E-ISSN:2456-3110

Case Report

Avabahuka

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

Role of Upanaha Sweda in the management of Avabahuka - A Case Study

Sunil Joshi T.1*, D. Bahatkar S.2
DOI:

1* Tanvi Sunil Joshi, Final Year Post Graduate Scholar, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.

2 Seema D. Bahatkar, Professor and HOD, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.

According to Ayurveda, Vata Dosha is responsible for most of the body functions including movements of all joints. Avabahuka described by Acharya Sushruta in eighty Vata Vikara is a disease of Ansa Sandhi. It represents with Shoola, Graha and Sakashta Sandhi Kriya. Ansa Sandhi i.e., shoulder joint has a very wide range of motion, so, pain and restriction of movements severely affects the daily activities. Upanaha Sweda is a type of Swedan Karma explained in the management of Vata Dosha. Acharya Vangasena has specifically mentioned Upanaha Sweda in treatment of Avabahuka. Application of mixture of Vatahara Patra and other Dravyas at the affected part helps to relieve pain, stiffness and difficulty in movements. In this case study, a female patient having symptoms of Avabahuka since 8 months was treated with Upanaha Sweda for 14 days and significant improvement was observed.

Keywords: Vata Vikara, Avabahuka, Swedan, Upanaha Sweda

Corresponding Author How to Cite this Article To Browse
Tanvi Sunil Joshi, Final Year Post Graduate Scholar, Department of Panchakarma, R.A. Podar Ayurved Medical College, Worli, Mumbai, Maharashtra, India.
Email: 		Tanvi Sunil Joshi, Seema D. Bahatkar, Role of Upanaha Sweda in the management of Avabahuka - A Case Study. J Ayu Int Med Sci. 2022;7(9):181-185.
Available From
https://www.jaims.in/jaims/article/view/2007

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-27 2022-08-29 2022-09-05 2022-09-12 2022-09-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Tanvi Sunil Joshi, Seema D. Bahatkarand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Joshi T et al: Role of Upanaha Sweda in the management of Avabahuka

Introduction

Vata Dosha, being the most important among Tridoshas plays a very important role in normal functioning of all body functions.[1] Proper mobility and movements according to type of joints is provided by normal Vata Dosha.

Avabahuka is a Vatavyadhi described by Acharya Charaka in eighty Vata Vikara.[2] Avabahuka term is composed of two words, Ava - dysfunction or separation and Bahu - is the term used for upper limb which is Shakha explained in Shadanga Sharir. In Avabahuka, Kupita Vata Dosha enters Ansa Sandhi and causes Akunchan of Sira and Snayu forming Ansa Sandhi.[3] Due to this, there is moderate to severe pain, stiffness and restricted movements of Ansa Sandhi. The symptoms are observed increasing gradually.

According to modern science, this condition can be correlated with frozen shoulder or adhesive capsulitis. It is a self-limiting disease having three stages - pain phase, frozen phase and thawing (recovery) phase. Etiology of frozen shoulder is not known. It can affect any person of either gender but commonly observed in patients with diabetes mellitus.

Case Report

Case history: A female patient of age 46 years came to OPD of Panchakarma of our hospital with symptoms Shoola (severe pain) in left shoulder joint and arm region, Graha (stiffness), Sakashta Kriya and Kriya Alpata (restriction in movements of shoulder joint specifically in flexion, extension, abduction, and overhead abduction) since 8 months. Patient is a house wife but previously worked as a cook in catering business for 7-8 years. The onset of symptoms was sudden and increasing gradually affecting the daily activities also.

Signs and symptoms

  • Vama Ansa Sandhi Shoola since 8 months
  • Vama Ansa Sandhi Graha since 8 months
  • Vama Ansa Sandhi - Sakashta Kriya
  • Khandit Nidra - Shoolajanya

Personal History

K/C/O- Hypertension since 1 year - Ongoing medicines - Tab. Telmisartan 20 mg.

No any surgical history.

Menstrual History - 3-4 days / 32 days; regular, mild painful with moderate flow.

Obstetric History- G2 P2 A0 L2 D0

1st- FTND - Female child; 16 years ago.

2nd- FTND - Male child; 12 years ago.

No any known allergy.

Examination

Table 1: Samanya Parikshan (General examination)

SN Examination Observations
1. Nadi Vatapradhan Kapha
2. Jivha Alpa Saama
3. Mala 1-2 Vega Pratidin, Asamadhankarak
4. Mutra 5-6 Vega Pratidin; 1 Vega Ratrau
5. Shabda Prakrut
6. Sparsha Alpa Ushna
7. Druk Nikat Drushtimandya, Upanetra Asti
8. Akruti Madhyam

 Table 2: Srotas Parikshan

Srotas name Examination Srotas name Examination
Pranavaha Srotas Avishesh Medovaha Srotas Avishesh
Annavaha Srotas Avipaka Asthivaha Srotas Ansa Sandhi Shoola, Graha
Udakavaha Srotas Avishesh Majjavaha Srotas Ansa Sandhi Shoola, Graha
Rasavaha Srotas Angagaurav, Aruchi Artavavaha Srotas Avishesh; Niyamit Rajapravartan
Raktavaha Srotas Ansagata Sira Sankoch Purishavaha Sorts 1-2 Vega Pratidin; Asamadhankarak
Mamsavaha Srotas Ansagata Snayu Sankoch Mutravaha Srotas 4-5 Vega Pratidin, 1 Vega Ratrau
    Swedavaha Srotas Avishesh

Table 3: Sthanik Parikshan (Local examination)

Range of motion of bilateral shoulder joints.

SN Range of motion Rt. Shoulder joint Lt. Shoulder joint
1. Flexion 90 degree 90 degree
2. Extension 70 degree 50 degree
3. Abduction 60 degree 40 degree
4. Adduction 40 degree 40 degree
5. Overhead abduction 170 + degree 110 degree

Investigations: All routine investigations of the patient were performed to assess basic parameters including BSL which were in normal limits.


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X-Ray of Lt Shoulder joint was done. Mild osteoporotic changes were observed. Rest was insignificant.

Nidana Panchak

Hetu - Sheeta Vata Sevan, Sheeta Jala Sevan, Atishram, Agniseva, Atichintan, Ratri Janar, Ateetakalashan, Ruksha Sheeta Guru Ahar.

Pooravaroopa - Ansa Sandhi Shoola, Alpa Graha

Roopa - Ansa Sandhi Shoola, Graha, Sakashta Kriya

Upashay-Anupashay - Alpa Upashay after Lepan or Swedan.

Samprapti

Vata- Prakopak Ahar Sevan

↓

Ansa Sandhi Sthani Vata Gamana

↓

Ansa Sandhigata Sira- Snayu Sankocha

↓

Ansa Sandhi Shoola, Graha, Sakashta Kriya

↓

Avabahuka

Treatment

Table 4: Abhyantar Aushadhi (Internal Medicines)

Medicine Kala Dose and anupana
1. Ajmodadi Vati Apana (Before meal) 500 mg with warm water
2. Triphala Guggul Vyanodana (After meal) 500 mg with warm water
3. Maharasnadi Kwatha Vyanodana (After meal) 20 ml with warm water
4. Haritaki Churna Nisha 5 gm with warm water

Panchakarma Chikitsa: In Vatavyadhi Chikitsa Upakrama, Swedan is described as one of the treatment modality.[4] Swedana or sudation is the procedure in which sweat is produced that helps to relieve Shaitya, Gaurav and Stambha.[5] There are two main types of Swedan - Saagni (13 types) and Niragni Sweda (10 types).[6] Upanaha Sweda is considered in both types of Swedan.

The word Upanaha is formed of two words- Upa- as Upasarga that means near and Nah-Bandhane which means tie or bind.

Upanaha Sweda is application of mixture of Vatahara or Vata-Kaphahara Dravya in the form of Churna or Kalka and covering it with large Vatahara Patra. These mixtures are kept there for a certain time approx. 12 hours. Acharya Charaka has explained that Upanaha tied in the morning should be released in the night and Upanaha tied at the night should be released in the morning.[7]

Upanaha Sweda as Panchakarma Chikitsa was performed in this patient for 14 days with Vatahara Patra and Dravyas.

Materials

1. Eranda Patra

2. Nirgundi Patra

3. Arka Patra

4. Erand Tail

5. Erandamoola + Nirgundi + Rasna Churna

6. Haridra Churna + Saindhav

7. Roller bandage

8. Gas stove with cylinder

9. Pan and spoon

10. Golves

Upanaha Swedan

Poorvakarma: Preparation of Upanaha

1. Fresh leaves of Eranda, Nirgundi and Arka are cut into small pieces.

2. Erand Tail - approx. 10 ml was taken in pan and heated. Haridra Churna, Erandamool Churna, Rasna Churna, Nirgundi Churna and Saindhav is added and mixed well.

3. Fresh cut leaves are added to the mixture and stirred well to cook properly.

4. A bolus of this hot mixture is formed and packed in large Eranda Patra.

Preparation of the patient

1. Cleaning and drying of the shoulder joint with warm water was done.

2. Sthanik Samvahan with warm was performed covering the Ansa Sandhi, neck, arm and scapular region.


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Pradhan Karma: After Sthanik Samvahana, the prepared 2 bolus of Upanaha is placed at Ansa Sandhi and posterior to Ansa Sandhi and are tied properly with the roller bandage at night.

Upanaha Bandhan Kala - 12 hours

Pashchat Karma: In the morning, the Upanaha is removed. Patient is advised to clean the part with warm water and dry it.

Again, Samvahan is performed with at the warm Sahachar Tail.

jaims_2007_01.JPGjaims_2007_02.JPG

Upanaha Bandhan

Assessment

Subjective assessment

Shoola (Pain by VAS Scale) - 0 to 10 cms

Stambha or Graha (Stiffness)

No stiffness 0
Mild stiffness; on movement of shoulder joint 1
Moderate stiffness, on movement of joint or rest; interfering the daily activities 2
Severe stiffness, very difficult movements and also rest, inability to sleep, disturbs all daily activities. 3

Objective assessment

Range of motion measured with the help of goniometer - Lt shoulder joint.

Observed Assessment in the patient

Assessment Criteria Before Treatment After Treatment
Shoola (Pain by VAS scale) 7 2
Graha (Stiffness) 3 1

 

Assessment Criteria Before Treatment After Treatment
Flexion 90 degree 90 degree
Extension 70 degree 80+ degree
Abduction 60 degree 80 degree
Adduction 40 degree 40 degree
Overhead abduction 110 degree 155 degree

Discussion

Swedana is one of the prime modalities in treatment of Vatavyadhi. Due to its Sheetaghna, Gauravghna, Stambhaghna and Swedakarak properties it pacifies Vata, helps in reducing Stambha in Sira and Snayu, reduces Shoola in the treatment of Avabahuka. Acharya Vangasena has thus explained Upanaha Swedan Chikitsa in management of Avabahuka.[8]

According to Acharya Sushruta, Vyana Vayu takes role in proper functioning of all locomotor activities.[9] Shleshak Kapha lubricates the joints to prevent friction and provides easy movements.[10]

Thus, vitiation of Vata and Kapha Dosha, in Ansa Sandhi cause Sira and Snayu Sankocha resulting in Shoola, Graha etc. symptoms leading to Avabahuka.

Upanaha Sweda with mainly Vatahara Dravyas or Kapha-Vatahara Dravyas as given here, with their Lagu, Ushna, Snigdha, Madhur, Katu, Lavan Rasa etc. properties help in reducing symptoms of Avabahuka.

Also, Upanaha Sweda improve Rasa-Rakta Vikshepan in the affected region that provides better nourishment to the joint maintaining the Shleshak Kapha and balancing the Vata Dosha.

Conclusion

Upanaha Sweda proves very beneficial in reducing signs and symptoms of Avabahuka.

Swedan Karma is very useful in reducing Shoola, Graha, restricted movements in the Ansa Sandhi and provide easiness in activities, Shoola Shaman thus improves quality of life.



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Reference

1. H.S. Paradkar, Ashtanga Hridaya of Acharya Vagbhata with Sarvang sundara teeka by Hemadri, Nidansthan, adhyay 12, verse 1, pg.no.182, Chaukhamba Surabharti publications, Varanasi, reprint ed.2015.

2. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, sutrasthan, adhyay 20, verse 11, Vaidyamitra publications, Pune, reprint ed. 2018.

3. Acharya Yadavji Trikamji, Sushrut Samhita with Nibandhsangraha teeka of Dalhana, Nidansthan, adhyay 1, verse 82, pg.no.269, Chaukhamba Surabharti publications, Varanasi, reprint ed.2015

4. H.S. Paradkar, Ashtanga Hridaya of Acharya Vagbhata with Sarvang sundara teeka by Hemadri, Nidansthan, adhyay 13, verse 1, pg.no.211, Chaukhamba Surabharti publications, Varanasi, reprint ed.2015.

5. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Sutrasthan, adhyay 22, verse 11, pg.no.279, Vaidyamitra publicatios, Pune, reprint ed. 2018.

6. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Chikitsasthan, adhyay 14, verse 65, pg.no.209, Vaidyamitra publications, Pune, reprint ed. 2018.

7. Dr.Y.G. Joshi, Charak Samhita of acharya Agnivesha and Charak with Ayurved Deepika teeka of Chakrapanidatta, Sutrasthan, adhyay 14, verse 38, pg.no.203, Vaidyamitra publicatios, Pune, reprint ed. 2018.

8. Acharya Vangasena, Vangasena samhita, Chikitsasthan, adhyay 4, verse 36, pg.no.204, Chaukhamba publications, Varanasi, reprint ed.2013.

9. Acharya Yadavji Trikamji, Sushrut Samhita with Nibandhsangraha teeka of Dalhana, Nidansthan, adhyay 1, verse 17-18, pg.no.260 Chaukhamba Surabharti publications, Varanasi, reprint ed.2015



10. H.S. Paradkar, Ashtanga Hridaya of Acharya Vagbhata with Sarvang sundara teeka by Hemadri, Nidansthan, adhyay 12, verse 18, pg.195, Chaukhamba Surabharti publications, Varanasi, reprint ed.2015


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