Comparative study of efficacy of ‘Mulakadi taila’-Basti and Nasya...

[Full title: Comparative study of efficacy of ‘Mulakadi taila’-Basti and Nasya in management of Kampavata w.s.r. to parkinson’s disease]

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67 Journal of Ayurvedic and Herbal Medicine 2016; 2(3): 67-72 Research Article J. Ayu. Herb. Med. 2016; 2(3): 67-72 May- June © 2016, All rights reserved www ayurvedjournal.com *Corresponding author: Dr. Shukla Mukesh B. Shukla Professor & Head of Department of Panchakarma, K.G.M.P. Ayurved Mahavidyalaya & Hospital, Netaji Subhash Road, Mumbai-400002, India Email: shukla 5 karma[at]gmail.com Comparative study of efficacy of ‘Mulakadi taila’-Basti and Nasya in management of Kampavata w.s.r. to parkinson’s disease Shukla Mukesh B. 1 , Dwivedi Amarprakash P. 2 1 Professor & Head of Department of Panchakarma, K.G.M.P. Ayurved Mahavidyalaya & Hospital, Netaji Subhash Road, Mumbai-400002, India 2 Professor, Department of Shalya Tantra, D.Y.Patil University School of Ayurveda, Navi Mumbai, Maharashtra- 400706, India ABSTRACT Tremors, bradykinesia and rigidity are the cardinal symptoms of Parkinson’s disease. The symptoms of the disease are bothersome to the patient because they affect the quality of life of the Patient. The main line of treatment in Parkinson's disease is administration of drugs affecting the dopaminergic system. Although they significantly reduce the presenting symptoms they cannot prevent the progression of the disease. Thus, there remains a need for a therapy which would also slow down disease progression and improve quality of life. The trail was undertaken to study the comparative efficacy of ‘Mulakadi Taila’ Basti and Nasya in management of Kampavata (Parkinson’s disease) by giving Mulakadi Taila Basti and Nasya in two groups of Patients. Mulakadi Taila from Gadanigraha is selected because Chikitsa siddhanta says that Vataja disorders can be treated with Sneha (Taila) incorporated with Vatahara dravyas. The principle constituents of this very balanced formulation are all Vata-shamak, Vatakapha-shamak or ‘Tri-Doshaghna’, and especially indicated in Vata disorders. The clinical assessment was done using Modified Universal Parkinson’s Disease Rating Scale. All symptoms were given scoring depending upon their severity from 0 to 4. The scores were subjected to ‘t’ test and it suggests significant difference after the treatment. Overall the results are a little better with Basti group. But, both the groups have their own areas of strength over the other group in certain symptoms. Hence, by changing the Mode of administration the treatment can be tailor-made as per the requirements of individual Patient. So far, our experience with treatment has been good and the results are encouraging Keywords: Mulakadi Taila, Basti, Nasya, Kampavata, Parkinson’s Disease. INTRODUCTION P arkinson’s disease belongs to the group of extra pyramidal neurological disorders [1] . It is a chronic progressive disorder in which idiopathic Parkinsonism (variable combination of Tremor, Rigidity and Bradykinesia) occurs, with a characteristic disturbance in Gait and Posture. 1 to 2 per 1000 of general population and 1 per 100 among people older than 65 years; (approximately 6.3 million people) are affected by Parkinson’s disease worldwide. Tremors at rest had been first mentioned as an independent clinical entity by Madhavakar in Madhav Nidanam in the 7 th century. He states that the tremors in the whole body and head caused by Vata are called ‘Vepathu’. ‘Kampavata’ was first described in Basavarajiyam with cardinal symptoms as Hastapadatale Kampa, Dehabhramana Deenata and Ksheenamati [2] . Parkinson’s disease is caused by an idiopathic degeneration of dopamine-producing cells in the substantia nigra [3] . The main line of treatment in Parkinson's Disease is administration of drugs affecting the dopaminergic system. These drugs significantly reduce the presenting symptoms but cannot prevent the progression of the disease. Also they have limitations regarding dosage and have their own side-effects. Thus there remains a need for a therapy which would also slow down disease progression and improve quality of life. Application of Ayurvedic principles on the pathology involved, reveal a distinct vitiation of Vata-dosha. The cardinal symptoms of Bradykinesia, Rigidity, Tremors and Speech defects indicate an involvement of Vyana and Udana Vayu; Majja, Mamsa, Meda and Rasa are the dhatus involved with Upa-dhatu Snayu; the type of Srotodushti involved is ‘Sanga’. This multi-factorial vitiation of V ata can be possibly normalized using the golden standard of V ata treatment – the ‘ Basti Chikitsa’. ‘Basti’ is stated to be ‘Ardha Chikitsa’ or ‘Sarva Chikitsa’; capable of curing half or all of the curable diseases [4] .

[Find the meaning and references behind the names: Bala, Pala, Bal]

J Ayu Herb Med ǀ Vol 2 Issue 3 ǀ May- June 2016 68 Nasya is an intranasal drug therapy, wherein medication is administered through the nasal route [5] . ‘Shiras’ or the ‘Uttamanga’ i.e. the ‘Mastishka’ is the chief seat of Prana Vayu and the Udana Vayu as well as the Indriyas , and the nose is said to be a doorway to it [6] . Hence, drug given by nasal route is known to be highly efficient on the central nervous system. ‘Mulakadi Taila’ is a formulation mentioned in ‘Gadanigraha’ is said to treat ‘Kampa’ along with other Vatavyadhis [7] . The principle constituents are ‘Bal Mulak’, Amlakanji, Dadhi and Godugdha which are all Vata-shamak, Vatakapha-shamak or ‘Tri-Doshaghna’ , and especially indicated in Vata disorders [8] . This combination when administered by the route of Basti acts directly on the Vata dosha , whereas given by means of Nasya is potent to act directly on ‘Shiras’ ( Uttamanga ) i.e. Central Nervous System. The interest of this study is oriented in analyzing the effects of ‘Mulakadi Taila’ on ‘Kampavata’ and also which route of administration of the formulation is more beneficial for the same. Kampavata can be limited by progressive, graded nourishment of all the seven dhatus, inclusive of the Majja dhatu . ‘Rasayana Chikitsa’ or the rejuvenation therapy; which can potentially revert or stall or delay the degenerative changes of aging; is a unique stronghold of Ayurveda [9] . Ayurveda is currently being viewed as a source of a disease modifying drugs and formulations. Naimittik Rasayana or the antidegenerative treatment in Ayurveda has drawn considerable attention of the world. Thus, this is a potent therapy which may delay the rate of disease progression. AIMS & OBJECTIVES: 1 To evaluate the clinical efficacy of ‘Mulakadi Taila’- Basti and Nasya in the management of Kampavata w.s.r. to Parkinson’s disease. 2 To compare effect of Basti and Nasyakarma in the management of Kampavata and to observe their probable mechanism of action. 3 To establish a potent modality for Parkinson’s disease by application of Ayurved Chikitsa Siddhanta . MATERIAL & METHOD Title of study: Comparative study of efficacy of ‘Mulakadi taila’-Basti and Nasya in management of Kampavata w.s.r. to parkinson’s disease. Type of Study: Open (Non blind) comparative clinical study. Place of study: Panchkarma Dept., K.G.M.P. Ayurveda Mahavidyalaya & Hospital, Mumbai. No. of patients: 10 (5 in each group) well diagnosed & established patients of Parkinson’s disease from IPD & OPD of Department of Panchakarma. Drug, Dosage and Duration: Mulakadi taila as stated in Gadanigraha are mentioned in Table 1. Table 1: Drug, Dosage and Duration in Group A and Group B Patients Institutional Ethical committee clearance reference number of trail :- KGMP/MUHS/PG (Dissertation/thesis)/1069 dated 3.12.2011 Group GROUP A- Mulakadi Taila Basti GROUP B- Mulakadi Taila Nasya No of patient 5 5 Dose 60 ml/day X 16 days [ 10] 5 ml/day in each nostril X 16 days [ 11,12] Time Pratahpashchatbhukta 12:30-13:30 Pratahkala 06:30-10:00 Procedure Basti (rectal route) Nasya (intranasal drug therapy ) Table 2: Ingredients of Mulakadi taila as described in Gadanigraha. Contents with latin name Matra in text Metric system (approx.) Mulak Rasa -Raphanus Sativus 1 Aadhak 3720 ml. Dadhi -Cow’s milk curd 1 Aadhak 3720 ml. Amlakanji -Sour gruel 1 Aadhak 3720 ml. Ksheer -Cow’s milk 1 Aadhak 3720 ml. Til Taila -Sesamum indicum 1 Aadhak 3720 ml. Rasna -Pluchea lanceolata 1 pala 48 gm. Bhallatak -Semicarpus anacardium Linn. 1 pala 48 gm. Saindhav -Sodii Chloridum 1 pala 48 gm. Pippali -Piper longum 1 pala 48 gm. Gajapippali -Scindapsus officinalis 1 pala 48 gm. Bala -Sida cordifolia 1 pala 48 gm. Ativisha -Aconitum heterophylum 1 pala 48 gm. Shunthi -Zinziber officinale 1 pala 48 gm. Chitrak -Plumbago zeylanica 1 pala 48 gm. Vacha -Acorus calamus 1 pala 48 gm. Gokshur -Tribulus terrestris Linn. 1 pala 48 gm. Drug Profile: Mulakadi taila as stated in Gadanigraha was prepared as per standard Tailpaka vidhi. The ingredient of Mulakadi taila are mentioned table 2.

J Ayu Herb Med ǀ Vol 2 Issue 3 ǀ May- June 2016 69 INCLUSION CRITERIA 1) Age group : Between 40 to 80 years 2) Gender : No barrier 3) Race & Religion : No barrier 4) Well diagnosed and established case of Parkinson’s disease. 5) Willing to give informed written consent. EXCLUSION CRITERIA 1) Parkinsonism other than Parkinson’s disease 2) Any other neurological disease 3) Hepatic Diseases 4) Cardiac Disorder 4) Koch’s Disease 5) Metabolic disorders 6) Pregnancy ASSESSMENT PARAMETER Objective Assessment: Parkinson’s disease does not have objective parameter of assessment, therefore assessment of efficacy depends entirely on clinical findings. Subjective assessment: Gradation as ‘Modified Universal Parkinson’s Disease Rating Scale’. OBSERVATIONS AND RESULTS I PRE-TREATMENT AND POST TREATMENT OBSERVATIONS WITH GROUP – A Table 3: Showing pre-treatment and post treatment observations with group - A. GROUP A-BASTI PRE - TREATMENT POST- TREATMENT 1 2 3 4 5 TOTAL 1 2 3 4 5 TOTAL I. DISORDERS OF COGNITION & MEMORY 1. Intelectual impairment 0 1 1 2 0 4 0 0 1 1 0 2 2. Thought disorder 1 1 2 1 1 6 1 1 1 1 0 4 3. Depression 2 3 1 3 1 10 1 1 1 3 1 7 4. Loss of Memory 2 2 2 2 1 9 2 1 1 1 1 6 II. AFFECTED ACTIVITES OF DAILY LIVING 5. Salivation 2 2 3 2 1 10 1 0 1 1 0 3 6.Swallowing 1 1 2 0 0 4 0 0 1 0 0 1 7. Handwriting 2 2 3 2 2 11 2 1 2 1 1 7 8. Cutting Food & handling Utensils 1 1 2 2 1 7 1 1 1 1 0 4 9. Dressing 2 1 2 3 1 9 1 1 1 2 1 6 10. Hygiene 2 1 2 2 1 8 1 0 1 1 0 3 11. Turning in bed, Adjusting bed clothes 1 1 3 1 1 7 1 0 1 0 0 2 12. Walking 2 2 3 2 2 11 1 1 1 1 1 5 13.Sensory complaints related to 0 0 0 0 0 0 0 0 0 0 0 0 Parkinson's Disease III. MOTOR EXAMINATION 14. Bradykinesia 3 2 3 3 2 13 2 1 2 2 1 8 15. Posture 2 1 2 3 1 9 1 0 1 1 0 3 16. Postural Stability 1 0 1 2 1 5 0 0 1 1 0 2 17. Rigidity 2 3 3 2 2 12 1 1 2 1 1 6 18. Gait 3 2 3 3 1 12 1 1 2 2 1 7 19. Falling 0 0 0 0 0 0 0 0 0 0 0 0 20. Freezing while walking 1 1 2 1 0 5 1 0 1 0 0 2 21. Tremors at rest 1 2 2 2 1 8 1 1 0 1 1 4 22. Action Tremors 2 2 3 3 2 12 1 1 1 2 1 6 23. Speech 2 2 2 3 2 11 2 1 1 2 1 7 24. Facial Expression 2 2 2 3 1 10 2 1 1 2 1 7 25. Finger taps 1 1 2 2 1 7 0 0 1 1 1 3 26. Hand Movements 2 1 3 3 2 11 1 1 2 2 1 7 27. Arising from Chair 2 2 3 2 2 11 0 1 1 1 1 4 28. Rapid Alternating Movements of Hand 2 2 3 2 2 11 1 1 1 1 1 5 TOTAL 44 41 60 56 32 233 26 17 30 32 16 121 COMPLICATIONS OF THERAPY Dyskinesia 0 0 3 0 0 3 0 0 1 0 0 1 Anorexia 0 0 1 2 0 3 0 0 0 0 0 0 Nausea, Vomitting 0 0 0 0 0 0 0 0 0 0 0 0 Insomnia/ Hypersomnolence 1 2 1 2 1 7 0 1 1 1 1 4 Symptomatic Orthostasis 0 0 0 0 0 0 0 0 0 0 0 0

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J Ayu Herb Med ǀ Vol 2 Issue 3 ǀ May- June 2016 70 II PRE-TREATMENT AND POST TREATMENT OBSERVATIONS WITH GROUP B Table 4: Showing pre-treatment and post treatment observations with group - B III PRE AND POST TREATMENT OBSERVATION WITH MULAKADI TAILA IN BOTH – GROUP A & B. The results obtained and statistical processing is as follows in table 5. Mulakadi Tail in Basti form was administered in Group A and in Nasya form in the second Group B. The drug administered in both the routes provided significant improvement in majority of cardinal and associated signs and symptoms of Kampvata . Mulakadi Tail has properties like Katu-Madhur Rasa, Madhur Vipak and Ushna Veerya . Sneegdha Guna and Strotoshodhan, Vibandhagna , Probable Balya, Brimhana, Rasayan and Vrishya , these properties alleviate vitiated Vata and due to Katu pradhan Rasa it acts as a Kaphahara . As Vata is main culprit in the pathogenesis of Kampavata , and that tremor is due to vitiation of Vata, specially that of Vyan Vayu by its Chal Guna and probably, due to Avarana of Kapha and/or Dhatukshaya , the formulation that holds Anti Vata- Kapha properties like Mulakadi Tail is desirable. The drug works against both Avarana and Dhatukshya pathology. This is a very rare property because properties of drug that act against Avarana and those acts against Dhatukshaya are seldom similar. GROUP B-NASYA MODIFIED. UPDRS PRE-TREATMENT POST- TREATMENT PATIENTS 1 2 3 4 5 TOTAL 1 2 3 4 5 TOTAL 1. Intelectual impairment 1 0 1 2 0 4 1 0 1 1 0 3 2. Thought disorder 2 1 2 2 2 9 1 0 1 1 1 4 3. Depression 2 2 2 3 3 12 1 1 1 1 1 5 4. Loss of Memory 1 0 1 2 2 6 1 0 1 1 1 4 5. Salivation 1 2 1 1 2 7 0 1 0 0 0 1 6.Swallowing 2 0 2 1 0 5 1 0 1 0 0 2 7. Handwriting 3 3 3 2 2 13 1 3 1 1 1 7 8. Cutting Food & handling Utensils 1 1 1 1 1 5 1 1 1 1 0 4 9. Dressing 2 3 2 1 1 9 1 2 1 1 1 6 10. Hygiene 2 3 2 1 1 9 1 2 1 1 0 5 11. Turning in bed, Adjusting bed clothes 2 3 2 1 1 9 1 1 1 0 0 3 12. Walking 3 3 3 2 2 13 2 2 2 2 1 9 13.Sensory complaints related to 0 0 0 0 0 0 0 0 0 0 0 0 Parkinson's Disease 14. Bradykinesia 2 2 2 1 1 8 1 1 1 1 0 4 15. Posture 2 1 2 1 2 8 1 1 1 1 1 5 16. Postural Stability 1 2 1 0 1 5 1 1 1 0 0 3 17. Rigidity 2 3 2 2 2 11 1 2 1 1 1 6 18. Gait 3 3 3 1 2 12 1 2 1 1 1 6 19. Falling 0 2 0 0 0 2 0 0 0 0 0 0 20. Freezing while walking 1 2 1 1 1 6 1 1 1 0 0 3 21. Tremors at rest 2 2 2 2 2 10 1 1 1 1 1 5 22. Action Tremors 2 3 2 3 2 12 1 1 1 2 1 6 23. Speech 2 3 2 2 2 11 1 2 1 1 1 6 24. Facial Expression 2 1 2 1 2 8 1 1 1 1 1 5 25. Finger taps 1 2 1 1 1 6 1 1 1 0 1 4 26. Hand Movements 1 2 1 2 2 8 1 1 1 1 1 5 27. Arising from Chair 2 2 2 2 2 10 1 1 1 1 1 5 28. Rapid Alternating Movements of Hand 3 3 3 2 2 13 2 2 2 1 2 9 TOTAL 48 54 48 40 41 231 27 31 27 22 18 125 COMPLICATIONS OF THERAPY Dyskinesia 0 0 0 0 0 0 0 0 0 0 0 0 Anorexia 0 1 0 2 1 4 0 0 0 0 1 1 Nausea, Vomitting 0 0 0 0 0 0 0 0 0 0 0 0 Insomnia/ Hypersomnolence 2 2 2 3 3 12 1 1 1 1 1 5

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J Ayu Herb Med ǀ Vol 2 Issue 3 ǀ May- June 2016 71 Table 5: Pre and Post treatment observation with Mulakadi Taila in both – Group A & B. PRE T/T POST T/T GROUP A PRE- T/T POST- T/T GROUP B Grp.A Grp.A D d/PRE*100 Grp. B Grp. B D d/PRE*100 TOTAL TOTAL In % TOTAL TOTAL In % 1. Intelectual impairment 4 2 2 50 4 3 1 25 2. Thought disorder 6 4 2 33.34 9 4 5 55.55 3. Depression 10 7 3 30 12 5 7 58.33 4. Loss of Memory 9 6 3 33.34 6 4 2 33.33 5. Salivation 10 3 7 70 7 1 6 85.71 6.Swallowing 4 1 3 75 5 2 3 60 7. Handwriting 11 7 4 36.36 13 7 6 46.15 8. Cutting Food & handling Utensils 7 4 3 42.85 5 4 1 20 9. Dressing 9 6 3 33.34 9 6 3 33.33 10. Hygiene 8 3 5 62.5 9 5 4 44.44 11. Turning in bed, Adjusting bed clothes 7 2 5 71.42 9 3 6 66.67 12. Walking 11 5 6 54.54 13 9 4 30.76 13.Sensory complaints related to PD 0 0 0 0 0 0 14. Bradykinesia 13 8 5 38,46 8 4 4 50 15. Posture 9 3 6 66.67 8 5 3 37.5 16. Postural Stability 5 2 3 60 5 3 2 40 17. Rigidity 12 6 6 50 11 6 5 45.45 18. Gait 12 7 5 41.66 12 6 6 50 19. Falling 0 0 0 0 2 0 2 100 20. Freezing while walking 5 2 3 60 6 3 3 50 21. Tremors at rest 8 4 4 50 10 5 5 50 22. Action Tremors 12 6 6 50 12 6 6 50 23. Speech 11 7 4 36.36 11 6 5 45.45 24. Facial Expression 10 7 3 30 8 5 3 37.5 25. Finger taps 7 3 4 57.17 6 4 2 33.33 26. Hand Movements 11 7 4 36.37 8 5 3 37.5 27. Arising from Chair 11 4 7 63.63 10 5 5 50 28. Rapid Alternating Movements of Hand 11 5 6 54.54 13 9 4 30.77 TOTAL 233 121 112 48.0686 231 125 106 45.88 Mulakadi Tail probably helps to tackle the Avarana owing to its Tikshana and Laghu Properties. Thus, it becomes Sookshma strotogami and act on deep seated Doshas. d = difference in signs and symptoms scoring Pre –Treatment and Post- Treatment d/Pre*100= relief percentage in signs or symptoms T/T= Treatment If H o = μ 1 = μ 2 i.e., There is no result in the symptoms after treatment. We have to reject H o , if t cal > t tab for 5% error, i.e., t cal > 2.05 t cal for these symptoms is 11.7967 for Group A and 11.325 for Group B. Therefore Hypothesis is rejected. Thus, it is statistically proven that this treatment shows results for symptoms of Kampavata . DISCUSSION Parkinson’s disease is a highly specialized area where the defined role of Ayurveda is not clearly known to the us. Most patients approach to the doctors of Indian system of medicine with a hope that their disease will be cured. Unregulated tall claims fuel this false perception creating a difficulty in explaining realistic outcome of the treatments to the patients. Due to an apparent lack of complete remission in the primary motor symptoms specially tremors and bradykinesia, the other possible long term benefits that the hebal medicine would provide are not known to all. With lack of proper understanding of the disease and with an attitude to expect complete or near complete cure, patient many a time fail to follow up and thus do not derive of the other benefits offered by the system. As stated earlier, the contemporary medicines definitely have their limitations in treating such challenging ailments. There is a definite need to reduce dyskinesias, and wearing off associated with Levodopa treatment and to improve non motor clinical features specially, constipation, hallucinations, depression etc and advocate agents that would confer neuro protection which is a challenging task for Ayurveda researchers too. As of now, the clinical trial has been conducted in 10 patients. Basti and Nasya were given to 5 patients in each group with appropriate Purvakarma as mentioned in texts for 16 days. Patients were assessed during and after treatment on the basis of the signs & symptoms of Kampavata (Parkinson’s Disease). Symptoms better managed in Basti Group: Intellectual impairment, Freezing while walking, Rigidity, Activities of daily living, Hand Movements, Rapid alternating movements of hands, Finger taps, Posture etc. Symptoms better managed in Nasya Group: Speech, Depression, Thought Disorder, Bradykinesia, Postural Tremors, etc. Probable Mode of Action Mulakadi Taila from Gadanigraha is selected because Chikitsa siddhanta says that Vataja disorders can be treated with Sneha (Taila) incorporated with Vatahara dravyas . The principle constituents of this very balanced formulation are ‘Bal Mulak’, Amlakanji, Dadhi and Godugdha which are all either Vata-shamak, Vatakapha-shamak or ‘Tri-Doshaghna’ , and especially indicated in Vata disorders.

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J Ayu Herb Med ǀ Vol 2 Issue 3 ǀ May- June 2016 72 It is a very balanced formulation wherein the drastic effects of one drug is counter-corrected by the opposite properties of the other, making it fit for wide usage in many Vataja Disorders along with Kampavata as stated in the text. It has Rasayana karma which can potentially reverse or delay the degenerative changes that are the indispensible part of this disease. Thus this can be a neuro protective therapy which may delay the rate of its progression. There is possible role of Naimittik Rasayanas in preventing and reversing complications, and potentially reduce the rate of neurological degeneration in Kampavata (Parkinson’s Disease). Its role in reducing the symptomatic manifestation of the disease and improving quality of life of the patient is also very important. LIMITATIONS OF STUDY Small Sample Size and Less Significant improvement in the para meters observed are the obvious limitation of present study. For the said trail, patients were approached at support group meetings of ‘Parkinson’s Disease and Movement Disorder Society- Mumbai’ held regarding possibility in Ayurveda for management of Parkinson’s disease. It was noticed that though patients were very curious to find out if there exists cure for disease in other system of medicine. Thus, opting for Ayurveda treatment is by and large the choice of patients themselves or by the close relatives. Further, unfortunately, the patients who were enrolled for the study, were not aware about the Ayurveda treatment modalities like Enema (Basti) or Intranasal drug therapy (Nasya). They had to be convinced regarding scope of Basti and Nasya treatment. Furthermore, the time and economical commitment of 16 days treatment on working days, travelling within the city in public transport in spite of their crippling disease needed constant motivation and support from the family members, such were the constraints of the outpatient administrations. In case of admitted patients, the daily bed charges added on to additional economical burden. Also, patients with Hoehn Yahr staging 4 and above needed full time attendant to stay with them. Arranging for the attendant was not feasible due to lack of supportive manpower and extra money for the same. This further, limited the sample size of patients in the study. Most of the patients in this study were retired people having meager income or pension, while few others were totally dependent on their family. This, further posed a problem of initial unwillingness in few, while others demanded miraculous outcomes of the treatment, having incurred the expenses. Such cases needed constant counseling and motivation while promoting only realistic possible expectations from the treatment intervention. In the presence of cognitive impairment and anxiety disorder, repetitive explanations and attempt to allay fears of the recruited patients had to be done. CONCLUSION Both the groups have their own areas of strength over the other group in certain symptoms. Hence, by changing the mode of Administration the treatment can be tailor-made as per the requirements of individual Patients. The clinical improvement provided by Mulakadi Taila Basti and Nasya reveals new availability in the management of Kampavata , so that the Quality of Life of the patients can definitely improved. As per our experience we have seen significant results. We recommend that this procedure should be done in cycles & should be further evaluated scientifically using the principles of neurology. REFERENCES 1 Davidson’s Principal and Practice of medicine by Nicolas A Boon, Nicky R. Colledege, Brain R. Walker, John Hunter,20 th Edition ,2006,page no.1218- 1219. 2 Charak samhita of Agnivesha, Elaborated by Charak and Drdhabala, Edited with Charaka-Chnadrika hindi Commentary along with special deliberation And Appendices by Dr. Brahmanad Tripathi, foreword by Dr. Ganga Sahay Pandey, Part -1, Chaukhamba Bhartiya academy, edition 2001. Cha.su 20/11, page 390.,cha. Su. 17/61 Page no. 349. 3 Davidson’s Principal and Practice of medicine by Nicolas A Boon, Nicky R. Colledege, Brain R. Walker, John Hunter, 20 th Edition, 2006, page no.1218-1219. 4 Charak Samhita of Agnivesha, Elaborated by Charak and Drdhabala, Edited with Charaka-Chnadrika hindi Commentry along with special deliberation And Appendices by Dr. Brahmanad Tripathi, forword by Dr. Prabhakar Janardan Deshpande, Part 2, Chaukhamba Bhartiya academy, edition 2001. Ch. Si 1/38-40,Page 1168. 5 Astanghahrdayam of Vagabhata edited with Vidyotini Hindi Commentary by Kaviraj Atridev Guota, edited by Vaidya Yadunandan Upadhyaya, Chaukhamba Prakashan, edition 2008,page no.171. 6 Astanghahrdayam of Vagabhata edited with Vidyotini Hindi Commentary by Kaviraj Atridev Guota edited by Vaidya Yadunandan Upadhyaya, Chaukhamba Prakashan, edition 2008,page No.171. 7 Vangasen Samhita of Vangase (Chikitsa Sar Sangraha) by Dr. Ravi Kumar Roy, editor Dr. Ram Kumar Roy, first edition 1983, Prachya Prakashan, Varanasi, Page no 295. 8 Vangasen Samhita of Vangase (Chikitsa Sar Sangraha) by Dr. Ravi Kumar Roy, editor Dr. Ram Kumar Roy, first edition 1983, Prachya Prakashan, Varanasi, Page no 295. 9 Charak samhita of Agnivesha, Elaborated by Charak and Drdhabala, Edited with Charaka-Chnadrika hindi COmmentry along with special deliberation And Appendices by Dr. Brahmanad Tripathi, forword by Dr. Ganga Sahay Pandey, Part -1, Chaukhamba bhartiya academy, edition 2001. Cha.su 20/11, page 390.,cha. Su. 7/47-48 Page no. 184. 10 Charak samhita of Agnivesha, Elaborated by Charak and Drdhabala, Edited with Charaka-Chnadrika hindi Commentary along with special deliberation And Appendices by Dr. Brahmanad Tripathi, forward by Dr. Prabhakar Janardan Deshpande, Part 2, Chaukhamba Bhartiya academy, edition 2001. Ch.si 4/52,53 page.1223. and ch.si 1/40, page 1170. 11 Sharangdhar Samhita of Acharya Sharangdhara, Jiwanprad Hind Commenrty, Dr. Smt. Shailaja Shrinivastava, chaukhamba orientalia, varanasi., addition 2009, sha. Ut 8 /25-27. Page no.402. 12 Bhaishyaratnawali of Kawiraj Govind Das Sen edited with Siddhiprad’ hindi commentary by Prof. Sidhi Nandan Mishra, Chaukhamba Surbharti Prakashan, Varanasi.edition 20011. Man paribhasha 2 nd chapter, page No.15. HOW TO CITE THIS ARTICLE Shukla Mukesh B., Dwivedi Amarprakash P. Comparative study of efficacy of ‘Mulakadi taila’-Basti and Nasya in management of Kampavata w.s.r. to parkinson’s disease. J Ayu Herb Med 2016;2(3):67-72.

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Dhatu, Indriya, Rasa, Avarana, Uttamanga, Dadhi, Balya, Mamsa, Medas, Udanavayu, Nasya, Vyanavayu, Snayu, Laghu, Vrishya, Pranavayu, Brimhana, Basti, Majjadhatu, Gadanigraha, Vatavyadhi, Kaphahara, Dhatukshaya, Godugdha, Vatadosha, Rasayan, Speech, Kampavata, Gait, Dressing, Swallowing, Falling, Posture, Facial expression, Walking, Hygiene, Salivation, Depression, Comparative study, Loss of memory, Anorexia, Vata disorder, Quality of life, Rasayana-chikitsa, Age-group, Inclusion criteria, Exclusion criteria, Clinical efficacy, Subjective assessment, Objective assessment, Research article, Parkinson's disease, Rigidity, Bradykinesia, Srotodushti, Ushna veerya, Ksheenamati, Assessment parameter, Institutional Ethical Committee, Basti Chikitsa, Intellectual impairment, Cardinal symptom, Ayurved Mahavidyalaya, Naimittik rasayana, Basavarajiyam, Vataja Disorder, Pre-treatment, Post treatment, Dopaminergic system, Speech defect, Dyskinesia, Postural stability, Vyan Vayu, Madhur vipak, Strotoshodhan, Vatahara Dravya, Vata shamak, Handwriting, Thought disorder, Ayurvedic and Herbal Medicine, Hand movement, Dwivedi Amarprakash, Tikshana, Rapid Alternating Movement, Chal Guna.