A ROLE OF AYURVEDIC MANAGEMENT OF AVABAHUKA W.S.R. TO FROZEN SHOULDER (ADHESIVE CAPSULITIS)- A CASE STUDY

KEY WORDS:-  Adhesive capsulitis, Avabahuka, Frozen shoulder

An imbalance in the Vata Dosha causes Avabahuka, a condition primarily impacting the shoulder joint, also known as Amsa Sandhi. Vata Vydhi, a type of illness arising from disturbances in the Vata Dosha, classifies this disorder. Although it may not be listed among the specific diseases caused by Vata in some classical texts, renowned Ayurvedic scholar Acharya Sushruta, among others, has recognised it as a Vata-related disorder.

According to Sushruta Samhita,

“अ्ंसदशस्थितो वायु शोषवित्वम शिराश्चनकुंचया अ्ंसबंधनम्, तत्रस्थो जनयत्वबाहुकम्”

This refers to the disease known as Ansha Shosha, in which the enraged local Vayu dries up the normal Kapha around the shoulder joints, and the form known as Avabahuka, in which the aggravated local Vayu contracts the nerves of the arms. [1]

The Ansa Shosha, which can be considered the preliminary stage, is due to the single action of the enraged Vayu, while the next stage, Avabahuka, is due to the concerted action of the deranged Vayu and Kapha. The Ashtanga Hridaya and Ashtanga Sangraha depict it.

“अंसमुलस्थि, वायु सिरग संकासव तत्र, बहुस्पंदितकम ज्ञात्यपबाहुकम”

which means the condition in which the vata gets located at the root of the shoulder, by constricting the siras (veins) therein, produces Apabahuka, characterised by the loss of the movements of the arms. [2] Acharya Charaka, in the Sutra Sthana of Charak Samhita, mentioned Bahushoshal3 under Vata Nanatmaja Vyadhis, and in the Chikitsa Sthana, it was mentioned as Bahuvata. [4] In Madhava Nidana, Amsa Shosha (Vataj) and Avabahuka (Vata Kaphaj), two separate diseases are mentioned. [5]

Hetu (causes) like Vatakarak Ahara (Vata-aggravating diet), Ativyayam and menopause age, Vata Dosha (Vyana Vayu), and Aam made by Agnimandhya have built up in the Amsa Sandhi. Together with Vata Prakopa's removal of Sandhi lubrication, this caused joint constriction, which led to Shool (pain) and Stambha (stiffness), which are the main signs of Avabahuka and are typical of Vata and Kapha, respectively. In addition, Amsa Sandhi is the seat of Kapha. Therefore, we established the therapy regimen to pacify the Vata-Kapha Dosha Dushti both internally and externally, and to address the Kha Vaigunya by strengthening the joints.

➤ Abhyanga - Has Snigdha (unctuous), Guru (heavy), and Mridu (soft) properties, which reduce the vitiation of Vata thus addressing the Kshaya (decay) in the Dhatu.

► Swedana- Is very useful for symptoms such as Sankocha (contraction or flexion), Ayama (extension), Shula (pain), Stambha (stiffness), Gaurava (heavine ss), and Supti (numbness). Swedana relieves Stambha (stiffness), Gaurava (heaviness), Seeta (coldness), and induces Sweda (sweating).

➤ MANYABASTI-  Help with blood circulation. Nourishes and strengthens the neck muscles and tendons; hence, it increases the flexibility and mobility of the neck. Relieves pain, swelling, redness, and stiffness.

► Viddhakarma- The procedure involves inserting a needle into the skin. Acharya Vagbhta describes two significant aspects that occur during vata dosha ventilation: Dhatu Kshaya (degenerative pathology) and Avarana (obstructive pathology). Suchivedhana expels the vitiate dosha from the body and eliminates the Avarana of the vatadi dosha, providing immediate pain relief. Avabahuka's sampratibhanga also lessened stiffness in the subsequent repeating settings. The blockage is removed, allowing for good circulation around the shoulder joint. Sira carries Vata, Pitta, Kapha, and Rakta (doshas). When we perform Rakta (blood) through any kind of Raktamokshana, the majority of vitiated Doshas are discharged.

Suchivedan- The majority of tender sites are associated with central filaments, which are also responsible for conveying pain impulses. In Avabahuka, we disrupted the route responsible for the production of pain.

► Physiotherapy-Specific exercises will help restore mation.

► Therapy includes stretching or range of motion exercises for the shoulder.

► Sometimes heat is used to help loosen the shoulder up before the stretching exercises.

SHAMAN CHIKITSA

After panchkarma, chikitsa shaman drugs should be administered. They can be given as single drugs or compound drugs. The drugs used in this treatment are vaathar, vaatanulomak, and aam pachak.

Triphala Guggul

Is an old Ayurvedic mixture of herbs that gives you the benefits of Triphala, Pippali, and Guggulu all at once. Guggul is beneficial for reducing inflammation, while Triphala helps with detoxification and going to the toilet. When pippali is added, it gives the mixture strong stomach properties.

Punarnava Guggul

Punarnava guggul helps reduce the inflammation occurred due to Vata Dosha and also useful to promote strength of bones and joints. It acts as an excellent anti inflammatory, analgesic medicine

Vaatvidhvans

Ras-immunomodulatory and anti-inflammatory properties, which make it effective in reducing joint inflammation and pain. Tablets is made with heavy metals and works as alterative, diuretic and analgesic medicine.

Arogyavardhini vati

By improving the digestive system, Arogyavardhini vati boosts the digestive fire, clears the body's pathways for nutrients to reach the tissues, regulates fats, and eliminates toxins. By managing all three doshas, Arogyavardhini vati makes health better all around.

► Dashmul bharad kwath-

As a potent immunomodulator. Analgesic nervine, and it helps to direct the Vata doshas in the body to flow downward and alleviates most nervine disorders associated with weakness, debility and pain.

► Swadisht virechan churn- Swadishta virechan churn used as vaatanulomak and balance vata.

1. Sushruta. Sushruta Samhita (Ayurveda tatva Sandipika Hindi Vyakhya), Vol. 1. Kaviraj Ambikadutta Shastri, editor. Varanasi: Chowkhamba Sanskrit Sansthana; Edition reprint, 2014. Nidana Sthana, 1/82.p.304.
2. Vagbhata. Astanga Samgraha (English Translation) Vol. II. Translated by K.R. Srikantha Mu rthy, Varanasi: Chaukhamba Orientalia, 3rd Edition, 2003. Nidana Sthana 15/45, Pg.no 247.
3. Caraka. Caraka Samhita (Vidyotini hindi commentary). Rajeshwardatta Shashtri, Kashinath Shastri, Gorakh Nath Chaturvedi, editors. Varanasi: Chaukhamnba Bharti Academy; 2013. Sutra Sthana, 20/11.p.399.
4. Caraka. Caraka Samhita (Vidyotini hindi commentary). Rajeshwardatta Shashtri, Kashinath Shastri, Gorakh Nath Chaturvedi, editors. Varanasi: Chaukhamnba Bharti Academy; 2013. Chikitsa Sthana, 28/98.p.794.
5. Madhavkar. Madhav Nidana (Madhukosha Sanskrit commentary). Vijayarakshita and Srikantha Datta; edited with Vimala- Madhurdhara Hindi Commentary and Notes by Brahm anand Tripathi; Vol.1. Varanasi Chaukhamba Surbharati Prakashan; 2014; 22/64.p. 5 45.
6. Retrievedfrom:https://www.ncbi.n Im.nih.gov/pmc/articles/PMC1315 655/
7. Boon Nicholas A, Colledge Nicki R, Walker Brain R, Hunter John A A Davidson's Principles & Practices of Medicine. Chapter 25, Musculoskeletal Disorders. 20th ed. 2006. p.1079-1080.
8. D'Orsi GM, Via AG, Frizziero A, Oliva F. Treatment of adhesive capsulitis: a review. Muscles Ligaments Tendons J. 2012 Sep 10;2(2):70-8.PMID: 237382 77; PMCID: PMC3666515