The Ayurvedic Approach to Parkinson's Disease (Kampavata) by Scott Gerson, MD, M. Phil. (Ayu), Ph.D. (Ayu)
Parkinson’s Disease is one of the most common neurodegenerative disorders affecting more than 1 million Americans and 10 million people worldwide. Parkinson’s Disease gets its name from an essay written in 1817 by a British pharmacist James Parkinson entitled “An Essay on the Shaking Palsy”. In the essay he describes six patients with what he called paralysis agitans (“shaking palsy”) characterized by:
“…involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forward, and to pass from a walking to a running pace: the senses and intellects being uninjured.”
Although it is notoriously difficult to precisely interpret and correlate the Ayurvedic understanding of disease with modern diseases, it is nevertheless apparent and important to realize that what we today call Parkinson’s Disease has been known for millennia in Ayurvedic medicine as evidenced by the symptoms and treatments recorded in the ancient literature.
Chapter 20 of the Sutrasthana section of the Charaka Samhita is arguably one of the most important chapters of the entire Ayurvedic literature. This chapter is entitled Maharoga Adhyaya or “Lessons of the Great Diseases” and it details the specific diseases caused by each of the three individual doshas, how the doshas cause each disease (i.e., the pathophysiology), and the line of treatment.
Ayurveda categorizes diseases in several different ways. One of these schemas is to distinguish between:
Agantuja Roga – Diseases caused by exogenous factors (e.g., fire dahana), sharp objects (vyadhi), blunt trauma (abhighata), teeth (dashana), falls (patana), curses (shaapa), spells (abhichara), etc.
Nija Roga – Diseases caused by endogenous imbalance of the Tridosha
The Nija Rogas (endogenous diseases) are again divided into two types:
Samanyaja Vyadhi – Diseases caused by disturbances of Vata, Pitta, and Kapha in different combinations
Nanatmaja Vyadhi – Diseases primarily caused by individual doshas
Now, regarding these Nanatmaja Vyadhis (endogenous diseases caused by a single dosha), Ayurveda, although it recognizes that the number of possible diseases caused by any single dosha is truly innumerable, nevertheless lists the 80 most common ones caused by Vata dosha. One of these 80 Vata-caused diseases is called “Vepathu,” meaning shaking or trembling. This term is derived from the Sanskrit root vip meaning “to tremble, shake, vibrate, shiver, or quiver.” Another Sanskrit word for tremble or shake is kampa and the condition originally known as vepathu came to be commonly known as kampavata. In the late 7th century A.D. the physician Madhava in his 79 chapter book on the causes of various diseases, described vepathu as being characterized by sarvangkampa (feeling of whole body tremor) and shirokampa (head tremor). By the 12th century AD, the term “kampavata” appeared in the famous text known as the Vangasena Samhita replacing “vepathu” in the Ayurvedic literature and has continued to do so ever since, appearing in the 13th century Sarangadhara Samhita’s list of the 80 nanatmaja vyadhis of Vata. By the 18th century, the text Bhaishajya Ratnavali by Govindas Sen, is describing kampavata as a condition whose symptoms more closely resembles modern day Parkinson’s disease, i.e., karpadatale kampa (tremor in the hands and legs), nidrabhanga (sleep distrubance), kshinmati (slowness of utterance and thought).
If we study the all available literature of Ayurveda the following are the key observed symptoms of kampavata
Sthambha (Rigidity) '
Chestasanga (Slowness Of Movement)
Vak Vikriti (Speech Disorder)
Avanamana (Flexion Posture )
Smritihani (Loss Of Memory)
Kampa (tremor) is described to occur many parts of body including Shirakampa (tremor of the head), Oshtakampa (lip tremor), Hastakampa (tremor of the hands), Padakampa (tremor of the legs).
Parkinson’s Disease (PD) is a chronic, progressive neurodegenerative disease characterized by both motor and nonmotor features. The motor symptoms of PD [resting tremor, bradykinesia (slow movements), and muscular rigidity] are attributed to the loss of nigrostriatal dopaminergic neurons, although the presence of non-motor symptoms (sleep disorders, depression, and cognitive changes) which almost always precede the classical motor symptoms supports neuronal loss in non-dopaminergic areas as well.
While modern medicine has only recently acknowledged that these preceding preclinical non-motor symptoms represent the beginning of the PD disease process, these symptoms and many more and even more subtle are documented in the Ayurvedic description of the purvarupas (lit. “preceding form”) of this disease. In fact, the ancient observations of the beginning of Parkinson’s Disease goes far deeper than the physical realm, or even the mental realm, and ultimately focuses on the earliest changes of the innermost fundamental energies at the core of our being.
Etiopathogenesis means knowledge of how a disease process begins and then proceeds. Ayurveda has a sophisticated method of understanding how every disease forms and identifies the six stages of advancement of any disease. This method is known as samprapti (from samyak, proper, correct and prapta, to deduce through observation). Sometimes samprapti is alluded to as the Six Stages of Disease.
As many people know, the current conventional medical understanding of the “cause” of PD is that it is the loss of function and number of specialized cells in the substantia nigra compacta region of the brain stem. These cells produce the neurotransmitter dopamine. So, PD has become known as a disease mediated by a deficiency of dopamine in the brain. However, this is only a small part of the genesis of the condition and there is much more to the story. Of note is that less than 10% of PD cases can be directly linked to genetic mutations. Environmental factors, or a combination of both environment and epigenetic susceptibility, are the most likely causative factors (hetu). Many studies point to the role of a long list of both endogenously produced and environmentally-introduced toxins as causative. Examples of these are 6-hydroxydopamine (made by the body), paraquat, rotenone, reserpine, isoquinoline (in foods and plants), lipopolysaccharide (from bacteria), iron, manganese, various solvents, metals, and pesticides. I feel that it is unlikely that any of these are the cause of PD but rather undoubtedly serve to “unmask” latent PD by accelerating neuronal loss in the substantia nigra compacta due to ageing, epigenetic, and other factors. I also have no doubt that the removal of these toxic substances from the body will have both protective and therapeutic effects.
As you will see, as I explain the samprapti of kampavata (PD), the recurring theme will be vata vitiation, although the other two doshas—particularly Kapha dosha—play important roles.
Unless we are living an isolated, tranquil, monk-like life, due to the stresses of the modern world with all its stimulation and inputs, we all tend to accumulate excessive Vata dosha. This is especially true as we reach middle age (>60) which is when Vata dosha naturally predominates.
In the human body, each dosha has its own single highly-specific abode or “main home” called the vishesha sthana (vishesha-special; sthana-place). Each dosha also has other secondary sites too known as samanya sthana.
For Vata dosha, the vishesha sthana is Pakvashaya: the colon. So, when Vata begins to accumulate due to diet, lifestyle or just getting older, it is in the colon that this process begins. If no measures are taken to reduce it, it will continue to accumulate and become aggravated to the point of overflow and spread into the gross (blood) and/or subtle (nadis) circulations. This mixing of excess Vata dosha with the blood (dosha-dushya sammurchana) disturbs vyana Vata subdosha leading to signs of Vata vitiation anywhere in the body (coldness, dryness, roughness, irregularity, lightness, quickness, loss of density, loss of structure). If Vata relocates (sthana-samsraya) into Majja Dhatu it can cause dysfunction of the sensitive homeostatic centers in the brain and brainstem. In Parkinson’s disease we know that there is damage to the extrapyramidal nerve tracts whose neurons originate in the medulla and pontine regions and regulate fine motor movements. This damage is the result of Vata dosha which initially accumulated in the pakvashaya (colon) entering and relocating to this brainstem region (majja dhatu).
While predominantly a Vata disease, kampavata (PD) also involves varying degree of Pitta and Kapha dosha vitiation as well in different individuals. Pitta vitiation represents an inflammatory response--possibly to toxic protein fibrils of alpha-synuclein (α-syn) which are known to be released by affected neurons. This same protein, α-syn, when it becomes misfolded, forms different degrees of intracellular clumps known as Lewy Bodies—a manifestation of dysregulated Kapha dosha. How does α-syn cause neuron damage? It involves epigenetics and cannot be explained in this article. In brief, α-Syn ‘masks’ histone proteins, preventing their acetylation, and as such the resulting histone hypoacetylation alters DNA expression and is thought to contribute to neurodegeneration in PD. Interestingly, these extracellular α-syn aggregates can then transfer from neuron to neuron where they can nucleate further intracellular aggregation and trigger neuro-inflammation, exacerbating the neurodegenerative process. This would make PD a prion-like condition. There is already evidence that abnormal α-syn spreads in a sequential and predictable manner beginning in the lower brainstem, then extending to the upper brainstem (where substantia nigra compacta is located), and finally to the cerebral hemispheres. But now for the really interesting part of the story: neurologically healthy, non-Parkinson’s individuals who are suspected of having pre-clinical PD, were found to have misfolded α-syn in the autonomic nerve plexi of their gastrointestinal tracts! This includes the abdominopelvic splanchnic neurons which innervate the colon and rectum. Thus, the initial site of Parkinson’s Disease may very well be the lower gastrointestinal tract—which just happens to also be the site of Vata vishesha sthana, where Ayurveda declares this condition originates.
Ayurveda teaches that dushyas are the tissues which are made dysfunctional by contact with the vitiated doshas:
Doshadushyasammoorcchanaajanito vyaadhihi || Madhava Nidana 1/7
“For the manifestation of any disease there is necessity of samurcchana (mixing) of Dosha and Dushya.”
In kampavata, the vitiated doshas are apana Vata, vyana Vata, Tarpaka Kapha, and shleshaka Kapha.
These vitiated doshas combine with majja dhatu which becomes the pradhana dushya (main disrupted tissue).
This concept suggests that Ayurvedic medicines directed toward reducing Vata and Kapha doshas and the formation and propagation of misfolded α-syn, or purification therapies which facilitate its clearance so as to arrest or reverse the self-propagation process, might represent novel Ayurvedic therapeutic interventions for the treatment of PD.
First, what is the difference between a sign and a symptom? A sign is an objective finding that could be observed by both the patient or any other person. In contrast, a symptom is a subjective finding only perceptible by the patient. For example, a skin rash is a sign; a swollen lump in the armpit is a sign; the tenderness of that lump, however, can only be felt by the patient and so is a symptom. Fever can be both a symptom (the patient feels herself to be warm) and a sign (the thermometer reads 101.8°F).
For Parkinson’s Disease, the physical signs (observable by others) include:
tremor at rest
rigidity on passive movement (“cogwheel rigidity” of the limbs)
slowness of movement (bradykinesia); shuffling feet when walking
decreased bodily movement (hypokinesia); arms don’t swing normally when walking
postural instability; festinating gait
mask facies, the face appears to be fixed and without expression
These features are unilateral at onset, but become bilateral as the condition progresses. Later, postural instability (and falls), orthostatic hypotension, and dementia can develop.
The cardinal motor symptoms (experienced by the patient) of Parkinson's disease are:
shaking (lips, arms, legs)
stiffness; difficulty getting up from a chair
slowness; feet feel “stuck to the floor” when walking or changing directions
poverty of movement; difficult to initiate movements
Common non-motor symptoms include:
Cognitive impairment, especially with concentration
Sleep disorders, such as excessive daytime sleeping, insomnia, or REM Sleep Disorder
Postural hypotension (low blood pressure when standing)
Impaired speech (slurred or low volume) and swallowing
Anosmia (loss of sense of smell)
As was true 3000 years ago, no specific test exists today to diagnose Kampavata (Parkinson's disease). The diagnosis is based on your medical history, a review of your signs and symptoms, and a neurological and physical examination. Resting tremors associated with rigidity, postural imbalance, shuffling gait, and slowness of movement or increased clumsiness is strongly suggestive of this disease. Conditions that are commonly mis-diagnosed as PD and which must be thoroughly and carefully excluded include: benign essential tremor, malignancy of the brain, multiple sclerosis, supranuclear palsy, Huntington’s disease, and multiple system atrophy.
Loss of dopamine-secreting neurons within the substantia nigra and presence of α-syn Lewy bodies are the major pathological findings in Parkinson disease. Early in the disease course, dopamine deficiency is the predominant neurochemical abnormality. As the disease progresses, involvement of non-dopaminergic brain regions results in levodopa-resistant motor and nonmotor symptoms. Conventional Western Medicine says there are no established disease-modifying or neuroprotective therapies and that medication should be initiated when patients experience functional impairment or social embarrassment from their symptoms.
Levodopa, coupled with carbidopa, a peripheral decarboxylase inhibitor, remains the gold standard of symptomatic treatment for Parkinson disease. Carbidopa inhibits the decarboxylation of levodopa to dopamine in the systemic circulation, allowing for greater levodopa delivery into the central nervous system. Levodopa provides the greatest antiparkinsonian benefit for motor signs and symptoms, with the fewest adverse effects in the short term; however, its long-term use is associated with the development of motor fluctuations (“wearing-off”) and dyskinesias. Once fluctuations and dyskinesias become established, they are difficult to resolve.
Monoamine oxidase (MAO)-B inhibitors can be considered for initial treatment of early disease. They inhibit the breakdown of dopamine in the synapse. These drugs (e.g. selegiline or rasagiline) provide mild only symptomatic benefit but have better adverse effect profiles.
Dopamine agonists (e.g. ropinirole, pramipexole) provide moderate symptomatic benefit and delay the development of dyskinesia compared with levodopa. But there are unacceptable adverse effects such as somnolence, sudden-onset sleep, hallucinations, edema, and impulse control disorders (pathologic gambling, shopping, and Internet use; hypersexuality; and hoarding).
In addition, amantadine, clozapine, beta-blockers, valproate and others are sometimes used to control symptoms in addition to levodopa/carbidopa. In my opinion, of these, valproate which besides being an old anti-seizure drug is also is a histone deacetylase inhibitor, is the most interesting.
The above mentioned symptomatic anti-Parkinson disease medications can provide good control of motor signs of Parkinson disease for 3-5 years. After this, disability often progresses despite increasing the dosages, and many patients develop long-term motor complications, including fluctuations and dyskinesias, balance difficulty, and dementia.
For patients whose motor fluctuations and dyskinesias cannot be adequately managed with medication manipulation, surgery is nowadays offered. The principal surgical option is deep brain stimulation (DBS), which has largely replaced neuroablative lesion surgeries. It is much too early to say whether it is having overall clinical success.
Before I cease with this infusion of Western science into this article, I want to add one last idea.
It has become increasingly apparent that the basal ganglia are involved in more than motor control. Almost no attention is being paid to the effect of Parkinson’s Disease on the mesolimbic dopamine reward system, an important system for the integrating emotions and behavior. This system is known as the limbic cortex. You may have heard of it. It is primarily involved in controlling emotional tones, motivation, memory, learning and engagement with the world. These are all aspects of the Parkinson’s patient which Ayurvedic physicians, oriented to holism, address but which do not receive enough attention by Western doctors. The traditional view of Parkinson’s disease as a circumscribed basal ganglia motor disorder is highly reductionist, inappropriate and must change.
Before explaining the details of Ayurvedic treatment, you need to know that kampavata is a vatavyadhi condition (diseases caused by spread of vitiated Vata dosha throughout the mind-body). Vatavyadhi diseases are divided into two types i.e. Dhatukshayajanya and Margavrodhjanya. Dhatukshayajanya diseases are caused by the destruction or loss of vital tissues; Margavrodhjanya diseases are caused by blockages to the proper flow of energies and nutrients through their channels. The treatment of these two types of disease is very different. One reason that kampavata is classified as a very difficult disease to cure because it can involve both of these underlying pathologies.
The precise treatment of the patient with kampavata will depend on the physicians understanding of which type of vatavyadhi is present, the patients unique prakriti, vikriti, lakshanas, samprapti, satmya, and several other factors. Here, I can outline the general principles that I have found effective for many of my patients.
In dhatukshayajanya vatavyadhi the weakening and reduction in majja dhatu results in the srotamsi (channels) composing that tissue to become empty. That vacuum is filled up by Vata dosha leading to Vatavyadhi. The treatment of any dhatukshayajanya vatavyadhi, including kampavata boils down to three approaches which can be implemented concurrently or in sequence, based on the characteristics of both the patient and the disease.
Complete purification and removal of toxic substances from all of the dhatus (tissues)
Controlling vitiation of Vata dosha
Correcting the destruction of involved dhatus
Panchakarma exists and is designed expressly for this purpose. Because the chief dosha is Vata which has the gunas (qualities) of ruksha (dry), sheeta (cold), laghu (light), khara (rough), chala (moving), and Sukshma (subtle), we apply the opposite qualities of oily, warm, heavy, smooth, etc. These qualities are perfectly present in fats and oils. Thus, the most important upakrama (supporting treatment) for kampavata is internal and external oleation. This is done by having the patient ingest pure cow’s ghee or other fat substance for 4-7 days (depending on the patients digestive capacity). Concurrently or following this, the patient is given 6-14 days of bahya snehana (external oleation) in the form of abhyanga chikitsa with a properly medicated oil. This is commonly a variant of sahacharadi taila (from Strobilanthes ciliates Wall ex Nees), narayana taila or vishagarbha taila. During treatment there are specific marma points which are addressed as indicated.
The second very useful upakrama is sarvanga swedana chikitsa (chikitsa=treatment), whole body fomentation (heat) treatment. Commonly we use bashpa swedana, in which the patient is enclosed in a steam box or covered with a wooden or fabric tent as herbalized steam fills the chamber. The head is left outside the chamber. Since significant increases in blood pressure and pulse rate can occur immediately after the procedure, patients need to be carefully monitored. Blood pressure and pulse rate then show a significant reduction within 15-20 minutes.
Virechana treatment is a pradhanakarma (main therapy) which usually is also employed as it eliminates both Vata and Pitta doshas very effectively if properly administered. This therapy involves the administration of a gentle purgative after the patient is properly prepared with internal oleation for several days prior. Eranda taila (castor oil) is gentle and effective for this purpose. Dosages are determined according to patients unique characteristics and the physicians experience, normally range between 1-4 oz). Following this purgation, it is important for patients to observe the samsarjana krama, or prescribed light dietary regimen for four to seven days, before resuming the normal diet. This usually consists of peya (water from cooked rice), kitchari (unspiced and spiced), and other easily digestible foods.
The other supremely important main therapy of Panchakarma, which usually comes after virechana, is basti, or daily therapeutic enemata. These are of two types which are alternated in a specific pattern over an 8, 14, or 21-day period. The first type of basti is oil -based (anuvasana) enema, consisting chiefly of sesame oil with the addition of a small quantity of herbal decoction. The second type (niruha) is the opposite, consisting of a greater proportion of herbal decoction along with honey, salt, herbal paste and a smaller quantity of oil.
The reason for the importance of basti is that it is administered directly to the rectum and colon which is the main site of Vata accumulation. Kampavata cannot be treated without basti chikitsa.
“Vata, in its normal state, whose movements are regular, remaining in its normal locations, help man to live a hundred years without any disease.” Madhavanidan, Chap.22 “Vatvyadhinidanam,” Shloka 80
Depending on the relative presence of a margavrodhjanya avastha (obstructive condition) component, the degree of Kapha dosha, and the presence of ama, the physician will employ, in addition to the treatments above, vamana (therapeutic vomiting), alabu pracchana (a gentle form of bloodletting), nasya (nasally administered herbalized oils, dhoomapana (inhalation of medicated smoke through the nostrils, and other modalities. Detailed descriptions of these can all be found on my website.
I will list these two categories of medicines together as in kampavata they often are administered concurrently. Aushadhis are naimattika or specific medicines for a specific disease; rasayanas are sarvajanya or medicines with a more general global effect on many different tissues/systems with the aim to promotevitality and longevity. I will list them by preparation form (i.e. powder, decoction, etc).
The precise formula for each individual is highly individual. Often more than one preparation form is indicated.
Powdered Medicines (Churna): Amalaki (Emblica officinalis), Guduchi (Tinospora cordifolia), Ashwagandha, (Withania somnifera), Kapikacchu (Mucuna pruriens), Kushta (Saussurea lappa), Rasna (Pluchea lanceolata), Shankhapushpi (Evolvulus pluricaulis), Mandukaparni (Centella asiatica), yastimadhu (Glycyrrhiza glabra)
Compound Medicines (Powdered or Tablet): Shatavaradi Guggulu, Amritadi Guggulu, Arogyavardhini
Decoctions (Kwatha): Mashabaladi kwatha, Dashmoolrasnadi kwatha, Atmaguptaharitakadi kwath, Gambharipippiladi kwatha
Herbalized Ghees (Ghritas): Narasimha rasayana, Dashmooladi ghrita, Apatyakara ghrita, Brahmi ghrita, Saraswata ghrita, Mahatriphaladi ghrita, Ashwagandha ghrita
Mineral and metal substances (Rasaushadhis): Brihat Vatachintamani Ras, Rasaraja Ras, Smritisagar Ras, Abhrak bhasma, Suvarna bhasma
Herbal Jam (Avaleha): Chyavanprash
Medicinal Wines (Asava-Arishtas): Saraswatarishta, Ashwagandharishta, Balarishta, Aravindasava, Bhallatakasava
Pathyapatha (Diet): A well-balanced, nutritious diet with sufficient fiber and healthy fats is the recommendation. Foods should be as much as possible organic. In truth, the most beneficial diet is a Vata-reducing Ayurvedic diet because it would support the actions of the medicines prescribed which also in most cases seek to reduce Vata dosha. Please see my website for a complete Vata-reducing food list.
Asana/Pranayama/Dhyana (Yoga postures/Breathing Exercise/Meditation): The aspect of health involving subtle energies are addressed by these practices which are considered as essential as the physical therapies and herbal medications described above.
Asanas (Yoga Postures): Patients generally have balance or posrual stability issues and may feel insecure. I have found that the restorative form of asana practice helps not only alleviate some of the symptoms (less slumping, better balance, greater range of motion, decreased rigidity), but more importantly enhances confidence, self-esteem, and creates a positive emotional experience. The greatest benefit come from yoga postures that are gentle, slow, and precise.
Examples of helpful asanas for most patients include (but are not limited to): Bhadrasana (Gracious Pose), Tadasana (Mountain Pose), Vrksasana (Tree Pose), Urdhva Hastasana (Upward Saute), Uttanasana (Standing Forward Bend), Virabhadrasana II (Warrior Pose II), and Supta Badda Konasana (Reclining Bound Angle Pose).
Pranayama (lit: Controlled Breath): Pranayama is part of the Yoga system which teaches how to promote the movement of prana (“life force”) throughout the entire mind and body. Research has documented the medical benefit of simple deep breathing. Many Pranayama techniques goes a step further by engaging abdominal muscles and the diaphrgm to allow the lower lobes of the lungs to participate and deliver more oxygen to the brain.
Different techniques have different specific effects on the body-mind and should be learned from teachers experienced and expert in these practices. The following are all excellent for kampavata.
Nadi Shodan Pranayama
Anuloma Viloma Pranayama
Dhyana (Meditation; from dhyai, to contemplate, reflect): Meditation is a way to achieve integration and balance among the three aspects of the human mind: intellect, emotion, and will. Ayurveda understands that the mind is an arena of conflicting ideas, urges and emotions which thwart the cultivation of any real, sustained peace, happiness, or healing. Volumes could be written on the health benefits of regular meditation practice. For kampavata it is highly recommended that patients seek out an experienced teacher of an authentic lineage of meditation to learn correctly. Both mantra-based and mindfulness-based practices are appropriate and wonderful.
Ayurvedic medicine has a great deal of practical experience in treating kampavata, the ancient correlate of Parkinson’s Disease. While the use of the l-DOPA-containing herb Kapikacchu (Mucuna pruriens) has received much attention, comprehensive treatment of this condition requires a much more holistic approach. Parkinson’s is an incredibly complex disease with more than 20 motor and nonmotor features. The notion that dopamine, and its analogs, are the treatment and there’s nothing more you can do – is not true. Sinemet three times a day just won’t work. Ayurvedic therapy for this condition is not simple. Treatment mandates complete purification through one or several courses of panchakarma chikitsa, carefully selected herbs, mineral, and metal derived medicines, a proper diet, and a healthy lifestyle which includes regular asana, pranayama, and meditation practice. Not everyone will be able to do this. Following these recommendations, however, will not only improve the physical symptoms but may eventually give insight as to the psychological factors contributing to the disease. Living in disharmony with one’s unique nature (prakriti) is the root cause of disease and re-aligning oneself at the physical, emotional, intellectual, and pranic levels is essential for true healing to take place.
The Ayurvedic approach to Parkinson’s Disease goes far beyond the effect of our herbal medicines on brain chemistry. The real effect of Ayurveda lies in its ability to reform and re-constitute the subtle energetic body which is the foundation of health and the cause of disease. The approach outlined above is based on healthy lifestyle changes, refinement of the mind through Yogic practices, and living in harmony with Nature.