E-ISSN:2456-3110

Research Article

Management of Avabahuka

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 3 March
Publisherwww.maharshicharaka.in

Evaluation of the effect of Bala Tailam Nasya and Baladi Kwatha Pana in the management of Avabahuka - A Pilot Study

Singh Songara T1*, Dash B2
DOI:10.21760/jaims.9.3.3

1* Tarendra Singh Songara, Post Graduate Scholar, Department of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.

2 Babita Dash, Lecturer, Department of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.

Avabahuka is a disease mainly affects the Amsa Sandhi (shoulder joint) which is painful, affecting the normal routine life style of an individual. The sedentary and restless lifestyles of people, and lack of priority to physical exercise, have an effect on the body that can cause disease. The main Dosha involved Avabahuka is Vatadosha and the treatment adopted for this are like Snayu-Sandhi-Asthi-Gata-Vata treatment. In Frozen Shoulder synovial inflammation occurs followed by capsular fibrosis. The shoulder joint becomes gradually painful and stiff with a reduction in range of motion. The current pilot study aim is to investigate the impact of Nasya with Baladi Taila and Baladi Kwath in Avabahuka. There are references for Nasya Karma in Avabahuka. Acharya Sushruta and others have considered it as Vataja Vikara. Amsa Shosha can be considered a pre-disease stage in which loss or dryness of the Shleshaka Kapha is found, as well as other symptoms like Shula during movement of shoulder joint.

Keywords: Nasya, Baladi Taila, Baladi Kwath, Avabahuka, Frozen Shoulder

Corresponding Author How to Cite this Article To Browse
Tarendra Singh Songara, Post Graduate Scholar, Department of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College Institute, Bhopal, Madhya Pradesh, India.
Email: 		Singh Songara T, Dash B, Evaluation of the effect of Bala Tailam Nasya and Baladi Kwatha Pana in the management of Avabahuka - A Pilot Study. J Ayu Int Med Sci. 2024;9(3):14-21.
Available From
https://jaims.in/jaims/article/view/3166

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-01-12 2024-01-22 2024-02-02 2024-02-10 2024-02-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 21.78

© 2024by Singh Songara T, Dash Band 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(3)14
Tarendra Singh Songara et al. Effect of Bala Tailam Nasya in Avabahuka

Introduction

Vata is considered to be the most important component in the maintenance of body physiological function. The Vatavyadhi is caused by the vitiation of Vata Dosha Vikrita Vata Janita Asadharana Vyadhi Vata Vyadhi. Vatavyadhi is considered as one of the Ashta Mahagada,[1] makes the consequences generated by Avabahuka self-explanatory. Avabahuka is Vatajvikara, but it is not included in the Vata-Naanatmaja Vyadhi by Acharya Charaka[2,3] (disease caused only by vitiated Vata).[4] According to Sushruta[5] and Vagbhatta,[6] Avabahuka is a Vatavyadhi (illness caused by Vata Dosha vitiation). Madhavkar describes the Avabahuka in Vatavyadhi chapter of Madhav-Nidan.

Avabahuka is consists of two words Ava and Bahu. Ava means Viyoga, Vikratau, which means dysfunction or separation and Bahu refers to upper limb that is one among the Shadanga.

The common features of Avabahuka are Sira-Sankocha at Ansha-Sandhi, loss of functional activity of arm (Baahu- Praspandithar), atrophy of arm (Bahu- Shosha) (Anshamool Sthitovaayu Sira-Sankochyatatragaah, Baahupraspanditharam Janyatayavabaahukam), Karmakshaya of Bahu (arm).

Various Etiological factors such as Ruksha, Laghu, etc., as well as Atibharavahana, produce Vata vitiation directly. In another approach, Kapha Prakopaka Nidanas such as Atisnigdha, Atiguru Dravya, etc. augment the Vikruta Kapha, resulting in the Kaphavritavata condition. The Vikruta Vata Dosha accumulates in the bio channels (Srotas) in both ways and exhibits symptoms. Sthana Samsraya Avastha of Vyadhi occurs with the localization of aggravated Vata in the specific Dhatu, that is, Dosha Dushya Sammurachana, which occurs in the specific organ.

Avabahuka appears owing to a depletion of tissue elements (Dhatu Kshaya) as well as Samsrushta Dosha. Amsa Shosha can be thought of as the preclinical stage in which the Shleshaka Kapha is loss or dry from the shoulder joint. Because of which, symptoms such as Shoola during the movement of the joint, restricted movement of joint and other manifestations occur.

With modern co relation and explanation Shoulder

pain is estimated to affect 16-26% of the population. It is the third most common reason for primary care musculoskeletal consultation. Prevalence of frozen shoulder is 3-5% in general population.[7] Females are more affected than male.[8] The incidence of frozen shoulder is 2-4 times higher in diabetes then in the general population.[9]

Commonly Analgesics, corticosteroids, and anti-inflammatory medications are used for frozen shoulder patients. This method may provide a temporary cure but not long-term pain relief. Given the above frequency and incidence rates, a treatment with a low cost and few adverse effects is necessary.

Ayurvedic treatment modality for Avabahuka includes Nasya Karma, Snehapana, Sneha intake after meal, and local Abhyana-Swedana (oleation - sudation) is indicated.[10]

The primary goal of Panchakarma therapy is to cleanse the body of accumulated toxins and impurities with the help of Shodhana therapy, while also nourishing the tissues. Nasya Karma is the preferred treatment in Urdhwa Jatrugata Vyadhis,[11] and it is also advised in the treatment of Avabahuka. Nasya aids in the development of strength of shoulder muscle.

Baladi Taila[12] which is described in Chakradatta for Avabahuka contains drugs having Vata-Kaphara properties and Baladi Kwath[13] (containing Choorna of Parijata Patra, Baalamoola Churna and Kraunch Beej Churna) is given.

Aim and Objective

To study the effect of Baladi Taila Nasya and Baladi Kwatha in Avabahuka.

Materials and Methods

Data Source - 10 Patients of either sex diagnosed with Avabahuka from the OPD/ IPD of Pandit Khushilal Sharma Ayurveda Hospital, Bhopal were selected for the study.

Criteria for the Selection of the Patients

The patients presenting with the signs and symptoms of Avabahuka according to Ayurvedic and modern texts were selected from the OPD of Panchakarma of Pt. Khushilal Sharma Ayurvedic College and Institute for the study.


J Ayu Int Med Sci 2024;9(3)15
Tarendra Singh Songara et al. Effect of Bala Tailam Nasya in Avabahuka

Study Design

The present study is a pilot clinical study conducted in the department of Panchakarma of Pt. Khushilal Sharma Govt. Ayurvedic College and Institute Bhopal.

Study Duration - 21 Days

Inclusion Criteria

1. Avabahuka diagnosed according to the classical signs and symptoms described in Ayurveda.

2. Patients of both sexes within the age group of 20 - 60 years.

Exclusion Criteria

1. Systemic diseases presented with Avabahuka as a complication

2. Patients with a history of fracture of the affected hand

3. Pregnancy and lactating women are excluded.

Criteria for assessment

The patients' improvements were evaluated based on the relief signs and symptoms. To assess the drug's efficacy, the ranges of motion were assessed using a Goniometer Scale.

Objective Parameter[14]

Range of motion of shoulder jointNormal Range (in degrees)
Flexion180
Extension60
Abduction180
Adduction45
Lateral Rotation90
Medial Rotation90

Subjective Parameters[15]

1. Bahupraspandita Hara

SNSymptomScore
1.Can do work without being affected0
2.Can do strenuous work with difficulty1
3.Can do daily routine work with great difficulty2
4.Cannot do any work3

2. Shula

SNSymptomScore
1.No pain in moving hand0
2.Mild pain, can do strenuous work with difficulty1
3.Moderate pain, can do normal work with support2
4.Severe pain, unable to do any work with hand3

3. Atopa

SNSymptomScore
1.No Atopa0
2.Palpable Atopa with sound1
3.Audible from a little distance2
4.Audible and palpable3

4. Amsha Shosha

SNSymptomScore
1.No wasting0
2.Mild wasting, can do work1
3.Moderate wasting, works with difficulty2
4.Severe wasting, cannot move affected region3

5. Stambha (stiffness)

SNSymptomScore
1.No stiffness0
2.Mild, has difficulty in moving the joints without support1
3.Moderate, has difficulty in moving, can lift only with support2
4.Severe, unable to lift3

Criteria for assessment of the overall therapy

Complete relief

Complete relief in the complaints of patients, along with elevation of shoulder joint up to 180° and flexion and abduction of the joint up to 90°.

Marked improvement

More than 75% relief in the complaints as well as significant improvement in the elevation of joint up to 135°, and flexion and abduction up to 60°.

Moderate improvement

More than 50% relief in the complaints along with improvements in elevation of joint up to 90° and flexion and abduction of joints up to 30°.

Mild Improvement

Twenty-five to fifty percent reliefs in the complaints of the patient.

Oral Medicine

Kashayam made of Bala (Sida cordifolia) 1 part, Parijata (Nyctanthes arbortristis) 1 part and Kapikachhu (Mucuna pruriens) 1 part, 40 ml twice a day empty stomach.

SNDrugBotanical namePart usedUsed FormQuantity
1.BalaSida cordifoliaMoolaChurna1 part
2.ParijataNyctanthes arbortristisPatra1 part
3KapikachhuMucuna PruriensBeeja (Seed)Churna1 part

J Ayu Int Med Sci 2024;9(3)16
Tarendra Singh Songara et al. Effect of Bala Tailam Nasya in Avabahuka

Treatment Regimen

Nasya oil: Bala Taila

SNDrugBotanical nameQuantity
1.BalaSida cordifolia4.8 kg
2.ChinnaruhaTinospora cordifolia1.2 kg
3.RasnaPluchea lanceolata600 g
4.Water-12.0 liters, boiled and reduced to 3.072 liters
5.MastuSupernatant liquid of curds3.072 liters
6.IkshurasaSaccharum officinarum3.072 liters
7Taila3.072 liters
8.AjaksheeraGoat milk1.563 litres
9.DaruCedrus deodara48 gm
10.ElaElettaria cardamomum48 gm
11.SaralaPinus roxburghii48 gm
12.ManjishtaRubia cordifolia48 gm
13.AgaruAquilaria agallocha48 gm
14.ChandanaSantalum album48 gm
15.PadmakaPrunus puddum48 gm
16.AtibalaAbutilon indicum48 gm
17.MustaCyperus rotundus48 gm
18.MudgaparniPhaseolus trilbbus48 gm
19.MashaparniTeramnus labialis48 gm
20.HarenuVitex negundo48 gm
21.YashtiGlycyrrhiza glabr48 gm
22.SurasaOcimum sanctum48 gm
23.VyaghranakhaCapparis zeylanica48 gm
24.RishabhakaManilkara hexandra48 gm
25.JivakaMalaxis acuminata48 gm
26.PalashaButea monosperma48 gm
27.KasturiMusk48 gm
28.NeelikaIndigofera tinctorea48 gm
29.JatiMyristica fragrans48 gm
30.SprikkaDelphinium zalil48 gm
31.KumkumaCrocus sativus48 gm
32.ShaileyaParmelia perlata48 gm
33.KatphalaMyrica nagi48 gm
34.AmbuPavonia odorata48 gm
35.TwakCinnamomum zeylanicum48 gm
36.KunduruBoswellia serratar48 gm
37.KarpooraCinnamomum camphora48 gm
38.TurushkaHyoscyamus niger48 gm
39.ShrinivasakaPinus roxburghi48 gm
40.LavangaSyzigium aromaticum48 gm
41.NakhaCapparis zeylanica48 gm
42.KankolaPiper cubeba48 gm
43.KushtaSaussurea lappa48 gm
44.MamsiNardostachys jatamansi48 gm
45.PriyanguCallicarpa macrophylla48 gm
46.SthauneyaClerodendrum infortunatum48 gm
47.TagaraValeriana wallichi48 gm
49.DhyamaAnogeissus latifolia48 gm
50.VachaAcorus calamus48 gm
51.MadanakaRandia spinosa48 gm
52.PlavaCyperus bulbosus48 gm
53.NagakesharaMesua ferrea48 gm

Method of Nasya Karma[16]

Nasya Karma can be explained in the following three headings as mentioned in the classics.

Poorva Karma

1. Collection of necessary facility - It includes points such as Oushadhi Sangraha, Nasya Yantra, Atura Vaya, Kala, Atura Siddhata.

2. Preparing the patient - The patient was told not to resist natural urges. He should be empty stomach before performing the Nasya Karma After that, the patient is moved to a pleasant room that is free of dust, strong breezes, and direct sunshine.

3. Performing Abhyanga & Swedana - The patient is positioned on the table in the Supine Position for the Stanika Abhyanga/Snehana. The therapist stands at the head end of the table, facing the foot, to perform Abhyanga and Swedana. The patient's face and neck are anointed with lukewarm oil, and then the face and anterior neck are massaged. Linear Thumb movements are used to massage the forehead, brows, nose, chin, and maxillary area. The cheek and temporal region are massaged using circular palm movements in both clockwise and anticlockwise directions. The flat of the palms is moved from the base of the neck to the Mandible to massage the anterior of the neck.

For the purpose of Sthanika Swedana, Nadi Sweda was done with hot water containing Patra of Eranda, Vasa, Nirgundi and Dashamula. Sweda is performed over the parts of the body above the shoulder, excluding the patient's eyes. The aim for doing Abhyanga & Swedana is for to move Doshas from Shakha to the Koshtha.

Pradhana Karma

1. Positioning the Patient: the patient is asked to be in supine position with the head in little lower position. The table used for Nasya Karma have facility for lowering the head portion.

2. Administering the Medicine: while standing at the head end of table the tip of the nose is elevated with left Thumb and then allows to drop 8-8 drops of lukewarm Baladi Tailam from Dropper in an uninterrupted manner called ‘Avicchinna Dhara’ into each Nostrils one after the other. After dropping the Oil into one Nostril, the Patient is asked to take deep inhalation so that the medicine reaches deep inside the Nose. The other nostril must be closed during administration of the medicine in one nostril.


J Ayu Int Med Sci 2024;9(3)17
Tarendra Singh Songara et al. Effect of Bala Tailam Nasya in Avabahuka

Pashchata Karma

After administration of the medicine, the patient is strictly asked not to swallow the medicine, but to spit it out. Then the patient is allowed to relax in the same posture for 100 Matra Kalas, without going to sleep. The Patient is asked to spat out the medicine that reaches the throat. Swedana is repeated on the face after Nasya. Gentle massage on forehead, palms and soles of the Patient, then he asked to take rest in for several minutes. Then he allowed wash mouth and face with hot water.

Statistical Analysis

For assessing the improvement of symptomatic relief and to analyze it statistically, the observations were recorded before and after treatment. The mean, mean difference, SD, SE and Wilcoxon sign rank test were calculated from the observations recorded.

Result

SymptomsMeanMDWilcoxon sign rankSDSEP valueResult
BTAT
Bahupraspandita Hara2.11.11450.56760.17950.0039Very Significant
Shula2.211.2450.63250.20000.0039Very Significant
Atopa1.51.10.4100.51640.16330.1250Not Significant
Amsa Shosha21.30.7210.67490.21340.0313Significant
Stambha2.111.1450.56760.17950.0039Very Significant

Objective Parameter

Range of motion of shoulder jointNormal Range (in degrees)BT (Mean)AT (Mean)
Flexion180110140
Extension602030
Abduction180100135
Adduction451530
Lateral Rotation904055
Medial Rotation905060

Overall assessment of the intervention

SNOverall assessmentPercentage reliefNo. of patientsPercentage
1.Complete relief100%0000
2.Marked improvement>75%0220%
3.Moderate improvement>50%0550%
4.Mildly improved>25%0330%
5.No improvement00%0000%

The drug Baladi Taila Nasya and Baladi Kwath had a moderately significant effect (P < 0.01) on the symptom Bahupraspandita Hara (53.33%) and (P < 0.05) on Shula (26.66%). the therapy showed 10 % relief On Atopa, 20% relief on Amsa Shosha, and 30% relief on Stambha.

Discussion

Avabahuka- Vata is aggravated by either Avarana or Dhatu Kshaya. Snehan, a kind of Brihmana Nasya Karma is particularly beneficial in the disease Avabahuka due to Dhatu Kshaya.

Absorption of the medicaments in Nasya mainly occurs via three pathways: Vascular, neural and lymphatic. The instilled medicine moves up the channels to the Shringaataka, spreads all over the head, channels of eyes, ears, and throat there by removing Doshas. Thus cures the diseases affecting the Urdhva Jatru.[17] According to the commentator Indu, the Shringatakamarma's precise Sthana is "Shiraso Antarmadhya Murdha," which might be considered for the middle cranial fossa. The expulsion of morbid Doshas from supraclavicular parts by Nasya administration is also explained using the example of Munja and Ishika, where the drug administered as Nasya enters the head and expels morbid Doshas as Ishika is removed after removing the fibrous coating of Munja adhered to it.[18]

Sthanika Abhyanga and Swedan improve medication absorption increasing blood circulation. As the efferent vasodilator nerves expand to the face's superficial surface, they are stimulated by fomentation, which may enhance blood flow to the brain and hence increase the potency of the Bala Tail in the Nasya process.

The drugs used for the Brihana Nasya are haves the Guna like Snigdha, Sukshama, Sara, Ushna etc. Which are antagonstic to Gunas of Vata and thus palliates the Vata Dosha. The Bala oil Nasya that is selected for the study mainly contains drugs having Vatahara, Shula Prashamana, Shothahara, Brimhana and Balya actions and widely indicated for the purpose of Vata Vikaras.

  • Bala oil contains medicines like Bala (Sida Cordifolia), Chhinaruha (Tinosporia cordifolia), Rasna (Pluchea Lanceolata) Vacha (Acorus Calamus).
  • Bala serves the function of

J Ayu Int Med Sci 2024;9(3)18
Tarendra Singh Songara et al. Effect of Bala Tailam Nasya in Avabahuka
  • supplying adequate energy to the muscular tissue. In Baladi Taila as well, it has effective supporting qualities such as Madhura Rasa and Madhura Vipaka in showing the Vata Hara

Chinnaruha (Tinospora cordifolia) contains alkaloids, glycosides, flavonoids, steroids and terpenoids in the aerial part of the plant. So, the observed analgesic activity may be attributed to any of these phytoconstituents. There are also reports of analgesic activity of flavonoid which is mediated by inhibiting the production of prostaglandins

Rasna is considered as ‘Vata-Samanam’ (diseases involving nervous system) ‘Rasayana’ (herb for rejuvenation). It has antipyretic, analgesic effect. Rasna is used to prevent the swellings of joint in arthritis, rheumatism and neurological diseases. The roots are antipyretic, bitter, laxative and thermogenic and are used for allaying the pain. Plant extract is used as a cooling agent in summer.[19,20] Tila Taila: It is the main base ingredient for the other drugs because it is Yogavahi and carries all essential ingredients into the system by virtue of its Sukshama and Ashukari Guna.

  • The decoction Baladi Kwatha contains three ingredients - Bala, Parijata and Kapikachhu that mainly helps in relieving the pain and increases the strength of the shoulder joint.

Kapikachu (Mucuna pruriens): Kapikachhu is a Vatahara Dravya having its own effective activity and attributes like Snigdh, Madhura, and Ushna. Kapikachhu seeds contains high amount of protein, thus it is used internally as, which tones the muscle and functions as a nervine tonic, which is the most crucial necessity in Avabahuka.

Parijat (Nyctanthes arbortristis) is a natural vasodilator, it is also used to treat painful muscle spasms, sore muscles etc.

Overall Baladi Kwath is effective in reducing pain by alleviating the Vata and improving movements of the affected shoulder joint in Avabahuka (frozen shoulder).

Conclusion

A clinical trial with Baladi Taila Nasya and Baladi Kwath orally has shown encouraging results in the improvement in the symptoms of Avabahuka. Not many complications were observed in the patients at the end of the study. So, this treatment protocol

can be a good option for the management of Avabahuka (Frozen Shoulder).

In the current study, as it was a pilot study, the sample was very small and the follow-up period was short, it may be difficult to arrive at a conclusion about the effectiveness and safety of the treatment, a clinical trial with a big sample size and a long follow-up period will be needed.

References

1. Charaka Samhita. Ayurveda Deepika commentary by Chakrapani datta. In: Yadav T, editor. Indriya sthana, 11/8-9. Fourth Edition. Varanasi: Chaukhamba Orientalia; 1994. pp. 8–9.

2. Shastri Pandit Kashinath, Chaturvedi Gorakhanatha Charaka Samhita of Agnivesh, edited with vidyotini hindi commentary, Chaukhambha Bharati Academy; part-1; Sutra Sthana 1992; 20/11:399.

3. Tripathi Bramhanand. Charaka Samhita of Agnivesh, edited with Charaka Chandrika hindi commentary, Chaukhambha Surbharati Prakashan; part-2; Chikitsa Sthana. 1998;28/98:956

4. Shastri Pandit Kashinatha and Chaturvedi Gorakhanatha, Charaka Samhita of Agnivesh, edited with vidyotini hindi commentary, Chaukhambha Bharati Academy; part-1; 1992; Sutra Sthana 20/11:399.

5. Sushrut: Sushruta Samhita, edited with Ayurvedatatvasandeepika Hindi commentary by Shastri Kaviraj Ambika Dutta. Varanasi India: Chaukhambha Sanskrit Sansthan; part-1; 2014; NidanSthana 1/82:304

6. Kanjiv Lochan, Vagbhata: Astanga Hridaya English commentary; Chaukhambha Publications; vol-2; 2017; Nidhanasthana 15/43:140

7. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med. 2008. 1007 PMID: 19468904 DOI: /s12178-008-9031-6;1:180–189.

8. Chokkalingam M, Saradha S, Navitha A. Incidence and clinical profile of patients with a frozen shoulder after cardiac surgery y. J Clin Prevent Cardiol 2017; 6(4):142.

9. Prevalence and determinants of frozen shoulder in patients with diabetes: a single center experience from Pakistan. Cureus. 2017. 9(8):1544.


J Ayu Int Med Sci 2024;9(3)19
Tarendra Singh Songara et al. Effect of Bala Tailam Nasya in Avabahuka

10. Nirmal, et al. Management of Avabahuka (Frozen Shoulder) with Abhyanga Swedana, Pratimarsha Nasya and Ayurveda Medicines: A Case Study, World Journal of Pharmaceutical Research. 2017;6(8):2099-2103. ISSN 2277–7105.

11. Anna Moreshwar Kunte and Krishna Ramachandra Shastri Navre, Asthanga Hridaya, Varanasi; Chaukhambha Surabharati Prakashan; 2004; p. 287

12. Kaviraj Atridev Gupt, Vagbhata: Astanga Hridaya vidyotini Hindi commentary; Chaukhambha Publications; vol-1; 2017; Chikitsasthana 21/73-81:pg. 422

13. Indra Dev Tripathi; Chakradatta; chakradatta Samhita; Savimarsha Vaidyaprabha Hindi commentary; edited by Acharya Ramnath Dwivedi; Chaukhambha Publications; vol-1; Chikitsaprakarana verse26:pg. 135

14. Carolyn K. (2013) Therapeutic Exercise –foundations and techniques, New Delhi: Jaypee Brothers Medical Publishers.

15. Patil P. (2014, May 2) Effect of Masha-Saindhava Taila in Avabahuka (IJAM).

16. https://www.researchgate.net/publication/319851664_Effects_of_Kumkum_Nasya_Crocus_sativus_L_formulation_on_BhruShankha_Pradesh_Shula_Temporal_Headache_Suryawarta_Roga_Myasthenia_Gravis_Ardhawbhedaka_Roga_Migraine_Headache.

17. Ashtanga Sangraha, Sasilekha commentary, Sutra sthana, 29th chapter, Govt of Kerala, (Govt. Ayurveda college, Thiruvananthapuram) 1982:399.

18. Ashtanga Sangraha, Sasilekha commentary, Sutra sthana, 29th chapter, Govt of Kerala, (Govt. Ayurveda college, Thiruvananthapuram) 1982:403.

19. Charkapani tika on Charaka Samhita, Chaukhambha Bharati Academy, Varanasi, Reprint 2005: 102.


J Ayu Int Med Sci 2024;9(3)20