2. INTRODUCTION
• Avabahuka - affects Amsa Sandhi.
• Avabahuka - not mentioned in the
Nanatmaja Vata Vyadhi.
• Acharya Susruta, Vagbhata - Avabahuka a
Vata Vyadhi.
• Madhava Nidana - Amsa Shosha and
Avabahuka.
• Amsa Shosha - preliminary stage -
Sleshaka Kapha Sosha in Amsa Sandhi.
• Avabahuka - Shleshaka Kapha Sosha +
Shoola during movement, restricted
movement etc.
• Madhukosha Teeka:
– Amsa Shosha - Dhatu Kshaya i.e., Sudha
Vata Janya
– Avabahuka - Vata Kapha Janya.
3. MODERN VIEW
• Aches and pains related to
musculo-skeletal system are
common and the incidence of such
illness increases with age.
• Avabahuka can be compared to
the musculo skeletal disorders of
the shoulder girdle and brachial
plexus neuropathy.
• In allied sciences the therapeutic
aspect of management of these
disorders still remain in infancy.
4. LITERARY REVIEW
• Charaka – Bahusirshagata Vata
• Sushruta – Avabahuka
• Vagbhata – Avabahuka
• Dalhana, Arunadatta, Hemadri – analyzed
Avabahuka in detail.
• Madhava Nidana, Yoga Ratnakara –
Avabahuka.
• Madhavakara is the first to differentiate it
from bahushosha.
• Bhavamishra, Sharangadhara etc. –
Rasoushadhis in this context.
• Vangasena – Chikitsa with different
Yogas.
• Gadanigraha, Brihat NighantuRatnakara,
Nidana Sara etc. – Avabahuka with its
management.
5. NIRUKTI AND PARIBHASHA
• Avabahuka comprises of two words
'ava' and 'bahuka'.
– Ava means ‘Viyoga’ or ‘Vikratou’
which means dysfunction or
separation.
– It can be taken as deterioration or
dysfunction.
– Bahuka - (at the end of a
compound) - bahu - the arm.
– Bahuka - Muscular gender.
• Thus Avabahuka can be defined as,
– Bahustambho Avabahuka
– Bad arm, stiffness in the arm joint
6. AMSA SANDHI VIVECHANA
• This is a major joint of upper limb.
• This is one type of chala and
Ulookhala sandhi.
• This is formed by the combination
of Pragandasthi, Akshakasthi and
Amsaphalakasthi.
• Pratanavati type of Snayu cover this
sandhi.
• Shleshaka Kapha present in this
joint acts as lubricant and helps in
protection and movement of the
Sandhi.
7. AMSA SANDHI & MARMA
• The Amsa Marma - head (Murdha), neck (Greeva) and the
arm (Bahu).
• Formed by the union of Amsa Peetha (glenoid) and the
Skanda (acromio clavicular joint).
• This is a Snayu Marma to a length of half finger's width (1
cm).
• Amsa Marma consists of Mamsa, Sira, Snayu, Sandhi and
Asthi. But it is a Snayu Marma.
• It is one of Vaikalyakara Marma, any trauma to this will
produce disability or deformity of the shoulder joint.
8. NIDANA
• Bahya Hetu – causing injury to the
Marma or the region surrounding
that.
• Abhyantara Hetu – indulging in
Vata Prakopaka Nidana leading to
vitiation of Vata in that region.
– This may be again of Bahya
Abhigataja (External cause)
which manifest Vyadhi or
disease first and the other is
Dosha Prakopajanya
(Samshraya) which in turn leads
to Karmahani of Bahu.
9. SAMANYA SAMPRAPTI
Nidana
Mithya Ahara Vihara Old Age
Provocation of Vyana Vata
Sthanasamsraya in Amsa Pradesa
Sleshaka Kapha Sosha Affliction of Sira, Snayu,
Mamsa, Asthi, Kandara
Bahu Cheshta Hara
Avabahuka
12. DOSHA INVOLVEMENT
Vata Vyana: Chalagunataha Kshaya.
Vyanavayu Ruksha Gunataha Kshaya.
Prana: Karmataha Kshaya.
Kapha Sleshakha: Dravyataha Kshaya.
Avalambaka: Supports the srotas of the kapha by
virtue of its Ambukarma
Dravyataha kshaya.
Pitta Pitha dushti because of Asraya-
Asrayi bhava of Rakta, due to Sira,
Snayu vishosha.
13. ROOPA
• Bahu Praspandida Hara
(impaired or loss of movement of
the upper limb)
• Amsa Bandhana Shosha
(Muscle waisting) (Sushruta)
• Shoola (Pain)
16. SAMANYA CHIKITSA
• Vatavyadhi – Snehana, Swedana, Mrudusamshodhana, Vasti,
Sirovasti, Nasya, etc.
• Charaka – Sthana, Dushya - Specific therapies.
• Vagbhata - Jatroordhva Vatavikaras – Nasyakarma.
• Three major approaches are made in the management of
Vatavyadhi.
– Treatment of Kevala Vata
– Treatment of Samsrusta Vata
– Treatment of Avruta Vata
20. Mahatwa of Uttara Bhaktika Snehapana
• Acts on Vyana and Prana Vata
Shamana
• Acts as Brumhana
• Acts on Urdhwa Jatru Gata Roga
• Does Snehana effect on Sandhi
• Acts on Sleshaka Kapha
• Acts as Snehana on Shoshita Sira,
Snayu, Mamsa, Asthi, Kandara.
21. MARMABHIGHATA CHIKITSA
• When there is Marmabhighata of Amsa Marma leading to Avabahuka prime
importance is given for Marmabhighata Chikitsa.
• Lepa – Marma Gulika mixed with Murivenna.
• Lepa – Karuttha Gulika mixed with Murivenna.
• Gandha Taila 10-20 drops internally at bed time with Prasarinyadi Ksheera
Kashaya or with Ushna Ksheera Anupana.
22. BRUMHANA NASYA
• Same like Uttara Bhaktika Sneha
Pana
• Acts as Brumhana which is
Vatahara in nature
• Acts on Urdhwa Jatru Gata Roga
• Does Snehana effect on Sandhi
• Acts as Snehana on Shoshita Sira,
Snayu, Mamsa, Asthi, Kandara.
23. LEPA
• Vatahara Lepa which are having
Brumhana, Ushna can be used.
• Vruddhadarvadi Lepa – Vatahara,
Brumhana, Ushna.
• Dasamoola Ksheera Lepa –
Brumhana, Vatahara.
24. ABHYANGA
• Abhyanga with Various Taila
mentioned for Avabahuka like
• Mahamasha Taila
• Parinatakeriksheeradi Taila
• Karpasasthyadi Taila
• Prasarinyadi Taila
• does the action of Vatahara, Brumhana,
brings Snehana effect to the Sandhi
25. SWEDANA
• Various kind of Swedana like
• Jambeera Patrapinda Sweda
• Shastika Shali Pinda Sweda
• Kukudanda Sweda
• Dasamoola, Bala Kashaya Nadi Sweda
• acts as Vatahara, Rujahara, Brumhana
• Vasodilator, Improves the circulation.
26. SEKA
• Seka with various Vatahara
Kashaya and Taila are used
in Avabahuka.
• Acts as like Abhyanga.
29. Dasamoola Bala Masha Kwatha
• Chakradatta, Vatavyadhi.25
• -
• Indicated as Pana and Nasya.
• Indicated in Avabahuka, Viswachi.
• Acts as Brumhana, Vatahara, Balya.
• Adding Sneha / Ajya in it facilitates the action
of the Kwatha.
59. PERSONAL DATA OF THE PATIENT
Name : Mr. shivaputrappa.gurappanavar
Age : 42 Yrs.
Sex : Male
Religion : Hindu
Occupation : farmer
Economic status : poor
Educational status : 10th
std
Marital status : Un Married
Habitat : Rural
Address : atpost yaraguppi tal kundagol
dist dharawad
OPD No. : 9862
Date : 23 – 11 - 09
60. PRADHANA VEDANA:
• Severe Pain in the right shoulder joint (Amsa Sandhi Shoola)
since – 3 months
• Pain radiating to RUL
• Difficulty in range of movements (Stambha)
• Numbness
• Unable to carry on his daily regimen (Karmakshayakari)
ANUBANDH VEDANA:
• Chest Pain
• Bilateral knee jts pain
61. ADYATANA VYADHI VRUTTANTA:
Patient was apparently normal 3 months ago. One fine day patient fell
down with outstretched hand when he went to procure water from the
well, he had an injury to rt shoulder joint, chest, both knees etc. he had
lacerations over knees and elbow. Initially pt was administered with
nsaids and his rt shoulder jt was immobilized with figure of 8 bandage
by a local vaidya . After 4 days the condition worsened and he developed
swelling of the affected part and above mentioned complaints for which
he consulted the same person. again he was immobilized in their own
method for 20 days by which he had minimal relief. But Since from last 20
days the symptoms aggravated and pt was unable to carry on his daily
regimen for which he came to our hospital.
62. VAYUKTIKA VRUTTANTA:
Aahara : Vegetarian
Rasa satmy : Katu, Tikta, Kashaya rasa pradhana
Vihara
Nidra :poorvakalina Prakruta ( 6 – 7 hrs)
now adhyatanakalina disturbed due to pain
Vyasana : occasional smoker
TREATMENT HISTORY:
NSAID’s
Immobilization
PURVA VYADHI VRUTTANTA:
h/o Fall.
63. SAMANYA PAREEKSHA:
Ashta Sthana Pareeksha;
Nadi : 80/min.
Mala : Malabaddata
Frequency: once a day, imcomplete evacuation
Characteristics: Hard, Dry
Mootra : Prakruta,
Frequency: day – 2-3 times, Night –1-2 times
Characteristics: Normal coloured, non turbid
Jihwa : Prakruta
Shabdha : Prakruta
Sparsha : Prakruta
Drik : Prakruta
Aakruti : Madhyama
66. II. Motor System :
Muscle Strength : Weak on right upper extremity
Bulk of muscles : Reduced in right upper extremity
Tone of muscles : Hypotonia (Decreased in rt upper
limb)
Gait : Normal
III. Sensory System:
Pain : Pricking type of pain present
Touch : No signs of Inflammation
Joint Position : Normal
67. 2. Respiratory system
O / I : Respiration Rate – 18/min.(Regular)
O / A : Normal vesicular Breath sounds
3. C.V.S.
O / I : Pulse–80 / min,BP – 140/90 mm Hg
O / A : S1 S2 heard
4. GIT
P / A
O / I : Normal Contour
O / A : Normal Bowel sounds heard
O / P : No Organomegaly
73. TREATMENT GIVEN:
Amapachana with Panchakola churna 10 gms twice daily with hot
water for 2 days
1) Jambeera pinda sweda
2) Nasapaana with dasamooli balamaasha kwath 7 Days
SHAMANA:
1) Yogaraja Guggulu 500mg, Thrice daily after food along with
2) Prasarinyadi Ksheera Kashaya 40ml as Anupana for 45 Days.
75. RESULT:
• Patient felt 85% improvement after 7 days of
procedures.
Assessment
GM ROM readings
Right shoulder joint : BT AT
Adduction Painful Normal
Abduction Painful Normal
Flexion 60 180
Elevation 50 180
Hyperextension 40 90
76.
77.
78. Dr. PRASHANTH. A. S. M.D. (Ay), (Ph.D.),
PROFESSOR
DEPARTMENT OF POST GRADUATE STUDIES IN KAYACHIKITSA
AYURVEDA MAHAVIDYALAYA, HUBLI (KARNATAKA)
Cell: 09448135575 drprashanthas@gmail.com
For further details:
Ayurveda Mahavidyalaya, Hubli