E-ISSN:2456-3110

Case Report

Management of Avabahuka

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 5 May
Publisherwww.maharshicharaka.in

Management of Avabahuka with Prasarni Taila Nasya and Sthanik Patra Pinda Swedana - A Case Study

Juyal R1*, Mahajan K2, Tiwari A3, Kumar Agrawal A4
DOI:10.21760/jaims.9.5.49

1* Ruchi Juyal, Post Graduate Scholar, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India.

2 Ketan Mahajan, Professor HOD, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India.

3 Amit Tiwari, Assistant Professor, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India.

4 Atul Kumar Agrawal, Assistant Professor, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India.

Avabahuka is a disease that causes problem in daily routine of an individual like wearing clothes, eating, personal hygiene and work etc. Shoulder joint is the most mobile joint in the body. Clinical presentation and pathogenesis of Avabahuka can be correlated with the symptoms of adhesive capsulitis, which is commonly known as Frozen Shoulder. Panchakarma is the branch of Ayurveda which deal with the purification of the Vitiated Doshas of the body through Shodhana therapy. Nasya is mainly indicated for Avabahuka. Swedana also helps in managing the condition, Avabahuka. The aim of the present study was to evaluate the effectiveness of Nasya Karma and Sthanik Patra Potali Swedana in the management of Avabahuka. A 62 years old male patient came to Panchakarma OPD with an accidental history 3 months ago due to which he suffered with acute pain, swelling and stiffness in right shoulder joint. Patient was unable to move right shoulder joint and to carry out daily activities. Patient took 7 days Panchakarma therapy in which Mukhabhyanga with Prasarni Taila and Mridu Swedana was done. It was followed by Prasarni Taila Nasya. After 7 days of treatment marked relief was seen in the symptoms like pain, stiffness and swelling. The therapies were found significantly effective and clinically safe with no adverse reaction were reported during the treatment period.

Keywords: Avabahuka, Adhesive capsulitis, Nasya, Swedana, Vata-Kapha Roga

Corresponding Author How to Cite this Article To Browse
Ruchi Juyal, Post Graduate Scholar, Dept of Panchakarma, Patanjali Bhartiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India.
Email: 		Juyal R, Mahajan K, Tiwari A, Kumar Agrawal A, Management of Avabahuka with Prasarni Taila Nasya and Sthanik Patra Pinda Swedana - A Case Study. J Ayu Int Med Sci. 2024;9(5):291-295.
Available From
https://jaims.in/jaims/article/view/3149

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-03-13 2024-03-23 2024-04-03 2024-04-13 2024-04-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 23.97

© 2024by Juyal R, Mahajan K, Tiwari A, Kumar Agrawal Aand 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].

J Ayu Int Med Sci 2024;9(5)291
Ruchi Juyal et al. Management of Avabahuka with Prasarni Taila Nasya

Introduction

Avabahuka a term coined by Acharya Sushruta is considered as Vata Vyadhi. It is a disease of Skandh Pradesh.[1] Aggravated Vata gets lodged at the root of shoulder joint, dry the Shleshmaka Kapha in and around the shoulder joint and constrict of vessels.[2]

Vata is most important because it is responsible for all type of sensation, motor actions and all neuromuscular activities. According to signs and symptoms it is correlated with frozen shoulder (Adhesive capsulitis) an insidious painful condition persistent for more than 3 months. This inflammatory condition causes fibrosis of the capsule causing progressive stiffness and significant restriction of range of movement. Risk factors included are cervical disk disease, diabetes, shoulder injury, shoulder surgery, thyroid etc. Shoulder pain is common complaint in both genders over the age of 40 and is most often due to degenerative disorder of tendons in the rotator cuff. In modern treatment anti-inflammatory drugs (NSAIDs) and steroidal injection at local site are suggested. Long term use of steroidal causes side effects.

We used Nasya Karma with Patra Pinda Swedana in Avabahuka. According to Ayurveda, Nasya is considered best procedure for the Urdh Jatru Gata Rogas. The nose is the door way to Siras (head),[3] medicine administration trough nasal route is known as Nasya. Medicine spread through channels and enhance sensory and motor organs which lie above clavicle and cures it. Nasya has potent effect on Shroto Shodhana (cleansing of micro channel) and to retard the Dhatukshaya (depletion of Dhatus).[4] Acharya Charak very clearly states that the Swedana Karma is the procedure which relief Stambh, Gaurav and Sheetata. Patra Pinda Swedana is based on the principle of Sankar Sweda which is one of the thirteen Sagni Sweda.[5]

Case Report

Name: XYZ

Age: 62 years

Gender: Male

Residence: Dastura, Bulandshaher, Uttar Pradesh

History of Present Illness

A 62 years old male patient came with an accidental history 3 months ago due to which he suffered with acute pain, swelling and stiffness in right shoulder joint. Patient was unable to move right shoulder joint and he was unable to carry out daily activities. He took medications but did not get much relief so he came to our hospital for his treatment.

History of Past Illness

An accidental history 3 months ago.

Family history

No other family member is having same complaint.

Personal history

Prakriti - Pitta-Kapha

Ahara - Pure vegetarian diet.

Appetite - Decreased

Dominance of Rasa - Lavana, Katu

Nidra - Disturbed due to pain in right shoulder region

Addiction - no addiction.

General Examination

Built: Moderate

BP: 130/90 mm of mg

Pulse: 72 per minute

Temperature: 98.4° Fahrenheit

Tongue: Clear

Pallor: Absent

Icterus: Absent

Cyanosis: Absent

Systemic examination

Respiratory System

Chest is clear

Bilateral symmetrical

No abnormal sound detected

Cardiovascular system

S1 and S2 heard normally


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Ruchi Juyal et al. Management of Avabahuka with Prasarni Taila Nasya

No added sound heard.

Gastrointestinal system

Shape - Scaphoid

Umbilicus placed centrally

Bowel sound - Regular

No organomegaly detected

Central nervous system

Well conscious

Well oriented with time, person and place

Reflexes are normal

Local examination

Swelling over shoulder joint is present, on palpation tenderness is present.

Examination of shoulder joint movement

1. Flexion: Normal/Restricted (45 Degree)/Absent

2. Extension: Normal/Restricted (50 Degree)/Absent

3. Adduction: Normal/Restricted/Absent

4. Abduction: Normal/Restricted (60 Degree)/Absent

5. External Rotation: Normal/Restricted/Absent

6. Internal Rotation: Normal/Restricted/Absent

Investigation

CBC

Hb - 12.8g/dl

TLC - 5790/cumm

Total RBC count - 4.50 millions/cumn

PCV - 38.8%

DLC

Neutrophil - 67

Lymphocyte - 24

Eosinophil - 02

Monocyte - 06

Basophil - 01

ESR - 9mm/fst hr.

RA-factor (quantitative) - 23.40 Iu/ml

CRP - 1.60 mg/dl

Serum Uric acid - 6.3mg/dl

RBS - 95.1 mg/dl

Ashtavidha Pariksha

SNSthanaLakshan
1.Nadi (Pulse)72 bpm
2.Mala (Stool)Vibandha
3.Mutra (Urine)Samyak
4.Jihva (Tongue)Nirama
5.Shabda (Speech)Prakrut
6.Druk (Eye)Ruksha, Khara
7.Sparsh (Touch)Prakrut
8.Akruti (Shape)Madhyam

Samprapti Ghatak

Dosha - Vata-Kapha, Pitta Sanshlisht Vata-Kapha

Dusya - Ras, Rakta, Mamsa, Asthi, Majja,

Updhatu - Sira, Snayu Marma.

Agni - Jatharagni and Respective Dhatwagni Ama–Jatharagni Mandyajanya ama and respective Dhatwagnijanya Ama

Agnidushti - Mandagni

Srotasa - Asthivaha, Majjavaha

Srotodushti Prakara - Sanga, Vimargamana

Udbhava - Amapakvashaya Sthana

Vyakta Sthana - Bahu Pradesh

Adhisthana - Amsa Pradesh

Swabhava - Chirkari

Treatment Plan

After the Samyak Pariksha of Roga and Rogi, it was found that his Jathragni was Manda, Therefore, instead of providing him only medicines, Nasya with Swedana Chikitsa for 7 days was planned for all round benefit.

SNSign and symptoms
1.Pain (as main feature of vitiated Vata) in shoulder regionPresent
2.Shoulder stiffnessPresent
3.Restriction in shoulder joint range of motionPresent
4.SwellingPresent

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Ruchi Juyal et al. Management of Avabahuka with Prasarni Taila Nasya

Assessment Criteria

1.Pain (as main feature of vitiated Vata) in shoulder region0-  Absent1-  mild2-  moderate3-  severe
2.Shoulder stiffness0-  Absent
1-  mild
2-  moderate
3-  severe
3.Restriction in shoulder joint range of motion0-  Absent
1-  mild
2-  moderate
3-  severe
4.Swelling1-  Slight
2-  Moderate
3-  Bulging beyond joint margins

Treatment Protocol

ProcedureMedicineQuantityDuration
Patra Pinda Swedana[6]Patras: Eranda, Arka, Chincha, Dhatura, Nirgundi Churna: Devdaru, Rasna, Kustha, Satpushpa, Haridra, grated Coconut, Nimbu, Prasarni TailaPatra: 50-75 gm each
Churnas: 5 gm each		7 days
NasyaPrasarni Taila[7]8 drops in each nostril7 days

Mode of Action of Nasya Karma[8]

According to Ayurveda Nasya Karma performs the functions of nourishing, liquefying and cutting. Mode of action of Nasya according to Ayurveda

Drug administered through each nostril

↓

Drug Sringatak Marma (By Nasa Srotas)

↓

Spread in the Murdha (enter in to the intra cranial circulation)

↓

Reaches at the junctional place of Netra (eyes), Srotra (ears), Kantha (Throat), Siramukhas (opening of the vessels)

↓

Remove and detach the morbid Doshas present in Urdh Jatru Gata (Supraclavicular region) and Expel them from the Uttamanga.

Signs and symptomsBTAT
Pain (as main feature of Vitiated Vata) in shoulder region31
Shoulder stiffness32
Restricted in shoulder joint range of motion31
Swelling32

After 7 days of treatment patient got relief in pain, stiffness and there was increase in range of movement of affected right shoulder joint.

Discussion

Nasya Karma is one among the Panchakarma. In the management of Urdhvajatrugata Vikaras Nasya has got an important role. Nasya is also known as the gateway of Siras. In Nasya Karma medicine administered through nose spread through the Siras and helps in the evacuation of accumulated Dosha, thereby pacifying the diseases. Nasya Karma is the main line of treatment for diseases above the clavicle and it is the only Shodhana Karma for Urdhwang (Ch. Si.9/88). Prasarni Taila was used for Nasya Karma along with Patra Pinda Swedana. Prasarni Taila is prepared by using Madhuk (Glycyrrhiza glabra), Pippalimoola (Piper longum), Chitraka (Plumbago zeylanica), Saindhav Lavana (Rock salt), Vacha (Acorus calamus), Prasarni (Paederia foetida), Devdaru (Cedrus deoadera), Rasna (Pluchea lanceolata), Gajapippli (Scindapsu officinails / Piper chaba), Bhallataka (Semecarpus anacardium), Purified Shatpushpa (Anethum sowa), Jatamanshi (Nardostachys jatamansi), Til oil (Sesamum indicum), curd, Kanjika (Fermanted gruel), cow milk. In Patra Pinda Swedana we used some Vata-Kaphanashak Patras and Churnas. Patras like Eranda, Dhatura, Chincha, Arka, Sahijan, Nirgundi and Churnas like Rasna, Devdaru, Kustha, Vacha, Satpushpa, Saindhav Lavana, grated coconut powder & lemon. Patra Pinda Swedana is a Snigdh Sankara Swedana which is very effective in diseases having involvement of Vata and Kapha Dosha. In Shleshmaka Kapha-Chhaya condition Patra Pinda Swedana has good result.

Conclusion

This case study demonstrated that Ayurvedic management of Nasya Karma along with Swedana Karma seems very effective for the treatment and management of Avabahuka (Frozen shoulder). This treatment is very effective and safe and treats the patient within short span of time. From the above case, it can be concluded that Aavbahuka/ frozen shoulder can be successfully managed through Nasya with Patra Potali Swedana as Shodhana and external therapy.


J Ayu Int Med Sci 2024;9(5)294
Ruchi Juyal et al. Management of Avabahuka with Prasarni Taila Nasya

References

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2. Vagabhatta: Ashtanga Hridayam, edited by dr. Brahmanand Tripathi, hindi commentary. New Delhi India:Chaukhambha publications: vol-2 2017; Nidhana Sthana 15/43:140.

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