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PARKINSON’S DISEASE- An Ayurveda view - Dr. Hiba Ismail

Parkinson’s disease (PD) is an age-related neurodegenerative disorder with progressive degradation of dopamine production in substantia nigra. Parkinson's disease known as Kampavata in Ayurveda is a slow progressive neurological disorder of late adult life fourth most prevalent neurological disorders found in elderly. This disorder affects 1% of the population over the age of 65 and is associated with degeneration in dopaminergic nigro striatal neurons. It is reported that 60- 80% dopaminergic neurons are lost before the motor signs of PD occurs. Because of its crippling nature and non-availability of curative treatment, this disease has remained a great problem in t h e ageing society. In Western medical world the diseases was described in 175 AD by physician Galen under the name “Shaking Palsy” and then in 1819 James Parkinson gave a detailed description of the disease and then after disease is named after him.

PARKINSON'S DISEASE IN AYURVEDA LITERATURE

According to Ayurveda most of the diseases of vata are degenerative disorders of nervous system. 80 types of vatic disorders are described in Ayurveda texts. The Parkinson’s disease is comparable to Kampavata, which is categorised among nanatmaja disorders of Vata.

  • Charaka Samhita

    • Vepathu has been considered under Nanatmaja disorder of Vata. Many other references regarding the Kampa are available in the name of Vepathu, Vepana, Prevepana. The main symptoms of the disease viz. Kampa( tremor) and Stambha are found in some pathological conditions of Vata Vyadhi. The decreased Vata affecting the Marma cause Vepana.This concept provides understanding for the pathology of tremors relating to brain

    • Stambha in symptoms of vitiated Vata and explained that Stambha is a disorder of Snayu. Charaka mentions that the conditions where Pitta is decreased and Kapha and Vata are increased then they produce symptoms like Kampa and Stambha.

    • Avarana of Vyana and Udana by Kapha produces symptoms likeGatisanga, Vakswaragraha, Gurugatrata, Stambhana and Kampanam. In Shirahkampahas been considered as one of the most important disease of Shirah and Nasya has been advocated.

  • Sushruta Samhita

    • Stambha and Kampa are mentioned in Snayu Prapta

    • Vepathu is also a long term complication of Dusivisha

    • Excessive use of Katu, Tikta Rasa.Trauma in Pranavaha Srotasa can also produce the similar symptoms

  • Ashtanga Sangraha

    • Kayasya Vepathu as symptom of ageing and Kampa is noted in Raktakshaya, Pittakshaya and Kaphakshaya condition.

  • Madhava Samhita

    • Vepathu in Vatavyadhi chapter which is characterized by Sarvanga Kampa (tremors all over body) and Shirokampa (tremors in head).

  • Commentator Vijayarakshita

    • Shirokampa, tremors of limbs

PARKINSON'S DISEASE IN AYURVEDA LITERATURE

Although aetiology of the disease not well known. PD is believed to be due to a combination of genetic and environmental factors. The factors as accelerated ageing, neurodegenerative changes, increased free radical and iron content in the Substantia Nigra repeated head injury, environmental factors as pesticides, contribute in the pathogenesis of this disease.

In Ayurveda Kampavata is described as a Vataja disorder, so the causative factors of Vata Vyadhi can be considered as etiological factors of Kampavata. They are reviewed and reclassified as Kashayanna (Astringent taste), Katvanna (Acrid taste), Tiktanna (Bitter taste), Abhojana(starvation), Alpasana , Pramitasana ( less quantity food). running), Atiprajagara (Excessive awakening), Ativyavaya(Excessive sexual intercourse), Ativyayama (Violent exercise) , Dhatukshaya(Loss of body elements) Atiyoga of Stambhana and complication of Vamana Karma, symptom or complication of Vataja Ardita (B.P.Vatavyadhi). Dalhana Mentions Kampa as Kalabalapravritta disease which signifies age related pathology of disease. Vagbhata observes tremor and flexion posture as symptoms of aging. Vepathu is the symptom of second VishavegaPoisoning due to Kalakuta nad Mustkaa manifest as Gatrastambha or rigidity and Vepathu or tremor. Vepathu is a long term complication of Dushivisha. alkaloids (reserpine), tetrabenzene, procaine cause reversible Parkinsonism. They all can be included in Ayurvedic concept of Vish a. The dietary factors resposbile for disease relates to undernourishment, elderly persons are frequently devoid of essential dietary factors both in terms of macro and micronutrients especially vitamin B 12, B6, folic acid and Omega 3 fatty acids. Researches have proved the relation of dietary deficiencies and hyperhomocysteine, a mitochondrial poison.reponsible for increased risk for Parkinson's disease. Schwab et al. 1950 propounded the concept of stress as crucial trigger for initiation of disease and suggested that chronic anxiety might conceivably cause rigidity and mild obsessional personality traits. So it is concluded that Ayurvedist reached near to the understanding of etiology of Kampavata (Parkinson's disease).

SYMPTOMS OF PARKINSON'S DISEASE IN AYURVEDA

The main clinical presentations in Parkinsonism are bradykinesia, tremor and rigidity and postural instability. In Ayurvedic classics, the diseases mentioned in a similar fashion are shirakampa, kampavatha and vepathu. The symptoms of PD according to aetiopathogenic mechanisms of Ayurveda is discussed for better understanding of the disease.

Kampa is described as Venpanam Ekdeshe Vyakta Kampanam . Kampa is a disorder of Vyana vayu and the increase in its chala property results in Kampa. Caraka mentions that, in condition where Pitta and Kapha are in stage of diminution, the increased Vata affecting the Marma (Vital parts ) does away with consciousness and causes trembling in the patients29. This concept provides a base for understanding pathology of tremor relating to brain. Onset of Parkinson’s disease is typically asymmetric with the most common initial finding being an asymmetric rest tremor in an upper extremity. Often attributed to spontaneous oscillatory behavior of group of neurons within the CNS.Vyana actually carries out all the movements, so it is direct cause for movement like Utkshepana, Apakshepana, Akunchana , Prasarana thus disturbance in the function of this Vayu leads to disordered movements. Kapha by its Manda, Guru Property causes slow all the movements' during the process of Avarana.

Chestasanga has been described as symptom of Pittavritta Vyanawhen Vata and Pitta are in state of diminution, the Kapha obstructs the channels and give rise to loss of activity i.e. Chehtapranash. Trauma to Snayu can head to the proverty of movementwhile trauma to head can produce the symptoms like Chestanasha, Spandana. In Kampavata the functions of Prana, Vyana, Udana are impeded by Avarana of Kapha resulting in Cheshtasanga.

Stiffness (Sthairya) And Coldness (Saitya ) which are the attributes of Kapha. This implies the predominance of Kapha in the pathogenesis of this disease. Stambha is also a sign of Avarana of Vyana Vata in compassed by Kapha give rise to stiffness of the body.

CLINICAL MANIFESTATION

  • Bradykinesia

  • Masked Face

  • Pill Rolling Movements

  • Lack Of Postur e

  • Festinating Gait

  • Stooped Posture

  • Drooping Of Saliva

  • Hyperkinesia.

  • Autonomic Dysfunction

  • Depression, Psychosis

  • Rigidity

  • Monotonous Soft Voice

  • Aches And Pain In Body

  • Absence Of Arm Swing

PATHOPHYSIOLOGY OF PARKINSON'S DISEASE IN AYURVEDA

Ayurveda as holistic system of medicine considers whole body physiology by explaining the physiology of body in terms of Tridosa(Vata, Pitta, Kapha), the three biofactors. The applied aspect considers Vata to represent neuroscience in Ayurveda. It has five major types or components- Prana,Udana, Samana and Apana responsible for neurophysiological functions in the body. Wide variety of etiological factors including tissue degeneration and damage (dhatu kshaya) and neuro obstructive diathesis(margavarana) disturb the equilibrium of Vata leading to development of 80 types of Vata disorders.

The eiopathogenesis of PD is not precisely known yet. Specific etiology of PD is related to aging and ageing related neurodegeneration related to oxidative and nitrosative street mediated free radicals. The brain is the most susceptible organ to oxidative damage. Reactive microglias, which produce wide array of proinflammatory and neurotoxic including cytokines and eicosanoids that subsequently induce inflammation mediated death of dopamine containing neurons. The initial free radical mediated injury in the substantia nigra of the brain followed by programmed cell death may underlie the pathogenesis of Parkinson's disease. There is no specific genetic component involved in most of the cases except mutation in alpha synuclein in some cases of PD. Exposure to environmental chemicals causes damage to brain cells and basal ganglion.

In Ayurvedic classics, the etiological factors of Vata Vyadhi described. Parkinsons disease resembles kaphavritha vyana and udana in many stages of the disease. Chalatva is the karma of Vata. It is being normally contributed by the normalcy in gunas of Vata dosha such as rooksha, seetha, laghu etc. The fractions of Vata the cheshta and gati is the property of vyana vata.The bala is the contribution of Udana Vata. In Parkinsonism, both the functions of Udana Vata and Vyana vata seems to be deranged. As for the status of doshas, it is concered it is seen that for the symptoms of this disease to manifest, Vata is vridha or kupitha, Pitta is ksheena and Kapha is vridha and kupitha again. The dhatus, there is involvement of rasa ie. rasakshaya. The updhatus involved in the pathology are snayu and to an extend sira. Here, the avritha dosha is kapha and the avaraka are the udana vatha and vyana vathaCheshtahani as well as gatisanga is the feature of kaphavritha vyana. Postural instability is also the manifestation of kaphavrita udana. Vakgraha or dysarthria is seen in both kaphavrita vyana and udana. In the later stages of the Parkinson’s disease, higher mental functions, mainly memory is impaired and also cognitive and mood disturbances are on the rise. Here we can assume the involvement of prana vatha in the samprapthi in this stage.

MANAGEMENT APPROACHES

  1. Prevention

    1. Balance diet is primarily recommendation .Use sali (old rice), godhuma (wheat), citrus fruit, vegetable, nuts, milk and milk products, dadima (pomegranate), nimbu (lemon), mango, orange, guava, apple, peach, garlic, asafoetida, sprout etc.

    2. Avoid yava (barley), peas, puga (arecanut), jambu (jamun), excess protein diet, hot spicy food and incompatible food article.

    3. Practice regular aerobic exercises, yoga and meditation.

    4. Judicious use of anti-psychotics or any other medication under close supervision of doctor.

  2. Medical

    1. Line of treatment Ayurvedic treatment for this condition centres around the treatment of vata disturbance.

    2. Nidana parivarjana (avoidance of aetiological factors) - Modifiable causative factors like environmental toxins, drugs, head injuries, infections should be avoided.

    3. Vangasena Samhita: For the first time stared the principles of the treatment of Kampavata. It has been asserted that, Abhyanga, Sweda, Nasya, Niruha, Anuvasana, Virechana and Shirobasti are the useful measures for the Samsodhana chikitsa (Bio-cleansing therapies) followed by shamana chikitsa (Palliative therapy) should be advocated.

    4. Snehana (Oleation): Gentle massage with medicated oils such as:Mahanarayan taila, Ksirabala taila, Sahacharadi taila, Dhanvantara taila, Mahamasa taila, Bala taila

    5. Sarvanga sveda (Steam bath) / Patrapinda sveda for 3-7 days.

    6. Matra Vasti with Sahacaradi taila 50 ml with Saindhava lavan and Satpuspa daily for 15-21 days.

    7. Nasya karma/ Brmhana nasya with Purana ghrita (old ghee)/ Narayan taila /Kshirbala taila Mashadi Kwatha Nasya 8-8 drops in both nostrils for 7 days.

    8. Sirovasti with medicated oils (Kshirbala taila, Mahamasa taila, Mahanarayan taila) daily 45 minutes for 7 days.

    9. Sirodhara with medicated liquids (milk/water)/ oils (Kshirbala taila, Mahamasa taila, Mahanarayan taila) daily 45 minutes for 7 days.

  3. Drug therapy

    1. Kappikacchu beeja (Mucuna pruriens Linn ) 5-10 gm with milk

    2. Ashvagandha(Withania somnifera ) 3-5 gm with milk

    3. Brahmi (Bacopa monnieri )5-10 ml with water

  4. Yogic practice

    1. The following yogic practices are beneficial in Parkinson's disease; however, these should be performed only under the guidance of qualified Yoga therapist. Duration should be decided by the Yoga therapist.

    2. Practice of Pranayama (Anuloma viloma, Nadi shuddhi, Bhramari) and meditation along with the practice of Yama and Niyama

    3. Asanas to correct the postural imbalances, weight bearing postures to manage the tremors

    4. Deep relaxation technique and Yoga Nidra.

Dr. Hiba Ismail

Tips For Parkinson's Patients
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