SHAMANA CHIKITSA IN AVABAHUKA

DR.PRASHANTH.A.SProfessor

Department of Post Graduate Studies in Kayachikitsa

Ayurveda Maha VidyalayaHubli, Karnataka – 580024Telephone: 0836-2335575Mob: +91-94481-35575

Mail: drprashanthas@gmail.com

© COPYRIGHT RESERVED, Dr.Prashanth.A.S, Professor, Dept. of PG studies in KC, AMV, Hubli, KA

INTRODUCTION• Avabahuka - affects Amsa Sandhi. • Avabahuka - not mentioned in the

Nanatmaja Vata Vyadhi.• Acharya Susruta, Vagbhata - Avabahuka a

Vata Vyadhi. • Madhava Nidana - Amsa Shosha and

Avabahuka.• Amsa Shosha - preliminary stage -

Sleshaka Kapha Sosha in Amsa Sandhi. • Avabahuka - Shleshaka Kapha Sosha +

Shoola during movement, restricted movement etc.

• Madhukosha Teeka:– Amsa Shosha - Dhatu Kshaya i.e., Sudha

Vata Janya – Avabahuka - Vata Kapha Janya.

MODERN VIEW• Aches and pains related to

musculo-skeletal system are common and the incidence of such illness increases with age.

• Avabahuka can be compared to the musculo skeletal disorders of the shoulder girdle and brachial plexus neuropathy.

• In allied sciences the therapeutic aspect of management of these disorders still remain in infancy.

LITERARY REVIEW• Charaka – Bahusirshagata Vata• Sushruta – Avabahuka• Vagbhata – Avabahuka• Dalhana, Arunadatta, Hemadri – analyzed

Avabahuka in detail.• Madhava Nidana, Yoga Ratnakara –

Avabahuka.• Madhavakara is the first to differentiate it

from bahushosha.• Bhavamishra, Sharangadhara etc. –

Rasoushadhis in this context.• Vangasena – Chikitsa with different

Yogas.• Gadanigraha, Brihat NighantuRatnakara,

Nidana Sara etc. – Avabahuka with its management.

NIRUKTI AND PARIBHASHA • Avabahuka comprises of two words

'ava' and 'bahuka'.– Ava means ‘Viyoga’ or ‘Vikratou’

which means dysfunction or separation.

– It can be taken as deterioration or dysfunction.

– Bahuka - (at the end of a compound) - bahu - the arm.

– Bahuka - Muscular gender.

• Thus Avabahuka can be defined as,– Bahustambho Avabahuka– Bad arm, stiffness in the arm joint

AMSA SANDHI VIVECHANA• This is a major joint of upper limb. • This is one type of chala and

Ulookhala sandhi.• This is formed by the combination

of Pragandasthi, Akshakasthi and Amsaphalakasthi.

• Pratanavati type of Snayu cover this sandhi.

• Shleshaka Kapha present in this joint acts as lubricant and helps in protection and movement of the Sandhi.

AMSA SANDHI & MARMA• The Amsa Marma - head (Murdha), neck (Greeva) and the

arm (Bahu).

• Formed by the union of Amsa Peetha (glenoid) and the

Skanda (acromio clavicular joint).

• This is a Snayu Marma to a length of half finger's width (1

cm).

• Amsa Marma consists of Mamsa, Sira, Snayu, Sandhi and

Asthi. But it is a Snayu Marma.

• It is one of Vaikalyakara Marma, any trauma to this will

produce disability or deformity of the shoulder joint.

NIDANA• Bahya Hetu – causing injury to the

Marma or the region surrounding that.

• Abhyantara Hetu – indulging in Vata Prakopaka Nidana leading to vitiation of Vata in that region. – This may be again of Bahya

Abhigataja (External cause) which manifest Vyadhi or disease first and the other is Dosha Prakopajanya (Samshraya) which in turn leads to Karmahani of Bahu.

SAMANYA SAMPRAPTINidana

Mithya Ahara Vihara Old Age

Provocation of Vyana Vata

Sthanasamsraya in Amsa Pradesa

Sleshaka Kapha Sosha Affliction of Sira, Snayu, Mamsa, Asthi, Kandara

Bahu Cheshta Hara

Avabahuka

MARMABHIGHATA SAMPRAPTI

Abhyantara Marmabhighata Bahya Marmabhighata

Amsa Marmabhighata

Affliction of Mamsa, Sira, Snayu, Asthi, Kandara

Provocation of Vata

Bahu Chesta Hara

Avabahuka

SAMPRAPTI GHATAKAUdbhavasthana AmapakwashayaSancharasthana RasayanisAdhisthana Amsa PradeshaVyaktastana Bahu Pradesha, AmsasandhiDosha Vata predominant : (Vyana and Prana)

Anubandha Dosha : Kapha (Sleshaka), PittaDooshya Pradhanataha: Asthi, Majja, Rakta, Mamsa.Upadhatu Sira, Snayu, Kandara.Agni Jataragni and respective DhatwagnisAma Jatraagni mandyajanya Ama and respective Dhatwagni

Mandyajanya AmaSrotas Asthivaha, Majjavaha srotasSrotodusti Prakara SangaRoga marga MadhyamaRoga Avastha Chirakari

DOSHA INVOLVEMENT Vata Vyana: Chalagunataha Kshaya.

Vyanavayu Ruksha Gunataha Kshaya.Prana: Karmataha Kshaya.

Kapha Sleshakha: Dravyataha Kshaya.Avalambaka: Supports the srotas of the kapha by

virtue of its Ambukarma Dravyataha kshaya.

Pitta Pitha dushti because of Asraya-Asrayi bhava of Rakta, due to Sira, Snayu vishosha.

ROOPA

• Bahu Praspandida Hara (impaired or loss of movement of the upper limb)

• Amsa Bandhana Shosha (Muscle waisting) (Sushruta)

• Shoola (Pain)

• Avabahuka: (A.H)

• Viswachi: (A.H)

• Manya Stambha: (C.S)

• Ekanga Vata: (C.S)

• Amsa Sosha: (S.S)

SAPEKSHA NIDANA

• Ashtanga Hrudaya – Avabahuka Chikitsa:

• Sushruta Samhita – Avabahuka Chikitsa:

• Charaka Samhita – Bahusirsha Gata Vata:

CHIKITSA SUTRA

SAMANYA CHIKITSA

• Vatavyadhi – Snehana, Swedana, Mrudusamshodhana, Vasti, Sirovasti, Nasya, etc.

• Charaka – Sthana, Dushya - Specific therapies.

• Vagbhata - Jatroordhva Vatavikaras – Nasyakarma.

• Three major approaches are made in the management of Vatavyadhi.

– Treatment of Kevala Vata

– Treatment of Samsrusta Vata

– Treatment of Avruta Vata

VISHESHA CHIKITSA• Ashtanga Hrudaya - Nasya and

Uttarabhaktika Snehapana.

• Astanga Sangraha - Navana Nasya and Sneha Pana.

• Sushruta - Vatavyadhi Chikitsa except Siravyadha.

• Chikitsa Sara Sangraha - Nasya, Uttara bhaktika Snehapana and Sweda.

• Vagbhata - Brumhana Nasya.

• Chakradatta - Nasapana.

LINE OF TREATMENT

Samanya

• Nidana parivarjana

• Abhyanga

• Swedana

• Uttarabhaktika Snehapana

• Nasyakarma

• Nasaapaana

• Shamanoushadhi

Vishesha

• Marmabhighata Chikitsa

‘Samprapti Vighatanameva Chikitsa’

SHAMANA CHIKITSA SIDDHANTA• Vata Hara Oushadha Sevana• Uttara Bhaktika Sneha Sevana• Marmabhighata Chikitsa• Brumhana Nasya• Lepa• Abhyanga• Sweda• Seka

Mahatwa of Uttara Bhaktika Snehapana• Acts on Vyana and Prana Vata

Shamana

• Acts as Brumhana

• Acts on Urdhwa Jatru Gata Roga

• Does Snehana effect on Sandhi

• Acts on Sleshaka Kapha

• Acts as Snehana on Shoshita Sira, Snayu, Mamsa, Asthi, Kandara.

MARMABHIGHATA CHIKITSA• When there is Marmabhighata of Amsa Marma leading to Avabahuka prime

importance is given for Marmabhighata Chikitsa.

• Lepa – Marma Gulika mixed with Murivenna.

• Lepa – Karuttha Gulika mixed with Murivenna.

• Gandha Taila 10-20 drops internally at bed time with Prasarinyadi Ksheera

Kashaya or with Ushna Ksheera Anupana.

BRUMHANA NASYA• Same like Uttara Bhaktika Sneha

Pana

• Acts as Brumhana which is

Vatahara in nature

• Acts on Urdhwa Jatru Gata Roga

• Does Snehana effect on Sandhi

• Acts as Snehana on Shoshita Sira,

Snayu, Mamsa, Asthi, Kandara.

LEPA• Vatahara Lepa which are having

Brumhana, Ushna can be used.

• Vruddhadarvadi Lepa – Vatahara,

Brumhana, Ushna.

• Dasamoola Ksheera Lepa –

Brumhana, Vatahara.

ABHYANGA• Abhyanga with Various Taila

mentioned for Avabahuka like

• Mahamasha Taila

• Parinatakeriksheeradi Taila

• Karpasasthyadi Taila

• Prasarinyadi Taila

• does the action of Vatahara, Brumhana, brings Snehana effect to the Sandhi

SWEDANA

• Various kind of Swedana like

• Jambeera Patrapinda Sweda

• Shastika Shali Pinda Sweda

• Kukudanda Sweda

• Dasamoola, Bala Kashaya Nadi Sweda

• acts as Vatahara, Rujahara, Brumhana

• Vasodilator, Improves the circulation.

SEKA• Seka with various Vatahara

Kashaya and Taila are used

in Avabahuka.

• Acts as like Abhyanga.

Specific Shamanoushadhi in Avabahuka

• Dasamoola Bala Masha Kwatha – Chakradatta

• Ashtavarga Kwatha – Sahasrayogam

• Maharasnadi Kwatha – Sahasrayogam

• Prasarinyadi Kwatha – Sahasrayogam

• Ekanga Veera Ras – Rasarajasundara

• Vata Gajankusha Ras – Bhai.Rat

• Prasarinyadi Taila – Ash.Hru

• Ketakyaadi Taila – Sahasrayogam

• Parinatakeri Ksheeraadi Taila – Sahasrayogam

• Kaarpaasasthyaadi Taila – Sahasrayogam

• Mahaakukkudamaamsa Taila – Bhai.Rat

• Bruhat Masha Taila – Chakradatta

Dasamoola Bala Masha Kwatha• Chakradatta, Vatavyadhi.25• -

• Indicated as Pana and Nasya.• Indicated in Avabahuka, Viswachi.• Acts as Brumhana, Vatahara, Balya.• Adding Sneha / Ajya in it facilitates the action

of the Kwatha.

Maharasnadi Kwatha

Maharasnadi Kwatha• Sahasrayoga, Kashaya Prakarana• Anupana – Sunti Ch, Pippali Ch, Yogaraja

Guggulu, Ajamodadi Ch, Eranda Taila• Indication – Sarvanga kampa, Kubja,

Pakshaghata, Avabahuka, Grudrasi, Amavata, Sleepada, Apatanaka, Antravrudhi, Adhmana, Janugatavata, Ardita, Sukramaya etc.

• Acts mainly as Vatahara, Soolahara, Srotoshodhana.

Ashtavargam Kwatha• Sahasrayoga, Kashaya prakarana

• -

• Vatahara, Ushna

• Can be given with Ksheerabala (101)

• Acts as Vaso-dilator

Prasarinyadi Kwatha

• Sahasrayoga, Vishista Kashaya prakarana

• -

• Vatahara, Ushna, Teekshna, Brumhana, Balya

• Has vaso-dilator property.

Ekangaveera Ras• Rasarajasundara, P-458• -

• Anupana – Ardraka swarasa• Indication – Pakshaghata, Ardita, Apabahuka,

Viswachi, Gridrasi, Vata roga, Dhanurvata

Vatagajankusha Ras

Vatagajankusha Ras

• Bhaishajya Ratnavali, Vatavyadhi.488-492

• Anupana – Pippali Ch, Manjishta Kwatha

• Indication – Gridrasi, Kroshtukasirsha,

Avabahuka, Manyastambha, Urustambha,

Pakshaghata

Prasarinyadi Taila

• Ashtanga Hrudaya. Chi.21/65-66• -

• Vatahara, Ushna, Teekshna, Brumhana, Balya• Has vaso-dilator property.

Parinatakeri Ksheeraadi Taila• Sahasrayoga, Taila Prakarana

• -

• Used for Abhyanga

• Vatahara, Ushna, Brumhana

• Indicated in Avabahuka.

Kaarpaasasthyaadi Taila• Sahasrayoga, Taila Prakarana• -

• Indicated for Pana, Nasya, Abhyanga• Indicated in Avabahuka, Pakshaghata, Ardita• Vatahara, Ushna, Teekshna, Balya• Prabhava – Acts on Urdhwa Jatru Vikaras.

Ketakyaadi Taila• Sahasrayoga, Taila Prakarana

• -

• Vatahara, Ushna

• Indicated in Asthigata Vata

• Useful in Marmabhighata Janya Avabahuka

Mahaakukkudamaamsa TailaIngredients Indications

Mahaakukkudamaamsa Taila

• Bhaishajya Ratnavali, Vatavyadhi.511-520

• Indicated in almost all Vatavyadhi

• Brumhana, Balya, Vatahara

Bruhat Masha Taila

Bruhat Masha Taila

• Chakradatta, Vatavyadhi.192-196

• Used as Vasti, Abhyanga, Nasya

• Indication – Hastakampa, Shirakampa, Bahusosha, Avabahuka, Badirya, Karnanada, Karnasula, Visvachi etc.

• Brumhana, Vatahara, Ushna

• Prabhava – Acts on Urdhva Jatrugata Roga

Shamanoushadhi’s in other conditions

Chakradatta• “Moolam balaayaastvatha paaribhadraat tathaa aatmaguptaa

swarasam pibed vaa Nasyantu yo maamsarasena kuryaan maasadasou vajra samaana baahu” (Vatavyadhi.26)

• “Baahushoshe pibet sarpir bhuktvaa kalyaanakam mahat” (Vatavyadhi.28)

• Trayodasanga Guggulu – Gridrasi baahu prishte hanu grahe... (Vatavyadhi.69-73)

• Narayana Tailam – Hanusthambe Manyaasthambe... (Vatavyadhi.120-130)

• Mahanarayana Tailam – Hanugraham... (Vatavyadhi.131-140)• Swalpamaasha Tailam – Baahuseersha gata vata...

(Vatavyadhi.154-155)

Bhaishajya Ratnavali• Balaadi Kashayam – Baahushosha... (Bha.Rat.26/67)• Yogarajaguggulu Vati – Sarvaan Vataamayaan...

(Bha.Rat.26/102-113, Sarngadhara)• Brihat Vaata Chintaamani Ras – Vaata Rogam...

(Bha.Rat.26/141-144)• Vaata Vidwamsa Ras – Manyaa Sthambam...

(Bha.Rat.26/178-184, Rasendra Sara Sam)• Maashabalaadi Tailam – Hanusthambham Manyaasthambam...

(Bha.Rat.26/551-556)• Vishagarbha Tailam – Hanusthambham Manyaasthambham...

(Bha.Rat.26/560)• Balarishtam – Sarva Vata Roga hara... (Bha.Rat.26/572-574)

Ekamoolika Prayoga

Guggulu

• Rasa : Katu, Tikta, Kashaya• Guna : Laghu, Sara, Vashada• Virya : Ushna• Vipaka : Katu• Karma : Balya, Rasayana,

Varnya, Vatakaphahara, Bhagnasandhanakrut,Medohara

• DOSE - 2- 4 g of the drug.

Rasna

• Rasa: Tikta• Guna : Guru• Virya : Ushna• Vipaka : Katu• Karma : Amapacana,

Kaphavatahara• Dose : 25 - 50 g. (Decoction)

Lashuna

• Rasa: Madhura, Katu• Guna: Guru, Picchila, Sara,

Snigdha, Teekshna• Virya: Usha• Vipaka: Katu• Karma: Balya, Deepana,

Hrudya, Kaphavatahara, Raktadoshahara, Bhagnasandhanakara, Rasayana, Asthimamsa Sandhankara

• Dose: 3 g of drug

Prasarini

• Rasa: Tikta• Guna: Guru, Sara• Virya: Ushna• Vipaka: Katu• Karma: Vatahara, Vrushya,

Balakrut, Sandhanakrut• Dose: 2 - 4 g of drug in

powder form

Ashwagandha

• Rasa: Tikta, Kashaya• Guna: Laghu• Virya: Usha• Vipaka: Madhura• Karma: Rasayana,

Vatakaphahara, Balya, Vajikarana

• Dose: 3 - 6 g of the drug in powder form

Bala

• Rasa: madhura• Guna: laghu, snigdh, pichhil• Virya: sita• Vipaka: madhura• Karma: balya• Dose: 25 - 50 g (Decoction)

Other Shamanoushadhi’s

• Kwatha : Bhadradarvadi Kwatha (S.Y)

Dhanadanayanadi Kwatha (S.Y)

Mahamanjishtadi Kwatha (S.Y)

• Rasoushadhi : Ardhangavatari Ras (R.R.S)

Amruta Sanjeevani Rasayana (R.R.S.S)

Kalakandaka Ras (R.Y.S.S.)

Mallasindoora (R.T.S.)

Yogendra Ras (B.R.)

Rasaraja Ras (B.R.)

• Guggulu : Shadasheeti Guggulu (Y.R.)

Simhanada Guggulu (B.R.)

• Ghrita yoga : Brihat chagaladi ghrita (B.R.)

Indukanta ghrita (S.Y.)

• Taila Yoga : Triteeya Prasarani Taila (Ch.D.)Niramisha Masha Taila (B.R.)Bala Taila (B.R.)Madhyama Narayana Taila (B.P.)Maha Saindavadi Taila (B.P.)Laghu Vishagarbha Taila (Y.R.)Visha Tinduka Taila (R.T.)Ksheerabala Taila (S.Y.)Balaswagandhadi Taila (S.Y.)Dharwantharam Taila (S.Y.)

PERSONAL DATA OF THE PATIENT

Name : Mr. shivaputrappa.gurappanavarAge : 42 Yrs.Sex : MaleReligion : HinduOccupation : farmerEconomic status : poorEducational status : 10th stdMarital status : Un MarriedHabitat : RuralAddress : atpost yaraguppi tal kundagol dist dharawad OPD No. : 9862Date : 23 – 11 - 09

PRADHANA VEDANA:• Severe Pain in the right shoulder joint (Amsa Sandhi Shoola) since – 3 months

• Pain radiating to RUL

• Difficulty in range of movements (Stambha)

• Numbness

• Unable to carry on his daily regimen (Karmakshayakari)

ANUBANDH VEDANA:

• Chest Pain

• Bilateral knee jts pain

ADYATANA VYADHI VRUTTANTA:

Patient was apparently normal 3 months ago. One fine day patient fell down with outstretched hand when he went to procure water from the well, he had an injury to rt shoulder joint, chest, both knees etc. he had lacerations over knees and elbow. Initially pt was administered with nsaids and his rt shoulder jt was immobilized with figure of 8 bandage by a local vaidya . After 4 days the condition worsened and he developed swelling of the affected part and above mentioned complaints for which he consulted the same person. again he was immobilized in their own method for 20 days by which he had minimal relief. But Since from last 20 days the symptoms aggravated and pt was unable to carry on his daily regimen for which he came to our hospital.

VAYUKTIKA VRUTTANTA:

Aahara : Vegetarian Rasa satmy : Katu, Tikta, Kashaya rasa pradhana

ViharaNidra :poorvakalina Prakruta ( 6 – 7 hrs)

now adhyatanakalina disturbed due to painVyasana : occasional smoker

TREATMENT HISTORY:

NSAID’sImmobilization

PURVA VYADHI VRUTTANTA:

h/o Fall.

SAMANYA PAREEKSHA:

Ashta Sthana Pareeksha;Nadi : 80/min.Mala : MalabaddataFrequency: once a day, imcomplete evacuationCharacteristics: Hard, DryMootra : Prakruta, Frequency: day – 2-3 times, Night –1-2 timesCharacteristics: Normal coloured, non turbidJihwa : PrakrutaShabdha : PrakrutaSparsha : PrakrutaDrik : PrakrutaAakruti : Madhyama

Dashavidha Pariksha:

Prakruti : Vatapittaja

Vikruti : Vata pradhana kapha anubanda

Sara : Madhyama

Samahanana : Madhyama

Pramana : Madhyama ( Ht: 5’2” wt – 46 kg)

Satmya : Katu, tikta, Kashaya rasa satmya

Satwa : Madhyama

Ahara shakti : Avara

Vyayama shakti : Madhyama (Now reduced)

Vayaha : Madhyama (Parihani) (42 years)

Vitals Examination:

Temperature : 98oF

Pulse : 80/min.

Respiration Rate : 18/min.

Blood Pressure : 140/90 mmHg

Height : 5’2”

Weight : 46 Kgs

II. Motor System :

Muscle Strength : Weak on right upper extremity

Bulk of muscles : Reduced in right upper extremity

Tone of muscles : Hypotonia (Decreased in rt upper

limb)

Gait : Normal

III. Sensory System:

Pain : Pricking type of pain present

Touch : No signs of Inflammation

Joint Position : Normal

2. Respiratory system O / I : Respiration Rate – 18/min.(Regular)O / A : Normal vesicular Breath sounds

3. C.V.S. O / I : Pulse–80 / min,BP – 140/90 mm HgO / A : S1 S2 heard

4. GITP / AO / I : Normal ContourO / A : Normal Bowel sounds heardO / P : No Organomegaly

SROTAS PAREEKSHA:• Pranavaha Srotas : Prakruta• Udakavaha Srotas : Prakruta• Annavaha Srotas : Prakruta• Rasavaha Srotas : Karshya• Raktavaha Srotas : Ruja, Karshya• Mamsavaha srotas : Atiruja• Medovaha srotas : Prakruta• Asthivaha Srotas : Asthi Shoola • Majjavaha Srotas : Ruja, Stabdata• Mutravaha Srotas : Prakruta• Purisavaha Srotas : Malabaddata•Swedhavaha srotas : Prakruta

LOCAL EXAMINATION:

1. Tenderness

Rt. Shoulder : Present

Rt. Upper Ext : Present

Chest Region : Mild ( right side)

Cervical Region : Absent

2. Numbness

Rt. Upper Ext. : Present 3. Grip Strength : Reduced 4. ROM Rt shoulder jt : Painful Adduction &

Abduction GM Readings : Flexion 60

Elevation 50 Hyperextension 40

ROGA PAREEKSHA:•Nidana : Abhighata, Vatakara Ahara, Vihara• Roopa : Karmahaani Shoola

StambhaVedana in uraha, amsa, bahu

• Upashaya : Madhura amla lavana rasa yukta aharaAlpa Vyayama.

• Anupshaya : Vata vardhaka ahara ( ruksha, sheeta, laghu, katu, tikta, kashaya)

Vata vardhaka vihara (atijagarana, vyayama, vegavidharana)

DIAGNOSIS:Apabahuka

SADHYA-ASADHYA:Kastha Sadhya

VYAVACHEDAKA NIDAN:

- Ekangavata (Monoplegia)

- Vishvachi (Radio Ulnar Neuritis)

- Apabahuka (Frozen shoulder)

- Amsa shosha

TREATMENT GIVEN:

Amapachana with Panchakola churna 10 gms twice daily with hot

water for 2 days

1) Jambeera pinda sweda

2) Nasapaana with dasamooli balamaasha kwath 7 Days

SHAMANA:1) Yogaraja Guggulu 500mg, Thrice daily after food along with

2) Prasarinyadi Ksheera Kashaya 40ml as Anupana for 45 Days.

PATHYA:

• Abyanga, svedana, mardana• Madhura amla, lavana, snigdha padartha

APATHYA:

• Vata vardhaka ahara vihara

RESULT:• Patient felt 85% improvement after 7 days of

procedures.

Assessment GM ROM readings

Right shoulder joint : BT AT

Adduction Painful NormalAbduction Painful Normal

Flexion 60 180 Elevation 50 180

Hyperextension 40 90

Dr. PRASHANTH. A. S. M.D. (Ay), (Ph.D.),

PROFESSOR

DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA

AYURVEDA MAHAVIDYALAYA, HUBLI (KARNATAKA)

Cell: 09448135575 drprashanthas@gmail.com

For further details:

Ayurveda Mahavidyalaya, Hubli

Ayurveda Mahavidyalaya, HubliAyurveda Mahavidyalaya, Hubli