A COMPARATIVE CLINICAL STUDY OF NASYAKARMA AND

www.wjpps.com Vol 4, Issue 11, 2015. 1619

Aramani et al. World Journal of Pharmacy and Pharmaceutical Sciences

A COMPARATIVE CLINICAL STUDY OF NASYAKARMA AND

UTTARABHAKTIKA SNEHAPANA IN APABAHUKA

Rohini A. Aramani1*

, Srinivas P.2, Prameela Devi K.

3, Ramakrishna Allam

4, Kasthuri

5,

G. K. Swamy6

*1, 4, 5

Senior Research Fellow, 2,3

Research officer, Scientist 2, 6Assistant Director, Scientist 4.

Dr. A. Lakshmipathi Research Centre for Ayurveda, (CCRAS), Chennai, Tamilnadu, India.

ABSTRACT

Nasyakarma & Snehapana are among Panchakarma, specially

indicated in Urdhwajatrugata vataja vikaras.[1]

Brimhana nasya and

Brimhana snehapaana are found effective in vatavyadhi.[2]

Apabahuka

is one among vatavyadhi‟s which hampers the normal function of

upper limb due to Vataprakopa. Shoola and Bahupraspandahara are

the clinical features of Apabahuka. Nasyakarma and Uttarabhaktika

Snehapana have great significance in the treatment of Apabahuka.[3]

It

is a comparative clinical study conducted to assess the efficacy of

Nasyakarma and Uttarabhaktika Snehapana in Apabahuka. As per the

inclusion and exclusion criteria, the subjects were selected randomly &

divided into two groups. Group A- 15 Patients were received

Nasyakarma. Group B- 15 Patients were received Uttarabhaktika

snehapana. The treatment modalities used in this clinical study are Nasya and Uttarabhaktika

snehapana, which includes Pachana-Deepana with Ajamodadi choorna, Abhyanga with

Moorchita Tila Taila, Swedana with Dashamoola bashpa, Nasya and Uttarabhaktika

Snehapana with Masha taila and follow up for 14 days. In Group A, out of 15 patients, 9

(60%) got moderate improvement and 6 (40%) patients got mild improvement. In Group B,

out of 15 patients, 3 (20 %) got marked improvement and 12 (80%) patients got moderate

improvement. Both the procedures show statistically highly significance. Among these

groups, Uttarabhaktika Snehapana is establishing more effective clinically.

KEYWORDS: Brimhana Nasya, Uttarabhaktika Snehapana, Apabahuka.

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

SJIF Impact Factor 5.210

Volume 4, Issue 11, 1619-1630 Research Article ISSN 2278 – 4357

Article Received on

07 Sept 2015,

Revised on 01 Oct 2015,

Accepted on 25 Oct 2015

*Correspondence for

Author

Rohini A. Aramani

Senior Research Fellow,

Dr. A. Lakshmipathi

Research Centre for

Ayurveda, (CCRAS),

Chennai, Tamilnadu, India.



INTRODUCTION

Ayurveda plays a significant role for the maintenance of harmony in today‟s busy professions

and changing lifestyle. Beauty of Ayurvedic literature is mentioning the guidelines in the

sootra roopa (quotation) and leaving everything to the interpretation (Yukti) of Physician.

The economy of the country relies on its work force. Apabahuka is one such disease that

hampers the day-to-day activity of an individual. The fact that „Vatavyadhi’ is one among

the major diseases mentioned in the Ayurveda (Ashta maha gada)[4]

and is self explanatory,

with regard to the consequences caused by Apabahuka. Even though a definite factor

responsible for the manifestation of this disease is not mentioned, a set of etiological factors

can be interpreted. On analyzing the etiopathology, it may be interpreted that the depletion of

tissue elements (dhatu kshaya) as well as Samsrushta dosha( associated with other doshas).

Apabahuka is considered to be a disease that usually affects the shoulder joint (amsa sandhi)

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

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

a Vata vyadhi.[5]

Amsa shosha can be considered as the preliminary stage of the disease where

loss or dryness of the Shleshaka Kapha from the shoulder joint occurs. In the next stage, pain

(shoola) during movement will occurs due to the loss of Shleshaka Kapha and symptoms

like, restricted movement, and so on, are manifested. In the literature, it has given

importance, while describing Shodhana & Shamana chikitsa (Panchakarma), which is a

unique therapeutic procedure because of its preventive, primitive, prophylactic & rejuvinative

properties. Nasya karma & Snehapana is among Panchakarma specially and indicated in

Urdhwajatrugata vataja vikaras. Uttarabhaktika Snehapana is one type of Brihmana i.e.

Snehapana done after intake of food which is useful in the disorders of vyana vata.[6]

Hence,

Brimhana nasya and Brimhana snehapaana are found effective in vatavyadhi. In present study

Nasyakarma and Uttarabhaktika Snehapaana with Masha taila were taken as the comparative

study of Apabahuka.

OBJECTIVES OF THE STUDY

To evaluate the efficacy of Nasya Karma and Uttarabhaktika Snehapana in Apabahuka

individually as well as compare the results.

MATERIALS AND METHODS

The materials required for the study

1) For Nasyakarma: Ajamodadi choorna for pachana-deepana.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202264/#ref1



Moorchita tila taila for abhyanga.

Dashamoola kwatha for bashpasweda.

Masha taila 8ml daily.

2) For Uttarabhaktika Snehapana: Ajamodadi choorna for pachana-deepana. Masha taila

24ml daily.

Preparation of Masha taila

Contents of Masha taila: Masha Kwatha, Saindhavalavana kalka, Moorchita Tila Taila.[7]

Taila is prepared according to Madhyama Taila Paaka Vidhi mentioned by Ayurvedic

classics.(Sharangadhara Samhita).[8]

DIAGNOSTIC CRITERIA

The diagnosis of the disease is mainly based on the signs and symptoms mentioned in

classics and modern text as follows:

Shula in the shoulder joint.

Bahupraspandahara in the shoulder joint.

Drop arm sign.

INCLUSION CRITERIA

Patients between the age group of 30-60 years were selected.

Patients fit for Nasya karma and Snehapana.

Patients irrespective of sex, occupation, religion, socio economic status were selected.

The cases of Apabahuka with the features mentioned in the method of collection of data

were included.

EXCLUSION CRITERIA

Patients below 30 years & above 60 years were excluded from the study.

Patients not fit for Nasya karma and Snehapana.

Patients with any disorders other than which interfere the line of treatment of Apabahuka.

Patients of shoulder joint dislocation/fracture.

STUDY DESIGN

This Clinical Study conducted on 30 Patients who attended the OPD and IPD of Shri

Jayachamarajendra Institute of Indian Medicine Hospital, Bangalore after fulfilling the



inclusion criteria were randomly divided into 2 Groups, Group A and Group B each

consisting of 15 patients.(table no 1).

Group A – In this group 15 patient were given Nasya with Masha taila for 7 days.

Group B - In this group 15 patients were given Uttarabhaktika Snehapana with Masha taila

For 7 days.

Table No 1: Study design.

Group A (Nasya karma) Group B (Uttarabhaktika Snehapana)

Poorvakarma

Deepana pachana with Ajamodadi

churna 3 – 5 gms BD with hot water

till nirama lakshanas.

Deepana pachana with Ajamodadi churna

3 – 5 gms BD with hot water till nirama

lakshanas.

Pradhanakarma

Nasya with Masha Taila, 8 drops

(bindu) in each nostril in continuous

flow (Avichinnadhara) for 7 days.

Uttarabhaktika Snehapana with

Mashataila 12ml after Pratah (morning

breakfast) and Sayam bhojana (Dinner)

for 7 days.

Pashchatkarma Gandusha with ushna jala Ushna jalapana

Follow up: after 14 days & Study duration 24 days in each group.

PROCEDURE OF UTTARABHAKTIKA SNEHAPANA

The patient is advised to complete morning regimens and asked to take food when hungry.

Immediately after food 12 ml of luke warm Masha Thaila along with Milk (ksheera) taken in

a Steel glass, advised the patient to close eyes and nostrils if any aversion towards smell and

sight of taila. After taking taila ask the patient to smell the lemon to avoid nausea. In

between patient may drink hot water, and to take food at evening (dinner) only. Then the

same procedure should repeat after food. This will be administered for 7 days.

ASSESSMENT CRITERIA

Patients were assessed before, after the completion of treatment and on follow up. The

following parameters were considered while assessment and they were graded and scores

were given as follows.

A.SUBJECTIVE PARAMETERS.

1) Shula

Pain Grade

1)No pain. 0

2)Mild pain particularly on moving the

shoulder but able to continue routine work

without difficulty.

1

3)Moderate pain felt on movement 2



and,interfere routine works.

4)Severe pain felt on movement and also at

rest,disturbing sleep, unable to carry most of

the routine work.

3

2) Bahupraspandahara.

Stiffness Grades

1) No stiffness. 0

2) Mild stiffness particularly during shoulder

movement able to continue routine work

without difficulty.

1

3) Moderate stiffness felt on movement and

unable to continue work. 2

4) Severe stiffness particularly during

shoulder movement and also at rest,

interfering routine work.

3

OBJECTIVE PARAMETERS

Range of shoulder movements (Goniometric examination)

1)Ant.Elevation

G0: >160 & <180

G1: .>120 & <160

G2: >60 & <120

G3: >0 & <60

2)Int.Rotation

G0 : No pain or stiffness can touch upto midscapular region.

G1 : Mild pain and stiffness , can touch upto infrascapular region.

G2 : Moderate pain and stiffness , can touch upto lower lumbar Vertebrae.

G3 : Severs pain and stiffness, cant move the joint.

3) Ext.Rotation

G0 : No pain or stiffness can touch upto infrascapular region.

G1 : Mild pain and stiffness , can touch upto midscapular region.

G2 : Moderate pain and stiffness , can touch upto suprascapular Region.

G3 : Severs pain and stiffness, cant move the joint.



ASSESSESMENT OF CLINICAL IMPROVEMENT

The sum point of all the parameters of assessment before, after and at follow up day was

taken into consideration to assess the total effect of the treatment as follows.

STASTICAL ANALYSIS: Data were collected from sample before, after and post follows

up treatment. Statically analyzed by using student “t” test in consultation with Bio-

statistician0.

OBSERVATIONS

Among 30 patients more patients were from 51-60 years age group i.e. 11 (36.66%), male

17(56.66%), 19 (63.33%) patients were having vishamagni, 18 (60%) of madhyama koshta

and more of vata kaphaja prakruthi i.e. 20 (66.67%).

Considering the aharaja nidanas 17 patients were consuming katu kashaya rasa pradhana

ahara, 17 (56.66%) were taking ruksha sheeta pradhana ahara and 15 (50%) were taking

pramitashana. In Viharajas nidanas, 22 (93.3%) were during Ativyayama, 18(60%) had

Vegadharana and 20 (66.7%) had Atiyaanadi. Considering the duration of disease more

patients i.e. 18 (60%) were in between 4-6 months, in duration of treatment, 16 patients took

pachana-deepana for 3 days and 14 patients for 4 days.

In Group A, out of 15 patients, Sukhochwasa was found in 11(73.3%), Sukha swapna

prabodha in 13 (86.7%) patients and Akshapatavam in 12(80%) patients.

In Group B, out of 15 patients, Deeptagni was found in 12(80%) patients, Parishuddhakoshta

in 13(86.7%) patients, Pratyagra dhatu balavarnayukta in 13 (86.7%) patients and

Vyadhyupashamana in 12(80%) patients.

RESULTS

The results thus obtained before, after and during follow up of the treatment were analyzed

statistically. The results were statistically interpreted based on subjective and objective

parameters.

Marked improvement > 75%

Moderate improvement 50-75%

Mild improvement 25-50%

No improvement < 25%



Table No 2: EFFECTS OF NASYA (Group-A)

Effect of Nasya Therapy on Subjective and Objective Parameters in Group A.

Table No 3: EFFECT OF UTTARABHAKTIKA SNEHAPANA (Group-B)

Effect of Snehapana Therapy on Subjective and Objective Parameters in Group B.

Table No 4: COMPARATIVE RESULTS OF GROUP-A and GROUP-B

Characteristics GROUP-A GROUP-B

Signs and Symptoms Mean score % of

relief

Mean score % of relief

BT FU BT FU

Shoola 2.27 0.94 59% 2.07 1.20 42%

Bahupraspandahara 2.20 1.26 43% 2.27 0.27 88%

Anterior Elevation 2.06 1.06 49% 2.27 0.40 82%

Internal Rotation 2.20 0.94 57% 2.07 0.74 64%

External Rotation 2.20 0.94 57% 2.00 0.67 67%

Drop Arm Sign 1.00 0.07 93% 1.00 0.07 94%

Symptoms

Measures

% S.D

(+-)

S.E

(+-)

t

value

p

value BT BT-

AT

Shoola 2.27 AT 1.20 1.07 47.13 0.703 0.181 5.87 <0.0001

FU 0.94 1.33 58.59 0.723 0.186 7.135 <0.0001

Bahupraspandahara 2.2 AT 1.40 0.80 36.36 0.414 0.106 7.483 <0.0001

FU 1.26 0.94 42.72 0.457 0.118 7.897 <0.0001

AT 1.26 0.80 38.83 0.414 0.106 7.483 <0.0001

Anterior Elevation 2.06 FU 1.06 1.00 48.54 0.534 0.138 7.246 <0.0001

Internal Rotation 2.2 AT 1.2 1.00 45.45 0.654 0.169 5.916 <0.0001

FU 0.94 1.26 57.27 0.703 0.181 6.971 <0.0001

AT 1.14 1.06 48.18 0.593 0.153 6.959 <0.0001

External Rotation 2.2 FU 0.94 1.26 57.27 0.593 0.153 8.264 <0.0001

AT 0.14 0.86 86 0.351 0.090 9.5 <0.0001

Drop Arm Sign 1.00 FU 0.07 0.93 93 0.258 0.067 14 <0.0001

Symptoms

Measures

% S.D

(+-)

S.E

(+-)

t

value

p

value BT BT-

AT

Shoola 2.07 AT 1.34 0.74 35.74 0.593 0.153 4.785 <0.0001

FU 1.20 0.86 41.54 0.516 0.133 6.500 <0.0001

Bahupraspandahara 2.27 AT 0.60 1.67 73.56 0.816 0.210 7.906 <0.0001

FU 0.27 2.00 88.10 0.845 0.218 9.165 <0.0001

AT 0.74 1.53 67.40 0.915 0.236 6.487 <0.0001

Anterior Elevation 2.27 FU 0.40 1.86 81.93 0.833 0.215 8.671 <0.0001

Internal Rotation 2.07 AT 1.07 1.00 48.30 0.654 0.169 5.916 <0.0001

FU 0.74 1.33 64.25 0.488 0.126 10.58 <0.0001

AT 1.00 1.00 50.0 0.654 0.169 5.916 <0.0001

External Rotation 2.00 FU 0.67 1.33 66.5 0.617 0.159 8.367 <0.0001

AT 0.07 0.93 93% 0.258 0.067 14 <0.0001

Drop Arm Sign 1.00 FU 0.07 0.94 94% 0.258 0.067 14 <0.0001



Table No 5: ASSESSMENT AND TOTAL EFFECT OF THERAPY

Remarks Group A % Group B % Total %

Marked relief

Above 75% 00 00% 03 20% 03 10%

Moderate relief

50-75% 09 60% 12 80% 21 70%

Mild relief

25-50% 06 40% 00 00% 06 20%

No relief

Below 25% 00 00% 00 00% 00 00%

In Group A, out of 15 patients, 9(60%) got moderate improvement and 6 (40%) patients got

mild improvement. In Group B, out of 15 patients, 3(20 %) got marked improvement and 12

(80%) patients got moderate. In total out of 30 patients, 3(10%) got marked improvement,

21(70%) got moderate improvement and 6(20%) mild improvement.

EFFECTS OF NASYA (Group-A) Statistically highly significant (p <0.0001) results were

observed i.e 58.59% relief in shula, 42.72% relief in bahupraspandahara, 48.54% relief in

anterior elevation,57.27% relief in internal rotation,57.27% relief in external rotation and

93% in drop arm sign.

EFFECT OF UTTARABHAKTIKA SNEHAPANA (Group-B):Statistically highly

significant results (p <0.0001) were observed i.e 41.54% relief in shula, 88.10% relief in

bahupraspandahara,81.93% relief in anterior elevation,64.25% relief in internal

rotation,66.50% relief in external rotation and 94% in drop arm sign.

Comparison of total effect of two groups had analysed. However there was 60%

improvement in Group A and 73% improvement in the Group B. The difference in treatment

was 13%.But clinically Group B, Uttarabhaktika Snehapana has got highly significance than

Group A Nasya.

DISCUSSION

Nasya karma is one of the major Brimhana and Shodhana Modality specially indicated for

vitiated dosha and the diseases situated in jatru urdhwa pradesha, as nasa is told as dwara for

shiras which is a uttamanga and considered as moola of human body which has coated since

Vedic Ages.[9]



Snehana is the measure adopted (Bahya & Abhyantara) to bring about Snigdhata in the body.

Charaka defines Snehana as, the procedure by which Snigdhata, Vishyandana, Mardavata and

Kledana are produced in the body.[10]

The administration of Sneha along with Mamsa Rasa,

Madya, Kshira etc., are known as Brimhana Snehana. If it is given before food, will cures

Adhobhaga rogas, in the middle it cures Madhyamabhaga rogas and after food cures

Urdhwabhaga rogas and strengthens the body.[11]

Apabahuka is a disease caused by kupita vata dosha, localizing around the amsa pradesha

causing the shoshana of amsa sandhi, there by leading to akunchana of sira at that site and

giving rise to bahupraspandaharatwam which means restricted movement of bahu.[12]

Vyanavata and siras are responsible for all types of motor functions namely prasarana,

aakunchana, vinamana. The kapha present as lubricating material within the sandhi aids in

the movements such as prasarana, aakunchana etc. Shoshana of kapha or kshaya in the

quantity of kapha leads to impaired range of movements. In Apabahuka Vatahara and

Brimhana Dravyas are useful in the form of Nasya and Snehapana. As aushadha kala of

Vyana and Udanavata is adhobhakta, Uttarabhaktika Snehapana is useful.

As in Apabahuka rookshadi gunas are dominant, vipareeta gunas like Snigdhadi are required,

hence Mashataila is selected. As Masha is having Snigdha, Ushna and Guru guna do the

shamana of Vataja gunas like ruksha, sheeta, laghu and also Bala and Shleshmakaraka.

For Shareeraja doshas, taila, ghrita and madhu are respectively paramaushadhas in vata, pitta

and kapha vyadi. Hence taila is selected in Apabahuka (vatavyadhi). Taila is having Ushna,

Snigdha gunas and Madhura vipaka, which are vata shamaka properties.[13]

Mode of action of Masha taila in Shoola: Masha is having ushna guna. Shoola and sheeta

are interrelated. All painful vatavyadhi get aggravated by shayithyatha. If we give hot

fomentation i.e. ushna the pain subsides. It suggests that due to ushna guna Masha helps in

subside pain of apabahuka.

Mode of action of Masha taila in Bahupraspandahara: Bahupraspandaharatwa is having

sheeta as well as ruksha guna. Masha taila is having ushna and snigdha guna. Ushna guna

subsides the sheetha (sthabthatha) of Apabahuka, and Snigdha guna subsides the rukshatha

(sthabthatha) of Apabahuka.[14]



Brimhana action

Vatettu Brimhanam Kuryat, Pittettu Parishodhanam |

Kaphettu Prachchardhanam Sadhu Sannipate Virechanam ||

(Bhe.Su 25/6)[15]

Masha taila has madhura vipaka. Due to the madhura vipaka it does the Brimhana effect.

Brimhana 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 vitiation of Shleshaka

Kapha and Siras which is present in the amsa Sandhi. To reduce this Rooksha quality and to

normalize the Siras & Shleshaka kapha qualities, Brimhana Nasya and Snehapana is given.

CONCLUSION

Based on the conceptual analysis and observations made in the clinical study, the following

conclusions can be drawn. Present study revealed that the bharavahana, ati yaana, rooksha,

alpa ahara and vegadharana, ativyayama are the most incident causes for the manifestation of

disease Apabahuka. Vyana vayu prakopa is the prime pathology of Apabahuka. This can

happen either due to dhatuksaya or kapha avarana (vata dosha encircled with kapha).

Masha taila Nasya and Uttarabhaktika Snehapana can be practiced safely without any adverse

effect. Nasyakarma and Uttarabhaktika Snehapana are effective in eliminating Shula and

Bahupraspandahara and to improve functional ability of patient.

In both the groups subjective and objective parameters shows statistically Highly

Significance result (P< 0.0001). Group B is more effective than Group A in all parameters

except Shula, as Snehapana is best Vatashamaka and gives Ashu Bala and do the Ashu dhatu

poshana.

Overall the Group B is more effective clinically and statistically than Group A in almost all

the parameters. Being this study is done with very minimal resources (subjects, parameters

etc.), we feel it requires a large scale clinical trial to establish the effect.

ACKNOWLEDGEMENT

I have no word to express my feelings to appraise my whole hearted gratitude and deep sense

of indebtedness to my respected guide Dr. Shalini Eli– HOD and Professor, Dept. of

Panchakarma for her motherly affection, guidance, care and valuable suggestions throughout

the course of my study have helped in completing this work successfully.



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Documents

A COMPARATIVE CLINICAL STUDY OF NASYAKARMA AND