Apendice Estudio Kampavata

A Clinical Study on Kampavata (Parkinson ’s disease) and Its Management with Kapikacchu and Vishwadi Guggul
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RESEARCH PROFORMA
KAYACHIKITSA DEPARTMENT
Title: A Clinical Study on Kampavata (Parkinson’s disease) And Its

Management with Kapikacchu Churna and Vishwadi Guggul
Scholar: Dr. Sanjay. A. Dhurve Guide: Prof. Dr. B. B. Kadlaskar
…………………………………………………………………………………………
Name Of Patient :-
Address:-
Age / Sex:- M/F Sr.No:-
Religion :-H / M / S / Ch / J Group
Marital Status:-M / UM /D / W O.P.D.No:-
Education:- Un / E / P/ M / HS /G / PG I.P.D.No:-
Occupation:- Ward No / Bed No:-
Socio-Economic Status:-VP/ LM / M / D.O.A:-

UM / R
Diagnosis:- D.O.D:-
Result:- Cure / MI / I / UI / DAMA D.O. Commencement:
Follow Up:- Recurrence Y/ N D.O. Completion:
338
Chief Complaints (Pradhana Vedanaa with duration):-
A.T.
Chief Complaints Duration B.T. I II III IV V VI VII VIII
1)Tremor
2) Rigidity
3) Gait
4) Bradykinesia
5) Slow
Monotonus Voice
6) Loss of
Memory
7) Depression
8) Expressionless
Face
9) Vibandha
10) Gurugatrata
11) Angamarda
12) Mutra Daha
13) Katishula
14)
15)
16)
17)
339
H/O Present Illness (Vartaman Vyadhi Vritta):-
Treatment Taken And Course Of Disease:-
H/O Past Illness / Associated Disease (Purva Vyadhi Vritta):-
Stroke / Hypertension / M.I. / Valvular Heart Disease/Intermittent Claudication /

Convulsion / T.B. / Asthma / Toxemia of Pregnancy / Chronic Nephritis / Polycythemia
/ Syphilis/ Trauma / Severe Fluid Loss /
Others
Family History (Kula Vritta):-
Father Husband
Mother Wife
Brother Son
Sister Daughter
Onset: Sudden/ Gradual
Aggravating Factor:
Treated/ Untreated:
340
Personal History (Vaiyaktika Itivritta)
Aahaaraja:-
Agnibala: - Sama /Vishama / Tikshna / Manda
Type of Diet: - Vegetarian / Mix
Dominant Rasa in Diet:-M /A / L / K / T / Ks
Dominant Guna in Diet: - G / L / St / U /Sn. / R
Dietary Habits: - Samsana / Adhyasana / Vishamaasana / Regular / Irregular
Supplementary Diets: - Tea / Coffee / Cold Drinks / Other Quantity:-
Vyasana (Habit);-Tobacco (Smoking / Chewing / Snuffing) / Alcohol / Sedative /

Other
Quantity:-
Vihaaraja:-
Vyaayaama: - Regular / Irregular No / Proper / Excess
Vishraama (Rest):- Hrs. / Day Hrs. / Night
Nidraa Santushta/ Asantushta:-Normal / Alpa / Prabhuta / Khandita Hrs. / Day
Bowel Santushta / Asantushta Sama / Niraama
Kathina / Drava / Sakashtam / Vivarna / Alpa / Muhurmuhuh
Frequency: Time / Day
Koshta: - Mridu / Madhya / Krura
Micturition:-Samyaka / Krucchra / Vaivarnya / Daha / Alpa / Prabhuta

Frequency: Time / Day
Snaana: - Daily / Irregular
Emotional Make Up: - Normal / Jolly / Tensive /Anxious / Depressive / Sentimental
341
Voice: Smooth/Sharp/Coarse/Fine/Dry/Rough/Sluggish
Menstrual History: - Regular / Irregular
Obstetric History: - No. Of Delivery / Abortion / Miscarriage
Special History: - Use Of Drug
Aatrabala (Deha Bala) Parikshaa:-
1) Prakriti: - Sharira: - V / P / K / VP / VK / PK / VPK

Maanashika: - S / R / T
2) Saara: - P / M / A 3) Samhanana: - P / M / A 4) Sattva: - P / M / A
5) Saatmya: - P / M / A 6) Vyaayaama Shakti: - P / M / A
7) Agni Pareeksha: - P / M / A 8) Pramaana: - Height: - Weight:-
9) Nadi: - V / P / K Rate: / Min

Volume- Touch-Feeble/Deep/Superficial
Rhythm: Regular/ Irregular/Reg.Ire / Irr.Irregular/Equality/Symmetry
10) Respiration: Abo-Tho/ Tho-Tho/Reg/Irreg Pr…………../Min.
11) CVS Exam: Heart Sound: Heart Rate: …………../Min. Any Other:
12) B.P. : Mm of Hg 13) Temp. : C.
Nidan of Present illness:
Aharmat : Ruksha/Shita/Alpa/Laghu/Ek Rasa/Astmya
Viharat : Ratri Jagrana / Vega Dharan/ Marma Aghata/ Ati Maithuna/

Ativyvyama/ Sharma/Upavasa/Atisanshodhana
Sharir : Roga Janita Durbalata / Dhatuksha
Manas : Chinta/Shoka/Shobha/Krodha
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Srotas Parikshana:
Pranavaha Srotas Pariksha: Atisrta/Abhikshna/Sashula/Prakupit/Atibaddha
Udakavaha Srotas Pariksha: Jivha Suskata/Talu Sushkta/Ostha Sushkta/Kantha
Sushkta
Annavaha Srotas Pariksha: Anannabhilasha/ Avipaka/ Soola/ Pipasa/ Arochaka/
Adhaman
Rasavaha Srotas Pariksha: Aruchi/Tama/Angamarda/Krsanga/Hrllasa
Raktavaha Srotas Pariksha: Kushtha /Raktapitta /Asrkdara/Gudapaka/Medharapaka
/ Asyapaka/Vidradhi/Kamala/Raktamandal/Jwara/Daha/Panduta.
Mamsavaha Srotas Pariksha: Adhimamsa / Arbud / Galshalik / Galashundika /
Alaji / Patimamsa
Medoaha Srotas Pariksha: Atisthula/Atikrsna / Padadaha / Panidaha / Kati Shunyata
/ Sharma /Alpha-Chesta
Asthi Vaha Srotas Pariksha: Adhyasthi/Asthi Arbuda/Adhi Danta/Kesha
Vridhi/Nakha Vriddhi/Asthi Toda/Sharma/Rukshata
Majjavaha Srotas Pariksha:Netra Anga Gaurava/Tamo Darshana/Murccha/Bhrama
Shukravaha Srotas Pariksha: Kalibata/Aharsanam/Sukarsmari
Central Nervous System Examination
Higher Function
1) Consciousness (Nidraa / Tandraa / Mada / Murchchhaa / Sanyaasa )
2) Intelligence
3) Memory :- Past And Present
4) Orientation:- In Time , Place And Person
5) Hallucination, Delusion
6) Speech
Cranial Nerves:-
1) I Cranial Nerves: - Anosmia, Parsomia, Cacosmia
2) II Cranial Nerves: - Field Of Vision

Colour Vision
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3) III, IV, VI Cranial Nerves:-
External Ocular Movement on Follow and Command
Pupils: - Pin Point Pupil, Dilated Pupil, Unequal Pupil, Irregular Pupil
Reaction to Light:-
4) V Cranial Nerves: - Sensation Over Face
Motor Part:-
1) Contraction of Massator & Temporalis
2) Deviation of Jaw
3) Side To Side Jaw Movement
4) Paralysis of Tensor Tympani ( Deafness For Pitched Sound)
5) Paralysis of Tensor Palate ( Slight Descend of The Palate- Pharyngeal

Arch )
6) Abnormal Active Jaw Movement
7) Lower Jaw Drop
8) Jaw Jerk 9)Corneal Reflex
Facial Nerve (7th):-
Facial Expression Mobility of Face

Oblitered Nasolabial Fold Droping of Corner of Mouth
Widened Palpebral Fissure
Special Test:-
Lagopthalamus: - Wrinkling of Fore Head ShowingTeeth: -

Closing of Eyes: - Puffing Check on Expiration: -
Smiling: - Pronouncing Labials: -
Hyperacusis:- Sense of Taste:-
Auditory Nerve (8th) (Cochlea Vestibular Nerve) :-

1) Aquity of Hearing
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Glossopharyngeal (9th) and Vagus (10th) Nerve:-
1) Position of Uvula: - Central / Right Deviation / Left Deviation

2) Movement of Post Pharyngeal Wall
3) Pharyngeal Reflex
4) Movement of Larynx
5) Nasal Regurgitation
6) Nasal Speech
7) Sense of Taste (Post 2/3rd)
Spinal Accessory Nerve (11th):-
Trapizeous: - Shoulder Drop: -

Deviation of Upper End of Scapula
Deviation of Sup.Angle of Scapula
Sternocledomastoid:
Atrophy: - Tone Power
Hypoglossal (12th) Nerve: -

Deviation of Tongue Lateral Movement of Tongue
Curling of Tongue Atrophy
Fasciculation Immobility of Tongue
Bulbar Palsy: - Pseudo-Bulbar Palsy
345
PARKINSON’S DISEASE TEST
A.T.
Test B.T. I II III IV V VI VII VIII
Hand Only
Hands & Legs Only
Hands ,Legs, Head
Hands ,Legs, Head
&Tongue
Bradykinesia :-
Reaction Time
Picking Pins:- Rt./ Lt.
Buttoning Time
Rapid Alternating
Movement
Rapid Touch Index
Finger With Thumb
Opening & Closing
of Fists
Pronation &
Supination of Hand
Chest Expansion:-
(By Tape
Measurement)
Inspiration
Expiration
Marie Sign:-
Walking Time:-
(Distance Up To 30
Feet In Straight Line)
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Inability to Hold The
Hand Above The
Head
Facial Impression:-
Constantly Change-
Comfortable-
Uncomfortable-
Totally Immobile-
Neck Movement:-
Rigidity
Eye Movement:-
Easy For Movement
Difficulty In
Movement
Abnormalities of
Posture / Stance:-
Spinal Movement
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FUNCTIONAL ASSESSMENT TEST
Test B.T. A.T.
1. Hand Grip Power:

(Pressure- By B.P. Apparatus)
2. Foot Pressure :
(Foot Upon Weighing Machine Noted on Kg.)
3. Examination Of Memory:
Short Term Memory:
Long Term Memory:
(Score:- Good-0,Mild-1,Moderate-2,Poor-3)
REFLEX EXAMINATION
Test B.T A.T
Superficial Reflex
Corneal
Conjunctival
Pharyngeal
Palatal Reflex
Abdominal Reflex
Plantar Reflex
Deep Reflex
Jaw Reflex
Bicep Reflex
Brachio-Radial Reflex
Triceps
Knees
Ankle
Visceral Reflex
Micturation
Defecation
Spine Position
348
MOTOR SYSTEM EXAMINATION
Test B.T A.T
State Of Nutrition & Wasting

(Soft/Flabby/Wasted/Normal/Atrophy/ Disuse
Atrophy/Hypertrophy)
Muscle Tone:
(Normal/Hyper/Hypo/Mayo/Atonia/Site)
Muscle Power
Finger
Wrist
Elbow
Knee
SIGNS TEST IN PARKINSONISM PATIENTS
Sign Test B.T. A.T.
Micrographia
Pill-Rolling
Marie-Sign
Myerson’s Sign
Romergism Sign
Finger To Nose
Drooling
Slowing Of Eye Movements
Kinesis-Paradoxia
Stellawag Sign
Seborrhea And Excessive Sweating
Palmomental
Glabellar Tap
Impairment Of Upward Gaze And
Convergence
349
Coordination (Ataxia)
Romberg’s Test Tandem Walking

Finger Nose Test Finger To Finger Test
Dysdiadochokinesia Knee Heel Test
Involuntary Movements: -
Tremors: - Static / Postural / Intentional / Hysterical
Type :- Simple / Compound Site :- Unilateral / Bilateral
Rhythm:- Regular / Irregular Amplitude :- Fine / Moderate / Coarse
UNIFIED PARKINSON’S DISEASE RATING SCALE (UPDRS)
MENTATION, BEHAVIOR AND MOOD ASSESSMENT TEST
Test B.T. A.T.

Mentation
Thought disorder
Depression
Motivation & initiative
ACTIVITIES OF DAILY LIVING ASSESSMENT TEST
Test B.T. A.T.

Speech Test
Salivation Test
Swallowing Test
Handwriting Test
Cutting of food Test
Dressing Test
Hygiene Test
Turning in bed Test
Falling Test
Freezing Test
Walking Test
Tremor Test
Sensory symptom Test
350
MOTOR EXAMINATION ASSESSMENT TEST
Test B.T. A.T.

Speech Test
Facial Expression Test
Tremor at Test
Action Tremor
Rigidity Test
Finger taps
Hand Movement Test
Hand Pronation-Supination Test
Leg agility Test
Arising from chair Test
Posture Test
Gait Test
Postural Test
Body Bradykinesia Test
TREMOR ASSESSMENT TEST
Test B.T. A.T.

Head tremor
Face tremor
Tongue tremor
Jaw tremor
Voice tremor
Rest tremor
Postural tremor
Kinetic tremor
Tremor while walking
Trunk tremor
Leg tremor action
Leg tremor rest
Standing tremor
Spiral drawing
Handwriting
Hold pencil
Pour water from one glass into another
351
DYSKINESIA ASSESSMENT TEST
Test B.T. A.T.

Duration of Dyskinesia Test:-
i) 0 - None
ii) 1 - 1-25 % of day
iii) 2 - 26-50 % of day
iv) 3 - 51-75 % of day
v) 4 - 76-100 % of day
Painful dyskinesia Test

Disabling dyskinesia Test
MODIFIED SCHWAB & ENGLAND ACTIVITIES OF DAILY LIVING SCALE

ASSESSMENT TEST
Scales B.T. A.T.
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
352
STAGING: - INTERNATIONAL MODIFIED HOEHN AND YAHR STAGING
Stages B.T. A.T.
Stage 0
Stage I
Stage I.5
Stage II
Stage II.5
Stage III
Stage IV
Stage V
PARIKSHA:-
Agni Pariksha: Sama/Visama/Manda/Tikshna/Additional
Kostha Pariksha : Mrudu /Madha/Krura/Visesha
Dosha Lakshana:-
Vata Vriddhi Lakshana:- Karsya/Usnakamita/Alpa Balavata/Karshya/Nidra Nasa
Vata Prakopa Lakshana:- Toda/Bheda/Chesta/Shula/Kampa/Stambha/Gatrasuptata/

Samkoca/ Harsa/ Moha/ Mala Varodha/ Anaha/ Asthi
Shoola/ Adhmana / Atopa/Bhaya/Shoka.
Pitta Vriddhi Lakshana: Pita Mutrata/Pita Netrata/Pita Vabhasta/Murcha/Sita

Kamita/Santapa/Balahani/Indriya Daur Balya.
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Pitta Prakopa Lakshana:-Daha/Aushya/Sveda/Kleda/Koth/Bharma/Arati/Murcha/
Puti/Daurgandha
Kapha Vriddhi Lakshana: Tandra/Nidra/Alasya/Saitya/Murcha/Hrilasa/Agni

Sada/Praseka
Kapha Prakopa Lakshana: Svaitya /Saitya /Kandu /Gaurava /Sneha /Supti /Kleda /
Bandha /Madhuya Chirkari.
ROGA PARIKSHA:-
Dosha: V/P/K/VP/VK/PK/VPK/Avrta/Gatavata
Dushya: Rasa/Rakta/Mamsa/Meda/Asthi/Majja/Sukra
Sroto Dushti:-
Srotodusti Prakara: Atipravritti/Sanga/Siragranthi/Vimrga Gamana
Agni: Sama/Visama/Manda/Tiksha
Roga Marga: Bahya/Madhyama/Abhyantara
Vdbhava Sthana: Amashaya/Pakvashaya
Vyakti Sthana:
Vyadhi Vinichchaya:
Vyadhi Prabhava: Asukari/Chirakari
Sadhya Sadhyata: Sukhasdhya/Kasta Sadhya/Yapya/Pratyakheya
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INVESTIGATIONS
Investigations B.T A.T

Haematological Investigation
Haemogram
ESR
TLC
DLC
Bio-Chemical Investigation
BSL:-F/PP
BUL
Sr. Creatinine
Thyroid Function Test
T3
T4
TSH
Urine Investigation Routine/ Microscopic
ECG
Dr. Sanjay A. Dhurve Prof. Dr. B. B. Kadlaskar

(Research student) (Research Guide)
355
FORMAT OF INFORMED CONSENT FORM FOR SUBJECTS PARTICIPATING
IN A CLINICAL TRIAL .
Informed consent form to participate in a clinical trial.
STUDY TITLE: - A CLINICAL STUDY ON KAMPAVATA (PARKINSON’S

DISEASE) AND IT’S MANAGEMENT WITH KAPIKACCHU CHURNA AND
VISHWADI GUGGUL.
Study Number
Subject’s Initials:- Subject’s Name:-
Date of birth / Age:- Please initial Box

(Subject)
i) I confirmed that I have read and understand the [ ]

Information sheet dated ------------------for the above study and have had the
opportunity to ask questions.
ii) I understand that my participation in the study in [ ]

Voluntary and that I am free to withdraw at any time, without giving any reason,
without my medical care or legal right being affected.
iii) I understand that the sponsors of the clinical [ ]

Trial, others working sponsors behalf, the Ethics committee and the regulator
authorities will not need my permission to look at my health records both in respect
of the current study and any further research that may be conducted in relation to it,
even if I withdraw from the trial I agree to this access. However, I understand that my
identity will not be revealed in any information released to third parties or published.
iv) I agree not restrict the use of any data or result [ ]

that arise from this study provide such a use 15 only for scientific purpose
v) I agree to take part in the above study. [ ]

Signature (or Thumb impression) of the subject / Legally Acceptable
356
Representative: __________________________________
Date: - ____ /____/_____
Signatory’s Name: _______________________________
Signature of the Investigator: ___________________________
Date: - ____ /____/_____
Study Investigator’s Name: - ___________________________
Signature of the Witness: - _____________________________
Date: - ____ /____/_____
Name of the Witness: - ________________________________
357
WRITTEN INFORMED CONSENT
Full Title of Protocol
A CLINICAL STUDY ON KAMPAVATA (PARKINSON’S DISEASE) AND IT’S

MANAGEMENT WITH KAPIKACCHU CHURNA AND VISHWADI GUGGUL
Name of the Subject:-
Date of Birth:-
Age / Gender:-
Full Address:-
Telephone Number:-
i) PURPOSE OF THE TRIAL:-

1) To study of Kapikacchu Churna & Vishwadi Guggul.
2) Study the clinical improvement in sign and symptom of
Kampavata(Parkinson’sDisease)
ii) PROCEDURES TO BE FOLLOWED :-
In the trial you will be examined by DR.SANJAY ANANT DHURVE at
regular intervals as per research protocol. Physical examination and other
investigations will be done before and end.
iii) RISK:-
If any adverse reaction occurs and become intolerable, the dose will be
reduced or stopped.
iv) BENEFITS:-
The medicine is being studied as potential treatment of. It may improve your
condition of course, this can’t be guaranteed or promised & you may not
active experimental treatment. Your partiChipation in this trial will
contribute in the enhancement of medical science & will help in providing
scientific knowledge for better of mankind.
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A Clinical Study on Kampavata (Parkinson ’s disease) and Its Management with Kapikacchu and Vishwadi Guggul

Title: A Clinical Study on Kampavata (Parkinson’s disease) And Its

Scholar: Dr. Sanjay. A. Dhurve Guide: Prof. Dr. B. B. Kadlaskar

Age / Sex:- M/F Sr.No:-

Religion :-H / M / S / Ch / J Group

Marital Status:-M / UM /D / W O.P.D.No:-

Occupation:- Ward No / Bed No:-

Socio-Economic Status:-VP/ LM / M / D.O.A:-

Result:- Cure / MI / I / UI / DAMA D.O. Commencement:

Follow Up:- Recurrence Y/ N D.O. Completion:

Chief Complaints Duration B.T. I II III IV V VI VII VIII

12) Mutra Daha

Treatment Taken And Course Of Disease:-

H/O Past Illness / Associated Disease (Purva Vyadhi Vritta):-

Stroke / Hypertension / M.I. / Valvular Heart Disease/Intermittent Claudication /

Family History (Kula Vritta):-

Onset: Sudden/ Gradual

Agnibala: - Sama /Vishama / Tikshna / Manda

Type of Diet: - Vegetarian / Mix

Dominant Rasa in Diet:-M /A / L / K / T / Ks

Dominant Guna in Diet: - G / L / St / U /Sn. / R

Dietary Habits: - Samsana / Adhyasana / Vishamaasana / Regular / Irregular

Supplementary Diets: - Tea / Coffee / Cold Drinks / Other Quantity:-

Vyasana (Habit);-Tobacco (Smoking / Chewing / Snuffing) / Alcohol / Sedative /

Vyaayaama: - Regular / Irregular No / Proper / Excess

Vishraama (Rest):- Hrs. / Day Hrs. / Night

Nidraa Santushta/ Asantushta:-Normal / Alpa / Prabhuta / Khandita Hrs. / Day

Bowel Santushta / Asantushta Sama / Niraama

Kathina / Drava / Sakashtam / Vivarna / Alpa / Muhurmuhuh

Frequency: Time / Day

Koshta: - Mridu / Madhya / Krura

Micturition:-Samyaka / Krucchra / Vaivarnya / Daha / Alpa / Prabhuta

Snaana: - Daily / Irregular

Emotional Make Up: - Normal / Jolly / Tensive /Anxious / Depressive / Sentimental

Obstetric History: - No. Of Delivery / Abortion / Miscarriage

Special History: - Use Of Drug

Aatrabala (Deha Bala) Parikshaa:-

1) Prakriti: - Sharira: - V / P / K / VP / VK / PK / VPK

2) Saara: - P / M / A 3) Samhanana: - P / M / A 4) Sattva: - P / M / A

5) Saatmya: - P / M / A 6) Vyaayaama Shakti: - P / M / A

7) Agni Pareeksha: - P / M / A 8) Pramaana: - Height: - Weight:-

9) Nadi: - V / P / K Rate: / Min

10) Respiration: Abo-Tho/ Tho-Tho/Reg/Irreg Pr…………../Min.

12) B.P. : Mm of Hg 13) Temp. : C.

Nidan of Present illness:

Aharmat : Ruksha/Shita/Alpa/Laghu/Ek Rasa/Astmya

Viharat : Ratri Jagrana / Vega Dharan/ Marma Aghata/ Ati Maithuna/

Sharir : Roga Janita Durbalata / Dhatuksha

1) Consciousness (Nidraa / Tandraa / Mada / Murchchhaa / Sanyaasa )

3) Memory :- Past And Present

4) Orientation:- In Time , Place And Person

1) I Cranial Nerves: - Anosmia, Parsomia, Cacosmia

2) II Cranial Nerves: - Field Of Vision

External Ocular Movement on Follow and Command

4) V Cranial Nerves: - Sensation Over Face

1) Contraction of Massator & Temporalis

3) Side To Side Jaw Movement

4) Paralysis of Tensor Tympani ( Deafness For Pitched Sound)

5) Paralysis of Tensor Palate ( Slight Descend of The Palate- Pharyngeal

6) Abnormal Active Jaw Movement

7) Lower Jaw Drop

8) Jaw Jerk 9)Corneal Reflex

Date: - //_

Date: - //_

Date: - //_