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Sunday, June 23, 2013

Scientific Basis for Ayurvedic Therapies -30




















































Scientific Basis for
Ayurvedic Therapies 


edited by
Brahmasree Lakshmi Chandra Mishra





The role of environmental factors has not been adequately ruled out. In fact, socioeconomic,
environmental, and dietary factors are currently considered causal, based on epidemiological
studies for many diseases previously thought to be related to genetics (e.g.,
cancer).
6
The same may be true for psychiatric disorders.
25.4 Psychopathology
Sthana
), in a very systematic manner in terms of eight essential psychological factors
considered to be centrally affected in all psychiatric disorders in varying degrees
7
:
1. Emotion, mood, affect
(
mana
)
2. Thought and decision (
buddhi
)
3. Orientation (
sajna-jnana
)
The psychopathology in Ayurveda is described by Charaka Samhita, Chapter 7 (Nidana

4. Memory and learning
(
Smrti
)
5. Desire (
bhakti
)
6. Habits (
sila
)
7. Psychomotor function
(
cesta
)
8. Conduct and behavior
(
acara
)
25.5 Clinical Description of Psychiatric Disorders
A wide range of psychiatric conditions and affective behaviors have been described in
Ayurveda. Besides their aetiopathogenesis, the texts describe briefly but vividly the
signs, symptoms, and behavioral alterations in different psychiatric diseases and their
classifications. The psychiatric conditions described in original texts may be classified
as follows:
1. Primary psychological conditions caused purely by
manasa
dosas
(i.e.,
rajas
and
tamas
)
.
An example is the set of
manas dosas vikaras
7
: lust (
kama
), anger (krodha),
greed (lobha), delusion (moha), jealousy (irsya), pride (mana), eurphoria (mada),
sorrow (dukha), grief (soka), anxiety (cinta), neurosis (udvega), fear (bhaya), and
happiness (harsa).
2. Psychiatric conditions, neurological problems, and symptoms caused by the
mixed pathology (samprapti) including both the body dosas (vata, pitta, kapha) and
mental dosas (raja, tama). Examples include psychosis (unmada), convulsive diseases
(apasmara), hysteria (apatantraka), obsession (atattvabhinivesa), vertigo
(bhrama), drowsiness (tandra), neuresthenia (klama), comas (mada-murccha-sanyas),
alcoholism (madatyaya), and hypochondriasis (gadodvega).
3. Personality (prakrti) disorders: There are 16 mental disorders (manasa prakriti)
representing 16 types of behavior traits. When such personality behavior becomes
overt and overrides the range of normalcy, the patient may have a psychiatric
disorder.
4. Mental retardation (buddhimandya).
5. Neurological and behavioral problems of the elderly (jara-janya manasa vikara).
6. Psychosomatic diseases, where the cause of disease is mental and manifestation
is somatic (manodaihika vyadhis,[ e.g., sokatisara]).
The psychiatric syndromes named symbolically after the name of planets (e.g., bhutonmada
and grahavesa) warrant prayers (daivavyapasraya cikitsa). This is because herbal and
purification treatments (yuktivyapasraya cikitsa) based on fundamental doctrines of
Ayurveda are not possible.
In conventional medicine, mental diseases in general are characterized by altered behavior.
The clinical diagnosis is done on the basis of the pattern of alteration of the behavior
and certain associated signs and symptoms. Common psychiatric diseases described in
the conventional medicine8 and Ayurveda7 are (1) psychosis (unmada), (2) depressive
illness (cittavasada), (3) anxiety disorders (cittodvega), and (4) somatoform disorders, alcoholism,
and drug abuse (mada). These diseases are briefly discussed here.

25.5.1 Psychosis
Psychosis is described in Ayurveda as a major psychiatric disease. There are several types
identified in terms of the set of signs, symptoms, and the pattern of behavior alterations
referable to the three dosas and their combinations.
A separate category of psychosis, described as agantuja unmada by Charaka and as
bhutonmada by Susruta, forms an interesting dimension of Ayurvedic psychiatry. In this
context about a dozen psychiatric syndromes are described and named after different
planets or divinities (grahas). Thus, bhutonmada is a specialized aspect of Ayurvedic psychiatry
using symbolic terms and need not be pushed into the realm of demonology.
In the conventional medicine, schizophrenia is a major psychotic (presence of hallucinations
or delusions) illness. The major feature of schizophrenia is a decline in psychosocial
functioning, with a tendency to move down in a person’s social circle. Some patients may
have acute full-blown symptoms, whereas others may have chronic and less severe symptoms.
Characteristic symptoms are delusions, hallucinations, disorganized speech, grossly
disorganized behavior, and hallucinations consisting of a voice or two voices that converse
with each other and affect the behavior or thought of the patient. Prevalence of the disease
is about 1% for lifetime risk. Schizophrenia affects both sexes equally. It affects all ages,
although most cases are known to occur between the age of 15 and 35 years.8
25.5.2 Depressive Illness (Cittavasada)
Major clinical features of depressive disorders include persistent depressed mood, markedly
diminished interest or pleasure, insomnia or too much sleep, psychomotor agitation,
fatigue, loss of energy, diminished ability to think, and suicidal tendencies. An examination
of the patient history does not reveal any organic factor or pathology or any family disaster
to explain symptoms, nor does it reveal delusions, hallucinations in the past 2 weeks, or
schizophrenia. In some cases, however, the family history may show biological or genetic
propensity.
The mechanism responsible for depression is believed to be the decrease of catecholamine.
This is based on the observations in 1950s that reserpine, a catecholamine and
indolamine depleter, causes depression and drugs that replenish these amines are therapeutic;
it was suggested that a reduction in the levels of these amines in the brain are
related to depression. A specific cause responsible for the reduction in amine levels is not
clear. It is possible that a thinking process in the cortex responding to an adverse physical
or psychosocial environment may trigger the reduction in amine levels. Thus, the reduction
in amine levels may be a manifestation of the disease and not the cause. Almost all
antidepressant drugs are known to increase the availability of catecholamine and indolamine
at the synapse in the central nervous system.8
25.5.3 Anxiety Disorders (cittodvega)
Major features of anxiety disorders include nervousness, sleeplessness, hypochondriasis,
and somatic complaints. No age is immune to these disorders. Clinical symptoms may
occur as an episode, such as paniclike anxiety, or may show chronic generalized anxiety.
A panic anxiety episode may consist of following symptoms: shortness of breath, dizziness,
unsteady feeling, fainting, accelerated heart rate, trembling, sweating, choking, nausea,
depersonalization, paresthesia, hot flashes, chills, chest pain, fear of dying, and fear
© 2004 by CRC Press LLC
444 Scientific Basis for Ayurvedic Therapies
of going crazy. No clear etiology is known, but a cluster of cases in families indicates some
genetic component similar to depression. However, physical and sociopsychological environmental
factors must be considered. Neurophysiology and neurobiochemistry of anxiety
disorders suggests the involvement of the noradrenergic system.8
25.5.4 Somatoform Disorders, Alcoholism, and Drug Abuse (Mada)
Somatoform disorders basically have one common characteristics: mimicry of medical
diseases involving exaggeration of severity or disability accompanying actual medical
illness. There is still no credible neurobiological basis for these disorders. Some examples
of these diseases are listed below8:
1. Somatization disorder — This is a multisystem disorder characterized by complaints
of pain, gastrointestinal, sexual problems, and pseudoneurologic problems.
It begins early in life.
2. Hypochondriasis — Patients believe that they are going to contract some serious
illness.
3. Conversion disorder — Patients mimic symptoms of neurological or medical
illness and show dominant psychological factors as the cause.
4. Body dysmorphic disorder — Patients are concerned with an imagined defect in
physical appearance.
5. Pain disorder — Patients complain of pain and indicate some dominant psychological
factor as the cause.
Examples of somatiformlike disorders include the following:
1. Dissociative disorder — Patients show disrupted consciousness, memory, identity,
or perception judged to be attributed to psychological factors.
2. Factitious disorder — Patients intentionally create physical and psychological
signs of illness when no cause (financial gain, avoidance of responsibility, etc.)
can be identified.
3. Malingering — Patients intentionally create false physical and psychological signs
of illness and an identifiable cause (financial gain, avoidance of responsibility, and
others).
4. Chronic fatigue syndrome — The syndrome has the basis in reports appeared in
1980s in the U.S. of pathologic fatiguability. Unconscious psychological factors are
believed to be involved as important contributors.
25.6 Diagnosis of Psychiatric Disorders
The clinical examination in Ayurveda has two objectives: (1) to examine and assess the
primary nature of the patient as an individual as opposed to a disease and his or her
health (rogi pariksha) and (2) to examine and assess the nature and severity of the disease
(rog-parikhsa). The examination of the patient is done by a 10-point interrogation (dasavidha
pariksa):

1. Constitution (prakriti)
2. Morbidity (vikrti)
3. Quality of tissues (sara)
4. Body stucture (samhanana)
5. Anthropometry (pramana)
6. Adaptability (satmya)
7. Mental stamina (sattva)
8. Digestive power (ahara sakti)
9. Physical strength (vyayama sakti)
10. Age and aging (vaya)
The clinical examination includes an interview (prasna pariksa) with the patient, a reliable
attendant, or relative. The physical examination of the patients (pancendriya pariksa)
includes the following:
1. A general survey by eight-point examination (astavidha pariksa): pulse (nadi), urine
(mutra), stool (mala), tongue (jihva), voice (sabda), skin (sparsa), eyes (netra), facies
(akrti).
2. Systemic examination (sadanga pariksa) of the six parts of the body: head-neck,
trunk, and the four limbs along with 13 channels (srotamsi) distributed over the
entire body (sadangas). The examination of channels (srotas) with psychiatric
patients must include the examination of mental channels (manovaha srtoas).
The clinical data available through the above methods are critically examined and
evaluated in the light of the doctrine of Ayurvedic knowledge of clinical description,
signs and symptoms, pathology, and diagnostic criteria (pramana vijnana and nidana
pancake, nidana, purvariipa, rupa, samprapti, upasaya-anupasaya). The diagnosis is made not
merely by name of a disease or syndrome, but in a descriptive way identifying the
constitution, etiology, and abnormal personality (prakrti, hetu, vikrti); this includes dosa
tissues (dusya) and seat of the vitiated dosa (adhisthana). The Ayurvedic physician pays
special attention to the patient’s environment, hereditary and genetic background, and
original personality makeup in terms of tridosa and three personality properties (triguna).
25.7 Treatment
The Ayurvedic management of a psychiatric patient is carried out through three broad
streams of therapy: (1) divine therapy (Daivavyapasraya cikitsa), (2) biological therapy
(Yuktivyapasraya cikitsa), and (3) psychotherapy (Sattvavajaya). The divine therapy includes
the use of religious activities (mantra, japa) and wearing of precious stones. Ayurvedic
psychotherapy is practiced incorporating the principles of assurance therapy (asviisana),
replacement of negative emotions with positive emotions, and psychological shock therapy.
In addition, it includes encouraging the patient to find or develop a specific goal,
purpose, or meaning in life; find a job that gives better job satisfaction; improve relationships
with family members; contribute own share of responsibilities to the household;

maintain a healthy lifestyle with respect to daily routine (sleeping schedule and exercise);
and join some sports activity, fitness club, and volunteer groups to help the community.
In biological therapy, the patient is subjected to biopurification by pancakarma in order
to cleanse the channels of the body. This is followed by salisamana therapy or palliative
treatment with the help of ausadhi (medicinal herbs and herbal formulas), anna (dietetics),
and vihara (lifestyle). The drugs used in the treatment are mostly nootropic (medhya)
herbs or herbomineral formulas or nootropic rasayanas, which are believed to act as
brain tonics and adaptogens. The nootropic herbs are considered as specific molecular
nutrients for the brain, affording a better mental health and leading to alleviation of
behavioral alterations.9 The vajikarana drugs such as kapikacchu and others are used in
the treatment of depression. The entire Ayurvedic management is more health oriented
than disease oriented. As such, there is a big scope of utilizing Ayurvedic approach and
therapeutics as an adjunct to the disease-oriented therapy of modem psychiatry to afford
a full treatment.
25.7.1 Ayurvedic Herbs and Herbal Formulas
Besides the nondrug approach to prevention and treatment of mental disorders, the
Ayurvedic texts describe a large number of herbal and herbomineral formulas for treating
mental diseases. Many of these formulas are still in popular use in the hands of a large
number of Ayurvedic practitioners. The scientific validity of many of these herbs and
herbal formulas drugs has been tested on scientific parameters, and several of these have
been found effective.
Ayurveda describes a class of herbs termed as medhya herbs and medhya rasayana. All
medhya and medhya rasayana drugs are claimed to be nutraceutical agents specific to neuronutrition.
They are called medhya because they are beneficial for medha (i.e., intellect). All
such herbs have been found to possess nootropic effect besides varying degrees of anxiolytic
activity. In addition to other aspects of the rasayana effect, they bring about antistress
effect and improve the memory and cognitive power. The popularly used Medhya herbs
and commercially available herbal compound formulas are listed below:
All these plants are tropical and grow in India and other tropical countries profusely.
The recent clinical and laboratory studies conducted on these herbs have shown mild to
moderate nootropic and antistress effects with high safety profile.10–17
In addition to the medhya herbs as mentioned above, it is pertinent to mention that the
herbs of vrisya and vajikarana categories are also used in psychiatric care. Vrisya and
vajikarana herbs are essentially aphrodisiacs and are commonly used for promotion of
sexual stamina and virility. Some Ayurvedic physicians use this category of herbs for
treating depression. The most popular herbal drug of this category is kapikacchu (Mucuna
Single Herbs Herbal Formulas
1. Sankhapuspi (Convolvulus pluricaulis)
2. Mandukaparni (Centella asiatica)
3. Brahami (Bacopa monnieri)
4. Vaca (Acorus calamus)
5. Jatamansi (N. jatamansi)
6. Ashwagandha (Withania somnifera)
7. Sarpagandha (Rauwolfia serpentina)
8. Jyotismati (Celestrus panniculatus)
9. Yasti madhu (Glycyrrhiza glabra)
10. Guduchi (Tinospora cardifolia)
1. Saraswatarista
2. Aswagandharist
3. Smriti sagar rasa
4. Krisna chaturmukha rasa
5. Unmada gajankusa rasa
6. Unmada gajakeshri rasa
© 2004 by CRC Press LLC
Psychiatric Disorders 447
pruriens). The seeds of this plant, which are also edible as a vegetable, are used in the
treatment of depression and also for treatment of Parkinsonism because of high levadopa
(L-DOPA) content.
25.7.2 Nonherbal Therapies
The Ayurvedic classics describe sattvavajaya as one of the three major therapeutic streams
of Ayurveda. Sattvavajaya is a special form of psychotherapy where the therapist attempts
to divert the thought process of the patient from unwanted targets (ahit bhawas) to beneficial
targets (hita bhawas). This is done through supportive therapy, assurance, and replacement
of negative emotions by positive emotions.
In addition to this classic Ayurvedic psychotherapy, the role of yoga and meditation can
not be over emphasized. Scientific evidence has already accumulated to suggest that
several yogic practices have great psychorehabilitative and antistress effect.
Similarly, certain traditional practices of keraliya panchakarma (i.e., sirodhara and sirobasti)
are used for treatment of chronic mental diseases and have good results. However, their
mode of action has not yet been validated scientifically.
In conventional medicine, treating psychiatric disorders essentially consists of identifying
and eliminating socioenvironmental factors and administration of antipsychotic drugs
(neuroleptic drugs) similar to that in Ayurveda. The drugs used for the treatment of
psychosis include phenothiazines, structurally similar thiozanthenes, and heterocyclic
dibenzazepines; butyrophenones and diphenylbutylpiperdines; and indolones and other
heterocyclic compounds. These drugs act via blocking the mesolimbic dopamine receptors.
The adverse side effects of the drugs are as follows:
1. Acute spasm of the tongue, face, neck, or back may mimic seizures, not hysteria
2. Motor restlessness
3. Bradykinesia, rigidity, variable tremor, mask facies, and shuffling gait
4. Catatonia, stupor, fever, unstable blood pressure, and myoglobinemia can be fatal
5. Perioral tremor
6. Oral facial dyskinesia, widespread choreoathetosis, or dystonia
7. Agranulocytosis8
The pharmacologic agents available to treat depression disorders exert their antidepressant
effect by inhibiting the reuptake of serotonin at presynaptic membrane selectively
(fluoxetine) and the reuptake of both serotonin and norepinephrine or (imipramine),
directly inhibiting monoaminao oxidase enzyme (phenelzine) or causing dopamine blockage
(trazodone). These drugs provide symptomatic relief and remissions but do not cure
the disease. The side effects of these drugs include dry mouth, constipation, postural
hypotension, tachyarrhythmia, nervousness, insomnia, tremor, agitation, headache,
weight loss, hypertensive crisis, and priapism.2
The drugs used for the treatment of anxiety disorders are primarily antihistamines and
benzodiazepines. The adverse side effects of these drugs include dry mouth, mental confusion,
addiction, ataxia, drowsiness, sedation, nervousness, headache, and bradycardia.8
No drug treatment should be given to patients suffering from somatoform disorders,
alcoholism, or drug abuse (mada) unless there are secondary signs that require drug
treatments. Attempts should be made to identify and eliminate sociopsychological factors
and other environmental factors associated with the diseases. The psychiatrist and family
members need to take care of the patient with assurances, spiritual guidance, and prayers.8

25.8 Prevention
Ayurveda places great emphasis on preventing diseases; psychiatric disorders are no
exception. As a matter of fact, a healthy lifestyle, a healthy diet, balanced physical activities,
living up to social and family responsibilities, enjoying work, regularly exercising, practicing
a proper daily routine (dincharya), and keeping personal living spaces (such as
bedrooms and cars) presentable and pleasing may prevent many psychiatric disorders,
particularly if children are also raised with this lifestyle. According to Ayurveda, the
human body is like a vehicle driven by the soul (spirit, atma). When the vehicle takes
control of the travel, a disaster is bound to occur. One must not surrender his or her life
to the body; the soul must drive the body.
25.9 Scientific Basis of Ayurvedic Therapies
Although the therapies mentioned above have been in traditional use for thousands of
years, with the recent demand of evidence-based Ayurveda, modest efforts have been
made to generate scientific evidence for the safety and efficacy of the traditional medications.
Reports on such studies are accumulating in scientific journals. Some such studies
are highlighted below.
25.9.1 Antistress Agents
A large number of Ayurvedic herbs have been described to possess the medhya effect. All
such herbs are believed to have neuronutraceutical effect with varying degree of anxiolytic
and antistress effect. The potentiation of barbiturate hypnosis by sankhapuspi (C. pluricaulis)
in rats and the evidence of anxiolytic and adaptogenic effect of this drug in patients of
anxiety and neurosis has been demonstrated.18 In another study, similar effects for
mandukaparni (C. asiatica) and aswagandha (W. somnifera) have been reported in animal
models and in clinical settings, respectively.19 The effect of brahmi (B. monnieri) in similar
clinical and laboratory models was also investigated and was found to lower the level of
anxiety and promote memory and adaptation.11 Singh and associates screened a series of
herbal therapies in albino rats for antistress effect by measuring swimming performance,
changes in adrenal weight, and ascorbic acid and cortisol content of adrenal glands during
stress; they also measured the incidence of stress ulcers in stomachs that were under the
influence of herbs in stressed rats. The investigators found highly significant antistress
effect in ashwagandha (W. somnifera) and tulasi (O. sanctum). These two drugs were found
to be twice more effective than P. ginseng in terms of ED50.16,17
25.9.2 Memory-Enhancing Agents
All medhya rasayana of Ayurveda are conceptually nootropic agents. Recent studies
conducted on these herbs have shown evidence for this conceptual claim. Singh and
Singh reported a memory-enhancing effect in brahmi (B. monnieri) followed by several
studies conducted at the Central Drug Research Institute, Lucknow, India, by Dhawan

and Associates in recent years characterizing active constituents of this plant responsible
for the memory enhancing effect.10,20
25.9.3 Treatment of Residual Psychosis
With the advent of strong antipsychotic drugs in modern medicine, it is no longer difficult
to control the acute episodes of psychotic disease. It is becoming more and more difficult,
however, to take care of the long-term chronic residual phase of these diseases and their
negative symptoms. Modern medicines are not suitable for such long-term use because
of drug dependence and adverse side effects. In such cases, Ayurvedic medications are
the only logical answer. Certain Ayurvedic herbs, particularly the polyherbomineral compounds
like smrti sagar rasa21,22 and unmada gaja kesari rasa, have shown encouraging
results.23
25.9.4 Antidepressants and Mood Elevators
A number of Ayurvedic herbs, particularly the vajikarana formulas (Ayurvedic aphrodisiacs),
have been evaluated for their possible role in the management of depressive illness.
Aswagandha (Withania somnifera), kapikacchu (Mucuna pruriens), jyotismati (Celeastrus panniculatus),
and vaca (Acorus calamus) have shown good results in pilot studies. In one study,
aswagandha and kapikacchu used alone in patients of depressive illness exhibited an antidepressant
effect when measured on the Hamilton Depression Rating Scale.20 The potentiation
of hypothermia effect of the agonist in aswagandha-treated animals suggests that
aswagandha sensitizes serotonin (5-HTIA) autoreceptors. A similar effect was also found
for sankhapuspi (C. pluricaulis).20
25.9.5 Geriatric Mental Health
Aging is generally associated with a range of psychological symptoms. The rasayana
formulas of Ayurveda are the logical remedy. The antiaging effects of selected rasayana
formulas like aswagandha (W. somnifera) and tulasi (O. sanctum) were evaluated by using
a standardized biological age scale and brief psychiatric rating scale, memory span test,
and mental fatigue rate.24 It was observed that use of aswagandha and tulasi singly for a
sample test period of 3 to 6 months exhibited notable beneficial effect in elderly individuals.
Such an effect is attributed to the drugs’ antistress and adaptogenic activities.
25.9.6 Medhya Rasayana and Mental Retardation
A varying degree of mental retardation is a major health hazard in children prevalent
throughout the world and belong to divergent etiology. Besides self-recovery and compensation,
there is no definite treatment for this condition in conventional Western medicine.
But the Ayurvedic texts describe a range of restorative remedies (i.e., rasayana),
especially for the promotion of mental health and cognitive functions. Such rasayanas are
called medhya rasayana. It is claimed that such rasayanas, because of their nutritive impact
on the brain, may help mentally retarded children. Mandukaparni (C. asiatica) is one of the
four medhya rasayanas described by Charaka Samhita.7 This drug is in traditional use and
was studied preliminarily for its utility in mental retardation.15 More recently, a clinical
study on mandukparni in 30 mentally retarded children (6 to 18 years old), fulfilling the

selection criteria for mental retardation and excluding any other major organic cause, was
conducted.14 These children received the mandukparni (whole plant granules) at a dose of
5 g twice/day for 6 months. The observations showed significant improvement in performance
intelligence quotient, social quotient (measured by Vineland social maturity scale
for behavior and social adoptability), immediate memory span, and reaction time. The
authors concluded that such an effect of mandukaparni could be due to the rasayana effect
of the drug both in terms of its microneuronutrient effect and its srotas (microvascular)
effect by promoting the blood supply to the brain.
25.10 Summary and Conclusions
Mental health and ailments of psyche have been important considerations in the field of
medicine from the very beginning. Ayurveda has a well-developed branch of psychiatry,
and the principles and practices of mental health care which developed thousands of years
ago are again drawing attention because of their unique holistic approaches. There is a
need to integrate this novel wisdom into the mainstream of the health care delivery system
of today.
References
1. Singh, R.H., Ayurvediya Manas Vijnana, Choukhamba Amara Bharati Prakashan, Varanasi,
India, 1985.
2. Baldessarini, R.J., Drugs and the treatment of psychiatric disorders, in Goodman and Gillman's
The Pharmacological Basis of Therapeutics, Hardman, J.G., Limbird, L.E., et al., Eds., McGraw-
Hill, New York, 1996, chaps. 18 and 19.
3. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed.,
text revision, Washington, D.C., 2000.
4. Singh, R.H., Singh, M.B., and Udupa, K.N., A study of tridosa as neurohumours, J. Res.
Ayurveda Siddha, 1(1), 1–20, 1979.
5. Udupa, K.N., Singh, R.H., Dubey, G.P., Rai, V., and Singh, M.B., Biochemical basis of psychosomatic
constitution (prakriti), Indian J. Med. Res., 63(7), 923, 1975.
6. Cotran, R.S., Kumar, V., and Collins, T., Neoplasia, in Robins Pathological Basis of Disease, Cotran,
R.S., Kumar, V., and Collins, T., Eds., W.B. Saunders, New York, 1999, chap. 8.
7. Charaka Smhita (700 B.C.), translated by Sharma, P.V., Choukhamba Orientalia Varanasi, U.P.,
India.
8. Schiffer, R.B., Psychiatric disorders in medical practice, in Cecil Text Book of Medicine, Goldman,
L. and Bennett, J.C., Eds., W.B. Saunders, Philadelphia, 2000, chap. 450.
9. Singh, R.H., Sinha, B.N., Sarkar, F.H., and Udupa, K.N., Comparative biochemical studies on
the effect of medhya rasayana drugs on brain in rats, J. Res. Indian Med., 14(3), 7–14, 1979.
10. Singh, H.K. and Dhawan, B.N., Neuropsychopharmacological study of B. monieri Linn. (brahmi),
Indian J. Pharmacol., 29, 5359–5365, 1997.
11. Singh, L. and Singh, R.H. (Sup), (1978): Studies on Psychotropic Effect of the Medhya Rasayan
Drug, Brahmi (Bacopa Monieria), M.D. thesis (Kayachikitsa), Banaras Hindu University, Varanasi,
India, 1978.
12. Singh, N., Study of anti-stress effect of plant drugs, Ann. Natl. Acad. Indian Med., 1(1), 1987.
13. Singh, R.H., Singh, L., and Sen, S.P., Studies on medhya rasayan drug brahmi (Bacopa monnieri
Linn.). II. Experimental studies, J. Res. Indian Med., 14(3)1–6, 1979.

14. Agrawal, S.C. and Singh, R.H., Effect of medhya rasayana drug mandukaparni on cognitive
functions and social adaptability of mentally retarded children, J. Res. Ayurveda Siddha, 18(3–4),
97–107, 1998.
15. Apparao, M.V.R., Srivastava, K., and Rao, K., The effect of mandukaparni (Centella asiation)
on general mental ability of mentally retarded children, J. Res. Indian Med., 8(4), 9–16, 1973.
16. Archana, R. and Namasivayam, A., Anti-stressor effect of Withania somnifera, J. Ethnopharmacol.,
64, 91–93, 1999.
17. Bhattacharya, S.K., Satyan, K.S., and Ghosal, S., Anxiolytic activity of glycowithanolides from
Withania somnifera, Indian J. Exp. Biol., 35, 236, 1997.
18. Mehta, A.K. and Singh, R.H. (Sup), Studies on the Psychotropic Effect of the Medhya Rasayana
Drug: Shankhapuspi (Convolvulus Pluricaulis), M.D. thesis (Kayachikitsa), Banaras Hindu
University, Varanasi, India, 1976
19. Mishra, B.K. and Singh, R.H. (Sup), Clinical and Experimental Evaluation of Medhya Rasayan
Effect of Mandukaparni (Hydrocotyle Asiatica), M.D. thesis (Kayachikitsa), Banaras Hindu
University, Varanasi, India, 1980.
20. Koirala, R.R. and Singh, R.H. (Sup), Clinical and Behavioural Study of Medhya Drugs on
Brain Functions, M.D. thesis (Kayachikitsa), Banaras Hindu University, Varanasi, India, 1992.
21. Tripathi, J.S. and Singh, R.H. (Sup), A Clinical Study on Personality Factors in Cases of Residual
Schizophrenia and Its Ayurvedic Management, M.D. thesis (Kayachikitsa), Banaras Hindu
University, Varanasi, India, 1992.
22. Tripathi, K.M. and Singh, R.H. (Sup), A Study on Stress Profile and Personality Factors in
Some Psychosomatic Disorders, Ph.D. thesis (Kayachikitsa), Banaras Hindu University, Varanasi,
India, 1982.
23. Choudhuri, O. and Singh, R.H. (Sup), Development of an Ayurvedic Regimen for the Management
of Residual Schizophrenia, M.D. thesis (Kayachikitsa), Banaras Hindu University,
Varanasi, India, 2001.
24. Dwivedi, K.K. and Singh, R.H. (Sup), A Study on Psychiatric Symptoms of Geriatric Patients
and Response to Ayurvedic Therapy, Ph.D. thesis (Kayachikitsa), Banaras Hindu University,
Varanasi, India, 1997.

26
Parkinson’s Disease (Kampa Vata)
Lakshmi Chandra Mishra and R.H. Singh

26.1 Introduction
According to Ayurveda, most of the diseases of the
vata
system are essentially the conditions
of degenerative diseases of the nervous system. As many as 80 kinds of
vata
diseases
are described in Charak Samhita.
1
The syndrome of parkinsonism is commonly compared
with
kampa vata
(
kampa
literally means tremors). The syndrome was comprehensively
described by James Parkinson in 1817, but the review of much early literature would show
that syndromes strikingly similar to parkinsonism were already known and were categorized
among the
vata
diseases in Ayurveda.
Parkinson’s disease (PD) is prevalent all over the world and has no definitive treatment
in conventional medicine except for the palliative prescription of anticholinergics together
with levodopa and dopadecarboxylase inhibitor. The Ayurvedic treatment strategy is to
combat
vata dosa
and to sustain neuronutrition by
rasayana
remedies. This chapter discusses
vata
diseases (neurological diseases) as a class with emphasis on Ayurvedic therapies of
PD and a possible scientific basis for the therapeutic effect.
26.2 Etiology
whole body physiology by explaining the body functions in terms of three biofactors called

tridosa
(
vata
,
pitta
,
and
kapha
). In all applied considerations, the
vata
system of the
tridosa
doctrine represents neuroscience in Ayurveda. The
vata
dosa
is responsible for the entire
neurophysiological phenomena operating in the body.
1
There are five major components
of
vata
systems:
prana, udana, vyana, samana,
and
apana
. These components are responsible
for five different aspects of neural functions at five different levels in the body. When the
vata
dosa
looses its equilibrium due to a wide range of aetiological factors, including tissue
degeneration and damage (
dhatu ksaya
) and neuro-obstructive diathesis (
margavarana
), it
leads to the development of 80 types of
vata
diseases or neurological diseases.
The etiopathogenesis of PD is not precisely known in conventional medicine, but it is
understood to be caused by lesions in the basal ganglia and is especially associated with
the damage to the interconnecting system between substantia nigra and corpus stratum.
Specific etiology of PD is related to aging, and it develops in people over 50 years old.
There is no specific genetic component involved in most cases, but mutation in the gene
for alpha synuclein has been linked to PD in some cases.
2
Exposure to environmental
chemicals may cause damage to basal ganglia and brain stem resulting in parkinsonism.
For example, exposure to 1-methyl 4-phenyl-1, 2, 3, 6-tetrahydropyridine, a contaminant
present in a psychoactive meperidine analog, can cause an acute onset of parkinsonism
symptoms and the associated destruction of substantia nigra.
26.3 Pathology
In Ayurveda, no specific structural pathology of PD is described other than its identification
as a
vata
dosa
disease.
In conventional medicine, PD is described as a chronic progressive disease of extra
pyramidal system of the brain where voluntary movement is disturbed with the appearance
of involuntary movements and altered muscle tone. The pathology of PD essentially
involves a loss of pigmented dopaminergic neurons in the substantia nigra pars compacta
(SNPC) of the brain with the appearance of intracellular inclusions known as Lewy
bodies.
3,4
SNPC provides dopaminergic innervation to the dopamine content (caudate and
putamen). Early studies have shown 80% reduction in the dopamine content of the striatum.
This reduction parallels a loss of neurons in the SNPC, indicating that dopamine
loss may be the cause of PD symptoms and that replacement of dopamine could be
helpful.
5,6
The major symptoms of PD are related to the deficiency of dopamine. Cholinergic
nucleus basilis degeneration is believed to be related to dementia that affects many
patients. Noradrenergic locus nucleus degeneration is believed to be associated with the
facial expression of freezing and with depression.
7
26.4 Classification of
Vata
Disorders
The
vata
diseases as described in Ayurvedic classics include a wide range of neurological
morbidities, including inflammatory, degenerative, obstructive, and functional. The
vata
diseases may manifest as neural hyperfunctioning (
vata vriddhi
), neural hypofunctioning
(
vata ksaya
), or masked functioning (
avarana
). It is not possible to innumerate and classify

all 80 types of
vata
diseases here. However, Ayurvedic texts describe the etiology, symptomatology,
and treatment of a variety of paralytic conditions, painful neuropathies, conditions
with tremors, and involuntary movements and convulsions in detail. PD is one of
those diseases. The descriptions of these conditions in Ayurveda are very similar to those
described in conventional medicine. Some of these conditions are listed here as examples.
1. Paralysis and paresis — Facial paralysis (
ardita
), hemiplegias (
pakavadha
), paraplegias
(
adharanga vata
), quadruplegi (
sarvauga vata
), and others
2. Painful neuropathies — Sciatica (
gridhrasi
), limb cramp (
khalli
), brachial neuritis
(avavahuka
and
viswachi
), trigeminal neuralgia (
siragrah
), lumbago (
kati-sula/pristhasula
), cervical neuropathy (
manyastambh
), peripheral neuritis (
rasagata vata
), and
others
3. Coordination disorders and convulsive diseases: parkinsonism, tremors, choreas
(
kampa vata
), convulsive neuropathies (
aksepa
), epilepsies (
apasmara
), pseudo seizure
disorders (
apatantraka
), and others
4. Visceral neuropathies — A large number of diseases and syndromes related to
the neuropathy of different visceral organs of the digestive system, urogenital
system, and sensory organs as described in Ayurveda
26.5 Clinical Features and Diagnosis of Parkinson’s Disease
Clinical features of
kampa vata
in Ayurveda are similar to those described for parkinsonism
and Huntington chorea in conventional medicine. These are the two most important
neurodegenerative diseases of the basal ganglia and brain stem.
8
These diseases are frequently
associated with movement disorders, rigidity, abnormal posturing, and involuntary
movements marked by fine disorganized and random movements of the extremities
(usually the hands and to a lesser extent proximal limb and muscles). The four main
features of parkinsonism are (1) bradykinesia (abnormal slowness of voluntary movements,
often associated with diminution of the range of movements), (2) muscular rigidity,
(3) resting tremor, and (4) postural imbalance (leading to disturbance of gait and falling).
9
These features are also seen in other conditions, such as idiopathic PD, progressive supranuclear
palsy, and corticobasal degeneration, with common damage to the nigro-striatal
dopaminergic system.
Other symptoms of PD are related to mood, intellect, and the autonomic nervous system.
These symptoms are hypophonic disarthria, monotonous speech pattern, difficulty in
getting in and out of a chair or a bed, shuffling gait with short steps, decreased automatic
movements, and arm swing. The resting tremors are slow, regular oscillations (3 to 6/sec)
that usually cease during voluntary movements of the affected part, though occasionally
the tremors may be of action type. Tremors are exacerbated by fatigue and cold; they can
also affect the lips, lower jaw, and tongue. Tremors may be a dominant feature in some
patients, whereas postural instability may be dominant in others.
7
Other PD-like conditions can be differentiated from PD on the basis of a low to no degree
of tremor and poor response to levodopa. The good response to levodopa in PD is because
dopamine receptors are preserved in PD, but they are decreased in other PD-like conditions.

26.6 Prognosis
In Ayurveda, the prognosis of PD is not specifically given. Most
vata
diseases are not
curable, but the patient may be able to live with the disease with certain degree of
inconvenience and difficulties. As the disease progresses, patients develop rigidity and
cannot take care of themselves. In extreme cases, death may occur from the patient’s
inability to breath, resulting in aspiration pneumonia or pulmonary embolism. Ayurvedic
therapies available can make life much easier and increase life expectancy. Treatment with
pharmacologic agents or direct electrical stimulation of target areas (thalamus, subthalamic
nucleus, or globus pallidus) can provide relief in symptoms, good functional mobility for
many years, and a substantial increase in life expectancy.
9
26.7 Treatment
Ayurveda takes a unique approach to the management of the above-mentioned neuropathies
with a special emphasis on eliminating their causes by
panchakarma
, physiotherapy,
and medicinal treatment with the help of a wide range of herbal and herbomineral drugs.
Ayurveda describes a large number of nootropic drugs (stimulating to mental activity,
causing cerebral or intellectual activity) and nervous system tonics (i.e., rasayanas in the
treatment of
vata
diseases).
Panchakarma
therapy is especially advocated in the treatment
of neurological diseases. Using different kinds of oil massage (
snehana–abhyanga
) and
medicated heat treatment (hot room) (
swedana
) is very efficacious. Besides special treatments
like
sirovasti
and
sirodhara, vasti
therapy is indicated in such diseases and administered
in the form of a specially planned therapeutic enema. With all this, contemporary
Ayurvedic medicine claims good success in the practice of neuromedicine.
Being a neurodegenerative disease, parkinsonism is essentially treated by
rasayana
or a
rejuvenative approach in Ayurveda.
10,11
The
rasayana
drugs of Ayurveda are essentially
nutraceutical agents, and the
medhya rasayana
are specific neuronutrients or nervine tonics
with nootropic effect.
Aswagandha
(
Withania somnifera
),
brahmi
(
Bocopa monnieri
),
mandukaparni
(
Centella asiatica
), and
bala
(
Cida cordifolia
) are the common classical drugs advocated
for this purpose. This is because Ayurveda considers such movement disorders under
vata
vyadhi
, and in common practice the term
kampa vata
is used to describe the syndrome. The
strategy is to combat
vata
dosa
and to sustain neuronutrition by
rasayana
remedies.
Kapikacchu
(
Mucuna pruriens
), an edible legume and popular Ayurvedic aphrodisiac, has also been
used in the hands of Ayurvedic practitioners for treating
kampa
vata
. With the recent
discovery that
Mucuna pruriens
seeds are a highly rich source of levodopa, the use of
kapikacchu
in
kampa
vata
has tremendously increased.
Kapikacchu
(
Atmagupta
) has been
traditionally used for treating tremor disorders in Ayurveda.
12
In conventional medicine, the treatment of PD is primarily based on increasing the levels
of dopamine in SNPC. Carbidopa and levodopa, dopamine receptor agonists (pergolide
and bromocriptine), and monoamino oxidase inhibitor (selegiline) are used to maintain
the levels of dopamine. The other less-used drugs are muscarinic receptor antagonists and

amentidine, an antiviral agent. The common side effects of levodopa are psychiatric
problems, dyskinesis, and the wearing-off-effect (loss of effectiveness). The pharmacological
treatments are only symptomatic; they do not change the progression of the disease.
If used skillfully, these drugs may dramatically improve the quality of daily life and
functional ability. Another treatment option is surgery. The main surgical approach commonly
used is pallidotomy (incision or partial destruction of globus pallidus) and highfrequency
deep-brain stimulation with an electrode implanted in one of these target areas:
thalamus, subthalamic nucleus, or globus pallidus. These procedures are effective in
providing relief from major symptoms and improving the quality of daily life but do not
alter the course of the disease.
7,13
26.8 Scientific Basis
The levodopa content of
M. pruriens
appears to be the basis for the therapeutic effect. MP
endogenously accumulates L-dihydroxyphenylalanine in the range between 0.2 and 2.0%
on a dry-weight basis in tissue culture.
14
In a clinical trial, HP-200 made from MP was
found to be an effective treatment for patients with PD.
15
A concoction of powdered
M. pruriens
seeds,
Hyoscyamus reticulatus
seeds,
W. somnifera
roots, and
C. cordifolia
roots in cow’s milk was clinically tried in 18 diagnosed patients
with PD.
16
Of these 18 patients, 13 cases underwent biopurificatory (
panchakarma
) procedures
for 28 days and palliative therapy for 56 days, whereas the remaining 5 patients
underwent palliative therapy alone for 84 days. The former group showed significant
improvement in daily activities. Symptomatically, they showed a better response in tremor,
bradykinesia, stiffness, and cramps as compared with the latter group. Salivation increased
in both groups. Chemical analysis of the concoction revealed about 200 mg of levodopa
per dose. The study shows the importance of cleansing therapy in Ayurveda medication
before palliative therapy. It also confirms the usefulness of some Ayurvedic herbal preparations
in PD.
17
In an interesting study, PD was treated with the compound Parkino at 20 ml twice/day
for 8 weeks.
18 The response was assessed symptomatically in terms of the subjective
feelings of the patient, degree of involuntary movements, and facial expressions. All the
patients exhibited highly significant improvement in symptoms during the first 2 to 4
weeks of treatment. However, during subsequent intervals, no further improvement was
noted.






Om Tat Sat
                                                        
(Continued...) 


(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)

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