Ayurvedic management of Parkinson’s Disease - A Case Study

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[Find the meaning and references behind the names: Sri, Hassan, Long, Gopan]

CASE REPORT July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 309 Ayurvedic management of Parkinson’s Disease - A Case Study Anush N 1 , Yadu Gopan 2 , Lakshmiprasad L Jadhav 3 1 Post Graduate Scholar, Dept. of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India. 2 Assistant professor, Dept. of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India. 3 Professor, Dept. of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India. I NTRODUCTION 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 Address for correspondence: Dr. Anush N Post Graduate Scholar, Dept. of Kayachikitsa, Sri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India. E-mail: anushn 67@gmail.com Submission Date: 13/05/2024 Accepted Date: 27/06/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.7.48 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, LRRK 2, 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 A B S T R A C T 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 gaitrelated 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. Key words: Abyanga, Basti, Parkinson’s disease, Swedhana, Shamana

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[Find the meaning and references behind the names: Heart, April, Min]

Anush N et al. Ayurvedic management of Parkinson’s Disease ISSN: 2456-3110 CASE REPORT July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 310 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] C ASE R EPORT 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 2022 Healthy and asymptomatic November 2022 Observed mild tremors in left hand December 2022 Observed generalised weakness and tremors in both hands February 2023 Underwent conservative allopathic management April 2023 Admission 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 Pressure 130/90 mmHg Heart Rate 70/min Height 170 cm Weight 70 kg BMI 24.2 kg/m 2 Table 3: Physical Examination Gastro intestinal system Soft Abdomen, Non-Tender and No Organomegaly Respiratory system Symmetrical Chest, No added sound Cardio vascular examination S 1, S 2 heard, No Murmurs Table 4: CNS Examination Higher mental function Intact Muscle movements Coordination Poor Tandem walking Normal Romberg’s sign Normal Knee heel test Normal Finger to nose test Negative, patient was unable to do it with precision due to tremors Involuntary movements Resting tremors in right upper limb Tone Both Upper Limb - Rigid Power Both Upper Limb and Lower Limb - 4/5 Reflexes Both triceps, biceps - + Both knees - ++ Assessment Criteria Table 5: Hoehn & Yahrscale: Stage III Stages Description Stage I Unilateral involvement only with minimal or no functional disability Stage II Bilateral or midline involvement without impairment of balance

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[Find the meaning and references behind the names: Bala, Guna, Vega, Rasa]

Anush N et al. Ayurvedic management of Parkinson’s Disease ISSN: 2456-3110 CASE REPORT July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 311 Stage III Bilateral disease: mild to moderate disability with impaired postural reflexes; physically dependent. Stage IV Severely disabling disease; still able to walk or stand unassisted Stage V Confinement to bed or wheelchair unless aided Diagnostic assessment Table 6: MRI Brain Dated 31/04/2023 Diffuse age-related cerebral atrophy Normal study Diagnosis: Kampavata, Parkinson’s disease stage II, 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 Date Treatment 01/05/2023 Admitted 01/05/2023 - 02/05/2023 1. 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 03/05/2023 Sadyovirechana with Gandharvahastadi Erandataila - 60 ml + warm water No of Vegas: 7 04/05/2023 To 09/05/2023 1. Saravnga Abhyanga with Mahanarayana Taila + Shashtika Shali Pinda Sweda 2. Veshtana with Mahanarayana Taila to all four limbs 3. Niruha Basti with Yeshtimadhu Ksheerapaka 300 ml 4. Anuvasana Basti with Ashwagandha Bala Lakshadi Tail a - 70 ml 5. Cap Balamoola 4-0-4 before food with warm milk 6. Ekangaveera Rasa 1-0-1 after food with warm water R ESULT The condition of the patient improved with gradual course of treatment. Table 8 Before treatment After Treatment Hoehn and Yahr scale: Stage II with B/L involvement Hoehn 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 agerelated disorders. It offers Pushti (nourishment) and

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[Find the meaning and references behind the names: Shankar, Yadav, Ayu, Bali]

Anush N et al. Ayurvedic management of Parkinson’s Disease ISSN: 2456-3110 CASE REPORT July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 312 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 . 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, 19 th Edition, page no. 996 2 Kasper, Fauci, Hauser, Longo, Jameson, Loscalzo, Harrisons Principle of Internal Medicine, 19 th 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 14 th 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 28 th 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 13 th 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 2 nd 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

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[Find the meaning and references behind the names: Gopa, Nil, Med]

Anush N et al. Ayurvedic management of Parkinson’s Disease ISSN: 2456-3110 CASE REPORT July 2024 Journal of Ayurveda and Integrated Medical Sciences | July 2024 | Vol. 9 | Issue 7 313 9 K R Shrikantha Murthy, Bhavaprakasha of bhavamishra; Vatavyadi Adikara vol 2. 3 rd edition. Varanasi: Chaukamba Krishnadas Academy; 2005 verse 151-162 ******************************* How to cite this article: Anush N, Yadu Gopan, Lakshmiprasad L Jadhav. Ayurvedic management of Parkinson’s Disease - A Case Study. J Ayurveda Integr Med Sci 2024;7:309-313. http://dx.doi.org/10.21760/jaims.9.7.48 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/unported [CC BY 4.0]), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Agni, Ayu, Balya, Stambha, Rasayana, Pushti, Brimhana, Basti, Kshaya, Vatavyadhi, Koshtashuddhi, Dhatukshaya, Vatahara, Vataprakopa, Vatanulomana, Anuvasanabasti, Kampavata, Mahanarayanataila, Clinical feature, Shamanacikitsa, Case report, Swedana, Ayurvedic Management, Case study, Shodhana Chikitsa, Vataja Nanatmaja Vyadhi, Therapeutic intervention, Parkinson's disease, Ayurvedic intervention, Shamanaoushadi, Shodhana and Shamana, Sarvanga Abhyanga, Shashtika Shali Pinda Sweda, Neurodegeneration, Movement Disorder, Postural instability, Chala guna, Sadyovirechana, Ekangaveera Rasa, Abyanga, Balamoola, Hoehn and Yahr Scale, Brimhana Dravya, Resting tremor.