PPT on Kampavata.pptx

This is a PPT on the Ayurvedic aspect of Parkinson disease Which is known as Kampavata in Ayurveda along with the Case presentation on Parkinsonism patient treated by ayurveda.

1. KAMPAVATA Presented by – Rupali Purohit PG Scholar 3rd year Department of Panchakarma Himalayiya Ayurvedic P.G Medical College and Hospital, Doiwala, Dehradun.

2. DEFINITION The word Kampavata is formed by the union of two words – Kampa + Vata The word Kampa means “to Move” or “to Shake” and vata is one among the three humours of body. So, the word Kampavata means the disorders of Vata which is impaired or not in Samadoshavastha and it is characterised by Kampa .

3. LITERARY VIEW In Charaka Samhita , Kampavata is found by the name Vepathu and has been included in the 80 Vataja Nanatmaja disorders. Acharya Sushruta has mentioned the symptoms like Chestasanga , Stambha and Gurugatrata in the Condition of Kaphavritta Vyana Vayu . Kampa has been mentioned as the updrava of Prameha . Vepathu is described as a symptom in Sthavara Visha Vigyana . Acharya Madhava explained the disease Vepathu in Vata vyadhi for the first time . In Madhava Nidana, he has described two types of Kampavata , Sarvanga Kampavata and Ekanga Kampavata . As per Ashtanga Hridaya , Kampa is found as a symptom in vata Prakopa and Sarvanga vata. According to Ashtanga Samgraha , Kampa is Rasakshaya , Pittakshaya and Kaphakshaya condition. Acharya Kashyapa has mentioned Vepathu under the Vataja Nanatmaja vikara . Acharya Sarangdhar has mentioned Kampa under Vataja Roja and explained Shira Kampa under Shiro roga . Mashadi nasya has been explained in the management of Kampavata . In Bhavprakasha , Acharya Bhavamishra has explained symptoms of Stambha and Kampa in conditions of Snayugata Vata . He explained even excessive rasa of Tikta rasa will lead to Kampa . Yogratnakara has explained Sarvanga Kampa and Shiro Kampa under disease Vepathu in Vata Vyadhi .

4. Vangasena has replaced Vepathu by Kampavata as Sarvanga Kampa under Vata Vyadhi and has also described about the treatment of Kampavata . It has been asserted that Abhyanga, Swedana, Niruha Basti , Anuvasana Basti, Shirobasti and Virechana are the useful measures for the treatment ( Vata vyadhi adhikara – 155) Acharya Chakradatta explains some remedies useful for Kampavata, Dwitiya mashataila (Vata vyadhi 157-161) and Tritiya mashataila (Vata vyadhi 162-164) and Saptaprastha mahamasha Taila (Vata vyadhi 162-164) can be used for the treatment of Bahukampa, Shirokampa and Hastakampa. Internal Snehana, Abhyanga , Nasya and Basti are also indicated. Bhaisajya Ratnawali has mentioned specific Chapters named “ Tandava Rogadhikara” and “Vepathu Vatadhikara” which are found similar to the Symptoms of Parkinsonism. According to Bhel Samhita , Ruksha diet is one of the symptoms of Shira Kampa. Basavarajiyam has described and explained the symptoms of Kampavata which resembles with the symptoms of Parkinson’s disease.

5. NIDANA Kampavata is a Vatika disorder , so the causative factors which provoke vata can be considered as the etiological factor. According to Acharya C haraka : रूक्षशीताल्पलघ्वन्नव्यवायातिप्रजागरैः|विषमादुपचाराच्च दोषासृक्स्रवणादति ||१५|| लङ्घनप्लवनात्यध्वव्यायामातिविचेष्टितैः|धातूनां सङ्क्षयाच्चिन्ताशोकरोगातिकर्षणात् ||१६|| दुःखशय्यासनात् क्रोधाद्दिवास्वप्नाद्भयादपि|वेगसन्धारणादामादभिघातादभोजनात् ||१७|| मर्माघाताद्गजोष्ट्राश्वशीघ्रयानापतंसनात्|देहे स्रोतांसि रिक्तानि पूरयित्वाऽनिलो बली||१८|| करोति विविधान् व्याधीन् सर्वाङ्गैकाङ्गसंश्रितान्|१९| (Ch. Chi. 28/15-19] AHARA: Ati Ruksha, Sheeta, Laghu & Alpabhojana VIHARA: Ati Vyavaya, Ratrijagarana, Langhana, Vyayama, Dukhashayyasana, Divaswapna & Vegasandharana ABHIGHATAJA: Marmaghata, Balvad Vigraha, Prapatana, Prapeedana & Vikshepa Abhighata MANASIKA: Chinta, Shoka, Krodha & Bhaya

6. PURVAROOPA अव्यक्तं लक्षणं तेषां पूर्वरूपमिति स्मृतम् ( Ch.chi28/19) Acharya Charaka Says that the Avyakta l akshanas are the Purvarupa of Vata vyadhi.

7. ROOPA Basavarajiyam has described in detail the symptoms of Kampavata. He explained Two types of Kampavata Lakshanas 1. Sarvanga Kampavata करपादतले कम्पो देहभ्रमणदुखिते निद्राभग्नो मति: क्षीणा कम्पवातस्यलक्षणम् । Hand and feet tremors Difficulty in body movements Disturbed sleep Memory loss 2. Bahukampa एकबाहुप्रकम्पच्च विकारच्चापि देहिनाम् महादुखंदिवरात्रो बहुकम्पस्य लक्ष्णम् । When tremor is located in one arm, abnormal structural changes take place in body, all these symptoms produces difficulty and person suffers from hand tremors throughout day and night.

8. SAMPRAPTI Nidana Sevana like intake of Vata Vitiating Ahara and Vihara & Jara ( Old Age) Dhatu Kshaya Vata Prakopa Affecting Mastulunga Majja In Shira Marma Affecting Snayu, Vatavahi Sira Karyahani (Pani, Pada) Kampa Kapha Vruddhi by Nidana Sevana Avarana of Vata by Kapha Vyana Udana Gurugatrata, Vakaswaragraha Aruchi Gatisanga Further Avarana of Udanavrutta Vyana Chestahani

9. कफावृत व्यान वायु के लक्षण – गुरुता सर्वगात्राणां सर्वसन्ध्यस्थिजा रुजः। व्याने कफावृते लिङ्गं गतिसङ्ग स्तथाऽधिकः॥ (Ch.Chi. 28/228) कफावृत उदान वायु के लक्षण – आवृते श्लेष्मणोदाने वैवर्ण्य वाक्स्वरग्रहः। दौर्बल्यं गुरुगात्र त्व मरुचि श्चोपजायते॥ (Ch.Chi. 28/224) उदानावृत व्यान वायु के लक्षण – स्तब्धताऽल्पाग्निताऽस्वेद चेष्टाहानि र्निमीलनम्। उदानेनावृते व्याने तत्र पथ्यं मितं लघु॥ (Ch. Chi. 28/214)

10. SAMPRAPTI GHATAKA Dosha Vata ( Vyana & Udana ), Kapha ( Tarpak Kapha ) Dushya Rasa, Rakta, Mamsa, Meda, Asthi, Majja, Snayu, Kandara Agni Jatharagni, Dhatavagni Srotas Rasavaha, Raktavaha, Mamsavaha, Medavaha, Asthivaha, Majjavaha Srotodushti Sanga, Vimargagamana Udbhava Sthana Pakwashaya Vyatka Sthana Sarva Shareera Adhisthana Mastishka Vyadhi marga Madhyama Sadhyata- Asadhyata Krichha Sadhya

11. CHIKITSA SUTRA According to Acharya Charaka केवलं निरुपस्तम्भमादौ स्नेहौरुपाचरेत् वायुं सर्पिर्वसातैलमज्जापानौर्नरं ततः स्नेहल्कान्तं समाश्वास्य पयोभिः स्नेहयेत् पुनः यूषैर्ग्राम्याम्बुजानुपरसैर्वा स्नेहसंयुतैः । पायसैः कृशरैः साम्ललवणैरनुवासनैः॥ नावानैस्तर्पणैश्चान्नैः सुस्निग्धं स्वेदयेत्ततः। (Ch. Chi. 28/75-76) According to Acharya Vangasena वायुं वेपथुनामानं स्वेदाभ्यगानुवासनैः । उपाचरेन्निरुहैश्च शिरोबस्ति विरेचनम्॥ (Vatarogadhikara 155)

12. घृत के गुण – घृतं   पित्तानिलहरं   रसशुक्रौजसां   हितम् । निर्वापणं   मृदुकरं   स्वरवर्णप्रसादनम् ॥ ( Ch. Su. 13/14) तैल के गुण – मारुतघ्नं   न   च   श्लेष्मवर्धनं   बलवर्धनम् । त्वच्यमुष्णं   स्थिरकरं   तैलं   योनिविशोधनम् ॥ ( Ch. Su. 13/15 ) वसा के गुण – विद्धभग्नाहतभ्रष्टयोनिकर्णशिरोरुजि । पौरुषोपचये   स्नेहे   व्यायामे   चेष्यते   वसा ॥ ( Ch. Su. 13/15 ) मज्जा के गुण - बलशुक्ररसश्लेष्ममेदोमज्जविवर्धनः । मज्जा   विशेषतोऽस्थ्नां   च   बलकृत्   स्नेहने   हितः ॥ ( Ch. Su. 13/15 )

13. LINE OF TREATMENT Shodhana Chikitsa Nidana Parivarjanam Shamana Chikitsa

14. Nidana Parivarjana - संक्षेपतः क्रियायोगो निदानपरिवर्जनं ।। ( Su. Ut. 1/25)

15. SHAMANA AUSHADHIS RASA YOGAS Ekangveera Rasa Rasaraja Rasa Triguna rasa 4 . Kanaka Sundara rasa 5 . Gandharva rasa 6. Chaturbheeja rasa 7. Nagarjuna rasa 8 . Sarvanga Kampa Rasa 9 . Vatagajankusha rasa 10. Gandharva Rasa 11. Chaturbhuja Rasa 12. Smritisagar Rasa 13. Brihatvatachitamani rasa 14. Mahavata Vidhvansa Rasa 15. Trailokya Chintamani rasa 16. Tapyadi Loha TAILA & GHRITA 1. Nakula Taila 2. Vijaya Bhairava taila 3. Rasna Taila 4. Sahacharadi Taila 5. Ksheerabala Taila 6. Varuni Taila 7. Dhaturradi Taila 8. Mahanarayana Taila 9. Nakuladya Ghrita 10. Brihat Chagaladi Ghrita 11. Masha taila 12. Brihana masha taila 13. Mahamasha taila 14. Karpasa taila EKAMULIKA PRAYOGA Kapikacchu Bala Shatavari Rasna Eranda Ashwagandha Shalparni Sahachara

16. GULIKA Nagarjuna Vati Yograj Guggulu Mahayograj Guggulu Brahmi Vati Smritisagar Rasa ASAVA / ARISHTA Ashwagandharishta Balarishta Sarasvatharishta Dashmularishta Draksharishtam Brihaniya Mahakashaya RASAYANA Vanari Kalpa Ashwagandha Rasayana Kushmanda Rasayana Kapikachhu Chitrak Lasuna Amalaki Medhya Rasayana like Shankhapushpi Shilajeeta

17. Shodhana Chikitsa – Same as vata vyadhi Chikitsa i.e. Snehana Swedana Mridu Virechana Basti Nasya etc Acharya Vangasena has described specific therapies for treatment of Kampavata वायुं वेपथुनामानं स्वेदाभ्यगानुवासनैः । उपाचरेन्निरुहैश्च शिरोबस्ति विरेचनम्॥ (Vatarogadhikara 155) Abhyanga Swedana Anuvasana Basti Niruha Basti Shirobasti Virechana

18. I mportance of Abhyanga Abhyanga prevents old age, removes pain in the body and gives Pushti to the body. The veerya of the drug used for Abhyanga gets digested with the help of Sthanika Bhrajakagni and enters into srotas and starts its action. A bhyanga with various Taila mentioned for Kampavata like Mahamasha Taila , Karpasathyadi Taila, Prasriniyadi Taila etc after entering into the body nourishes tissues, gives strength and increases Agni . Does the action of Vatahara, Brimhana , brings Snehana effect to the sandhi . Abhyanga has Snigdha, Guru and Mridu properties. In Kampavata , it acts on Laghu guna and Chala guna and it also does the B alavardhana, A gnivardhana and nourishes S hushka dhatus . Abhyanga with Balaswagandhadhi tailam, Ksheerbala Tailam, Mahamasha tailam, Karpasathyadi Tailam, Sahacharadi tailam .

19. Importance of Swedana Acts as a Vatahara, Rujahara, Brimhana . It acts as vasodilator, Improves the circulation. Hence, it is very much beneficial in conditions where Shoola, Stambha and Sankocha are present. It cures Stambha, Guruta and Sheetata . In Kampavata , it acts on Sheeta and Guru Guna of Kapha and Vata producing Stambha . It can be given as Nadi sweda , Pinda sweda , Ava gaha sweda etc. Various Swedana karma for Kampavata – 1. Choorna Pinda Swedana with Dhanyamla and Kolakulathadi Choorna . 2. Shastika Shali Pinda sweda 3. Patra pottali Swedana 4. Upanaha by Kakolyadi gana can be done in Kandara snayu gata vata 5. Kaya Seka with prabhanjan vibharjan taila + Karpasathyadi taila 6 . Anna lepan 7. Kapikachhu Kwath Dhara

20. Importance of Nasya Acharya Chakradatta and Acharya Vangasena has recommended Nasya Karma in Kampavata. Brimhana Nasya provides nourishment to the shiroindriya and other organs and alleviates the vitiated vata . Hence, it is useful in Vatajanya ailments. Brimhana nasya, Shodhana nasya, Pratimarsha nasya are used widely for Kampavata according to the condition and severity of the disease. Nasya with Anu Taila, Ksheerbala 101 avarti, Karpasathyadi Taila, Mahamasha Taila can be given in the Kampavata.

21. Importance of Basti All our acharyas have advocated Basti Karma for treating Vata Dosha . The Basti karma with appropriate adoption facilitates expulsion of mala , kapha, pitta, Adhovata and Mutra and improves strength. Anuvasana Basti , by their Snigdha, Guru and Ushna properties destroys Ruksha, laghu and Sheeta Characteristics of Vata . Niruha Basti cause expulsion of Malas and doshas from all circulating channels. It relieves Sankocha and Stabdhata . Basti which can be given in Kampavata are – Matrabasti with Dhanvantara Taila, Sahacharadi Taila, Ashwagandha Taila Niruha Basti with Baladi Yapana Basti, Erandamuladi Basti, Dashmoola Basti, Dashmoola Ksheera Basti, Rajyapana Basti, Mustadi Yapana Basti , Panchshali Yapana Basti, Kukutanda Yapana Basti, Mamsa Aatmaguptadi Yapana Basti

22. Importance of Virechana According to Acharya Charaka , In Kampavata no specific drug have been mentioned. For all Vata vyadhi, Virechana with Snehasamyukta aushadhi is advised. Eranda taila is recommended as Mrudu Virechana . Taken with milk it provides Bala to Indriyas and improves Agni and does Koshtashuddhi .

23. Importance of Shirodhara/ Shirobasti According to Acharya Vagbhata, Murdhni Taila is highly beneficial for Brain, Nerves, sense organs and hairs. It Controls Vitiated Vayu and Pitta in the head. Murdhni taila is of 4 types – Shirobhyanga Shirodhara Shiropichu Shirobasti Mainly Shirodhara and Shirobasti are indicated in Kampavata . Taila used are – Mashabaladi Taila, Kampavata- Ksheerabala Taila, Dhanvantaram Taila, Kampavata Himsagar Taila, Brahmi Taila, Balashwagandha Taila etc

24. Shamana and Shodhana Chikitsa according to Various Samhitas Samhita Chikitsa Basavarajiyam Mashataila - Basti prayoga in Bahukampa Karpasatailam – Bahukampa, Vijayabhairava rasa Ashtanga Hridaya (A.H.Ch 21/66) Brihatamasha Taila Sarangdhar Samhita Sahacharadi Taila Dashmoola Taila Varuni Taila. Vangasena Brihanmasha Taila -Hasta , Shirokampa Sahacharadi Taila, Mashataila- Hastakampa Mahamasha Taila, Brihanmashataila - Basti, Abhyanga, Pana, Navana in Hastakampa and Shirokampa. Bhaisajya Ratnawali Nakulataila Nakulagrita Brihatchagaldya ghrita Sarvanga kampari rasa

25. Samhita Chikitsa Chakradatta Dwitiya Mashataila – Pana, Abhyanga, Basti, Nasya in Hastakampa and Shirokampa Tritiyamasha Taila- Basti, Nasya, Parisheka in Bhujakampa, Saptaprastha mahamasha Taila- Basti, Abhyanga, Pana, Navana in Hastakampa Bhel Samhita Snehapana, Nasya & Anuvasana Basti – Shirokampa Rasna Taila – Gatrakampa Sahastrayogam Sarvamyantakaghrita, Ajamamsaghrita, Datturataila and Maharasanadi kwatha in Shirokampa AFI Chagaladhya ghrita: Hastakampa & Shirokampa..

26. CASE PRESENTATION

27. DESCRIPTION OF PATIENT NAME : XYZ AGE : 52 YEAR SEX : MALE RELIGION : HINDU ADDRESS : RAIWALA OCCUPATION : BUSINESS SOCIO – ECPONOMIC STATUS : UPPER MIDDLE CLASS EDUCATION : GRADUATE OPD NO. : 33523

28. CHIEF COMPLAINTS K/C/O Parkinsonism and Type 2 DM Tremors in both upper and lower limbs especially in Left hand and feet since 5 years Slowness in all movements Slurred speech Difficulty in Balance and Co-ordination

29. ASSOCIATED COMPLAINTS Tendency to fall forward with difficulty in walking since 5 year Difficulty in writing, holding objects and activity of daily living since 4 year Constipation (on & off)

30. HISTORY OF PRESENT ILLNESS According to Patient, he was apparently healthy before 5 years. Suddenly he developed weakness in Right lower limb. After some time, he experienced weakness with mild tremors in Left hand. Then, after some days he experienced increased tremors in left hand with difficulty in writing and holding objects so at last he Consulted a Neurologist in Himalayan Hospital, Jollygrant and diagnosed with Parkinson’s disease and was put on medications. Patient took treatment for some time and then suddenly stopped the medication without consulting the doctor following which there was increase in the symptoms along with tendency to fall, slowness in movements and Stiffness in whole body. Then, he again Consulted Neurologist in Delhi who suggested for surgery. So, at last they visited HAMC hospital for better management.

31. PAST HISTORY Known Case of Diabetes Mellitus since 7-8 yrs. No H/O HTN, THYROID, ASTHMA, TUBERCULOSIS S/H – Surgery of Right hand because of Glass injury

32. TREATMENT HISTORY T. SYNDOPA PLUS – 1 Tab TDS T. SELEGILINE – 1 Tab BD T. PACITANE – 1 Tab BD T. TELELIGLIPTIN 20 MG – 1 OD T. GLYCOMET GP 1 – 1 TAB BD (Before Meals)

33. PERSONAL HISTORY DIET : Mixed Diet APPETITE : Reduced SLEEP : Disturbed since 1 year BOWEL : 1-2 times/day, Constipated ( Incomplete evacuation) MICTURITION : 5-6 times/day

34. GENERAL PHYSICAL EXAMINATION General Condition : Fair Built : Moderately Built Nourishment : Moderately Nourished Pallor : Not Present Oedema : Not Present Cyanosis : Not Present Icterus : Not Present Lymphadenopathy : Not Present BP : 110/70 mmhg PR : 82 BPM Tongue : Normal in Size, shape & Colour Height : 5’9” Weight : 74 kg

35. SYSTEMIC EXAMINATION PER ABDOMEN EXAMINATION – Inspection – No Scar, No Lesion + Palpation – No Palpable mass, No Tenderness + Percussion – Normal area of Dullness and resonance Auscultation – Bowel sound + ( 4/min )

36. RESPIRATORY EXAMINATION – Inspection – Chest B/L Symmetrical, No Scar + Palpation – No Tenderness + Percussion – Normal area of Resonance + Auscultation – Normal Breath sound here CARDIOVASCULAR EXAMINATION – Inspection – Chest B/L Symmetrical, No Scar + Palpation – No Palpable mass Percussion – Area of Cardiac dullness found normal Auscultation – S1 & S2 are heard normal

37. CENTRAL NERVOUS SYSTEM EXAMINATION 1. HIGHER MOTOR FUNCTION Conscious - YES Orientation to time, Place, Person – Present Memory – Recent - Intact Remote – Intact Intelligence - Intact Hallucination & Delusion – Absent Speech Disorder - Mild Slurring of Speech present

38. 2. CRANIAL NERVES EXAMINATION Olfactory - Smell sensation – Intact Optic - a) Visual acuity - difficulty in distant reading b) Visual field -Not affected c) Light reflex Not affected d) Drooping of eye lids (Ptosis) -Absent Oculomotor , Trochlear, Abducent Nerve - Eye ball movement – possible in all directions. Pupil - Position - Shape - Size – Symmetry - No abnormality detected Trigeminal Nerve - Sensory – Touch, Pain, Pressure sensation - Present Motor - Clenching of teeth - Possible Lateral movements of jaw - Possible Facial Nerve - a) Forehead frowning - Present b) Eyebrow raising - Possible c) Eye closure against resistance – Possible d) Teeth showing - No deviation of angle of mouth e) Blowing of cheek - Not Possible f) Nasolabial fold - Equal on both sides

39. Vestibulo cochlear - Rinne’s test - Negative Weber’s test - Equal on both sides Glossopharyngeal & Vagus nerve - Position of uvula - No deviation Taste sensation - Intact Accessory Nerve – Shrugging the shoulder - Possible against resistance Neck movement - Possible against resistance Hypoglossal Nerve – Protrusion of tongue - Possible Tongue movements - Possible

40. 3. SENSORY EXAMINATION Superficial - a) Touch – Intact b) Temperature - Intact c) Pain – Intact 4. MOTOR EXAMINATION Attitude of limbs - Upper limb : Normal Lower limb : Normal Muscle Bulk - Right (in inches ) Left (in inches) a) Upper limb Arm 12 12 Forearm 9 9.5 b) Lower limb Thigh 18 19 Calf 13 12.5

41. Tone - Upper limb – Mild Rigidity present Lower limb - Normal Power – 5/5 Coordination - Romberg sign- + ve Upper limb- Finger nose test- Able to perform (slowly) Lower limb-Knee heel test – Able to perform Involuntary movements - Present Left hand - Tremor Gait- Parkinsonian/festinating gait

42. Reflex Reflex Right Left Biceps jerk 2+ 2+ Triceps jerk 2+ 2+ Knee jerk 1+ 2+ Ankle jerk 2+ 2+ Plantar Reflex Babinski Sign Negative Negative

43. DASHVIDHA PAREEKSHA प्रकृति - वात- कफज विकृति - दोष​- वात- कफज दूष्य - रस​, रक्त​, मांस​, मेद​, अस्थि, मज्जा, स्नायु सार - मध्यम संहनन – मध्यम प्रमाण - मध्यम​ सात्म्य - मध्यम​ सत्व - मध्यम​ आहार शक्ति - अभ्यवहरन शक्ति - अवर जरण शक्ति - अवर​ व्यायाम शक्ति - अवर​ वय - मध्यम​

44. CHIKITSA

45. DATE TREATMENT TREATMENT 04/05/2022 TO 20/05/2022 SHAMANA 1) Dhanadanyanadi Kashaya – 20 ml BD With equal amount of water ( empty stomach ) 2) T. Zandopa Plus – ½ tsf TDS with lukewarm water ( After meal ) 3) Bruhat vatachintamani Rasa – 1 Bd (After meal) 4) Cap. Bravobol – 1 BD (After meal) 5) Ksheerbala Capsule – 1 BD (After meal) SHODHANA 1) Patra Pottali sweda with Mahanarayana Taila 2) Yapana Basti 3) Nasya with Karpasathyadi Taila ( 8 drops each nostril ) 4) Virechana by Trivritta Avleha DATE TREATMENT OBSERVATION 14/08/2022 TO 14/09/2022 SHAMANA 1) Zandopa Plus – 1 tsf BD with lukewarm water ( After meal ) 2) Cap. Bravobol – 1 BD (After meal) 3) Ashtavargam Kashayam – 20 ml BD with equal amount of water ( Empty Stomach ) 4) T. Anshield – 1 BD (After meal) 5) Jatamansi Phanta – 5 gm BD with 1 cup water (Empty stomach) Mild Improvement in Balance problem and weakness in Left hand. TO SHODHANA Ksheerbala 101 oil Pratimarsha nasya – 2 drops each nostril - BD

46. DATE TREATMENT OBSERVATION 14/09/2022 TO 13/10/2022 SHAMANA 1) Zandopa Plus – 1 tsf BD with lukewarm water ( After meal ) 2) Gandharvahastadi Kashayam - 20 ml BD with equal amount of water ( Empty Stomach ) 3) T. Anshield – 1 BD (After meal) 4) Cap. Bravobol – 1 BD (After meal) 5) Jatamanshi Churna - 5 gm Ashwagandha Churna - 3 gm Guduchi Churna - 5 gm Vacha Churna - 3 gm 1 x 2 ( After meal ) Tremor reduced markedly Sleep Improved Romberg Sign Negative Constipation relieved Able to hold objects without any involuntary movements for 5 minutes Sound Sleep 14/12/2022 SHODHANA 1) Shastika Shali Pinda Sweda for 16 days 2) Brahmi Ghrita Pratimarsha Nasya – 2 drops in each nostril – BD for 1 month 2) Matra Basti with Ksheerbala Oil – 60 ml for 16 days

47. DATE TREATMENT OBSERVATION 15/11/2022 TO 30/11/2022 SHAMANA 1) Zandopa Plus – 1 tsf BD with lukewarm water ( After meal ) 2) Rasnaerandadi Kashayam - 20 ml BD with equal amount of water ( Empty Stomach ) 3) Vasant kusumarkar Rasa – 1 BD (After meal) 4) Cap. Bravobol – 1 BD (After meal) 5) Brahmi Ghrita – 1 Tsf BD Tremor reduced markebly Sleep Improved Romberg Sign Negative Improvement in slowness of movements Constipation relieved Able to do his routine activities 14/12/2022 SHODHANA Matra Basti with Ksheerbala Oil – 60 ml Sarvanga Abhyanga & Swedana Shirodhara with Ksheerbala oil Nasya with Ksheerbala oil

48. THANK YOU