2 Dec : Clinical study of Ayurvedic Approach, Mamsagni Rasayana & Panch Karma in the Active Management Of Duchenne Muscular Dystrophy: 28 Patients
* Mukesh D Jain BSc BAMS MD PPHC (Apollo Hosp) FISCA FAMY (France)
* Prof M P Pandey Former Dean of Ayurveda, Ravi Shankar University, Program Director, Panch Karma Clinic on Neuro Muscular Disease, Sanjivani Ayurvedic Wellness Center, Supela, Bhilai 490023 India
A small care through clinical research trial involving Gold bhasma based Mamsagni Rasayana (MRG) along with Til-Mash pinda swedana, Shat-Bala Prasarni anuvasana vasti yielded mixed results in 28 boys with Duchenne Muscular dystrophy (DMD). Although this Ayurvedic program did not have the hope for the genetic effect of restoring dystrophin production, it did reduce serum CPK levels. This could be a sign of decreased muscle damage. It is possible that Ayurvedic treatment with MRG allow longer survival by increasing production of muscle CPK enzyme.
Duchenne Muscular Dystrophy is a severe genetically x-linked progressive degenerative disorder of muscle tissue, affects only males. DMD is characterized by (i) Onset of muscle weakness usually before 4 years of age, (ii) Selective muscle involvement of pelvic and pectoral girdles, (iii) Hypertrophy of the calves muscle, (iv) grossly elevated serum CPK levels and (v) Relentlessly progressive weakness of muscle, leading to inability to work within 10 years of onset and later to contractures and thoracic deformity. There is no specific cure in any system of medicine and the death usually occurs before the age of 20 years caused by respiratory failure or less frequently by cardiac involvement.(1)
DMD is a genetic defect and is caused by lack of a single muscle protein Dystrophin (1 of 3000 muscle proteins). Usually DMD is inherited but is also caused by spontaneous mutation more than 30% of the time. Each child of the carrier mother has a 50% chance of inheritance of DMD. Though girls can be carriers, more than 80% show no muscular dystrophy related symptoms. At present a hypothesis postulates a defect in the sarcolemmal membrane which allows a substance (or substances), as yet unknown but which could possibly be calcium, to enter the muscle fibre too freely, and there to activate neutral proteases which, in turn, maintain an excessive degree of muscle catabolism and lead to muscle fibre necrosis. (2, 3, 4, 5)
No treatment is at present known in any system of medicine which has any definite influence upon muscular dystrophy. The absence of specific treatment for muscular dystrophy makes it all the more important to consider alternative approaches of treatment. In India, the Duchenne boys always seek Ayurvedic treatment in the hope for some relief. The Ayurvedic treatment involving medicine and Panch karma massage have shown definite protective influence and longer survival upon muscular dystrophy. Ayurvedic Acharyas carefully consider this condition as adibala-pravrit Mamsa-vata-kshaya due to srotorodha. There is depletion of Mamsagni paving the way of ama formation. It is followed by vitiation of kapha dosha. (6, 7) While srotorodha produces hypertrophy in particular region, it also manifests as first prokopa and then depletion of vata element. This complex pathogenesis is responsible for progressive wasting and necrosis of the affected muscle fibres.
Ayurveda visualizes 13 major types of Agnis (enzyme complex) which are responsible for the process of metabolism. Each of seven dhatus has individual dhatvagnis. The increase or decrease of a particular dhatus depends upon the increase or decrease of respective dhatvagnis. According to Charak, Mamsa-kshaya may be present when there is prolonged majjagata kupita vata. This is always followed by depletion of vata element.
It is genetic predisposition (Beeja dosha) that convert physiological vata element in to pathological morbidity. The srotodushti (? Sarcolemmal membrane defect) is responsible for the mamsa dhatu kshaya.
The concept of Dosha-Dhatu-Mala (D. D. M) is unique in Ayurveda. The dhatus are those substances which are retained by the body and always rejuvenated or replenished. Ras-Rakta-Mamsa-Meda-Asthi-Majja and Sukra are seven dhatus which develops in human body in a fixed, sequential manner one from the other. Each succeeding dhatu is a metabolic refinement of the previous dhatu and get nourished by it. The first dhatu, Rasa (nutrient fluid) is the metabolic end product of the digestion that takes place within gastro-intestinal tract. The Rasa dhatu has to be metabolized in to Rakta dhatu. The Mamsa dhatu comes from Rakta dhatu and in turn, give rise to Meda dhatu. The Asthi dhatu is the product of Meda dhatupaka that contains Majja dhatu which is the prime seat of vata element. ( 6, 8 )
We know that vata (Prana) and Rakta dhatu are two major life sustaining elements in the body. The vata has been attributed like genetic material that carries life information essential for different activities. The Rakta dhatu is the basis of biological force that provides nutrition at cellular level and paves the way of excretion of metabolic toxins. The driving force beyond Rakta dhatu is vata element which circulates itself to cellular level along with Rakta. The conjoint circulation of both Rakta and vata is manifestation of life (Prana). This Prana is responsible for the contraction and relaxation of muscle fibres or muscular activity. It means we have to focus our attention on the dhatvagnis paka of Rasa-Rakta-Mamsa and Meda dhatus besides Asthi and Majja dhatus. In this context Ayurvedic Rasayana therapy has significant role to play. (9, 10)
Rasayana are special ayurvedic resources that increase enzymatic essence of each dhatu starting from Rasa dhatu. The pure gold bhasma in low dose has been used successfully in the management of degenerative diseases of mamsa and Majja dhatu. (11, 12, 13) Usually Rasayana molecule does not work without purificatory procedures. The deepana, pachana process must be strengthened, the dosha must be balanced and metabolic toxins must be eliminated from dhatus through panch karma procedures in order for rasayana molecule to work.
Material & Methods
Keeping in view the complex pathogenesis involved in Duchenne muscular dystrophy, a special Ayurvedic rasayana drug was developed using low dose pure gold bhasma, along with deepan-pachan-srotorodhahara and mamsa dhatu vardhak Ayurvedic resources. The compound prepared and named as Mamsagni Rasayana with Gold (MRG). The active ingredients are bio-enhanced and standardized Marich, Triphala, Gurvel, Guggul, Kuchla, Parad and Gold Bhasma. The dose of the MRG was fixed 20 mg per kilo body weight. The drug was administered orally in two equal doses before meal for a period of 6 months.
Over 55 cases of DMD was enrolled at Panch Karma Clinic of Central Medical Institute, Bhilai and treated during March 1998 and September 2001. We have selected total 28 DMD boys for inclusion in our clinical study. All the Duchenne boys were subjected to 2 weeks Panch karma procedures before administration of oral Mamsagni Rasayana for 6 months. The treatment agenda consisting of (i) Modified Til-Mash Pinda Sweda using fresh leaves of Tejapatra ( Cinnamomum tamala ), Nirgundi (Vitex negundo ) and sprouted Methi ( Trigonella foenum ) seeds as additional ingredients to Til, Masha, unpolished rice and wheat bran, all cooked in the decoction of Bala ( Sida cordifolia ), Ashwagandha ( Withania somnifera ) and milk. (ii) Anuvasana vasti with Shatbala-Prasarni oil.
OBSERVATION & RESULTS
It was observed that degeneration of muscle fibres were arrested after 6 weeks of administration of Mamsagni Rasayana. This was presumed on the basis of reduced CPK level in blood. All the DMD boys who completed clinical Study showed definite sign of improvement such as (i) Weight loss, (ii) Decrease in walking difficulty and (iii) Decrease in the severity of contractures and scoliosis. However DMD boys have shown very slow progress, but it is possible that Ayurvedic treatment program may allow longer survival by increasing production of muscle CPK enzyme (Mamsagni).
Today we know that muscle degenerative wasting conditions in young patients are caused by defect in genes for the muscle proteins. Most of these proteins appear to play a role in supporting the structure of muscle fibres, although some play a role of biochemical enzymes. DMD is caused by lack of dystrophin protein. The Ayurvedic rasayana drugs are well known for its effect to delay / slow or reverse the progressive muscular degeneration. (14). The MRG is supposed to boost Mamsagni at muscle tissue level. It also retards the muscular degeneration due to fat deposition. The Til-Masha Pinda Sweda improves the membrane defect. Since we have noticed a fall in serum Creatine Phosphokinase (CPK) it means there is check on further muscle destruction.
Muscular dystrophy is genetic disorder with no satisfactory treatment in any system of medicine. Ayurvedic program of panch karma procedure and rasayana drugs are useful in the long term management of Duchenne muscular dystrophy. There is further need of controlled studies on a large scale with improved trial study and assessment techniques.