E-ISSN:2456-3110

Review Article

Panchakarma

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 10 November
Publisherwww.maharshicharaka.in

Role of Panchakarma treatment in Avabahuka - A Critical Review

Chinky.1*, Jain A.2, Aarti.3, Yadav N.4
DOI:

1* Chinky, Post Graduate Scholar, Post Graduate Department of Panchakarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

2 Anup Jain, Assistant Professor, Post Graduate Department of Panchakarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

3 Aarti, Post Graduate Scholar, Post Graduate Department of Panchakarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

4 Neha Yadav, Post Graduate Scholar, Post Graduate Department of Panchakarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, India.

Avabahuka is an Urdhwajatrugata Vata Vikara caused by Kupita Vata Dosha localised around the Ansa Pradesh (Shoulder region) causing Shoshana (wasting) of the Ansa Bandanam (Shoulder joint complex), there by leading to Akunchana of the local Sira causing Bahupraspandanhara (Hampered normal functioning of the shoulder) and Shoola (pain). Due to its clinical manifestations Avabahuka can be compared with frozen shoulder. Prevalence of frozen shoulder is 2-5% in general population and Females are more affected than male. The incidence of frozen shoulder is 2- 4 times higher in diabetes then in the general population. Due to sedentary lifestyle, food, stress more population face these problems and incidence of disease increase drastically. Hence Snehana, Swedana, Uttarbhaktika Snehapana, Nasya Karma can be used for treating such patients.

Keywords: Chinky et al: Avabahuka, Frozen shoulder, Panchakarma

Corresponding Author How to Cite this Article To Browse
Chinky, Post Graduate Scholar, Post Graduate Department of Panchakarma, Ch. Brahm Prakash Ayurved Charak Sansthan Khera Dabar, New Delhi, , India.
Email: 		Chinky, Anup Jain, Aarti, Neha Yadav, Role of Panchakarma treatment in Avabahuka - A Critical Review. J Ayu Int Med Sci. 2022;7(10):198-203.
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https://www.jaims.in/jaims/article/view/2133

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-09-28 2022-09-30 2022-10-07 2022-10-14 2022-10-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 19%

© 2022by Chinky, Anup Jain, Aarti, Neha Yadavand 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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Role of Panchakarma treatment in Avabahuka A Critical Review

Introduction

Avabahuka is a disease described in ayurvedic literature which is characterized by localized Samprapti which affects Ansa Sandhi (Shoulder joint) and causes Shoshana (Wasting/ weakness) of Ansa Bandhanam which leads to Aakunchan of local Sira.[1] It is characterized by Bahupraspanditahara (Hampered normal functioning of the shoulder) and Shoola (pain).[2]

Avabahuka word is derived from combining two terms: Ava meaning Viyoga[3] i.e., dysfunction or separation[4] and Bahuka meaning arm, therefore the term Avabahuka represents dysfunction in arm.[5]

It is an Urdhwajatrugata Vata Vikara caused due to vitiation of Vata Dosha. Acharya Sushruta mentioned Vatavyadhi in Astamahagada[6] Ansa (Shoulder joint) is described as a Snayu and Vaikalayakar Marma, [7] any injury to which can cause Stabdhta.[8]

Acharya Sushruta described the disease Avabahuka for the first time in Nidansthana. Siraakunchana (contraction of tendons) is one of the common symptoms as described by Acharya Sushruta. Bahusosha (muscle wasting of arm) and Ansabandhanshosh (contraction of shoulder ligaments) are the other symptoms mentioned in different texts.[9]

Due to its clinical manifestations Avabahuka can be compared with frozen shoulder. Shoulder joint is complex and has the greatest range of motion. Frozen shoulder means a significant loss of its range of motion in all direction (capsular pattern). It is a result of inflammation, scarring, thickening and shrinkage of the capsule that surrounds the normal shoulder joint.[10] It is also called as adhesive capsulitis and is one of the most common causes of shoulder pain and disability.

Frozen shoulder is divided into two types as per their cause primary and secondary, Primary frozen shoulder has insidious onset usually without any known aetiology, while the secondary frozen shoulder is due to the clinical conditions like rheumatoid arthritis, osteoarthritis, trauma or immobilization has three stages, painful, freezing, frozen and thawing. Though it is not a life threatening disease, it causes problems in day-to-day activities, thus affecting the quality of life.[11]

Prevalence of frozen shoulder is 3-5% in general population.[12] Females are more affected than male.[13] The incidence of frozen shoulder is 2-4 times higher in diabetes then in the general population.[14]

Treatment in other system of medicine commonly includes anti-inflammatory, analgesics and muscle relaxant medications, non-steroidal anti-inflammatory drug or NSAIDs, and topical application of heat/ ice is also found effective in relieving back pain.

Considering the above scenario and the needs of modern society to find an effective cure, it becomes imperative to review or search for safe and effective interventions in cases of Avabahuka (Frozen shoulder).

Aim and Objectives

Aim: This review study is primarily planned to review previous conducted clinical researches based on the type of intervention i.e., various Panchakarma interventions used for management of Avabahuka and to make its specific treatment protocol.

Objective: To assess the efficacy and safety of Panchakarma Chikitsa for management of Avabahuka.

Materials and Methods

All the information relevant to the study is compiled from previous research studies, i.e., clinical trials, randomized or not having interventions of various Panchakarma modalities and published in various peer reviewed journals and also available on multiple databases such as PubMed, Google scholars, Shodhaganga, Cochraine library etc.

Observations and Results

This review is based on information from a total 8 interventional studies by critically analysing them to verify the necessity and assess the role of Panchakarma Chikitsa.

Observations

1. Joydip Tripathi et al: April-2018: A Clinical Study on the role of Nasya Karma in the Management of Avabahuka (Frozen Shoulder) with Vatada Taila[15]


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It was an Open label, Single arm, Non-comparative Clinical Trial in which 30 patients were enrolled and was treated with Vatada Taila Nasya 3 drops per nostrils twice a day were administered for 15 consecutive days. All the subjective and objective parameters were recorded after 15 days of the study. It has been revealed that the features like pain and stiffness have reduced markedly that is about 58.82% and 68.58% respectively having p value less than 0.001 that is highly significant. On the other hand, the objective parameters like flexion, extension, external rotation, internal rotation, abduction showed improvement with enhancement of their respective angles with percentage of relief by 2.46%, 10.78%, 9.66%, 8.57%, 2.50% respectively. And the therapy may be declared as safe and effective.

2. Revathi K et al: Sep 2018: A Clinical Study to Evaluate Effect of Nasya with Shudhabala Taila in Apabahukas.r. to Frozen Shoulder[16]

It was an open label single group clinical trial in which 30 patients of Avabahuka were enrolled and was treated with Nasya Karma with Shudhabala Taila 8 drops per nostrils for 7 days and follow up was done on 21th day. Result of this study showed that Nasya with Shudhabala Taila was effective in relieving the symptoms of Apabahuka and found statistically significant.

3. Sujatha M et al: Nov 2020: A Controlled Clinical Study to Evaluate the Efficacy of Shulahara Gritha Nasya in the Management of Apabhahuka Vis-A-Vis Frozen Shoulder[17]

It was an Interventional Controlled Clinical Trial in which 50 patients of Apabahuka were enrolled. Group A was treated with Nasya Karma with Ashwagandhagritha in a dose of 8 Bindu (4ml) to each nostril for 7 consecutive days and Trayodashanga Guggulu internally and Group-B was treated with Nasya Karma with Shulaharagritha in a dose of 8 Bindu(4ml) to each nostril for 7 consecutive days and Trayodashanga Guggulu internally. The assessment was done on the 0day, 8th day, 15th day after the completion of trial. Overall assessment of following movement of shoulder joint: Flexion -complete relief in 88% patients, moderate relief in 12%, abduction-complete relief in 90% patients, 10% had moderate relief and pain showed complete relief in 86% patients.

In Group-A 84% patients were completely relieved from pain and 16% patients had moderate relief from pain. In Group- B, 88% patients were completely relieved from pain and 12% patients had mild pain. Comparison between the groups showed that both the groups were effective in reducing symptoms of Apabahuka. Statistically the results of restricted movements of flexion and abduction between the groups was non- significant with the p value 0.627 and 0.609 and pain with the p value 0.079 indicating equal effectiveness of both the groups.

4. Rohini A. Aramani et al. Oct 2015: Comparative Clinical Study of Nasya Karma and Uttarabhaktika Snehapana in Apabahuka[18]

In this study, 30 patients of Apabahuka were enrolled by dividing them in 2 Groups (15 in each): Group A was administered Nasya Karma with Masha Taila 8 drops per nostrils for 7 days. In Group B was administered Uttarbhaktika Snehapana with Masha Taila 12ml after morning and evening meal for 7 days and follow up was done after 14th day. Total duration of the study was 24 days. Before given Nasya and Uttarbhaktika Sanehpana, firstly we should be taken Deepana Pachana with Ajamodadi Churna with luke warm water till Nirama Lakshanas appears. In Group A, out of 15 patients, 9 (60%) got moderate improvement and 6 (40%) patients got mild improvement. In Group B, out of 15 patients, 3 (20%) got marked improvement and 12 (80%) patients got moderate improvement. Comparison of total effect of two groups had analysed. However, there was 60% improvement in Group A and 73% improvement in the Group B. Overall Group-B was more effective clinically and statistically than Group-A in almost all the parameters.

5. Banmali Das: Oct-Dec 2010: A study on Apabahuka (frozen shoulder) and its management by Laghumasha Taila Nasya[19]

It was a Randomized Standard Single Blind Clinical Study. In this study, Marsha Nasya with Laghumasha Taila in doses of 6, 8 and 10 drops respectively were administered to 15 patients for seven days, and the following results were obtained. After treatment, 53.33% relief was found on Bahupraspanditahara, 26.66% on Shoola, 30.00% on Stambha, 60.00% on Atopa, and 37.50% on Shoshna (wasting of muscles).


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On the overall effect of therapy alone, one (6.60%) patient got marked improvement, eight (53.33%) got moderate improvement, four (26.66%) were improved, and two (13.33%) patients remained unchanged.

6. Conception Costa et al: July-Aug 2020: A comparative clinical study on the efficacy of Nasya with Pinyaka / Panchamula Taila and Swalpa Masha Taila in Apabahukas.r. to Frozen shoulder[20]

It was a single blind randomised clinical study in which 40 patients of Apabahuka were enrolled and divided into two groups - Group A was treated with Pinyaka / Panchamula Taila Nasya and Group B was treated with Swalpa Masha Taila Nasya. Statistically Group-A showed better results in Pain (51.2%), Stiffness (48%), Tenderness (58.33%), with improvement in goniometric readings of shoulder ROM than Group-B in Pain (39.4%), stiffness (40.9%), Tenderness (58%). Thus, it was concluded that Group A Nasya with Pinyaka Taila showed better effect than Group B Nasya with Swalpa Masha Taila.

7. Vikramaditya Jangir :2017: A Comparative Study of Swalpa Masha Taila Nasya and Swalpa Masha Taila Uttarabaktika Snehapana in the Management of an Avabahuka[21]

In this study, 60 Patients were enrolled and divided into 2 groups (30 in each group). In Group-A was treated with Swalpamasha Tailam Nasya with the Dosage of 4 drops in each nostril for 7 days and Group-B was treated with Swalpa Masha Tailam Uttarabhaktika Snehapana 3 Aksha Pramana for 7 days with luke warm water for 7 days and follow up after 21 days. Total duration of the study was 28 days. Comparison of the total effect of two groups had analysed. However, there was 60% improvement in Group A and 73% improvement in the Group B. But clinically Group B (Uttarabhaktika Snehapana) has got highly significance than Group A (Nasya).

8. Bindu P Patil, Veena G Rao: 2014: Effect of Masha Saindhava Taila in the Management of ApabahukaS.R To Frozen Shoulder[22]

It was a single blind clinical study in which 30 diagnosed patients of Apabahuka were selected and was treated with Nasya with Masha Saindhava Taila for 7 days. Assessment was done after the treatment on 14th, 22nd and 30th

day of follow ups. Improvement in Stabdhta after treatment was highly significant with P value<0.001. Internal rotation: This movement was majorly affected in 53% of patients with grade 3 and on follow ups it was gradually reached to grade one. External rotation: 50% patients with grade 3 had increased in range of motion i.e. to grade 2 on 1st follow up, 46% patients of grade 2 to grade1 observed on last follow up. Flexion: 53% with grade 3 showed improvements in two levels i.e., mild on last follow up, 20% showed good improvement with grade 0 from grade1. Extension: 56% from grade 3 to grade 1 on 3rd follow up, 13% from grade2 to grade1, 3% from grade 2 to grade 0. Abduction: 53% from grade 3 to grade 1 on last follow up and grade 1, 20% grade 2 to grade 1, 20% from grade 2 to grade 0 on last follow up. Thus, it was concluded that moderate improvement was observed in flexion, abduction and external rotation and not much improvements was observed in the movement extension and internal rotation.

Discussion

Avabahuka is a disease in which Vata get vitiated and situated in Ansa Sandhi and produce symptoms like Shoola, Stabdhta. As it is Krichrsadhya Vyadhi only Shamana Aushadi is not enough to treat the disease so Panchakaram Chikitsa is of prime importance.

Role of Uttarbhaktika Snehapana in Avabahuka

In Avabahuka mainly Vyana Vayu is vitiated and in text Aushadha Kala defines for Vyana Vayu is Adhobhakta. Snehapana done after intake of food which is useful in the disorders of Vyana Vata. Acharya Vagbhata said that when Sneha is given before food, will cures Adhobhaga Roga, in the middle it cures Madhyamabhaga Roga and after food cures Urdhwabhaga Roga,[23] so Uttarbhaktika Snehpana is useful in Avabahuka.

Role of Snehana and Swedana in Vatavyadhi

For Vatavyadhi, Snehana and Swedana are the best line of treatment. As Sneha Dravya possesses Drava, Sukshama, Sara, Snigdha, Manda, Mridu, Guru Guna which are just opposite to Vata so it alleviates Vata. Snehana when administered provides nourishment to emaciated tissue. As Avabahuka is a Vatavyadhi, Snehana with Vatahara Taila brings Snigdhata (oleation) in


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the body which leads to minimize the Bahu Shoola (Pain), Stabdhta (Stiffness) and Praspanditahara (Restricted movement) and softens the muscles, ligaments and tendons present in shoulder joint. After Snehana, Swedana should be given which alleviates Shoola (pain), Stambha (stiffness), Shotha (oedema) in shoulder joint and also clears the blocking of passages (Srotorodha).

Role of Upanaha Sweda in Vatavyadhi

Upanaha Sweda is a type of Sweda in which warm paste of herbs is applied on affected joint that increases the local skin temperature and further it prevents heat loss a thick layer of herbal paste works as a bad conductor of heat. The tactile receptors are very sensitive to temperature changes and respond quickly to even small change in temperature. Increase the temperature of a particular area cause the stimulation of nerve endings for giving fight and flight response to combat the increasing temperature through opening of sweat glands and maintenance of homeostasis. In this procedure the secretion of inflammatory mediators by local receptors, hampering the secretion of various cytokines and interleukins and therefore obliterating the pathogenesis of inflammation. So, Upanaha Sweda is used for reducing pain, stiffness, tenderness, swelling and increased range of movement of shoulder joint.

Role of Nasya in Avabahuka

Avabahuka is an Urdhwajajatrugata Vikara and caused by Vata Dosha. Acharya Vagbhata recommends Nasya and Uttarbhaktika Snehpana in the management of Avabahuka.[24] For reduction of Vata Dosha we can administer Brihana Nasya in which Sneha is administers through nose. Acharya Vagbhata has stated that, the ‘Nasa Hi Shiraso Dwaram’ that is, the nose, is the easiest and closest opening for conveying the potency of medicines to the cranial cavity.

Acharya Charaka has said that Nasya drug usually acts through absorption by the Shringataka Marma. After absorption of the drug, it acts on the diseases of Skanda, Amsa, and Greeva Pradesha and the Prakupita Doshas are expelled out through the principle of ‘Munjadishikhavat’ from Uttamanga.[25] Brihana Nasya provides nourishment to the Shiroindriya and other organs and alleviates the vitiated Vata Dosha.


Conclusion

In treatment of Avabahuka, Nasya plays a vital role not only symptomatically but in overall manner.

Reference

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