Review of the intended work 1 need for the study



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6. BRIEF REVIEW OF THE INTENDED WORK

6.1) NEED FOR THE STUDY:

Kampavata is a slowly progressive disorder of late adult life and is one of most prevalent neurological disorder. In Charaka Samhita vepathu has been described as one of the eighty types Nantmaja disorders of vata and Kampa has been mentioned one of vikara of vata1. There are many vata vyadhis commonly seen but Kampavata is one of the rare mentioned under vata vyadhis because of its crippling nature and non availability of curative treatment this disease has remained a great problem in the ageing society. This disease doesn’t have or knows no boundaries with regards to race, rationality, gender or social class2. As this can interfere with activities of daily living, there is need of assistance with more routine activities of daily life such as grooming, bathing, dressing and feeding3.

This condition has an annual incidence of about 0.2/100 & prevalence of 0.5/100 throughout the world among which 10% of patients are under the age of 45years4. Prevalence rate in Bombay India 328/100000 .Worlds highest prevalence is in the vincities of ferromanganese plants near Brescia, Italy with 407/100000 and lowest prevalence recorded in Ethopia5 at the rate of 7/100000. Among the management of vata vyadhis very less work has been carried out in management of Kampavata. Symptoms of Kampavata simulate to that of Parkinson’s disease with characteristic features like tremor, rigidity, and bradykinesia6. Parkinson’s disease remains the only neurodegenerative disorder that has demonstrated significant responsiveness to therapeutic intervention7.

However the treatments which are present now have a little evidence that this treatment changes the course of disease. In this regard newer targets are being explored.

The goal of treatment is to provide the best possible function and quality of life over the long term.

In Ayurveda Snehana8, Svedana, Niruha basti, Virechana and nasya9, Anuvasana basti10 Sirobasti11 have been indicated in management of Kampavata. The management of Kampavata can be done by the oral administration of Triguna Rasa which is explained in shasra yoga12 as the karma of Haritaki over nadivaha samsthan is balya and medhya indicated in conditions like mastishkya dourbalya, nadidourbalya and best in all vata vyadhis13, kajjali (parada and gandhaka) mitigates all types of roga and even tridoshas14.



6.2) REWIEW OF LITREATURE

As the external Vayu is responsible for the fall of ulkapath (comet), mahikampana (earthquake) etc similarly the vrddha vata is responsible for Kampa in shareera 15

The Kampana is explained under the heading of vrddha vata karma in Astanga Hridaya.16 The disease Kampavata(shirakampa) is explained with regards to its nidana & smparpati in Bhela samhita17

The disease kampavata is explained with regards to lakshana in Vaghabhata Astanghridayam18, Sarngadharsamhita19, Kashyapasamhita20, Sushrutasamhita 21, Charaka samhita 22, Vangasena23

The chikitsa of Kampavata is explained in Astanghridayam24, Sarangadhar samhita25 - 27, Bhelasmhita 28, Chakradatta 29, Charakasamhita30 -32, Vangasena33, Bhaisjya Ratnavali34, Sahasrayoga35.

Review of Parkinson’s disease explained in physiology36 will be done.

Review of Parkinson’s disease explained in pathology37 will be done

Review of Parkinson’s disease explained in contemporary science will be done.

Previous work done on the disease Kampavata will be reviewed such as


  • A study was conducted on the role of Basti and Rasayana in the management of Kampavata(Parkinson’s disease) in GAU, Jamnagar38

  • A study was conducted on the role of Nakula taila in the management of Kampavata(Parkinson’s disease) in GAU, Jamnagar39.

  • A study was conducted on.A clinical study on Kampavata (Parkinson's disease) and it’s management with Kapikacchu in GAU, Jamnagar 40

  • A study was conducted on preparation and physio-chemical analysis of Rajata Bhasma and its efficacy in degenerative diseases of brain with special reference to Parkinson’s disease in RGUHS, Bellary41.

  • A study was conducted on management of Kampavata with special reference to Parkinson’s disease RGUHS, Mysore42.

In sahasrayoga Triguna Rasa is directly indicated for Kampavata. The main ingredients of this yoga are Haritaki and Kajjali. As Hartaki choorna is indicated in conditions like mastishka dourbalya & best in all types of vata vyadi 43. Parada & Gandhaka (kajjali) mitigates all types of rogas & even tridoshas 44.Thus an effort is made to evaluate the efficacy of internal administration of Triguna Rasa in Kampavata 45.

6.3) AIMS AND OBJECTIVES OF STUDY

1) To evaluate the efficacy of Triguna Rasa in Kampavata46

2) To evaluate the efficacy of Triguna Rasa in Minimizing effects of Parkinson’s disease.

3) To study the literary work in Kampavata.

4) To study the literary work in Parkinson’s disease.

7. MATERIALS AND METHODS

7.1) a) SOURCE OF DATA:

The source for the selection of patients will be from OPD, IPD & Special camps conducted in DGMAMC & Hospital, after fulfilling the present inclusion & exclusion criteria.



b) LITERARY

Required literary information for the intended study will be procured from both the Ayurvedic & contemporary books & updated with recent journals of both faculties.



c) TRIALDRUG:

Internal administration of Triguna Rasa



7.2) COMPOSITION OF TRIAL DRUG

The composition of the trial drug is as follows



S.N

SANSKIRT NAME

SCIENTIFIC NAME

PROPORTION

1

Parada

Mercury

1 part

2

Gandhaka

Sulphur

8 part

3

Haritaki

Terminalia chebula

9 part


7.2) b) PREPARATION OF MEDICINE

Shudda Parada & Gandhaka according to the reference mixed and made into kajjali & heated on moderate fire, after melting add equal quantity of Haritaki choorna and mixed. The preparation will be undertaken according to classical text instructions.



7.3) METHODS OF COLLECTION OF DATA

A) STUDY DESIGN: A simple random single group observational study.

B) SAMPLE SIZE: The study is undertaken in single group of minimum 30 patients for clinical trial.

C) INCLUSION CRITERIA.

  1. Patients with clinical signs & symptoms of Kampavata vis-à-vis Parkinsonism disease will be selected.

  2. Patients of either sex are selected.

  3. Patients above 40 years of age.

D) EXCLUSION CRITERIA.

Patients with other systemic disorder which interfere with the treatment will be excluded such as



  1. Diffuse Lewy body disease

  2. Jacobs disease

  3. Striatonigral degeneration

  4. Wilson’s disease

  5. Huntington’s disease (chorea)

  6. Alzheimer’s disease

  7. Drug induced

  8. Trauma (pugilistic)

  9. Cardio embolic stroke

E) DIAGNOSIS: Diagnosis will be made based on clinical signs & symptom of Kampavata vis-à-vis Parkinson’s disease

F) POSOLOGY : Triguna Rasa orally

According to classical text Arohana and Avarohana karma will be followed for 41 days47



Anupana : Ghrita followed by Rice with milk.

G) STUDY DURATION : Treatment – 41 days

H) Follow up 30 days

I) ASSESSMENT OF RESULTS

The subjective and Objective parameters of base line data to post medication data compared for assessment of the final results. All the results will be analysed statistically for ‘p’ value using paired‘t’ test.



a) Subjective parameter

  1. Chestsanga: slowness and poverty of movements.

  2. Kampa (Resting tremor): at least in one limb.

  3. Sthamba (Rigidity): In any group of muscles in extremities.

  4. Avanamana (Postural changes): Which includes signs like Rombergism.

  5. Vak vikruti: Ekshruti (monotony) and Kala (low) speech.

  6. Gatisanga: Slow stepped & short stepped gait with proplusion & retropulsions.

b) Objective parameter

  1. Hand Grip power

  2. Foot pressure

  3. Chest expansion

  4. Picking of pins with hands

  5. Walking time

  6. Buttoning time

INVESTIGATIONS

  1. Haemoglobin%

  2. Total and differential leucocytes count

  3. Erythrocyte Sedimentation rate.

  4. Random blood Glucose.

  5. Blood urea, Serum creatinine, Serum copper.

  6. Complete urine examination.


7.5) ETHICAL CLEARANCE

Yes obtained & enclosed.



8) LIST OF REFERENCES

  1. Rajeshwar shastri edited Charaka samhita,Vidyotini hindi commentary part 1 sutrastana chapter 20/11, reprint edition 2001,pub: Choukamba Bharathi Academy, varanasi, pp399.

  2. Stewart Factor and William Weiner edtited Diagnosis and Clinical Management of Parkinson’s disease chapter 1, The man and the Essay. Pub Demtos NewYork.pp 3.

  3. Rahaman pourmand edited Neurologic clinics 22nd edition,edition 2004 chapter on Parkinson’s disease and quality of life: issues and challenges beyond motor symptom, pub: Elsevier Saunders,pp141.

  4. Nicholas A Boon, Nicky, Brain R Walker edited Davidson’s & Practice of medicine Neurological Disease 20th edition 2006 pub: Churchill Livingstone pp 1218.

  5. http://www.viartis prevalence of Parkinson’s disease 2006-2008.

  6. Rahaman pourmand edited Neurologic clinics 22nd edition, edition 2004 chapter on Parkinson’s disease and quality of life: issues and challenges beyond motor symptom, pub: Elsevier Saunders, pp 3

  7. Stewart Factor and William Weiner edited Diagnosis and Clinical Management of Parkinson’s disease chapter 1, the man and the Essay. Pub Demtos New York. pp16

  8. Ramakarana shrma edited Charaka samhita, vol –5 Chikitsa stana chapter 28/134 edition 2004, pub: Choukamba Sanskrit series, varanasi, pp 19

  9. DR Nirmal Saxena edited vangasena vol 1 28/155 edtition2004 pub: Choukamba Krishnadas Academy, varanasi, pp 409.

  10. P.V.Sharma edited Bhela Samhita Chikitsa sthana 26/ edition 2005, pub: Choukamba Bharathi Academy, varanasi,

  11. K.R.Srikanta Murthy edited Sharangadhara Samhita Uttharakhanda, Lepa kalpana edition,1984 pub: Choukamba Orientalia, varanasi, pp 249.

  12. DR Ramnivas Sharma & DR Surendra sharma edited sahasrayogam, gutika prakarana edition 1990 pub: Dakishna Prakashan Hyderabad pp 243.

  13. P.V. Sharma edited Dravya guna vol 2 reprint edition 2003 pub: Choukamba Bharathi Academy, varanasi, pp 755-756.

  14. Kashinath shastri Rasatarangini Shasta taranga sloka 112, edition1979 pub: motilal Banarasi das Delhi pp 126

  15. .P.V.Sharma edited Bhela Samhita Chikitsa sthana 24/55 edition 2005, pub: Choukamba Bharathi Academy, varanasi, pp 456.

  16. Vidhyadhar Shukla, R.D Tripati edited Charaka samhita, Vaidya Manorama Hindi commentary Chikitsa sthana chapter18/46, edition 2004, pub: Choukamba Sanskrit Prathistana Delhi, pp 444.

  17. P.V.Sharma edited Bhela Samhita Chikitsa sthana 21/30 edition 2005, pub: Choukamba Bharathi Academy, varanasi, pp 436.

  18. K.R.Srikanta murthy edited Astanga Hridaya vol -3 Uttara sthana 23/15 edition 1997, pub: Krishna Das Academy, Varanasi, pp220.

  19. K.R.Srikanta Murthy edited Sharangadhara Samhita prathama khanda 7/150 edition,1984 pub: Choukamba Orientalia, varanasi, pp 43.

  20. P.V.Tewari edited Kashypa Samhita Khila sthana 18/4 edition 2002 Choukamba vishwabarathi, varanasi pp 649.

  21. Kaviraj Ambikadatta Sashtri edited Sushruta Samhita Nidana sthana 1/27 reprint edition ,2005 Choukamba publications, varanasi, pp 230

  22. Vidhyadhar Shukla, R.D Tripati edited Charaka samhita, Vaidya Manorama Hindi commentary Siddi sthana chapter9/86, edition 2004, and pub: Choukamba Sanskrit Prathistana Delhi, pp 157.

  23. DR Nirmal Saxena edited vangasena vol 1 28/155 edtition2004 pub: Choukamba Krishnadas Academy, varanasi, pp 409.

  24. K.R. Srikanta murthy edited Astanga Hridaya vol -3 Uttara sthana 23/15 edition 1997, pub: Krishna Das Academy, Varanasi, pp220.

  25. K.R.Srikanta Murthy edited Sharangadhara Samhita madhyma khanda 9/112 edition, 1984 pub: Choukamba Orientalia, varanasi, pp 126.

  26. K.R.Srikanta Murthy edited Sharangadhara Samhita madhyma khanda 9/132 edition, 1984 pub: Choukamba Orientalia, varanasi, pp 128.

  27. K.R.Srikanta Murthy edited Sharangadhara Samhita madhyma khanda 9/136 edition, 1984 pub: Choukamba Orientalia, varanasi, pp 136.

  28. P.V. Sharma edited Bhela Samhita Chikitsa sthana 21/30 edition 2005, pub: Choukamba Bharathi Academy, varanasi, pp 436.

  29. P.V.Sharma edited Chakradatta vata vyadhi chikitsa 23/160-161edition 1998 pub: Choukamba varanasi, pp 200-201.

  30. Rajeshwar shastri edited Charaka samhita,Vidyotini hindi commentary part 1 sutrastana chapter 5/60, reprint edition 2001, pub: Choukamba Bharathi Academy, varanasi, pp 5.

  31. Vidhyadhar Shukla, R.D Tripati edited Charaka samhita, Vaidya Manorama Hindi commentary Chikitsa sthana chapter18/46, edition 2004, pub: Choukamba Sanskrit Prathistana Delhi, pp 444.

  32. Vidhyadhar Shukla, R.D Tripati edited Charaka samhita, Vaidya Manorama Hindi commentary Siddi sthana chapter9/94, edition 2004, and pub: Choukamba Sanskrit Prathistana Delhi, pp 160.

  33. DR Nirmal Saxena edited vangasena vol 1 28/155 edtition2004 pub: Choukamba Krishnadas Academy, varanasi, pp 409.

  34. Rajeshwari datta shastri, Ambikadatta shastri edited Bhaisjya Ratnavali vata vyadhi chikitsa 26/567 edition 2005 pub Choukamba publication varanasi, pp 583

  35. DR Ramnivas Sharma & DR Surendra sharma edited sahasrayogam gutika prakarana edition 1990 pub: Dakishna Prakashan Hyderabad pp 243

  36. K. Sembulingam & Prema shembulingam edited Essentials of Physiology, chapter on nervous system, applied physiology disorders of basal ganglia pub: Jaypee Brothers New Delhi pp 685.

  37. William Boyd edited on Text Book of Pathology chapter on nervous system idiopathic degeneration, reprint edition 1970-1973 pub: Great Britain Henry Kempton London pp 1262.

  38. Kulkarni Milind, Role of Basti and Rasayana in the management of Kampavata(Parkinson’s disease) (Dissertation) Jamnagar, GAU, 1991.

  39. Shukla, V, role of Nakula Taila in the management of Kampavata (Parkinson’s disease) (Dissertation) Jamnagar, GAU, 1993.

  40. Sanjay Dhurve.A clinical study on Kampavata (Parkinson's disease) and it’s management with Kapikacchu in , (Dissertation) Jamnagar, GAU, 2001.

  41. T. Geerish, Krishna, Preparation of physio – chemical analysis of Rajata Bhasma

and its efficacy in degenerative diseases of Brain with special reference to Kampavata(Parkinson’s disease) (Dissertation), Bellary, 2002.

  1. Kashavva V. Hiremath Management of Kampavata with special reference to Parkinson’s disease. (Dissertation) Mysore.2006

  2. P.V. Sharma edited Dravya guna vol 2 reprint edition 2003 pub: Choukamba Bharathi Academy, varanasi, pp 755-756.

  3. Kashinath shastri Rasatarangini Shasta taranga sloka 112, edition1979 pub: Motilal Banarasi das Delhi pp 126.

  4. DR Ramnivas Sharma & DR Surendra sharma edited sahasrayogam gutika prakarana edition 1990 pub: Dakishna Prakashan Hyderabad pp 243.

  5. DR Ramnivas Sharma & DR Surendra sharma edited sahasrayogam gutika prakarana edition 1990 pub: Dakishna Prakashan Hyderabad pp 243

  6. DR Ramnivas Sharma & DR Surendra sharma edited sahasrayogam gutika prakarana edition 1990 pub: Dakishna Prakashan Hyderabad pp 243.


9) Signature of candidate :

(VIJAYAMAHANTESH)

10) Remarks of Guide : ‘‘The present study on Kampavata with TrigunaRasa certainly add values to the Ayurvedic medicinal treasure,’’



1
Dr. Raghavendra.V. Shettar

M.D. (Ayu)

DGM AMC, PGSRC, Gadag-582103
1) Name and Designation :


(In Block Letters)

11.1) Guide :
11.2) Signature :
11.3) Co-Guide : - NA -

11.4) Signature :

1
Dr.SHIVARAMAPRASAD KETHAMAKKA

M.D. (K.C)(Osm), C.O.P. (German) M.A., Ph.D. (Jyo)

Professor, H.O.D in Kayachikitsa (PG)

DGMAMC, PGS&RC, GADAG-582103
1.5) Head of the department:


11.6) Signature :

12) Remarks of Chairman and Principal:

The above synopsis is scrutinized by the Postgraduate Studies and Research Centre committee of D.G.M. Ayurvedic Medical College, Gadag and submitted for registration as subject of dissertation at R.G.U.H.S, Bangalore.


12.1) Signature of Chairman and Principal: Dr. G.B. Patil

Principal/ C.M.O








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