E-ISSN:2456-3110

Research Article

Prasaranyadi Kashaya

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 12 December
Publisherwww.maharshicharaka.in

An open label single arm clinical study of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya in Apabahuka (Frozen Shoulder)

Gangaram BG1*, Jadhav LL2, Chaithra M3
DOI:10.21760/jaims.8.12.3

1* Bhagiya Gayatri Gangaram, Final Year Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

2 Lakshmiprasad L Jadhav, Professor, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

3 M Chaithra, Final Year Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.

Background: Apabahuka is a Vata Vyadhi which affects Amsa Sandhi and causes Amsa Bandha Shoshana. Prakupita Vata causes Kshaya of Shleshaka Kapha and Sira Sankochana leading to Bahupraspanditahara. Nasya and Uttarbhaktika Snehapana are the indicated Chikitsakrama for Apabahuka. Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya are the indicated Chikitsa Yoga for Apabahuka in Vatavyadhichikitsa. Hence this study is intended to evaluate the same. Objective: To clinically evaluate the combined effectiveness of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya in Apabahuka (Frozen Shoulder). Methodology: 36 subjects were administered with Dashamooladi Yamaka Pratimarsha Nasya 2 Bindu in each nostril after food morning and night and Prasaranyadi Kashaya 16ml 3 times a day on before food for a period of 14 days. Subjective and objective parameters were assessed by Constant Murley score. Results: Statistically significant (P < 0.05) improvement was observed in subjective parameters such as Amsasandhi Shoola, Bahupraspanditahara. With objective parameters like range of movement of shoulder significant change was observed. Conclusion: Dashamooladi Yamaka in the form of Pratimarsha Nasya and Prasaranyadi Kashaya orally together were found effective in the management of Apabahuka.

Keywords: Apabahuka, Frozen Shoulder, Dashamooladi Yamaka Pratimarsha Nasya, Prasaranyadi Kashaya

Corresponding Author How to Cite this Article To Browse
Bhagiya Gayatri Gangaram, Final Year Post Graduate Scholar, Department of Kayachikitsa, Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, Karnataka, India.
Email: 		Gangaram BG, Jadhav LL, Chaithra M, An open label single arm clinical study of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya in Apabahuka (Frozen Shoulder). J Ayu Int Med Sci. 2023;8(12):14-19.
Available From
https://jaims.in/jaims/article/view/2804

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2023-10-12 2023-10-19 2023-10-31 2023-11-10 2023-11-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared. Nil yes 14.62

© 2023by Gangaram BG, Jadhav LL, Chaithra Mand 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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Gangaram BG et al. open label single arm clinical study of Apabahuka (Frozen Shoulder)

Introduction

Apabahuka has two words. Apa and Bahuka. “Apa” means Viyoga (dysfunction) and “Bahuka” means Bahu.[1] Apabahuka is caused by Vata Prakopa in Amsa Desha. Prakupita Vata causes Shoshana of Amsa Bandha and Sankocha of Sira of Amsa Pradesha.[2] This leads to Stambha and Bahupraspanditahara.[3] BahumeansKoorparasya Urdhvabhaga that is part above elbow. Praspandana - Chalana, Chesta or movement. Vyana Vata is responsible for Cheshta like Prasarana, Akunchana, Vinamana, Unnamana and Tiryagagamana.[4] Hara means loss of or impaired. Thus, Bahupraspanditahara means difficulty in movement or impaired or reduced range of movement of shoulder joint. Sira Akunchana - Sira is formed from Snayu and Snehamsa of Medas. Sira is responsible for Akunchana and Prasarana of Sandhi. In Apabahuka Prakupita Vata leads to Sira Akunchana in Amsa Desha. This leads to difficulty in Akunchana and Prasarana which results in Bahuprasapaditahara. Apabahuka being a Vatavyadhi, Samanya Vatavyadhi Chikitsa is applicable. According to Acharya Charaka[5] and Acharya Vagbhat,[6] Uttarabhaktika Snehapana and Nasya are indicated in Bahusheershagatavata. Nasya, Mardana, Bahuparivartanam, Shamana Aushadhi and Uttarabhaktika Snehapana are mentioned in the management of Apabahuka in Yogaratnakara.[7]

Frozen shoulder is estimated to occur in 2-5% of general population.[8] Every 5% of the consecutive new patients attend a clinic for Frozen shoulder. Diabetes mellitus is an independent risk factor for Frozen shoulder. Diabetic patients are 5 times more likely to develop it. The estimated prevalence is 13.4% in diabetic patients and 2-10% in non-diabetics. This tends to occur in patients of middle age and women. Frozen shoulder is a clinical condition characterized by painful restriction of both active and passive shoulder movements. Frozen shoulder has two causes. Shoulder and non- shoulder causes. Shoulder causes include bicipital tendinitis, fracture or dislocations of shoulder. Frozen shoulder has three stages, Stage of pain, Stage of stiffness and Stage of recovery.[9]

Materials and Methods

Source of data: Subjects of Apabahuka

were selected from Out Patient and In patient department of Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan.

Methods of collection of data

Screening

A screening form was prepared with all aspects of history, signs and symptoms of Apabahuka.

Diagnostic criteria

Diagnosis was made on the basis of Samanya Lakshana of Apabahuka viz. Bahupraspanditahara, Amsa Sandhi Shoola and symptoms of frozen shoulder.

Inclusion Criteria

1. Subjects aged between 30 and 70 years.
2. Subjects of either gender irrespective of caste, occupation and religion.
3. Subjects who are willing to participate and sign the informed consent form.

Exclusion criteria

1. Subjects presenting with fracture or dislocation of shoulder joint.
2. Uncontrolled Diabetes Mellitus and Hypertension.
3. Known case of neoplasm and infective condition.
4. Pregnant and lactating women.

Investigation

  • X- Ray Shoulder joint - to rule out fracture
  • HbA1c, if Diabetic

Ethical clearance and CTRI registration:

Ethical clearance was obtained from Institutional Ethics Committee. IEC No: SDM/IEC/78/2021. Trial was registered on www.ctri.gov.in with Registration No: CTRI/2022/08/044850 dated 19/07/2022

Study design

Study was an open label single arm clinical study on Apabahuka (frozen shoulder) (n=30) selected using the convenience (non-random) sampling technique with pre and post design conducted in tertiary Ayurveda hospital.

Dosage and Drug Administration

Dashamooladi Yamaka

Dosage: 2 Bindu each nostril (twice daily) after food


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Gangaram BG et al. open label single arm clinical study of Apabahuka (Frozen Shoulder)

Route of administration: Nasal

Duration: 14 days

Prasaranyadi Kashaya

Dosage: 16 ml thrice a day before food

Route of administration: Oral

Duration: 14 days

Assessment Criteria

Subjective and objective parameters were assessed using Constant Murley Score.

a. Pain: (15 Points)

b. Activities of daily living: (20 Points)

  • Sleep
  • Normal daily living
  • Normal recreation activity
  • Hand comfort

c. Movement: (40 Points)

  • Flexion
  • Abduction
  • External rotation
  • Internal rotation

d. Strength: (25 Points)

Observation

In the present study 67 subjects were screened, 36 subjects registered for the study, 30 subjects completed the study. Among 30 subjects maximum (n=14) were from the age group of 41-50 years and majority were males (n=19). 16 subjects were from middle lower-class group. Majority of them (n=32) had gradual onset. Diet wise distribution showed (n=22) had mixed diet. 18 subjects had disturbed sleep.

Results

30 subjects were administered with Dashamooladi Yamaka Pratimarsha Nasya 2 Bindu each nostril after food morning and night and Prasaranyadi Kashaya 16ml 3 times a day before food for a period of 14 days. Paired t test was run on subjective and objective parameters and had shown significant improvement in symptoms like Amsa Sandhi, Bahuprasapanditahara and range of movement of

shoulder joint.

Table 1: Paired T-test showing the combined effect of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya on Part A (Pain)

Gross Score IGross Score JMean Diff. (I-J)Std DeviationStd Error MeanT ValueSig.Remark
BT7th day-1.731.7410.318-5.450.001S
7th dayAT-2.861.7170.313-9.140.001S
BTAT-4.602.5540.466-9.860.001S

Paired T-test showed improvement in Part A (pain)with a mean difference of -1.733 between the 7th day and BT, -2.867 between 7th day and AT, and -4.600 between BT and AT was statistically significant with p< 0.05.

Table 2: Paired T-test showing the combined effect of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya on Part B (Normal activity, Recreational activity, Sleep, Painless activity level of shoulder)

Gross Score IGross Score JMean Diff. (I-J)Std DeviationStd Error MeanT ValueSig.Remark
BT7th day-2.102.1860.399-5.250.001S
7th dayAT-3.832.1980.401-9.550.001S
BTAT-5.933.1280.571-10.30.001S

Paired T-test showed improvement in Part B (Normal activity, Recreational activity, Sleep, Painless activity level of shoulder) with mean difference of -5.259 between 7th day and BT, -9.550 between 7th day and AT and -10.380 between BT and AT was statistically significant with p< 0.05.

Table 3: Paired T-test showing the combined effect of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya on Part C (Flexion, Abduction, External rotation, Internal rotation)

Gross Score IGross Score JMean Diff. (I-J)Std DeviationStd Error MeanT ValueSig.Remark
BT7th day-5.2004.0200.734-7.080.001S
7th dayAT-4.0664.0500.739-10.90.001S
BTAT-13.266.1361.120-11.80.001S

Paired T-test showed improvement in Part C (Flexion, Abduction, External rotation, Internal rotation) with mean difference of -7.084 between 7th day and BT, -10.907 between 7th day and AT and -11.842 between BT and AT was statistically significant with p< 0.05.


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Table 4: Paired T test showing the combined effect of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya on Part D (Power)

Gross Score IGross Score JMean Diff. (I-J)Std DeviationStd Error MeanT ValueSig.Remark
BT7th day-1.331.6250.296-4.490.001S
7th dayAT-2.331.5160.276-8.420.001S
BTAT-3.662.1860.399-9.180.001S

Paired T-test showed improvement in Part D (Power)with mean difference of -4.492 between 7th day and BT, -8.429 between 7th day and AT and -9.184 between BT and AT was statistically significant with p< 0.05.

Table 5: Paired T test showing the combined effect of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya on Total score

Gross Score IGross Score JMean Diff. (I-J)Std DeviationStd Error MeanT ValueSig.Remark
BTDay 7-10.407.7931.422-7.310.001S
Day 7AT-17.107.0431.285-13.280.001S
BTAT-27.5012.5552.292-11.990.001S

Paired T-test showed improvement in Total Score with mean difference of -10.400 between 7th day and BT, -17.100 between 7th day and AT and -27.500 between BT and AT was statistically significant with p< 0.05.

Discussion

Effect of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya on Bahupraspanditahara

Significant result was observed in range of active movements such as flexion, abduction, external rotation and internal rotation after the treatment.

Bahupraspanditahara is a symptom of Apabahuka where active movements are restricted due to stiffness of the shoulder joint. This may be due to increased Sheeta and Ruksha Guna of Vata and decreased Snigdha Guna of Kapha.

The combination of Dashmooladi Yamaka and Prasaranayadi Kashaya help in pacifying Vata and it normalises Kapha. Majority of the drugs have properties like Snigdha Pichhila, Shlakshna and Guru Guna.

which normalises the Kapha Dosha and along with these Guna’s Ushna Veerya pacifies Vata.

Effect of Dashamooladi Yamaka Pratimarsha Nasya and Prasaranyadi Kashaya on Amsa

Statistically significant improvement was noticed in Amsa Sandhi after treatment using Paired t-test (P value <0.05).

Amsasandhi is manifested as a result of Nidana such as Atibharavahana, Vishama Cheshta, Ativyayama leads to Vataprakopa in Amsa Pradesha and causes Amsa. Prasarini, Rasona, Bala, Masha, Shunthi and Dashamoola have Madhura Rasa and Madhura Vipaka. Tarpana and Brumhana properties of this drugs helps in reducing Amsasandhi by pacifying Vata.

Discussion on Probable Mode of Action of Drug

Prasarani has Guru Guna, Ushna Veerya and it is Balakaraka and Vatashamaka. The drug has proven efficacy as an effective anti-inflammatory, analgesic activity.

Rasna has Guru and Snigdha Guna, Ushna Veerya, and is a potent Vata Shamaka drug. It is having Shoolaghna & Shothahara action which helps in reducing Amsa Shoola.[10]

Rasona has Snigdha Guna and Ushna Veerya, which helps in pacifying the Vata. It acts as Shothahara, Shoolahara and Balya.[11]

Shunthi has Guru Guna, Ushna Veerya, Madhura Vipaka, Shophaghna, Shoolaghna, Agnivardhaka and Amapachaka property, which help in reducing Shoola and Shopha.[12]

Masha has Snigdha Guna, Ushna Veerya which help in reduction of Vata. It is Mamsabalaprada, Brumhaka, Balya, Tarpana which helps in Kapha Vardhana.

Bala enlisted under Brumhaneeya Mahakashaya and is Agrya for Vata Shamana. It has Madhura Rasa, Guru, Snigdha, Pichila Guna which helps to pacify Vata.[13]

Dashmoola has Shotha-Shoolahara and Amapachana properties and anti-inflammatory, analgesic effect which help in reducing Amsa Sandhi Shoola.

Discussion on mode of action of Yamaka

Tila Taila is Brumhanakaraka and Vatahara.


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Vyavayi and Sookshma, Teekshna Guna of Tila Taila help Yamaka to spread faster into Sookshma Srotas.[14] Tarpana Karma of Tila Taila can correct Shleshaka Kapha which is in Kshaya Avastha. Ghrita is Yogavahi and does Agnideepana and Vatashamana.[15] It has Guru and Snigdha Guna which helps in Vata Shamana. Rasayana and Balya properties of Ghrita helps in nourishing Shleshaka Kapha. Lipid-based formulations increase the intraluminal solubility of lipophilic drugs and enhance the drug absorption.[16]

Discussion on Pratimarsha Nasya

Auttarabhaktika Snehaprayoga is indicated in Bahusheershagatavata. Apabahuka being a condition with involvement of Bahu, Dashamooladi Yamaka Nasya was administered after food in the form of Pratimarsha Nasya. Dashamooladi Yamaka Nasya is indicated in the evening after food. Bhuktabhakta being a contraindication for Nasya in general, Pratimarsha mode of Nasya was done.

Probable mode of action - Vascular pathway- Highly vascularized nasal tissue makes effective and quick absorption of the drug administered through nose.[17] Neurological pathway - Chemoreceptors make up the olfactory nerve which end in the olfactory bulb. Bulbar olfactory pathway is made up of sensory neurons that project directly to the hypothalamus. Hypothalamus is responsible for regulating chemical mediators for pain. Therefore, Nasya may help in pain regulation in Apabahuka by acting upon hypothalamus.[18]

Conclusion

Dashamooladi Yamaka Pratimarsha Nasya 2 Bindu each nostril after food morning and night and Prasaranyadi Kashaya 16ml 3 times a day before food for a period of 14 days have shown significant results on subjective and objective parameters like Amsashoola, Bahupraspanditahara and range of movement of shoulder joint.

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