BY BY

Dr. Raviganesh. M Dr. Raviganesh. M B.A.M.S. B.A.M.S.

(R.G.U.H.S, Bangalore) (R.G.U.H.S, Bangalore)

Dissertation submitted to Dissertation submitted to

Rajiv Gandhi University of Health sciences, Karnataka, Bangalore Rajiv Gandhi University of Health sciences, Karnataka, Bangalore in partial fulfillment in partial fulfillment

of the requirements for the degree of of the requirements for the degree of “Ayurveda Vachaspati” (M.D) “Ayurveda Vachaspati” (M.D)

in in

KAYACHIKITSA KAYACHIKITSA GUIDE Co-GUIDE GUIDE Co-GUIDE Prof. Pramod Kumar Mishra Dr. Banamali Das Prof. Pramod Kumar Mishra Dr. Banamali Das

M.D. (Ayu),(RSU) M.D. (Ayu) M.D. (Ayu),(RSU) M.D. (Ayu)

Head of the Department Kayachikitsa Department of Roga Nidana Head of the Department Kayachikitsa Department of Roga Nidana and VikruthiVignana and VikruthiVignana

DEPARTMENT OF POSTGRADUATE STUYDIES IN KAYACHIKITSA DEPARTMENT OF POSTGRADUATE STUYDIES IN KAYACHIKITSA A.L.N RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE, KOPPA-577126 A.L.N RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE, KOPPA-577126

CHICKMAGALUR DISTRICT, KARNATAKA, INDIA CHICKMAGALUR DISTRICT, KARNATAKA, INDIA

MARCH-2006 MARCH-2006

A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur

Department of Post Graduate Studies in KAYACHIKITSA

Declaration

I here by declare that this dissertation entitled Management of

Apabahuka with ‘Laghumasha taila nasya’ and ‘Ekanga veera rasa’ is a

bonafide and genuine research work carried out by me under the guidance

of Dr.Pramod Kumar Mishra, Department of Post Graduate Studies in

Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P. G.

Centre, Koppa.

Date:

Place: Koppa

Dr.Raviganesh.M P.G.Scholar, Dept. of Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur

Department of Post Graduate Studies in KAYACHIKITSA

Certificate

This is to certify that the dissertation entitled Management of

Apabahuka with ‘Laghumasha taila nasya’ and ‘Ekanga veera rasa’ is a

bonafide research work done by Dr. Raviganesh.M in partial fulfillment of

the requirement for the degree of Ayurveda Vachaspati (M.D.) in Kayachikitsa, of Rajiv Gandhi University of Health Sciences, Bangalore,

Karnataka.

Date:

Place: Koppa

Guide:Prof.Pramod Kumar Mishra

M.D. (Ayu) (RSU)

Head of the Department P.G. Studies in Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur

Department of Post Graduate Studies in KAYACHIKITSA

Certificate

This is to certify that the dissertation entitled Management of

Apabahuka with ‘Laghumasha taila nasya’ and ‘Ekanga veera rasa’ is a

bonafide research work done by Dr. Raviganesh.M in partial fulfillment of

the requirement for the degree of Ayurveda Vachaspati (M.D.) in

Kayachikitsa of Rajiv Gandhi University of Health Sciences, Bangalore,

Karnataka.

Date:

Place: Koppa

Co-Guide:Dr.Banamali Das M.D. (Ayu) Department of Roga Nidana and Vikruti Vignana A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

A.L.N.Rao Memorial Ayurvedic Medical College, Koppa – 577126 Dist: Chikmagalur

Department of Post Graduate Studies in KAYACHIKITSA

Endorsement

This is to certify that the dissertation entitled Management of

Apabahuka with ‘Laghumasha taila nasya’ and ‘Ekanga veera rasa’ is a

bonafide research work done by Dr. Raviganesh.M under the guidance of

Prof. Pramod Kumar Mishra, Department of Post Graduate Studies in

Kayachikitsa, A.L.N. Rao Memorial Ayurvedic Medical College and P.G.

Centre, Koppa.

Date:

Place: Koppa

Dr.Jagadeesh Kunjal M.D. (Ayu)

Principal, A.L.N.Rao Memorial Ayurvedic Medical College, Koppa –577126, Dist: Chikmagalur

COPYRIGHT

I here by declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this

dissertation in print or electronic format for academic/research purpose.

Date:

Place: Koppa

Dr. Raviganesh.M

P.G.Scholar, Dept. of Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College, Koppa – 577 126

© Rajiv Gandhi University of Health Sciences, Karnataka

INDEX Page No.

INRODUCTION 1-3

Chapter - I OBJECTIVES 4

Chapter - II REVIEW OF LITERATURE

A) Disease review 5-57

Historical review 5

Nirukti 6

Rachana 7-16

Nidana 17-20

Samprapti 21-25

Poorvaroopa 26

Roopa 27-34

Upashaya, Anupashaya, Sadhyaasadyata 34

Upadrava 35

Sapeksha Nidana 36-37

Sadhyasadhyada 38

Chikitsa 39-54

Pathya apathya 55-57

B) Drug Review 58-69

Chapter - III METHODOLOGY 70-88

A) Materials and Methods 70-76

B) Observations 77-88

Chapter - IV RESULTS 89-110

Chapter - V DISCUSSION 111-122

Chapter - VI CONCLUSION 123

SUMMARY 124-125

REFERENCES

BIBLIOGRAPHY

ANNEXURES

Tables

Sl.No: List of Tables Page No:

1 Showing Muscles bringing about movements at the shoulder

joint.

14

2 Nidanas of Vatavyadhi and Vata prakopa vis-à-vis

Apabahuka.

17-19

3 Showing Sapeksha/ Vyavachedaka nidanas of Apabahuka. 37

4 Showing Nasya matra 45

5 Showing Patyaapatya. 56-57

6 Age wise distribution of 45 patients of Apabahuka. 77

7 Sex wise distribution of 45 patients of Apabahuka. 78

8 Religion wise distribution of 45 patients of Apabahuka. 79

9 Occupation wise distribution of 45 patients of Apabahuka. 80

10 Marital state wise distribution of 45 patients of Apabahuka. 81

11 Socio- economic status wise distribution of 45 patients of

Apabahuka.

82

12 Dietary pattern of 45 patients of Apabahuka. 83

13 Family history of 45 patients of Apabahuka. 84

14 General Nidana observed in 45 patients of Apabahuka. 85

15 Main symptoms observed in 45 patients of Apabahuka. 86

16 Associated symptoms observed in 45 patients of Apabahuka. 87

17 Sroto dusti lakshana observed in 45 patients of Apabahuka. 88

18 Effect of Shodhana on main symptoms of Apabahuka in 15

patients after treatment.

89

19 Effect of Shodhana on main symptoms of Apabahuka in 15

patients after follow up.

89

20 Effect of Shodhana on Associated symptoms of Apabahuka

in 15 patients after treatment.

90

21 Effect of Shodhana on Associated symptoms of Apabahuka

in 15 patients after follow up.

91

22 Effect of Shodhana on Sroto dusti lakshanas of Apabahuka

in 15 patients after treatment.

91

23 Effect of Shodhana on Sroto dusti lakshanas of Apabahuka

in 15 patients after follow up.

92

24 Effect of Shamana on main symptoms of Apabahuka in 15

patients after treatment.

93

25 Effect of Shamana on main symptoms of Apabahuka in 15

patients after follow up.

93

26 Effect of Shamana on Associated symptoms of Apabahuka

in 15 patients after treatment.

94

27 Effect of Shamana on Associated symptoms of Apabahuka

in 15 patients after follow up.

95

28 Effect of Shamana on Sroto dusti lakshanas of Apabahuka in

15 patients after treatment.

95

29 Effect of Shamana on Sroto dusti lakshanas in 15 patients of

Apabahuka after follow up.

96

30 Effect of Shodhanashamana on main symptoms in 15 patient

of Apabahuka after treatment.

97

31 Effect of Shodhanashamana on main symptoms of

Apabahuka in 15 patients after follow up.

97

32 Effect of Shodhanashamana on Associated symptoms of

Apabahuka in 15 patients after treatment.

98

33 Effect of Shodhanashamana on Associated symptoms of

Apabahuka in 15 patients after follow up.

99

34 Effect of Shodhanashamana on Sroto dusti lakshanas of

Apabahuka in 15 patients after treatment.

99

35 Effect of Shodhanashamana on Sroto dusti lakshanas of

Apabahuka in 15 patients after follow up.

100

36 Total effect of Shodhana therapy on 15 patients of

Apabahuka after treatment.

101

37 Total effect of Shodhana therapy on 15 patients of

Apabahuka after follow up.

101

38 Total effect of Shamana therapy on 15 patients of

Apabahuka after treatment.

102

39 Total effect of Shamana therapy on 15 patients of

Apabahuka after follow up.

102

40 Total effect of Shodhana shamana therapy on 15 patients of

Apabahuka after treatment.

103

41 Total effect of Shodhanashamana therapy on 15 patients of

Apabahuka after follow up

104

Charts and Graphs

Sl.No: List of Charts Page No:

1 Schematic Representation of samprapti of Apabahuka. 24

2 Marmaabhigata Apabahuka Samprapti. 25 3 Nasya - Classification according to Charaka 44 4 Nasya -Classification according to Vagbata 44

5 Probable mode of action of Nasya. 53

List of Graphs

6 Age wise distribution of 45 patients of Apabahuka. 77

7 Sex wise distribution of 45 patients of Apabahuka. 78

8 Religion wise distribution of 45 patients of Apabahuka 79

9 Occupation wise distribution of 45 patients of Apabahuka 80

10 Marital state wise distribution of 45 patients of Apabahuka 81

11 Socio-economic status wise distribution of 45 patients of

Apabahuka

82

12 Dietary pattern of 45 patients of Apabahuka. 83

13 Family history of 45 patients of Apabahuka. 84

14 General nidana observed in 45 patients of Apabahuka. 85

15 Main symptoms observed in 45 patients of Apabahuka. 86

16 Associated symptoms observed in 45 patients of

Apabahuka

87

17 Sroto dusti lakshana observed in 45 patients of Apabahuka 88

18 Comparative effect of therapies on main symptoms of

Apabahuka after 30 days, of treatment

105

19 Comparative effect of therapies on main symptoms of

Apabahuka after 30 days, after follow up.

105

20 Comparative effect of therapies on Associated symptoms

of Apabahuka after 30 days, after treatment.

106

21 Comparative effect of therapies on Associated symptoms

of Apabahuka after 30 days, after follow up.

107

22 Comparative effect of therapies on Sroto dusti lakshana of

Apabahuka after 30 days, after therapy.

107

23 Comparative effect of therapies on Sroto dusti lakshana of

Apabahuka after 30 days, after follow up

108

24 Comparitive effect of overall therapies on Apabahuka after

treatment.

108

25 Comparative effect of over all therapies on Apabahuka

after follow up

109

ABBREVIATIONS

A.H.Chi. Astanga Hridaya Chikitsasthana.

A.H.Ni. Astanga Hridaya Nidanasthana.

A.H.Su Astanga Hridaya Suthrasthana.

Amar. Amarakosha.

A.N. Anjana Nidana.

A.S.Su. Astanga Sangraha Sutrasthana.

A.S.Chi. Astanga Sangraha Chikitsasthana.

Ay.Ras. Ayurveda Rasashastra.

B.N.R. Brhat Nigantu Ratnakara.

B.P.N. Bhava prakasha Nigantu.

Cha.Chi. Charaka Samhita Chikitsasthana.

Cha.Ni. Charaka Samhita Nidanasthana.

Cha.Su. Charaka Samhita Suthrasthana.

Cha.Si Charaka Siddi.

Chau. Ana. Chaurasia Anatomy.

Hari. Harisson,s principle of Internal Medicine.

Ma.Ni. Madhava Nidana.

N.S. Nibandha Sangraha.

P.V.S. P.V.Sharma.

S.E.D. Sanskrit English Dictionary.

S.K.D. Sanskrit Kannada Dictionary.

S.E.D.M.W M Sanskrit English Dictionary Monier William.

Su.Chi. Sushruta Samhita Nidanasthana.

Su.Chi. Sushruta Samhita Chikisthana.

Su.Su. Sushruta Samhita Suthrasthana.

Su.Sha. Sushruta Samhita Shareerasthana.

Su.U. Sushruta Samhita Uttaratantra.

Tora Ana Tortora Anatomy and Physiology.

V.S. Vangasena Samhita.

Vach. Vachaspati.

Y.R Yoga Ratnakara.

ABSTRACT

Apabahuka is one of the vatavyadhi, which affects the normal function of the

upper limb. Even though this disease it being a life threatening one, it hampers daily

activity of the person. It is a neurological as well as musculo-skeletal disorder,

cardinal features being restricted movements of the shoulder joints and shoola.

Objectives:

The objectives of the present study are-

1. Management of Apabahuka with the trial drugs- “Laghumasha taila

and Ekanga veera rasa”.

2. To establish an effective treatment with the trial drugs for Apabahuka.

3. To asses the merits and demerits of the trials drugs.

4. To compare the efficacy of Laghumasha taila nasya & Ekanga veera

rasa individually and in combined form.

5. Detailed study of the disease covering classical and modern literature.

6. Study of the trial drugs covering classical literature.

Methodology:

Total 45 patients who fulfilled the inclusion criteria was randomly selected for

the study. The patients were grouped in to three groups.

Shodhana group – Laghu masha taila marsha nasya for 7 days.

Shamana group – Ekanga veera rasa 125mg B.D after food with ushna

jala.

Shodhana Shamana group - Laghu masha taila marsha nasya for 7 days

and Ekanga veera rasa 125 mg B.D after food with ushna jala.

Interpretation and results:

At the end of treatment schedule of 30 days the results were collected

and statistically analyzed. It was found that shodhana shamana group

gave highly significant relief (p<0.001) in the management of

Bahupraspandita hara and shoola. Shamana group provided moderate

significant results and Shodhana group provided moderate significant

result in Bahupraspandita hara and mild significant result in Shoola.

Conclusion:

Laghu masha taila have brihmana effect when used as marsha nasya

brought out moderate significant result in Bahupraspanditahara and

mild significant relief in Shoola.

Ekanga veera rasa showed moderate significance in decreasing Shoola

and Bahupraspandita hara but sustained relief was not seen.

Combined therapy showed highly significant relief in

Bahuprspanditahara and Shoola.

ACKNOWLEDGEMENT

It is with the great pleasure I wish to express my profound gratitude to all those who

helped me to bringing out this dissertation. I am ever indebted to my parents whose blessing,

encouragement, affection and moral support helped me to complete my work.

I am ever grateful to Prof. Pramod Kumar Mishra. MD (Ayu), HOD, Dept. of Kaya

Chikitsa, Postgraduate centre, A.L.N Rao Memorial Ayurvedic Medical College, Koppa. for his

complete guidance, meticulous supervision, motivation and constant support that he extended

through out the course of work.

I am very thankful to Dr. Banamali Das MD (Ayu) for his constant supervision, valuable

advises, constructive discussions with out which my study would have been incomplete.

I am grateful to Aroor Ramesh Rao, President, Aroor trust Koppa, for giving me a chance

to pursue my post-graduate studies in his esteemed institution.

My enormous thanks to Dr. Jagadeesh Kunjal MD (Ayu), Principal, A.L.N Rao

Memorial Ayurvedic Medical College, Koppa, for his help and support in completing this work.

My sincere gratitude to Prof. D.S Lucas MD (Ayu), FRAS (Londan), FRAV (India), for

his motivational inspiration and support.

I am awfully thanking Dr. P.K Narayana Sharma for his valuable suggestions during my

synopsis work.

I show gratitude to Dr. T.K Mohanta MD (Ayu), Ph.D and Dr. Reshmi Rekha Mishra

MD (Ayu), Dr. C.B Singh. MD (Ayu) for their constant motivation during this work.

My sincere thanks to Statistician, Dr. Shyamalan, Dr. Christy Thundiparambil for

helping me in the statistical analysis.

My special thanks to Dr. Dinesh Kumar Mishra MD (Ayu) and Dr.Galib. MD (Ayu),

Dept. of Rasa shastra and Bhaishajya Kalpana, for their factual support and co-operation in

preparation of medicine.

I also take opportunity to thank Mr. Mathew and Mr. Nithyanand, Miss.Violet for

assisting in the preparation of medicine.

I am thanking Dr. Ramesh N.V. whose constant support was an asset for me in the

completion of this work.

I am ever grateful to Dr. Sanjaya K.S. MD (Ayu), Dr. Pradeep H.R MD (Ayu),

Dr. Sridhar.V. MD (Ayu), Dr. Radhakrishana, Botanist; for their constructive suggestions for the

completion of this dissertation.

I am great full to Dr. Rajesh Kumar MD (Ayu), Dr. Sathish Sringeri MD (Ayu), for their

kind support. My sincere gratitude to Dr. Ramohan, Dr.Lalitha Bhaskar and Dr. Abhinetri Hegde

for their priceless support throughout the clinical study.

I am thankful to Miss. Amruta for helping in laboratory investigations. I am thankful to

Mrs. Triveni and Miss. Manjula, Librarian, for their support in the reference work.

It is with immense amicability I express my gratitude to Dr. Sarat. K. Babu, Dr. James

Chacko, Dr. Partthasarathi, Dr.Ratheesh. P. Nair, Dr.Dayanand R.D, Dr. Guruprasad,

Dr. Harihara Prasad.

With amicable gratitude I thank Dr. Purushotham K.G and Dr. Harvin George. N for

providing me the technical support.

I express my deep gratitude to my seniors Dr. Anil Varkey, Dr. Srinivas, Dr. Prasanth

Bhat, Dr. Pradeep K.V, Dr.Shivakumar, and Dr. Leeladhar. Dr. Rakesh, Dr. Indu, Dr. Clarence

for their support in every aspect of my work.

I am also thankful to my colleagues Vijayendra, Prathibha, Pradeep, Kishore, Sanjeev,

Prashanth, Pankaj, Binu, Roshy, Vishwanath, Kavitha, Suja.

I am also thankful to Sandesh Shetty, Susheel Shetty, Raghuram for their moral support.

I am thankful to all my junior PG scholars, House surgeons, and UG students who helped

me during this work.

I will be grateful to all my patients with out whom achievement of this work would have

been impractical.

Finally thanks to all those people who helped me directly and indirectly to complete this

exposition.

I dedicate this thesis with sweet memories, to my beloved mother Late. Mrs.Lalitha.

Date :

Place : Koppa. Dr. Raviganesh.M.

Introduction

INTRODUCTION

The entire vedic tradition is composed of highly spiritual wisdom and pure

knowledge revealed through the hearts of enlightened Rishis. It is not a creation made

by man but rather unfolded in the hearts of meditative minds. This ancient wisdom

came from the caves and mountains of India where the Sages and Seers had their

ashrams and disciples.

The knowledge of Ayurveda has been passed down to us in sootras or small

phrases and the wisdom they contain is to be unlocked by the enquiring mind. The

knowledge contained in it deals with the nature, scope and purpose of life. It embraces

both the meta-physical and physical, health and disease, happiness and sorrow, pain

and pleasure. It defines life as the expression of cosmic consciousness as exemplified

by the entire sphere of creation. Stated simply, the purpose of life is to know or realize

the creator and to express this divinity in one’s daily life.

“Change is constant” this is a confirmed principle of life from time

immemorial and noted social economists have clarified the fact that rate of change

accelerated much faster in the past 50 years compared to last 2,000 to 3,000 years.

The change has resulted in an acute social upheaval all around the world, ultimately

resulting in the present day’s reality of globalization. As a result there has been a

drastic economic industrial revolution that has caused unprecedented life style

changes which society has not been able to confront to with ease.

In Ayurveda, we deal with diseases and their treatments and give importance

to the preventive aspects. It is obtained by attaining the equilibrium of doshas and any

violence of this hampers the healthy state.

Page : 1

Introduction

Dosha, Dhatu and Mala are considered as the responsible factors for the

normal maintenance of health. When these factors derange, they produce several

types of diseases in the body. Among the above, these tridoshas play an important role

as they are prime factors to be involved in the either stages i.e., Swastha and

Aswastha of the body. These tridoshas vitiate in different ways, under different

pathological conditions of the body and manifest several diseases. Vata is a dosha

which also helps the other two doshas for the manifestation of different vikaras. As

vata plays a pivotal role in the maintenance of equilibrium, it is considered to be

superlative to the other doshas.

Generally, in the body vata is considered as a chief factor for physiological

maintenance. So factors provoking it results in instantaneous manifestation of

diseases, which can prove even fatal. There fore vataja nanatmaja vyadhis have

utmost importance than the vyadhis produced by other two doshas. Contradictory

approaches to pacify this vitiated state have to be resorted to maintain the equilibrium.

In the modern point of view under vata vyadhi, the diseases involving

neurological, musculo-skeletal, psychosomatic and gastro-intestinal system disorder

can be considered. It indicates the wide-ranging involvement of vata in various

systems of body.

Economy of country relies on its work force. Apabahuka is one of such

disease which hampers the day to day activity of an individual. The fact that Vata

vyadhi is one amongst the asta-maha gada makes it self-explanatory regarding the

consequences caused by Apabahuka. Even though a definite factor responsible for the

manifestation of this disease is not mentioned, however a set of etiological factors can

be interpreted. On analyzing etio-pathology, it may be interpreted that the disease

Apabahuka manifest due to the dhatu kshaya as well as samsrusta dosha.

Page : 2

Introduction

Apabahuka is considered as a disease that affects usually the amsa sandhi and

is produced by the vata dosha. Even though the term Apabahuka is not mentioned in

the nanatmaja vata vyadhi, Acharya Susruta and others have considered Apabahuka as

a vata vyadhi. In Madhava nidana two conditions of the disease has been mentioned –

Amsa shosha and Apabahuka. Amsa shosha can be considered as the preliminary

stage of the disease where loss or dryness of Sleshaka kapha from amsa sandhi

occurs. In the next stage i.e., Apabahuka, due to the loss of shleshaka kapha

symptoms like shoola during movement, restricted movement etc are manifested.

While commenting on these in Madhukosha teeka it is mentioned that Amsa shosha is

produced by dhatu kshaya i.e., sudha vata janya and Apabahuka is vata kapha janya.

Considering these facts an attempt is made to study the disease Apabahuka in

detail and to counter act the disease process by adopting suitable therapies.

Vata vyadhis can be relived by therapies like Abhayanga, Swedana, Sneha

pana, Nasya karma, Vasti karma and shamana oushadhis like vata shamaka oushadhi

sevana. In the present study nasya karma with Laghu masha taila and shamana

oushadhi Ekanga veera rasa are advised to the patients of Apabahuka, comprising of

three different groups. In the first group i.e., Shodhana group, Laghu masha taila

nasya, is advised in the form of marsha nasya. In the second group i.e., shamana

oushadhi group, Ekanga veera rasa 125 mg b.d is advised which contains vata kapha

shamaka and nadi balya karaka dravyas. And in the third group i.e shodana shamana

group, both Laghu masha taila nasya and Ekanga veera rasa is advised.

Page : 3

Objectives

OBJECTIVES

The objectives of the present study are-

1. Management of Apabahuka with the trial drugs- “Laghumasha taila

and Ekanga veera rasa”.

2. To establish an effective treatment with the trial drugs for Apabahuka.

3. To asses the merits and demerits of the trials drugs.

4. To compare the efficacy of Laghumasha taila nasya & Ekanga veera

rasa individually and in combined form.

5. Detailed study of the disease covering classical and modern literature.

6. Study of the trial drugs covering classical literature.

Hypothesis:

1. Null hypothesis - Laghumasha taila nasya and Ekangaveera rasa

individually or in combinations does not have any effect on

Apabahuka.

2. Alternate hypothesis - Laghumasha taila nasya and Ekangaveera rasa

administered individually and in combined form in cases of

Apabahuka has Apabahukahara property.

Page : 4

Disease Review

DISEASE REVIEW

HISTORICAL REVIEW:

The Vedas:

In the Vedas the references related to vata vyadhi are not found. Yajurveda

Rudra sookta mentions about Dasha vatas. These are prana, vyana, udana, samana,

apana, naaga, krakara, kurma,devadatta and dananjaya. The word Apabahuka

denoting a disorder is never found in the elaborate text of Vedas.

Samhita:

Samhita that are adjunct to the Vedas are the key source of every existing

principles of Ayurveda. Out of which Charaka samhita considered to be epitome of

knowledge. In Charaka samhita there is no direct reference regarding the disease

Apabahuka. But he gives the reference regarding the disease Bahushosha in sutra

sthana.1

In Sushruta samhita samprapti, lakshana and chikitsa has been discussed in detail.

In Astanga sangraha a complete description regarding the disease has been dealt.

In Anjana nidana explanation regarding Apabahuka has been given

Transitional period:

Many commentators like Arunadatta, Dalhana, Hemadri have tried to analyze

Apabahuka.

Compilation period:

Madava nidana, Yogaratnakara, Vangasena samhita explained Apabahuka in

Vata vyadhi chapter. Madavakara was the first to differentiate Apabahuka from

Amsashosha. Other authors like Bhavamishra, Sarangadara have discussed

Apabahuka.

Page : 5

Disease Review

The modern period:

The recent text like Gadanigraha, Brihatnigantu ratnakara, Nidana sara

explained Apabahuka.

NIRUKTI AND PARIBHASHA:

Before proceeding to Apabahuka it is better to deal with the nirukti and paribhasha of

Vata vyadhi as it is one of the vata vyadhi -

“Vikrita vata janito asadharana vyadhi vata vyadhi2”

Extra- ordinary disease resulting from vikrita vata is known as vata vyadhi.

Apabahuka comprises of two words 'Apa' and 'Bahuka'.

APA means

a) Viyoga, vikratou3

Viyogaou means dysfunction, separation4

b) Upasarga vishesha, Bhramsa, Vairoopyam, Tyaga iti durgadasa

c) Apakristarthah, viyoga, viparyaya, vikruti, chourya iti medini5

d) Bhramsa apa shabdasyat, that is dislocation6

'Ava' used as alternate for 'Apa' in some texts gives the following meaning.

a) ‘Ava’ as a prefix to verbs and verbal norms that express of, away or down.7

Thus in the present context the 'Ava' or ‘Apa’ can be taken as deterioration or

dysfunction.

The word 'Bahuka' means,

a) Bahuka - Muscular gender

b) Bahu - Bahu prabahu cha koorparasya urdhwadha bhagou iti

(Vishnupurana)

Page : 6

Disease Review

Thus Apabahuka can be defined as,

i) Bahustambho Apabahuka8

ii) Bad arm, stiffness in the arm joint7

To summarize the above discussion and considering the relevant clinical

feature, the term Avabahuka or Apabahuka would mean "dysfunction of bahu

(stiffness or disability in the arm) i.e, bahu praspanditahara.

AMSA SANDHI SHAREERA VIVECHANA:

This is a major joint of upper limb. This is one type of chala9 and ulookhala

sandhi.10 This is formed by the combination of pragandasthi, akshakasthi and

amsaphalakasthi.

Pratanavat types of snayus cover this sandhi11

Shleshmadhara kala is presents in this joint and secretes Shleshaka kapha.12

This acts as lubricant and helps in protection and movement of the sandhi.13

Amsamarma is present near this sandhi. A brief explanation of it can be done as

follows.

The word Amsa denotes a specific area of the shoulder. The Amsa marma is

situated within the line of the area joining head (murdha), neck (greeva) and the arm

(bahu). This is a Snayu marma measuring to a length of half finger's width (1 cm) 14

This Marma is located on the Amsa that is formed by the union of Amsa

peetha (glenoid) and the Skanda (acromio clavicular joint).

The physical matrix that are present in Amsa marma are mamsa, sira, snayu,

sandhi and asthi.15 But it is a Snayu marma.16

As it is one of Vaikalyakara marma, any trauma to this will produce disability

or deformity of the shoulder joint.17

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Disease Review

ANATOMY OF THE SHOULDER JOINT: 18, 19

This is a synovial joint of the ball and socket variety.

Articular surface - The joint is formed by articulation of the scapula and the head of

the humerus. Therefore, it is also known as the gleno humeral articulation.

Structurally it is a weak joint because the glenoid cavity is too small and

shallow to hold the head of the humerus in the place. (The head is four times the size

of glenoid cavity). However, this arrangement permits great mobility. Stability of the

joint is maintained by the following factors.

1) The coracoacromial arch or secondary socket for the head of the

humerus.

2) The musculotendinous cuff of the shoulder.

3) The glenoid labrum helps in deepening the glenoid fossa. Stability is also

provided by the muscles attaching the humerus to the pectoral girdle, the long

head of the biceps, the long head of the triceps and atmospheric pressure.

Ligaments of the Joint:

1) The Capsular Ligament - It is very loose and permits free movements. It is

least supported inferiorly where dislocations are common. Such a dislocation may

damage the closely related axillary nerve.

Medially the capsule is attached to the scapula beyond the supraglenoid

tubercle and the margins of the labrum. Laterally, it is attached to the anatomical

neck of the humerus with the following exceptions. Inferiorly the attachment extends

down to the surgical neck. Superiorly it is deficient for passage of the tendon of the

long head of the biceps brachii. The joint cavity communicates with subscapular

bursa, with the synovial sheath for the tendon of the long head of the biceps brachii,

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Disease Review

and after with the infraspinatus bursa. Anteriorly, the capsule is reinforced by 3

supplemental bands called the superior, middle and inferior glenohumeral ligaments.

An extension of this membrane forms a tubular sheath for the tendon of the long head

of the biceps.

The coracohumeral ligament - it extends from the root of the coracoid process to the

neck of the humerus opposite the greater tubercle. It gives strength to the capsule.

Transverse humeral ligament - It bridges the upper part of the bicipital groove of the

humerus (between the greater and lesser tubercle). The tendon of the long head of the

biceps brachii passes deep to the ligament.

The Glenoidal labrum - It is a fibrocartilaginous rim which covers the margins of the

glenoid cavity, thus increasing the depth of the cavity.

Bursae related to the shoulder joint:

1) The subacromial (subdeltoid) bursa

2) The subscapularis bursa, communicates with the joint cavity.

3) The infraspinatus bursa, may communicate with the joint cavity

4) Several other bursae related to the coraco brachialis, teres major, long head

of the triceps, latissimus dorsi, and the coracoid process are present.

Relations:

• Superiorily - coracoacromial arch, subacromial bursa,

supraspinatus and deltoid.

• Inferiorly - long head of the triceps

• Anteriorly - subscapularis, coracobrachialis, short head of

biceps and deltoid.

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Disease Review

• Posteriorily - Infraspinatus, teres minor and deltoid, within the

joint - tendon of the long head of the biceps brachii.

Blood Supply:

• Anterior circumflex humeral artery

• Posterior circumflex humeral artery

• Suprascapular artery

• Subscapular artery

Nerve Supply:

• Axillary nerve

• Musculocutaneous nerve

• Suprascapular nerve

Movements at the Shoulder Joint:

The shoulder joint enjoys great freedom of mobility at the cost of stability.

There is no other joint in the body which is more mobile than the shoulder. This wide

range of mobility is due to laxity of its fibrous capsule, and the large size of the head

of the humerus as compared with the shallow glenoid cavity. The range of

movements is further increased by concurrent movements of the shoulder girdle.

Movements of the shoulder joint are considered in relation to the scapula

rather than in relation to the sagittal and coronal planes. When the arm is by the side

(in the resting position) the glenoid cavity faces almost equally forwards and laterally

and the head of the humerus faces medially and backwards Keeping these directions

in mind, the movements are analysed as follows.

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Disease Review

1) Flexion and extension - During flexion the arm moves forwards and medially and

during extension, the arm moves backwards and laterally. These flexion and

extension take place in a plane parallel to the surface of the glenoid cavity.

2) Abduction and adduction takes place at right angles to the plane of flexion and

extension (i.e., approximately midway between the sagittal and coronal planes).

In abduction, the arm moves anterolaterally away from the trunk. This movement

is in the same plane as that of the body of the scapula.

3) Medial and lateral rotation is best demonstrated with a midflexed elbow. In this

position, the hand is moved medially in medial rotation, and laterally in lateral

rotation of the shoulder joint.

4) Circumduction is a combination of different movements as a result of which the

hand moves along a circle.

The range of any movement depends on the availability of an area of free articular

surface on the head of the humerus. It may be noted that the articular area on the

head of the humerus is four times larger than that of the glenoid cavity.

Muscles Producing Movements:

1) Flexion is brought about-

a) Mainly by the clavicular part of the pectoralis major, the anterior fibres

of the deltoid, and the coracobrachialis and

b) Is assessed by the short head of the biceps. A fully extended arm is

Chiefly flexed by the sternocostal part of the pectoralis major.

2) Extension

a) In the resting position extension is brought about by the posterior

fibres of the deltoid and by the teres major.

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Disease Review

b) A fully flexed arm is brought back to the plane of the body by the

latissimus dorsi and sternocostal part of the pectoralis major.

3) Abduction of the arm is brought about by the deltoid, the supraspinatus, the

serratus anterior and the upper and lower fibres of the trapezius. In the initial stages

of abduction the deltoid exerts an upward pull on the head of the humerus. This is

counteracted by a downward pull produced by the subscapularis, the infraspinatus and

the teres minor (thus avoiding upward displacement of the humerus).

Thus the deltoid and these three muscles constitute a couple which permits

true abduction in the plane of the body of the scapula. The supraspinatus assists in

bringing about and maintaining the movement, but its precise role is controversial.

The serratus anterior and the trapezius increase the range of abduction considerably

by rotating the scapula so that the glenoid cavity faces upwards.

4) Abduction is brought about;

a) Mainly by the pectoralis major and the latissimus dorsi

(b) Is assisted by the teres major, the coracobrachialis, the short head of

the biceps and the long head of the triceps.

5) Medial rotation is produced by the pectoralis major, the anterior fibres of the

deltoid, the latissimus dorsi and the teres major; when the arm is by the side, the

movement is also assisted by the subscapularis.

6) Lateral rotation is produced by the posterior fibres of the deltoid, theinfraspinatus

and the teres minor.

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Disease Review

Analysis of Abduction at the Shoulder - Abduction at the shoulder occurs through 180

degrees. The movement takes place partly at the shoulder joint and partly at the

shoulder girdle (forward rotation of scapula around the chest wall). The humerus and

scapula move in the ratio of 2:1 throughout abduction, for every 15 degrees of

elevation, 10 degrees occur at the shoulder joint and 5 degrees are due to movement

of the scapula. Rotation of the scapula is facilitated by movements at the

sternoclavicular and acromioclavicular joint.

The articular surface of the head of the humerus permits abduction of the arm

only upto 90 degrees. At the limit of this movement, there is lateral rotation of the

humerus and the head of the bone comes to lie deep to the coraco-acromial arch.

Abduction is initiated by the supraspinatus, but the deltoid is the main abductor. The

scapula is rotated by combined action of the trapezius and serratus anterior.

THE BRACHIAL PLEXUS:18

The plexus consists of roots, trunks, divisions and cords.

a) Roots: These are constituted by the anterior primary rami of spinal nerves (5,

6, 7, 8) and T1 with contributions from the anterior rami of C4 and T2. The

origin of the plexus may shift by one segment upward or downward, resulting

in a prefixed or postfixed plexus respectively. In a prefixed plexus the

contribution by C4 is large and that form T2 is often absent. In a postfixed

plexus the contribution by T1 is large, T2 is always present, C4 is absent, and

C5 is reduced in size. The roots join to form trunks as follows.

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Disease Review

Table No: 1

Showing muscles bringing about movements at the shoulder joint:

Movements Main muscles Accessory muscles

Flexion Clavicular head of the

pectoralis major, Anterior

fibres of deltoid

Coracobrachialis,

Short head of biceps,

Sternocostal head of

the pectoralis major

Extension Posterior fibers of deltoid,

Latissimus dorsi

Teres major,

Long head of triceps

Adduction Pectoralis major,

Latissimus dorsi

Teres major,

Coracobrachialis,

Short head of biceps,

Long head of triceps

Abduction Deltoid, Supraspinatus

Serratus anterior,

Upper and lower fibres of

trapezius

Medial rotation Pectoralis major, Anterior

fibres of deltoid

Latissimus dorsi

Teres Major

Subscapularis

Lateral rotation Posterior fibres of deltoid

Infraspinatus

Teres minor

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Disease Review

2) Trunks

Roots C5 and C6 join to form the upper trunk

Root C7 forms the middle trunk

Roots C8 and T1 join to form the lower trunk

3) Divisions of the trunks : Each trunk divides into ventral and dorsal divisions (which

ultimately supply the anterior and posterior aspects of the limb). These divisions join

to form cords as follows.

Cord:

i) The lateral cord is formed by the union of the ventral divisions of the upper

and middle trunks

ii) The medial cord is formed by the ventral division of the lower trunk

iii) The posterior cord is formed by union of the dorsal divisions of all the three

trunks.

Branches of the Plexus for the Upper Limb

The root value of each branch is given in brackets

a) Branches of the roots

i) Nerve to serratus anterior (long thoracic nerve) (C5,6,7)

ii) Nerve to rhomboids (Dorsal scapular nerve) (C5)

b) Branches of the trunks, these arise only from the upper trunk which gives 2

branches

i) Suprascapular nerve (C5,6)

ii) Nerve to subclavius (C5,6)

c) Branches of the Cords - Branches of Lateral cord

i) Lateral pectoral (C5,6,7)

ii) Musculocutaneous (C5,6,7)

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Disease Review

iii) Lateral root of median (C5,6,7)

Branches of medial cord

i) Medial pectoral (C8,T1)

ii) Medial cutaneous nerve of arm (C8,T1)

iii) Medial cutaneous nerve of fore arm (C8,T1)

iv) Ulnar (C7 & T1

v) Medial root of median (C8, T1)

Branches of Posterior Cord

i) Upper subscapular (C5, 6)

ii) Nerve to latissimus dorsi (thoracodorsal) (C6,7,8)

iii) Lower subscapular (C5, 6)

iv) Axillary (circumflex) (C5, 6)

v) Radial (C5, 6, 7, 8, T1)

In addition to the branches of brachial plexus, the upper limb is also supplied,

near the trunk, by the supraclavicular branches of the cervical plexus and by the

intercostobrachial branch of the second intercostal nerve. Sympathetic nerves are

distributed through the brachial plexus. The arrangement of the various nerves in the

axilla will be studied with the relations of the axillary artery.

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Disease Review

NIDANA

The factor, which is responsible for the causation of disease, is nidana20.

Proper awareness about the factors responsible for the disease becomes very helpful

in determining the line of treatment, prognosis and diagnosis.

Even though a specific bahya hetu(external cause) have not been mentioned

for Apabahuka, however the general factors told for vata prakopa have to be analyzed

and elicited.

In case of Apabahuka hetu may be classified into two groups;

Bahya hetu – causing injury to the marma or the region

surrounding that.

Abhyantara hetu – indulging in vata prakopaka nidanas 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.

Table No: 2

Showing nidanas of vatavyadhi and vata prakopa vis-a-vis apabahuka:

Nidanas CS21 Su.S22 AS23 AH24 MN25

Aharaja(food)

Rasa- Katu - + + + -

Tikta - + + + -

Kashaya - + + + -

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Guna- Laghu + + + - +

Ruksha + + + + +

Sheeta + + + - +

Dravya -Adhaki - + + - -

Chanaka - - + - -

Kalaya - + - - -

Masura - + + - -

Mudga - + + - -

Nishpava - + + - -

Shuskashaka - + - - -

Tinduka - - + - -

Matra- Abhojana + + - - +

Alpashana - + + + -

Vishamashana - + + - +

Viharaja (external)

Atiplavana + + - - +

Atiprapatana - + - - -

Atiprapidana - + - - -

Ativichestitam + - - - +

Ativyayama + + + + +

Kriyatiyoga + - + + +

Mityayoga-Asama Chalana - - + - -

Balavat Vigraha - + + - -

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Disease Review

Bhara harana - + + + -

Dukhasana + - - - +

Vegadharana + + + + +

Kalaja- Aparatra - - + + -

Agantuja-Abhighataja + - - - +

Marmaghata + - - - +

Amongst these, aharaja and viharaja responsible for the manifestation of Apabahuka

are elicited as –

Aharaja :

Katu, tikta, kashaya rasas, laghu sukshma, sheeta guna causes vitiation of vata.

Viharaja:

These either directly or indirectly causes abhigata to the marma present in the

amsa desha resulting in Apabahuka.

Vyayama:

Those exercises directly or indirectly influencing the shoulder or amsa desha

should be considered here.

Plavana:

Results in vata kopa due to over exertion in sandhi.

Bharavahana:

Carrying heavy loads over shoulder will cause vata prakopa and deformity in

the joint capsule. This leads to disease formation.

Balawat Vigraha:

Wrestling with a person who is more powerful will cause agahata to

amsapradesha and vataparkopa takes place. This manifests the disease.

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Disease Review

Dukha Shayya:

Improper posture that gives more and more pressure over the amsasandhi will

disturb the muscular integrity and provokes vata. This manifests the disease. Other

viharaja nidana told in vatavyadhi context may influence the condition by provocating

vatadosha.

To summarize, the above said nidanas mentioned under vihara especially

involving amsa sandhi and marmabhighata to amsa leads to the development of

Apabahuka.

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Disease Review

SAMPRAPTI

The word samprapti refers to the cumulative events involved right from the

time inception to the time of complete manifestation of disease26.The disease

Apabahuka is considered as a type of vata vyadhi. The term vata vyadhi is specific for

the disease like “Vikrutha vata janito asadharana vyadhih” means the very specific

diseases produced only by vikruta vata2. Regarding the vitiation of vata, it is told that

vata can either be aggravated by dhatu kshaya or by avarana.

“Vayuh dhatukshayat kopo margasya avaranena cha”

Sushruta has mentioned three pathological conditions of vata i.e kevala vata,

doshayukta vata and avrita vata27.

Kevala vata (Shuddha vata): Kevala vata means shuddha vata or dosha asamsrista

vata i.e pathological state of vata without association of other dosha. The etiological

factors of vata are depletion in nature here, due to that decrease in body tissues occur;

resulting in the increase in akasha (vacuum) and to fill the vacuum, vata is increased

leading to its prakopa. In such condition, hetu are of vata, symptoms are of vata and

upasya and anupasaya are also of vata.

Doshayukta vata: It refers to the samsarga or sannipata with other doshas, which is

different from avarana. In this condition clinical manifestation of vata as well as of

the associated dosha as anubandha may be there. In that case, generally vata is the

primary dosha, which dominates the hetu, symptoms and treatment of other dosha.

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Disease Review

Avrita vata: Avarana means to mask or to cover or to obstruct. Gati is the unique

feature of vata. Whenever the gati of vata is obstructed due to avarana then its

vitiation occurs. This has been the central idea of avrita vata.

Avarana of vata is a distinctive pathological condition, where obstruction to its

gati occurs due to the etiological factors other than its own, leading to its prakopa

resulting into various avarana type of vata vyadhis. The dosha, dhatu, mala, anna and

ama can cause the avarana of vata. Even any sub type of vata may cause avarana of

each other i.e anyonya avarana. The symptoms manifested in avrita vata are

comprised of disturbed function of vata, the obstructing factor as well as the

obstructed vata. According to Astanga sangraha, the symptoms are produced based on

the principles of rupahani, rupavriddhi and anyakarma, which depend upon the

intensity of the obstruction i.e partial or complete, functional or organic. The

symptomatology also depends upon the place wherever dosha dushya sammurchana

has taken place28.

In case of Apabahuka, either way of vitiation of vata can be considered. The

nidanas like ruksha, laghu etc and atibharavahana etc cause vitation of vata directly.

In another way, kapha prakopaka nidanas like taking of atisnigdha, atiguru etc dravya

cause increase of vikruta kapha which produce kaphavrita-vata condition. In both

ways, vikruta vata dosha gets accumulated in the srotas and manifests the symptoms

like stabdha poorna kosthata. In the prakopa avasta, the vata produces symptoms like

kostha toda and sancharana and the prasara avasta symptoms like atopa also may

produce. But Ashukaritva being one among the symptoms of vata, the symptoms

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Disease Review

produced by it is very quick in onset and hence the dosha kriyakalas of the vyadhi are

ill defined and cannot be observed properly.

Stana samsraya avasta of the vyadhi occurs with the localization of aggravated

vata in the specific dhatu i.e dosha dushya sammurachana, which occurs in the

specific organ of the body where kha vaigunya previously has taken place by the

specific part of nidanas simultaneously with the dosha vikruti.

Shiro marma is considered as the uttamanga and is mentioned as seat or moola

of all indriyas. Shiro marma performs all types of chesta in the presence of normal

vata because; among the three doshas only vata helps for all the varieties of chesta.

Charaka samhita has mentioned that29 when shiro marma gets affected, it produces

symptom like chestahani. In this case, sthana samsraya of the dosha can be taken as

in siro pradesha. Usually in sthana samsraya avasta, poorvaroopa of vyadhi are

manifested.

As Apabahuka is considered as a vata vyadhi and vata having ashukari guna

the poorvaroopas like bahupraspanditahara and shoola may manifest mildly or are

totally absent. But the above symptoms are clearly manifested in the vyaktha avastha

or in roopa avastha of the vyadhis in the vyakta sthana i.e in the amsa pradesha. In

this stage the amsa pradesha gets affected by aggravated vata for which Amsashosha

occurs in the initial stage by the decrease of shleshaka kapha and further leading to

manifestations of Apabahuka by the symptoms like bahupraspanditahara and shoola.

There fore Madhava nidana, Madhukosha commentary has mentioned that amsa

shosha and Apabahuka are the two stages of the vyadhi30.

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Disease Review

Marma abhighata:

Morbid vyana vata in other way may cause abhyantara marmabhighata or any

external trauma to amsapradesha may cause bahya marmbhighata to the amsa marma

present in amsadesha. Because this is a snayu16 and vaikalyakara marma,17 by

afflicting snayu will manifest bahupraspanditahara.

Even in modern medical science, the partial loss of blood supply in the area of

insertion of tendons or some idiopathic cause, can produce localized degeneration of

the collagen. This induces autoimmune response and cause tear or distortion of

tendinous sheaths and ligaments. This obliterates the integral stability of the joint and

results in restricted movement with painful and stiffened joint.31

Chart No.1

Schematic Representation of Samprapti of Apabahuka:

Nidana sevana

Ahara Vihara Swabhavika(old age)

Provocation of vyana vata

Adhisthana in amsadesha

Shleshaka kapha shosha

Amsa shosha Sira akuncha

Bahu chesta hara

APABAHUKA

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Disease Review

Chart No: 2.

Marmabhighata Apabahuka samprapti :

Marmabhighata(amsa)

Abhyantara marmabhighata

Amsa marmabhighata

Provocation of vata

Affliction to mamsa, sira, snayu, asthi,

Bahya marmabhighata

Bahu chesta hara

APABAHUKA

SAMPRAPTI GHATAKA

Dosha - Vata (vyana vata)

Kapha (sleshaka)

Dushya - Mamsa, meda, sira, snayu, kandara,

Srotas - Mamsavaha, medovaha, astivaha, majjavaha.

Srotodustiprakara - Sanga

Rogamarga - Madhyama

Adhisthana - Amsadesha

Vyaktasthana - Bahu

Vyadhi swabhava - Chirakari

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Disease Review

POORVA ROOPA

Before the actual onset of disease, some symptoms develop and they give

clues about the forth coming disease. Such symptoms are called prodromal symptoms

or poorva roopa. Pathological process of every disease starts before the clinical

manifestations of a disease. Due to the on going pathological process certain features

will develop, though a complete clinical picture is not manifested

In Ayurveda, these lakshanas were considered as poorva roopa32. In the

present context the poorva roopa of Apabahuka which is a vata vyadhi may be

“Avyaktam laxanam tesham poorvaroopamiti smrutam” 33.

In case of vata vyadhi the phase of poorva roopa will be in latent forms. So the

patient will not appreciate them. Here in Apabahuka some of the minor symptoms like

slight difficulty in the movement of shoulder joint and slight pain may be felt.

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Disease Review

ROOPA

The fifth stage of kriya kala is the vyakta stage, where the vaguely appeared

signs and symptoms of the disease seen in poorva roopa or 4th stage will be exhibited

in a fully manifested form and this particular stage is called roopa.34

Here in this stage, the dosa-dooshaya sammoorchana gets completed with the

manifestation of all the lakshanas of vyadhi including the the pratyatma linga, which

are essential for the diagnosis of the disease.

As the name itself indicates, in “Apabahuka,” the term itself is self

explanatory. Mainly it gives rise to local symptoms as -

• Bahupraspandita harana35

• Shoola36

• Amsashoshana37

Bahupraspandita hara:

The term bahupraspandita hara has three words.

• Bahu – upper limb,

• Praspandana – praspandana shareerasya chalanam idam vyanasya karmam.38

Means movement or chalana, considered to be a normal function of vyana

vata.

Dalhana commenting on this says that praspandana means chesta/ movement39.

● Hara –loss of /impaired/ difficulty. Thus, in the present context bahupraspandita

hara may be taken as difficulty in the movement or impairment or loss of movement

of upper limb. As told in the samprapti, the dusta vyana vata in amsa sandhi causes

siraakunchana resulting in loss of movement of the particular limb, which may be

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Disease Review

complete or partial. Thus the movements of shoulder joints like abduction, rotation,

elevation etc are affected. The degree of affection varies depending on the

presentation of etiological factors, such as the site of the structures injured and the

extent of injury and duration. Thus, this is one of the most important symptoms

amongst the other lakshanas and the patient is compelled to approach the doctor.

Shoola or Vedana:

Shoola is one among the symptom in Apabahuka. In Anjana nidana it is told

that “Amoola eka bahoschet vyathasyath apabahukaha” 40

The Amsa marma being a snayu marma, when it is injured or get afflicted by

vata will produce shoola, because Shoola is one of the symptoms of snayu gata vata41.

Recent Ayurvedic text like Chikitsa sara sangraha clearly mentions about

Vedana42, as a predominant lakshana of Apabahuka, along with other lakshanas. It is

to be noted that vata is responsible for the production of pain43. Thus, pain is

considered as a prominent symptom in this thesis.

Amsa shosha:

Amsa shosha means drying up of the kapha in amsa pradesha or atrophy

caused by lack of nutrition. From the reference given by the Acharya Susruta, 37 it can

be interpreted that Amsa shosha also occurs as a lakshana of Apabahuka. This can be

considered as muscle wasting around the joint due to lack of nourishment and disuse

atrophy. It can also be interpreted from the reference by Sushruta that Amsa shosha

can lead to Apabahuka.

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Disease Review

In the context of akshi roga samprapti, Sushruta mentions that sleshma does

the bandhana of sira, kandara and medas of kalakasti and any derangement of

shleshma leads to the pathological state through the medium of siras44 This proves

that shleshma is responsible for structural stability of sira, kandara and medas and not

the amsa sandhi alone. So in this case, drying up of kapha leads to the akunchana of

sira resulting in Apabahuka.

In the context of marma, it is told that four types of siras are present around

marma region that nourishes snayu, asti, marma and sandhi in total. So akunchuna of

sira results due to lack of nourishment to the snayu, asti, marma present in the sandhi

leading to shosha of amsa pradesha45.

There are some clinical conditions of modern science, which may be compared with

that of Apabahuka. These may be categorized as follows.

i) Periarthritis or frozen shoulder or adhesive capsulitis.46

ii) Incomplete rupture of supraspinatus tendon46

iii) Lesions of the rotatory cuff 46

iv) Sub acromial or subdeltoid bursitis 46

v) Sub coracoid bursitis 46

vi) Painful shoulder 46

vii) Bicipital tendinitis 46

viii) Osteo arthritis of shoulder joint 47

ix) Brachial plexes neuropathies 48

i) Periarthitis or frozen shoulder or adhesive capsulitis - This is a descriptive term

used to indicate a clinical syndrome where in the patient has a restricted range of

active and passive glenohumeral motion.

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Disease Review

Simmonds' report on the tight inelastic tissues around the shoulder joint. They

believed that the pathological changes in frozen shoulder were due to degeneration

and focal necrosis of the supraspinous tendon. With revascularization, the tendon

pathology could resolve. With in-adequate vascular response, the tendons would

continue to degenerate, developing tears of varying size, or a secondary biceps

tendinitis could develop.

In this condition, pain and stiffness of the shoulder joint are the cardinal

symptom leading to inability or loss of function of affected upper limb. This may be

achieved by 3 phases.

i) Painful phase

ii) Stiffening phase

iii Thawn / Resolving Phase

The patient gives a history of having noticed a slight painful catch in the

region of the shoulder and upper arm for several months. Gradually becoming aware

of the inability to perform certain tasks, because of stiffness of the arm. Night pain,

often awakening him after he has fallen asleep, is a common complaint. Frequently it

radiates down the arm to the hand without being localized to any nerve distribution.

Stiffness of the shoulder increases until all movements are lost.

Bridgman identified an increased incidence of frozen shoulder in patients with

Diabetes mellitus. Those patients who were insulin dependent were particularly

predisposed.

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Disease Review

Incomplete rupture of supraspinatous tendon-

It is a common sequel to tendinitis though often not diagnosed. Pain is

complained of over the shoulder. Tenderness is present over the insertion of the

tendon.

Lesions of the Rotatory Cuff:

The rotatory cuff consists of the common tendinous insertion of supraspinatus,

infraspinatus and teres minor muscles, as well as the subscapularis tendon. These

tendons form a continuous fibrous sheath, which is intimately adherent to the

underlying shoulder capsule when the shoulder is moved from the anatomical position

of full elevation or abduction. The rotator cuff comes in contact with the under

surface of the coracoacromial ligament and is subjected to mechanical irritation and

degenerative changes occurs. With sufficient degeneration, bursitis may develop in

the intervening subacromial bursa. This separates the under surface of the acromion

and coracoacromial ligament from the rotator cuff. With changes in the tendon,

deposition of calcium occurs in the worn and degenerative tendon, as well as in the

subacromial bursa.

In the absence of pre-existing symptomatology, patient may note the

spontaneous acute onset of severe unrelieving pain in the shoulder and in the region of

greater tuberosity. The onset may occur after unusual vigorous exercises or sport

activities in the patient over thirty five years. Any motion of the shoulder causes pain.

Plain X-ray may show a calcium deposit in the acromial bursa or supraspinatous

tendon.

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Disease Review

Subdeltoid or Subacromial bursitis:

Pain in the shoulder on abduction and internal rotation of the humerus- severe

at night, and tender points in the shoulder is usually felt near the insertion of the

deltoid muscle, rather than in the joint itself, although it may radiate wide.

Usually there is point tenderness on the greater tuberosity, which disappears

under the acromion on abduction (Dawbamis sign). This tenderness may be absent or

it may be wide spread over the deltoid region.

In some cases, the patient gives a history of an injury to the shoulder. This

usually takes the form of a fall on the outstretched arm or stabbed shoulder. When the

pain follows, an injury there is usually an interval of few days before it manifests

Subcoracoid Bursitis:

This is situated between the tip of the coracoid process and the capsule of the

shoulder joint. It extends upto and even over the lesser tuberosity of the humerus.

Normally, the humerus and the coracoid are closely applied to each other, the tip of

the latter resting against or being opposite to the lesser tuberosity of thehumerus. It

follows that, though this bursa is not particularly exposed to external violence, it is yet

distinctly liable to suffer derangement through irritation from the pressures of the

lesser tuberosity against the coracoid when the arm is used at great deal.

The patient complains of pain in the region of the coracoid and there is

definite tenderness over the interval between two bones. Chronic cases on which

adhesions are present have marked limitations of lateral rotation and abduction.

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Disease Review

Painful Shoulder:

Spontaneous pain or pains after minor strains of the shoulder are extensively

common after the age of 35 years. The most common lesion responsible for shoulder

pain in this age group is that of rotator cuff, bicipital tendinitis or subacromial bursitis.

Bicipital tendinitis:

Shoulder symptoms resembling supraspinatous tendinitis may be due to a

bicipital tendon, which has become irritated, and inflammed in its groove and long

passage through the shoulder joint. The symptoms are quite similar, but

differentiation may be made based on pain and tenderness extending further distal to

the bicipital groove.

Osteo Arthritis of Shoulder Joint:

Repeated slight trauma or one major injury is an important etiological factor.

Men after 50 are the usual victims. Large joints like knee, shoulder are affected.

Morning stiffness, which gradually progress after continued use of the limb owing to

increased synovial secretion, is pathognom.

On Examination

i) Limitation of movements

ii) Radiological imaging shows diminished joint space with osteophytes

The loss of mobility results from-

i) Articular cartilage destruction with marked loss of joint space

ii) Muscle spasm and contractures with fibrosis of overlying fascia and

their musculo tendinous junction.

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Disease Review

Brachial Plexus Neuropathy:

Although the entity of Brachial plexus neuropathy is idiopathic, it presents

with the symptoms of pain that comes with no apparent reason. The location of pain

can vary but usually involves the shoulder. The pain is followed in days or weeks by

loss of motor function in the limb.

To summarize

Considering the cardinal features of Apabahuka and the features of above

conditions, Apabahuka may be compared to the above said conditions.

UPASHAYA AND ANUPASHAYA

In the process of investigating a disease, occasionally upashaya and

anupashaya method i.e., therapeutic trials with certain diet, drugs and viharas are also

considered as a diagnostic tool in some cases.49, 50

In case of Apabahuka, use of shoulder joint during physical work provokes the

problem.On the other hand hot fomentation and rest gives relief. So the factors

aggravating vata are said to be Anuupashaya and pacifying factors of vata are

Upashaya.

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Disease Review

UPADRAVA

The occurrence of another disorder on the wake of a primary disease is termed

as upadrava.51 Sushruta has described upadravas of Mahagadas including vatavyadhis.

They are Pranakshaya, Mamsakshaya, Jwara, Atisara, Murcha, Trisna, Hikka, Chardi

and Swasa.52 He further specifies the upadravas for vatavyadhis as Shosha, Kampa,

Supta twacha, Adhmana, Bhanga and Antah ruja.53

According to Dalhana. ‘Pranakshaya’ means ‘Utsahakshaya’, mamsakshaya means

Upachayakshaya, Supta tvacha means ‘Badhira twacha’ Bhanga means

Vedanatrutitam and Antah ruja means Gambhira vedana.

Among various musculo-skeletal disorders of the shoulder joint explained earlier and

even Brachial plexus neuropathies, if left untreated may result into local muscular

atrophy. This may cause permanent disability of that particular arm.

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Disease Review

SAPEKSHA NIDANA

There are many diseases having close resemblance. After the complete

manifestation of disease, it should be differentiated from its allied one. This is being

done based on the cardinal features of the disease. In the present context, same thing

is discussed.

Apabahuka is to be differentiated from the following disease conditions that

affect the upper limb.

• Vishwachi

• Amsa shosha

• Ekanga vata

Vishwachi:

In this context our Acharya mentions that the pain which is present at the

posterior aspect of the arm radiates to the dorsal aspect of the fingers 54. In case of

Apabahuka, clinical features like difficulty in the movement and pain in shoulder

joints are observed.

Amsa shosha:

This being mentioned as a separate entity by Madhavakara30, it should be

differentiated from Apabahuka. The cardinal feature of this disease is wasting of

muscles. However, in case of Apabahuka, other symptoms like difficulty in movement

and pain are the predominating features.

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Disease Review

Ekanga vata;

This disease affects the whole upper limb and features like loss of function

(akarmanya) and sensory loss (vichetana) are observed here. Where as in Apabahuka

symptoms like difficulty in movement and pain occurs only in the amsa prdesha.

Table No: 3.

Showing Sapeksha / vyavachedaka nidana of Apabahuka:

Apabahuka Vishwachi Amsashosha Ekangavata

A. Nidana Vatakara Vatakara Vatakara Vatakara

B. Adhisthana Amsasandhi Bahu Amsasandhi Murdha

C. Laxanas

• Bahupraspa

ndahara

Bahu

karma

kshaya

Amsashosha Akarmanya

and

vichetana

• Shoola

present in

amsa sandhi

Radiates

from tala to

bahupristha

Absent Absent

• Amsashosha

present

_ Cardinal

feature

_

D. Dosha Vatakaphaja

or vataja

Vataja Vataja Vataja or

pitta / kapha

anubandha

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Disease Review

SADHYASADHYATA

After the diagnosis and before starting the treatment it becomes essential to know the

prognosis of a disease.55 Next few paragraphs will explain about the sadhyasadhyata

of Apabahuka.

The sadhyasahdyata of Apabahuka is not mentioned anywhere in the classics.

Even the recent scholars of Ayurveda have not mentioned about its prognosis. But

however, following points are necessary to be considered while dealing with

prognosis of Apabahuka.

As Apabahuka is considered as Vatavyadhi which is a ‘Maharoga’ inspite of

effective treatment, will not yield good results, when it is associated with

balamamsakshaya56

Yogaratnakara says that vatavyadhi is sadhya, if it is of recent onset and if the

patient has good bala.57 In Madhava nidana, it is said that if patient is strong and

without any complications then the patient should be treated, as it is sadhya for

chikitsa.58

Sushruta59 and Madhavakara60 say that shuddha vataja roga is Krichrasadhya,

Dhathukshayaja is asadhya and samsargaja is sadhya. Bhava prakasha61 and

Vagbhata62 opines the same.

Even while explaining vatavyadhi chikitsa Charakacharya has mentioned that

all the vatavyadhi after lapse of one year becomes Krichrasadhya or Asadhya.63

Sadhyasadhyata can also be assessed by considering hetu, poorvaroopa, roopa,

dosha, dushya etc.64 Thus Apabahuka in the initial stage will become sadhya and is

Krichrasadhya or Asadhya after certain

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Disease Review

CHIKITSA

After the diagnosis of a disease, the next step will be its management. In the

present chapter, the management of Apabahuka is discussed.

The general line of treatment mentioned for vatavyadhi in Ayurvedic classics

include Snehana (both internal and external), Swedana, mrudusamshodhana, basti,

sirobasti Nasya, etc.65

Charaka further says that depending on the location and dushya (tissue

element vitiated by vata) each patient should be given specific therapies.66

Nasyakarma has been mentioned by Vagbhata in jatroordhva vatavikaras.

Three major approaches are made in the management of vatavyadhi.67

1. Treatment of Kevala vata

2. Treatment of Samsrusta vata

3. Treatment of Avruta vata

Ayurvedic classics explain the chikitsa of Apabahuka as follows.

1. Nasya and uttarabhaktika Snehapana are useful in the management of

Apabahuka.68

2. Astanga Sangraha mentions Navana Nasya and sneha pana for Apabahuka.69

3. Sushrutacharya advice vatavyadhi chikitsa for Apabahuka, except

siravyadha.70

4. Chikitsa sara sangraha advice Nasya, Uttara bhaktika Snehapana and

Sweda for the treatment of Apabahuka.71

5. Brumhana nasya indicated in Apabahuka by Vagbhata7

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Disease Review

By considering the above references, following can be said as the line of

treatment of Apabahuka.

1. Nidana parivarjana

2. Abhyanga.

3. Swedana

4. Uttarabhaktika snehapana

5. Nasyakarma

6. Shamanoushadhi.

Abhyanga

Anointing oil on the body is abhyanga. This abhyanga brings about the

following qualities. “It prevents old age, removes pain in the body and gives pusthi to

the body.”73

The virya of the drug used for abhyanga gets digested with the help of

sthanika bhrajakagni and enters in to the srotus and starts its action.74

Taila used for abhyanga after entering in to the body nourishes the body

tissues, gives strength and increases agni.75

Massage profoundly influences the entire nervous system and by mechanical

means affects all the tissues of the body. The effects of massage upon the nerves may

be either stimulating, promoting activity of the muscles, vessels and glands governed

by them or sedative producing relief of pain and of nervous irritability. Massage

promotes nutrition of nerves by its beneficial effects upon digestion and circulation.

The influence of massage on the circulation is very helpful in eliminating pain

after injuries.

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Disease Review

Swedana: Stambha Gourava Sheetaghnum swedanum swedakarakam.76 This is

defined as the process, which brings about swedana or perspiration in the body. It

does the dilation of the vessels thus improving blood circulation. Hence, it is very

much beneficial in conditions where Shoola, Stambha and Sankocha are present.

In the context of vatavyadhi sweda karma like pinda sweda, nadisweda,

avagaha sweda are mentioned which alleviate vatadosha. It also helps to relieve

Stambha (Stiffness), Gourava (heaviness) and Sheeta (cold).

Uttarabhaktika Snehapana:

In the classics, Abhyantara Snehapana is divided into 3 types.77

1. Shamana

2. Shodhana

3. Brumhana

Shamana and shodhana are used in case when we need palliation and

alliviation of the morbid doshas from the body respectively.

Brumhana is the one, which is done or used for the nourishment. In the present

context of Apabahuka, the vitiated vata due to its rookshadi qualities does the

shoshana of shleshaka kapha that is present in the amsasandhi. To subside this

rooksha quality and to normalize the shleshaka kapha qualities, brihmana snehapana

is advisable. Brumhana type of snehapana is adviced prior, middle and after the

intake of food, as explained by Hemadri.78

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Disease Review

Uttarabhaktika snehapana i.e., snehapana done after intake of food is useful in

the disorders of vyanavata.79 Uttarabhaktika snehapana indicated in Apabahuka

fulfills the need of treatment required in case of vynavata disorder and also acts as

Brumhana. Here alpa matra of snehapana should be used. Sneha used here should be

Taila, because taila is best amongst snehas in vatavyadhi.80

NASYA KARMA

The administration of either medicine (drug) or medicated oil through the nose

is known as Nasya Karma. 81

Navana, Nastakarma are the words used for Nasya karma. This is useful in

Shiroshunyata. It gives strength to neck, shoulders, chest and increases vision.82 Thus

Nasya is useful in Apabahuka.

By studying our classics, it is observed that Nasya Karma is adviced to

maintain the health in healthy persons and to alleviate the diseases. This chapter

describes Nirukthi, Paribhasha, Classification, Dosage, Indications, and method of

Nasya karma, Samyak laxana, Vyapat and its chikitsa.

Vyutpatti Nirukti and paribhasha:

The word Nasya Karma is composed of two words Nasya and Karma.

Nasya: ‘ Nas’ is substituted for Nasa when it is followed by the suffix ‘Yath’.

Nasika + Yath = Nasadeshancha

Nasikaayai hitam – Nasya

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Disease Review

In Vachaspathyam the word, ‘Nasya’ has been defined as the one, which is

administered through the nose.

Chakrapani explains that “Nastha Prachardanam iti Shirovirechanam.”

Considering the above definitions, Nasya can be defined as that which is administered

through nose by using the medicines to alleviate Jatrurdhva Vikaras in particular.

Synonyms of Nasya:

Shirovirechana, Shirovireka, Murdhavireka, Navana, Nastha karma, nastham

etc.

Karma:

The action done by Kartru according to his will is known as karma.

The treatment of diseases done with Nasya is called Nasya Karma where Karma is

used in the meaning of chikitsa.

Classification of Nasya Karma:

Depending on the forms of medicine used, the mode of action of drugs and the

quantity of medicine used, Nasya is classified as follows.

Classification according to its matra: 83

1. Marsha

2. Pratimarsha

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Disease Review

Page : 44

Chart No:3

Nasya - Classification according to Charaka: 84

Nasya

Chart No:4

Nasya -Classification according to Vagbhata: 85

Nasya

Navana DhmapanaAvapeeda Dhooma Pratimarsha

Snehana Shodhana Proyogika Virechanika Snaihika

Stambhana Virechana Snaihika

Nasya

Virechana Bruhmana Shamana

Shodhana

Disease Review

Nasya Matra:

The unit of Nasya is the quantity of medicine that dribbles down when the first

two digits of index finger are dipped in to the medicine and taken out which is called

a “Bindu” (drop).86

Table No: 4

Maximum Moderate Minimum

For snehas 10 8 6

(Bramhana)

For kwatha, 8 6 4

Swarasa etc.

According to Sushruta:

Snehanasya 64 32 16

(Bramhana) (32+32) (16+16) (8+8)

Shirovirechana 8 6 4

Marshanasya

Or 10 drops 8 drops 6 drops

Snehanasya

Other forms of

Medication like 8 6 4

Kwatha, Swarasa

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Disease Review

Pradhamana nasya, which will be in powder (churna) form, is administered

with the help of a hollow tube of 6 Angulas in length having openings at both ends.

The powder is filled in to it and blown in to the nostrils of the patient till the powder

reaches his throat.87

Kala for Nasya Vidhi: 88

Vataja disorders- Afternoon

Pittaja disorders- Noon

Kaphaja disorders – Fore noon

Swastha, - cold seasons- Noon

Sharat rutu and Vasanta rutu- Fore noon

Greeshma rutu – Afternoon

Rainy season- bright sunlight

For persons undergoing Panchakarma, it should be done after basti. Nasya

Karma is contraindicated during cloudy weather irrespective of season.

Navana nasya: 89

Sneha dravyas are mainly used. It acts as Brumhana. It is of two type- snehana

and shodana.

Avapeedana nasya: 90

Nasya performed by squeezing a wet drug is avapeedana. This may be

Shodhana or Sthambhana depending on the drug used.

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Disease Review

Dhmapana: 91

A form of nasya where in medicated powders are blown in to the nostrils

through a hollow tube. This is virechana nasya.

Dhooma nasya: 92

Medicated fumes are inhaled through nostrils and exhaled from the mouth.

This may be vairechanika or snehika.

Pratimarsha nasya: 93

When the nasya dravya is used with minimum quantity (2 bindus), it is called

Pratimarsha. Usually sneha dravyas are used. This is different from marsha nasya

where in the quantity used will be 6, 8, 12 bindus.

Navana nasya:

Navana type of nasya which is done with Taila acts as Brumhana nasya which

is useful in case of Apabahuka. The same is explained in the forthcoming paragraphs.

Method of Nasya Karma:

Nasya Karma can be explained in the following three headings as told in the

classics.

Poorva Karma: 94

This encompasses the following points like Oushadhi sangraha, Nasya yantra,

Atura vaya, Kala, Atura siddhata etc. Patient is instructed not to suppress the natural

urges and go through the normal routines. Before taking Nasya Karma he should not

have any food. Then, patient is taken to a comfortable room, which is without dust,

extreme breeze and sunlight. Bahyasnehana in the form of mrudu Abhyanga is done

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Disease Review

to shiras first and then over gala, kapola, lalata and karna. After snehana, mild

swedana is done to the part of the body above the shoulders. Care of the eyes should

be taken with closing the patient’s eyes with a band of cloth.

Pradhana Karma: 95

Once the poorva karma is over, the patient is made to lie down on the table in

the supine position with legs slightly raised. Eyes should be covered with a cloth.

With the help of the tepid medicine, panitapa sweda is done to the parts of the body

above the shoulder excluding the patient’s eyes. The head of the patient is then highly

raised and medicine is poured in each nostril one after the other. The other nostril

should be closed while administering the medicine in one nostril. The medicine

should be slowly instilled in an uninterrupted manner called “Avicchinna dhara”. The

patient is advised to inhale the medicine slowly and forcefully. The same procedure is

repeated in either of the nostrils. Care should be taken not to shake the head during

the procedure. Tapasweda can be repeated conveniently.

After the administration of the medicine, patient is adviced strictly not to

swallow the medicine but should spit it out. The spitting can be done till the smell and

taste of the medicine disappears from the throat. Then, the patient is allowed to relax

in the same posture for 100 matra kala. (30-32 sec) without going to sleep.

Paschat Karma: 96

Pradhana karma is followed by dhoomapana, gandoosha and kavala graha.

The patient is adviced to follow certain rules and regimen.

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Disease Review

Samyak yoga laxanas: 97

The symptoms like Shirolaghava, Sukhaswapna, Prabhodhana, Vikaropa

shamana, indriya prasannata, manah prasannata and srotovishuddi indicate samyak

nasya laxanas.

Ayoga laxanas: 98

The medicine administered in insufficient quantity produces kandu, gouravata,

vikara anupashamana and indriya rukshata which are heena yoga laxana.

Atiyoga laxanas: 99

Kaphasrava from nose, shirogouravata, indriyavibhrama are atiyoga laxana.

When ayoga laxanas are observed, samyak nasya karma should be done. In atiyoga,

ruksha chikitsa should be done.

Nasya vyapat chikitsa100

Nasya vyapats are of 2 types.

1. Doshotkleshaja

2. Doshakshayaja

The following complications arise when nasya is done in anarhas, jalapeeta,

ajeerna, bhaktabhukta and in durdina. Kaphaja vikara will manifest and these should

be treated with kaphahara chikitsa. Rukshajanya vikaras that manifest in Krisha,

virikta, vyayama klanta, garbhini and trishnartha are treated with snehana and

Brumhana chikitsa.

Nasya karma done in Shokabhitapta, Madhyapeeta and Jwara rogi, lead to

timira roga. This should be treated with rooksha, sheetala lepa, anjana and

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Disease Review

putapaka.101 During the course of nasya karma, if the patient becomes unconscious,

then sheetal jala parisheka is done over lalata and kapola.102

Nasya karmukata:

Nasya karma one of the therapeutic procedure of pancha karma where in drug

is administered through the nasal route. This is one of the pancha karma procedures,

which not only alleviates the vitiated doshas but also causes complete eradication of

vitiated dosha and the disease. The same is applicable for nasya karma also.

Nasya karma especially exerts its effects on the urdhvajatrugata pradesha.

Acharya Vagbhata has stated “Nasa hi shirasodwaram”103 i.e., nose is the easiest and

closest opening for conveying the potency of medicines to the cranial cavity. He is

the first person to narrate the mode of action of drugs by Nasya karma. The drugs

administered will reach the Shringataka marma and spread through the opening of

shiras of eye, ear and throat etc. and to the head.

Acharya Sushruta opines Shringhataka marma as a sira marma104 situated at

the site of the union of siras supplying to nose, ear, eye, tongue. Acharya Charaka, 105

while explaining indication for nasya in siddhisthana has emphasized that the nasya

drug will act through absorption by Shringataka marma. After the absorption of drug,

it acts on the diseases of Skanda, Amsa and Greeva. Then it takes out the doshas like

‘munjadi shikavat’.

How does the drugs enter in to the brain can be discussed as follows.

The absorption of the drugs is carried out in 3 media. They are;

1. By general blood circulation after absorption through mucous

membrane.

2. The direct pooling in to venous sinuses of brain via inferior ophthalmic veins.

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Disease Review

3. Absorption directly in to the cerebrospinal fluid.

Apart from the small emissary veins entering cavernous sinuses of the brain, a

pair of venous branch emerging from alaenasi will drain in to facial vein. These

opthalmic veins in other hand also drain into cavernous sinuses of the meninges and

in addition, neither the facial vein nor the ophthalmic veins have any valves.

Therefore, there are more chances of blood draining from facial vein in to the

cavernous sinus in the lowered head position.

The nasal cavity directly opens in to frontal, maxillary and sphenoidal air

sinuses. Epithelial layer is also continuous through out the length. The momentary

retention of drug in nasopharynx and suction causes oozing of drug material in to air

sinuses. These sites have rich blood vessels entering the brain and meninges through

the existing foramens in the bones. Therefore, there are better chances of drug

transportation in this path. The shringataka marma has been explained by recent

authors as middle cephalic fossa of the skull consisting para nasal sinuses and

meningial vessels and nerves. One can see in to the truth of narration made by

Vagbhata here- the drug administered enters the para nasal sinuses. That is

Shringhataka where the ophthalmic vein and the other veins spread out. The

sphenoidal sinuses are in close relation with intra cranial structures. Thus there may

be a so far undetected root between air sinuses-cavernous sinuses establishing the

transudation of fluids as a whole. The mentioning of the shringataka in this context

seems to be more reasonable.

As the procedure of nasya itself involves massaging and fomenting over many

marmas existing on the face and head, this also helps in allievation of marmaksobha

and vatashamana.

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Disease Review

The action of nasya karma depends upon the dravya used in it. Based on these,

it is divided into shodhana, shamana and Brumhana. In case of shamana nasya, it

alleviates the dosha and helps in reducing kshobha of marma and indriya caused by

vitiated dosha. Brihmana nasya provides nourishment to shiroindriya and other organs

and alleviates the vitiated vata. Hence, it is useful in vatajanya ailments.

The following paragraph explains why Ayurveda has mentioned siddha sneha

in majority of nasya karma. Nose is a highly vascular structure and its mucous

membrane provides good absorbing surface. Hence, siddha sneha on their

administration spread along the nasal mucous membrane. An active principle along

with sneha get absorbed inside the olfactory and respiratory mucosa and from there is

carried to different places. Sneha provides nourishment to nasal structures and other

shirogata organs also. The networks of nasal blood and lymph vessels have many

communications with those of sub dural and sub arachnoid spaces. This fact is one of

the important factors contributing to the extension of mentioned drugs from the nose

in to cranial cavity.

Myelin sheath is the first covering of nerve fibre. Neurolemma being the

second.Myelin sheath is composed of lipid material. Blood- brain barrier is highly

permeable for lipid substances and substances, which are fat-soluble. Therefore, these

substances can pass easily through the blood-brain barrier and exert their actions.

Certain lipids are used for providing energy to the nervous tissue. The lipid contents

of “Laghumasha taila” may pass through the blood-brain barrier easily due to its

transport. Some of the active principles may reach up to certain levels in the nervous

Page : 52

Disease Review

Page : 53

system to exert their vataghna property. Laghumasha taila provides nourishment to

nervous system and helps in removing the irritation. It may act as an anti-

inflammatory agent also. On its nasal administration, it reaches to different shirogata

indriya to cause vatashamana and Brumhana.

To conclude, nasya karma helps in Apabahuka by its vatashmana and

Brumhana karma. In other words, Laghumasha taila acts as anti-inflammatory.

Nutritive and provides nourishment to the nerves.

Chart No. 5

Probable Mode of Action of Nasya:

Maxillary Sinus

Nose

Frontal Sinus

Ethmoid Sinus

Sphenoidal Sinus

Opthalmic Vein (Inferior)

Facial Vein

Nourishes Nerve

Stimulates Pituitary Gland

Potency of the Drug

Nasya Dravya

Cavernous Sinus

Disease Review

Shamanoushadhi:

Vatavyadhis are very difficult to manage, more so in case of shoola pradhana

and stambha pradhana vikaras. In such conditions internal administration of

Shamanoushadhi are essential. .Ekangaveera Rasa is said to be very effective in case

of Apabahuka.106 This contains the drugs which have vatahara, balya, shoola-

shothahara properties.

Nidana parivarjana:

For all the disease to occur, nidana is the important factor. So, Sushruta has

given importance to nidana parivarjana as first line of treatment.

Sankshepatah kriyayogo nidana parivarjanam.107

In case of Apabahuka, the vatakara ahara-viharas told under nidana chapter

should be restricted.

Page : 54

Disease Review

PATHYAPATHYA

Once the treatment is adopted, it is essential to advocate pathyapathya to the

patient for the purpose of efficient results. This chapter describes about the

pathyapathya that should be adviced in case of Apabahuka.

Pathya is the one which when taken in an appropriate time in proper

proportions becomes beneficial to the body. This helps to correct the morbid

condition of dhatus bringing them to homeostatic state. Thus the diseased condition

can be cured and further complications can be prevented.

Charakacharya while explaining vatavyadhis advices the following pathya:

Sarpi, taila, vasa, majja, mamsa, rasa, madhura- amla-lavana rasa dravyas and all

Brumhana dravyas.108

Yoga Ratnakara109 explains following as pathya- Kulattha, masha, godhuma,

raktashali, patola, shigru, varthaka, dadima, parooshaka, ghrita, dugdha, lashuna etc.

Chakradatta110 advices following pathya for Apabahuka patient-

Shashtikashali, sarpi, taila, yusha, masha, kulattha, naveena taila, godhuma, lashuna,

rohita, draksha, snigdha-ushna bhojana and snigdhoshna anulepana.

One, which is not suitable to the mind and body is called as apathya- Chinta,

jagarana, vegadharana, katu-tikta-kashaya rasa, ashwayana, chankramana etc are told

as apathya.111

Considering the above points, it can be inferred that the nidanas of Apabahuka

are itself apathya for that disease. Following table classifies different categories of

pathyapathya.

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Disease Review

TableNo: 5

Showing the Pathyapathya:

Dravya Pathya Apathya

1. Drava Varga Ksheera, Gojala, Matsyandika, Seetambu, Kodrava

Dhanyamla, Dadhi kurchika, Pradushta salila, Kshara

Sarpi taila, sura

2. Anna varga Naveena tila, naveena godhuma, Chanaka,kalaya,

Samvatsarothita masha, shali, Neevara,Venu,

Shashtika kulatha shyamaka,churna,

Kuruvinda,

Thrinadhanya,

Raja-masha, mudga, yava

Karira,simbi, patrashaka

3. Phalavarga Patola, Shishuvartaka, Lashuna, Jambu, Kramuka,

Dadima, Pakvatala, Parushaka, Nishpava, Mrinala

Jambeera, Badara, Draksha, Udumbara,Shaluka,

Gokshura, Paribhadra Tinduka

4. Mamsavarga Vasa, Majja, gramya - Gomamsa, Shushka palalam

Ushtra, ashva, Vrishab, anupa,

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Disease Review

Maheesha, Gaja, Hamsa, Kadamba,

Jangala - Chataka, Kukkuta

Matsya - Kurma, Nakra, Silindra

5. Samanya ahara Swadu - amla rasa Kashayarasa

Snigdha ushna bhojna Katurasa, Tiktaras

6. Vihara Abhyanga Vyavaya

Mardhana, sneha Hastiyana

Sweda, Avagaha Ashwayana

Samhanana, Chankramana

Vata varjana, Agnikarma

Upanaha, Bhooshayya,

Snana, Ashana, Tailadroni

Atapa, Snigdha - ushna

Anulepa

Page : 57

Drug review

DRUG REVIEW

The two-trial drug Laghumasha Taila (Marsa Nasya) and Ekangaveera Rasa

(Oral administration) are taken for the comparative clinical study.

The reference of Laghumasha Taila is from Gadanigraha - part 1, Tailadhikara

154 -155. The reference of Ekangaveera rasa is from Bruhat Nigantu Ratnakara - Vata

vyadhi.

This comprises of two sub headings:

A) Compound Drug Study

B) Individual Drug Study

A) Compound Drug Study

1) Laghu MashaTaila

Ingredients:

i) Kapikacchu ii) Bala iii) Shatavari

iv) Sita v) Punarnava vi) Saindava

vii) Jingini Taru Niryasa----------------------------250 gms each for kalka

viii) Katu Taila -------------------------------------------1 litre

ix) Masha Kwatha--------------------------------------2 litre

Steps involved in the preparation:

Step----1

Kalka dravyas are washed properly and triturated to get fine kalka.

Page : 58

Drug review

Step---2

Properly processed 2 kg coarse powder of Masha was taken and boiled with 8

litres of water. It was reduced to get 2 litres of kashaya under mandagni.

Step—3

Above mentioned kalka and kashaya are added with one litre of Katu Taila in a

vessel. It was boiled under mandagni till it attained mrudu paka .The oil is filtered and

kept in a closed container.

Indication: Bahu ruja

2) Ekangaveera Rasa

Ingredients:

Shudda Gandhaka Rasa Sindoora Loha Bhasma

Vanga Bhasma Naga Bhasma Tamra Bhasma

Abhraka Bhasma Loha Bhasma Shunti

Maricha Pippali------------------50 gms each.

Bhavana Dravyas:

Triphala Kwata Trikatu Kwatha Nirgundi Kwatha

Chitraka Kwatha Ardraka Kwatha Shigru Kwatha

Kusta Kwatha Amalaki Kwatha Shudda Kupeelu Beeja Kwatha

Arkahata Kwatha Ardraka Kwatha------------ 3 bhavanas with each kwatha.

Steps involved in the preparation

All the above-mentioned ingredients are taken in proper quantity as per the given

reference and 3 bhavanas given with each Bhavana dravya. At the end, vati of 125mg is

prepared and kept under aseptic measures.

Indications: Apabahuka, Vishwachi, Pakshagata, Ardita, Grudrasi.

Page : 59

Drug review

B) Individual Drug Study

1) Laghu MashaTaila

a) Kapikacchu112

Botanical Name : Mucuna prurita Hook.

Family : Leguminosae

Rasa : Madhura,Tikta

Guna : Guru,Snigdha

Veerya : Ushna

Vipaka : Madhura

Dosha Karma : Vataghna,Pittaghna,Kapha pitta vardaka, Balya,

Bruhmana

Part used : Beeja

b) Bala 113

Botanical Name : Sida cordifolia Linn

Family : Malvaceae

Rasa : Madhura

Guna : Laghu,Snigdha,picchila

Veerya : Sheeta

Vipaka : Madhura

Dosha Karma : Vata pittashamaka, Balya, Bruhmana.

c) Shatavari114

Botanical Name : Asparagus racemosus Willd

Family : Liliaceae

Page : 60

Drug review

Rasa : Madhura,Tikta

Guna : Guru,Snigdha

Veerya : Sheeta

Vipaka : Madhura

Dosha Karma : Vatapitta shamaka, Balya, Rasayana, Shoolahara.

Part used : Kanda

d) Sita 115

Rasa : Madhura

Guna : Sheeta,Laghu,Sara.

Dosha karma : Vataghna,Pittaghna

e) Punarnava 116

Botanical Name : Boerhavia diffusa Linn.

Family : Nyctaginaceae

Rasa : Madhura, Tikta, Kashaya

Guna : Laghu , Ruksha

Veerya : Ushna

Vipaka : Madhura

Dosha Karma : Tridosha hara, Lekhana, Shothahara, Deepana,

Rasayana.

Part used : Moola

f) Saindava117

Guna : Snigda,Laghu

Rasa : Lavana

Page : 61

Drug review

Veerya : Sheeta

g) Jingini118

Botanical Name : Odina wodier

Family : Anacardiaceae

Rasa : Madhura,Kashaya,

Guna : Ushna

Veerya : Ushna

Vipaka : Katu

Dhosha Karma : Vatahara, Skanda amsa bahu rujapaha.

Part used : Taru niryasa

h) Sarshapa Taila119

Botanical Name : Brassica compestris Linn.Var.

Family : Cruciferae

Rasa : Katu, Tikta

Guna : Snigdha

Veerya : Ushna

Vipaka : Katu

Dosha Karma : Kapha vata shamaka, Lekhana, vedana sthapana,

deepana.

Part used : Beeja

Page : 62

Drug review

i) Masha120

Botanical Name : Phaseolus mungo Linn

Family : Leguminosae

Rasa : Madhura

Guna : Guru, Snigdha

Veerya : Ushna

Vipaka : Madhura

Dosha Karma : Kapha vardhaka, Balya, Bruhmana, Jeevaniya

Part used : Phala

2) Ekangaveera Rasa

a) Shudda Gandhaka121

Karma – Rasayana ,Vishanashaka , Kandughna , Kusthaghna ,Visarpaghna .

b) Rasa sindoora121

Karma – Shoola hara, Rasayana, Vata vikara.

c) Loha Bhasma 121

Karma – Tridoshaghna, Rasayana,Vajikarana, Balya, Bruhmana.

d) Vanga Bhasma121

Karma – Balya, Bruhmana, Rasayana, Deepana, Pachana.

e) Naga Bhasma121

Karma – Prameha nashaka, Vrushya, Balya.

f) Tamra Bhasma121

Kaphapitta nashaka, Brumhana, Lekhana, Netrya .

g) Abhraka Bhasma 121

Page : 63

Drug review

Karma – Vatapittakapha nashaka, Rasayana, Balya, Vrushya, Medhya.

h) Shunti122

Botanical Name : Zingiber offiicinale Roxb

Family : Zingiberaceae

Rasa : Katu

Guna : Snigdha, Laghu

Veerya : Ushna

Vipaka : Madhura

Dosha Karma : Kapha vatashamaka, Vedana sthapaka, Deepana,

Pachana.

Part used : Kanda

i) Maricha 123

Botanical Name : Piper nigrum Linn

Family : Piperaceae

Rasa : Katu

Guna : Laghu, Teekshna

Veerya : Ushna

Vipaka : Katu

Dosha Karma : Vatakapha shamaka, Balya, Deepana, Pachana.

Part used : Phala

j) Pippali 124

Botanical Name : Piper longum Linn

Family : Piperaceae

Page : 64

Drug review

Rasa : Katu

Guna : Laghu, Teekshna, Snighda.

Veerya : Anushnasheeta

Vipaka : Madhura

Dosha Karma : Kaphavata shamaka, Deepana, Rasayana, Balya.

Part used : Phala

Bhavana Dravya

i) Triphala

a) Haritaki125

Botanical Name : Terminalia chebula Retz

Family : Combretaceae

Rasa : Pancha rasa ( Lavana varjita) Kashaya rasa

pradhana.

Guna : Laghu, Ruksha

Veerya : Ushna

Vipaka : Madhura

Vosha Karma : Tri dosha hara, vedana sthapana, Balya, Rasayana.

Part used : Phala

b) Vibitaki126

Botanical Name : Terminalia bellirica Roxb

Family : Combretaceae

Rasa : Kashaya rasa

Page : 65

Drug review

Guna : Ruksha.Laghu.

Veerya : Ushna

Vipaka : Madhura

Dosha Karma : Tri dosha hara, Vedana sthapana, Deepana,

Dhatuvardaka.

Part used : Phala.

c) Amalaki127

Botanical Name : Emblica officinalis Gaertn

Family : Euphorbiaceae

Rasa : Pancha rasa (Lavana varjita) Amla rasa pradhana.

Guna : Guru,Ruksha, Sheeta.

Veerya : Sheeta.

Vipaka : Madhura

Dosha Karma : Tridosha hara, Deepana, Rasayana.

Part used : Phala.

ii) Trikatu – Shunti, Maricha, Pippali.

iii) Nirgundi 128

Botanical Name : Vitex negundo Linn.

Family : Verbenaceae

Rasa : Katu, Tikta.

Page : 66

Drug review

Guna : Laghu, Ruksha

Veerya : Ushna

Vipaka : Katu.

Dosha Karma : Kapha vata shamaka, Deepana, Vedana sthapana,

Balya, rasayana

Part used : Patra.

iv) Chitraka 129

Botanical Name : Plumbago zeylanica Linn.

Family : Plumbaginaceae.

Rasa : Katu.

Guna : Laghu ,Ruksha, Teekshna

Veerya : Ushna

Vipaka : Katu.

Dosha Karma : Kapha vata shamaka, Lekhana, Deepana, Pachana

Part used : Moola twak.

v) Ardraka 130

Botanical Name : Zingiber officinale Rosc.

Family : Zingiberaceae

Rasa : Katu.

Guna : Guru ,Ruksha, Teekshna.

Veerya : Ushna.

Vipaka : Katu.

Page : 67

Drug review

Dosha Karma : Kapha vata shamaka, Deepana, Pachana

Part used : Kanda.

vi) Shigru 131

Botanical Name : Moringa oleifera Lam.

Family : Moringaceae.

Rasa : Katu, Tikta.

Guna : Laghu ,Ruksha, Teekshna.

Veerya : Ushna

Vipaka : Katu.

Dosha Karma : Kapha shamaka, Shoola prashamana, Deepana,

Pachana.

Part used : Moola twak.

vii) Kustha 132

Botanical Name : Saussurea lappa C B clarke.

Family : Compositae.

Rasa : Tikta, Katu, Madhura.

Guna : Laghu ,Ruksha, Teekshna

Veerya : Ushna

Vipaka : Katu.

Dosha Karma : Kapha vata shamaka, Shoola prashamana,

Deepana, Pachana.

Part used : Moola.

Page : 68

Drug review

viii) Vishamusti 133

Botanical Name : Strychnos nuxvomica Linn.

Family : Loganiaceae

Rasa : Katu, Tikta.

Guna : Ruksha, Laghu, Teekshna.

Veerya : Ushna

Vipaka : Katu.

Dhosha Karma : Kapha vata shamaka, Shoola prashamana, Balya.

Part used : Shodhita Beeja majja.

ix) Arkahata (Akarakarabha) 134

Botanical Name : Anacyclus pyrethrum DC.

Family : Compositae

Rasa : Katu.

Guna : Ruksha, Teekshna.

Veerya : Ushna

Vipaka : Katu.

Dosha Karma : Kapha vata shamaka, Balya, Vedana sthapana.

Part used : Moola.

Page : 69

Methodology

METHODOLOGY

A) MATERIALS & METHODS:

1. Source of data:

Patients of either sex diagnosed as Apabahuka from the O.P.D and

I.P.D of A.L. N Rao Memorial Ayurvedic Medical College and Hospital, Koppa

are selected for the study. Out of 52 selected patients, 7 patients were droped out in

the initial stages of the study and 45 patients completed the course of treatments.

The dropouts were not included in the total number of patients in the observation

Graphss and the remaining 45 patients were included in the study.

2. Criteria for selection of patients:

The patients presenting with the signs and symptoms of Apabhauka

according to Ayurvedic texts were selected for the present study. Patients of both

sexes in the age group of 20 – 60 years were taken. The main criteria for diagnosis

was the presence of clinical symptoms of Apabhuka ie, Bahu praspaditahara and

shoola. The symptoms of sroto dusti were also assessed along with the main

symptoms for the selection of the patients.

a) Inclusion criteria:

1) Apabahuka diagnosed according to the classical signs and

symptoms described in Ayurveda.

2) Patients of both sexes within the age group of 20 – 60 years.

Page: 70

Methodology

b) Exclusion criteria:

1) Systemic diseases presented with Apabahuka as complication.

2) Patients with the history of fracture of affected hand.

3) Pregnancy and lactating women.

c) Laboratory investigations:

The modern laboratory investigations included for the clinical

study are

a) Blood - Hb%, TC, DC, ESR, RBS. As a routine investigation

b) Urine - Sugar, Albumin, Microscopic.

c) X-ray - Shoulder joint - AP, lateral – To rule out the history of

fracture.

3) Study design:

Randomised standard single blind comparative clinical study with pre

test and post test design is adopted.

4) Treatment schedule:

After diagnosis, the selected patients were randomly catagorised into the following

three therapeutic groups.

1) Shodhana group:

It contains marsha nasya with Laghu masha taila in the dose of 6, 8 or 10 drops

as required according to the patient for 7 days. In this group 18 patients were selected

for the treatment. Out of them, 3 patients were discontinued the course of therapy.

Page: 71

Methodology

2) Shamana group:

This group contains the administration of Ekanga veera rasa 125 mg twice

daily after food for 30 days. In this group, 17 patients were selected for the study, out

of which 2 patients discontinued the course of therapy.

3) Shodhana shamana group:

This group comprises of Laghu masha taila marsha nasya for 7 days and after

wards administration of Ekanga veera rasa 125 mg b.d for 30 days. In this group, 17

patients were selected for the study out of which 2 were drop outs and only 15 patients

completed the course of therapy.

5) Criteria for the assessment of symptoms:

The improvements of patients were assessed on the basis of relief in the signs

and symptoms of diseases. To analyse the efficacy of the drug, marks were

given statistically to each symptoms. According to severity of the symptoms,

the grading were given as below;

6) Score of specific symptoms:

I) Main symptoms:

1) Bahu praspanditahara Score

a) Can do work unaffectedly 0

b) Can do strenuous work with difficulty 1

c) Can do daily routine work with great difficulty 2

d) Cannot do any work 3

2) Shoola

Page: 72

Methodology

a) No pain 0

b) Mild pain, can do strenous work with difficulty 1

c) Moderate pain, can do the normal work with support 2

d)Severe pain, unable to do work at all 3

II) Associated complaint:

1) Stambha (stiffness)

a) No stiffness 0

b) Mild, feels difficulty to move the joints without support 1

c) Moderate, feels difficulty to move, can lift only with support 2

d) Severe, unable to lift 3

2) Atopa

a) No atopa 0

b) Palpable atopa 1

c) Audible 2

3) Wasting of muscles

a) No wasting 0

b) Mild wasting, can do work 1

c) Wasting present, work with difficulty 2

d) Wasting present, cannot move 3

III) Sroto dusti

Page: 73

Methodology

a) No symptoms 0

b) One symptom present 1

c) Two symptoms present 2

d) Three or more symptoms present 3

IV) Shoulder joint movements

i) Elevation

a) Up to 180o 0

b) Up to 135o 1

c) Up to 90o 2

d) Up to 45o 3

e) Cannot elevate 4

ii) Flexion

a) Up to 90o 0

b) Up to 60o 1

c) Up to 30o 2

d) Cannot flex 3

iii) Abduction

a) Up to 90o 0

b) Up to 60o 1

c) Up to 30o 2

d) Cannot abduct 3

Page: 74

Methodology

The improvement is documented through statistical significance. The subjective

and objective parameters are assessed by means of interrogation and by ascertaining

the signs and symptoms before and after the treatment.

The clinical study is based on the comparative study of the trial groups. The

response of the drug is assessed weekly through interrogation, signs and symptoms.

The trial Shamana drug was given for a period of 30 days and Shodhana therapy was

given for 7 days. The observations were recorded in the following weeks. The follow-

up period was also given for 30 days for patients of all groups.

7) Statistical Analysis:

For assessing the improvement of symptomatic relief and to analyse

statistically the observations were recorded before the treatment, after the treatment

and after follow- up. The mean, percentage, S.D, S.E, and t-value (paired t-test) were

calculated from the observation recorded. The total result including the overall effect

of therapy is given in tables for three groups.

8) Criteria for assessment of overall effect of therapy:

i) Complete relief:

100% relief in the complaints of patients along with elevation of shoulder

joint up to 180o, flexion, abduction of the joint is 90o.

Page: 75

Methodology

ii) Marked improvement:

More than 75% relief in the complaints as well as significant improvement in

elevation of joint up to 135o, flexion & abduction up to 60o.

iii) Moderate improvement:

More than 50% relief in the complaints along with improvements in

elevation of joint up to 90o, flexion & abduction of joint up to 30o.

iv) Improvement:

25% to 50% relief in the complaints.

v) Unchanged:

Less than 25% relief in the complaints were regarded as unchanged.

B) OBSERVATIONS

Page: 76

Methodology

Table No: 6

Age wise distribution of 45 patients of Apabahuka:

Age group

in yrs

Shodhana

group

Shamana

group

Shodhana

& Shamana

group

Total Percentage

20 – 30 2 4 3 9 20.00

31 -40 7 4 4 15 33.33

41 – 50 4 5 3 12 26.66

51 - 60 2 2 5 9 20.00

Maximum number of patients were obtained in the age group of 30 – 40 years, i.e

33.33%. In the age group of 40 – 50 years, 26.66% of patients were obtained. In the

age group of 50 – 60 years, 20% of patients were got. And minimum numbers of

patients were got from the age group of 20 – 30, i.e 20.00%.

Graph No:1

Age wise distribution of 45 patients of Apabahuka:

0

10

20

30

40

20 - 30 30 - 40 40 - 50 50 - 60

Table No: 7

Page: 77

Methodology

Sex wise distribution of 45 patients of Apabahuka:

Sex Shodhana

group

Shamana

group

Shodhana

& Shamana

group

Total Percentage

Male 9 8 10 27 60

Female 6 7 5 18 40

Male patients were 60% and females were 40%.

Graph No: 2

Sex wise distribution of 45 patients of Apabahuka:

0

20

40

60

80

Male Female

Table No:3

Page: 78

Methodology

Religion wise distribution of 45 patients of Apabahuka:

Religion Shodhana

group

Shamana

group

Shodhana

&Shamana

group

Total Percentage

Hindu 7 6 8 21 46.66

Muslim 5 4 4 13 28.88

Christian 3 5 3 11 24.44

46.66% of patients were Hindus, 28.88% of patients were Muslims and 24.44% of

patients were observed as Christians.

Graph No:3

Religion wise distribution of 45 patients of Apabahuka:

0

10

20

30

40

50

HindusMuslimChristian

Table No: 9

Page: 79

Methodology

Occupation wise distribution of 45 patients of Apabahuka

Occupation Shodhana

group

Shamana

group

Shodhana

&

Shamana

group

Total Percentage

House wife 3 4 4 11 24.44

Unemployed 1 2 1 4 8.88

Labour 6 5 6 17 37.77

Service 2 3 2 7 15.55

Business 2 1 1 4 8.88

Student 1 0 1 2 4.44

37.77% of patients were found in the labour category, 24.44% of patients were house

wife, 15.55% of patients were service, 8.88% were both in business and unemployed

category, 4.44% were students.

Graph No: 4

Occupation wise distribution of 45 patients of Apabahuka:

0

10

20

30

40

House wife Unemployed Labour Service Business Student

Table No: 10

Page: 80

Methodology

Marital state wise distribution of 45 patients of Apabahuka:

Marital

status

Shodhana

group

Shamana

group

Shodhana

& Shamana

group

Total Percentage

Married 9 11 10 30 66.66

Unmarried 6 4 4 14 31.11

Widow 0 0 1 1 2.22

66.66% of the patients were married, 31.11% were unmarried and 2.22% of patients

were widow.

Graph No: 5

Marital state wise distribution of 45 patients of Apabahuka:

0

10

20

30

40

50

60

70

Married Unmarried Widow

Table No: 11

Page: 81

Methodology

Socio-economic Status wise distribution of 45 patients of Apabahuka:

Socio-

economic

status

Shodhana

group

Shamana

group

Shodhana

& Shamana

group

Total Percentage

Lower 6 7 5 18 40.00

Middle 6 4 7 17 37.77

Upper 3 4 3 10 22.22

40 % of the patients belong to lower class, in the middle class, it is 37.77 % and in

upper class, it is 22.22 %.

Graph No: 6

Socio-economic Status wise distribution of 45 patients of Apabahuka:

0

10

20

30

40

50

Lower Middle Upper

Table No: 12

Page: 82

Methodology

Dietary pattern of 45 patients of Apabahuka:

Dietry

pattern

Shodhana

group

Shamana

group

Shodhana

& Shamana

group

Total percentage

Vegetarian 6 8 5 19 42.22

Non-Veg 9 7 10 26 57.77

Among the 45 patients Vegetarians were found to be 42.22% and non-vegetarians

were found to be 57.77 %.

Graph No: 7

Dietary pattern of 45 patients of Apabahuka:

0

20

40

60

Veg Non-veg

Table No:13

Page: 83

Methodology

Family history of 45 patients of Apabahuka:

Family

history

Shodhana

group

Shamana

group

Shodhana

& Shamana

group

Total percentage

Positive 3 2 1 6 13.33

Negative 12 13 14 39 86.66

86.66 % of patients did not have any family history where as 13.33 % of patients had

related family history.

Graph No: 8

Family history of 45 patients of Apabahuka:

0

20

40

60

80

100

+ve -ve

Table No:14

Page: 84

Methodology

General nidana observed in 45 patients of Apabahuka:

Nidana Shodhana

group

Shamana

group

Shodhana

& Shamana

group

Total percentage

Vatakara

ahara

5 4 5 14 31.11

Vatakara

vihara

9 8 7 24 53.33

Manasika 1 3 3 7 15.55

Vatakara ahara were observed in 31.11 % of patients, vatahkara vihara were observed

in 53.33 %, manasika nidanas were observed in 15.55%.

Graph No: 9

General nidana observed in 45 patients of Apabahuka:

0

10

20

30

40

50

60

Ahara Vihara Manasika

Table No: 15

Page: 85

Methodology

Main symptoms observed in 45 patients of Apabahuka:

Main symptom Shodhana

group

Shamana

group

Shodhana

&

Shamana

group

Total Percentage

Bahupraspandita

hara

15 15 15 45 100.00

Shoola 15 15 15 45 100.00

Both the above symptoms were found in all the patients.

Graph No: 10

Main symptoms observed in 45 patients of Apabahuka:

1

51

101

Bahupraspanditahara

Shoola

Table No: 16

Page: 86

Methodology

Associated symptoms observed in 45 patients of Apabahuka:

Associated

symptoms

Shodhana

group

Shamana

group

Shodhana

&Shamana

group

Total Percentage

Stambha 10 11 12 33 73.33

Atopa 5 5 6 16 35.55

Wasting

of Muscles

8 7 8 23 51.11

73.33 % of patients presented with symptoms of Stambha, 51.11 % of patients had

Wasting of muscles and 35.55 % of patients were suffering from Atopa.

Graph No: 11

Associated symptoms observed in45 patients of Apabahuka:

01020304050607080

Stambha Atopa Wasting ofmuscles

Table No: 17

Page: 87

Methodology

Srotodusti lakshana observed in 45 patients of Apabahuka:

Sroto dusti Shodhana

group

Shamana

group

Shodhana

&

Shamana

group

Total Percentage

Mamsavaha 6 7 8 21 46.66

Medovaha 5 8 10 23 55.11

Asthivaha 15 15 15 45 100

Majjavaha 15 15 15 45 100

All the patients had dusti of Asthivha and Majjavaha srotas. 55.11 % of patients had

Medovaha sroto dusti, and 46.66 % of patients had Mamsavaha sroto dusti.

Graph No: 12

Srotodusti lakshana observed in 45 patients of Apabahuka:

0

20

40

60

80

100

Mamsavaha Medovaha Asthivaha Majjavaha

Page: 88

Results

RESULTS

THERAPEUTIC EFFECT OF SHODHANA IN APABAHUKA

Table No: 18

Effect of Shodhana on main symptoms of Apabahuka in 15 patients after

treatment:

Measures Sl.

No

Main

Symptom BT AT BT-

AT

% S.D

(+-)

S.E

(+-)

t

value

p value

1 Bahuprasp

anditahara

1.266 0.66 0.60 53.33 0.632 0.163 3.674 < 0.010

2 Shoola 1.20 0.94 0.266 26.66 0.457 0.118 2.25 < 0.050

Shodhana drug provided moderately significant relief (p< 0.010) in the management

of Bahupraspanditahara by 53.33 %, where as in the management of shoola, it was

mildly significant (p<0.050) by 26.66%.

Table No: 19

Effect of Shodhana on main symptoms of Apabahuka in 15 patients after

follow up:

Measures Sl.

No

Main

Symptom BT AFU BT-AFU

% S.D

(+-)

S.E

(+-)

t

value

p value

1 Bahuprasp

anditahara

1.266 0.93 0.33 33.33 0.487 0.125 2.643 <0.020

2 Shoola 1.20 1.00 0.20 20.00 0.414 0.146 1.870 >0.50

Page : 89

Results

After follow up, Shodhana drug showed mild significant relief (p<0.020) in the

management of Bahuprspanditahara by 33.33%, where as in the management of

Shoola, it was insignificant (p>0.50) by 20%.

Table No: 20

Effect of Shodhana on associated symptoms of Apabahuka in 15 patients after

treatment:

Measures Sl.

No

Associated

symptoms BT AT BT-AT

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Stambha 1.40 1.00 0.40 30.00 0.699 0.221 1.80 >0.100

2 Atopa 1.60 1.00 0.60 60.00 0.5977 0.244 2.44 <0.100

3 Wasting of

muscles

1.375 1.00 0.375 37.50 0.517 0.182 2.049 <0.100

In the management of Stambha, the result was insignificant (p>0.50) by 30%. In the

management of Atopa and wasting of muscles, the result was insignificant (p>0.50)

by 60% and 37.50% respectively.

Page : 90

Results

Table No: 21

Effect of Shodhana on associated symptoms of Apabahuka in 15 patients after

follow-up:

Measures Sl.No

Asssociated symptom

BT AFU BT-AFU

% S.D (+-)

S.E (+-)

t value

p value

1 Stambha 1.40 1.20 0.20 20.00 0.421 0.133 1.50 >0.100

2 Atopa 1.60 0.80 0.40 40.00 0.547 0.244 1.63 >0.100

3 Wasting of muscles

1.375 1.225 0.25 25.00 0.462 0.163 1.52 >0.100

After the follow up, the Shodhana therapy provided insignificant relief (p>0.100) in

the management of Stambha, Atopa and Wasting of muscle by 20%, 40% and 25%

respectively.

Table No: 22

Effect of Shodhana therapy on sroto dusti lakshnas in 15 patients of Apabahuka

after treatment:

Measures Sl.No

Srotas

BT AT BT-AT

% S.D (+-)

S.E (+-)

t value

p value

1 Mamsa 1.33 0.83 0.50 50.00 0.547 0.223 2.23 >0.50

2 Meda 1.40 0.60 0.80 80.00 0.447 0.20 4.00 <0.020

3 Asthi 1.46 1.13 0.33 33.33 0.487 0.125 2.619 <0.050

4 Majja 1.40 1.00 0.40 33.33 0.632 0.163 2.44 <0.050

Page : 91

Results

In the management of Asthivaha and Majjavaha sroto dusti the result was mildly

significant (p<0.050) by 33.33% each. In the Medovaha sroto dusti, it was mildly

significant (p<0.020) by 80% where as it provided insignificant result (p>0.50) in

Mamsa vaha sroto dusti by 50%.

Table No: 23

Effect of Shodhana therapy on sroto dusti lakshnas in 15 patients of Apabahuka

after follow up:

Measures Sl.

No

Srotas

BT AFU BT-AFU

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Mamsa 1.33 1.00 0.33 33.3 0.516 0.210 1.579 >0.50

2 Meda 1.40 0.80 0.60 60.0 0.547 0.244 2.449 >0.50

3 Asthi 1.466 1.20 0.266 26.6 0.457 0.118 2.250 <0.050

4 Majja 1.40 1.20 0.20 20.0 0.414 0.106 1.870 >0.100

Shodhana therapy provided insignificant significant result (p>0.50) in the

management of Medovaha and Majja vaha sroto dusti by 60% and 20% respectively.

In the management of Mamsa vaha sroto dusti, the result was insignificant (p>0.50)

by 33.33% where as in the management of Asthi vaha sroto dusti, the result was

mildly significant (p<0.050) by 26.66%.

Page : 92

Results

THERAPEUTIC EFFECT OF SHAMANA IN APABAHUKA

Table No: 24

Effect of Shamana therapy in the main symptoms of Apabahuka in 15 patients

after treatment:

Measures Sl.

No

Main

Symptom BT AT BT-AT

% S.D

(+-)

S.E

(+-)

t

valu

e

p

value

1 Bahupraspa

nditahara

1.40 0.867 0.533 53.3 0.516 0.133 3.99 <0.010

2 Shoola 1.40 1.00 0.40 40.0 0.507 0.130 3.05 <0.010

Shamana therapy provided moderately significant relief (p<0.010) in the management

of Bahuprspranditahara and Shoola by 53.33% and 40% respectively.

Table No: 25

Effect of Shamana therapy in the main symptoms of Apabahuka in 15 patients

after follow up:

Measures Sl.

No

Main

Symptom BT AFU BT-AFU

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Bahupraspa

nditahara

1.4 0.80 0.60 60.0 0.507 0.130 4.582 <0.001

2 Shoola 1.4 0.93 0.466 46.66 0.516 0.133 3.499 <0.010

Page : 93

Results

After follow up, Shamana drug provided moderately significant relief (p<0.010) in the

management of Shoola by 46.66%. Where as, it provided highly significant relief

(p<0.001) by 60% in the management of Bahupraspanditahara.

Table No: 26

Effect of Shamana therapy in the associated symptoms of Apabahuka in 15

patients after treatment:

Measures Sl.

No

Asssociated

symptom BT AT BT-AT

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Stambha 1.454 1.091 0.363 36.3 0.504 0.152 2.390 <0.050

2 Atopa 1.60 0.8 0.80 60.0 0.836 0.374 2.138 >0.50

3 Wasting of

muscles

1.428 0.714 0.714 71.4 0.987 0.184 3.87 <0.010

Shamana therapy provided moderately significant relief (p<0.010) in the management

of wasting of muscles by 71.4%. In Stambha it was mildly significant (p<0.050) by

36.36%. In the management of Atopa it was insignificant (p>0.50) by 60% relief.

Page : 94

Results

Table No: 27

Effect of Shamana therapy in the associated symptoms of Apabahuka in 15

patients after follow up:

Measures Sl.

No

Asssociated

symptom BT AFU BT-AFU

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Stambha 1.45 1.00 0.45 45.4 0.522 0.157 2.886 <0.020

2 Atopa 1.60 0.8 0.80 80.0 0.447 0.20 4.00 <0.020

3 Wasting of

muscles

1.42

8

0.57

8

0.85 85.7

0

0.377 0.142 5.59 <0.010

Shamana therapy provided moderately significant relief (p<0.010) in the management

of wasting of muscles by 85.70%.Where as in Stambha and Atopa, the result was

mildly significant (p<0.020) by 45.45%, 80% respectively.

Table No: 28

Effect of Shamana therapy on sroto dusti lakshnas in 15 patients of Apabahuka

after treatment:

Measures Sl.

No

Srotas

BT AT BT-AT

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Mamsa 1.571 1.00 0.571 57.1 0.534 0.262 2.82 <0.050

2 Meda 1.375 0.87 0.5 50.0 0.534 0.188 2.695 <0.050

3 Asthi 1.33 0.67 0.66 66.0 0.617 0.159 4.179 <0.001

4 Majja 1.466 0.80 0.533 53.3 0.516 0.133 3.997 <0.010

Page : 95

Results

Shamana therapy provided highly significant relief (p<0.001) in the management of

Asthi vaha sroto dusti by 66%. In the management of Mamsa vaha and Medo vaha

sroto dusti, mildly significant relief was observed (p<0.050) by 57.1% and 50%

respectively. It provided moderate significant relief (p<0.010) in the management of

Majja vaha sroto dusti by 53.33%.

Table No: 29

Effect of Shamana therapy on sroto dusti lakshnas in 15 patients of Apabahuka

after follow up:

Measures Sl.

No

Srotus

BT AFU BT-

AFU

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Mamsa 1.571 0.857 0.714 71.4 0.987 0.184 3.871 <0.010

2 Meda 1.375 0.75 0.625 62.5 0.517 0.182 3.415 <0.020

3 Asthi 1.33 0.53 0.80 80.0 0.676 0.174 4.58 <0.001

4 Majja 1.466 0.66 0.60 60.0 0.507 0.130 4.582 <0.001

Drug provided highly significant relief (p<0.001) in the management of Asthivaha

and Majja vaha sroto dusti by 80% and 60%.In the management of Mamsa vaha sroto

dust,i the result was moderately significant (p<0.010) by 71.40% and in the

management of Medo vaha sroto dusti, it was mildly significant (p<0.020) by 62.50%.

Page : 96

Results

THERAPEUTIC EFFECT OF SHODHANA & SHAMANA IN APABAHUKA

Table No: 30

Effect of Shodhana & Shamana on main symptoms of in patients of Apabahuka

after treatment:

Measures Sl

.N

o

Main

Symptom BT AT BT-

AT

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Bahuprasp

anditahara

1.40 0.667 0.733 73.3 0.593 0.153 4.782 <0.001

2 Shoola 1.33 0.673 0.66 60.0 0.617 0.15 4.179 <0.001

Both Bahupraspanditahara and Shoola received highly significant relief (p<0.001) by

73.3% and 60% respectively.

Table No: 31

Effect of Shodhana & Shamana on main symptoms in 15 patients of Apabahuka

after follow up:

Measures Sl.

No

Main

Symptom BT AFU BT-AFU

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Bahupraspan

ditahara

1.40 0.60 0.80 80 0.560 0.144 5.526 <0.001

2 Shoola 1.33 0.73 0.60 60 0.507 0.130 4.582 <0.001

After follow up, it provided highly significant relief (p<0.001) in the management of

Bahupraspanditahara and Shoola by 80% and 60% respectively.

Page : 97

Results

Table No: 32

Effect of Shodhana & Shamana therapy on associated symptoms of Apabahuka

in 15 patients after treatment:

Measures Sl.

No

Asssociated

symptom BT AT BT-AT

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Stambha 1.33 0.67 0.606 60.6 0.492 0.142 4.682 <0.001

2 Atopa 1.33 0.33 1.00 83.33 0.632 0.258 3.88 <0.02

3 Wasthing of

muscles

1.50 1.00 0.50 50.00 0.534 0.188 2.645 <0.05

It provided highly significant relief (p<0.001) in the management of Stambha by

60.6% and it provided mildly significant relief (p<0.020) in the management of Atopa

by 83.33% respectively. It provided mildly significant relief (p<0.050) in the

management of Wasting of muscles by 50%.

Page : 98

Results

Table No: 33

Effect of Shodhana & Shamana therapy on associated symptoms of Apabahuka

in 15 patients after follow up:

Measures Sl.

No

Asssociated

symptom BT AFU BT-AFU

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Stambha 1.33 0.58 0.75 75.0 0.452 0.130 5.744 <0.001

2 Atopa 1.33 0.50 0.83 83.3 0.408 0.166 4.99 <0.01

3 Wasting of

muscles

1.50 0.75 0.75 75.0 0.462 0.163 4.58 <0.01

After follow up, it provided highly significant relief from (p<0.001) in the

management of Stambha by 75%. It provided moderately significant result (p<0.010)

in the management of Atopa and Wasthing of muscles by 83.33% and 75%

respectively.

Table No: 34

Effect of Shodhana & Shamana therapy on sroto dusti lakshnas in 15 patients of

Apabahuka after treatment:

Measures Sl.

No

Srothus

BT AT BT-AT

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Mamsa 1.50 0.875

0.625

62.5 0.744 0.263 2.375 <0.050

2 Medha 1.50 1.00 0.50 50.0 0.527 0.166 3.00 <0.020

3 Asthi 1.53 0.73 0.80 80.0 0.676 0.174 4.582 <0.001

4 Majja 1.40 0.66 0.73 73.3 0.593 0.153 4.784 <0.001

Page : 99

Results

It provided highly significant effect (p<0.001) in the management of Asthi vaha and

Majja vaha sroto dusti by 80% and 73.3% respectively. It provided moderately

significant relief (p<0.020) in the management of Medo vaha by 50%, it provided

mildly significant relief (p<0.050) in the Mamsa vaha sroto dusti by 62.50%.

Table No: 35

Effect of Shodhana & Shamana therapy on sroto dusti lakshnas in 15 patients of

Apabahuka after follow up:

Measures Sl.

No

Srothus

BT AFU BT-AFU

% S.D

(+-)

S.E

(+-)

t

value

p

value

1 Mamsa 1.50 0.50 1.00 87.5 0.534 0.188 5.291 <0.010

2 Medha 1.50 0.80 0.70 70.0 0.483 0.152 4.582 <0.010

3 Asthi 1.533 0.53

3

1.00 86.6 0.534 0.138 7.245 <0.001

4 Majja 1.40 0.54 0.86 80.0 0.516 0.133 6.495 <0.001

It provided highly significant relief (p<0.001) in the management of Asthi vaha and

Majja vaha sroto dusti by 86.67% and 80% respectively. It provided moderately

significant relief (p<0.010) in the management of Mamsa vaha and Medo vaha

srotodusti by 87.50% and 70% respectively.

Page : 100

Results

TOTAL EFFECT OF SHODHANA

Table No: 36

Total effect of Shodhana therapy on 15 patients of Apabahuka after treatment:

Results No: of patients (%)

Complete relief 0 0

Marked improvement 1 6.6

Moderate improvement 8 53.33

Improved 4 26.66

Unchanged 2 13.33

In this group, 53.33% of patients were assessed under moderately improved category.

26.66% patients were assessed under improved category. Only 6.6% showed marked

improvement. 13.33% were under unchanged category whereas nobody included

under complete relief.

Table No: 37

Total effect of Shodhana therapy on 15 patients of Apabahuka after follow up:

Results No: of patients (%)

Complete relief 0 0

Marked improvement 1 6.6

Moderate improvement 7 46.66

Improved 4 26.66

Unchanged 3 20.00

Page : 101

Results

After follow up, 46.66% of patients had moderate improvement and 26.66% of

patients came under improved section. 6.6% of patients had marked improvement,

20% of patients were unchanged. None of them had complete relief.

TOTAL EFFECT OF SHAMANA

Table No: 38

Total effect of Shamana therapy on 15 patients of Apabahuka after treatment:

Results No: of patients (%)

Complete relief 0 0

Marked improvement 2 13.33

Moderate improvement 8 53.33

Improved 3 20.00

Unchanged 2 13.33

In this group, 53.33% of patients were assessed under moderately improved category.

20% patients were assessed under improved category. Only 13.33% showed marked

improvement. 13.33% were under unchanged category, whereas nobody included

under complete relief.

Table No: 39

Total effect of Shamana therapy on 15 patients of Apabahuka after follow up:

Results No: of patients (%)

Complete relief 0 0

Marked improvement 2 13.33

Moderate improvement 9 60.00

Improved 2 13.33

Unchanged 2 13.33

Page : 102

Results

After follow up 60% of patients had moderate improvement and 13.33% of patients

came under improved section. 13.33% of patients had marked improvement, 13.33%

of patients were unchanged. None of them had complete relief.

TOTAL EFFECT OF SHODHANA & SHAMANA

Table No: 40

Total effect of Shodhana & Shamana therapy on 15 patients of Apabahuka after

treatment:

Results No: of patients (%)

Complete relief 0 0

Marked improvement 3 20.00

Moderate improvement 10 66.66

Improved 1 6.6

Unchanged 1 6.6

In this group 60.66% of patients were assessed under moderately improved category.

6.6% patients were assessed under improved category. Only 20% showed marked

improvement. 6.6% were under unchanged category, where as nobody included under

complete relief.

Page : 103

Results

Table No: 41

Total effect of Shodhana & Shamana therapy on 15 patients of Apabahuka after

follow up:

Results No: of patients (%)

Complete relief 0 0

Marked improvement 3 20.00

Moderate improvement 10 66.66

Improved 2 13.33

Unchanged 0 0

After follow up 60.66% of patients had moderate improvement and 13.33% of

patients came under improved section. 20% of patients had marked improvement.

None of them had complete relief.

Page : 104

Results

COMPARATIVE EFFECT OF THERAPIES

Graph No: 13

Comparative effect of therapies on main symptoms after 30 days, of treatment:

0

20

40

60

80

100

Shodana 53.3 40

Shamana 53.3 76.6

Shodana & Shamana 73.3 60

Bahupaspantita hara Shoola

From the above data we can conclude that the Shodhana & Shamana group got best

relief than other groups in both symptoms. In Bahuparspanditha hara both Shodhana

& Shamana group got equal results, where as in Shoola, Shodhana group provided

better results than Shamana group.

Graph No: 14

Comparative effect of therapies on main symptoms after 30 days, after follow

up:

0

20

40

60

80

100

Shodana 33.33 20

Shamana 60 46.66

Shodana & Shamana 80 60

Bahupaspantita hara Shoola

Page : 105

Results

From the above data we can conclude that Shodhana & Shamana provided best results

in the management of both symptoms. Shamana provided better results and the least

result provided by Shodhana group.

Graph No: 15

Comparative effect of therapies on associated symptoms after treatment:

0

20

40

60

80

100

Shodana 30 60 37.5

Shamana 36.6 60 71.45

Shodana & Shamana 60.6 83.33 71.42

Stamba Atopa Wasting of muscles

In the management of Stambha and Atopa, the Shodhana Shamana group provided

better results, whereas in the management of wasting of muscle, the shamana group

provided better results. The least results were shown in Shodhana group. Shamana

group showed better results than Shodhana group.

Page : 106

Results

Graph No: 16

Comparative effect of therapies on associated symptoms after follow up:

0

25

50

75

100

Shodana 20 40 25

Shamana 45.45 60 71.42

Shodana & Shamana 75 83.33 75

Stamba Atopa Wasting of muscles

From the above data, we will come to know that both group shamana and Shodhana

shamana showed more improvement in their result after follow up,where as the

Shodhana group showed less results after follow up. If we compare the result the

Shodhana shamana group provided best results than other groups.

Graph No: 17

Comparative effect of therapies on sroto dusti lakshana after therapy:

0

20

40

60

80

100

Shodana 50 80 33.33 33.33

Shamana 57 50 66 53.33

Shodana & Shamana 62.5 50 80 73.3

Mamsa Meda Asti Majja

Page : 107

Results

From the above data expect in Medovaha sroto dusti shodhana group provided least

result, where as Shodhana shamana groups provided best result in all the srothas.

Graph No: 18

Comparative effect of therapies on sroto dusti lakshana after follow up:

0

20

40

60

80

100

Shodana 33 60 26.66 20

Shamana 71.9 62.5 80 80

Shodana & Shamana 87.5 70 86.67 80

Mamsa Meda Asti Majja

From the above data, we can conclude that both groups i.e shamana and Shodhana

shamana showed improvements in the results after the follow up.

Graph No: 19

Comparative effect of overall therapies after treatment:

0

20

40

60

80

Shodana 0 6.6 53.33 26.66 13.33

Shamana 0 13.33 53.33 20 13.33

Shodana & Shamana 0 20 60 6.6 6.6

Complete Marked Moderate Improved unchanged

Page : 108

Results

From the above data, it is clear that the entire group does not provide complete relief.

In the marked improvement category, Shodhana shamana group provided best results

i.e. 20%, followed by shamana group by 13.33%and least was Shodhana group

(6.6%).

In moderate improvement category, Shodhana shamana group provided best

result (60%), followed by both Shodhana and shamana group (53.33%).

In improvement category, shodhana group provided better results than

shodhana shamana group i.e(26.66%).

In unchanged category, both shodhana group and shamana group provided

better results (13.33%) than the Shodhana shamana group (6.6%).

Graph No: 20

Comparative effects of over all therapies after follow up:

0

20

40

60

80

100

Shodhana 0 6.6 46.66 26.66 20

Shamana 0 13.33 60 13.33 13.33

Shodhana & Shamana 0 20 60 13.33 0

Complete Marked Moderate Improved unchanged

Page : 109

Results

From the above data, it is clear that no group provided complete relief i.e 0%

result. In the marked improvement category, the group of shodhana shamana provided

best results for most patients (20%), followed by shamana group (13.33%), and least

results by Shodhana group (6.6%).

In moderate improvement category, both the shamana group and Shodhana

shamana group provided results for maximum number of patients (60%), and

Shodhana group provided only 46.66% relief.

In improvement category, Shodhana group showed results for maximum

number of patient’s i.e 26.66%. The patients in both shamana group and Shodhana

shamana patients were relieved from the signs and sympyoms by 13.33% each.

In unchanged category, no patients observed relief from Shodhana shamana

group (0%). In shamana group 13.33% of patients got relief and in Shodhana group,

20% of patients got good results.

Page : 110

Discussion

DISCUSSION

Apabahuka is one of the vata vyadhi which affects the normal functioning

of the upper limb. In a developing country like India where agriculturists and

laboures form a major population, the incidence of Apabahuka is more. Even

though this disease not being a life threatening one, it hampers the daily activity of

the upper limb.

Acharya Vagbata advises bruhmana nasya in Apabahuka as shoshana of

Sleshaka kapha occurs. Laghu masha taila being a bruhmana nasya which is

indicated in Bahu roga is selected for the study in shodhana group. Apart from

these procedures the shamana type of therapy that includes oral administration of

medicine is of the utmost importance as administration is easy and effective. Many

herbal and herbo-mineral combinations are described in Ayrurveda and their

therapeutic effect is yet to be explored. Ekanga veera rasa explained in Bruhat

nighantu ratnakara is a herbo-mineral drug which is indicated for diseases like

Apabahuka, Vishwachi, pakshagata, grudhrasi and other vata vyadhis. As this is a

potent drug used in different vata vyadhis, it is taken for the present study.

The present dissertation work entitled – “Management of Apabahuka with

Laghu masha taila nasya and Ekanga veera rasa – A clinical evaluation” consist of

following parts:

Page : 111

Discussion

Review of literature.

Clinical study.

Discussion.

Conclusion and Summary.

The conceptual study comprises of three separate chapters.

The first, where a brief description of the historical aspect of the illness from

vedic era to the present time is being explored and is entitled as historical review.

The second chapter elaborates the general descriptions of the disease

Apabahuka. The etymological derivation, etiology, anatomy, clinical

manifestations, pathogenesis, prognosis and general principle of treatment of

Apabahuka has been discussed in detail.

The composition of the drug compounds Laghu masha taila and Ekanga

veera rasa has been described in third chapter entitled as Drug review. The

properties of the individual herb used in the preparation of the medicinal

compound in brief have been discussed.

In the clinical study, materials and methods of the present work with

complete description of the assessment criteria has been discussed.

The descriptive statistical analysis of the sample taken for the study is

methodically elaborated. The observations, results and their statistical analysis are

presented in order with tables and graphs.

Page : 112

Discussion

In the chapter entitled as discussion the results obtained are critically

analyzed to reveal the truth of efficacy of the combination taken for the study. The

final conclusion drawn from the present clinical research work is described in this

chapter as conclusion and summary.

This clinical study is a sincere effort to add newer combinations of shodhana

and shamana chikitsa in Apabahuka. The treatment adopted here may have some

edge over the other combinations prescribed in the routine practice. With this hope,

the present work is carried out. It is also hoped that this work will pave new

avenues for enthusiastic research workers in this field and find a better cure for this

lingering malady.

PLAN OF STUDY:

This study is carried out on 45 patients treated in three groups. Total 52

patients were obtained, out of that s 7 patients were got dropped out due to various

reasons. The criteria of diagnosis were based on the classical signs and symptoms

of the disease. In the first group i.e., shodhana group fifteen patients out of 45

patients of Apabahuka were treated under Laghu masha taila nasya for 7 days.

In the second group i.e., shamana group fifteen patients were treated by

Ekanga veera rasa 125mg b.d for 30 days. Remaining fifteen patients were treated

by shodhana shamana group, a combined therapy of both the above shodhana

shamana treatment.

Page : 113

Discussion

The improvements in the symptoms of the disease as well as sroto dusti after

the treatment were the main criteria of assessment in the present study. The total

effect of the therapies were also assessed in terms of complete relief, marked

improvement, moderate improvement, improved and unchanged.

DIAGNOSTIC CRITERIA AND ASSESSMENT CRITERIA:

To diagnose Apabahuka, the main symptoms Bahupraspanditahara and

Shoola was considered. Bahupraspanditahara is the first feature which is present in

all the patients and shoola is the second feature where the intensity of Shoola may

differ from patient to patient.

Goniometer was used to see the degree of movement of shoulder and different

grading was given accordingly. Shoola being a subjective feature, its assessment

was done on the severity and clinical observation.

INVESTIGATION:

All the patients were advised for routine blood and urine examination. ESR

also was advised to rule out the infectious disorders. X-ray was advised in some

patients to rule out fractures or dislocation of the shoulder.

Page : 114

Discussion

GENERAL OBSERVATION:

All the patients were taken care during the course of treatment.

Out of 52 patients 3 patients developed fever during the treatment

and totally 7 patients were dropped out from the study.

No patients developed any vyapath during the treatment.

NIDANATMAKA ASPECTS:

Age: Maximum numbers of patients were obtained in the age group of 30 –

40 years, i.e., 33.33% compared to the other age groups. This shows that the age

groups of 30 – 40 years are mostly affected.

Sex: Male patients’ i.e., 60% exceeded the female patients who were 40%.

This may be due to the demographic factor.

Religion: Majority of the patients was Hindus 46.66% and Muslims and

Christians were 28.88%and 24.44% respectively. This may be due to demographic

factors.

Occupation: 37.77% of the patients were in labour category, 24.44% were in

house wife category, 15.55% in service category, 8.88% were from business and

unemployed category. Only 4.44% from student category. So, this proves that

labour and hard working people are mostly affected from this disease.

Marital status: 66.66% of patients were married and 31.11% were

unmarried.

Socio-economic status: Majority of the patients (40%) belong to lower

socio-economic status while 37.77% from the middle class and only 33.33% are of

upper class. As labour class peoples are mainly affected by this disease, their

socio-economic status is poor.

Page : 115

Discussion

Dietary pattern: 57.77% patients had mixed food habits while 42.22% of

patients were of vegetarian diet section.

Family history: 86.66% of the patients did not show any family relation;

where as 13.33% had related family history. This clearly shows that the diseases

have no genetic predisposition.

EFFECT OF THERAPIES:

Effect of therapies on main symptoms:

(a) After therapy - shodhana, shamana, shodhana shamana group.

Shodhana shamana group provided highly significant relief (p<0.001) in the

management of bahupraspandita hara and shoola 80% and 60% respectively.

Shamana group provided moderately significant result (p<0.010) in the

management of bahupraspandita hara and shoola by 53.33% and 40% respectively.

Shodhana provided moderately significant relief (p<0.010) in the

management of bahupraspandita hara by 53% were as in shoola, it was mildly

significant (p<0.050) by 26.66%.

(b) After follow up - shodhana, shamana, shodhana shamana group.

After follow up, shodhana group provided mildly significant results

(p<0.020) in the management of bahupraspandita hara by 33.33% and in shoola,

insignificant result i.e., (p>0.50) by 20% and shamana drug provided moderately

significant relief (p<0.010) in the management of shoola by 46.6% and it provided

highly significant relief (p<0.001) by 60% in bahupraspandita hara.

Page : 116

Discussion

Effect of therapies on associated symptoms:

(a) After therapy - shodhana, shamana, shodhana shamana group.

In the shodhana group, the result was insignificant (p>0.5) by 30% in

stambha. In the management of atopa and wasting of muscles, the result were also

insignificant (p>0.5) by 60% and 37.5%, where as in the management of swelling,

it was mildly significant (p<0.020) by 62.50%.

In shamana therapy, it gave moderately significant relief (p<0.010) in

wasting of muscles by 71.42%, in swelling it was moderately significant (p<0.020)

by 50%, and in stambha, it was mildly significant (p<0.050) by 36.36%, where as

in the management of atopa it was insignificant (p>0.5) by 60%.

In shodhana shamana it provided highly significant result (p<0.001) in the

management of stambha by 60.6%, it provided mildly significant result (p<0.020)

in the management of atopa and swelling by 83.33% and 62.5% respectively. It

provided mildly significant relief (p<0.050) in the management of wasting of

muscles by 50%.

(b) After follow up - shodhana, shamana, shodhana shamana

group.

After follow up, shodhana shamana group provided highly significant result

(p<0.001) in stambha and swelling by 75% and 85.7% respectively.

Shamana therapy provided mildly significant relief (p<0.020) by 45% and

70% in stambha and swelling respectively. In stambha, it gave insignificant result

in Shodhana group (p>0.100) by 20% and in swelling, mildly significant (p<0.050)

by 50%. Shodhana shamana group gave mildly significant result (p<0.010) in the

evaluation of atopa and wasting of muscles by 83.33% and 75% respectively.

Page : 117

Discussion

Shamana provided moderate significant result (p<0.010) by 85.70% in

wasting of muscles. It was mild significant in atopa (p<0.020) by 80%.

Effect of therapies on sroto dusti lakshana:

(a) After therapy - shodhana, shamana, shodhana shamana group.

Shodhana shamana provided mild significant results in asthi vaha and majja

vaha sroto dusti (p<0.001) by 80% and 73.3% respectively. It provided moderately

lyand mildly significant result against mamsa vaha sroto dusti (p<0.050) by 62.5%.

Shamana therapy provided highly significant relief in the management of

asthi vaha sroto dusti (p<0.001) by 66%.In mamsa vaha and medo vaha sroto dusti,

it gave mildly significant relief (p<0.050) by 57.1% and 50% respectively where as

moderately significant result were provided in the management of majja vaha sroto

dusti (p<0.010) by 53.33%.

Shodhana therapy provided mild significant relief in the evaluation of asthi

vaha and majja vaha sroto dusti (p<0.050) by 33.33%. In the medo vaha sroto dusti

it was mildly significant (p<0.020) by 80% and insignificant results were seen in

mamsa vaha sroto dusti (p>0.5) by 50%.

(b) After follow up - shodhana, shamana, shodhana shamana group.

Shodhana therapy provided insignificant results in the medo vaha, majja

vaha, mamsa vaha sroto dusti(P>0.100) by 60%, 20%, 33.33% respectively. In

asthi vaha sroto dusti, it provided mildly significant result (p<0.050) by 26.66%.

Shamana provided highly significant result (p<0.001) in the management of

asthi vaha and majja vaha sroto dusti by 80% and 60%. In mamsa vaha sroto dusti

results were moderately significant (p<0.010) by 71.40% and in medo vaha sroto

dusti, mildly significant (p<0.020) by 62.5%.

Shodhana shamana provided highly significant relief (p<0.001) in the

management of asthi vaha and majja vaha sroto dusti by 86.67% and 80%

respectively. It provided moderately significant relief (p<0.010) in the management

of mamsa vaha and medo vaha sroto dusti by 87.5% and 70% respectively.

Page : 118

Discussion

MODE OF ACTION:

Laghu masha taila:

Laghu masha taila is a combination of nine drugs – Kapikacchu, Bala,

Shatavari, Sita, Punarnava, Saindhava, Jingini, Sarshapa and Masha.

Kapikacchu : Different varieties are available, has its potent action as vata

hara, with its qualities as snidha, madhura and ushna. Dravya is well known

for its anti- parkinsonism effect (Kampavata hara) since it contain

dopamine. Seed is rich in protein (Kerala or Tamilnadu germplasm), hence

it isutilized internally as taila which tones the muscle and act as nervine

tonic, which is the most important requirement in Apabahuka.

Bala : It is generally considered as nervine stimulant or nervine tonic, better

term can be given as nervine stimulant. Bala term is applied with its balya

property of moola. In Laghu masha taila, this serves its purpose to generate

sufficient energy to the muscle tissue, also by its effective supporting

factors as madhura rasa and madhura vipaka as vata hara.

Shatavari : Fascicled tuberous root is utilized in the different ailments as it

has the vata hara property. The absorption level of this drug through the

taila during nasya karma is found to be excellent.

Sita : serves the function of enhancing the energy of the other dravyas and

nourishes mastishka.

Punarnava : “Dhatu punarnavatwam” – a drug which brings the new

tissues in the body means, which is helpful in preventing degeneration of

Page : 119

Discussion

the tissues. In other words, it does the regeneration of sapta dhatus with its

specific activities on muscle tissues.

Saindhava : During nasya the taila used here is the fixed oil base.

Therefore the ideology of formulating the taila for its easiest absorption in

the procedure of Nasya karma has been balanced by the addition of

Saindhava lavana. Saindhava lavana has the potent action to facilitate the

easy absorption of taila through its effective properties.

Jingini : By its madura rasa and ushna virya acts as vata hara but katu

vipaka helps in the easy digestion of the taila through the nasya karma.

Sarshapa taila : Acts as a base for the dravyas of this Laghu masha taila,

helpful through its easy absorption activity due to teekshna, katu and ushna

properties.

Masha kwatha : A potent dhatu vardhana dravya supportive as vata hara

with its dominant madhura rasa and ushnadi gunas.

By observing the above ingredients and their actions, it is evident that

Kapikacchu, bala, shatavari, masha are main ingredients which gives balya

bruhmana effects. Sita in the combination acts as a energy enhancer by virtue of its

madhuratwa (glucose). Punarnava with its shotha hara and rasayana karmas

rejuvinate brain functions and Saindhava lavana acts a kapha vilayana kari and

sroto mukha vishodhana.

Katu taila is the main base ingredient for the other drugs (oil soluble). Katu

taila is a yoga vahi and carries all essential ingredients into the system by virtue of

its teekshna, sukshma, ashukari guna.

Page : 120

Discussion

Ekanga veera rasa:

Exacerbated vata, when involves the kandara, sira, snayu, sandhi in amsa

pradesha, the classical signs and symptoms of Apabahuka will get manifested. The

main causes is mentioned for the exacerbation of vata in classics are

i) Marga avarodha

ii) Dhatu kshaya

So, these two factors supposed to be verified while treating the disease.

The combination selected for the study, Ekanga veera rasa which is a herbo-

mineral compound has showed significant activity over this specific manifestation.

The probable mode of action can be divided into –

a) Activators: This group of components will have a direct role in the

treatment of the disease. Ingredients like Naga bhasma and Tamra bhasma

have their direct role over tendons and nerves. In Rasa classics, the

therapeutics have been described as Snayu sakthi vrudhikara, Nadi mandala

balya kara etc. Rasa sindoora, another main component of this yoga plays a

vital role in controlling the functions of vata and strengthens the functions

of motor neurons. On the other hand, ingredients like Abhraka bhasma,

Vanga bhasma and Tamra bhasma are beneficial in pacifying the

aggravated vata. These three bhasmas also acts as rejuvenators and

revitalizes the body functions.

b) Potentiators: They enhance the therapeutic qualities of drugs against the

disease. All the bhavana dravyas of the compound act as vata shamaka,

which is most important in breaking the pathological process of

Page : 121

Discussion

Apabahuka. More over, these drugs also act as Vedana sthapaka, Nadi

balya, Shoolaprashamaka, Shothahara, which is most essential in promoting

symptomatic relief. Plumbagin, an alkaloid present in Chitraka is a known

stimulant of muscle tissue. It also stimulates the motor neurons. Chitraka

moola, used as bhavana dravya during the pharmaceutical process,

incorporates considerable amounts of Plumbagin in to the Ekangaveera

rasa, and thus helpful in reducing the intensity of disease.

c) Antidote action: The herbal part incorporated into the product by levigation

process checks the vata kopaka property of mineral part and helps in

maintaining the normalcy of the body elements. More over, the Trikatu

checks the visceral deposition of Tamra, Naga, Vanga and Loha etc. This

kind of balancing activity reduces the incidences of toxicity with herbo-

mineral compounds.

d) Increasing Bio-availability: The deepana and pachana dravyas like sunti,

pippali, maricha and ardraka helps the medicine to get metabolise easily

and completely. They also show their action in the cellular level

(Dhatwagni) and helps the cells to uptake the medicine in optimum level.

e) Increasing the shelf life: The essential oils and volatile principles of ardraka

and trikatu helps in keeping the therapeutic principles actively for longer

peroids. These volatile principles also helps in increasing the palatability of

the compound, which indirectly influences the mode of action of the drug.

Thus, the compound probably shows therapeutic effects in Apabahuka. The

art of combination of different components reveals the scientific vision of ancient

seers.

Page : 122

Conclusion

CONCLUSION

Based on the conceptual analysis and observations made in the clinical study, the

following conclusions can be drawn.

The disease Apabahuka is vata kaphaja and Amsa shosha is kevala vataja.

Strenuous physical work and direct abhigata is the predisposing factors in the

manifestation of the disease.

Maximum incidence of this disease was seen in the age group of 30-40 years.

Work power decreases with the chronicity of the disease.

Ekanga veera rasa showed moderate significance in decreasing shoola and

bahupraspandita hara but sustained relief was not seen.

Laghu masha taila haveing bruhmana effect, when used as marsha nasya

brought out moderate significant result in bahupraspanditahara and mild

significant relief in shoola.

Combined therapy showed highly significant relief in bahuprspanditahara

and shoola.

The size of samples and time period were small to draw a generalized

conclusion. So the therapy can be tried in a large sample for appropriate

duration to observe its proper efficacy.

Page : 123

Summary

SUMMARY

The present dissertation entitled “MANAGEMENT OF APABAHUKA WITH

LAGHU MASHA TAILA NASYA AND EKANKANGA VEERA RASA – A CLINICAL

EVALUATION” has been carried out to find out the efficacy of the therapeutic drug

combinations Laghu masha taila as nasya and Ekanga veeera rasa as shamana oushadhi

on patients of Apabahuka. This study contains Introduction, Objectives, and Review of

literature, Methodology, Results, Discussion and Conclusion.

Chapter 1 - Objectives of the study is explained.

Chapter 2 - Review of literature has detailed descriptions regarding the disease

Apabahuka according to the classics. The description about the most

resembling conditions of Apabahuka in modern science has been dealt in

detail. The ingredients of the trial drugs have been studied and explained

in brief.

Chapter 3 – Methodology- Material and methods includes criteria for selection and

grouping of patients, treatment schedule and grading of the disease etc. are

explained. Observation of patients includes distribution of patients

according to age, sex; economical status, diet etc. are represented along

with the tables and charts.

Page : 124

Summary

Chapter 4 – Results – Results of the therapies after the treatment, after follow-up along

with the statistical analysis are mentioned along with tables and charts.

Chapter 5 – Discussion – Includes elaborate discussion about disease, chikitsa, result

of therapies and probable mode of action of drugs.

Chapter 6 - Conclusion – It is concluded that the combination of trial drugs

“Laghumasha taila nasya and Ekanga veera rasa” has a highly significant

result in providing better relief on the main and associated symptoms of

Apabahuka compared to the individual administration of each trial drug.

Page : 125

References

REFERENCES Historical review:

1. Cha.Su 20/11 Nirukti and Paribhasha:

2. Ma.Ni 22/1 commentary 3. Vach 4. S.E.D 5. S.K.D 6. Amar 7. S.E.D.M.W 8. N.S.

Shareera Vivechana:

9. Su.Sha. 5/24-25 10. Su.Sha 5/27 11. Su.Sha.5/31 12. Su.Sha. 4/14 13. A.H.Su.12/18 14. Su.Sha 6/26 15. Su.Sha 6/3 16. Su.Sha.6/7 17. Su.Sha.6/13

Anatomy of Shoulder:

18. Chau.Ana 19. Tora. Ana

Nidana:

20. Ma.Ni 1 21. Cha. Chi 28/15-17 22. Su.S 23. A.S 24. A.H 25. Ma.Ni 22/1-4

Samprapti:

26. A.H.Ni 1/8 27. Su.Chi 5/29 28. As.Ni 16/47. 29. Cha.Si 9/6. 30. Ma.Ni 22/64 31. Sho.chap 21,Page No 841

References

Poorvaroopa:

32. Cha.Ni 8/1 33. Cha.Chi 28/19

Roopa:

34. Cha.Ni 1/9 35. A.H.Ni 15/43 36. Su.Ni 1/27 37. Su Ni 1/82. 38. Su.Su 15/4 39. Su.Ni 1/18 Dal 40. A.N-107 41. Su.Ni 1/27 42. V.S.VataVyadhi/112 43. Su.su 17/7 44. Su.U 1/19 45. Su..Sha 6/18 46. Hari, Part-12, Chap-326 47. Hari, Part-12, Chap-322 48. Hari, Part-14, Chap-381

Upashaya and Anupashaya:

49. A.H.Ni 1/6-7 50. Cha.Ni 1/10

Upadrava:

51. Ma.Ni 1 52. Su.Su 33/5-6 53. Su.Su 33/7

Sapeksha Nidana:

54. Su.Ni 1/74 Sadhyasadhyata:

55. Cha.Su 10/7-8 56. Su.Su 33/4 57. Y.R.Vata vyadi-100 58. Ma.Ni.22/74 59. Su.Ni 1/64 60. Ma.Ni22/76 61. B.P. 24/207-208 62. A.H.Ni 15/38 63. Cha.Chi 28/142 64. A H Su1/31

References

Chikitsa:

65. Cha.Su 20/13 66. Cha.Chi 28/104 67. Su.Chi 5/29 68. A.H.Chi 21/44 69. A.S.Chi 23 70. Su.Chi 5/33 71. V.S.Vata vyadhi 72. A.S.Su 29/5 73. A.H.Su 2/8 74. Su.Sha 9/9 Dalhana 75. Cha.Chi 28/81 76. Cha.Su 22/11 77. A.H.Su 16/18 78. A.H 6/20 79. A.H.Su 13/39 80. A.H.Su 1/25 81. Su.Chi 40/21 82. Su.Chi 40/22 83. A.S.Su 29 84. Cha.Si 9/8 85. A.H.Su 20/2 86. A.S.Su 29/12 87. A.S.Su 29/12 88. A.H.Su 20/13-14 89. Cha.Si 9/89 90. Cha.Si 9/90 91. Cha.Si 9/91 92. Cha.Si 9/91 93. Cha.Si 9/92 94. A.S.Su 29/13 95. Su.Chi 40/25 96. A.S.su. 29/16 97. Cha.Si 1/51 98. Su.Chi 40/30 99. Su.Chi 40/40

100. Su.Chi 40/49-50 101. Cha.Si 9/115 102. A.H.Su 20/21 103. A.S.Su 29/2 104. Su.Sha 6/27 105. Cha.Si 2/22 106. Brhat.Ni.Rat 107. Su.U 1/25

References

Pathyapathya:

108. Cha.Chi 28/104 109. Y.R.Vata 418 110. Chakradatta 22 111. Y.R.Vata 419

Drug review:

112. P.V.S–page 569 113. P.V.S-page 735 114. P.V.S-page 562 115. B.P.N. Ikshu varga / 31 116. P.V.S- page 630 117. Cha.Su 27/300 118. B.P.N vatadi varga / 42 119. P.V.S-page 152 120. P.V.S-page 393 121. Ay.Ras 122. P.V.S-page 331 123. P.V.S-page 362 124. P.V.S-page 275 125. P.V.S-page 753 126. P.V.S-page 239 127. P.V.S-page 758 128. P.V.S-page 66 129. P.V.S-page 359 130. P.V.S-page 331 131. P.V.S-page 111 132. P.V.S-page 572 133. P.V.S-page 83 134. P.V.S-page 578

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• Bruhat Nighantu Ratnakara with hindi teeka by shri Datta rama shri

Krishnalal Mathur published by Khemraj Shri Krishna Das publication

Bombay, 1996.

• Dr.Mahajan B.M Methods in Biostastics, Jaypee Brothers, New Delhi.

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Edition, Ed - Anthony Fauci S. et al., 1998.

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by CBS Publishers and Distributors, Delhi 32, 1991.

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• M.Monier William A Sanskrit English Dictionary, National Banarasidas

Publishers Pvt. Ltd. New Delhi, 1st edition 2002.

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and Sons, Inc., New York, 9th edition, 2000.

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Ropper, 6th International Edition, Library of Congress Cataloging in

Publication, 1997.

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Published by Chowkhambha Sanskrit Series, Varanasi, 3rd edition, 1967.

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Prakashana, Varanasi.

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Varanasi, 8th edition 1998.

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Orientalia, Varanasi, 1st edition 2001.

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Published by Chowkambha Sanskrit Series, Varanasi, 3rd edition, 1967.

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Clinical Proforma

Department of Kayachikitsa A.L.N. Rao Memorial Ayurvedic Medical College

Koppa-577126, Chikmagalur

PROFORMA FOR CLINICAL STUDY ON APABAHUKA

P.G. Scholar: Dr. Raviganesh M. B.A.M.S Co-guide: Banamali Das. M.D (Ayu)

Guide: Dr. P.K. Mishra M.D (Ayu) Part A: Examination

Name of the Patient : Case No. : Age : O.P. No. : Sex : Male / Female I.P. No. : Religion H/M/C/O : Ward No. : Marital Status M/UM/W/D : Bed No. : Socio-economic class : P/M/UM/UC Date of Commencement : Education : Un / Pr / Sec / Gr Date of Completion : Occupation : HW / W / B / S / E Address : Group :

A) Shodhana B) Shamana C) Shodhana & Shamana I. Chief Complaint

Duration BT AT a) Bahupraspandithahara

b) Shoola

II. Associated Complaint a) Stamba

b) Atopa c) Wasting of Muscles III. History of Present illness A) Pain

i) Mode of Onset – Trauma / Dislocation / Spontaneous ii) Onset – Acute / Chronic iii) Duration of pain

iv) Site of pain v) Presentation - Unilateral / Bilateral vi) Character vii) Intensity of pain – Mild / Moderate / Severe / No

B) Atopa – Audible / Nonaudible

C) Stabdatha – Restricted / Not restricted IV. History of Past illness A) Any disease B) History of injury to the joint C) Treatment history - Medicine Local application Surgery / Traction etc., V. Family History VI. Personal History

A) Ahara : Veg / Mixed Habit : Samasana / Visamasana / Adhyasana / Anasana Rasapradhana : M/A/L/K/T/KS/Sarva rasa B) Agni : Samagni / mandagni / vishamagni (BT), …….. (AT) C) Koshta : Mridu / madyama / krura (BT), …….. (AT) D) Nidra : Sound / Disturbed / Irregular / Ratri jagarana E) Vyasana : Alcohol / smoking / tobacco chewing / Others F) Vihara : Nature of work – stress / exercises G) Malapravrutti : Regular / Irregular / Constipation / Loose / Soft / Hard. No of frequency …………… H) Mootrapravrutti : Regular / Irregular ……….times / day …….. times / night

VII. Occupational History

Nature of work :

Time of work : Day / Night / Day and Night

VIII. Social History

Hygienic Condition of residence : Poor / Moderate / Good.

IX. Gynecological/Obstetrics History

Part – B

I. General Examination

BT ………………………………. AT Pulse BP Heart rate Temperature Pallor Icterous Cyanosis Clubbing Pedal Oedema Lymphadenopathy

Dasha vidha Pareeksha

• Prakruthitha – V/P/K/VP/VK/PK/VPK • Vikruthitha – P/M/A • Satwatha – P/M/A • Saratha – P/M/A (T/R/M/M/A/M/S/S) • Samhanatha – P/M/A • Satmyatha –P/M/A • Aharatha – Abhyavaharana P/M/A (BT), P/M/A (AT) – Jaranashaktitha P/M/A (BT), P/M/A (AT) • Vyayamashaktitha –P/M/A • Pramanatha – Height ……….. ft. Weight …….kg. • Vayatha – Baala / Madyama / Vruddha

B) Asthavidha Pareeksha

Nadi Mutra Mala Jiwha Shabda Sparsha Drik Akruthi

C) Sroto Pareeksha

Mamsavaha srothas Greva Shusktha / Thoda / Dhamanishaithilya Medhava Srothas Asthisputana / Glaani / sandishunyata Asthivaha Srothas Asthibedha / Sandhi shaithilya Majjavaha srothas Parvabheda / Asthinistoda / Asthishunyata

II. Systemic Examination

a) G.I.T. b) R.S. c) C.V.S. d) C.N.S. e) L.S.

III. Vishishta Pareeksha - Joint Examination BT…………….AT

a) Inspection i) Swelling: Present / absent ii) Muscular wasting: Present / absent b) Palpation BT…………….AT i) Local temperature : Present / absent ii) Local tenderness : Present / absent

iii) Crepitus : Audible / palpable c) Joint movements BT…………….AT

i) Elevation Up to 1800 …… 0 Up to 1350 …… 1 Up to 900 …… 2 Up to 450 …… 3 Cannot elevate …4

ii) Flexion BT…………….AT Up to 900 …… 0 Up to 60 0 …… 1

Up to 300 …… 2 Cannot flex …… 3

iii) Abduction BT…………….AT Up to 900 …… 0 Up to 60 0 …… 1 Up to 300 …… 2 Cannot abduct …..3

IV. Investigation 1. Haematological Investigation : Hb

TC DC E.S.R. R.B.S.

2. Routine Urine Investigation : Alb Sugar

Micro 3. X-ray : Shoulder Joint. : AP, Lateral

Scoring Chart

Main Complaint

Bahupraspandithahara Score

Can do work,unaffectedly 0

Can do sternous work with difficulty 1

Can do daily routine work with great difficulty 2

Cannot do any work 3 Shoola No Pain 0 Mild Pain, can do strenuous work with difficulty 1 Moderate Pain, can do normal work with support 2

Severe Pain at rest, unable to do work at all 3

Associated Complaint Stambha No stiffness 0 Mild stiffness, feels difficulty to move the joints with out support 1 Moderate feels difficulty to move, and can lift only with support 2 Severe stiffness, unable to lift 3 Atopa No atopa 0 Palpable atopa 1 Audible atopa 2

Wasting of muscle No wasting 0 Mild wasting, can do work 1 Wasting present, work with difficulty 2 Wasting present, cannot move 3

V. Provisional Diagnosis :

VI. Final Diagnosis :

Part – C

1. Treatment Shedule

Shodhana group: Poorva karma – Abhyanga

Swedana

Pradhana karma - Pratimarsha nasya – Laghu masha taila

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Paschat karma – Doomapa Shamana group: Ekangaveera rasa 125 mg b.d for 30 days.

Anupana – Ushana jala

Shodhana Shamana group: : Poorva karma – Abhyanga

Swedana

Pradhana karma - Pratimarsha nasya – Laghu masha taila

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

&

Ekangaveera rasa 125 mg b.d for 30 days. Anupana – Ushana jala

Any Complication:

Part – D

Pathyaapathya:

Signature of the Researcher Signature of the Guide

POST GRADUATE STUDIES AND RESEARCH CENTRE

DEPARTEMENT OF KAYACHIKITSA

A.L.N. RAO MEMORIAL AYURVEDIC MEDICAL COLLEGE

KOPPA-CHICKMAGALUR

PATIENT CONSENT FORM I __________________________________________ exercising my free power of

choice, hereby give you my complete consent to be included as a subject in the

Clinical trial on “MANAGEMENT OF ‘APABAHUKA’ WITH LAGHU MASHA TAILA

NASYA AND EKANGA VEERA RASA”. I have been informed to my satisfaction by the

attending Doctor, the purpose of the Clinical Trial and the nature of drug treatment,

therapeutic procedures, follow-up and probable complications. I am also ready to

undergo necessary Laboratory Investigations to monitor and safeguard my body

functions.

I am also aware of my right to opt out of the trial at any time during the

course of the trial without having to give the reasons for doing so.

Signature of the Doctor Signature of the Patient/

Guardian

(£Á£ÀÄ N¢/ N¢¹ CxÀð ªÀiÁrPÉÆAqÀÄ

¸À»

ºÁQgÀÄvÉÛãÉ.)

MASTER CHART – 1 SHODHANA GROUP AFTER THERAPY

Main symptoms I II

Sl. No.

Name Age Sex Religion Occupation Economical status

Diet Family History

BT AT BT AT 1. Somu 39 M H Lb L Mx N + + + + 2. TqU 46 M Mu Lb L Mx N ++ + + + 3. Rup 28 F H Se Mi V N ++ - + + 4. Ram 30 M H St Mi V P + + + + 5. Tak 43 F H Lb L V N + - ++ ++ 6. Moh 37 M Mu Ue Mi Mx N + + + + 7. Grm 45 F H Hw Mi V P + - ++ + 8. Adk 24 M Mu Bs U Mx N + + + + 9. Mry 39 F C Lb L Mx P + - + - 10. Azi 49 M Mu Bs Mi Mx N + + + - 11. Trs 36 F C Hw U Mx N ++ + ++ ++ 12. Abu 57 M Mu Lb L Mx N + + + + 13. Lob 36 M C Lb L Mx N + - + + 14. Sub 54 M H Se Mi V N ++ + + + 15. Van 31 F H Hw U V N + + + -

I – Bhahupraspanditha hara, II – Shoola, M-Male, F-Female, H-Hindu, C-Christian, Mu-Muslim, Lb- Labour, Hw- House wife, Se- Service, Bs-Business, Ue – Unemployed, St – Student, L-Lower Class, Mi- Middle Class, U- Upper Class, V- Vegetarian, Mx- Mixed diet, P- Positive, N- Negative, +- 1 score, ++- 2 scores, -ve- 0 score, B.T.- Before Treatment, A.T.- After Treatment.

MASTER CHART – 2 SHODHANA GROUP AFTER THERAPY

Associated symptoms Srotho dusti I II III IV V VI VII Sl.No

BT AT BT AT BT AT BT AT BT AT BT AT BT AT 1 A A A A + + A A A A ++ + + -

2 + - A A A A + + A A ++ ++ + + 3 + + A A + + A A A A ++ ++ + - 4 ++ ++ + + A A A A A A + - + + 5 ++ + + - ++ ++ ++ ++ A A + + ++ ++ 6 A A A A + - A A A A + + + + 7 + + A A A A ++ + + + ++ ++ ++ + 8 ++ ++ A A A A + - + - + - ++ ++ 9 + + ++ ++ + - A A A A + + + + 10 A A A A A A + - A A ++ ++ ++ ++ 11 ++ - ++ + A A A A A A ++ + ++ + 12 + + A A ++ ++ A A A A + + + + 13 A A A A ++ + + + ++ + + + + + 14 + + ++ + A A A A ++ + + + + + 15 A A A A + + A A + - ++ + ++ -

I–Stamba, II- Atopa, III-Wasting of muscles, IV- Mamsa vaha, V-Medho vaha, VI- Asthi vaha, VII- Majja vaha, P- Positive, N- Negative, A – Absent, +- 1 score, ++- 2 scores, -ve- 0 score, BT- Before treatment, AT - After Treatment.

MASTER CHART – 3 SHODHANA GROUP AFTER FOLLOW UP

Main symptoms I II

Sl. No.

Name Age Sex Religion Occupation Economical status

Diet Family History

BT AFU BT AFU 1 Somu 39 M H Lb L Mx N + + + + 2 TqU 46 M Mu Lb L Mx N ++ ++ + + 3 Rup 28 F H Se Mi V N ++ + + + 4 Ram 30 M H St Mi V P + + + + 5 Tak 43 F H Lb L V N + - ++ ++ 6 Moh 37 M Mu Ue Mi Mx N + + + + 7 Grm 45 F H Hw Mi V P + + ++ ++ 8 Adk 24 M Mu Bs U Mx N + + + + 9 Mry 39 F C Lb L Mx P + - + - 10 Azi 49 M Mu Bs Mi Mx N + + + - 11 Trs 36 F C Hw U Mx N ++ + ++ ++ 12 Abu 57 M Mu Lb L Mx N + + + + 13 Lob 36 M C Lb L Mx N + + + + 14 Sub 54 M H Se Mi V N ++ + + + 15 Van 31 F H Hw U V N + + + -

I – Bhahupraspanditha hara, II – Shoola, M-Male, F-Female, H-Hindu, C-Christian, Mu-Muslim, Lb- Labour, Hw- House wife, Se- Service,Bs-Business, Ue – Unemployed, St – Student, L-Lower Class, Mi- Middle Class, U- Upper Class, V- Vegetarian, Mx- Mixed diet, P- Positive, N- Negative, +- 1 score, ++- 2 scores, -ve- 0 score, B.T.- Before Treatment, A.F.U.- After Follow up.

MASTER CHART – 4 SHODHANA GROUP AFTER FOLLOW UP

Associated symptoms Srotho dusti I II III IV V VI VII Sl.No

BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU 1 A A A A + + A A A A ++ + + -

2 + + A A A A + + A A ++ ++ + + 3 + + A A + + A A A A ++ ++ + - 4 ++ ++ + + A A A A A A + + + + 5 ++ + + + ++ ++ ++ ++ A A + + ++ ++ 6 A A A A + - A A A A + - + + 7 + + A A A A ++ ++ + + ++ ++ ++ ++ 8 ++ ++ A A A A + - + - + - ++ ++ 9 + + ++ ++ + - A A A A + + + + 10 A A A A A A + - A A ++ ++ ++ ++ 11 ++ + ++ + A A A A A A ++ + ++ ++ 12 + + A A ++ ++ A A A A + + + + 13 A A A A ++ ++ + + ++ + + + + + 14 + A ++ ++ A A A A ++ ++ + + + + 15 A A A A + + A A + - ++ + ++ +

I–Stamba, II- Atopa, III-Wasting of muscles, IV- Mamsa vaha, V-Medho vaha, VI- Asthi vaha, VII- Majja vaha, P- Positive, N- Negative, A – Absent, +- 1 score, ++- 2 scores, -ve- 0 score, BT- Before treatment, AFU - After follow up.

MASTER CHART – 5 SHAMANA GROUP AFTER THERAPY

Main symptoms I II

Sl. No.

Name Age Sex Religion Occupation Economical status

Diet Family History

BT AT BT AT 1 Har 27 M H Lb L V N + + + + 2 Naj 32 F Mu Lb L Mx P ++ + + - 3 Rob 31 M C Se U V N ++ ++ + + 4 Sum 23 F H Lb L V N + - ++ + 5 Roz 39 M C Se U V N ++ ++ ++ ++ 6 Ani 23 M Mu Se U Mx N + - ++ + 7 Yus 40 M Mu Bs U Mx N + ++ ++ ++ 8 Mry 43 F C Hw L Mx N + - + - 9 Tmp 54 M H Lb L V N + + + + 10 Sbn 49 F Mu Hw L Mx P + - + - 11 Gta 29 F H Hw Mi V N + + + + 12 Raj 45 M H Lb L V N ++ + + - 13 Gyr 30 F H Ue Mi V N ++ ++ ++ ++ 14 Sud 48 M C Ue Mi Mx N ++ + + + 15 Ags 52 F C Hw Mi Mx N + - ++ ++

I – Bhahupraspanditha hara, II – Shoola, M-Male, F-Female, H-Hindu, C-Christian, Mu-Muslim, Lb- Labour, Hw- House wife, Se- Service,Bs-Business, Ue – Unemployed, L-Lower Class, Mi- Middle Class, U- Upper Class, V- Vegetarian, Mx- Mixed diet, P- Positive, N- Negative, +- 1 score, ++- 2 scores, -ve- 0 score, B.T.- Before Treatment, A.T.- After Treatment.

MASTER CHART – 6 SHAMANA GROUP AFTER THERAPY

Associated symptoms Srotho dusti I II III IV V VI VII Sl.No

BT AT BT AT BT AT BT AT BT AT BT AT BT AT 1 A A A A + + A A A A + + + +

2 + - A A A A A A A A ++ + + -

3 + + A A A A A A A A ++ ++ ++ ++ 4 ++ ++ A A A A A A A A + - + -

5 ++ + A A A A ++ + + - + + + ++ 6 A A A A A A ++ + ++ ++ + - + - 7 ++ ++ + + A A A A ++ + + - ++ ++

8 ++ ++ ++ - + - ++ ++ A A + + ++ + 9 + - ++ ++ ++ ++ A A + + + - + - 10 + + A A A A A A A A ++ + + +

11 + + ++ + + - + - + - ++ ++ ++ + 12 + + + - A A + - A A + - ++ ++ 13 A A A A ++ + A A ++ ++ + - + - 14 A A A A ++ + ++ ++ + + + + ++ +

15 ++ + A A + - ++ + + - ++ - ++ ++

I–Stamba, II- Atopa, III-Wasting of muscles, IV- Mamsa vaha, V-Medho vaha, VI- Asthi vaha, VII- Majja vaha, P- Positive, N- Negative, A – Absent, +- 1 score, ++- 2 scores, -ve- 0 score, BT- Before treatment, AT - After Treatment.

MASTER CHART – 7 SHAMANA GROUP AFTER FOLLOW UP

Main symptoms

I II

Sl. No.

Name Age Sex Religion Occupation Economical status

Diet Family History

BT AFU BT AFU 1 Har 27 M H Lb L V N + + + + 2 Naj 32 F Mu Lb L Mx P ++ + + +

3 Rob 31 M C Se U V N ++ ++ + + 4 Sum 23 F H Lb L V N + - ++ +

5 Roz 39 M C Se U V N ++ ++ ++ ++ 6 Ani 23 M Mu Se U Mx N + - ++ +

7 Yus 40 M Mu Bs U Mx N + + ++ ++ 8 Mry 43 F C Hw L Mx N + - + -

9 Tmp 54 M H Lb L V N + + + + 10 Sbn 49 F Mu Hw L Mx P + - + -

11 Gta 29 F H Hw Mi V N + - + + 12 Raj 45 M H Lb L V N ++ + + - 13 Gyr 30 F H Ue Mi V N ++ + ++ ++

14 Sud 48 M C Ue Mi Mx N ++ + + - 15 Ags 52 F C Hw Mi Mx N + - ++ ++

I – Bhahupraspanditha hara, II – Shoola, M-Male, F-Female, H-Hindu, C-Christian, Mu-Muslim, Lb- Labour, Hw- House wife, Se- Service,Bs-Business, Ue – Unemployed, L-Lower Class, Mi- Middle Class, U- Upper Class, V- Vegetarian, Mx- Mixed diet, P- Positive, N- Negative, +- 1 score, ++- 2 scores, -ve- 0 score, B.T.- Before Treatment, A.F.U.- After Follow up.

MASTER CHART – 8 SHAMANA GROUP AFTER FOLLOW UP

Associated symptoms Srotho dusti I II III IV V VI VII Sl.No

BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU 1 A A A A + + A A A A + - + +

2 + - A A A A A A A A ++ + + -

3 + + A A A A A A A A ++ ++ ++ ++ 4 ++ + A A A A A A A A + - + -

5 ++ + A A A A ++ + + - + + + + 6 A A A A A A ++ + ++ + + - + - 7 ++ ++ + - A A A A ++ + + - ++ ++

8 ++ ++ ++ + + - ++ ++ A A + + ++ + 9 + - ++ ++ ++ + A A + + + - + - 10 + + A A A A A A A A ++ - + +

11 + + ++ + + - + - + - ++ ++ ++ + 12 + + + A A A + - A A + - ++ ++ 13 A A A A ++ + A A ++ ++ + - + - 14 A A A A ++ + ++ + + + + + ++ +

15 ++ + A A + - ++ + + - ++ - ++ + I–Stamba, II- Atopa, III-Wasting of muscles, IV- Mamsa vaha, V-Medho vaha, VI- Asthi vaha, VII- Majja vaha, P- Positive, N- Negative, A – Absent, +- 1 score, ++- 2 scores, -ve- 0 score, BT- Before treatment, AFU – After follow up.

MASTER CHART – 9 SHODHANA SHAMANA GROUP AFTER THERAPY

Main symptoms I II

Sl. No.

Name Age Sex Religion Occupation Economical status

Diet Family History

BT AT BT AT 1 Aky 25 M H St Mi V N + + + + 2 Syd 40 M Mu Lb L Mx N ++ + + - 3 Vid 29 M H Se U V P ++ ++ ++ ++ 4 Krt 34 F H Hw U Mx N ++ + + - 5 Stl 42 F H Hw Mi V N ++ + + + 6 Kua 51 M H Lb L Mx N + + + - 7 Stp 54 M H Lb L Mx N + - + + 8 Mhd 48 M Mu Lb L Mx N + - ++ + 9 Dsz 33 M C Ue Mi Mx N ++ ++ ++ ++ 10 Aln 59 M C Lb L Mx N + - + - 11 Gpl 53 M H Bs U V N + - + - 12 Amn 38 F Mu Hw Mi Mx N + - + + 13 Rkn 56 M H Lb Mi V N ++ - + - 14 Sbu 22 F Mu Hw Mi Mx N + - ++ + 15 Sun 35 F C Se Mi Mx N + + ++ -

I – Bhahupraspanditha hara, II – Shoola, M-Male, F-Female, H-Hindu, C-Christian, Mu-Muslim, Lb- Labour, Hw- House wife, Se- Service, Bs-Business, Ue – Unemployed, St – Student, L-Lower Class, Mi- Middle Class, U- Upper Class, V- Vegetarian, Mx- Mixed diet, P- Positive, N- Negative, +- 1 score, ++- 2 scores, -ve- 0 score, B.T.- Before Treatment, AT – After therapy.

MASTER CHART – 10 SHODHANA SHAMANA GROUP AFTER THERAPY

Associated symptoms Srotho dusti I II III IV V VI VII Sl.No

BT AT BT AT BT AT BT AT BT AT BT AT BT AT 1 + + A A A A + + + + + + + +

2 + + A A A A A A + - + - + -

3 A A A A A A A A ++ ++ + + + + 4 + - A A A A ++ ++ ++ + ++ + ++ ++

5 ++ + A A A A A A + + ++ + + - 6 ++ + A A A A + - ++ + ++ ++ + - 7 + + + + + - + + ++ ++ + - + +

8 ++ + ++ - A A + - ++ + + - + - 9 A A + - ++ + A A + + + + ++ + 10 + - A A + + ++ ++ + - ++ + ++ +

11 + - ++ + + - A A A A ++ - ++ ++ 12 + - A A ++ ++ ++ + A A ++ + + - 13 + - + - ++ + A A A A + + + - 14 ++ ++ + - + + ++ - A A ++ + ++ +

15 A A A A ++ ++ A A A A ++ - ++ - I–Stamba, II- Atopa, III-Wasting of muscles, IV- Mamsa vaha, V-Medho vaha, VI- Asthi vaha, VII- Majja vaha, P- Positive, N- Negative,A – Absent, +- 1 score, ++- 2 scores, -ve- 0 score, BT- Before treatment, AT - After Treatment.

MASTER CHART – 11 SHODHANA SHAMANA GROUP AFTER FOLLOW UP

Main symptoms I II

Sl. No.

Name Age Sex Religion Occupation Economical status

Diet Family History

BT AFU BT AFU 1 Aky 25 M H St Mi V N + + + +

2 Syd 40 M Mu Lb L Mx N ++ + + -

3 Vid 29 M H Se U V P ++ ++ ++ ++

4 Krt 34 F H Hw U Mx N ++ + + - 5 Stl 42 F H Hw Mi V N ++ + + +

6 Kua 51 M H Lb L Mx N + + + - 7 Stp 54 M H Lb L Mx N + - + +

8 Mhd 48 M Mu Lb L Mx N + - ++ +

9 Dsz 33 M C Ue Mi Mx N ++ + ++ ++ 10 Aln 59 M C Lb L Mx N + - + -

11 Gpl 53 M H Bs U V N + - + - 12 Amn 38 F Mu Hw Mi Mx N + - + +

13 Rkn 56 M H Lb Mi V N ++ - + - 14 Sbu 22 F Mu Hw Mi Mx N + - ++ +

15 Sun 35 F C Se Mi Mx N + + ++ +

I – Bhahupraspanditha hara, II – Shoola,, M-Male, F-Female, H-Hindu, C-Christian, Mu-Muslim, Lb- Labour, Hw- House wife, Se- Service, Bs-Business, Ue – Unemployed, St – Student, L-Lower Class, Mi- Middle Class, U- Upper Class, V- Vegetarian, Mx- Mixed diet, P- Positive, N- Negative, +- 1 score, ++- 2 scores, -ve- 0 score, B.T.- Before Treatment, AFU – After follow up.

MASTER CHART – 12 SHODHANA SHAMANA GROUP AFTER FOLLOW UP

Associated symptoms

Srotho dusti

I II III IV V VI VII Sl.No BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU BT AFU

1 + + A A A A + - + + + - + -

2 + + A A A A A A + - + - + -

3 A A A A A A A A ++ ++ + + + + 4 + - A A A A ++ + ++ + ++ + ++ ++

5 ++ + A A A A A A + - ++ + + - 6 ++ + A A A A + - ++ + ++ + + - 7 + + + + + - + + ++ ++ + - + -

8 ++ + ++ + A A + - ++ + + - + - 9 A A + - ++ + A A + - + + ++ + 10 + - A A + + ++ + + - ++ + ++ +

11 + - ++ + + + A A A A ++ - ++ ++ 12 + - A A ++ + ++ + A A ++ + + - 13 + - + - ++ + A A A A + + + - 14 ++ + + - + - ++ - A A ++ + ++ +

15 A A A A ++ ++ A A A A ++ - ++ - I–Stamba, II- Atopa, III-Wasting of muscles, IV- Mamsa vaha, V-Medho vaha, VI- Asthi vaha, VII- Majja vaha, P- Positive, N- Negative, A – Absent, +- 1 score, ++- 2 scores, -ve- 0 score, BT- Before treatment, AFU – After follow up.