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Introduction

Parkinson’s disease is a progressive degenerative neurological disorder which mainly affects the motor system of body, and it is characterized by resting tremors, slowness of movements, rigidity, gait disturbances/postural instability. It is correlated with Kampa Vata in Ayurvedaas it is characterized by Sarvanga Kampa. According to Ayurveda, Kampavata is a Nanatmaja disorder of Vata.  In time of Charaka and Sushruta, cluster of symptoms like Kampa (tremor), Stambha (rigidity), Chestasanga (bradykinesia and akinesia), Vakvikriti (disturbance in speech) etc. were described in different contexts. This disease becomes incurable quickly due to various reasons like old age, nature of disease, involvement of Shiromarma. The majority of the symptoms of Kampavata were found in Kaphavrita Udana and Kaphavrita Vyana. Even so no single Avarana process completely covers all symptomatology of Kampavata. In modern medical science, the goal of treatment for this disease is to alleviate symptoms that interfere with the patients’ activities of daily living and to prevent or limit its complication as Parkinson ‘s disease is a progressive disease leading to crippling of the patients. Whole world is looking towards alternative medicines to provide solutions to the management of Parkinson's disease like crippling incurable disorder devoid of side effect, motivates to do some work on this Disease. Ayurvedic drug Sahachara, Shunthi, Devdaru and Erand Taila all are Vata Kapha Shamak while Kapikacchhu is having Balya, Brimhana, Vrishya and Vatahara properties. It is a natural source of L-dopa and well known for its anti-parkinson activities.

AIMS: To study efficacy of Sahacharadi Kwath and Kapikacchubeeja Churna in Kampavata w.s.r.t. Bradykinesia in Parkinson ‘s disease.

Objective:

1. To study the aetiopathogenesis of Kampavata (Parkinson's disease) in light of both Ayurvedic and Modern perspectives.
2. To observe efficacy of Sahacharadi Kwath and Kapikacchubeeja Churna in Kampavata
3. To provide a safe and easily available drug for achieving functional independency and improving the quality of life of the patient.

Methodology:

1. Thorough history of patients was taken; each and every patient was carefully examined for general and systemic examination.
2. Full explanation of trial was given to each patient and informed written consent was taken.
3. 60 patients were randomly divided into two groups of 30 each.

Trial Group: In this group Sahacharadi Kwath 40 ml + Erand tail 10 ml 2 times and Kapikacchubeeja Churna 6gm with milk 2 times, after meal.

Control Group: Kapikacchubeeja Churna 6gm with milk (Godugdha) 2 times, after meal.

1. Pathya and Apathya: was same for both groups.

1)Diagnostic Criteria: Presence of Gatisanga (Bradykinesia) along with any 1 sign,

1. 1. Kampa (Tremor)
   2. Stambha (Rigidity)
   3. Avanaman (Posture)
2. Inclusion criteria:

• Patient of Age more than 16 years of both sexes willing for Trial.
• Patient upto stage IV of Hoehn and Yahr Scale.

1. Exclusion criteria:

• Patient with major Medical Illness

1. Withdrawal Criteria:

• On occurrence of serious event
• Unco-operative behavior of patient

1. Follow up:

• Follow up of patients of both groups were taken for observation on 15th, 30th, 45th, & 60th Day.

Table No. 1 Hoehn and Yahr Scale: -

Table No. 2 Criteria of Assessment

According to Unified Parkinson ‘s Disease Rating Scale.

As the study was mainly focused on bradykinesia (Gatisanga) the above criteria were selected. But along with this other clinical feature of Kampavata was also observed before and after to see the effect of therapy as these may give some other important conclusions for the research purpose. So, the grading of different clinical features of Kampavata is done as given below.

Observations & Results:

Table No. 3 Age Wise Distribution of Patients

χ2 Calculated = 1.68     χ2 Table = 7.82

As the above table shows χ2 Calculated < χ2 Table i.e., test is insignificant.   It means observations in both groups are at base line. So, there is no difference in age wise selection of patient in both groups. In this study Maximum numbers of patients are found in age group 61-75 years i.e., 48.33%.

Discussion

Kampavata (Parkinson's disease) is a progressive degenerative disorder of the cerebellum occurs in all ethnic groups has an equal sex distribution. It is characterized by slowly progressive Bradykinesia, Rigidity, Postural abnormality and Resting Tremor. Kampavata is a Nanatmaja disorder of Vata, description of a neurological disease identical to Parkinson's disease with rigidity a sensation of heaviness of the body and mental apathy was described in Charaka, subsequently description was seen in Sushruta Samhita. Though in modern medical science a lot of research works have been done. Some medication like Carbidopa, Levodopa, recently some stereotaxic neurosurgery like as thalamotomy, subthalamotomy some brain stimulation technique like thalamic stimulation, subthalamic stimulation these medicine and surgery are being used to subside the symptom, Oral mono therapy has number of unpleasant and occasionally even intolerable side effects while surgery was life threating. So, at present there is no therapy that equivocally checks the progress of Parkinson ‘s disease. In Ayurvedic classics different types of treatment measures have been counselled to use in various type of Kampavata, Charaka has mentioned that Asthapana Basti for Vepathu. Acharya Vangasena has advised Svedana, Snehana, Anuvasana, Niruha Basti, Shirobasti and Virechana etc in the management of Kampavata.

Probable mode of action of therapy: According to Samprapti in Kampavata,due to etiological factors Chala,Ruksha and Sheeta properties provoke Vata dosha (mainly Prana,Udana,Vyana ) at the same time Kapha dosha is provoked by its Guru and Manda guna. All Cheshtas which need Prayatna are diminished due to avarana of Vyana and Udana by kapha resulting in Cheshta sanga (gatisanga) i.e.Bradykinesia which is the first and foremost symptom of Kampavata. The content of Sahacharadi kwath,Sahachara having Madhur,Slightly Amla rasa and Ushna veerya act as Vatashamak and Kaphashamak by Tikta rasa,Katu vipaka and Ushna Veerya. Shunthi is also useful in Kaphavata vyadhis being Katu,Snigdha and Ushna, it also helps to reduce Shaitya ( cold) and Stambha ( Stiffness). It stimulates nerves, improves impulse transmission and relieves Pain. Devdaru is also Kaphashamak by Tikta, Katu and Ushna properties, Vatashamak by Snigdha and Ushna properties. Erand Tail is Vatakapha shamak by Madhur, Katu, Kashaya rasa,Madhur Vipaka and Ushna Veerya.It also act as Anulomaka (purgative),again inducing effect on Vata and Kapha dosha. Kapikachhubeeja having Madhur rasa and Vipak causing Vatashaman while Ushna veerya causes Kapha Vata shamana. Manda and Sheeta properties of Kapha causes Stambha (rigidity) in Parkinsons Disease, on using  Sahacharadi kwath, of which all dravyas are of Ushna veeryatmak causing reduction in            Stambha           due       to Viruddhaguna (opposite properties) of Kapha dosha. Chala guna of Vata produces Kampa, Sahacharadi Kwath having Madhur Rasatmak and Ushna veerya dravyas helps to reduce the Chala guna of Vata which results in reduction in Kampa. In this study Gatisanga (Bradykinesia) is mainly targeted. According to Samprapti, Cheshtas (needing prayatna) are diminished due to avarana of Vyana and Udana by Kapha resulting in Cheshtasanga / Gatisanga. Increased Vata at one site (kampa) and decreased at other site (Gatisanga) may be considerd as hallmark of process of avarana. by using the Sahacharadi Kwatha we can stop this avarana process i.e.Samprapti bhanga,resulting in relief in symptoms which were Statistically significant and proved. Kapikachhu beeja churna is already proved useful in Parkinsons Disease, hence it was used in trial group and control group as a comparison for the study which was ethically according to science. Hence the thought comes that only Kapikacchu is seldom not very useful in the treatment especially long term,because Vata dosha shaman needs Sneha and Kapha dosha shaman needs Katu rasa.So Sahacharadi kwath with Erand tail as anupana may had more significant effect.

Scope of Study: The present study was conducted on limited number of patients with limited facilitis. Further study can be conducted on large population with advance techniques.The Sahacharadi kwath can be made more concentrated with some other herb or other herbs can be added in this to make it more effective. Like Sahachardi kwath and Kapikachhu beeja churna, effect of Snehana, Swedana, Vasti, Virechana or Nasya along with specific drug may be assessed for particular clinical feature of disease or for whole disease. Then different process can be mixed as per requirement of patient.

Conclusion

Analysing all the data it can be said that the Sahacharadi    kwath    with    Erand    Tail    and Kapikachhubeeja Churna with Godugdha in trial group has shown better result in improvement of Bradykinesia (Gatisanga) in comparision to only Kapikachhubeeja Churna with Godugdha given in control group and this result is statistically significant.Therapy is safe, easily available and can perform at home also.Therapy given in Trial group helps in achieving functional independency, thus improving the quality of life of patients and it may be due to Vata Kapha dosha shamak properties of Sahacharadi Kwath and Balya, Brimhan,Vrishya properties of Kapikachhubeeja Churna.