS Dīpana Pāchana Snehapāna Virechana Table 2. Test of Cure Good appetite Bradykinesia & tremor relieved. 2 min freezing reduced to 1 min. Can brush within 15 min. Buttoning is possible Both resting & action tremor increased Śamana Snehana Tremor relieved significantly. Wear slippers without negotiation. Slipper grip improved. Hypertonia & hyperhydrosis relieved significantly. Follow up after 2 weeks Tremor increased slightly. Improvement in bradykinesia was Maintained Symptoms were found to be considerably relieved during Snehapāna and Śamana Snehana, More significant relief was marked during the period of Śamana Snehana. But the complaints were aggravated after Virechana. It may be due to the Vāta Kopa occuring during Virechana. Difference in symptomatology were assessed on the basis of Unified Parkinson s Disease Rating Scale (UPDRS) vii. UPDRS Score Table 4. UPDRS Score Before treatment After treatment Follow - up after 2 weeks This showed considerable reduction in the score after treatment and also maintenance of state of wellness during follow-up also. Pathya (Regimen to be followed) Rice, Wheat, Green gram, Green Vegetables, Fruits, Milk, Ghee Adequate sleep at night Brisk walking and light exercises Evacuation of urges like Urine, Feces etc. at proper time Apathya (Regimen to be restricted) Oily, fried, spicy food items, fast food, ice cream, cold drinks, curd, bread, biscuit Suppression of natural urges Stress and strain Alcohol, tobacco, tea, coffee DISCUSSION Preparation of Rāsnā Daśamūla Ghritha Rāsnā Daśamūla Ghritha is mentioned in the context of Vātika Kāsa viii and its Vishesha Phalasruthi is Śirakampa (Titubation) & Sarvanga Ekanga Roga (Neuro - muscular disorders). Ingredients Quantity Indication Rāsnā Daśamūla Śatāvarī Kulatha Badara Yava Ajamāmsa Ghrita Kshīra Jīvanīya gana 1 Pala 1 Pala 1 Pala 8 Pala 8 Pala 8 Pala 50 Pala 64 Pala 64 Pala 1 pala Pancha Kāsa, Śirakampa, Yoni Vamkśana Vedana, Sarvānga Ekānga Roga. Plīha, Ūrdhva Anila As per Ayurvedic Classics, symptoms of Parkinson s disease can be correlated with conditions like Kaphāvritha Vyāna, KampaVāta, Hīna Pitta and Vriddha Vāta Kapha, Sarvānga Vāta, Snāyugatha Vāta etc. In the present case study, symptoms were showing more similiarity with Sarvānga Vāta. Hence, the treatment principle adopted was Vātavyādhi Chikitsa ie. Snehana, Swedana and Śodhana. Snehana, both Śodhanapūrvaka and Śamana Snehana were carried out with Rāsnā Daśamūla Ghrita, which was mentioned in Kāsa Chikitsa. Rāsnā Daśamūla Ghrita is indicated for Vyadhis having Pratilomata of Vāta eg: Pancha Kāsa, Yoni Vamkshana Vedana, Urdhvanila and it contains Daśamūla, Kulatha, Badara and Yava, which are more pronounced in the management of Marmasritha (Vital points) Rogas esp. Trimarmas Shira (Head), Hridaya (Heart) & Vasti (Urinary bladder) Vātika Hridroga, Mūtrakrichra ix, Apatantraka x, Vātavyadhi & also present in Yogas like Balātaila xi, Dhānwantara Ghrita xii, AAMJ / Vol. 2 / Issue 3 / May June

5 Dadhika Ghrita xiii. Ajamāmsa (Meat of goat) is having the property of Sarīra Dhātu Sāmānyatwa xiv (Similarity with human tissue). Jīvanīyagana as such is Prīnana Brimhana and Jīvana (Nourishing), which may help in the regeneration of the neurons. Ghrita kalpana easily crosses blood brain barrier and therefore produce desirable action satisfactorily. It can also be assumed that this drug may be more effective for PD of infectious origin as the Phalasruthi denotes TB spectrum of diseases. Relief of symptoms and improvement in Quality of Life of the patient patient has laid strong evidence for the efficacy of Snehana with Rāsnā Daśamūla Ghrita and the treatment protocol including Snehana, Swedana and Śodhana in the management of Parkinson s Disease. The experiment can be repeated with larger populations & long term follow up to provide more scientific evidence. Efficacy of different modes of applications such as Nasya (Nasal drops) & Basti (Enema) can also be evaluated and similar studies may be conducted with Taila Kalpana of Rāsnā Daśamūla Ghrita Remya., et.al., : A Case Report on Parkinson s Disease CONCLUSION So far this disease is concerned, the aims of treatment should be 1. Relief of rigidity, tremor & bradykinesia 2. Correction of mood changes 3. Pacification of other symptoms These desirable effects were obtained in a satisfactory level & Quality Of Life was improved with Snehana with Rāsnā Daśamūla Ghritha. This work will provide basis for further research in this topic. ΛΛΛΛ AAMJ / Vol. 2 / Issue 3 / May June

6 REFERENCES i i. KV Krishnadas, Textbook of medicine, 5 th Edition, Chapter 191, Page no: 1258, Jaypee Brothers Medical Publishers (P) Ltd, Reprint 2014, ISBN ii ii. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Nidanasthana, 16/32, Chaukhambha Sanskrit iii iii. Basavaraja Basavarajeeyam, Asheetivatavivaranam, Shashta prakaranam, Chaukhambha Samskrita Prathishtan, Delhi iv iv. Chakrapanidatta Ayurveda Deepika commentary on Charaka Samhitha, Sootrasthana 17/56, Choukhambha Orientalia, Varanasi, Reprint 2011 v v. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Nidanasthana, 15/15, Chaukhambha Sanskrit vi vi. Dalhana Nibandha sangraha commentary on Susrutha samhitha, Nidanasthana, 1/26, Chaukhambha Sanskrit Samsthan, Varanasi, Reprint 2013 vii vii. Fahn S, Elton R, Members of the updrs Development Committee. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds. Recent Developments in Parkinson s Disease, Vol 2. Florham Park, NJ. Macmillan Health Care Information 1987, , viii viii. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Chikitsasthana, 3/6, Chaukhambha Sanskrit ix ix. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Chikitsasthana, 11/19, Chaukhambha x x. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Chikitsasthana, 21/28, Chaukhambha xi xi. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Sareerasthana, 2/47-52, Chaukhambha xii xii. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Chikitsasthana, 12/19-24, Chaukhambha xiii xiii. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Chikitsasthana, 14/13-20, Chaukhambha xiv xiv. Arunadatta: Sarvanga Sundara Commentary on Astanga Hrdaya Sootrasthana, 6/63, Chaukhambha Sanskrit Source of Support: Nil. Conflict of Interest: None declared How to cite this article: Remya., et.al., : A Case Report on Parkinson s Disease AAMJ 2016; 3: AAMJ / Vol. 2 / Issue 3 / May June