Effect of multimodality Ayurveda treatment in Avabahuk w.s.r. to Frozen Shoulder - A Case Study

Vaishali Atri; Archana Suhas Wadkar

Effect of multimodality Ayurveda treatment in Avabahuk w.s.r. to Frozen Shoulder - A Case Study

Atri V.^1*, Suhas Wadkar A.²

DOI:

^1* Vaishali Atri, Post Graduate Scholar, Department of Panchakarma, Hon. Shri. Annasaheb Dange Ayurved Medical College, Post Graduate & Research Center, Ashta, Sangli, Maharashtra, India.

² Archana Suhas Wadkar, Reader, Department of Panchakarma, Hon. Shri. Annasaheb Dange Ayurved Medical College, Post Graduate & Research Center, Ashta, Sangli, Maharashtra, India.

Avabahuk is a disease of Ansa Pradesh explained under Vata Vyadhi in Samhitas. It affects Sira of Ansa Pradesh and causes symptoms like Stambhata (stiffness), Alpakriyata (restricted movements), Shotha (inflammation), and Shoola (pain) in the shoulder region. In today’s world where a person became habitual to a sedentary lifestyle. It leads to Kupita Vata Dosha or a Kupita Vata Kapha Dosha which causes Avabahuk. It is correlated with Adhesive capsulitis commonly known as frozen shoulder. Frozen shoulder is a clinical syndrome with painful restrictions of both passive and active shoulder movements. For the present case study, a patient with the above complaints is diagnosed with Avabahuk and managed with Jambir Pinda Sweda along with Nasya. Nasya Karma is one of the primary treatments of Avabahuk. It is especially indicated for diseases of the part in and above the shoulder. Consequently, Jambir Pinda Sweda is predominantly used in the Vata-Kaphaj condition. The constituent of Jambir Pinda Sweda has properties like Ruksha, Tikshna, and Shothahara. Thus, the aim of case study is to study the effect of multimodality treatment like Jambir Pinda Sweda and Nasya with Karpasasthyadi Taila in Avabahuk.

Keywords: Avabahuk, Frozen Shoulder, Jambir Pinda Sweda, Nasya

Corresponding Author	How to Cite this Article	To Browse
Vaishali Atri, Post Graduate Scholar, Department of Panchakarma, Hon. Shri. Annasaheb Dange Ayurved Medical College, Post Graduate & Research Center, Ashta, Sangli, Maharashtra, India. Email:	Vaishali Atri, Archana Suhas Wadkar, Effect of multimodality Ayurveda treatment in Avabahuk w.s.r. to Frozen Shoulder - A Case Study. J Ayu Int Med Sci. 2022;7(11):221-227. Available From https://jaims.in/jaims/article/view/2115

Introduction

In the 21st century, all people became busy in day-to-day life and not taking care of their health which causes varieties of diseases. Avabahuk is one of the diseases which hamper the function of the upper limb. It commonly occurs in people of age between 40-70yrs irrespective of sex. The prevalence of this disease is 2-3% in the worldwide population.

In classical Ayurveda texts, Avabahuk is explained under Vatavyadhi. It is formed with two words Ava + Bahuk. Ava means Vikruti, dysfunction, and Bahuk means an arm or forearm, thus it means dysfunction of Bahu. The cardinal feautures of Avabahuk are the loss of Bahuspanda, Shoola, and Stambhata.^[1]

Avabahuk in modern terms can be compared with Adhesive capsulitis commonly known as Frozen shoulder. It is characterized by stiffness and pain in the shoulder region along with restriction in movements of the arm.^[2] It interferes with the daily activities of a person and leads to difficulty in living a healthy and peaceful life. Also, affects routine activities like eating, dressing, personal hygiene, and other work because of immobility of hand. It is usually a common disease but ill-understood and tends to slow recovery under appropriate treatment.

In Ayurveda Samhitas, Avabahuk can be treated by Panchakarma like Abhyanga, Swedan, Snehapana, Nasya Karma, and Basti Karma as like the treatment of Vatavyadhi.^[3]

Considering all the above points’ patient was managed with Abhyanga, Jambir Pinda Swedan, and Nasya with Karpasasthyadhi Taila. Karpasasthyadi Taila is explained in the treatment of Avabahuk in Sahasrayoga which has Vata – Kaphahara properties.^[4] Also, Jambir Pinda Sweda has Shothahara, Ruksha, and Teekshna properties. In this case study, the combined effects of Nasya along with Jambir Pinda Sweda were observed.

Aim

Effect of Multimodality Ayurveda treatment in Avabahuk.

Objectives

1. To study the efficacy of Jambir Pinda Sweda in Avabahuk.

2. To study the efficacy of Nasya with Karpasasthyadi Taila in Avabahuk.

Review of Literature

Pallavi R Bhramadande - Ayurvedic management in Avabahuka – A case study, SGR Ayurvedic College, 2019
Dr PraveenKumar H. Bagali - Clinical management of Apabahuka through Nasya and Nasaapana, RGUHS, 2010
Dr Febin P. Jose - A comparative clinical study on the effect of Nasya with Karpasasthayadi Taila and Nagara Taila in the management of Avabahuka

Case Study

A 65-year-old male patient came to Dhanvantari Rugnalaya, IPD No. 20 with chief complaints of Dakshin Ansa Shoola associated with Stambha and Kriyaalpata. The patient is a farmer by his profession. The patient said that he was asymptomatic before 4 months then gradually pain starts associated with mild stiffness, and the pain was progressive. On further inquiry, he said that pain usually aggravates at night and alleviates only by analgesics. He was not able to lie down on the affected side. There was no history of falls and also, he was not suffering from any chronic illness like Diabetes mellitus, Hypertension, Dengue, or Hypothyroidism.

Examination

Samanya Pariksha

Nadi - 78 per minute

Dehoshma - 98.6°F

Raktachapa - 110/80mmhg

Bhara - 62 kg

Ashtavidha Pariksha

Nadi - 78 per minute

Mutra - Samyaka, Day - 5-6 times, Night 0-1 time

Mala - Samyaka

Jihva - Ishat Sama

Shabda - Spasta

Sparsha - Samsheetushna

Drika - Aprakrita (Presbyopic)

Aakriti - Madhyam

Local Examination

Table 1: Musculoskeletal system: Shoulder Joint

Examination	Right Shoulder Joint	Left Shoulder Joint
Inspection	No scar mark seen	No scar mark seen
Inspection	Mild swelling Present	No swelling present
Palpation	Tenderness present	Tenderness absent
	Temperature increases	Temperature normal
	Swelling present	Swelling absent
Movement	Abduction - restricted	Abduction - normal
	Adduction - restricted	Adduction - normal
	Flexion - restricted	Flexion - normal
	Extension - restricted	Extension - normal
	Internal Rotation - restricted	Internal Rotation – normal
	External Rotation – restricted	External Rotation – normal
Function	Restricted movements	Normal movement

Special Test

Drop arm sign - Positive

Empty Can test (Jobe’s test) - Positive

Nidana Panchaka

Nidana (Causes)

Table 2: Nidana of Avabahuk

Nidana	Present in Patient
Aaharaja Nidana
§ Katu Rasa	+
§ Tikta Rasa	-
§ Kashaya Rasa	-
§ Alpa Bhojana	+
§ Ruksha Bhojana	+
§ Guru Bhojan	+
Viharaja Nidana
§ Ativyayama	+
§ Prajagrana	+
§ Atishrama	+
§ Atibharaharana	+
§ Abhighata	-
§ Dukhkshaya	+
§ Visham upchara	-
§ Atiyana sevana	-
§ Diwaswapan	-
Mansika Nidana
§ Atibhaya	-
§ Atishoka	-
§ Atichinta	+

Purvarupa (Prodromal Symptoms)

Features of Disease like Shotha, Shoola, Stambhata, and Alpakriyata in its minimal severity.

Rupa (Symptoms)

Bahuspandanhara, Shoola, Sthambhta, and mild Shotha are features of Avabahuk.

Samprapti (Etiopathogenesis)

Flow Chart 1: Samprapti of Avabahuk

Samprapti Ghataka

Dosha : Vyana Vayu, Sleshmaka kapha
Dushya : Sira, Snayu, Mamsa, Kandara, and Asthi

Strotas : Mamsavaha, Asthivaha
Strotodushti : Sanga and Vimargagaman
Roga Marga : Madhyam
Udhbhava Sthana : Pakvashaya
Vyakta Sthana : Bahu
Adhisthana : Ansa Pradesh
Sadhyata Ashyadhyta : Kashtasadhya (Chirkari)
Upsahaya : Analgesics and rest
Anupashya : Atishrama

Chikitsa Sutra

अवबाहौ हितं नस्यं स्नेहाश्चोत्तरभाक्तिक:॥ (अ.ह् चि.२१।४४ )

In Ashatang Hridya Chikitsa Sthana, it is mentioned that Nasya and Snehapana should be used.^[3]

In Sushruta and Charak Chikitsa Sthana treatment of Avabahuk is as according to the treatment of Vatavyadhi.^[5,6]

Materials and Methods

Center of study - Dhanvantari Rugnalaya, Ashta, Sangli, Maharashtra

Study design - Simple Randomized Single Case Study

Treatment Schedule in Avabahuk

Panchakarma

Snehana with Karpasasthyadi Taila
Swedan with Jambir Pinda Swedan
Nasya with Karpasasthyadi oil
Gandush with Ushna Jala

Duration - 7 days

Follow up - 14th day

Table 3: Contents of Karpasasthyadi Taila^[4]

SN	Drug	Latin name	Rasa	Guna	Virya	Vipaka	Dosha Karmukta
1	Karpasa Asthi	Gossypium herbaceum	Madhura	Laghu Tekshna	Anushna	Katu	Vatapitta Shamak
2	Bala	Sida cordifolia	Madhura	Guru Snigdha Pichila	Sheeta	Madhura	Vata Pitta Shamaka
3	Masha	Vigna mungo	Madhura	Guru Snigdha	Ushna	Madhura	Vatashamak Pittakapha Kara
4	Kulatha	Macrotyloma uniflorum	Kashaya Madhura	Laghu Tekshna Ushna	Ushna	Katu	Vatakaphahara

5	Devadaru	Cedrus deodara	Tikta Katu	Laghu Snigdha	Ushna	Katu	Kaphavatahara
6	Rasna	Alpinia galangal	Tikta	Guru	Ushna	Katu	Vata-Kaphashamak
7	Kushta	Sausseria lappa	Tikta Katu Madhura	Laghu Ruksha Tikshna	Ushna	Katu	Kapha-Vata Shamak
8	Sarsapa	Brassica juncea	Katu Tikta	Tikshna	Ushna	Katu	Kapha-Vata Nashak Pitta Vardhaka
9	Nagara	Zingiber officinale	Katu Tikta	Laghu Snigdha	Ushna	Madhura	Kapha-Vata Shamaka
10	Shatapushpa	Anethum graveolens	Katu Tikta	Laghu Ruksha Teekshna	Ushna	Katu	Kapha-Vata Shamaka
11	Pippali Moola	Piper longum	Katu	Laghu Ruksha	Ushna	Katu	Vata-Kapha Shamaka Pitta Vardhak
12	Chavya	Piper branchy-stachykum	Katu	Laghu Ruksha	Ushna	Katu	Kapha-Vata Shamaka
13	Shigru	Moringa olifera	Katu Tikta	Laghu Ruksha Tekshna	Ushna	Katu	Kapha-Vata Shamaka
14	Punarnava	Boerhaavia diffusa	Madhura Tikta Kashaya	Laghu Ruksha	Ushna	Madhura	Tridoshahara
15	Tila Taila	Seasamum indicum linn	Madhura	Guru Drava Pichila Sara Manda Sukshma Teekshna	Ushna	Madhura	Vata-Pittaghana
16	Ajaksheera		Madhura	Drava Pichila Sara Manda Sukshma Teekshna	Ushna	Madhura	Vata Pittaghana

Jambir Pinda Swedana

Table 4: Contents of Jambir Pinda Swedana

Drug	Latin name	Rasa	Guna	Virya	Vipaka	Doshakarma
Jambir	Citrus medica	Amla	Laghu Ruskha	Ushna	Amla	Vatashamaka
Haridra	Curcuma longa	Katu Tikta	Laghu Ruksha	Ushna	Katu	Kapha-Vata Shamaka
Saindhav Lavan	Rock salt	Lavana	Laghu Sukshma	Anushna	Madhura	Tridosha Shamaka

Assessment Criteria: The patient was assessed on the basis of relief in signs and symptoms, according to severity of symptoms grading was given as below:

Bahuspandanhara

a. Can do work properly - 0

b. Can do exhausting work with difficulty - 1

c. Can do easy work with difficulty - 2

d. Cannot do any work - 3

Shoola

a. No pain - 0

b. Mild pain during exhausting work - 1

c. Moderate pain during work - 2

d. Severe pain, not able to do work - 3

Sthambhta

a. No Sthambhta - 0

b. Mild Sthambhta during strenuous work - 1

c. Moderate Sthambhta during daily work - 2

d. Severe Sthambhta, not able to do work - 3

Observational and Results

Table 5: Effect of therapy on symptoms

SN	Symptoms	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7
1.	Bahuspandanahara	2	2	2	1	1	1	1
2.	Shoola	2	2	2	1	1	0	0
3.	Sthambhta	2	2	1	1	1	1	1

Table 6: Result of the study

SN	Symptoms	Before Treatment	After treatment	During Follow up
1.	Bahuspandanhara	2	1	1
2.	Shoola	2	0	0
3.	Stambhata	2	1	0

As the treatment given to the patient for 7 days there was significant relief in symptoms after Nasya with Karpasasthyadi Taila and Jambir Pinda Sweda.

Discussion

In present case study, the patient was farmer which leads to Atibhara, Ativyayam, Atishrama, and Gurubhojan in his daily routine in all of his life span due to this there was morbidity of Vata Dosha along with Kapha Dosha. Due to vitiation of Vata Dosha Bahu Shoola was appeared and due to Kapha dosha Stambhata and Bahuparspanditahara which ultimately causes Avabahuk. The treatment mentioned in Ayurveda for the management of Avabahuk has a great efficacy.

Swedana^[7]

The process which reduces stiffness, heaviness, reduces the Sheetata and produces sweating, it dilates the blood vessel and ensures proper assimilation of medicated drug to the body.

Jambir Pinda Swedana

Swedana given by using a bolus formed of Jambir (lemon). Jambir has properties like Laghu and Ruksha guna, Ushna Veerya, and work as Vata Shamaka thus gives benefit in treating Avabahuk.

Nasya: Therapeutic procedure in which medicated drug is administered through nasal route. According to Ayurvedic classics in Urdhavajatrugata, Nasya is most favorable and thus beneficial in Avabahuk. The drug administered through nose enters in Uttamanga and eliminates the morbid dosha residing there. Nasya with Karpasasthyadi Taila is used as it comprises mainly Karpasa, Masha, Kulatha, Bala, Pippalimoola, etc., having the properties like Snigdha Guna, Ushna Veerya, and Vata Kapha Shamak so act as Vedana Shamak, Shothahara, and Brumhana.^[4]

Thus, combinedly, Swedana and Nasya work as Vata and Kapha Shamak and provides significant relief in treating Avabahuk. Above mentioned specific Panchakarma procedures help in treating Avabhauk and maintain the health of a person and improve his daily routine activities.

Conclusion

In a developing country like India where a major part of the population works as farmers, hard work labor, Avabahuk is common but unfortunately ill-understood by physicians. In conventional therapy Analgesics and Corticosteroids are used which only subside the symptoms of the disease, in that scenario Panchakarma treatment is like a boon for a patient of Avabahuk. There is a successful result in treating Avabahuk with the multimodalities of Ayurveda like Snehana, Jambira Pinda Sweda along with Nasya of Karpasasthyadi Taila. So, Nasya with Jambir Pinda Sweda is effective in treating Avabahuk. A large scale clinical study must be conducted to establish the efficacy of this modality of Panchakarma.

Reference

1. Madhav Nidana of Shri Madhavkara, Prof. Yadunandana Upadhyaya, Chaukambha Sanskrit Bhawan, 2004

2. Davidson Principle and Practice of Medicine, Haslett, Chilvers, Hunter, Boon, 18th edition

3. Ashtanga Hridyam, Kaviraj Atrideva Gupt, Chikitsa Sthana Vatavyadhi Adhaya, 2009

4. Sahasaryoga, Dr. Ramnivas Sharma, Dr. Surender Sharma, Taila Prakrana, 3rd edition, Chaukambha Publication, 2012

5. Charak Samhita, P.V Sharma, Chikitsasthana- Vatavyadhi Chikitsa, Chaukambha Orientalia, 9th edition, 2007

6. Sushruta Samhita, Prof. K.R Srikanta Murthy, Chikitsa sthana - Mahavatavyadhi , Chaukambha Orientalia, 2010

7. Charak Samhita, P.V Sharma, Sutrasthana -Sweda Adhaya, Chaukambha Orientalia, 9th edition, 2007

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-11-01	2022-11-02	2022-11-09	2022-11-16	2022-11-23
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	17%

Case Report

Frozen Shoulder

Journal of Ayurveda and Integrated Medical Sciences