Ayurvision 09 e Book

AYURVISION 2009

AYURVISION - 2009

CME IN AYURVEDA ON

“CURRENT UNDERSTANDING AND MANAGEMENT OF

AVABAHUKA”

19th& 20th December 2009

SOUVENIR

Exploring the new frontiers in academic and scientific Ayurveda

Organized by Department of Ayurveda, Kasturba Medical College & Hospital, Manipal 1

DEPT. OF AYURVEDA, Kasturba Medical College,

Manipal University, Manipal

AYURVISION 2009

AYURVISION - 2009

CME IN AYURVEDA ON “CURRENT UNDERSTANDING AND MANAGEMENT OF AVABAHUKA”

ORGANIZED BY:-DEPT. OF AYURVEDA

Kasturba Medical CollegeManipal University

Manipal


AYURVISION 2009

From the desk of H. O. D……….

Ayurvision

A MISSION WITH A VISION

“It needed a scientific age for the world to appreciate the full dignity of Ayurveda as a holistic system of perfect health. Now it has become clear to the world of science that every thing in the universe has its basis in the ‘unified field’ and everything can be successfully handled from this one area. It is this that has authenticated Ayurveda’s holistic approach to perfect health for both individual and society. Ayurveda today stands as the technology of the ‘unified field’ for perfect health of the individual of the nation, and of the world as a whole”

- MaharishMahesh Yogi


AYURVISION 2009

1. Ayurveda is Intellectual Property of we Indians. Every Indian has the

right to protect it.

2. Scenario of Ayurvedic education- Practice and research. Too much

emphasis on modern medicine. Neglect of Ayurvedic tradition and

practice. Ayurvedic profession is looked down by the public greatly

because graduates of Ayurveda sideline their science and resort to

unethical practice of Modern Medicine. Emphasis needed to improve

the quality and standards of Ayurvedic Education, accountability of

the Profession and standardization of Ayurvedic medicines.

3. Graduates of Modern medicine must be exposed to the principles and

practice of Ayurveda, either during their graduation level training or

during their Internship period. Medical Council of India, IMA and

Central Council Of Indian Medicine should come to single platform

and discuss this issue, as to how to implement this proposal.

4. Ayurvision is a step towards standardizing Ayurvedic Clinical

methods, based on which depends the quality and standards of

Ayurvedic Practice and research.

5. International Scenario of Ayurveda – India has to create world class

teaching – training centers for the foreigners, otherwise other

countries will develop there own institutions and apply there own

regulatory norms, and India will be a looser at the end.


AYURVISION 2009

6. Manipal University’s vision for future of Ayurveda - Create

atmosphere for exchange of views among different professionals.

Encourage multidisciplinary research and provide training to

practitioners of Medicine.

India has a large infrastructure for teaching and clinical care training under

Indian systems of Medicine and teaching and training has been availed of

according to the curriculum set up by the Central Council of Indian

Medicine. The diagnosis and treatment of various ailments, use of drugs and

Ayuvedic profession as a whole has its basis to the education based on

authoritative texts recognized for these systems, but, the scientific validation

of the treatment has not been done on a wide scale. The off take and output

from these institutions has so far been limited and has not been able to meet

the standards for scientific enquiry. In the present era of globalization and

development of a world market for Ayurveda as a whole (education, research

and medical care delivery), research and development is needed. It has

become more and more evident that the medical centers around the country

with the state of the art infrastructure to provide quality medical education,

clinical training and research are to be recognized as the center of excellence

and supported to conduct Ayurvedic teaching and training as per the

requirements of the CCIM. The same views and proposals have been

highlighted during various National and International Conferences.

- (views expressed by the Secretary ISM, Govt. Of India)


AYURVISION 2009

Through this Ayuvision we propose to explore the new frontiers in academic

and scientific Ayurveda.

Dr. M. S. Kamath MD (Ayu.)

Additional Professor & HeadDepartment of AyurvedaManipal UniversityKMC, Manipal.Tel. 0820 29 22105mail : [email protected]


AYURVISION 2009

AYURVISION-2009CME ON

“CURRENT UNDERSTANDING & MANAGEMENT OF AVABAHUKA”

19th and 20th of December 2009

Program Schedule

Day1. December 19, 2009Morning SessionSl No Time Events01 08.00-09.00 Registration

02 09:00-10:00 Inauguration

03 10.00-10:30 High Tea

04 10:30-11:30 “Imaging of Cervical Spine & Shoulder Joint by Dr.Charudutta Associate Professor, Dept of Radiology KMC, Manipal.

05 11:30-12:30 “Clinical approach to a painful Shoulder”by Dr.Vivek Pandey, Associate Professor, Dept of Orthopaedics, KMC, Manipal

06 12:30 – 01:45 LUNCH BREAK

After noon Session

Sl No Time Events01 02.00-3.00 pm “Understanding of Sirascha Akunchana &

Bahupraspandahari” by Dr.G.R.Vastrad,Prof, Dept of Kayachikitsa, Taranath Govt Ayurvedic Medical College, Bellary

02 03.00-4.00 pm. Poster Presentation (Competition for Delegates)

03 04.00-4.30 pm Tea Break

04 04.30-5.30 pm Live Demonstration of “Avabahuka” patients for Diagnosis and Management


AYURVISION 2009

Day 2. December 20, 2009Morning Session

Sl No Time Events01 09:00-10:00 “Differential Diagnosis of Avabahuka” by

Dr.S.G.Mangalagi, HOD, Post Graduate Studies in Kayachikitsa, Govt Ayurvedic Medical College, Mysore

02 10:00-10:30 Tea Break

03 10:30-11:30 “Understanding of Bahushirshagatavata according to Charaka” by Dr.Prasanna Mogasale, Asst Professor, Dept of Kayachikitsa, SDM College of Ayurveda,Udupi.

04 11:30-12:30 “Management of Avabahuka with Shamanaushadhis” by Dr.Prashanth Assistant Professor, Ayurveda Mahavidyalaya, Hubli, Karnataka

05 12:30-01:45 LUNCH BREAK

Afternoon Session

Sl No Time Events01 02:00-03:00 “Management of Avabahuka by

Panchakarma Chikitsa”by Dr.K.Govindan Namboodari, Prof. Dept of Kayachikitsa, GovtAyurvedicCollege, hiruvananthapuram, Kerala.

02 03:00-03:30 Collection of certificates by delegates

03 03:30- 04:30 Panel Discussion

04 04:30-05:00 Valedictory Function followed by High Tea

.


AYURVISION 2009

Contents.

01. Managemet of Avabahuka’ Shamanoushadhis. Dr. Prasanth…………….. ………………………………………………………12

02. Differential Diagnosis of Avabahuka. Dr.S.G. Mangalagi,……… ………………………………………………………22

03. Management of Avabahuka by Panchakarma. Dr. K. Govindan Namboodari. ………………………………………………………35

04. Clinical Approach to a painful shoulder Dr. Vivek Pandey……………. ………………………………………………………45

05. Abstracts………………………………………….50


AYURVISION 2009

AYURVISION – 2009CME ON “CURRENT UNDERSTANDING & MANAGEMENT OF

AVABAHUKA” 19th and 20th of December 2009

Chair person : Dr. Sripathi R Rao Dean, KMC, Manipal.

Co- Chair person : Dr. M.S. Kamath HOD Dept. of Ayurveda, KMC, Manipal.

Hon’ able adviser and Scientific CommitteeChairmen: Dr. K J Malagi Members:Dr. Basavaraj – Associate Professor Dr.Kamath Madhusudan.- Assistant ProfessorDr. Sripathi Adiga. – Assistant ProfessorDr.Anupama.- Assistant Lecturer

Master of Ceremony: Dr. Anupama

Reception committee:Chairmen – Dr. Anupama Dr. Divya Dr. SapanaMrs. Laxmi Mr. Ganesh Mrs. Divya

Transport Committee & Accommodation Chairmen – Dr.Sripathi AdigaDr. RajeshDr. Shivangoud Dr. Amruta Dr. Prthibha B.PMr. Praveen,Mr Vasudev,Mrs Sangeeta

Food & Catering Committee:Chairmen – Dr. Kamath MadhusudhanDr. ShaileshDr. Prathibha P.KDr. Jayanthi TMr VadirajMrs. BharathiMiss.GayathriMrs Savitha

Prayer By:Dr. Prathibha P.KDr Narind KhajuriaDr. SapanaDr. Amruta

Poster session judges:1. Dr. Govindan Nambodari.2. Dr. Vastrad.3. Dr. Prashant

e-BOOK editor: Dr Kamath Madhusudhana.


AYURVISION 2009

PAPERSOF

RESOURCE PERSON


AYURVISION 2009

SHAMANA CHIKITSA IN APABAHUKA

DR.A.S.PRASHANTH

Professor

Department of Post Graduate StudiesAyurveda Maha VidyalayaHubli, Karnataka – 580024Telephone: 0836-2335575Mob: +91-94481-35575Mail: [email protected]

INTRODUCTION:Apabahuka is a disease that affects 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.


mailto:[email protected]

AYURVISION 2009

LITERARY REVIEW:

In Charaka Samhita there is no direct reference regarding the disease

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

Sthana IN THE CONTEXT OF Nanatmaja Vata Vikaras.. In Sushruta Samhita

Samprapti, Lakshana and Chikitsa of Apabahuka has been discussed in detail in the

context of Vata Vyadhi. In Astanga Sangraha a complete description regarding the

disease has been dealt. Commentators like Arunadatta, Dalhana, Hemadri have

tried to analyze Apabahuka. 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. The recent text like Gadanigraha,

Brihatnigantu Ratnakara explained Apabahuka.

NIRUKTI AND PARIBHASHA:

Nirukti and Paribhasha of Vata vyadhi is - “Vikrita vata janito asadharana vyadhi

vata vyadhi”

Extra ordinary disease resulting from Vikrita Vata is known as Vata Vyadhi.

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

‘Apa’ means deterioration or dysfunction. The word 'Bahuka' means Muscular

gender. Thus Apabahuka can be defined as, Bahustambho Apabahuka / Bad arm,

stiffness in the arm joint.

NIDANA:

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

Bahya Hetu – causing injury to the Marma or the region surrounding that.


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Abhyantara Hetu – indulging in Vata Prakopaka Nidana leading to vitiation of

Vata in that region.This may be again of Bahya Abhigataja(External cause) which

manifest Vyadhi or disease first and the other is Dosha Prakopajanya (Samshraya)

which in turn leads to Karmahani of Bahu.

VARIOUS NIDANAS OF VATAVYADHI AND VATA PRAKOPA FOR

APABAHUKA:

Aharaja(food) : Rasa- Katu, Tikta, Kashaya Rasa; 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, Bhara

harana, Dukhasana, Vegadharana, Kalaja – Aparatra, Agantuja – Abhighataja,

Marmaghata.

SAMPRAPTI:As Apabahuka is considered as a Vata Vyadhi and Vata having Ashukari

Guna the Poorvaroopa 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 Vyadhi in the Vyakta Sthana i.e in

the Amsa Pradesha.


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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 Vyadhi.

SAPEKSHA NIDANA:

Apabahuka is to be differentiated from the following disease conditions that

affect the upper limb.

Vishwachi

Amsa shosha

Ekanga vata

SADHYA ASADHYATA:

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

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

Balamamsakshaya. Yogaratnakara says that Vatavyadhi is Sadhya, if it is of recent

onset and if the patient has good Bala.


AYURVISION 2009

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.

Sushruta and Madhavakara say that Shuddha Vataja Roga is Krichrasadhya,

Dhathukshayaja is Asadhya and Samsargaja is Sadhya. Bhava Prakasha and

Vagbhata opines the same. Even while explaining Vatavyadhi Chikitsa

Charakacharya has mentioned that all the Vatavyadhi after lapse of one year

becomes Krichrasadhya or Asadhya. Sadhyasadhyata can also be assessed by

considering Hetu, Poorvaroopa, Roopa, Dosha, Dushya etc. Thus Apabahuka in the

initial stage will become Sadhya and is Krichrasadhya or Asadhya after certain

period.

CHIKITSA:

The general line of treatment mentioned for Vatavyadhi in Ayurvedic

classics include Snehana (both internal and external), Swedana,

Mrudusamshodhana, Vasti, Sirovasti Nasya, etc. Charaka further says that

depending on the location and Dushya (tissue element vitiated by Vata) each

patient should be given specific therapies. Nasyakarma has been mentioned by

Vagbhata in Jatroordhva Vatavikaras. Three major approaches are made in the

management of Vatavyadhi.

1. Treatment of Kevala Vata

2. Treatment of Samsrusta Vata

3. Treatment of Avruta Vata


AYURVISION 2009

Ayurvedic classics explain the Chikitsa of Apabahuka as follows.

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

Apabahuka.

2. Astanga Sangraha mentions Navana Nasya and Sneha Pana for Apabahuka.

3. Sushrutacharya advice Vatavyadhi Chikitsa for Apabahuka, except Siravyadha.

4. Chikitsa Sara Sangraha advice Nasya, Uttara bhaktika Snehapana and Sweda for

the treatment of Apabahuka.

5. Brumhana Nasya indicated in Apabahuka by Vagbhata

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.


AYURVISION 2009

Some of the Shamanoushadhi explained in Texts:

Ashtanga Hrudaya:

Chikitsa Sutra:

'Apabaahou hitam nasyam snehascha uttarabhaktika:’ (A.H.Chi.21/44)

“Gudamanjaryaa khapuram vrushabeemoolam ca shishirajalapishtamNaavanavidhou prayojitam avabaahuka gala ruja arti haram” (Commentary)

“Dasamoola balaa maasha kwatham taila aajya mishritam Saayam bhuktwaa pibennasyam vishwachyaam avabaahuke” (Commentary)

“Prasaarinee tulaa kwathee taila prastham paya: samamDwimedaa mishi manjishthaa kushta raasnaa kucandanai:Jeevaka rushabha kaakolee yugula amaradarubhi:Kalkitai: vipacet sarva maarutaamaya naashanam” (A.H.Chi.21/65-66)

Balaa Tailam (A.H.Chi.21/73-81)

Cakradatta:

“Dasamoola balaa maasha kwatham taila aajya mishritam Saayam bhuktwaa pibennasyam vishwachyaam avabaahuke” (Vatavyadhi.25)

“Moolam balaayaastvatha paaribhadraat tathaa aatmaguptaa swarasam pibed vaaNasyantu yo maamsarasena kuryaan maasadasou vajra samaana baahu” (Vatavyadhi.26)


AYURVISION 2009

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

Vishvachi Chikitsa – Rakta mokshana (Vatavyadhi.57)

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

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

Mahanarayana Tailam – Hanugraham... (Vatavyadhi.131-140)

Ketakyaadi Tailam – Asthi gata vatam... (Vatavyadhi.150)

Swalpamaasha Tailam – Baahuseersha gata vata... (Vatavyadhi.154-155)

Masha Tailam – Vishvaachyaam Apabaahuke... (Vatavyadhi.157-161)

Masha Tailam – Apabaahukahara... (Vatavyadhi.162-164)

Saptaprastha Brihatmaasha Tailam – Apabaahuke... (Vatavyadhi.165-172)

Prasaarini Tailam – Asheeti Vatavikaareshu... (Vatavyadhi.173-186)

Mahaamaasha Tailam – Vishvaachi... (Vatavyadhi.187-191)


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Mahaamaasha Tailam – Apabaahuka Vishvaachyou... (Vatavyadhi.192-200)

Mahaaraajaprasaarini Tailam – (Vatavyadhi.258-264)

Bhaishajya Ratnavali:

Balaadi Kashayam – Baahushosha... (Bha.Rat.26/67)

Yogarajaguggulu Vati – Sarvaan Vataamayaan... (Bha.Rat.26/102-113, Sarngadhara)

Vatagajaankusha Ras – Apabaahuka Samgyakam... (Bha.Rat.26/114-118, Rasendra Sara Sam)

Brihat Vaata Chintaamani Ras – Vaata Rogam... (Bha.Rat.26/141-144)

Vaata Vidwamsa Ras – Manyaa Sthambam... (Bha.Rat.26/178-184, Rasendra Sara Sam)

Mahaakukkudamaamsa Tailam – Apabaahuke... (Bha.Rat.26/511-520)

Maashabalaadi Tailam – Hanusthambham Manyaasthambam... (Bha.Rat.26/551-556)

Vishagarbha Tailam – Hanusthambham Manyaasthambham... (Bha.Rat.26/560)

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


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Sahasra Yogam:

Ashtavargam Kashayam

Prasaarinyadi Kashayam

Rasnadwigunabhaagam Kashayam

Ketakyaadi Tailam

Parinatakeri Ksheeraadi Tailam

Kaarpaasasthyaadi Tailam

Ksheerabala (101)


AYURVISION 2009

Differential Diagnosis of Apabahuka W.S.R. To Frozen

Shoulder

Dr. S. G. Mangalgi,Professor and HOD,Dept. of Postgraduate studies in Kayachikitsa, GAMC, Mysore

INTRODUCTION:

The present day world is full of stress and strain with increasing

competitions in all walks of life. This has led to many diseases which though do

not kill a person, but hamper one’s day to day life.

Vataja disorders include major neurological problems, few conditions of the

musculo-skeletal system, few psychosomatic problems and very few gastro-

intestinal problems. More precisely in vataja disorder multiple systems of the body

get affected.

Apabahuka is one of the Vatavyadhi which affects the normal functioning of

the upper limb. Agriculture still continues to be the prime occupation of people in a

developing country like India. Incidence of Apabahuka is more among people who

use their upper limbs to perform strenuous work.

Apabahuka comprises of two words 'apa' and 'bahuka'. Apa means Viyoga,

vikratou means Viyogou ie dysfunction, separation. Bahuka - pra cha koorparasya

urdhwadha bhagou iti vishnupurane means it starts from Koorparasandhi (elbow

joint) to Shoulder girdle.


AYURVISION 2009

Thus Apabahuka can be defined as: stambho Apabahuka1 i.e. Stiffness in the

arm joint

To summarize the above discussion and considering the relevant clinical

feature, the term Apabahuka would mean "loss of function of bahusandhi i.e.

Praspanditahara (stiffness or disability in the arm).

By seeing the above definition of Apabahuka explained by our acharyas

correlates with the Frozen Shoulder/Adhesive Capsulitis explained in

contemporary science.

In clinical practice we do get the patients with the complaint of pain/

stiffness of shoulder joint/ upper arm in different conditions such as in infectious,

degenerative, and neurological problems. This requires a thorough differentiation

of these conditions for successful treatment.

Symptoms of Apabahuka/ Frozen Shoulder:

In case of Apabahuka sthanika laxana take important place, as compared to

sarvadaihika laxana. The cardinal features of Apabahuka are as follows.

i) Bahu Praspandidahara2

ii) Amsabandhana Shosha3

iii) Shoola4


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Bahu Praspandidahara - This has three terms

Bahu - means upper limb

Prasapandana - means movement or chalana, this is considered under normal

function of vata in Sushruta Samhita.5

Praspandana shareerasya chalanam, idam vyanasya karma6

Dalhana commenting on this says that praspandana means chesta or

movement and chesta to akunchana - prasaranadi karma,7 this karma is maintained

by vyanavata in the limbs.8

Hara - means loss of / impaired / difficult. Thus, in the present context this may

be taken up as (i.e. praspandahara) difficulty in the movement or impaired or

loss of movement of the upper limb.

Amsabandhana Shosha:

Sushrutacharya considered this as a major laxanas in case of Apabahuka.

But, this is practically seen in the later part of the disease.

Shoola:

Although any of the texts do not mention about the shoola as one of the

laxana of Apabahuka, it is still a feature practically seen in Apabahuka patients.

Recent Ayurvedic texts like Chikitsa Sara Sangraha and Nidana Sara, clearly

mention about Savedana as a predominant laxanas of Apabahuka, along with other

laxanas.

Based on the symptomatology, we can correlate the condition Apabahuka

with that of frozen shoulder mentioned in modern classics as follows:


AYURVISION 2009

Symptoms

a) Gradual onset of shoulder stiffness

b) Pain manifest after significant Shoulder Range of movement lost

c) Pain well localized to rotator cuff

d) Pain radiation into deltoid and anterior arm

e) Pain interferes with sleep (unable to lie on shoulder)

Signs:

Inspection:

a) Patient holds arm protectively at side

b) Deltoid and Supraspinatous atrophy

Palpation:

a) Generalized pain at rotator cuff and biceps tendon

b) Limited range of movement

c) Loss of both active and passive shoulder range of movement (pathognomonic)

d) Restricted movement in all planes

e) Normal range of motion excludes adhesive Capsulitis as a diagnosis

Associated Findings:

Reflex Sympathetic Dystrophy, Hand Edema, coolness, and discoloration

Sapeksha Nidana:

There are some clinical conditions of modern science which may be

compared with that of Apabahuka. These may be categorized as follows.


http://www.fpnotebook.com/Renal/Edema/Edm.htm

http://www.fpnotebook.com/Rheum/Neuro/RflxSympthtcDystrphy.htm

http://www.fpnotebook.com/Ortho/Exam/ShldrRngOfMtn.htm


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1. Peri arthritis or frozen shoulder or adhesive Capsulitis.

2. Incomplete rupture of supraspinatous tendon

3. Lesions of the rotatory cuff

4. Sub acromial or subdeltoid bursitis

5. Sub coracoid bursitis

6. Painful shoulder

7. Bicipital tendinitis

8. Osteo arthritis of shoulder joint

9. Brachial plexus neuropathies

Differential diagnosis:

Apabahuka should be differentiated with the following diseased conditions

that affect the upper limb

.

1. Vishwachi:

‘Talam Pratyangulinam ya kandara bhahu pristata

Bahvoho Karmakshayakari viswachinama sa smritah”||9

Here, the pain starts from hasta tala and angulis and radiates in the kandaras

of prista region and manifest with karmakshaya. Range of movement is more


AYURVISION 2009

restricted in case of Viswachi than apabahuka, where pain is more in Apabahuka

than viswachi.

2. Shosha:

“Asmsa desha sthito vayuhu shoshayet amsa bandhanam”|10

Shosha was considered as a separate condition by Madhavakara and it has to

be differentiated from apabahuka by considering it as an independent entity. Where

the wasting of muscles itself is the cardinal feature, have to be noted. Shosha will

appear in the later stages of Apabahuka. But, Apabahuka may be a predisposing

factor for Shosha which intern does not end up with Apabahuka.

3. Ekangavata:

‘Ekangavatam tam vidyaat anye pakshavadham viduh: ||11

Karmahani of affected limb is the main feature seen ekangavata. In case of

apabahuka, karmakshaya of bahusandhi is the main characteristic feature observed.

Ekangavata can be compared with that of monoplegia where the lesion is not in the

bahusandhi which is an uppermotor neuron disorder.

MODERN PERSPECTIVE:

1. Biceps tendon rupture:


AYURVISION 2009

Symptoms - Painful snap at elbow following forceful elbow flexion, Swelling and

Tenderness occur proximal to elbow, sudden onset with sharp snapping sensation,

Pain and weakness of shoulder and arm

Signs:

A. Weak flexion at elbow: where in some flexion may be maintained.

B. Weak supination at forearm.

C. Bulbous swelling in upper arm on flexion

Localized bulge at distal biceps when elbow flexed

Bulge represents retracted biceps muscle belly

Except shoulder pain the above signs and symptoms are not their so it is not a frozen shoulder.

2.Biceps Tenosynovitis:

Occurs above the age 40 years due to repetitive throwing, causes

Anterolateral Shoulder Pain referred down anterior arm.

Signs:

A Tenderness over bicipital groove

B. Pain limits active and passive range of motion

C Maneuvers that stretch biceps elicit pain

Forceful external rotation with abduction

Arm extension with elbow extended


http://www.fpnotebook.com/Ortho/Sx/ShldrPn.htm

AYURVISION 2009

Shoulder pain referred to anterior arm and restriction of movements on both

active and passive movements are not seen in frozen shoulder, so it could be

excluded.

2. Subluxing Biceps Tendon:

Symptoms: There will be congenital presence of shallow groove in the bicipital

region, shoulder pain and stiffness, frequent reoccurrence of subluxation.

Signs: Forceful external rotation and abduction of shoulder are painful. Surgery is

the choice of management. But in case of frozen shoulder, there won’t be any

bicipital groove/subluxation are not seen where all modalities of movements are

afflicted.

3. Clavicle fracture:

H/o of trauma i.e. fall against lateral shoulder (most common), fall on

Outstretched Hand, direct blow to clavicle,

Symptoms:

Shoulder pain and swelling localized to fracture site, patient unable to lift arm due

to pain.

Presentation:

Holding the affected arm adducted and supported with the opposite hand.

Signs:

Gross clavicular deformity observed or palpated, localized swelling, bruising,

tenderness, and crepitation.


http://www.fpnotebook.com/Ortho/Fracture/Frctr.htm

http://www.fpnotebook.com/Ortho/Sx/FlOnOtstrtchdHnd.htm

http://www.fpnotebook.com/Ortho/Sx/FlOnOtstrtchdHnd.htm

AYURVISION 2009

Complications:

Neurovascular injury of affected arm, Pneumothorax Subcutaneous Emphysema

Chest X ray of Antiro-postirior view shows fracture site.

Except shouder pain, all features of above condition are not go in favor of

frozen shoulder; hence it could be easily differentiated.

4. Gleno Humeral Instability:

Symptom:

Typically occurs below the age of 40 years, lateral deltoid numbness and pain

Signs:

Shoulder apprehension Test is positive. X ray of shoulder shows either Hill-Sachs

Lesion, Shoulder Dislocation, Inferior glenoid avulsion Fracture.

5. Shoulder dislocation:

Usually there is history of trauma or generalized seizers present; Acromion

is much more prominent, humeral head fullness absent under deltoid, Leaves

prominent cavity. Severe pain in the shoulder with any range of motion, Arm

"locked" in place (may be cradled by other hand), Patient refuses to move arm. In

case of –

Anterior dislocation - Arm held externally rotated, anterior shoulder appears

full with anterior bulge, Space below acromion appears empty, internal rotation

painful


http://www.fpnotebook.com/Ortho/Fracture/Frctr.htm

http://www.fpnotebook.com/Ortho/Shoulder/ShldrDslctn.htm

http://www.fpnotebook.com/Ortho/Exam/ShldrAprhnsnTst.htm

http://www.fpnotebook.com/Lung/COPD/Emphysm.htm

AYURVISION 2009

Posterior dislocation - Arm held in internal rotation, Forearm rests on

abdomen, Anterior shoulder flat, External rotation painful, Assess

neurovascular structures. X ray is the diagnostic.

6. Rotator Cuff Tendonitis:

Symptoms:

Pain worse at night, unable to lie on affected shoulder, locking sensation with

abduction, referred pain to deltoid.

Signs:

Tenderness at the insertion of supraspinatous, pain in the Acromioclavicular joints,

patient automatically turns palm up on abduction, and active "palm down"

abduction is painful. Intact muscle strength, Pain and crepitation worse between 60

to 120 degrees abduction, maximal compression of soft tissue in subacromial

space. X ray shows sclerosis at the tuberosity.

Based on the clinical features of above condition, we can easily distinguish it from

frozen shoulder.

7. Fracture of Proximal Humerus:

Symptoms:

Usually there is a history of trauma or fall is present, severe pain in the arm

provoked by any type of movement, stiffness of shoulder.

Signs:

Presence of signs like Swelling, echymosis and pain over shoulder are present. In

case of neuro vascular injury there is a sensory loss over the arm. Pallor of forearm

on examination reveals the injury of the brachial artery. AP view of X ray shows

fractured site.


http://www.fpnotebook.com/Hemeonc/DER/Prpr.htm

AYURVISION 2009

8.Osteo arthritis of Shoulder joint:

Symptoms-

Gradual onset of pain and stiffness, stiffness may significantly limit function when

advanced, chronic Shoulder Pain, Crepitus.

Signs :

Limited shoulder range of motion - active and passive. X ray shows degenerative

changes like narrowing of joint spaces, subchondral sclerosis and formation of

osteophytes.

7. Brachial Plexus Neuropathies:

Symptoms-

Severe Shoulder Pain or arm and neck pain worsens at night and is of short

duration. Shoulder weakness follows pain within 1 to 30 days.

Signs:

Atrophy of multiple shoulder muscle groups involved are deltoid muscle, rotator

cuff muscles, biceps muscle and triceps muscle Electromyogram shows neurogenic

atrophy.

8. Sub coracoids Bursitis:

Symptom:


http://www.fpnotebook.com/Neuro/Procedure/Elctrmygrm.htm




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

tenderness over the interval between two bones.

Signs: Chronic cases on which adhesions are present have marked limitations of

lateral rotation and abduction.

9. Sub Deltoid Bursitis:

Symptoms:

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

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

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

Signs:

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 itself.

Radiological imaging may show calcium deposits on the supraspinatous tendon.

CONCLUSION:

1. Apabahuka is a disease of shoulder joint with restricted movement.

2. Apabahuka can be compared with frozen shoulder


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3.Shoola though not told in the classics is one of the complaints that brings

patient to the doctor.

4. Samprapti and laxanas of Apabahuka and its physical examination can

better be understood and done with the help of modern medical techniques.

5.Apabahuka should be differentiated from other clinical conditions of

shoulder joint for successful treatment.

REFERENCES:

1. Nibandha Sangraha

2. A.Hr.Ni. 15/43

3. Su.Ni. 1/82

4. Su.Ni. 1/27

5. Su.Su.15/4

6. Su.Ni. 1/18

7. Su.Ni. 1/18 Dalhana

8. Cha.Chi. 28/9 - Chakrapani

9. Su.Ni.1

10.Ma.Ni.15/44

11.’Cha. chi.29.


AYURVISION 2009

MANAGEMENT OF APABAHUKA BY PANCHAKARMA

Dr. K. Govindan Namboodiri,M.D(Ay).Prof.Dept of Kayachikitsa.Govt.Ayurvedic College.Trivendrum.

Apabahuka is a major disease come across with daily practice.Vitiated vata

situated at amsamoola causes loss of motor activities or difficulty in movements of

hand and wasting of associated muscles .Many pathological conditions seen now

has resemblance to apabahuka cervical spondylosis,periarthritis of

shoulder,adhesive capsulitis(frozen shoulder},injury to supraspinatus muscle etc

Management of apabahuka is achieved by adopting the treatment measures

vatavyadhi in general and specific treatment for apabahuka.

1.General treatment of vatavyadhi-Snehana,swedana,mrudusodhana etc.

2.Specific treatment of apabahuka- a)Nasyam

b)Auttarabhaktika sneham

When we consider the management by panchakarma let us take the poorvakarma

also.


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A).SNEHANA-

Snehana is adviced in nirama stage.If the disease is in sama stage rookshana and

pachana are done toattain the nirama stage .Then snehana is done.In vatavyadhi

both the bahyasneha and abhyantara sneha isneeded.

a)Abhyantara sneha

-It is the specific treatment of apabahuka. The sneha is adviced to consume after

food .The sneha taken after food cures the diseases occurring in the upper part of

the body .It also gives strength to the body parts of that region. Thailas and

yamaka(thaila+ghrita) are adviced for pana after food. The sneha cures the dhatu

sosha and promotes dhatupushti.It promotes agni and increases the strength of the

body.The following thailas are used in apabahuka for internal use.

1.Karpasasthyadi thailam

2.Ksheerabala prepared with thailam and ghritam.

3.Masha thailam.

b)Bahya snehana-

As in other vatavyadhis abhyanga is beneficial in apabahuka also .Specific thailas

are described for this purpose.

1.Karpasasthyadi thailam.

2.Jambeera thailam.


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3.Parinatakeriksheeradi thailam.

4.Balaguloochyadi thailam for head.

B)SWEDANA-

Swedana alleviates toda,ruk,stambha,graha etc. One specific sweda applied in

apabahuka is jambeerapindasweda.

Shashtikapindasweda is effective where sosha(wasting of muscle)is present.

SHASHTIKA PINDA SWEDA

The word ‘PINDA’ means bolus. Pinda sweda refers to the sudation performed by

bolus of drugs. Shashtika pinda sweda is performed in ekanga or sarvanga with the

bolus of boiled Shashtika shali with Balamoola kwatha and ksheera. The main

properties of Shashtika are snigdha, guru, sthira, sheeta and tridoshaghna. Though

a sweda karma, it has brimhana guna.

Materials required:

1. Shashtika shali-500g

2. Balamoola-750g

3. Water- Q. S.

4. Cow’s milk-3litres

5. Cotton cloth(45cm X 45cm)- 4 pieces

6. Threads(75cm)- 8


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7.Vessels-

a. For preparing kwatha

b. For cooking rice

c. To heat the boluses in mixture of kwatha and milk during the

procedure (5 litres capacity with wide mouth made of bronze)

d. A plate for carrying heated pottali

7. Stove-1

8. Oil for talam- 10ml

9. Rasnadi choorna- 5g

10.Suitable oil for abhyanga-100ml

11.Coconut leaves/tongue cleaner-2

12.Tissue paper/towel- 2

13.Masseurs -2

14.Attendant - 1

Preparation of the medicine:

Balamoola kwatha-

750g of Balamoola is cleaned, crushed and boiled in 12 litres of water and reduced

to 3 litres.

Shashtika rice cooking-


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In 1.5 litres of Balamoola kashaya and 1.5 litres of milk, 500 g of Shashtika rice

should be added and boiled till it becomes thick and semisolid. Sufficient quantity

of hot water can be used for proper cooking of the rice. Another method is that the

Shashtika rice can be semi cooked in pure water; gradually added milk and kwatha;

cooked again.

Preparation of the boluses:

The cooked rice should be divided into 4 equal parts and put into 4pieces of

cotton cloths. The three corners should be folded neatly together so as to come

under the fourth corner and the fourth fold is used to cover the other three corner

folds underneath. One end of the thread is held tight with left hand and the other

end is wound around the folds. In short, the boluses should be tied in such a way

that the mouth of the sac leaves a tuft at the top of the bundle, for holding it with

ease. Conventionally, the size of a bundle is half kernel of a moderate coconut.

Pre operative procedure:

The patient should be seated with leg extended over the droni and talam should be

applied with suitable oil. Abhyanga should be then performed with prescribed oil

for about 10 minutes. Out of 4 pottalis, 2 are kept in the mixture of Balamoola

kwatha and milk (1.5 litres of each was already kept for this purpose), which

should be put on a stove with moderate heat.

Procedure:


AYURVISION 2009

2 warm potalis should be gently applied in a synchronised manner by the two

therapists on two sides of droni. It is followed by a gentle massage with other hand.

They should ensure that the heat of the boluses is bearable to the patient by

touching them over the dorsum of their hand.

The temperature of the boluses should be maintained throughout the procedure by

continuous relay of the four boluses after reheating by dipping in milk kwatha

mixture.The process should be continued till the patient gets samyak swinna

lakshana or until the contents of the boluses exhausted. This procedure is done in

the seven positions as in kayaseka or as advised by the physician.

Duration:

45 minutes -1 hour, preferable time is in between 7-11 am and 4-6 pm. The

procedure can be stopped if the medicine in the boluses or the milk mixture is

exhausted.

Post operative procedure:

At the end of the procedure, the medicine remained over the body should be

scrapped of with the coconut leaves or with any similar device and the body is

wiped dry with tissue paper or soft towels. After that medicated oil should be

applied.


AYURVISION 2009

Talam should be removed and Rasnadi choorna applied over the head.

Gandharvahastadi kashaya can be given for drinking. The patient should take

complete rest for at least half an hour, and then the patient is allowed to take warm

water bath.

Precautions:

1. During the preparation of the rice, care should be taken to avoid over/under

cooking and should be stirred frequently for the better extraction and

cooking.

2. Tie bolus firmly to avoid leaking of contents during rubbing.

3.The therapists in both the sides of the patient should massage with the bolus

in a synchronised manner.

4.Ensure uniformity of pressure and temperature on all the body parts

.5 Boluses should be applied with sufficient warmth (450C-50oC).

6.The therapy should be stopped at any time if the patient gets good

perspiration or shivering.

Complications and management:

1. Shivering: It usually occurs due to the uneven distribution of temperature or

prolonged time gap in between the taking up of new boluses; or if body is

exposed to cold breeze immediately after the procedure. Allow the patient to

take rest cover with a blanket and give warm liquid diet.


AYURVISION 2009

2. Fainting: Due to increased body temperature or low heat threshold of the

patient or atiyoga of kriyakrama. Sprinkle cold water over the face and body,

and put thalam with appropriate medicated oil and choorna. Drakshadi

kashaya can be given internally.


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AYURVISION 2009

MRUDU SODHANA.

After snehana and swedana,mrudusodhana is done.For this Eranda thailam with

milk is adviced.

NASYAM.

The main panchakarma procedure in apabahuka is nasyam.Nasyam is indicated in

diseases affecting upper part of the body and head .Brimhana nasyam is adviced in

apabahuka.Thailas used for nasya are

1.Karpasasthyadi thailam.

2.Masha thailam.

3.Ksheerabala thailam.

Nasal passage is the route to head. It is also the site of orifices of most of

paranasal sinuses. Its mucosal epithelium is sensitive to variety of stimuli.The

medicines applied by nasya will have local action as well as deeper action at

neurological level.


AYURVISION 2009

CONCLUSION.

Apabahuka is a major disease described under vatavyadhi.The main symptoms

being pain,difficulty in/painful movements and later wasting of muscles.

Management of this disease is done by general treatment of vatavyadhi and

specific treatment for apabahuka. In Kerala the practitioners used many internal

and external medications which are described in Chikitsamanjari,Yogamrita etc.

These measures are efficacious in managing apabahuka.


AYURVISION 2009

Clinical approach to a painful shoulder

Dr. Vivek Pandey, Associate prof.,Orthopaedic SurgeryKMC, Manipal

Normal shoulder function is needed for daily routine activities and sporting

actions. Over the years, the understanding of shoulder anatomy and function has

drastically improved and adjuncted with excellent imaging methods, the treatment

options have provided excellent outcomes in the shoulder problems.

The shoulder joint or gleno-humeral joint is a ball and socket joint. The glenoid or

socket is shallow and is inherently unstable. The stability is provided by various

ligaments, capsule, physical and muscular forces. These stabilizers also play role in

shoulder joint movement with adequate rhythm. Any disturbance in structural or

rhythmic support of the shoulder leads to a painful shoulder. Because there are

numerous structures that can cause shoulder pain, it is important that clinician

should narrow down into one or more of the following categories of shoulder pain.

(Image 1)

1. Rotator cuff musculature: tendinopathy / tears

2. Impingement

3. Biceps tendonitis

4. Stiffness: frozen shoulder


AYURVISION 2009

5. Acromio-clavicular and gleno-humeral joint arthritis

6. Disrupted scapula-humeral rhythm

7. Instability i.e. shoulder dislocation

8. Referred pain esp. from neck or others

A good clinical history and systematic examination of shoulder can establish the

diagnosis in most of the cases. A brief description of above listed problem will be

helpful in assessing the problem.

Rotator cuff pathology is more frequent in patients more than 30 years. Mostly,

supraspinatus and infraspinatus tendons are involved in tendinitis or tear.

Tendonitis or tendinopathy is usually seen in chronic overhead activities. They

present with pain usually with overhead activity. The pain is usually in the night

especially sleeping onto the side of affected shoulder. Cuff tears are seen with fall

on outstretched hand, rapid acceleration, and direct blow to shoulder or even after

long standing tendonitis. If there is complete tear, they present with weakness in

elevating shoulder. Partial cuff tears are more painful than full thickness tears.

Supraspinatus and infraspinatus muscle wasting is the key clinical feature. Resisted

abduction is painful with thumbs down position. Rotator cuff tendinopathy often

and partial cuff tears sometimes can be managed conservatively. Rehabilitation

plays an important role in treatment. Non responsive cuff problems or full

thickness cuff tears are best managed surgically. If a full thickness cuff tear is

ignored for long, it can lead to rotator cuff arthropathy which is a very difficult

condition to manage.


AYURVISION 2009

Impingement means compression of rotator cuff and subacromial bursa between

humeral head and under surface of acromian. It is due to narrowed space or

thickened and inflamed structure. The clinical presentation is similar to rotator cuff

tendinopathy. However, neither muscle wasting nor weakness of muscle is seen.

Biceps tendinopathy is seen in more than 25 years of patients. It is aggravated by

lifting or carrying bags or overhead reaching. It can lead to spontaneous rupture.

Rotator cuff signs are absent and movements are full.

It is important to rule out affections of subscapularis muscle in chronic biceps

tendonitis or subluxating tendon.

Shoulder stiffness is usually due to frozen shoulder. These patients are usually

more than 40 years and often first time diagnosed to have diabetes by orthopaedic

surgeon as frozen shoulder could be the presenting feature.

There is usually long standing history of pain accompanied by global loss of

movement of shoulder joint. Night pain and global loss of movement is the key

feature and patient cannot lie on the affected side. Loss of rotations is the key

finding. Treatment is mostly conservative in form of analgesics, physiotherapy and

occasional intra-articular injections. Sometimes, manipulation under anaesthesia is

done to restore movements and minimize pain. Arthroscopic release is also a good

option in non-responders.


AYURVISION 2009

Acromio-clavicular joint pain is quite common especially in patients more than 40

years of age. The pain is usually localized to the tip of shoulder. Treatment is

usually conservative, local steroid injections and sometimes arthroscopic resection.

Gleno-humeral arthritis is a feature of elderly population. It is associated with pain

and stiffness with arthritic changes on x-ray. Joint replacement is treatment of

choice for advance arthritis.

Disrupted scapular rhythm can give rise to vague pain around shoulder. It can be

diagnosed by clinical examination. Treatment is always conservative in form of

muscle strengthening exercises.

Image 1: algorithm to assess the shoulder pain


AYURVISION 2009

Shoulder instability is usually traumatic. It is more frequent in younger population.

Diagnosis of shoulder instability is not difficult to establish due to precise history

given by the patient. It is rarely accompanied by pain and night pain is usually not

the feature. The treatment is usually surgical.

Referred pain is one of the common entities to be kept in mind. The most common

area of referred pain is from neck. Cervical spondylitis and disc prolapse are the

common causes of neck pain. The patient will have neck pain which radiates to the

shoulder, arm and hand. The local examination of shoulder is normal whereas neck

movements are painful with or without radicular features. These patients may also

have night pain while lying on the side.

Other areas of referred pain are from chest and abdomen. Pancoast tumour of lungs

in an elderly can lead to shoulder pain. Chronic angina pain is also referred to the

shoulder on left side but with breathlessness, sweating etc. Chronic cholycystitis or

cholelithiasis can lead to right shoulder pain. Chronic splenic pain can lead to left

shoulder pain. So, a proper systemic evaluation is must.

A good history coupled with clinical examination usually establishes the diagnosis.

Non responsive shoulder pain or if cuff tear is suspected, it must be supplemented

with diagnostic ultrasound of the shoulder. Ultrasound is a cheap and quite

sensitive investigation in the hands of an expert sonologist. If necessary, MRI can

be done but MRI does not offer an exceptional advantage over ultrasound contrary

to the expected.


AYURVISION 2009

Abstracts.


AYURVISION 2009

Anatomy and applied anatomy of shoulder joint.

Dr. Sapna *, Dr. Jayanthi**, Dr. Anupama***.

______________________________________

ABSTRACT:

KEYWORDS: Visualization, understanding anatomy and applied anatomy. For obtaining better result while treating Avabahuka one should have sheer knowledge about anatomy and its applied aspects so that one can understand the different anatomical structures involved in the disease process; and thus select the appropriate treatment.. *PGCPK Scholar, Dept of Ayurveda KMC,Manipal.** PGCPK Scholar,Dept of Ayurveda,KMC,Manipal.*** Asst.Lecturer, Dept of Ayurveda,KMC,Manipal.


AYURVISION 2009

A RARE TREATMENT MODALITY FOR APABAHUKA- SIRAVYADHA

Dr.Ranjith.R.P*,Dr.Ravishankar.A.G**. __________________________________________________________

Abstract.

Apabahuka is a painful condition of shoulder joints which restricts the

normal movements of upper limbs. Now a days reporting cases of Apabahuka are increasing

because of the life style. About 15-20% of working group of people are affected with shouider

pain. Most of the treatments such as Snehana, Swedana, Nasya and internal medication are time

consuming and results will be delayed.

Raktamokshana ( siravyadha) is an affective treatment to relieve the

signs and symptoms of Apabahuka immediatly and also it is an effective treatment in

raktaavritha condition.

Highlights of the poster:-

1. Raktamokshana as a treatment of Apabahuka as per Ayurvedic literature.

2. Action of Siravyadha in relieving various symptoms of Apabahuka.

3. Applicability of Siravyadha in Apabahuka in now a days medical

practice. .

Details will be presented in the poster with pictorial support and scientific explanations.

*2nd year M S scholar, Dept of Shalyatantra,Alvas Ayurveda College,Moodbidri.**Asst.Professor, Dept of Shalyatantra,Alvas Ayurveda College,Moodbidri.


AYURVISION 2009

Differential diagnosis in Avabahuka

Dr. Rajesh B*.,Dr. Prathibha B P**. Dr. Basavaraj Hadpad***.

Abstract. Keywords:- Avabahuka, Vyavachedaka nidana. In clinical practice, in order to diagnose a disease, we should have a clear understanding of many other diseases which may mimic a given disease condition. Same is the case with avabahuka. To make its correct diagnosis we should know the lakshanas of many other diseases also, which may resemble like avabahuka, so that we can differentiate one from the other and come to a correct and final diagnosis. *PGCPK Scholar, Dept of Ayurveda KMC,Manipal.** PGCPK Scholar,Dept of Ayurveda,KMC,Manipal.*** Associate professor, Dept of Ayurveda,KMC,Manipal.


AYURVISION 2009

“Different treatment modalities in the management of Avabahuka”.

Dr. Prathibha P K*, Dr. Amrutha**, Dr. Shripathi Adiga H***.

Key words- vata vyadhi, management, different authors, various stages

Abstract –

Avabahuka, in spite of being included under Vata Vyadhis, shoulders numerous therapeutic procedures as a result of the timely work, wit, and experience of different authors.The management of the disease appears to be of different shades as the result of the varied interpretation of its doshic predominance and understanding of its samprapthi.

The copious drugs vow to the optimum utilization of the same in various stages of the disease.As science always endures change for sounder work, there exists immense scope for the proper understanding and therapeutic enhancement in terms of avabahuka.Here, is one such earnest attempt.

*PGCPK Scholar, Dept of Ayurveda KMC,Manipal.** PGCPK Scholar,Dept of Ayurveda,KMC,Manipal.*** Assistant professor, Dept of Ayurveda,KMC,Manipal.


AYURVISION 2009

Modern Correlations of Apabahuka

Dr Parvathy.S.P*,Dr. Zenica D’souza**.__________________________________________________________________

Abstract:Apabahuka is one among the nanatmaja vatavyadhi.Very limited information is available about this particular disease in the classics. It is mentioned for the first time by Acharya Susrutha.There is no mentioning about the disease in Caraka Samhitha. According to Susruta the features include Amsa sosha and Siraakunchana. Ashtanga Hrudayakara defines the disease in the similar way as Susrutha did, adding up another characteristic as Bahu praspanditahara. Clinically the features of Apabahuka are found in many conditions such as Scapulo Humeral Muscular Dystrophy, Osteoarthritis of Shoulder etc., the details of which will be illustrated in the poster presentation.

*2nd Year P G Scholar of dept of Panchakarma,Alvas Ayurveda Medical College, Moodabidri..** Asst. Professor and HOD, Dept of Panchakarma,Alvas Ayurveda Medical College,Moodabidri.


AYURVISION 2009

CURRENT UNDERSTANDING OF AVABAHUKA AND ITS AYURVEDIC MANAGEMENT

*Dr. Savita B. Bhosale ** Dr. R. S. Hiremath ***Dr. Nataraj

Abstract:Avabahuka considered, as one of the vatavyadhi and Sushurta is the first author who explained

nidana and samprapti of avabahuka under vatavyadhi. The vyadhi found mainly in amsa pradesh

(scapular region) characterized with pain, restricted movement of shoulder joint etc that can be

correlated with many pathological conditions of shoulder joint and scapular region. The exact

correlation of avabahuka with underlying modern pathology is not possible but it is always

necessary to put forward nearest postulation to use the objective diagnostic tools and its further

progression of disease process. For this purpose a update interpretation of ayurvedic avabahuka

may be beneficial.

The management as claimed by Ayurvedic physician’s posses it own peculiarity i.e. to eliminate

the Dooshika diathesis by means of Nasya and to revert the process of the dosa dusya

sammurchhana by a better scientific regimen. So in this paper critical analysis of avabahuka and

its management with modern clinical conditions will be discussed in detail.

* P.G Scholar, dept of Rasashastra, K.L.E’S B.M.Kakanwadi Ayurveda Mahavidyalaya

Belgaum.

** Asst. Professor, Dept of Rasashastra, K.L.E’S B.M.Kakanwadi Ayurveda Mahavidyalaya

Belgaum.

*** Lecturer, Dept of Dravyaguna, K.L.E’S B.M.Kakanwadi Ayurveda Mahavidyalaya

Belgaum.


AYURVISION 2009

Understanding Avabahuka under the aegis of contemporary modern science.

Dr Narind*, Dr K. J. Malagi**.________________________________________________________

Keywords: - Avabahuka, Bahu karma kshyakari, contemporary modern science, Syndrome

Abstract: -

Avabahuka, one of the Vata vyadhis explained in the Ayurvedic classics, can be better understood when it is considered as a syndrome rather than a single disease.‘Bahu karma kshayakari’, i.e., inappropriate or even lack of functioning of either one or both the upper limbs is the cardinal feature of the disease.

Contemporary modern sciences enumerate a number of conditions where in either retarded or complete absence of the functioning of the upper limbs are evident.

Here is an earnest attempt to understand the same.

** PGCPK Scholar,Dept of Ayurveda,KMC,Manipal.*** Associate professor, Dept of Ayurveda,KMC,Manipal.


AYURVISION 2009

VARIOUS WAYS TO TREAT APABAHUKA

DR.Priya chandan* ,Dr Zenica**, __________________________________________________________________

Apabahuka , which is a disease condition mainly affecting cervical and shoulder regions, thereby it disturbs the day to day activities. Relief from the symptoms of Apabahuka such as pain, restricted movements etc is essential for leading routine life properly. So thinking about remedies to give relief to such patients is necessary. Here I am doing a small try for the same. Main points to be discussed- (i).Various treatment modalities mentioned in Ayurvedic literatures. (ii) The effects of each treatment modalities. Above mentioned topics will be presented in the poster with the support of scientific and pictorial details.

*2nd Year P G Scholar of dept of Panchakarma,Alvas Ayurveda Medical College, Moodabidri..** Asst. Professor and HOD, Dept of Panchakarma,Alvas Ayurveda Medical College,Moodabidri.


AYURVISION 2009

VISION ON NIDANA & SAMPRAPTHI OF AVABAHUKA

Dr Shivanagouda.S.H *,Dr Madhusudan Kamath**,Dr Shripathi Adiga***.

Abstract :

Key words- disease, nidana, samprapthi, treatment, humors.

Avabahuka, one among the 80 vata vyadhis explained in the ayurvedic classics, incorporates various salient virtues which have always posed problems for the thorough understanding of the disease and formulation of the treatment modalities.

The quest for knowledge in the learned has always encouraged them to reach the zenith in their field of interest. Likewise, Ayurvedic scholars have pin pointed the importance of nidana in the manifestation of diseases and the need to get rid of them initially, as a means of treatment of the disease. The classics explain the same as ‘ nidana parimarjanameva chikitsa’.And also, the apt understanding of the stages in the manifestation of the disease, the humors involved in the same, are all of vitality while planning the treatment of the disease. This view is put forth as ‘samprapthi vighatanameva chikitsa’ in the precious classics of ayurveda, the science of life.

Considering the same in terms of the disease avabahuka, the vision regarding the nidana and samprapthi of the disease is in par with its treatment, in terms of importance. This is an attempt to understand the same.

* PGCPK Scholar,Dept of Ayurveda,KMC,Manipal.** Assistant professor, Dept of Ayurveda,KMC,Manipal.*** Assistant professor, Dept of Ayurveda,KMC,Manipal.


AYURVISION 2009

CURRENT CLINICAL UNDERSTANDING OF APABAHUKA

Dr.Kiran kumar Agadi*.

Abstract.

Keywords:Methods of Diagnosis of Apabahuka.Clinical examinations.Abyanga

sweda and Nasya.Physiotherapy.

Present era is an era of stress. Modern day life style and modern gadgets and competitions in all

walks of life has made man’s life more strenuous than before. It is also responsible for increase

in the incidence of many diseases. Most of these diseases may not be life threatening but hamper

day to day life and human productivity. Apabahuka is one among such diseases, which is

agonizing and affects normal routine work of human being.

Apabahuka is one of the Vatavyadhi, which affects the normal functioning of the upper limb,

especially movements around the shoulder girdle. Pain and stiffness around shoulder girdle

usually develops gradually over several months to a year, it may also progress rapidly in some

patients. Pain may also interference with sleep of individuals.

In contemporary medical science, there are lot of treatment strategies described for its

management. But still the available methods are not satisfactory. Most of the methods are

palliative and there is a high rate of reoccurrence of the problem. On the point of this view

clinical diagnosis of Apabahuka and its management is taken in to consideration for presentation.

Objectives of the poster

Nidanas of Apabahuka. Roopa of Apabahuka. Samprapti ghatakas of Apabahuka. Clinical examinations of Apabahuka. Investigations in Apabahuka. Management of Apabahuka. Pathya – Apathyas of Apabahuka.

* Second year P.G. Scholar.,G.A.M.C. Mysore 21


AYURVISION 2009

A CRITICAL ANALYSIS OF AVABAHUKA AND ITS MANAGEMENT - AN AYURVEDIC APPROACH.

DR. SUPRIYA .U. PRABHU DESSAI*.

ABSTRACT:

KEYWORDS: - Shoulder pain, Avabahuka.

Shoulder pain is a presenting complaint among adults in outpatient settings. It can be defined as pain in and around the articular surfaces of the shoulder girdle , including the glenohumeral, acromioclavicular, sternoclavicular joints and the scapulothoracic articulation. Common causes of chronic shoulder pain include rotator cuff strain or tear, biceps tendonitis, subacromial bursitis, glenohumeral osteoarthritis, impingement syndrome and adhesive capsulitis. The condition can produce substantial disability and difficulty with activities of daily living. This conditions can be correlated with Avabahuka- under both saam and niraam conditions. The elaborate descriptions are available in our classics to manage pain, in which the vaata is the main culprit as our acharya’s say, “na vaatena vina shula”. So, here an effort is made to overcome shoulder pain, one of the most common occupational disorders, by ayurvedic management, to relieve pain and stiffness and to improve function.

*PG Scholar,Dept of Kayachikitsa,SDM College of Ayurveda,Udupi


AYURVISION 2009

AYURVISION 2009Guests/ Resource Persons List

01.Dr. Charudatta. Asst .Prof, Dept. of Radiology, KMC,Manipal. 02.Dr. Vivek Pandey, Associate Professor, Dept. of Orthopaedics, KMC,Manipal.

03.Dr. G.R. Vastrad, Prof, Dept of Kayachikisa, Taranath Govt. Ayurvedic Medical Colleg,Bellary. 04.Dr.S.G. Mangalagi, HOD, Post Graduate Studies in Kayachikitsa, Govt Ayurvedic College, Mysore

05.Dr. Prasanth, Assistant Prof, Department of Kayachikitsa, Ayurveda Mahavidyalaya, Hubli.

06.Dr. K. Govindan Namboodari, Prof. Dept. Kayachiktisa, Govt. Ayurvedic College, Thiruvananthapuram.

07.Prasanna Mogasale. Asst Prof.Dept of PG Studies in Kayachikitsa, SDM College of Ayurveda.Udupi.


AYURVISION 2009

AYURVISION – 2009LIST OF DELEGATES REGISTERED

Sl. No. Name Place01. Dr. Rajesh , BAMS (PGCPK) PGCPK – Manipal02. Dr. Divya Nayak , BAMS (PGCPK) PGCPK – Manipal03. Dr. Shailesh, BAMS (PGCPK) PGCPK – Manipal04. Dr. Amruta , BAMS (PGCPK) PGCPK – Manipal05. Dr. Pratibha P. K, BAMS (PGCPK) PGCPK – Manipal06. Dr. Sapana Singh, BAMS (PGCPK) PGCPK – Manipal07. Dr. Narind Khajuria, BAMS (PGCPK) PGCPK – Manipal08. Dr. Pratibha B. P, BAMS (PGCPK) PGCPK – Manipal09. Dr. Shivan Gouda S. H, BAMS (PGCPK) PGCPK – Manipal10. Dr. Jayanti Tripati, BAMS (PGCPK) PGCPK – Manipal11. Agamya S Udupi 12. Dr. Akarshani A. M (MD) Mysore 13. Dr. Sidram M Guled (MD) Mysore 14. Dr. Shivanand K Pyati (MD) Mysore 15. Dr. Chitralatha (MD) Mysore 16. Dr. Triveni (MD) Mysore 17. Dr. Kiran Kumar Agadi (MD) Mysore 18. Dr. Mahesh Sharma M N (MD) Mysore 19. Dr. Sowmya S Bhat (MD) Mysore 20. Dr. Anil Kumar H K (MD) Mysore 21. Dr. Shubharani M (MD) Mysore22. Dr. Geetha Kumari S (MD) Mysore 23. Dr. Sween , PGCPK Haryana 24. Dr. Supriya , PGCPK Goa25. Dr. Arun J Wilson (MD) Moodbidri 26. Dr. Shweta A H (MD) Moodbidri


AYURVISION 2009

27. Arifa M P (MD) Moodbidri28. Dr. Rebu K Joseph (MD) Moodbidri29. Dr. Swapna Gunjal (MD) Moodbidri30. Dr. Susha John (MD) Moodbidri31. Dr. Parvathy S. P (MD) Moodbidri32. Dr. Priya Chandran (MD) Moodbidri33. Dr. R. P Ranjit (MD) Moodbidri34. Dr. Savitha B Bhonsle BAMS, PGCPK Belgaum35. Dr. Aravind M. C, BAMS, PGCPK Mumbai 36. Dr. Poornima Desai , BAMS, PGDPK Goa37. Dr. Rashmila Chindakar , BAMS Goa 38. Dr. Zenica , M. D Moodbidri39. Dr. Nayana, BAMS, PGCPK Moodbidri40. Dr. Anjali , BAMS, PGCPK Bangalore 41. Dr. Premanand, BAMS, PGCPK Tamil Nadu42. Dr. Anil Tamannavar , BAMS, PGCPK Gadag 43. Mrs. Savitha A Tamannavar, LLB Gadag 44. Dr. Ramesh Konkeri, MD Belgaum45. Dr. Laxmi R Konkeri , BAMS Belgaum 46. Dr. Meera, BAMS, PGDPK USA47. Dr. Akiko, BAMS Japan 48. Dr. Vijay Kumar B, BAMS Bellary 49. Dr. Deepak S Mummigatti, MD Dharwad50. Dr. Neeta D. Mummigatti , BAMS Dharwad 51. Dr. B. M. Anuradha, BAMS, PGCPK Belur52. Dr. Prakash Naik, BAMS Udupi53. Dr. Praveen Kumar, (MD) Hubli 54. Dr. Sivakumar, (MD) Hubli55. Dr. Vivekananda, BAMS Kannur 56. Dr. Vidyoth, BAMS Pallikannur


AYURVISION 2009

INSPIRED BY LIFE

“ EXPLORING THE NEW FRONTIERS IN ACADEMIC & SCIENTIFIC AYURVEDA”

CME ON “AVABAHUKA”ON 19th & 20th DEC AT K.M.C. OF UNIVERSITY OF MANIPAL, THE SOARING FOUNTAIN OF KNOWLEDGE


AYURVISION 2009

MAY THIS CME BE A GREAT OPPORTUNITY TO IGNIT MINDS TO DISCOVER & EXCEL WHILE ENCOURAGING

THE SPIRIT OF RESEACH & INNOVATION !


AYURVISION 2009

WITH BEST COMPLIMENTS FROM

Dr Kusala Wijesundara on behalf of AMDA Peace Clinic at Bodhgaya with the pure sense of “Sri Lankan Fellow ship” & “So go - Fu jo spirit”


AYURVISION 2009

POSTERS


AYURVISION 2009


AYURVISION 2009


AYURVISION 2009


AYURVISION 2009

Best Compliments From:

MR. VIDYAVANTH KAMATHAuthorised Dealer Kottakkal Arya Vaidya SalaOpp. Corporation, Bank, Manipal

The Himalaya Drug Company.

SG Phyto pharma Pvt Ltd.

Millenium Herbal Care Ltd.

Vasu Health Care Pvt Ltd.


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