Introduction
Avabhahuka word is derived from combination of two words ava and bhahuka – Ava means viyoga (1) i.e dysfunction or separation1 and bhahuka means arm therefore Avabhahuka means dysfunction in arm. 2
Avabhahuka is a condition caused due to vitiation of vata dosha with sthanasamshraya in the amsa pradesha and does the samkocha of siras leads to manifestation of sira samkocha and bhahu praspandana haratavam which is intimately same to the features of frozen shoulder. 3
Vata dosha is said to be and is considered as chief factor for the maintenance of the physiological maintenance of the body. Factors which leads to provoking of vata dosha results in the instantaneous manifestation of diseases which can even be fatal. The fact is that avabhahuka is one of the vata vyadhi, and is said that vata vyadhi is one among the ashta maha gada. 4
Amsa is described has one of the snayu vikalyakara marma., any injury to these marma can leads to stabdhata.5
Acharya Sushruta has described the avabhahuka vyadhi for the first time in the nidana sthana. Has described siraakunchana (contraction of tendons) is one of the common symptom in avabhahuka. Bahusosha (muscle wasting of arm) and amsabandhanashosha (contraction of shoulder ligaments) are the other symptoms mentioned in different texts. 6
Avabhahuka can be correlated to the frozen shoulder. Frozen shoulder is also known as adhesive capsulitis and is defined as “a condition of uncertain etiology characterized by significant restriction of both active and passive shoulder movement that occurs in the absence of known intrinsic shoulder disorder.7
Frozen shoulder is said to be one of the most common musculoskeletal problem which is seen in orthopaedics.8
The incidence of frozen shoulder ranges between 40 years to 60 years and is found more common in women and in manual worker.9, 10
Frozen shoulder is often seen as primary or secondary to several diseases, such as diabetes mellitus, stroke, local shoulder issue and many others as its etiology is still poorly understood. 11, 12, 13
In case of frozen shoulder the severity of pain worsens during night, insidious shoulder stiffness with near to complete loss of passive and active external rotation of the shoulder. 14
A person who is suffering from frozen shoulder undergoes three painful stages such as:
First stage: painful freezing stage: These stage is with no history of injury, pain and stiffness around the shoulder with nagging constant pain that get worsen at night.
This occurs with the duration of 10 weeks to 36 weeks with little response to NSAID (Non Steroidal Anti Inflammatory Drug).
Second stage – adhesive stage: Where the pain gradually subsides and is observed only at the extereme movements, but stiffness becomes constant and this occurs with 4 months to 12 months of duration.
Third stage – resolution stage: It is observed with spontaneous improvement in the range of movement with duration of 12 months to 24 months. It is with poor quality due to restriction of both active and passive range of shoulder movement.
The treatment modality used for the treatment of frozen shoulder are oral medication, corticosteroids, injections, exercise joint mobilization, distension, acupuncture, manipulation, nerve blocks and surgery etc. 15, 16
Nasya is one of the therapeutic procedures of panchakarma. Panchakarma is one of the specialised therapeutic application of ayurveda system of medicine which kot only cleanses the body but also deliver the drug to the target site.
Nasya is said to be the procedure where the medicated drug is introduced through the nasal route which is delivered to brain thereby acts on whole body, has it is said “ nasa hi shiraso dwaram “ nasya karma helps in delivering drugs to brain by which it helps in alleviating diseases. 17, 18
Nasya is said to be the one of the prime modality of treatment which is used in management of urdhwajatrugata vyadhi.
In ayurvedic system of medicine there are many treatment modality has been explained for the treatment of the avabhahuka among them nasya karma is said to be one of the prime modality of therapeutic treatment which is used in treatment, has it is considered as one of the prime modality in management of urdhwajatrugata vyadhi.
Nasya karma in avabhahuka helps by reducing inflammation, pain, Stiffness of the shoulder joint. Nasya also helps in stimulating the nerve block and stimulates blood vessels in head and neck region, which helps in improving the circulation and nourishment of the affected area which is especially above the clavicle. Nasya also helps in clearing the nasal passage and sinuses, which enhances the breathing and oxygenation to the body.
There are different types of nasya which can be used for the treatment of avabhahuka depending on the severity and nature of the condition of avabhahuka.
Case Study
A 60 years old male patient visited panchakarma OPD of Sindagi Shantaveereshwara Ayurvedic Medical College and hospital Haveri, Karnataka with the following details of patient name – ABC, age –60 years, sex – male, OPD no – 2314923, address– Karjagi.
Associated complaints
Numbness and weakness in right arm, pain and Stiffness in arm due to which patient is not able to perform his routine works.
Current medical history
The patient was apparently normal before gradually patient developed with pain and Stiffness from the nape of neck radiating to right shoulder joint and arm since 2years. The patient has consulted many hospitals and took allopathic treatment for about 1 ½ year has patient was not satisfied with the treatment, patient consulted to our hospital for further management.
Examination
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General examination
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Local examination
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Physical examination of right shoulder
Range of movement of shoulder joint – flexion, extension, abduction, adduction, internal rotation, external rotation are restricted and painful.
Inspection – redness, swelling, deformity are absent
Palpation – tenderness is present at right scapular region Temperature is present at right shoulder joint and elbow joint.
Spurling test – positive for right sidee
Compression test - positive for the right side
Appley’s scratch test – positive for right side
Drop arm test – positive for right side
Empty can test – positive for right side
Result
The treatmentof avabhahuka with vishnu taila in the form of nasya has effective relief or pacification of pain, stiffness and weakness of shoulder joint movement.
Table 1
Medication and therapeutics are enliste below
Discussion
Nasya with bruhat vishnu taila along with oral medication, sthanika basti and sthanika abhyanga helps in alleviating avabhahuka by alleviating vata.Bruhat vishnu taila is a medicated oil mentioned in Bhaishajya ratnavali vatavyadhi adhikara 307 – 314, cakradatta (22/113 – 120 ). The ingredients present in this oil are
Shalaparni mula – Desmodium gangeriaum
Prishnaparni mula – Uraria picta
Bala mula –Sida cordifolia
Shatavari - Aspargus racemosa
Eranda – Ricinus communis
Brihati mula – Solanum indicum
Kantakari – Solanum xanthocarpum
Putika – Holoptelia integrifolia
Garedhuka – Coix lacryma jobi
Sahachara – Strobilanthusheynianus
Tila taila – Sesanum indicum
Go Ksheera or Aja ksheera
As in the above mentioned drug majority of the drug are of ushna veerya which help pacification of vata dosha. As in case of avabhahuka the disease is caused due to vitiation of vata dosha in amsa pradesha which does Shoshana of kapha dosha. The vishnu taila is said to be the best medicine for the vata vyadhi. As avabhahuka is one of the vataja nanatmaja vyadhi which is having sthana samsraya in the urdhwajatrugata hence vishnu taila which is vatanasaka is used as nasya for avabhahuka which is one of the urdhwajatrugata vyadhi.
Conclusion
Nasya with vishnu taila in madhyama matra of 8 drops to each nostril along with greeva basti and abhyanga with masha tailaas the panchakarma procedures which act as shodhana and poshana i.e nasya karma with vishnu taila helps in the elimination of vitated dosha, basti karma in the form of greeva basti with masha taila helps in alleviating pain, stiffness of greeva pradesha. Shiro and greeva abhyanga helps in relieve and alleviating to patient.
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