E-ISSN:2456-3110

Review Article

Frozen Shoulder

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 10 OCTOBER
Publisherwww.maharshicharaka.in

A classical review on Avabahuka (Frozen Shoulder)

Verma S1*, Kulkarni YS2
DOI:10.21760/jaims.9.10.27

1* Sangita Verma, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.

2 Yogesh S Kulkarni, Professor and HOD, Department of PG Studies in Shalya Tantra, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.

Avabahuka is one among the Vataja Nanatmaja Vyadhis which affects the normal functioning of upper limbs there by affects the normal routine lifestyle of an individual. It is caused mainly by the Vyana Vata vitiation and gets Sthana Samshraya in the Amsa Pradesha. There it does the Shoshana of Shleshaka Kapha, Mamsa, Sira, Snayu leading to Bahupraspanditaharatwam, Shoola and Stambha. These clinical features closely resemble with painful stiffness and loss of motion of shoulder. After completion of treatment, significant improvement was observed in the parameters like Bahu Shoola, Stambha and Range of Movements. In Ayurveda Acharya’s have mentioned the specific line of treatment of Avabahuka are Agnikarma, Nasya, Swedana, Shamanoushadhis.

Keywords: Avabahuka, Frozen Shoulder, Vataja Nanatmaja Vyadhis

Corresponding Author How to Cite this Article To Browse
Sangita Verma, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, BVVS Ayurved Medical College and Hospital, Bagalkot, Karnataka, India.
Email: 		Verma S, Kulkarni YS, A classical review on Avabahuka (Frozen Shoulder). J Ayu Int Med Sci. 2024;9(10):165-167.
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https://jaims.in/jaims/article/view/3694

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-09-13 2024-09-27 2024-10-07 2024-10-17 2024-10-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.36

© 2024by Verma S, Kulkarni YSand 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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Sangita V et al. A classical review on Avabahuka (Frozen Shoulder)

Introduction

Most of the diseases are not life threatening but hamper day to day life of human. “Avabahuka” is one among such diseases. This condition affects the normal functioning of upper limbs there by it affects normal routine lifestyle of an individual. In contemporary medical science the condition Frozen shoulder seems to be very similar to Avabahuka. The prevalence of Frozen shoulder in the general population is reported to be 2%, prevalence of 11% in unselected individuals with diabetes. Frozen shoulder may affect both shoulders, either simultaneously or sequentially, the frequency of bilateral Frozen shoulder is higher in subjects with diabetes than in those without diabetes. It occurs most frequently in 5th and 6th decades of life.[1]

Management of Frozen Shoulder is by Analgesics, local intra articular injections of corticosteroids in glenohumeral joint followed by physiotherapy and surgical intervention.[2] Agnikarma is one among the para- surgical procedures. Agnikarma increases local Dhatwagni and thus helps curing diseases well as reducing the chance of recurrence.[3] Swedana is said to be the best form of treatment in expelling Pradushita Vata and Kapha. Acharya Charaka very clearly states that the Swedana Karma is the procedure which relieves Stambha (Stiffness), Gourava (Heaviness) and Sheetaghnam (Cold).[4]

Nirukti and Paribhasha

Avabahuka comprises of two words “Ava” and “Bahuka”. Ava states Viyoga or Vikratou, which means dysfunction or separation. It can be taken as deterioration or dysfunction. Bahuka word states the ending of Bahu (the arm). Bahuka is a muscular gender. Thus, Avabahuka can be defined as बाहो स्तम्भौ अवबाहकम It means bad arm or stiffness in the arm.

Nidana

There can be two types of Hetu causing Avabahuka which are as following

1. Bahya Hetu - causes that lead to injury to the Marma or the region surrounding that.
2. Abhayantara Hetu - indulging in Vata Prakopa. The Nidana leading to vitiation of Vata in that region are Abhyantara Hetu. This may be again

  • Bahya Aabhighataja (external cause)
  • Dosha Prakopajanya (Samshraya)

Bahya Aabhighataja which manifests Vyadhi or the disease first. Whereas, the other is Dosha Prakopajanya (Samshraya) which in turn leads to Karmahani of Bahu. As the disease come under Vatavyadhi, the Nidana of the Vatavyadhi can also be the Nidana of Avabahuka.[5] The causes of Vata Vyadhi are - 1) Dhatu Kshaya, 2) Aavarana Out of these two causes, Aavarana seems be the cause of Avabahuka.

Samprapti

jaims_3694_01.JPG
It is one of the Vatakapha Pradhana Vata Vyadhi, Due to Nidana Sevana, Vyana Vata vitiation occurs and gets Sthana Samshraya in the Amsa Pradesha. There it does the Shoshana of Shleshaka Kapha, Mamsa, Sira, Snayu leading to Bahupraspanditaharatwam (restricted movement of affected shoulder), Shoola (pain), Stambha (stiffness).

Samprapti Ghataka of Apabahuka

  • Nidana : Vataprakopaka Nidan
  • Dosha : Vata-Vyana (Chala Gunata Kshaya), Kapha-Shleshaka (Dravyata Kshaya)
  • Dushya : Asthi, Majja Sira, Snayu, Kandara
  • Srotas : Asthivaha, Majjavaha
  • Agni : Jataragni, Asthi-Dhatvagni
  • Ama : Jataragni& Dhatvagnijanya
  • Roga Marga : Madhyama
  • Udbhavasthana : Pakwashaya
  • Sancharasthana : Sarvashareera Rasayani
  • Adhisthana : Amsa Pradesha

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  • Vyaktasthana : Bahu
  • Swabhava : Chirakari

Rupa

  • Bahu Praspandida Hara - Lost / diminished movement of the upper limb
  • Amsa Bandhana Shosha - Muscle wasting
  • Shoola - Pain

According to Acharya Sushruta, when Vata gets vitiated at Amsa Sandhi, it causes wasting of the Amsa Bandhana and Sira Aakunchana. Such condition is called as Avabahuka. The same definition has been explained by Acharya Vagbhata in Nidana Sthana that vitiated Vayu when goes to Amsa-Moola Pradesh, it causes constriction of Sira of that Sthana. This results in loss of movements of the Bahu (arm). This condition is called Avabahuka.

Treatment in Ayurveda

Acharya Sushruta has described the treatment for Amsasandhi Sangha as follows: one should treat the Vayu, vitiated in Sandhi, Asthi and Snayu, by using and Agni Karma (therapeutic cauterization).[6] The standard line of treatment described in Ayurveda for different Vata Vyadhis is Snehan Swedana, Mrudusamshodhana, Basti, Sirobasti Nasya, and so on. Snehana is described as of two types viz.[7]

1. Bahya (external)
2. Abhyantara (internal)

Acharya Charaka further states that, each patient should be given specific therapies depending on the Dushya (tissue element vitiated by Vata) and location. In the Urdva-Jatrugata Vatavyadhis, Acharya Vagbhata has mentioned Nasyakarma.[8]

Three major approaches are followed in the management of Vata Vyadhi.

1. Treatment of Kevala Vata
2. Treatment of Samsrusta Vata.
3. Treatment of Avruta Vata

Discussion

Ayurvedic classics explain the Chikitsa of Avabahuka as follows- Sushruta Acharya advises Vatavyadhi Chikitsa for Apabahuka, except Siravedha.[9] But in Sharira Sthana, mentioned Siravedha at Bahumadhya in Avabahuka.[10] Ashtanga Hrudya - has explained Nasya Karma and Uttarbhaktikam in Avabahuka.

[11] Ashtang Sangraha mentions Navana Nasya and Snehapana for Avabahuka.[12] If we try to read in between the lines, we get to understand the paradoxical statement quite clearly. Raktamokshana is advised in Avabahuka, but care must be taken in order to ensure that the amount of blood drawn does not cause any Dhatu Kshaya symptoms in the patients.

Conclusion

Avabahuka is one among Vatavikara which involves vitiation of Asthi and Majja Dhatu; Sira, Snayu, Khandara Upadhatus. It is one of the Vyana Vata and Shleshaka Kapha Pradhana Vatavikara. It is characterized by Bahupraspanditaharatwam (restricted movement of affected shoulder), Shoola (pain), Stambha (stiffness). Based on the similar clinical features, Avabahuka can be closely compared with Frozen Shoulder. Chikitsa Upakramas described in Ayurveda like Agnikarma, Swedana are effective in management of Avabahuka.

References

1. Chetan Agrawal, Rashmi Kale. Case Study of Frequent Leech application in Diabetes mellitus with special reference to Frozen Shoulder. Ayurlog: National Journal of Research in Ayurved Science 2018; 6(2): 1-5.
2. Sharma S., Bhagat PJ, Reddy RG. Management of Avabahuka (Frozen Shoulder) with Ayurveda Therapeutic Regimen: A Case Study. J Res Ayurvedic Sci 2020;4(4):158-163
3. Sushruta Samhita, Kaviraj Ambikadutt shastri, Ayurvedtatwasandipika Hindi Commentary, Sutrasthana, Chapter-12, Shloka no-3, Choukambha Publication, Edition-2016, Varanasi, Page No -50.
4. Charaka Samhita, Vidyotini Hindi Commentary, by Dr. Gorakhnath Chaturvedi, Sutra Sthana Shloka no-14/41, Choukambha Bharati Academy Publication, Edition 2018, Pp-290.
5. Brahmanand Tripathi. Ashtang Hridyam, Delhi; Choukhamba Sanskrit Pratishthan; 2014 (Nidana 15/5- 6), p.537.
6. Ambika Dutt Shastri. Sushruta samhita, Volume 1, Varanasi; Choukhamba Sanskrit sansthan; 2011 (Chikitsa 5/23), p. 43
7. Kashinath Sastri and Dr. Gorakhnatha Chaturvedi. Charak Samhita, Volume 1, Choukhamba Bharti Academy; 2013 (Sutra 13/61) p.273


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8. Brahmanand Tripathi. Ashtang Hridyam, Delhi; Choukhamba Sanskrit Pratishthan; 2014 (Uttara 24/7), p.1056.
9. Ambika Dutt Shastri. Sushruta samhita, Volume 1, Varanasi; Choukhamba Sanskrit sansthan; 2011 (Chikitsa 5/23), p. 43
10. Ambika Dutt Shastri. Sushruta samhita, Volume 1, Varanasi; Choukhamba Sanskrit sansthan; 2011 (Sharira 8/17), p. 88.
11. Brahmanand Tripathi. Ashtang Hridyam, Delhi; Choukhamba Sanskrit Pratishthan; 2014 (Chikitsa 21/44), p. 809
12. Kaviraj Atridev Gupta. Astang Samgraha, Volume 2, Varanasi; Choukhamba Krishnadas Academy; 2005 (Chikitsa 23/13) p.125


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