A Comparative Clinical Study of Patra Pinda Swedana and Parisheka in Avabahuka

Ruchi Juyal; Ketan Mahajan; Atul Kumar Agrawal

doi:10.21760/jaims.9.7.5

E-ISSN:2456-3110

Research Article

Avabahuka

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY

Publisher

www.maharshicharaka.in

A Comparative Clinical Study of Patra Pinda Swedana and Parisheka in Avabahuka

Juyal R^1*, Mahajan K², Agrawal AK³

DOI:10.21760/jaims.9.7.5

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

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

³ Atul Kumar Agrawal, Assistant Professor, Department of Panchakarma, Patanjali Bhartiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India.

Introduction: Avabahuka is a Vata Vyadhi caused by vitiated Vata- Kapha Doshas. Vata causes wasting of Amsa Bandhana and Siraakunchana (constriction of vessels) and hampers the movement of Amsa Sandhi. Avabahuka causes problem in daily routine of an individual like wearing clothes, eating, personal hygiene etc. Avabahuka can be correlated with the symptoms of Adhesive capsulitis also known as Frozen Shoulder. It causes painful restriction, with significant loss of range of motion of the shoulder joint. As there is no promising and satisfactory treatment available in modern system of medicine. Panchakarma provides effective treatment through Shodhana therapy. Acharya Charaka has recommended Snehana- Swedana for the treatment of Vata- Kaphaj disorder.

Methods: 40 patients of Avabahuka, were randomly divided into two groups, Group A received Sthanik Abhyanga with Sthanik Patra Pinda Swedana and Group B Sthanik Abhyanga with Sthanik Parisheka for 7 days. With help of assessment tools and gradation of symptoms, the findings of research work were statistically analysed.

Results: Results of this study shows that both the study group were effective in reliving the symptoms of Avabahuka, Sthanik Patra Pinda Swedana was found statistically significant in comparison with, Sthanik Parisheka.

Discussion: Two group of Swedana Karma, showed recovery from the symptoms of Avabahuka efficiently. This study shows that, Patra Pinda Swedana provide better result in comparison with Sthanik Parisheka. Hence it can be said that Patra Pinda Swedana has its own effect also in relieving Avabahuka.

Keywords: Avabahuka, Pinda Sweda, Parisheka, Vata Vyadhi, Frozen Shoulder

Corresponding Author	How to Cite this Article	To Browse
Ruchi Juyal, Post Graduate Scholar, Department of Panchakarma, Patanjali Bhartiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India. Email:	Juyal R, Mahajan K, Agrawal AK, A Comparative Clinical Study of Patra Pinda Swedana and Parisheka in Avabahuka. J Ayu Int Med Sci. 2024;9(7):36-47. Available From https://jaims.in/jaims/article/view/3594

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2024-05-13	2024-05-23	2024-06-03	2024-06-13	2024-06-21
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
None	Nil	Yes	13.34

© 2024by Juyal R, Mahajan K, Agrawal AKand 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(7)36

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Objectives Materials and
Methods Observations and
Results Discussion Conclusion References

Ruchi J et al. A Comparative Clinical Study of Patra Pinda Swedana

Introduction

The main goal of Panchakarma therapy is to nourish the tissues and get rid of accumulated toxins of the body. It helps in rejuvenating the tissues and stopping the aging process becomes quite simple. Swedana Karma increases the permeability of capillary and bringing the morbidities into an extracellular fluid by dilating and clearing the channels of the body. This keeps the person healthy in old age and allows them to use their experience to benefit society without suffering from physical or mental degeneration.

Among the Panchakarma, Snehana-Swedana Karma is a crucial Chikitsa for Vata-Kaphaj Roga. The shoulders, neck, face, and chest become well-maintained by Swedana. Thus, Swedana contributes to the shoulder muscles and improve the circulation of this area.Within the category of illnesses, Vata Vyadhies have been considered significant by our Acharyas. These Vata Vyadhis have been listed under the Ashta Mahagadas.^[1]

Avabahuka is also known as Vataja Nanatmaja Vyadhi. Avabahuka, a term coined by Acharya Sushruta is a disease of Skandha/Amsa Sandhi (shoulder joint). Human body has six parts (Shadanga) and Shakha (upper limb and lower limb) is one among them where as Skandha is the root of Shakha.^[2]

Acharya Charaka described Baahushosha (Avabahuka) under eighty type of Vatavyadhi. Acharya Sushruta considered “Avabahuka” as Vatavyadhi. He described cause of Avabahuka is “Amsadeshasthitovayu Shoshayitvam Amsabandhanam, which means aggravated Vata Dosha cause “Shosha of Amsabandhan” in and around the shoulder, Shiracha Aakunchaya which means constriction of vessels.^[3]

Ashtanga Sangraha^[4]and Ashtanga Hridayam^[5] described Avabahuka as “Amsamulasthitovayu Sira Sankochaya” which means the condition where aggravated Vata gets lodged at the root of shoulder joint and cause vasoconstriction.

In Madhukosh Teeka of Madhav Nidana it is described as Vata- Kapha Pradhan Vyadhi and two conditions of disease has been mentioned Amsashosha and Avabahuka.^[6]

Amsa Sosha might be thought of as the initial stage of the sickness where Sleshaka Kapha at Amsa Sandhi is lost or becomes dry while during the Avabahuka stage, symptoms such as restricted motions and Shoola during movement arise from the loss of Shleshaka Kapha.

In Charaka Samhita Sutra Sthana and Chikitsa Sthana Bahushosha and Bahugata Vata respectively has been mentioned.^[7]

In Chakradutta Bahushosha and Avabahuka has been mentioned in Vatavyadhi Chikitsa Some experts claim that it is a Vata Kapha Pradhana Vyadhi.^[8]

In modern aspect the term “Frozen shoulder” was first introduced by CODMAN in 1934.^[9]

He described a painful shoulder condition of insidious onset that was associated with stiffness and difficulty in sleeping on the affected side. Frozen shoulder is a common disability but self-limiting condition and occurs when the connective tissue enclosing the joint becomes thickened and tight. It is also known as Adhesive capsulitis (inflammation of the capsule tissue surrounding the shoulder joint causing pain and restricted movement).^[10]

Typically, there are three phases in frozen shoulder progression freezing, frozen and thawing. The prevalence of frozen shoulder is 2-5% in the general population of India. The association is 2-4 times higher in patients with diabetes mainly in the age group of 35-65 but the issue can occur in the younger people who bare and get involved in overhead motions in their sports activities like tennis, basketball and volley ball other predisposing factors include rheumatic disease (gout, rheumatoid arthritis) progression recent shoulder surgery, thyroid disorders etc.

Acharya Charaka very clearly states that the Swedana Karma is the procedure which relieves, Stambha (stiffness), Gourava and Sheetata).^[11] He mentioned the Snehana and Swedana as the line of treatment for the Vata disorders. Patra Pottali Pinda Sweda (Ela Kizhi) refers to induction of perspiration by using heated Pottali (bolus) of specific herbal leaves. It falls into the category of Snigdha Sweda.It is also called Sanker Sweda comes under thirteen Sagni Sweda.^[12]

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Ruchi J et al. A Comparative Clinical Study of Patra Pinda Swedana

Parisheka is a type of Swedana. It comes under the category of Drava Swedana.^[13] It is unique procedure of pouring warm Kwatha, medicated oil, Dhanyamala, milk or medicated ghee on the body.

Aim and Objectives

1. To evaluate the effect of Sthanik Patra Pinda Swedana in Avabahuka (Frozen shoulder).
2. To evaluate the effect of Sthanik Parisheka in Avabahuka (Frozen shoulder).
3. To compare the effect of Sthanik Patra Pinda Swedana and Sthanik Parisheka in Avabahuka (Frozen shoulder).

Materials and Methods

Selection of patient

Patients with classical features of Avabahuka were selected randomly from OPD and IPD of Patanjali Ayurvedic Hospital, Haridwar. It is a clinical study with pre and post–test design where in a minimum of 40 patients suffering from Avabahuka were selected irrespective of their gender, caste, creed or occupation. Patients were divided randomly into two groups each comprising of 20 patient’s each on the basis of inclusion and exclusion criteria with detailed history and physical examination and other necessary investigations.

Method of data collection

1. Patients who were fulfilling the criteria for diagnosis and inclusion were included.
2. A clinical study of patients attending the OPD was made and patients fulfilling the criteria of diagnosis as per the patient case format were selected for the study.
3. Clinical evaluation of patients was done by collection of data through information obtained by history, physical examinations and routine blood investigations.
4. Review of literature was conducted from books, Authentic Research Journals, Websites and Digital Publications etc.

Inclusion Criteria

1. Age 18 - 70 years, either sex.
2. Patient fit for Patra Pinda Swedana and Parisheka.
3. Patient with classical features of Avabahuka.

4. Subjects with chronicity of disease pertaining from 3 months to 3 years
5. Patient with radiological findings of Frozen Shoulder.
6. Post traumatic shoulder injuries.
7. Shoulder joint arthritis.

Exclusion Criteria

1. Age less than 18 and more than 70 years, either sex.
2. Patient who are unfit for Patra Pinda Swedana and Parisheka.

3. Auto immune disorder like SLE, RA etc.
4. Respiratory disorders like bronchial asthma, Allergic bronchitis etc.
5. Uncontrolled metabolic disorders like Diabetes mellitus.
6. Pregnant and lactating mothers.
7. Critical illness like cardiac disease, carcinoma, tuberculosis, HIV, neurologica

Assessment Criteria

Improvement of signs and symptoms was assessed with suitable scorings. Assessment was done on subjective and objective parameters of Avabahuka and scoring was done before and after treatment.

Subjective Parameters

1. Sandhi Shoola (joint pain).
2. Sandhi Shosha (wasting of muscles).
3. Sandhi Graha (stiffness of joint).

Objective Parameters

1. Localized swelling on palpitation,
2. Tenderness
3. Movement restricted.

Grading of Amsa Shool (Shoulder Joint Pain)

Scale		Score
No Pain	Pain Free	0
Minor Pain	Very Mild	1
	Discomforting	2
	Tolerable	3
Moderate Pain	Distressing	4
	Very Distressing	5
	Intense	6
Severe Pain	Very Intense	7
	Utteribile Horrible	8
	Excruciating Unbearable	9
	Unimaginable, Unspakable	10

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Ruchi J et al. A Comparative Clinical Study of Patra Pinda Swedana

Grading of Amsa Sandhi Graha (Shoulder Joint Stiffness)

Scale	Score
No stiffness	0
Mild Stiffness and difficulty in moving the joints without support	1
Moderate Stiffness and difficulty in moving the joints with support	2
Stiffness relieved by medication	3
Severe Stiffness and unable to move the joints	4

Grading of Radiating Pain

Scale	Score
No radiation of pain	0
Pain at shoulder joint	1
Pain radiates upto elbow joint	2
Pain radiates upto forearm	3
Pain radiates upto hand and fingers	4

Grading of restricted movement of shoulder joint

Scale	Score
Can do work unaffectedly	0
Can do strenuous work with difficulty	1
Can do daily work with great difficulty	2
Can do any work	3

Grading of Amsa Shotha (shoulder joint swelling)

Scale	Score
No swelling	0
Slight	1
Moderate	2
Bulging beyond joint margins	3

Grading of restricted movement of shoulder joint using goniometer study

Flexion	Score
160-180 degree	0
120-159 degree	1
80-119 degree	2
40-79 degree	3
0-39 degree	4

Adduction	Score
40-50 degree	0
30-39 degree	1
20-29 degree	2
10-19 degree	3
0-9 degree	4

Abduction	Score
160-180 degree	0
120-159 degree	1
80-119 degree	2
40-79 degree	3
0- 39 degree	4

Extension	Score
40-50 degree	0
30-39 degree	1
20-29 degree	2
10-19degree	3
0- 9degree	4

External Rotation	Score
70-90 degree	0
50-69 degree	1
30-49 degree	2
0-29 degree	3

Internal Rotation	Score
70-90 degree	0
50-69 degree	1
30-49 degree	2
0-29 degree	3

Research Design

Selected 40 patients of Avabahuka (Frozen shoulder) were randomly divided into two groups as, Group A and Group B.

Group A: Sthanik Abhyanga followed by Sthanik Patra Pinda Swedana

Each patient in this group was subjected to, Sthanik Abhyanga with Mahamasha Taila followed by Sthanik Patra Pinda Swedana.

Timing: 30 -40 min.

Duration: Up to 7 days

Matra: 2 Pottali

Group B - Sthanik Abhyanga followed by Sthanik Parisheka with Dashmoolaadi Kwatha

Each patient in this group was subjected to with Sthanik Abhyanga with Mahamasha Taila followed by Sthanik Parisheka with Dashmoolaadi Kwatha.

Timing: 30 -40min.

Duration - Up to 7 days

Matra:3 litre Dashmoolaadi Kwatha

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Procedure: The whole procedure was under three steps, Purva, Pradhana and Pashchat Karma.

For Sthanik Patra Pinda Swedana

Preparation of Patra Pottali^[14]

Fresh leaves of the plant Arka, Eranda, Nirgundi, Shigru, Dhatura and Chincha were first cut into small pieces and then fried on a pan added with Mahamasha Taila till the mixture assumes reddish color. In this Pottali we added some Vata-Kaphanashak Churnas like Devdaru, Kustha, Rasna, Satpushpa, Saidhav Lavana, grated coconut powder and two pieces of lemon. Then this mixture was divided into two pieces of clothes and made into boluses. Average weight for a standard Pottali was taken 300gm approx.

Purva Karma

Patients were instructed not to suppress the natural urges and go through the normal routines. Patients were intimated, not to take any food immediately before taking Swedana Karma. Then patients were taken to a comfortable room, devoid of dust, extreme breeze and sunlight. Bahya Snehana in the form of Sthanik Abhyanga with Mahamasha Taila was done for 10-15 min in affected shoulder joint. Sthanik Abhyanga done in both supine and prone position with all techniques.

Pradhana Karma

Patient was made to lie down on the table in supine position with legs straight and then two Pottalies were kept in hot Mahamasha Taila. One of the two Pindas was used for massage and the other was kept in the pot over a low flame. Before beginning the procedure, bolus was taken from the right hand and the left hand's outer surface was used to measure the heat intensity. The bolus that was kept over the fire was used over the affected shoulder joint as soon as the current bolus lost its heat. The patient's left hand was slightly massaged over the area in the direction of the bolus and the process was run continuously for 30-40 minutes till the Samyaka Swedana Lakshanas were seen.

Pashchat Karma

After completion of the process applied Rasnadi Churna on the vertex of the patient and advised the patient to take rest in a non-windy room with his body covered using a thick blanket for about 1 hour after the rest advised the patient to perform bath using warm water.

The Pottali was used for 3 days and after 3 days process was continuing with fresh Pottali.
For Sthanik Parisheka
Prepration of Dashmoolaadi Kwatha (Dashmool, Masha, Bala)^[15]
Before making Dashmoolaadi Kwatha all the drugs were soaked the whole night before. The total quantity of decoction drugs was 500 gm. In which 1. Bilwa 2. Agnimantha 3. Syonaka 4. Patala 5. Gambhari 6. Salparni 7. Prushnaparni 8. Bruhati 9. Kantakari 10. Gokshura 11. Bala 12. Masha and taken all drugs in equal quantity 42 gm approx each. The above drugs were made in to small pieces (Yavakuta) and then Kwatha was prepared by boiling Yavakuta powder with 8 litres (16* Guna Jala of total Kwatha drugs) of water and reduce into one fourth (1/4) of the total quantity of water. The remaining quantity of Kwatha was 2 lit.
Purvakarma
Patient was made to sit /lie down on the Dhroni, and Sthanik Abhyanga With Mahamasha Taila was done to the afflicted shoulder joint. Sthanik Abhyanga (with exceptions which may need mild to moderate massage) was done for 10-15 minutes in both supine and prone position with all techniques. Gauze was tied around the head above the eyebrows and Ear plugged with gauze.
Pradhan Karma
The Dashmoolaadi Kwatha was filled in the Neti Pot a modified form of Varshulika. Sthanik Parisheka with Dashmoolaadi Kwatha was gradually conduct by stream poured on the afflicted shoulder joint with simultaneous massage respectively. The Dashmooladi Kwatha was poured 12 Angul of height. Sthanik Parisheka was done for a time period of 30-40 minutes. Sthanik Parisheka was done until the Samyaka Swedana Lakshanas were seen.
Paschat Karma
After the completion of Parisheka body was cleaned with soft towel. Ear plug and gauze were removed and Rasnadi Churna was applied to the head. Patient was advised to relax for a short while. After that take Snana (bath) with warm water.
Adjuvant therapy
Sthanik Abhyanga with Mahamasha Taila^[16] was done as adjuvant therapy in Both groups.

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Ruchi J et al. A Comparative Clinical Study of Patra Pinda Swedana

Investigations
X-ray shoulder joint AP and Lateral view.
CBC with ESR.
RBS
CRP
Serum uric acid.
RA
Selected Drugs
1. Medicated Vatahara herbs were for Potali, Patras of Arka, Erand, Nirgundi, Shigru, Chincha and Churnas like Devdaru, Kustha, Rasna, Satpushpa, Saidhav Lavana.
2. 2 Lemon
3. Mahamasha Taila was used for Sthanik Abhyanga.
4. Dashmoolaadi Kwatha (Dhashmool Masha, Bala Kwatha)
5. Mahamasha Taila - A dark golden coloured oil with pleasant aroma. Mahamasha Taila is a classical Ayurvedic herbal oil well known for its therapeutics benefits.
Composition of drug
Sthanik Patra Pinda Swedana by Vata-Kaphahar Patras of medicated herbs and oil (Mahamasha oil). Patras like Arka, Erand, Nirgundi, Shigru, Chincha and Dhatura were collected from Patanjali Research Herbal Garden and local area. Churnas like (Devdaru, Kustha, Rasna, Satpushpa, Saidhav Lavana, Devdaru, Kustha, Rasna, Satpushpa, Saidhav Lavana Parisheka by Dashmoolaadi Kwatha drugs were prepared at Divya Pharmacy in Haridwar.
Dose of medicine
For Sthanik Patra Pinda Swedana - Fresh leaves of Vata-Kaphahara drugs (Arka, Eranda, Nirgundi, Shigru, Dhatura and Chincha) - total 500 gm
Saindhav Lavana - 5 gm
Grated coconut - 50gm
Lemon - 2 (medium size)
Mahamasha Taila - as per required
Churanas like Rasna, Devdaru, Shatpushpa, Kustha - 5 gm each
Cotton cloth (45cm X 45cm) - 2 pieces

Tag - 2
Vessels -2 (for frying leaves and heating Pottali)
For Parisheka - For 2 lit. Dashmoolaadi Kwatha (Masha, Bala, Dashmoola)
Vessel 2-3 lit.
Rasanadi Churna - 5gm
Mahamasha Oil for Abhyanga - As per required
Parisheka Yanta - Apparatus was carrying out for Sthanik Parisheka was Neti Pot a modified form of Varshuulika Yantra - 2
Towel - 2
Observations and Results
Table 1: Showing effect of therapy in Group A.
Group A Mean Median SD Wilcoxon W P-Value % Effect Result
BT AT BT AT BT AT
Sandhishoola 4.20 1.10 3.50 1.00 2.17 0.97 -3.946b 0.0000795 73.81 Sig
Sandhi Sotha 1.80 0.40 2.00 0.00 0.83 0.60 -3.938b 0.0000821 77.78 Sig
Sandhigraha 2.65 0.90 2.50 1.00 1.27 0.72 -3.992b 0.0000656 66.04 Sig
Radiating of pain 2.85 0.80 3.00 1.00 0.75 0.62 -4.128b 0.0000365 71.93 Sig
Restricted movement of shoulder joint 2.00 0.40 2.00 0.00 0.79 0.60 -4.053b 0.0000506 80.00 Sig
Flexion 2.25 0.90 2.00 1.00 0.91 0.79 -4.072b 0.0000467 60.00 Sig
Extension 1.85 0.45 2.00 0.00 0.88 0.51 -3.938b 0.0000821 75.68 Sig
Adduction 2.25 0.60 2.00 0.50 0.79 0.68 -4.005b 0.0000620 73.33 Sig
Abduction 2.20 0.70 2.00 1.00 0.62 0.73 -3.919b 0.0000888 68.18 Sig
External rotaion 1.95 0.45 2.00 0.00 0.76 0.51 -3.912b 0.0000916 76.92 Sig
Internal rotation 2.10 0.55 2.00 0.50 0.72 0.60 -4.041b 0.0000531 73.81 Sig
Since observations are on ordinal scale (gradations), we have used Wilcoxon Signed Rank Test to test efficacy in Group A. From above table, we can observe that P-Value for all parameters is less than 0.05. Hence, we can conclude that effect observed in all parameters in Group A is significant.

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Table 2: Showing effect of therapy in Group B.
Group B Mean Median SD Wilcoxon W P-Value % Effect Result
BT AT BT AT BT AT
Sandhishoola 5.20 2.15 5.50 2.00 3.17 1.57 -3.943b 0.0000806 58.65 Sig
Sandhi Sotha 1.90 0.60 2.00 0.00 0.85 0.75 -4.099b 0.0000415 68.42 Sig
Sandhigraha 3.10 1.10 3.00 1.00 0.91 0.64 -4.029b 0.0000561 64.52 Sig
Radiating of pain 2.60 0.85 3.00 1.00 0.94 0.75 -4.018b 0.0000587 67.31 Sig
Restricted movement of shoulder joint 2.15 0.65 2.00 1.00 0.99 0.49 -3.825b 0.0001307 69.77 Sig
Flexion 2.25 0.75 2.00 1.00 0.79 0.79 -4.028b 0.0000562 66.67 Sig
Extension 1.90 0.60 2.00 0.00 0.85 0.75 -3.841b 0.0001223 68.42 Sig
Adduction 2.20 0.85 2.00 1.00 0.62 0.81 -3.834b 0.0001260 61.36 Sig
Abduction 2.15 0.70 2.00 1.00 0.93 0.73 -3.804b 0.0001422 67.44 Sig
External rotaion 1.85 0.65 2.00 1.00 0.81 0.67 -3.874b 0.0001071 64.86 Sig
Internal rotation 1.85 0.60 2.00 0.50 0.67 0.68 -3.987b 0.0000668 67.57 Sig
Since observations are on ordinal scale (gradations), we have used Wilcoxon Signed Rank Test to test efficacy in Group B. From above table, we can observe that P-Value for all parameters is less than 0.05. Hence, we can conclude that effect observed in all parameters in Group B is significant.

Table 3: Showing comparison between Group A and Group B
Variable Group N Mean Rank Sum of Ranks Mann-Whitney U P
Sandhishoola Group A 20 21.18 423.50 186.500 0.007
Group B 20 19.83 396.50
Total 40
Sandhi Sotha Group A 20 21.65 433.00 177.000 0.005
Group B 20 19.35 387.00
Total 40
Sandhigraha Group A 20 18.50 370.00 160.000 0.246
Group B 20 22.50 450.00
Total 40
Radiating of pain Group A 20 23.08 461.50 148.500 0.040
Group B 20 17.93 358.50
Total 40
Restricted movement of shoulder joint Group A 20 21.10 422.00 188.000 0.007
Group B 20 19.90 398.00
Total 40
Flexion Group A 20 19.33 386.50 176.500 0.457
Group B 20 21.68 433.50
Total 40
Extension Group A 20 21.50 430.00 180.000 0.025
Group B 20 19.50 390.00
Total 40
Adduction Group A 20 22.40 448.00 162.000 0.026
Group B 20 18.60 372.00
Total 40
Abduction Group A 20 20.95 419.00 191.000 0.791
Group B 20 20.05 401.00
Total 40
External rotaion Group A 20 22.50 450.00 160.000 0.023
Group B 20 18.50 370.00
Total 40
Internal rotation Group A 20 23.23 464.50 145.500 0.009
Group B 20 17.78 355.50
Total 40
Mann Whitney U Test is carried out for comparison between Group A and Group B. From above table, we can observe that P-Value for all parameters is less than 0.05. Hence, we can conclude that, there is significant difference between Group A and Group B.
Further we can observe that, mean rank for Group A is greater than Group B. Hence, we can conclude that, effect observed in Group A is better than Group B.

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Ruchi J et al. A Comparative Clinical Study of Patra Pinda Swedana

Table 4: Showing Mean rank score of Group A and Group B.
Parameters % Effect
Group A Group B
Sandhishoola 73.81 58.65
Sandhi Sotha 77.78 68.42
Sandhigraha 66.04 64.52
Radiating of pain 71.93 67.31
Restricted movement of shoulder joint 80.00 69.77
Flexion 60.00 66.67
Extension 75.68 68.42
Adduction 73.33 61.36
Abduction 68.18 67.44
External rotation 76.92 64.86
Internal rotation 73.81 67.57
Average % Effect 72.50 65.91

Table 5: Showing overall effect of therapy.
Overall Effect Group A Group B
N % N %
Marked Improvement 8 40.00% 3 15.00%
Moderate Improvement 9 45.00% 12 60.00%
Mild Improvement 2 10.00% 3 15.00%
No Improvement 1 5.00% 2 10.00%
Total 20 100.00% 20 100.00%
Group A: given moderate improvement with 45% followed by marked improvement of 40% and mild improvement 10%. There was 5% of no improvement after completion the treatment.
Group B: given moderate improvement of 60% followed by marked improvement of 15% and mild improvement 15%. There was 10% of no change after the completion of treatment.
Discussion
Discussion is an important and combined part of the research. Any Research study without discussion regarding its nature, utility and value is said to be incomplete. The clinical observations will be communicated by the researcher with textual references, and each observation will have a good justification. This section gives readers an interpretation of the results and highlights the importance of the discoveries.

Abhyanga (Bahya Snehana)

Karmas of Abhyanga are Snehana, Kledakara, Jarahara, Pustikara, Kapha Vata Nirodhan. Sneha which is used for Abhyanga, reaches to Mamsa, Meda, Asthi, Majja etc. Dhatu and provides nourishment to them.

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Ruchi J et al. A Comparative Clinical Study of Patra Pinda Swedana

According to Acharya Dalhana's detailed explanation, the oil used in the Abhyanga method can penetrate up to the various Dhatus.

Swedana

Best treatment for vitiated Vata and Kapha dominant diseases. Swedana is done to liquify the vitiated Doshas which are spread throughout the body. It is not recommended in disorders of aggravated Pitta but Swedana is recommended in Pittasanshlisht Vata-Kaphaj disease. Proper Sudation administered after oleation therapy pacifies the Vata.

By application of oil and then sudation therapy, the dry stick becomes soft and elastic. Then what will be its effect in alive human being. Generally, Guru, Teekshna and Ushna Dravyas induce sweating. Drugs with the Sara, Snigdha, Ruksha, Sukshma, Drava and Sthira Gunas are of Sweda.

The process which relieves Stambhaghnata, Gouravaghnata, Sheethaghnatha Swedakarakata, Vata Shaman, Dosha Draveekarana, Gatra Vinamana, Agnideepana, Twak Mardava and Prasadana, Bhakthasradha, Nidra-Tandra Nasha, Sandhicheshtakara, Dosha Shodhana.

Mode of action of Patra Pinda Swedana

Sroto Shuddhi And Ama Pachan

↓

Relieve in Sthambhagna (Stiffness), Gauravghna (Relieve in Heaviness)

↓

Due to Ushna Quality

↓

Shitaghna

↓

Swedakaraka (Promote Sweating)

↓

Impurities of Body Come Out

↓

Due to Usna and Tikshna Guna

↓

Increase Metabolic Rate in The Body

↓

Dilate the Capillaries (Vasodilation)

↓

Increase Circulation

↓

Enhance Elimination of Waste Products

↓

More Absorption of Sneha through Skin and nourish the tissue

Due to Vata Kapha Hara properties of Drugs Action with Swedana Stimulate Nerve, Muscles (Promotes its Renovation) and Hypo Analgesic Effect by Diverted Stimuli.

Mode of action of Parisheka

Swedana relieves Ruk, Stambha, Shotha, Toda symptoms of Vata and soften the body parts. Dharvasweda normalizes the vitiated Vata Dosha and helps in Samprapti Vighatana of Shoola. By Swedana, due to arterial dilatation the body parts get more blood circulation, so acts as Stambhaghna and Gouravaghna.

Stimulation Receptor

↓

Stimulation Hypothalamus Cause

↓

Sympathetic stimulation

↓

Cause adrenaline secretion

↓

Cause adipose Liposis

↓

Generation of sweat

J Ayu Int Med Sci 2024;9(7)44

Ruchi J et al. A Comparative Clinical Study of Patra Pinda Swedana

Drugs used in Patra Potali Sweda and Parisheka were having Vata-Kaphahara and Sothahara
Mahamasha Taila is Balya, Brihana, Dhatu Vardhaka and Vatahara in property and Avabahuka is a disorder of shoulder joint in which Sira gets affected due to increase in Khara Guna of Vata which results in restricted movement of shoulder joint. It has antiinflammatory properties and provides nourishment to Sira, Snayu, Asthi, Sandhi and Kandara. By pacifying Shleshma-Vata and nourishment of local musculature of shoulder joint it helps resolve the etiopathogenesis.

Conclusion

Sthanik Abhyanga with Sthanik Patra Pinda Swedana and Sthanik Parisheka with Dashmoolaadi Kwatha at affected shoulder joint were safe and effective in Avabahuka. There were no adverse effects found in the both groups. Statistically significant changes observed in the symptoms pain, stiffness, swelling, range of movements, Restricted Movement of joints, flexion, extension, adduction, abduction, external and internal rotation in both the groups.

From the present study it may be concluded Avabahuka was gradual in onset. Right Shoulder joint involvement was maximum compared to left shoulder joints. In this study Vata Pittaj Prakriti persons were found more prone to Avabahuka. Avabahuka was commonly found in patients having Adhyasana dietary habit, in female patients which were mostly housewifes and due to Vata Prakopa pain causes the disturbed sleep.

Avabahuka is commonly found in patients having vegetarian diet with dominant of Katu Rasa.

Excessive work with affected hand and season was reported as aggravating factors for Avabahuka in this study. Patra Pinda Swedana provides better results as it was also more effective in reducing symptoms of Avabahuka like Sandhi Shoola, Sandhigraha, Sandhi Sotha. In the present study it can be concluded that overall Patra Pinda Swedana can be better choice of treatment in the management of Avabahuka.

References

1. Sushruta: Sushruta Samhita, edited with Ayurvedatatvasandeepika Hindi commentary by Shastri Kaviraj Ambika dutta. Varanasi India: Chaukhambha Sanskrit Sansthan; part-12014; Shareera Sthana 5/3, 54

2. Charaka Samhita Ayurveda deepika commentary by Chakrapani Dutta. Dr. Laxmidhar Dwivedi, part-2, Indiya Sthana 9/8-9, Choukhamba krishnadas Academy, Varanasi, page no 1234, fourth edition 2017

3. Sushruta: Sushruta Samhita, edited with Ayurvedatatvasandeepika Hindi commentary by Shastri kaviraj Ambika Dutta. Vanarasi India: Chaukhambha Sanskrit Sansthan; 2014; Nidan sthan 1/82;304.

4. Vagabhatta Vridha: Ashtanga Sangraha with hindi commentary vol.1 Sutra- Shareer and Nidan Sthanas by Kaviraj Atrideva Gupta,Vidyalankar Bhishagratna foreword by Rajvaidhya Pandit Sri Nandakishor Sharma (Bhishagaacharya) Chaukhambha Krishanadas Acadmy, Varanasi INDIA: Nidana Sthana 402/45.

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

6. Madhavakar: Madhava Nidana, edited with Madhukosha Sanskrit commentary by Vijayrakshita and Dutta Shrikantha. Varanasi India: Chaukhamba Sansakrita sansthana; part- 1;1996;22/64:443.

7. Charaka-Charaka Samhita Agnivesh, edited with vidyotini Hindi commentary by shastri Pandit Kashinatha and Chaturvedi Gorakhanatha. Varanasi India: Chaukhamba Bharati Academy; part-1; 1992; Sutra Sthana 20/11:399.

8. Chakrapani: Chakradutta, edited with Bavartha sandipani Bhashatika by Tripathi jagdishwar Prasada. Varanasi India: Chaukhmba Sanskrit series office Vidyavilasa press; 1947; Vatavyadhi Chikitsa 100.

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9. Laubscher PH, Rosch TG. FROZEN shoulder: A review. S.A orthopaedic journal spring 2009 a clinical article. Available from: SA orthopaedic journal spring 2009. Accessed on April 22^nd,

10. Uppal Harpal singh, Evans Jonathan peter, smith Christopher. Frozen shoulder: A systemic review of therapeutic options. World J Ortho., 2015 mar 18; 6(2): 263-268. Published online 2015 mar 18 Doi:10.5312/wjo.v6.i2.263.PMCID:PMC4363808. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles Accessed on 22/4/2017.

11. Charaka Samhita. Ayurveda Deepika commentary by Chakrapani dutta. Dr. Laxmidhar Dwivedi, Part-1, Sutra Sthana 22/11, Chaukhamba Krishnadas Academy, Varanasi, Page no 414, Fourth edition, 2017.

12. Charaka Samhita. Ayurveda Deepika commentary by Chakrapani dutta. Dr. Laxmidhar Dwivedi, Part-1, Sutra Sthana 14/41, Chaukhamba Krishnadas Academy, Varanasi, Page no 318, Fourth edition, 2017 9.

13. Charaka: Charaka samhita of Agnivesh, edited with Vidyotini Hindi commentary bySshastri Pandit Kashinatha Sastri and Gorakhanatha Chaturvedi. Varanasi India: Chakhumbha Bharati Varanasi India: Chaukhambha Bharati Academy; part-1; 1992; Sutra Sthana cheptr 14:44(p.90).

14. Principle and Practice of Panchakarma, Dr. Vasant C. Patil, Chaukhambha Publications, New Delhi Page no 213.

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J Ayu Int Med Sci 2024;9(7)46

Group A	Mean		Median		SD		Wilcoxon W	P-Value	% Effect	Result
Group A	BT	AT	BT	AT	BT	AT	Wilcoxon W	P-Value	% Effect	Result
Sandhishoola	4.20	1.10	3.50	1.00	2.17	0.97	-3.946b	0.0000795	73.81	Sig
Sandhi Sotha	1.80	0.40	2.00	0.00	0.83	0.60	-3.938b	0.0000821	77.78	Sig
Sandhigraha	2.65	0.90	2.50	1.00	1.27	0.72	-3.992b	0.0000656	66.04	Sig
Radiating of pain	2.85	0.80	3.00	1.00	0.75	0.62	-4.128b	0.0000365	71.93	Sig
Restricted movement of shoulder joint	2.00	0.40	2.00	0.00	0.79	0.60	-4.053b	0.0000506	80.00	Sig
Flexion	2.25	0.90	2.00	1.00	0.91	0.79	-4.072b	0.0000467	60.00	Sig
Extension	1.85	0.45	2.00	0.00	0.88	0.51	-3.938b	0.0000821	75.68	Sig
Adduction	2.25	0.60	2.00	0.50	0.79	0.68	-4.005b	0.0000620	73.33	Sig
Abduction	2.20	0.70	2.00	1.00	0.62	0.73	-3.919b	0.0000888	68.18	Sig
External rotaion	1.95	0.45	2.00	0.00	0.76	0.51	-3.912b	0.0000916	76.92	Sig
Internal rotation	2.10	0.55	2.00	0.50	0.72	0.60	-4.041b	0.0000531	73.81	Sig

Group B	Mean		Median		SD		Wilcoxon W	P-Value	% Effect	Result
Group B	BT	AT	BT	AT	BT	AT	Wilcoxon W	P-Value	% Effect	Result
Sandhishoola	5.20	2.15	5.50	2.00	3.17	1.57	-3.943b	0.0000806	58.65	Sig
Sandhi Sotha	1.90	0.60	2.00	0.00	0.85	0.75	-4.099b	0.0000415	68.42	Sig
Sandhigraha	3.10	1.10	3.00	1.00	0.91	0.64	-4.029b	0.0000561	64.52	Sig
Radiating of pain	2.60	0.85	3.00	1.00	0.94	0.75	-4.018b	0.0000587	67.31	Sig
Restricted movement of shoulder joint	2.15	0.65	2.00	1.00	0.99	0.49	-3.825b	0.0001307	69.77	Sig
Flexion	2.25	0.75	2.00	1.00	0.79	0.79	-4.028b	0.0000562	66.67	Sig
Extension	1.90	0.60	2.00	0.00	0.85	0.75	-3.841b	0.0001223	68.42	Sig
Adduction	2.20	0.85	2.00	1.00	0.62	0.81	-3.834b	0.0001260	61.36	Sig
Abduction	2.15	0.70	2.00	1.00	0.93	0.73	-3.804b	0.0001422	67.44	Sig
External rotaion	1.85	0.65	2.00	1.00	0.81	0.67	-3.874b	0.0001071	64.86	Sig
Internal rotation	1.85	0.60	2.00	0.50	0.67	0.68	-3.987b	0.0000668	67.57	Sig

Variable	Group	N	Mean Rank	Sum of Ranks	Mann-Whitney U	P
Sandhishoola	Group A	20	21.18	423.50	186.500	0.007
	Group B	20	19.83	396.50
	Total	40
Sandhi Sotha	Group A	20	21.65	433.00	177.000	0.005
	Group B	20	19.35	387.00
	Total	40
Sandhigraha	Group A	20	18.50	370.00	160.000	0.246
	Group B	20	22.50	450.00
	Total	40
Radiating of pain	Group A	20	23.08	461.50	148.500	0.040
	Group B	20	17.93	358.50
	Total	40
Restricted movement of shoulder joint	Group A	20	21.10	422.00	188.000	0.007
	Group B	20	19.90	398.00
	Total	40
Flexion	Group A	20	19.33	386.50	176.500	0.457
	Group B	20	21.68	433.50
	Total	40
Extension	Group A	20	21.50	430.00	180.000	0.025
	Group B	20	19.50	390.00
	Total	40
Adduction	Group A	20	22.40	448.00	162.000	0.026
	Group B	20	18.60	372.00
	Total	40
Abduction	Group A	20	20.95	419.00	191.000	0.791
	Group B	20	20.05	401.00
	Total	40
External rotaion	Group A	20	22.50	450.00	160.000	0.023
	Group B	20	18.50	370.00
	Total	40
Internal rotation	Group A	20	23.23	464.50	145.500	0.009
	Group B	20	17.78	355.50
	Total	40

Parameters	% Effect
Parameters	Group A	Group B
Sandhishoola	73.81	58.65
Sandhi Sotha	77.78	68.42
Sandhigraha	66.04	64.52
Radiating of pain	71.93	67.31
Restricted movement of shoulder joint	80.00	69.77
Flexion	60.00	66.67
Extension	75.68	68.42
Adduction	73.33	61.36
Abduction	68.18	67.44
External rotation	76.92	64.86
Internal rotation	73.81	67.57
Average % Effect	72.50	65.91

Overall Effect	Group A		Group B
Overall Effect	N	%	N	%
Marked Improvement	8	40.00%	3	15.00%
Moderate Improvement	9	45.00%	12	60.00%
Mild Improvement	2	10.00%	3	15.00%
No Improvement	1	5.00%	2	10.00%
Total	20	100.00%	20	100.00%

Research Article

Avabahuka

Journal of Ayurveda and Integrated Medical Sciences

A Comparative Clinical Study of Patra Pinda Swedana and Parisheka in Avabahuka

Juyal R1*, Mahajan K2, Agrawal AK3

Introduction

Aim and Objectives

Materials and Methods

Observations and Results

Discussion

Conclusion

References

Juyal R^1*, Mahajan K², Agrawal AK³