MANAGEMENT OF KAMPAVATA W.S.R TO PARKINSON'S DISEASE THROUGH PANCHKARMA- A CASE REPORT

Abstract

Parkinson’s disease known as Kampavata in Ayurveda, is a degenerative neurological disorder of central nervous
system, mainly affecting the motor system. It is most common extra pyramidal crippling disease with a prevalence
of 1% of total population. On the basis of sign and symptoms; Parkinson’s disease is described under Vata
Nanatmaja vikara in Ayurveda. Symptoms like Kampa (Tremor), Stambha (Rigidity), Chestasanga (Bradykinesia
and Akinesia), Vakvikriti (disturbance in speech) etc were described in different contexts of Charaka Samhita,
Susruta Samhita and Basavarajeeyam. Because of non-availability of curative treatment in modern science, this
disease has remained as a great problem in the aging society. A 67 year old male patient presented with complaints
of tremors in lower limbs and head tremors, slow limited movement, difficulty with walking and balance,
sleeplessness, depression and face appearing without expression (mask face) and impairment in his Activities of
Daily Living (ADL) like bathing, cooking, talking etc brought by her relative in indoor patient department (IPD) of
Panchkarma, NIA, Jaipur. Previously patient had taken allopathic treatment but did not show any sign of
improvement. So patient was admitted and treated with Ayurveda treatment. This case study is about management
of known case of Parkinson’s disease with multimodality treatment in the form of Panchkarma procedures such as
Abhyanaga (Dashmool Tail), Svedana (Dashmoola Kwatha), Shirobasti (Ksheerbala Taila), Nasya (Ksheerbala
Taila) and Mustadi Yapana Basti. Significant improvement was found with Panchkarma along with oral
medicines. Assessment was done on the basis of signs and symptoms, bradykinesia and functional activities.
KEYWORDS: Parkinson’s disease, Kampavata, Kampa, Vata Nanatamaja Vikara, Ksheerbala Tail, Yapana
Basti

Full text

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Jatinder et al. World Journal of Pharmaceutical and Life Sciences
MANAGEMENT OF KAMPAVATA W.S.R TO PARKINSON'S DISEASE THROUGH
PANCHKARMA- A CASE REPORT
Dr. Jatinder Verma*1, Dr. Nishu Kasvan2, Dr. Gopesh Mangal3 and Dr. Surya Prakash4
1PG Scholar, Department of Panchkarma, National Institute of Ayurveda, Jaipur.
2PG Scholar, Department of Panchkarma, National Institute of Ayurveda, Jaipur.
3Assistant Professor & H.O.D (I/C), Department of Panchkarma, National Institute of Ayurveda, Jaipur
4Assistant Professor, Department of Panchkarma, SBMN Ayurved College, Asthal Bohar, Rohtak.
Article Received on 15/08/2018 Article Revised on 06/09/2018 Article Accepted on 27/09/2018
INTRODUCTION
Parkinson’s disease (PD) is the most common form of a
group of progressive neurodegenerative disorders
characterized by bradykinesia, rest tremors, muscular
rigidity, shuffling gait and flexed posture. Most of the
features match with the Ayurveda description of
KAMPAVATA. Worldwide incidence of PD is estimated
to be around 7 to 10 million. Its peak onset is in the early
60’s but cases can be seen in patients in their 20’s
progressively debilitating the affected individual
(Harrison’s Principles of Internal Medicine, 18th edition,
volume 2, chapter 372, p-3317). More than 1 million
cases are suffering from PD per year in India.
Case Report
ISSN 2454-2229
wjpls, 2018, Vol. 4, Issue 10, 115-119
World Journal of Pharmaceutical and Life Sciences
WJPLS
www.wjpls.org
SJIF Impact Factor: 5.088
*Corresponding Author: Dr. Jatinder Verma
PG scholar, Department of Panchkarma, National Institute of Ayurveda, Jaipur.
[1]
ABSTRACT
Parkinson’s disease known as Kampavata in Ayurveda, is a degenerative neurological disorder of central nervous
system, mainly affecting the motor system. It is most common extra pyramidal crippling disease with a prevalence
of 1% of total population. On the basis of sign and symptoms; Parkinson’s disease is described under Vata
Nanatmaja vikara in Ayurveda. Symptoms like Kampa (Tremor), Stambha (Rigidity), Chestasanga (Bradykinesia
and Akinesia), Vakvikriti (disturbance in speech) etc were described in different contexts of Charaka Samhita,
Susruta Samhita and Basavarajeeyam. Because of non-availability of curative treatment in modern science, this
disease has remained as a great problem in the aging society. A 67 year old male patient presented with complaints
of tremors in lower limbs and head tremors, slow limited movement, difficulty with walking and balance,
sleeplessness, depression and face appearing without expression (mask face) and impairment in his Activities of
Daily Living (ADL) like bathing, cooking, talking etc brought by her relative in indoor patient department (IPD) of
Panchkarma, NIA, Jaipur. Previously patient had taken allopathic treatment but did not show any sign of
improvement. So patient was admitted and treated with Ayurveda treatment. This case study is about management
of known case of Parkinson’s disease with multimodality treatment in the form of Panchkarma procedures such as
Abhyanaga (Dashmool Tail), Svedana (Dashmoola Kwatha), Shirobasti (Ksheerbala Taila), Nasya (Ksheerbala
Taila) and Mustadi Yapana Basti. Significant improvement was found with Panchkarma along with oral
medicines. Assessment was done on the basis of signs and symptoms, bradykinesia and functional activities.
KEYWORDS: Parkinson’s disease, Kampavata, Kampa, Vata Nanatamaja Vikara, Ksheerbala Tail, Yapana
Basti.

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The Vata which is considered to be the motivator and
controller of other two Dosha i.e. Pitta and Kapha, is
responsible for manifestation of almost all types of
diseases. All motor and sensory functions are governed
by Vata. Major neurological problems (essentially the
condition of various degenerative diseases of nervous
system) come under Vata vyadhi. Kampavata is one of
them. The word Kampavata means the disorder of
impaired Vata, in which the prime clinical manifestation
is Kampa.
“Na kampo vayuna vina”[1]
In Charaka Samhita, Vepathu has been described as one
of the eighty types of Vataja nanatamaja vyadhi.[2] The
term KAMPAVATA was explained for the first time in the
text Basavarajeeyam3 with most of its clinical features
similar to that of PD. The main clinical feature of
Kampavata is KAMPA (Tremor). Tremor is particularly
important in diagnosing PD, as it is present in 85% of
patients with true PD. Also as explained in the text,
Basavarajeeyam few more features of Kampavata can be
compared with that of PD;
 Karapadatale Kampa- Tremors in the hands and
feet.
 Dehabhramana- Postural instability.
Although PD defined clinically as a movement disorder,
it is now widely appreciated that PD can be accompanied
by a variety of non-motor symptoms, including
autonomic, sensory, sleep, cognitive and psychiatric
disturbances. These non-motor features can also be
related with Ayurvedic description on Kampavata as
given in the text of Basavarajeeyam;
 Nidrabhanga- sleep disturbances
 Matiksheena- Dementia
Acharaya Charaka noted tremors in different organs like
head. Various synonyms used are “Kampana”,
“Vepana”, “Vepathu”, and “Spandana” all indicating
tremors of varying nature and severity. Majority of
symptoms of Kampavata are mentioned in different
Avaranas, Charaka says that Avarana of Vyana and
Udana by Kapha produces symptoms like Gatisanga,
Vakswaragraha, Gurugatrata, Stambana and Kampana.
Especially the disorder “Kampavata” (Kampa- tremors)
bears a resemblance to the clinical features of “Shaking
Palsy” or Parkinson’s disease (PD). The basic
pathological is degeneration of a group of nerve cells
deep within the centre of the brain in an area called
substantia nigra. These cells use Dopamine as their
neurotransmitter to signal other nerve cells. As these
cells degenerate and stop functioning, Dopamine fails to
reach the areas of brain that affect motor functions.
Therapy for Parkinson’s disease is aimed at replacing
dopamine and to prevent the deneration which is caused
due to impaired Vata. Since the blood brain barrier
prevents dopamine from entering the brain from blood
stream, a precursor of dopamine (L-dopa, Levodopa) that
will enter the brain is given.
Ayurveda takes a unique approach to the management of
above mentioned neuropathies with a special emphasis
on eliminating their cause by Panchkarma. Panchkarma
procedures are especially advocated in the treatment of
neurological diseases. Different types of Snehana,
Swedana are efficacious. Besides a special treatment like
Shirobasti, Shirodhara, Nasya and Basti karma are
indicated in such diseases.
Now a day’s patients of Parkinson’s disease are opting
for Ayurveda management due to the long term
complications of Levodopa and other medications.
No satisfactory treatment is seen in contemporary system
of medicine. So a multi-modality treatment in the form
of Panchkarma procedures is selected for Parkinson’s
disease by giving satisfactory results in the treatment of
disease. Kampavata correlated with Parkinson’s disease
which is Dhatukshyaja, Vatavydhi, and Apatarpana in
nature.
Hence the principle of treatment is Santarpana Chikitsa.
Panchkarma procedures have been taken for the study.
Santarpana includes Bahyopakramas such as Sarwanga
Snehana with Dashmoola Tail and Sarvanga Swedana
by Dashmool Siddha kwatha, Shirobasti with Ksheerbala
Tail, Nasya with Ksheerbala Tail 101, Shiropichhu with
Ksheerbala tail and administration of Yapana Basti in
Karmabasti Krama. Along with this, various classical
Ayurveda formulations were used as oral medicine.
Remarkable results were observed in the form of
symptoms like tremors, rigidity, bradykinesia, facial
expression, sleeplessness and depression after the
administration of multimodality management. Their
daily performance (ADL) has proved most beneficial to
patients with this illness.
CASE REPORT
A 67 year old male patient living in urban area, with
Vata-pitta Prakriti came in the IPD of Panchkarma,
NIA, Jaipur on 22/06/2018. He was brought by his son
for Ayurveda treatment. He came with complaints of
tremors in lower limbs and head tremors, and slightly
slurred speech. Patient also had difficulty with walking
and balance, sleeplessness and depression. He had
problem in writing. He had problems in her activities of
daily living (ADL).
These symptoms developed since 4 years and had slow
progression. Patient consulted other physicians and taken
allopathic treatment (Syndopa-100mg+25mg,
Gabapentin) but symptoms had not shown any
improvement.
Patient was apparently well before four years, but he
developed gradual complaints of tremors in both lower
limbs, difficulty in walking, balance and sleeplessness.

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He had mild slurred speech and difficulty in writing. He
was unable to start his walking (Cog Wheel Rigidity). He
did not have any history of DM/IHD/PTB/Addiction or
any major surgical procedure. He had a history of HTN
for which he was taking allopathic medicine and was
under control. No history of any trauma or any drug
abuse was present.
On examination under Dashvidh Pariksha, he had
Madhyam Sara, Samhana, Aahar Shakti, Abhyarana
Shakti, Jarana Shakti, Satva, Satmaya. He had Avara
Vyayam Shakti, Avara bala and with Vridha Vaya. On
examination under Astavidh Pariksha, Nadi – 92/min
(Vata-pitta), Jivha – Sama, Mala -Malabaddhata , Mutra
– Samyaka , Shabda – Ksheen (low tone speech),
Sparsha – Ruksha , Drik – Samanya , Akriti – Madhyam .
On General Physical Examination, findings were, P/R –
92/min, B.P – 140/90 mm of Hg, Pallor – Negative,
Icterus – Negative, Cyanosis – Negative, Clubbing –
Negative, Edema – Negative.
On Systemic Examination, RS – B/L equal air entry with
no added sound, CVS – S1 S2, Normal, CNS –
Conscious and Oriented, P/A – Soft, Non tender. Liver,
Kidney and Spleen not palpable, Bowel sounds were
present. Pupillary reaction to light was normal.
On examination of Reflexes, Deep Tendon Reflexes:
Ankle jerk - ++, Knee jerk- ++, Biceps jerk - ++, Triceps
jerk - ++, Planter reflex - Extensor were found.
On examination of Muscle power grade, RT upper limb
5/5 and lower limb 5/5, LT lower limb 5/5 and upper
limb 5/5 were found.
On examination of Muscle Tone, Cog wheel type
Rigidity was seen in B/L lower limbs. He had a flexed
posture with msked face. On examining Muscles, no
Atrophy was seen. On assessing Samprapti Vighatana,
Dosha - Vataja Kaphaja, Dushya - Ras, Rakta, Majja,
Srotas - Rasavaha, Raktavaha, Adhisthana - Shira,
Hridaya was assessed. All the blood paramerters are
under normal range.
Diagnosis was done the basis of Kampa (tremor) -
Bilateral tremor in “lower limbs”, Gatisanga
(Bradykinesia) - Can walk without assistance slowly but
with shuffling gait, Vatavikriti (disturbance in voice) -
Slight slurring of speech, Stambha (Rigidity) - Cog
wheel rigidity, Sleeplessness - Disturbed Sleep, masked
faced and flexed posture (Avanamana).
As per Ayurveda Parkinson’s disease can be correlated
with Kampavata which comes under Vatavyadhi. It is
important to mention that Kampavata vitiated due to
Dhatukshaya as well as Avarana which is Apatarpana in
nature.
Hence the principle of treatment Santarapana Chikitsa, a
multi modality treatment in the form of Panchkarma
procedures has been taken for study.
Patient was given the following treatment
Session I: Sarwanga Abhyanga and Svedana along with
Shirobasti and Yapana Basti [Table 1]. For Bahya
Snehana 750ml of indirectly heated Dashmoola Tail was
applied in Anuloma gati for 15 min and Sarwanga
Svedana was done by Dashamoola Siddha Kwatha for
15 min. Shirobasti was done with Ksheerbala Tail
(lukewarm oil) for a period of 45 min. for 16 days. After
confirming presence of intestinal motility Yapana basti
was started in Kala Krama for sixteen days.
Session II: At last Nasya was done with Ksheerbala Tail
101 in dose of 6 drops /nostril for 7 days after the
completion of the above procedures. Along with the
above Panchkarma procedures, Shamana treatment with
Kampvatari Ras- 1Tab. twice a day, Mashbaladi Kwath -
10 gm, twice a day, Zandopa 5gm, twice a day was
given. In between and during the sessions of treatment
and after the completion of the treatment oral medicines
were continued. Allopathic medicines were continued
during the procedures for first seven days but were
discontinued. Zandopa was prescribed for thrice a day
thereafter. During the whole treatment monitoring was
done.
After the completion of the procedures, there was
significant improvement found in patient after
Panchkarma procedures and administration of
formulations [Table 2].
1. Tremors markedly abolished.
2. Improvement is seen in walking without any aid.
3. Improvement is seen in ADL (Activities of Daily
Living), as told by the patient.
4. Speech was also improved.
5. Rigidity was markedly improved after completion of
treatment.
6. Patient was able to sleep for 7-8hrs daily.
7. Marked improvement in facial expression.
8. Complete cessation of allopathic medicine.
Assessment of bradykinesia [Table 3] was done by
applying the following tests:
1) Picking of pins with Hands
2) Buttoning time
3) Marie sign (Blink rate/min)
4) Rapid alternating movements
5) Chest expansion
6) Walking time.
The method by which these tests were carried out is as
follows:
1) Picking of pins with hands: - The patient was asked
to pick up the head pins one by one and keep away until
the all hundred pins do collected. This test was
performed by the patients first by their right hand and
then their left hand separately. The time taken by the

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patient for this job was noted before and after the
treatment.
2) Buttoning time: - Patient was requested to fix five
buttons. Average time required to fasten one button was
noted in seconds.
3) Marie sign: - Blinking per minute was counted before
and after the treatment.
4) Rapid alternating- movements: Patient was asked to
carry out three repetitive movements:
a. Repeatedly by touching index finger with thumb.
b. Opening and closing of fists.
c. Pronation and Supination of hands.
5) Chest expansion: - The degree of expansion of chest
was measured by placing the tape measure. Just below
the nipples with its zero mark at the middle of sternum
and instructing the patient to take deep breath in and out
of as deep as possible. The difference of expansions in
and between inspiration and expiration was noted. This
test was carried out and after the treatment.
6) Walking time: - The walking time was measured by
asking the patient to walk a distance of 30 feet in straight
line. The patient was told to walk maximum possible
speed and the time was noted down. The walking time
was noted before and after the treatment.
Functional Assessment Tests [Table 4] were carried
out by assessing the following:
I) Hand grip power: - The hand grip power of both the
hands was measured. For this purpose the cuff of B.P
apparatus folded and tied and inflated to such an extent
so that the manometer recorded 20 mm of Hg constantly.
The patient was asked to press the cuff with maximum
power gripping the cuff in his hand. The record of the
maximum grip was noted down.
II) Foot pressure: - The pressure was calculated as the
force exerted by the single foot upon the platform of the
weighing machine. This was done by asking the patient
to press his leg with maximum possible strength on the
weighing machine. The reading by foot pressure was
noted in Kg before and after the treatment.
Table 1: Treatment Plan.
Session I
Sarvanga Abhyanga and Svedana, Shirobasti,
Yapana Basti
16 Days
Session II (After the completion of above procedures)
Nasya
7 Days
Table 2: Sign and Symptoms Assessment.
Sr.
No
Sign and Symptoms
B. T.
A.T.
1
Kampa (Tremor)
B/L Tremor in lower limbs
Unilateral Slight Tremor Present at rest
decreased by action and increase by emotion.
2
Gatisanga (Bradykinesia)
Can walk without assistance
slowly but with shuffling gait
Can walk brisk without aid
3
Stambha (Rigidity)
Cog wheel Rigidity
Markedly improved
4
Vakvikriti (Disturbance of Voice)
Slurring of Speech
Markedly improved
5
Sleep
Disturbed Sleep
Normal Sleep
6
Facial expression
None
Markedly improved
B.T. – Before Treatment, A.T. – After Treatment.
Table 3: Tests for Assessment of Bradykinesia.
S. No.
Test
Mean Score
BT
AT
1
Picking of pins with Hands
70 sec
58sec
2
Buttoning time
35 sec
20 sec
3
Marie sign (Blink rate / min)
07 / min
13/ min
4
Rapid Alternating Movements
12 movements/min
20 movements/min
5
Chest expansion
0.8 cm
1.6 cm
6
Walking time
58 sec
40 sec
B.T. – Before Treatment A.T. – After Treatment.
Table 4: Functional Assessment Test.
S. No.
Test
BT
AT
1
Hand grip Power
50 mm of Hg
65 mm of Hg
2
Foot Pressure
32 kg
36kg
B.T. – Before Treatment A.T. – After Treatment.

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DISCUSSION
Kampavata is Nanatmaja disorder of Vata as per
Ayurveda texts condition can be correlated with
Dhatukshya vatavyadhi as well as Vata vitiated due to
Avarana.[5] Ayurveda treatment for this condition is
mainly based on the treatment of unbalanced Vata.
Ayurveda provides such patient with its miraculous
treatment of Panchkarma and Shamana Chikitsa.[6]
In Kampavata Avarana of Vata and Dhatukshaya are the
chief pathological processes. Charaka has stressed on
Srotoshuddhi, Vatanulomana and Rasayana in general
management of Avarana.
For the first time Vangasena Samhita,[7] stated the
principles of the treatment of Kampavata. It clearly
mentioned that, Abhyanga, Swedana, Nasya, Niruha,
Anuvasana, Virechana and Shirobasti are the useful
measures that can increase the life expectancy of the
patient.
Ayurveda Panchkarma procedures available can make
life much easier and drastic increase can be seen in their
life expectancy.
Among the Panchkarma procedures Shirobasti,[8] and
Nasya (with Ksheerbala Taila) is chosen for the
management of Kampavata as it may not interfere with
the problems arising due to the disease and it can be done
with ease irrespective of the age of the patient.
Ksheerbala Taila is indicated in the management of
eighty types of Vata Vyadhi.[9] It is cost effective and is
chosen with consideration of socio-economic status of
the patient.
As Kapikacchu is having Dhatuvriddhikara,
Vatashamaka and Sukraviddhikara properties.[10] So it
also acts against the process of degeneration and may be
beneficial in the condition of Dhatukshaya. It also
corrects the function of Indriyas, which are found
impaired in Kampavata In addition, Zandopa (Mucuna
Pruriens) was prescribed, having L-dopa which has
antiparkinsonism activity.[11] Basically Kampavata
(Parkinson’s disease) needs the rejuvenation therapy.
The role of Basti is crucial in the management of
Kampavata (Parkinson's disease). It promotes Bala,
Mansa and Shukra. It is Sadyobalajanana and Rasayana.
It is Balya, Vrishya, Sanjivana, Chakshushya and
energizes the body,[12]
CONCLUSION
Parkinson’s disease can be clinically compared with
Kampavata according to Ayurveda. Among the various
Ayurveda treatments, various Panchkarma procedures
such as Abyanga, Svedana, Nasya, Shirobasti, Basti
proved to be effective for treating PD patient. Drastic
improvement can be seen from the above case study.
Both Samshodhana and Shamana Chikitsa play an
important role to improve the Activities of Daily Living
of a PD patient.
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