“A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF NASYA WITH KARPASASTHYADI TAILA AND NAGARA TAILA IN THE MANAGEMENT OF AVABAHUKA”

Introdution

The Effect of Nasya with Karpasasthyadi Taila & Nagara Taila in The Management of Avabahuka �

1. INTRODUCTION

Ayurveda is the rich storehouse of time-tested and effective recipes for the

treatment of several obstinate and otherwise incurable diseases. More important than

these recipes are the specialised therapies, which while curing such diseases

strengthen the immune system in the body and help in the preservation of positive

health. These specialised therapies in Ayurveda are called as Panchakarmas. It is no

wonder that the scientists and physicians in India and abroad are evincing deep

interest in the classical form of Ayurvedic treatment. Panchakarma therapy primarily

aims at cleansing the body of its accumulated impurities and nourishing the tissues.

Once this is achieved, it becomes very easy to rejuvenate the tissues and prevent the

process of ageing. This helps the individual to lead a disease free old age and

becomes capable of serving the society with accumulated experience without any

mental disability and physical decay.

It is necessary at this state to make it clear that these Panchakarmas do not

imply simple administration of emesis, purgation, enema or nasal drops as is

conventionally understood. Elaborate methods are described for the preparation of

these therapies, their administration, preparation of the individual prior to the

administration of these and the management of the patient after the therapy is

administered.

Nasya is an important therapeutic procedure as many of the courses of

Ayurvedic treatment. It comes under the Panchashodhanakarmas. Nasya Karma is

one of the important Panchakarma mainly for Urdhwajatrugata Vikaras . It is

more or less essential in all Urdhwajathru Vikaras. Nasya is effective not only for

inducing immediate results but also serves as a permanent cure.

Introdution


The present day, world is full of stress and strain due to change in life style,

sedentary work, increasing competitions in all walks of life. This has lead to many

diseases which though does not kill a person, but hamper his day-to-day life. Vata

among three humors is considered to be superior most in all aspects, for every action

or movement, strongest in its ability to produce diseases and worst mortality. Vata

which is motivating factor of other two doshas gets easily aggravated in this fast

paced life. Contradictory approaches to pacify this vitiated state have to be resorted to

maintain the equilibrium.

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

disease which hampers the day to day activity of an individual. In classics two disease

have been mentioned ie Bahushosha and Avabahuka. Bahushosha is due to

Kevalavataja and Avabahuka due to Vata and Kaphaja involvement (Avarana).In

Avabahuka Shoola during movement and Bahupraspanda Hara (Stabdhatha) are

manifested.

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

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

Avabahuka can be relieved by therapies like Nasya , Sneha Paana,Abhyanga,Swedana

etc according to the classics. In the present study Nasya is selected because this

procedure is more effective in different Vyadhyavasthaas of Avabahuka.

Karpasasthyadi Taila described in Vatavyadhi Adhikara of Sahasrayoga is

generally practiced in the treatment of Avabahuka. By considering the Samprapti of

Avabahuka, the Taila Yoga which is processed with the property of the drugs which

are having Vata Kaphahara nature would be affective. Nagara is a drug having Vata

Kaphahara property which is easily available and economical compared to

Karpasasthyadi Taila. Hence an attempt is made to compare the effect of

Karpasasthyadi Taila Nasya and Nagara Taila Nasya in the management of

Avabahuka, this study is undertaken.

Introdution


This dissertation is a sincere effort to study the Nidana Pancaka as well as

Chikitsa of Avabahuka with special reference to the therapeutic efficacy of Nasya

with Karpasasthyadi Taila and Nagara Taila. This dissertation consists of:

� Conceptual Study.

� Clinical Study.

� Discussion.

� Conclusion and Summary.

Conceptual study begins with the historical review and description of

Avabahuka, definition, etymological derivation, anatomical understanding of shoulder

joint in Ayurvedic and modern perspective, Nidana Panchankas, modern perpetuation

of the disease Avabahuka, Chikitsa and Pathyapathya. There after historical review

and description of Nasya Karma is decribed, followed by description of

Karpasasthyadi Taila and Nagara Taila in the drug review.

Clinical study starts with the materials and methods of the present work with

complete description of the assessment criteria and descriptive statistical analysis of

the sample taken for the study is methodically elaborated. Finally observations, results

and their statistical analysis are presented in order along with tables and graphs.

Discussion includes the critical conceptual analysis, observation and results

obtained in the present study.

The whole thesis work is summarized with conclusive points under the

headings of Conclusion and Summary.

Objectives


2. OBJECTIVES

Avabahuka occurs in Urdhwajatru Pradesha. Nasyakarma is one of the

important procedures in Panchakarma and it is the treatment of choice for

Urdwajatrugata vikara “Nasahi shiraso dwaram” i.e Nose is the gate way to head.

The ingredients of Karpasasthyadi Taila and Nagara Taila are having Ushna

Veerya, Snigdha Guna, Madhura Vipaka, Vatakapha Hara properties and having

Karmukata as ,Snehana and Brumhana .

In modern science, Adhesive Capsulitis or Frozen shoulder is a disease

having similar clinical features as Avabahuka. Frozen shoulder is a condition that

causes restricted range of active and passive glenohumeral motion in the shoulder

joint.

Adhesive Capsulitis or Frozen shoulder is not having much effective medicine

or therapy in contemporary system of medicine. Anti-inflammatory, analgesics are the

drugs of choice in contemporary system of medicine. Surgery occasionally is

performed. Unfortunately all the analgesics are prone to many side effects particularly

in prolonged usage. Ayurvedic approach to the Avabahuka is to retard the

degeneration process and strengthening the dhatus pacifying the Vata Dosha has

special importance in the management of any degenerative phenomenon. As

Avabahuka is one of the Urdhwajatrugata Vikara and especially Dhatukshayajanya

Vataroga Brumhana Nasya and Snehana, Swedana are more beneficial.

Ayurvedic scientists at various centers with an aim to study Avabahuka and to

evolve safer and economical medicaments for it have carried out several experimental

and clinical studies. The works are successful to some extent to relieve common

Objectives


complaints like pain and stiffness of this condition.

George P.J: Classical management of Avabahuka, 1981 Kerala University,

Thiruvananthapuram.

Philomina P.J: Avabahuka and its management, 1988 Government Ayurveda

Medical College, Mysore.

Shukla Niranjan: Effect of Nasya and Abhyanga on Avabahuka w.s.r to Masha

Taila, 1997 Gopabandhu Ayurveda Mahavidyalaya, Puri.

Naveen C.J: A study on Avabahuka and its management through Nasya

Karma and Vatagajankusha Rasa, 2004 Dr B.N.M Rural Ayurvedic Medical College,

Bijapur.

Only few works were carried out related to the present topic. In the

degenerative diseases, Brumhana Nasya and Vatashamaka Chikitsa are more effective

(A.S.Su. 29/16).

In the classics the line of treatament described as Nasya and Snehapana

(A.H.Chi. 21/44). No studies seem to have been conducted to evaluate the effect of

Karpasasthyadi Taila Nasya and Nagara Taila Nasya in Avabahuka. Hence it is

intended to evaluate the efficacy of these procedures in case of Avabahuka. So the

present study, “A comparative clinical study on the effect of Nasya with

Karpasasthyadi Taila and Nagara Taila in the management of Avabahuka” is under

taken.

Objectives of the study are -

1. To evaluate the efficacy of Karpasasthyadi Taila Nasya in Avabahuka.

2. To evaluate the efficacy of Nagara Taila Nasya in Avabahuka.

3. To compare efficacy of Karpasasthyadi Taila Nasya and Nagara Taila

Nasya in Avabahuka.

Review of Literature


3. REVIEW OF LITRATURE

DISEASE REVIEW

AVABAHUKA

HISTORICAL REVIEW

History is a part of description of any object. In this way before going in detail

about the Avabahuka, an attempt has been made to trace the reference regarding

Avabahuka in particular and Vatavyadhi in general available till now beginning right

from Vedic period. For the total coverage of historical aspect, it has been divided into

four sections viz.

• Vedic Period and Pauranika period

• Samhita Period

• Sangraha Period

VEDIC PERIOD AND PAURANIKA PERIOD

The Vedas are considered as the oldest recorded knowledge in our culture.

Avabahuka is not mentioned in any form of Vedas. However, in the Atharvaveda, the

word ‘Vatikrita’ is mentioned. Here, ‘Vatikrita’ word denotes Vata Vyadhi. In same

Pippali (Ath. 6/109/3) and Visanika (Ath. 6/44/3) have been claimed as ‘Vatikritasya’

Bhesaja and Vatikritanashini respectively.

Many Vatika disorders pertaining to voluntary movement of limbs are told in

Vedic Literature under the terms Viskanda, though clear description of Avabahuka is

not found. Though the term Vishkanda mainly used in Atharva Veda (Atha-2/4; 3/9)

and Taitireeya Samhita (TS-7/3; 2/1). Viskanda was mentioned along with Visra



which means crushing the limbs and Abhisochana (burning sensation) (Atha-2/4/2).

Vyamsa was mentioned in Rig Veda which indicates the disorders which hamper the

movement or Gati.

In Yajur Veda , Thaittireeya Yajur Brahmana,second Ashtaka,6th chapter,4rth

Anuvaka,Vata and Vata Vyadhi is told.

On the basis of above Vedic descriptions it appears that many types of Vata

disorders were prevalent during Vedic period which impair the movement of the

limbs resulted due to description of muscles and joints leading to disability and appear

to be considered under the name Vishkanda and Vyamsa.

More attention was paid on Vata in Upanishads normal functions, etiological

factors of its disorders, its alleviations etc., have been described in Upanishads in

detail. Upanishads are the books which treat of spiritual matters apart from

ceremonials or belongs to the Jnaana-Kaanda. Their dates cannot be fixed with

certainty, only it is certain that they are older than the Buddhist movement. Puraanas

are the next literatures which deals more on Bhakti though it deals history and

cosmology, dates unknown. There are elaborate description of the functions and types

of Vata, its locations, qualities etc.

Kenopanishads have given the meaning of Vayu as one, which is always in

motion and continued efforts (Keno.3/10)

Ishopanishad (Ishavaasyopanishad) also described it in a similar fashion.

Chandogyopanishad has highlighted the Cala property of Vayu and described its

association with body and movements. (Cando.4/16/1 & 4/3/1).



Bhrahmasutra has given importance of Vyana Vata as the one that resides in

the joints and it is responsible for the movements of the joint. The circulation is

considered as the function of Samaana. (B.S.1/5/3). In Garuda Puraana, Ayurveda

related subjects are described in details. In this treatise a separate chapter available as

Vaatavyaadhi Nidana.�

Paanini has mentioned Vata Kopa as well as Vaaa Shamana. He has given the

term Vatiki for disorders of Vata.

SAMHITA PERIOD

Detailed description regarding Avabahuka is available in different Samhitas.

• Charaka Samhita (200 –300 B.C.): Charaka Samhita is one among the

Brihatrayees and has not mentioned directly about Avabahuka. But Charaka

explains regarding Bahushosha1 a condition resembling Avabahuka.

• Sushruta Samhita (600 BC to 400 BC): has discussed the Samprapti Lakshanas

of Avabahuka in Nidana Sthana 1st Chapter and Chikitsa in 4

th Chapter of Chikitsa

Sthana.2

• Astanga Hridaya (5th

Century): explains about Avabahuka in Nidana Sthana 15th

Chapter and its Chikitsa is discussed in 21st chapter of Chikitsa Sthana.

3

• Astanga Sangraha (5

th Century): explains about Avabahuka, its Samprapti in

Nidana Sthana 15th

Chapter and its Chikilsa in Chikilsa Sthana.4

• Transitional Period: Many commentators of this period like Dalhana, Arundatta,

and Hemadri etc. have tried to Analyse Avabahuka.

SANGRAHA KALA :

Sangraha Kala - (100 A.D.-800AD): Different texts of Sangraha Kala contain


The Effect of Nasya with Karpasasthyadi Taila & Nagara Taila in The Management of Avabahuka

description regarding the disease Avabahuka.

• Madhava Nidan (7th

Century A.D.): In Madhava Nidan in Acharaya

Madhavakara has explained the Lakshana of Avabahuka. Madhavakara is the first

to differentiate Avabahuka from Bahu Shosha.5

• Chakradatta (12th

Century): In Chakradatta Acharya Chakrapanidatta

explained the treatment of Avabahuka.6

• Sharangdhara Samhita (13th

Century): In Sharangadhara Samhita Acharaya

Sharagadhara explained Avabahuka under one of the Nanatmaja Vata vyadhi.7

• Gada Nigraha (12th

Century): In Gad Nigraha Acharya Shodhya mentioned the

Lakshanas and Chikitsa elaborately.8

• Vangasena Samhita (12th

Century): In Vangasena Samhita, Lakshanas and

Chikitsa is mentioned.9

• Yogratnakara (17th

Century): In Yogratnakara Lakshanas and Chikitsa of

AVabahuka is been mentioned.10

• Bhaishajya Ratnavali (18th

Century): Treatment of Avabahuka is mentioned in

Vata Vyadhi Chikitsa Adhikar.11

• Sahasrayogam: It is complied by unknown author or authors containing

description of numerous preparations particularly used traditionally in Kerala.

While explaining the efficacy of Yogas he included Avabahuka. 12

��

NIRUKTI AND PARIBHASHA

Before proceeding to Avabahuka 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 vyadhi”

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

The word Avabahuka is formed by two components of words namely, Ava

and Bahuka.

Ava means:

• As per Sanskrit English dictionary edited by Vamana Shivaram Apte, Denotes

the meaning of Ava as away off or down.

• Ava as prefix to verbs and verbal nouns off, away down.13

Apa is used as alternate for ‘Ava’ in some like Astanga Sangraha and

Sharangdhar Samhita etc., which gives following meaning.

• Viyoga, Vikratau:14

Viyogou means Dysfunction.15

• Stiffness in the arm joint. 16

The usage of ‘Ava’ or ‘Apa’ change according to different regional

pronunciation. Thus in the present condition, the ‘Ava’ or ‘Apa’ can be taken as

Deterioration as Dysfunction.

Bahuka usually occurs at the end of a compound and is studied as follows:

a) Bahu – The shoulder.

b) Bahu – “Bahu Prabahu cha Koorparasyaurdhwadha bhagou iti” (Vishnupuran)

c) Bahu – Muscular Gender.

d) “Bahu (Pum) Badha Ku Dhashaha Bhuje Kakshyanguli Paryanthe avayave.

Bahu is structure from kaksha to anguli.”

Acharaya Sushruta has considered Bahu is a part between Amsa and Karpoora

Sandhi.


The Effect of Nasya with Karpasasthyadi Taila & Nagara Taila in The Management of Avabahuka ��

“Amsa Koorparantharam Prathyangamekam.”

Thus Avabahuka can be defined as Bahu Stambha Avabahuka.

Under Avabahuka Monires writes the meaning as spasm in the arm and refers

to Sushrutha Samhita with due respects to the Scholar, it may be said that “Spasm in

the arm” is not to be taken literally but to mean it something like “stiffness in the

arm” in the words.

To summarize the above discussion and considering the relevant clinical

features, the term Avabahuka and Avabahuka would mean dysfunction of the arm,

stiffness in the arm joint, disability of shoulder joint.

Paryayas: As such there are no Paryaya of Avabahuka mentioned in classics but

different words like Avabahuka and Apabahuka are used in different context. These

words may be considered as Paryaya of Avabahuka.

Paribhasha of Avabahuka: 17

Avabahuka is a disease characterized by aggravated Vata at Amsa Pradesa

,after constriction of Sira (Akuncana) causes the restricted movement(Bahupraspanda

Hara).

AMSA SANDHI RACHANA SHAREERA VIVEVACHANA:

��This is a major joint of upper limb. This is one type of Chala18

and Ulookhala

Sandhi.19

This is formed by the combination of Pragandasthi, Akshakasthi and

Amsaphalakasthi.

Pratanavat types of snayus cover this Sandhi20



Shleshmadhara Kala is presents in this joint and secretes Shleshaka kapha.21

This acts as lubricant and helps in protection and movement of the Sandhi.22,23

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

follows.

Acharaya Sushruta has described that the Rachana of Sandhi as like a wheel

having an axis. When the axis is lubricated by putting oil on it, the wheel can move

freely and friction does not occur. In the same way the bones or joints can move

freely in the presence of Shleshama.24

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) 25

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.26

But it is a Snayu Marma.27

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

or deformity of the shoulder joint.28

NIDANA PANCHAKA OF AVABAHUKA

To understand the entire process of manifestation of disease, Acharyas have

explained the five means through which one can diagnose a disease correctly. These

five individually or collectively helps to diagnose the diseases. These five means are

called as Nidana Panchak.



Nidana of Avabahuka:

The knowledge of Nidana is important for the proper understanding of the

disease, for deciding the line of treatment to be adopted. It is also helpful in deciding

the Sadyaasadyata of the disease.29

One of the Nidana that has been mentioned for the causation of the Vatavyadhi is

Marmabhighata. Charaka and Sushrutha have identified 107 Marma in the body,

where Sushrutha has elaborated all the types. While going through the Lakshana

mentioned for the Marmabhighata, it is said that the Amsa Marmabhighata, where the

Bahu lose its function and becomes stiff which mimics the Rupa of the disease

Avabahuka. Hence it can be considered as one of the specific Nidana for this illness.

The following are considered as the Vishista Nidana as these are directly or

indirectly cause detrimental effect on Amsapradesha.

Abhighata: Any direct or indirect trauma that causes injury to the Amsapradesha or

Amsamarma will change the structural integrity and can cause Kriyahani of Bahu.

Vyayama: Those exercises which directly or indirectly influence the shoulder joint

are to be considered here.Vyayama in excess or violent exercises related with Bahu

provocates Vata, producing Shoshana and Sankocha of the Sira and ultimately causes

dysfunction of the joint.

Plavana: This if done in excess will be a cause of over exertion to the Sandhi causing

Vataprakopa and then manifesting the disease Avabahuka.

Bharavahana: Carrying heavy loads over shoulder will cause deformity in the joint

capsule which further leads to disease.



Balatwat Vigraha: Wrestling with a person who is stronger will cause Aghata to

Amsapradesha and Vataprakopa can takes place.

Dhukka Shayya: An improper posture that gives more pressure over the Amsasandhi

will disturb the muscular integrity and can vitiate Vata. This leads to the disease.

Even though a specific Nidana have not been mentioned for Avabahuka,

however the general factors told for Vata prakopa have to be analyzed and elicited.�

According to Madhukosha Nidana may be classified into two groups;

1) Bahya Nidana – Bahya Nidana includes Ahara,Achara,kala etc, which include

the Manasika Bavas also.

2) Abhyantara Nidana – Doshas and Dushyas (Dhathus, Mala, Upadhathu,

Srotas) coming under Abhyanthara Nidana. Indulging in Vata Prakopaka

Nidanas leading to vitiation of Vata in that region.30�

In regard to Nidanas Vatavyadhi only Acharya Charaka 31

and Bhavprakasha

have explained in detail. While in Sushruta Samhita, 32, 33

Astanga Sangraha34

and

Astanga Hridaya35

etc, generally have been mentioned.

Nidanas of Vata Vyadhi and Vata Prakopa vis a vis Avabahuka

Aharaja: The Nidana in the form of Aharaja or faulty diet is included under this

group and this can be divided into 8 subgroups as follows:

i. Dravyataha: All the food articles responsible for Vata Prakopa have been

included under this group.



ii. Gunataha: The quality of food articles like Ruksha, Shita etc. that lead to the

Prakopa of Vata have been included under this group.

iii. Rasataha: Excessive use of certain Rasa which leads to the prakopa of Vata has

been included in this group.

iv. Karmataha: Vata Prakopa can occur due to excessive use of Vishthambhi food

article and those are included under this heading.

v. Viryataha: Shita Virya Yukta Ahara may cause the Prakopa of Vata.

vi. Matrataha: Taking food in Alpamatra, Atimatra etc. comes under this heading.

vii. Kalataha: The Vata Prakopa occurs at the end of Ahara Jeerna Kala and in

Varsha Ritu which is included here.

viii. Mithyopayogatah: Violating the rules of Ahara Sevana can lead to Vata Prakopa.

B) Viharaja: The Nidana in the form of Vihara or factors related to the habit and

behavior of the patient is considered here.

Any of the following two can cause Vataprakopa and leads to disease.

(1) Mithyaprayogataha: The faulty habits or the improper use of Sharira that may lead

to the Prakopa of Vayu is included under this heading.

(2) Atiyogataha: The excessive use of the Karmendriya can cause vata prakopa.

C) Agantuja: Vata prakopa which occurs due to external factors like trauma, etc. is

included under this heading.



D) Manasika: The Manasika Nidana like Chinta, Bhaya, Shoka etc. are also

responsible for Vata Prakopa.

E) Anya Heuja: All the other Nidanas except above are included under this heading.

Table no.1 Showing Nidanas of Vata Vyadhi and Vata Prakopa vis a vis Avabauka

Nidana C.S.37,38,39

Su.S40,41

A.H42,43

A.S.44

M.N45

Aharaja

Rasa

Katu

Tikta

Kashaya

+

+

+

+

+

+

+

+

+

+

+

+

Gunas Ruksha

Laghu

Sheet

Vishad

Khara

Vaistambya

Darunak

+

+

+

+

+

-

+

+

+

+

+

-

+

-

+

+

+

-

+

-

-

+

+

-

+

+

-

-

+

+

+

-

-

-

-

Veerya Sheeta + - - - -

Dravya Adhaki

Chanaka

Kalaya

Masura

Mudga

Nispava

Shushkashaka

Tinduka

-

-

-

-

-

-

-

-

+

-

+

+

+

+

+

-

+

-

+

+

+

+

-

-

+

+

-

+

+

+

-

+

-

-

-

-

-

-

-

-

Matra Heen Abhojana

Alpabhojana

Vishamashan

+

-

-

+

+

+

-

+

-

-

-

+

+

-

-

Viharaj Ati Maithuna

Ati Jagaran

Ati Plavan

Ati vyayam

Ati Vichestam

Bhaya

+

+

+

+

+

+

-

-

+

+

-

-

-

-

-

+

-

+

-

-

-

+

-

+

+

+

+

+

-



Cinta

Krodha

Mada

Soka

Utkantha

+

+

-

+

-

-

-

-

-

-

-

-

+

-

+

+

-

-

+

+

Mityayoga Dukhshaya

Asanat

Vegadharan

Balvat Nigraha

Bhar Haron

+

+

-

-

-

+

+

+

-

+

-

+

-

+

+

+

-

-

-

-

Kalaj Aparatra - - + + -

Agantuj Abhighataj

Marmaghata

+

+

-

-

-

-

-

-

-

-

Bhavprakasha46

,Yogaratnakara etc is also having the same opinion regarding

Vatavyadhi.To summarize, the above said Nidanas mentioned under Vihara specially

involving Amasa Sandhi and Marmabhighata to Amsa leads to the development of

Avabahuka.

POORVA ROOPA OF AVABAHUKA

Poorva Roopa are indicators of impending diseases. They occur prior to

complete manifestation of disease to suggest the forthcoming illness. In parlance with

the Shadkriyakala this stage denotes the Sthanasamshraya Avastha.47

“Poorva roopameva Sthana samshraya lingam (Chakradatta)”

In this stage the provocated Doshas having extended to the other parts of the

body become localized and it marks the beginning of specific symptoms pertaining to

those structures.



In the present context Poorva Roopa of Avabahuka have not been mentioned

anywhere in the text. So for that reason we have to take Poorva Roopa of the Vata

Vyadhi which are told as

“Avyaktam lakshanam tesham Poorvaroopamiti Smrutham”.48

In case of Vata Vyadhi the face of Poorva Roopa will be in latent form. So the

patient will not appreciate them.

Chakrapanidatta commenting on the word “Avyakta” mentions that few mild

symptoms are to be taken as Poorva roopa.49

But Vijayrakshita the commentator of Madhava Nidana has given the clear

meaning of the term Avyakta.50

ie unclear symptoms.

It is clear from the above reference that Avyakta is Alpa Vyakta or less

manifested. So in Avabahuka also Poorva Roopa can be taken as minor symptom like

Alpa Shoola and Sthabdhatha produced before the actual manifestation of disease.

ROOPA:

Next to the Poorvaroopa in pathological conditions will be Roopa. Roopa

appears in the Vyakta Avastha. This is the unique stage of the illness, where in, it is

clearly recognizable as all its characteristics signs and symptoms manifest.51

Based on

these Lakshanas a particular disease can be diagnosed.

The features of Avabahuka are as follows.

• Bahupraspandanahara52

(Stabdatha)

• Shoola553.54

Thus practically speaking Stabdata ( Sthambha= Graha) and Shoola are the

Pradhan Lakshana that occurs in Avabahuka. The intensity and nature of the pain is

recommended only on the basis of patient’s description. Apart from these

Lakshanas, Sparshaasahatva is also one of the features observed.



UPASHAYA AND ANUPASHAYA

Upashaya are the medicines, diets and regimens which are similar to the

causative factors of disease or are dissimilar/opposite to the causative factors of

disease which gives relief to the patient55

.

Upashaya for Avabahuka has not been mentioned in the text. But we have seen

some factors which aggravate the disease and some factors which give relief to the

patient. For example, Physical excretion , lifting heavy weights, exercises

etc.Increases pain in patient. These are Anupashaya.

Taking rest , application of oil , not indulging in physical excertions, there is

relief in pain in patient . These are Upashaya.

In the same way, in Shaithya (cold climate), and in rainy season patient feels

discomfort. These are Anupashaya.

On the other hand, in summer season, Ushnata or exposing to hot gives a feeling of

relief in patient, called as Upashaya in Apvabahuka.

SAMPRAPTI:

The manner of Doshic vitiation and the course they follow, culminating in the

development of specific clinical manifestation is known by the name Samprapti. In

other words, it briefly reflects the state of affairs brought about by the factors vitiated

by different source of etiological factors and afflicting different parts of the body,

resulting in either structural on functional changes in the part, finally developing a

series of signs and symptoms.

The knowledge of Samprapti helps in the comprehension of the features of a

disease like Dosha, Dushya, Sroto Dusti etc. A proper understanding of Samprapti is

Vital in planning of the treatment of any disease, since Chikitsa enunciated in

Ayurvedic text is nothing but Samprapti Vighatana.



This chapter discusses about Samprapti of Avabahuka. In the classics, the

Samprpati of Avabahuka is told as follows.

1 ) Samanya Samprapti

It is due to the Snayugata Vata.In this condition the Vyana Vata vitiates the

Snayu and produce Sthabdhatha in the Amsa Predesha and produce Avabahuka.56

2)Vishesha Samprapthi

The Morbid Vata, which gets lodged in Amsa Moola, will cause the

Sirasankochana (constriction of the Sira) locally and produces Bahupraspandanahara

(restricted movement), manifesting Avabahuka.

3)Avaranajenya (Kaphaavrtha vyana)

In this condition Vyanavata combines with Sleshakakapha and leads to

Gatisanga (restricted movement) and produces Avabahuka57

.

The Samprapti Ghatakas of Avabahuka can be taken as:

Dosha - Vata Vyana Vata

Dushya - Sira, Snayu.

Rogamarga - Madhyam

Udbavasthan - Pakwashaya

Vyaktasthan - Bahu (Amsa)

Adhisthana - Amsa Pradesh

�



Illustration No. 1 Showing the Schematic Representation of Samprapti of

Avabahuka

Nidana

(Bharavahana ,Vyayama etc)

�

�

�

�

SADHYA ASADHAYATH

Acharya Charaka, in Chikitsa Sthana, has explained that if Vata vyadhi more

than 1 year or chronic is difficult to cure or considered as incurable for treatment

(Asadhya)

He further explains that, Vata vyadhi should be treated if they are in strong

patient, newly originated or less than 1 year and also free from complications

(upadrava). They are Sadhya for treatment 58

.

According to Acharya Charaka, if Vatavyadhi is connected with Sandhichuti,

Kunjanam, Kubjata, Ardita, Pakshaghata, Angasamshosha, Pangutva and those which

are Majja and Asthigata are usually cured with difficulty or even incurable for

treatment.

Provocation of

Vyana Vata

��Vyaktasthana

(Amsa pradaesha Sira,Snayu)�

Avabahuka

Sthana Samsharya,Vyaktha

Sanchaya, Prakopa,Prasara



UPADRAVA:

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

as Upadrava59

. Acharya Sushruta says that if the patient of Vatavyadhi develops the

complications like Sunam (edema/inflammation), Suptatvacha (tactile senselessness),

Bhagna (Fracture), Kampa (tremors), Adhamana (distention of abdomen with

tenderness) and pain in internal organs, then he doesn’t survive 60

.

SAPKESHA NIDANA:

Sapeksha Nidana is the comparison of similar features, which are found in

many diseases. Once the Samprapti of a disease has been established, that diseased

condition should be differentiated from taking consideration of similar other

disorders. Vyavachedaka Nidana or differential diagnosis is the determination and

establishment of a diseased condition taking consideration of the various disorders.

The disorders are differentiated from one another on certain cardinal features.

Avabahuka should be differentiated with the following diseased conditions that affect

the upper limb.

1. Amsashosha61

2. Amavata62

3. Vata Raktha63

Table No.2 Showing Sapeksha / Vyavachedaka, Nidana of Avabahuka

Nidana

Panchaka

Avabahuka Amsashosha Amavata Vatarakta

Nidana Vatavridhikara

ahara-vihara

Vatavridhikara

ahara-vihara

Viruddha ahara,

Cheshta,

Mandagni,

Amla Lavana,

Madhura,Teeks

hna, Ushna,

Snigdha,

Viruddha,

Raktha



Prakopakara

Ahara, Vihara

Purvarupa Avyakta Lakshna Avyakta Lakshna Swedaatyartha

Karshnya,

Sparshgnatva,

Kshateatiruk,

Sandhi

Shitilyata

Gurutva

Vaivarnya,

Peedakodhbava

Rupa Bahuspraspandhar

a

vadana

Bahuspraspandhara

Shosha, Vadana

Rujam,

Shotham,Daurb

alya, Agni

mandhya,

Prasaka,

Aruchi,

Gauravam,Daha

m Vrischika

damshavat

Peeda.etc

Toda, Beda,

Shosha,Kandu,

Daha,

Spurana,Paka,

Teevra ruk,

Grathita-paki

Shvayathu

Spreads like

mooshikavisha

Starting from

Smaller joints

Samprapthi

1.Adhistana

Amsasandhi Amsasandhi Hasta,Pada,

Janu Gulpha,

Trika, etc

Padhamoola,

Hasthamoola

2.Agni Dusti Samagni Samagni Mandagni Samagni

3.Rogamarg

a

Madyama Madyama Trividha roga

marga

Bahya,

Madyama

4.Dushya Sandhi, Snayu Sandhi, Snayu All Datus exept

shukra

All Datus exept

shukra

5.Dosha Vata Kapha Vata Vata, Kapha Vata, Rakta

Upashaya Ushna-Snigdha Ushna-Snigdha Ushna-rooksha Sheeta



In Vata Raktha specific feature like Ahara, Vihara etc are indicated as Nidana

but specific Nidana is not told for Avabahuka. With this we can differentiate

Avabahuka from Vata Raktha. Guru Ahara, Agnimandhya are major Nidana for

Amavata, these are not told in Avabahuka Nidana. Agnimandya in Amavata is a

major Nidana which differentiate Amavata and Avabahuka.

In Vata Raktha specific features are mentioned under the headings of

Purvarupa, whith these we can differentiate it from Avabahuka as there is no

Purvarupa told in Avabahuka, Amavata, Amsashosha.

Bahuspraspandhara and Shosha, are the Lakshanas seen in Amsashosha. In

Avabahuka Shosha is not seen. In Amavata and Vata Raktha many features can be

seen as Rupa with which we can differentiate them from Avabahuka.

In Samprapthi of AmaVata and Vataraktha the Dushyas involved are all

Dathus exept Shukra. In Avabahuka Sandhi and Snayu Affected. In Amsashosha

Sandhi and Mamsa are affected. In the Roga Marga of AmaVata, Trividha Rogamarga

can be seen. In Vataraktha, Bahya and Madhyama Rogamarga is affected. In

Avabahuka and Amsashosha the Rogamarga is Madyama. In the Samprapti Of

Amavata Mandagni Plays a major role. Apart from these the Adisthana of the Roga

that is Amsa Sandhi is clearly mentioned in Avabahuka. With these we can

Differentiate Avabahuka from other diseases.

The Upashaya in Vataraktha is Sheeta. In Amavata it is Usna Rooksha in Ama

condition and Sneha and Usna in Nirama condition. In Avabahuka the Upasaya is

Usna, Snigdha which differentiates it from Vata Raktha and AmaVata



CHIKITSA:

After the Diagnosis of a Disease, the Next will be its Management. In the

Present chapter, the management of Avabahuka is discussed.

The general line of treatment mentioned for Vata Vyadhi in Ayurvedic

classics include Snehana (Both external and internal), Swedena, Mrdusamshodhana,

Basti, Sirobasti etc.64

. Ayurvedic classics explain the chikitsa of Avabahuka as follows:

1. Nasya Karma has been mentioned by Vagbhata in Jatroordhava Vata Vikaras65

2. Astanga hrudhaya explains Nasya and Uttara Bhaktika Snehapana are useful

in the management of Avabahuka66

.

3. Sushruta Acharaya advice to follow Vata Vyadhi Chikitsa for Avabahuka

except Siravedh67

.

4. Astanga Sangraha explains Nasya for Avabahuka. It also explains

Uttarbhaktika Snehapana68

.

5. Vangasena advices Nasya Uttarabhaktika Snehapana and Sweda for the

treatment of Avabahuka 69

By considering the above references, this can be concluded as line of

treatment of Avabahuka.

• Abhyanga

• Swedana

• Uttarabhaktika Snehapana

• Nasya Karma

• Shamanaoushadi

• Pathya Apathya



1) Abyanga: .

The Veerya of the drug used for Abhyanga gets digested with the help of

Sthanika Bhrajaka Pitta and enters into the Srotas and start its action. Taila used for

Abhyanga after entering into the body nourishes the body tissues, gives strength70

.

2) Swedana:

“Stambha Gourava SheetaGunam Swedanum Swedakarakam” 71

.

The process which reduces stiffness, heaviness, reduces the Shetatha and

produce sweating is called Swedana. It does the dilation of the vessels thus by

improving blood circulation. Hence it is very much beneficial in conditions where

Shoola, Stambha and Sankocha are present.

In the context of Vatavyadhi Swedana Karma like Pinda Sweda, Nadi Sweda,

Avagaha Sweda are mentioned which alleviate Vata Dosha. It also helps in relieving

Stambha (stiffness), Gourava (Heaviness) and Sheeta (cold).

3) Uttarbhaktika Snehpana:

In classics Abhyantara Snehapana is divided into 2 types.

1) Shamana

2) Shodhana

Shamana and Shodana are used in case, when we need palliation and allivation

of the morbid Doshas from the body respectively. Brumhana Snehapana comes under

the Shamana Snehapana.

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

present context of Avabahuka the vitiated vata due to its Rookshadi qualities does the

Shoshana of Shleshaka Kapha that is present in the amsa Sandhi. To subside this

Rooksha quality and to normalize the Shleshaka kapha qualities, Brumhana



Snehapana is advisable, Bruhmana type of Snehapana is advised prior, middle and

after the intake of food, as explained by Hemadri72

Uttarbhaktika Snehapana i.e. Snehapana done after the intake of food is useful

in the disorders of Udana vata73

.

Uttarabhaktika Snehapana indicated in Avabahuka fulfills the need of

treatment required in case of Udana Vata disorder and also act as Brumhana. Here

Alpa Matra Snehapana should be used. Sneha used here should be Taila, because

Taila is best amongst Snehas in Vata Vyadhi74

.

4) Nasya Karma

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

nose is known as Nasya Karma75

. Navan, Nastakarma are the words used for Nasya

Karma. It gives strength to neck shoulders chest and increase vision76

, thus Nasya is

useful in Avabahuka.

5) Shamanoushadi: Vata Vyadhis are very difficult to manage, in case of Shoola

Pradhan and Stambha Pradhana Vikaras. In such conditions along with Sthanika

procedures internal administration of Shamanaoushadi are essential.

6) Pathya – Apathya: ��

�� Pathya are the Ahara and Vihara that is congenial to the health both

in healthy and diseased where as the Ahara and Vihara that is quite opposite to the

above are named as Apathya.Specific Pathya and Apathya in regards to

Avabahuka is not mentioned in classics, so Pathya and Apathya told for the

Vatavyadhi in general are considered as Pathya and Apathya of Avabahuka.



Table No.3 Pathyaapathyas in Vatavyadhi77,78

Factors Pathyas Apathyas

Sneha Sarpi, Vasa, Taila, Majja, -

Shaka and Phala Vargas

Kulatha, Masha, Godhuma,

Raktashali,Patola,Vartaka,

Dadima,Parushaka,Badara,

Lashuna and Draksha.

Chanaka, Kalaya, Shyamaka,

Kuravinda, Mudga,

Rajamasha, Guda, Jambuka,

Kramuka, Mrinala, Nishpava,

Taalaphala, Shimbi, Shaka,

Mamsa varga

Chataka, Kukkuta, Tittira,

Shilindhra, Nakra, Gargars,

Khudisha, Bileshaya

All Jangala Mamsa Varga.

Rasa Pradhana Madhura, Amla, Lavana Kashaya, Katu, Tikta

Manasika Sukha Chinta, Prajagara

Vihara

Snehana, Swedana, Snehapana,

Snana, Abhyanga, Rechana,

Mardana, Basti,Avagahana,

Samvahana, Agni Karma,

Upanaha, Tailadroni,

Shirobasti, Nasya, Santarpana

Vyavaya, Ativyayama, Basti,

Ashva Yana, Chankramana,

Vegadharana, Chardhi,

Shrama,

�



MODERN REWIEW

Figure 1.Anatomy of the Shoulder Joint: 79,80

This is a synovial joint of ball and socket variety.

Articular Surface: The joint is formed by articulation of scapula and head of the

humerus. Therefore, it is also known as Gleno Humeral articulation.

Structurally it is a weak joint; because Glenoid cavity is too small and shallow to hold

the head of the humorous in the place (the head is four times larger than the size of the

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 humorous.

2) The musculotendinous cuff of the shoulder

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

provided by the muscle attaching the humorous to the pectoral girdle, the long

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

�



Ligaments of the Joint:

The capsular ligament: It is very loose and permits free movements. It is least

supported inferiorly where dislocation may damage the closely related axillary nerve.

The Coracohurmeral Ligament: It extends from the root of the coracoid process to

the neck of the humerus opposite to 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 brachi, passes deep to the ligament.

The Glenoidal Labrum: It is a fibro cartilaginous rim, which covers the margins of

the glenoid cavity, thus increasing the depth of the cavity.

Figure 2.Bursae Related to the Shoulder Joint:

1) The sub acromial (sub deltoid) bursa.

2) The Sub Scapularis bursa, communicates with the joint cavity.

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

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

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



Relations:

� Superiorly: Coracoarcomial arch, sub acromial bursa, supraspinatus and deltoid.

� Inferiorly: Long head of the triceps.

� Anteriorly: Sub Scapularis, corcao brachialis, short head of biceps and deltoid.

� Posteriorly: Infraspinatus, teres minor and deltoid within the joint tendon of the

long head of biceps brachii.

Blood Supply:

� Anterior circumflex humeral artery

� Posterior circumflex humeral artery

� Subscapular artery

� Suprascapular 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 large size of the head of

the humorous as compared with the shallow glenoid cavity. The range of movements

is further increased by concurrent movements of the shoulder girdle.

Movements of shoulder joint are analyzed as follows.

�



1. Flexion and Extension: During flexion the arm moves forwards and medially and

during extension the arm moves backwards and laterally. The flexion and

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

2. Abduction and Adduction: This takes place at right angles to the plane of flexion

and extension (i.e.-approximately midway between the saggital and coronal

plane). In Abduction, the arm moves antero-laterally away from the trunk. This

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

3. Medial and lateral Rotation are best demonstrated with mid-flexed elbow. In this

position the hand is moved laterally in lateral rotation of the shoulder joint. And

hand moved medially is medial rotation.

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

hand moves along the circle.

5. Elevation: Elevation is an upward movement of a part of the body. Here arm is

taken upwards.

The Range of any movement depends on the availability of an area of free

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

on the head of the humorous is four times larger than that of the Glenoid cavity.

Table No.4 Muscles acting on Shoulder Girdle.

Muscles Origin Insertion Action on Shoulder

Pectoralis major Clavicle medial

2/3, sternum and

costal cartilages 1-

6.

Humorous, crest of

greater tubercle

Flexion and medial

rotation. Adduction

and medial rotation.

Lattisimus dorsi Lower ribs, iliac

crest.

Humorous inter

tubercular groove.

Adduction, medial

rotation, extension if

flexed.



Deltoid Clavicle lat.1/3,

acromion spine of

scapula.

Deltoid tuberosity of

humerous.

Abduction, extension,

and lat. Rotation.

Biceps brachii

Short head

Long head

Coracoid process

Supraglenoid

tubercle

Radius

Radius

Flexion

Stabilization

Coracobrachialis Coracoid process Humerous middle

body

Flexion

Teres major Inf. 1/3 margin of

scapula

Crest of lesser

tubercle humerous

Adduction, medial

rotation.

Teres minor

Scapula, superior

2/3 lat. Margin

Humerous greater

tubercle post.

Surface

Lateral rotation,

stabilization

Supraspinatus

Scapula, supra

spinous fossa

Humerous greater

tubercle sup. Surface

Abduction,

stabilization

Infraspinatus

Scapula, infra

spinous fossa

Humerous greater

tubercle post.surface

Lat.rotation,

stabilization

Subscapularis Scapula,

subscapularis fossa

Humerous lesser

tubercle.

Med.rotation,

stabilization

Analysis of abduction at the shoulder occurs through 90 degrees. The

movement takes place partly at the shoulder joint and partly at the shoulder girdle

(forward rotation of scapula round the chest wall). The humorous and scapula move

in the ratio 2:1 throughout abduction, for every 15 degree of elevation, 10 degrees

occur at the shoulder joint and 5 degrees are due to movement of the scapula is

facilitated by movements at the sterno-clavicular and acromio-clavicular joint.

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

only up to 90 degrees. At the limit of this movement there is lateral rotation of the

humorous and the head of the bone comes to lie deep to the coraco-acroial arch.



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

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

MODERN REVIEW OF DISEASE:

In modern science, Avabahuka can be compared with

Periarthritis or Adhesive Capsulitis or Frozen shoulder81,82

:

Frozen shoulder is a condition that causes restricted range of active and

passive glenohumeral motion in the shoulder joint. The cause of the frozen shoulder is

not well understood, but it often occurs for no known reason. Frozen shoulder causes

the capsule surrounding the shoulder joint to contract and form scar tissue called

adhesions. The contraction of the capsule and the formation of the adhesions cause the

frozen shoulder to become stiff and cause movements, more painful. There is also

lack of synovial fluid, which normally lubricates the gab between arm bone and

socket to help shoulder joint move.

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

symptom leading to inability of affected upper limb.

� Painful / Freezing stage

� Frozen stage

� Thawing stage

a) Painful / Freezing Stage: This is the most painful stage of the frozen shoulder

motion is restricted, but the shoulder is not as stiff as the frozen stage. This

painful stage typically lasts 6-12 weeks.

b) Frozen Stage: During frozen stage, the pain usually eases up, but the stiffness

worsens. The frozen stage can last for 4-6 months.

�



c) Thawing Stage: The Thawing stage is gradual and motion steadily improves

over a lengthy period of time. The thawing stage can last more than a year.

The patient gives the history of having noticed a catch in the region of the

shoulder joint and upper arm with dull aging pain since 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.

Figure 3.Exercises for frozen shoulder.

PROCEDURE REVIEW

NASYA KARMA

Nasa is considered to be that Indriya, whose functions are not only limited to

respiration but is also considered as a pathway for drug administration. In Ayurveda,

special procedure called Nasya has been mentioned.



HISTORICAL REVIEW

VEDA K�LA: (PRE-SAMHITA PERIOD, 10,000 B.C. TO 500 B.C.)

In Puranas Nastam Kurut sentence meaning treat Nasagata roga is available,

the same sentence is not available in the Samhita Granthas but the very nearest

term Nasyakarma with the similar meaning treating the diseases of Nose is available.

Reference from Buddhist and Jaina traditions says that Jeevaka

administered Nasya karma. Buddha with a purgative drug sprinkled on lotus which

exerted its effect on smelling and 30 Vegas were observed.83

In Buddha period

procedure like Dantadhavana, Paadaprakshalana, Nasyakarma, Abhyanga, Vyayama,

Snana are mentioned. In Koushika sutra of Vedic times application of Jalauka and

administration of Nasyakarma is mentioned84

.

The reference regarding usage of Panchakarma is available in Jaina

period indicating the usage of Nasya karma.

In the same context while mentioning the different Chikitsa sutras, it is said

that Ghrita for Paana and Nasya Karma should be done to treat Dhanurvata, Anga

Kampa, Shareera Bhaga, etc. Vata Rogas85

In Ramayana86

, Lakshmana was given Nasyakarma by Vaidya Sushena

using Sanjeevini brought by Hanuman from Himalaya after which he regained

consciousness.

Reference about Pumsavana Karma where in medicated drops were instilled

into right nostril of a pregnant woman is explained widely by Charaka87

,

Sushruta88

and Vagbhata89

.



These are some of the scattered references available in different periods

indicating the usage of Nasyakarma for different purposes.

SAMHITA PERIOD

Charaka Samhita: (200 –300 B.C):

In Samhitas Nasyakarma has been described in detail. Charaka in Sutrasthana

first chapter has given the synonyms of Nasyakarma, in Siddhisthana has

classified Nasyakarma depending on the medicines used and on the pharamacological

action and also has stated indications and contraindications for Nasyakarma.90

He has

explained the procedure along with complications and Samyak and Asamyak

Yoga features. In Vimanasthana he mentions different types of Nasyakarma

depending on the parts of a plant used.91

Sushruta Samhita: (600 BC to 400 BC):

Sushruta has defined Nasyakarma as instillation of medicine through

Nose in Chikitsasthana. He has given the classification of Nasyakarma, even

the timing of administration based on rutu and doshas. He has also given the

indications and contraindications, procedure, Samyak, Heena and Atiyoga features,

complications and the things to be followed after Nasyakarma is being stated by

him.92

Astanga Hridaya: (5th

century):

Vagbhata mentioned Nasya Karma elaborately in Sutra Sthana93

and advised

in various diseases like Jwara, Raktapitta, Swasa, Hikka and Vata Vyadhi Chikitsa

etc.



Astanga Sangraha (5

th century)

Sangrahakara has also given extensive explanations regarding Nasyakarma,

the drugs to be used, indications and contraindications, procedure of Nasyakarma. He

has explained the Nasyakarma karmukata by using the terms shrungataka marma and

nasa as Shirodwara.Thus, Nasyakarma is being explained by all authors by

giving special importance to it.94

Sharangdhara Samhita (13th

century):

In Sharangadhara Samhita Acharaya Sharagadhara explained Nasya Vidhi in

Uttara Khanda.95

Adunika period

Recent text like Vangasena Samhitha, Yogaratnakara, Sahasrayaogam etc

mentioned the Nasya treatment in different diseases.

Etymology of Nasya Karma

In Sanskrit language each word is derived from a specific Dhatu and each

Dhatu bears an inherent meaning which is the crux of the word. The derivation of the

word Nasya is from “Nasa” Dhatu. It conveys the sense of Gati – motion. Vyapti

bears the meaning pervasion. Here, the Nasa Dhatu is inferred in sense of nose.

According to Vachaspatyam word “Nasata” means beneficial for nose.

Nasya is the term applied generally to medicines or medicated oil

administered through the nasal passage96

. Arunadatta states Nasayam Bhavam

Nasyam. According to Bhavaprakasha medicines administered through nose is termed

as Nasya97

.



Nasya karma is considered to be the most specific procedure for diseases of

the head or the diseases of Urdhwajatrugata region.Because, as stated by Vagbhata

the nasal passage is considered as the gateway of shirus (head) and the drugs

introduced through the nose spread throughout the head and its constituent

parts, accordingly influencing the dosha and the diseases situated in those parts.98

Shiras in brief:

In a living being, the head is the place where Prana of all sense faculties reside

and hence rightly called as Uttamanga99

.

Sushruta while enumerating Snayu has totally mentioned 900 out of which 70

are present in Greeva and Shiras100

. Among the types of Snayu, Prutula Snayu is

present in Shirus, Uras, Parshwa and Prusta101

. Out of 500 Peshis, 34 are present in

Shirus and Greeva102

.

Among the different Marmas present in Shirus, Shringataka Marma is

explained in direct relation to Nasya Karma. This Marma is the place of collection of

Siras of Shrotra, Netra, Kanta-adi. Ghrana or Nasa, being a Jnanedriya does Gandha

Grahana and is said to be the door of Shirus. Nasya instilled through Nose enters

Shrungataka Marma and gets distributed all over, through the siras103

.

Synonyms of Nasya :

• Navana

• Nastah karma

• Shirovirechana

• Shirovireka



• Murdha virechana , are the terms used synonymously.

Charaka has used the term Nastah Pracchardanam. Literally Pracchardanam is

a synonym of Vamana. Thus the term Nasya being used in relevance to terms

Virechana (Shirovirechana) and Vamana (Pracchardana) clearly appears to be a type

of Shodhana Karma administered through Nose. However, it comprises different

types and the purpose of all the procedures is one and the same.

Classification of Nasya karma

Nasya is classified in various ways by different Acharya. Each classification

has its own silent features and each is done with different angles. Classification

according to various Acharya is described in a tabular form as below

Table No 5 Showing Classification of Nasya according to Various Acharya

Sl No Name of

Acharya

Classification

1 Charaka According to mode of action -Rechana, Tarpana, Shamana

According to the methodof administration —

Navana, Avapeeda, Dhmapana, Dhooma, Pratimarsha

According to various parts of drugs utilized - Phala, Patra,

Moola, Kanda, Pushpa, Niryasa, and Twak Phala, Patra,

Moola, Kanda, Pushpa, Niryasa, Twak

2 Sushruta Shirovirechana, Pradhamana, Avapeeda, Nasya, Pratimarsha

3 Vagbhata Virechana, Brumhana, Shamana

4 Kashyapa Brumhana, Karshana

5 Sharangadhara Rechana, Snehana

6 Bhoja Prayogika, Snaihika

7 Videha Sanjya Prabodhaka, Stambhana,



Charaka’s classification of Nasya:

According to Charaka the Nasya is of five type’s viz. Navana,

Avapeeda, Dhmapana, Dhooma and Pratimarsha104

.

Navana is further divided in to Snehana and Shodhana, Avapeeda into

Shodhana and Stambhana, Dhooma into Prayogika, Vairechanika and Snaihika. While

Pratimarsha is divided into Snehana and Virechana.

The above-mentioned five types of Nasya are regrouped according to

their pharmacological action into three groups viz. — Rechana, Tarpana and

Shamana105

.

Charaka has also mentioned 7 types of Nasya according to parts of the drugs

to be used in Nasya karma viz. — Phala, Patra, Moola, Kanda, Pushpa, Niryasa, and

Twak106

.

Illustration No 2 Nasya according to Charaka

NASYA

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Illustration No.3 Nasya According to the action

NASYA

Illustration No.4 According to various parts of the drugs utilized in Nasya therapy

NASYA

Classification of Nasya according to Sushruta :

According to Sushruta, Nasya is of 5 types viz. Nasya, Avapeeda,

Pradhamana, Shirovirechana and Pratimarsha. These 5 types of Nasya are further

classified according to their functions into two groups viz. Shirovirechana and

Snehana107

.

Shirovirechana, Avapeeda and Pradhamana are used for Shirovirechana

purpose, i.e. for the elemination of morbid Dosha from Shirus while Pratimarsha and

Nasya may be used for Snehana.



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Illustration No.5 Classification of Nasya according to Sushruta

Vagbhata’s Classification of Nasya108

Ashtanga Sangraha has mainly classified Nasya according to its effect

viz. Virechana, Brumhana and Shamana. Snehana and Brumhana Nasya have been

further subdevided according to the doses into two groups i.e. Marsha and

Pratimarsha109

.

Avapeeda Nasya may be given for both Virechana and Shamana while

Pradhamana Nasya is given only for Shirovirechana.

Ashtanga Hrudaya has mainly classified Nasya in 3 types viz. Rechana,

Brumhana and Shamana.

Illustration No.6 Classification of Nasya according to Vagbhata



Kashyapa’s Classification of Nasya110

According to Kashyapa Samhita, Nasya has been classified into two groups

i.e. Brumhana and Karshana. These two types are also known as Shodhana and

Purana Nasya.

Illustration No.7 Classification of Nasya according to Kashyapa

Sharangadhara’s Classification of Nasya

Sharangadhara has also classified Nasya according to their functions into

twogroups viz. Rechana and Snehana. Rechana Nasya is further subdevied into

Avapeeda and Pradhamana while Snehana Nasya is subdevided into Marsha and

Pratimarsha111abc

.

Illustration No.8 Classification of Nasya according to Sharangadhara

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Videha’s Classification of Nasya

Videha has stated two types i.e. Samnja prabodhaka and Stamabhana

Illustration No.9 Classification of Nasya according to Videha

It is clear from the above discription that two types of classification of Nasya

Karma are available in Ayurvedic literature. One is based on the pharmacological

actions viz. Rechana, Tarpana etc. Other is based on the preparation of drug and the

method of its application e.g. Dhmapana (Powder is blowed) Avapeeda (Extracted

Juice is used) Dhooma (Smoking through nose).

Navana Nasya:

This is one of the important types of Nasya. It is further classified into

Snehana and Shodhana. Navana is instillation of the drops of medicated oil into the

Nose. Navana is generally a Sneha Nasya and is synonymously used for Nasyakarma

in general.

Avapeeda Nasya:

Avapeeda Nasya is the Nasya consisting of the Swarasa of a drug administered

through nasal passage. It is of two types-Stambhana Nasya and Shodhana Nasya

Dhmapana or Pradhamana Nasya:

��

�� %��



In Pradhamana Nasya, powder of drugs is blown or inhaled through nasal

passage. Its dose as mentioned by Videha as 3 munchuti (3 pinches).

Dhooma Nasya:

Dhooma Nasya is inhalation of medicated fumes through nasal route and

exhalation by oral route. It is of 3 types-

1. Prayogika

2. Snaihika

3. Vairechanika

Marsha-Pratimarsha Nasya:

Both consist of introduction of sneha through the nostrils. Marsha-Pratimarsha

is in the same principles but they have following distinctions-

Table No 6 Marsha-Pratimarsha Nasya

PRATIMARSHA MARSHA

*Never disturbs dosha

*Dose- 2drops morning and

evening

*Indicated in all seasons

*No complications

*Slow acting and less potent

*To all persons including

Swastha

*May disturb dosha

*Dose-

10 drops - uttama matra

8 drops - madhyam matra

6 drops - heena matra

*Seasons and age are to be considered

*May produce complications

*Quick effective and highly potent in action



Indication for Nasyakarma

Shirastambha, Manyastambha, Dantastambha, Dantashoola, Hanugraha,

Peenasa, Galashaluka, Galashundika, Shukraghataroga, Timira, Vartma roga, Vyanga,

Upajihwika, Ardhavabhedaka, Greevaroga, Skandaroga, Amsashoola, Mukharoga,

Nasashoola, Karna shoola, Akshishoola, Shirashoola, Ardita, Apatantraka,

Apatanaka, Galaganda, Danta shoola, Danta harsha, Arbuda, Swarabheda, Vakgraha,

Gadgadatwa.

Table No 7 Showing the indications of Shodhana Nasya

Si.

No

Vyadhi C. S.112

S.S.113

A.H. 114

A.S115

1 Shirogourava + + - +

2 Stambha + - - +

3 Supti + - - +

4 Shirah sheeta - + + -

5 Jadya - - + -

6 Soudnyaheena - - + -

7 Amaya - - + -

8 Shopha - - + +

9 Ganda - - + -

10 Krimi - + + +

11 Ghranti - - + +

12 Kushta - - + -

13 Apasmara - + + +

14 Peenasa - + + +

15 Upadeha - - - +

16 Kandu - - - +

17 Abhishyanda - - - +

18 Paka - - - +

19 Praseka - - - +



20 Asyavairasya - - - +

21 Arochaka - + - +

22 Svarabheda - - - +

23 Gandalaji - + - +

24 Arbhuda - - - +

25 Dadru - - - +

26 Kotha - - - +

27 Ardhavabhedak - + - -

Table No 8 showing the indications for Brumhana Nasya:

Si.

No

Vyadhi C. S.116

S.S.117

A.H 118

A.S119

.

1 Shirakampa + - - -

2 Ardhita + - - -

3 Shirashool (vataja) - + + +

4 Suryavarta - - + +

5 Swarakshaya - + + +

6 Nasa shosha - + + +

7 Asya shosha - + + +

8 Vaksanga - - + +

9 Krichrabhoda - + + +

10 Avabahuka - + + +

11 Ardhavbhedak - - - +

12 Krimi shiroroga - - - +

13 Akshi sankocha - - - +

14 Spanda - - - +



15 Timira - + - +

16 Dantashoola - - - +

17 Karna shoola - + - +

18 Karnanada - + - +

19 Manya roga + + - +

20 Apatanaka - - - +

21 Valipalitya - + - -

Contraindications of Nasya:

In Bruhatrayi some special conditions have been mentioned where Nasya

should not be administered, otherwise various complications may occur. In general,

in all patients Nasya should not be given on Durdina (Rainy day) or in Anritu

(Viparita Kala).

Table No 9 Contraindication of Nasya

Nasya Anarha Ch120

Su121

Va122

1.Bhuktabhakta + + +

2.Ajeerna + + -

3.Peeta Sneha + + +

4.Peeta Madhya + + +

5.Peetatoya + + +

6.Snehadi Patukamah + - +

7.Snatah Shirah + - +

8.Snatukamah + + +

9.Kshudharta + - +

10. Shramarta + + -

11.Matta + - -



12.Murchita + - -

13.Shastradandahrita + - -

14.Vyavayaklanta + - -

15.Vyayamaklanta Shranta) + + -

16.Panaklanta + - -

17.Navajwara Pidita + - -

18.Shokabhitapta + - -

19.Virikta + - +

20.Anuvasita + + +

21.Garbhini + + +

22.Navapratishyayarta + - -

23.Apatarpita - + +

24.Peetadravah - + +

25.Trishnarta + + -

26.Gararta - + +

27.Kruddha - + -

28.Bala - + -

29.Vruddha - + -

30.Vegavarodhitah (Vegarta) - + +

31.Raktasravita - - +

32.Sootika - - +

33.Shvasapidita - - +

34.Kasapidita - - +

Suitable time for giving Nasya:

According to Charaka generally Nasya should be given in Pravrit, Sharad and

Vasant Rutu. However in emergency it can be given in any season by

providing artificial conditions of the above mentioned seasons, for example in

summer Nasya can be given in cold places and in cold season it can be given in hot

places.



Nasya karma according to Rutus123

Grishma Rutu - ----- Before noon (morning)

Sheeta Rutu ---------- Noon

Varsha Rutu - ------- Day should be clear

Sharad + Vasanta - In the morning (Vagbhata) Shishira + Hemanta - Noon

Grishma + Varsha — Evening

According to Sushruta in normal conditions Nasya should be given in empty

stomach, at the time when the person usually takes his meal.

Nasya karma according to Doshas 124

Kaphaja Vikara — Poorvahna

Pittaja Vikara - Madhyahna

Vataja Vikara - Aparahna

Vagbhata has prescribed same timing as Sushruta has mentioned. According

to Doshaja Vikara it has suggested some more important points also. Nasya should be

given daily in morning and evening in Vataja Shiroroga, Hikka, Apatanaka,

Manyastambha and Swarabhramsha. Sharangadhara has described same time

schedule for different seasons as Sushruta has mentioned. He further states that —

Nasya can be given in night, if the patient is suffering from Lalasrava, Supti,

Pralapa, Putimukha, Ardita, Karnanada, Trushna, Shiroroga and such conditions

like excessive vitiated Doshas (Sha. Ut. 8I3)125



Table No 10 Course of Nasya Karma:

No. Name of Acharaya Days

1 Sushruta 1,2,7,21

2 Bhoja 9

3 Vagbhata 3,5,7,8

Nasya Karma may be given for seven consecutive days. In conditions like

Vata Dosha in head, Hikka, Manyastambha, Swarabheda. it may be done twice a day

(in morning and evening). (As. H. Su. 20I16).

Nasya should be given for 3 days, 5 days, 7 days & 8 days or till the patient

shows the symptoms of Samyak Nasya as stated in Ashtanga Samgraha126

.

Bhoja says that if Nasya is given continuously beyond nine days then it

becomes Satmya (adaptable) to patients and if given further, it neither benefits nor

harms the patients.

According to Sushruta127

, Nasya may be given repeatedly at the interval of 1,

2, 7 and 21 days depending upon the condition of the patient and the diseases he

suffers.

Charaka has not mentioned specific duration of the Nasya therapy, but

suggested to give according to the severity of disease.

Dose of Nasya:

The dose of Nasya drug depends upon the drugs utilized for it and the variety

of the therapy. Charaka has not prescribed the dose of the Nasya. Sushruta and



Vagbhata have mentioned the dose in the form of Bindus (drops), here one Bindu

means the drop which is formed after dipping the two phalanges of Pradeshini (index)

finger 128

.

Table No 11 showing the dosage of Nasya Karma:

Drops in each Nostrii Si

No.

Type of Nasya Hrasva Matra Madhyama

Matra

Uttama Matra

1 Shamana Nasya 8 16 32

2 Shodhana Nasya 4 6 8

3 Marsha Nasya 6 8 10

4 Avapeeda Nasya (Kalka Nasya) 2 2 2

5 Pratimarsha Nasya 2 2 2

According to Videha:

The common dose for Pradhamana Nasya is 3 Munchuti (here one Munchuti =

the quantity of Churna which may come in between Index finger and thumb = 2.4

Ratti.) Sharangadhara (Sha. Ut. 8I9, 10) has described the following dosage schedule

for Nasya Karma according to the variety of material used.

• Tikshnaushadhi Churna - 1 Shana (4 Masha) (24 Ratti)

• Hingu — 1 Yava (S Ratti)



• Saindhava — 1 Masha (6 Ratti)

• Dugdha — 8 Shana (64 Drops)

• Jala (Aushadha Siddha) — 3 Karsha (3 Tola)

• Madhura Dravya — 1 Karsha (1 Tola)

If the Nasya is given less than the prescribed dose then it does not eliminate

the Doshas completely and cause heaviness, loss of appetite, cough, salivation,

coryza, vomiting and disorders of the throat etc. If the Snehana Nasya is

administered in the excessive dose it may produce the symptoms of Atiyoga (As. San.

Su. 29/6) Danta Chala, Arbuda, Hanugraha, Skandharoga, Mukharoga, Amsashula.

According to Ashtanga Sangraha if the Nasya is to be given as the part

of performing the complete Panchakarma then, it should be given after Bastikarma.

Procedure of Nasya Karma:

The whole procedure is divided into three stages-

* Poorva karma

* Pradhana karma

* Paschat karma

Poorva karma:

This includes all the preparations and events that are to be done up to

instillation of medicine. This stage is further divided into three steps

• Collection of materials



• Deciding the exact time for the procedure

• Preparation of the patient

Collection of materiais:

A separate well ventilated room with adequate light is to be sellected131

. It

should flourish following needy things-Nasya Peeta or Nasya Shayya, Nasya

medicine, Nasya Yantra i.e. Gokarna Yantra, cotton or dropper for instillation,

spittoon, cloth, attainders, etc.

Ideal Time:

After considering the prevailing season and Dosha Pradhanyata, the time of

administration should be decided. In general Pravrut, Sharat,Vasanta Rutu are good.

In Varsha Rutu un-cloudy day, in Greeshma Rutu before Madhyanha and in Sheeta

Rutu during Madhyanha Nasya should be performed.

Preparation of patient:

Person to be administered with Nasya karma has to stay in Nirvata Pradesha,

light food is given, after resting for a short duration Dantadhavana and Dhoomapana

should be done and he should comfortably lie down relaxed on a cot in supine

position, hands and legs stretched straight. Snehana and Swedana to face is done.

Swedana is contraindicated to Shiras as it is a Marma. Even then for liquifaction of

Dosha and to facilitate easy expulsion of them Mrudu Swedana is performed over

Shira, Manya, Nasa, Greeva. Eyes are covered with a cloth to avoid any spilling of

medicine 129

.



Pradhana karma130

Head is slightly bent backwards by keeping a pillow below the shoulder

this facilitates easy instillation of Nasya medicine. Oil is warmed, nose tip is raised

with index finger of left hand and one nostril is closed with another finger, using right

hand medicine is instilled. Exact measured quantity of medicine is taken in a Gokarna

or even administered using a pad of cotton or cloth or a dropper and dropped in a

continues flow into each nostril one after the other.

Precautions to be taken before instiiiation:

Quantity of medicine should be exact neither more nor less, it should not be

poured all of a sudden, it should not be too warm or too cold, patients head should

neither be stretched down too much nor elevated and should lie relaxed.

Very little quantity of medicine will only excite the doshas but will not expel

them out and causes feeling of heaviness, loss of taste, cough, excessive salivation,

rhinitis, vomiting and diseases of kantha. More quantity of medicine will give

rise to complications i.e. atiyoga features. Pouring the entire quantity at once will

force the medicine to enter into the wrong routes causing diseases of head,

Pratishyaya, Ghrana Kleda, obstruction to expiration. If the medicine is too warm it

causes burning sensation, formation of ulcers, fever, bleeding through nose, headache,

blurring of vision. If it is very cold it will cause Ayoga features.

Medicine instilled in an improperly stretched position of the head too gives

Ayoga features as the medicine fails to spread all over the head uniformly. If the

head is stretched too much, the medicine traversing a long route causes Moorcha,

Jaadya, Kandu, Daha, Jwara. Nasya administered in an un-relaxed person causes



increase in Doshas as it is unable to spread all over, along with pain or stiffness131

. If

the head is not stretched then medicine fails to enter inside Shirus and if stretched too

much then the entered medicine fails to come back. Patient should be observed for

any complications, if present then necessary steps are to be taken accordingly.

Paschat karma :

This has following steps-

• Snehana and swedana

• Dhoomapana and Gandusha

• Assessing the yoga Ayoga lakshanas

• Complications if any and measures to be adopted

• Ahaara and Vihara

Mrudu Abhyanga and Swedana over Gala, Kapola, Lalata, Mardana over

shoulder, feet and hands done. Patient is instructed not to swallow but to spit the

expectoration as it contains doshas134

. Patient should lie still in same position for 100

Matra Kala133

, should not shake his head, talk, laugh, sneeze, yawn as these prevent

the medicine reaching the expected place and even Kasa, Pratishyaya, Shiro Akshi

rogas may occur especially if the medicine doesn’t reach Shrungataka Marma134

.

Dhoomapana and ushna jala gandusha should be done for kantha shuddi135

.

Dhoomapana136

Inhalation of Dhooma is indicated in the disorders of shiras, in general and in

particular Prayogika dhooma is indicated after Nasya karma137

.

Two to three puffs are to be taken through mouth and exhaled through mouth

only138

. By this lightness of head, sense organs, heart, Dosha Shamana takes place and



throat becomes clear139

.

Snehana and Swedana are Poorva Karma of Nasya, by these the Srotas

becomes soft and Doshas in them gets loosened. Administration of Nasya easily

expels them out but the Nasya dravya being a Sneha and Sneha by nature increases

Kapha due to its Sheeta Guna.

This retains a portion of Kapha, which was liquefied due to Snehana and

Swedana. And so retained Kapha can’t be expelled out by Nasya Dravya and gets

collected in Karna, Manya and causes different diseases. To remove this, dhoomapana

is administered140

. Dhooma by virtue of its ushna and teekshna Guna clears the dosha.

Gandusha:

After dhoomapana, Ushna jala gandusha is to be done. This removes the

Kapha present in the oral cavity and also increases the taste.141

Samyak Yoga, Ayoga and Atiyoga of Nasya Karma:

After Nasya Karma the symptoms of its Samyakyoga , Ayoga, Atiyoga should

be observed.

Samyak yoga:

Samyak yoga mentioned according to different Acharyas.

Table No 12 Showing Samyak Yoga Lakshana

Si. No Symptoms C. S142

a S. S142

b A. H142

c Sh. S142

d

1. Uraha Laghuta + - - +

2. Shiro Laghuta + + - +



3. Netra Laghuta - - + -

4. Shareera Laghuta - + - +

5. Srotovishuddhi + + - +

6. Swaravishuddhi - - + -

7. Urdwajatrugata Vikaropashaman - - - +

8. Prakruta Indriyaschesta + + - +

9. Netrateja Vruddhi - - + -

10. Chitta Prasada - + - +

11. Vikaropashamana - + - +

12. Sukha Svapna Prabodha - + + -

Ayoga:

Ayoga is mentioned according to different acharya as follows.

Table No 13 Showing Ayoga Lakshana


a S. S143

b A. H143

c Sh. S143

d

1. Shirogaurava, Dehagaurava + + - +

2. Galopalepa + - - -

3. Nishtheevana + - - -

4. Kandu - + - +

5. Kaphapraseka - + - -

6. Upadeha + - + +

7. Rukshata + - - +

8. Vata Vaigunya + - - -

9. Srotoriktata - + - -

10. Srotasamkaphasrava + - - +

11. Nasashosha - + + -



12. Asyashosha - + - -

13. Akshistabdhata - + - -

14. Shiroshunyata - + + -

15. Vyadhi Vrudhdhi - - + -

Table no 14 showing Atiyoga lakshana


a S. S144

b A. H144

c Sh. S144

d

1. Shirogourava - + + +

2. Shiroshunyata - + - +

3. Shirovedana + - - -

4. Netra Vedana + - - -

5. Shankhavedana + - - -

6. Suchitodavat Peeda + - - -

7. Indriya Vibhrama - + - +

8. Mastulungagama - + - -

9. Snehapurna Srotasa - - - +

10. Karna Talu Upadeha - - + -

11. Vata Vruddhi + - - -

12. Kandu - + + -

13. Praseka - + + +

14. Peenasa - + - -

15. Aruchi - - + -

16. Deha Daurbalya - - + -

Complications of Nasya145

Complications occur due to 2 reasons



a. Administration in a contraindicated state b. Improper technique of

administration These two give rise to Dosha Utklesha or Dosha Kshaya features

respectively. Dosha Utklesha is to be managed by Shodhana and Dosha Kshaya by

Brumhana Chikitsa.

Table No 15 Complications of Nasya Karma and their management

Si.No

Conditions where nasya

is contraindicated

Manifestations

occuring due to Nasya

Management

01. Ajeerna, bhukta bhakta

peeta toya, durdina

Kapha roga, shwasa,

peenasa, agnimandya

Kapha hara, teekshna,

ushna drugs

02. Krusha, virikta,

vyayaama

klanta, trushnarta, garbini

Vataja sula, angamarda,

mukashosha,garbastamba

Vatahara,snehana,

brumhana, in garbhini

milk and ghee is to be

given

03. Jwara,shokatapta,

Madyapeeta

Timira roga Rooksha, sheetala

anjana, lepa, putapaaka

Regimen to be followed after Nasya Karma-

After finishing Paschat Karma warm water is given to drink and light food is

given. One should avoid Abhishyandi Ahara, Sneha, Madya, Drava Pana, exposure to

Raja, Dhooma, Aatapa, Shira Snana, Atiyana, Krodha and should stay in Nirvata

Pradesha68. Cold water should not be used for drinking or for bathing only warm

water is to be used.146

The procedure may be conducted on alternative days or once in 3 days for

about 7 to 21 days or even until results are got. In Vata Vyadhi daily 2 times Nasya

can be given. But Vagbhata says that Nasya should not be conducted for more than 7

days147

.



Benefits of Nasya Karma:

Who regularly follows Nasya Karma will be free from diseases of eyes, Ears

and Nose. His hair and beard does not turn grey. His hair doesn’t falls but instead

grows fast. Diseases like common cold, migraine, headache, facial paralysis, etc. can

be alleviated. The joints, sinus, tendons and bones of his cranium acquires great

strength. His face becomes cheerful and plump and his voice becomes mallow, firm

and stentorian. Strength of all sense organs increases greatly. There will be no

sudden invasion of disease in the upper parts (Urdhvajatrugata) of the body. He

experiences the symptoms of old age later.

Disease of the supra clavicular region are cured in the person who practices

Nasya. He gets clarity of senses, good smell of mouth and the strength of jaw, teeth,

arms, chest, etc. He never suffers from the premature appearance of wrinkles,

premature hair falling and Vyanga.

Importance of Post Nasya Massage:

The texts have recommended light massage on the frontal, temporal,

maxillary, mastoid & on Manya region.

A comfortable massage on the above regions may help to subside the irritation of

somatic construction due to heat stimulation. It may also help in removing the slush

created in these regions

Pressure applied on the barroreceptors may bring the deranged cerebral arterial

pressure to normalcy (hejmadi s. 1985).

Guards against attack of baldness, Vyanga, premature appearance of wrinkles

or furrows.



Mode of action of Nasya Karma

The clear description regarding the mode of action of the Nasya karma is not

available in Ayurvedic classics. According to Charaka Nasa is the gate way of

Shirah.The drug administered through nose as Nasya reaches the brain & eliminates

only the morbidDoshas responsible for producing the disease.

Nasa being the gateway to Shiras, the drug administered through nostrils,

reaches Shringataka (a Sira Marma by Nasa Srota), spreads in the Murdha (brain)

taking Marma of Netra (eye), Shrotra (ear), Kantha (throat), Shiramukhas (opening of

the vessels, etc.) and scratches morbid Doshas in supra clavicular region and expels

them from Uttamanga (As.San.). Sushruta153

has clarified Shringataka Marma as a

Sira Marma formed by the union of Siras (blood vessels) supplying to nose, ear, eye

& tongue. He further points out that injury to this Marma will be immediately

fatal (Su. Sha. ). Indu in his commentary on Ashstanga Sangraha has opined

Shringhataka as the inner side of middle part of the head i.e. Siraso Antarmadhyam.

Under the complications of Nasya karma

Sushruta noted that the excessive eliminative errhine may cause Mastulunga

(cerebro spinal fluid) to flow out of the nose (Su. Ch. ).In Sushruta, Astanga Hridaya,

Bhavaprakasha, etc detailed descriptions are not found about the mode of action of

Nasya Karma. According to all prominent Acharyas Nasa is said to be the gateway of

Shirah. It does not mean that any channel connects directly to the brain but

they might be connected through blood vessels or through nervous system (olfactory

nerve, etc.).

It is an experimentally proved fact that wherever any type of irritation takes

place in any part of body, the local blood circulation is always increased. This is the



result of natural protective function of the body. When provocation of Doshas takes

place in Shirah due to irritating effect of administered drug resulting increase of the

blood circulation of brain. So extra accumulated morbid Doshas are expelled out

from small blood vessels.

Ultimately these morbid Doshas are thrown out as nasal discharge, tear and

salivation

NASA SHAREERA

In Ayurvedic literature there is no detailed description of Nasa Sharira is

available at a single context like the anatomical description of eye (Netra).By an

overall analysis of Ayurvedic classics we can see that a lot of terms are used by

different Acharyas which clearly indicate the anatomical parts of Nasa while

explaining the pathophysiology of Nasal diseases.Dalhana while commenting that the

Samyoga Sthala of Ghranendriya is called as Shringataka, injury to this causes death.

Nasa is one among the seat of Sukshma Jnanendriyas which is

dominant in Pruthwi Mahabhoota. Nasa is made up of Tarunasthi149

. The pramana of

Nasa puta is 4 anguli, Dalhana comments that it is pramana of one Nasaputa, others

opines that the pramana of one Nasaputa is 2I3 anguli, it is Bahirmukha Srotus and it

has two peshis.

According to Sushruta, Nasa has 24 siras they are 6 Vatavahini, 6 Pittavahini,

6 Kaphavahini and 6 Raktavahini siras150

. Nasa has 2 dhamanis.

Utpatti of Ghranendriya:

Acharya Charaka expained that development of Nasa occurs during the third

month of gestation.151In the third month of pregnancy at that time Indriyas involves.



Nasa is the opening of Shiras, Hence in Urdwajatrugata Vikara mainly Nasya

Karma152

is advised. Ayurvedic classics explained Nasa as the only route to the head.

So any medicine which is applying through the Nose can influence the head directly.

A lot of medicaments are advised to introduce through nose in

unconsciousness conditions as well as in fatal conditions like Sanyasa, Murcha, and

Sarpadamsha etc. We can conclude the structure of the Nasa as follows:

It is composed of

• 3 Asthis

• 2 Peshi

• 2 Dhamani

• 3 Marmas and

• 24 Siras.

Indria Panchapanchaka153

:

Indriya — Ghranendriya

Indriya Dravya — Pruthvi

Indriya Adhisthana — Nasa

Indriya Artha — Gandha

Indriya Buddhi — Ghrana Buddhi

These faculties are responsible for the perception of smell.

Anatomy154

: External Nose:

It is having the shape of a triangular pyramid; the supporting frame work

consists of bony part and cartilaginous parts.



Bony parts:

Forms the upper part of external Nose it consists of anterior part of body of the

maxilla with its frontal process.

Cartilaginous part:

Area around the nose, vestibule and upper lip is dangerous as infection. From

these areas may drain into cavernous sinus, anterior facial and cellulites of the area

may be spreading of infection cavernous sinus.

Figure 4 showing anatomy of Nose

The Nasal cavity:

The nasal cavity is divided into right and left halves by the median septum and

extends from anterior nasal to the posterior nasal apertures where it communicates

with the nasopharynx.

Floor:

Floor is formed by the palatine process of the maxilla and palatine bone .

Roof:

Roof has anterior sloping and is formed by nasal bones, central part is

horizontal and is formed by cribriform plate of the ethmoid bone. The posterior



sloping part is formed by under surface of body of the sphenoid.

Medial wall: It is formed by the septum.

Lateral wall: It is formed by maxilla and ethmoid bone.

Olfactory area:

It is the upper part of the nasal cavity from the level of superior conchae. It is

bounded above by the cribriform plate. Laterally by lateral wall of the nasal cavity

above the level of the superior turbinate, medially by corresponding part of the nasal

septum. Nasal septum; -

Medial wall is the portion which divides the nasal cavity and lies in or near the

mid line; it consists of perpendicular plate of the ethmoid bone above and behind.

Vomer below and behind.Septal cartilage anterio- inferiorly.

Minor contribution by anterior nasal spine of the maxilla septal crest of

the maxillary and palatine bones, nasal spine of the frontal bone the sphenoidal crest.

DRUG REVIEW –

INTRODUCTION.

Dravya has a vital role in curing the diseases, so it is considered as one among

four in the Chiikitsa Chatushpada Without its knowledge, a physician cannot cure a

disease.

The main objective of the present clinical study is to evaluate the effect of

Nasya with Karpasasthyadi Taila and Nagara Taila respectively in the management

of Avabahuka. The properties of these drugs are summarized below.



PROPERTIES OF INGREDIENTS OF NAGARA TAILA.

Nagara ( Zingiber officinale Rosc) belonging to the family Zingiberaceae is a

herb. It is extensively grown in India, widely available, cheaper and non controversial

drug and is used as a household remedy. Besides a common drug and spice condiment

including vegetable or edible household item, the drug is used in wide range of

therapeutics, pharmaceuticals and also in dietetics.

Nagara is one among the drugs told in”Vatagana Gana” in Vata Vyadhi

Chikitsa Adhyaya of different classics155

. In all most 70% of yogas told in Vata

Vyadhi Chikitsa in classics Nagara is present. Charaka describe Nagara in

Shoolaprashamana Gana, and Deepaneeya Gana156

. Susruta and Vagbhatta have

described Nagara in Pipalyadi Gana.(SU.SU 38/22)157

. This drug is also used in case

of Vatavyadhi, Shoola158

, Shopha 159

and it is one of the ingredient in Masha taila,

Maharasnadi Kwatha which is used in Vatavyadhi (Avabahuka)160

.In Bhavaprakasha

it is mentioned in Haritakyadi varga161

it is also mentioned in Panchakola,

Sadusana162

. In Shodala Nigandu it is mentioned in Shatapuspadi Varga163

. Raja

Nighantu mentions Nagara in Pipalyadi Varga164

.

SYNONYMS.

Ardraka, Ardrika, Sunthi, Usna, Nagara, Visvabhesaja, Srngavera,

Mahousadha, Gulmamoola, Moolaja, Kandala, Varam, Anupaja, Apakshakaa,

Saiktastha, Ardrakya, Rahuchatra shaka, Ardra shaka, Schaaka.(danwantari nigantu

pipalyadi varga).



BINOMIAL NOMENCLATURE165

NOMENCLATURE

Kingdom : Plantae

Division : Angiosperma

Class : Monocotyledoneae.

Order : Sciataminaea

Family : Zingiberaceae

Subfamily : Zingiberoideae

Genus : Zingiber

Species : Officinale

Botanical Name : Zingiber officinale.

REGIONAL NAMES

Hindi: Adarak, Malayalam: Inchi, Tamil: Ardrakamu, Kanada: Hasisunti

DESCRIPTION OF THE DRUG

A slender, perennial rhizomatous herb, leaves are linear, sessile, glabrous,

flowers yellowish green in oblong, cylindrical spikes, ensheathed in few scarious,

glabrous bracts, fruits oblong capsules. The rhizomes are white to yellowish brown in

colour, irregularly branched, somewhat annulated and laterally flattened. The growing

tips are covered over by scales. The surface of the rhizome is smooth and if broken a

few fibrous elements of vascular bundles project out from the cut ends.



HABITAT OF THE DRUG

Cultivated throughout India, run wild in some places in the Western ghats

THERAPEUTICALLY USED PART

Rhizomes (raw as well as dry)

Table No.16 Properties of Nagara

ACTION OF DRUG166

Doshaghna Karma – Kaphavatasamaka

Vyadhighna Karma – Triptighna-Rochana-Dipana-Pachana, Vatanulomana-

Sulaprasamanam, Arsoghna, Pittasamaka, Rakthasodhaka, Hridya, Shothahara,

Kaphaghana, Swasahara, Kasaghna, Svarya, Vrsya, Uttejaka. Jwaraghna,

Sitaprasamna, Balya, Vedanasthapana, Nadyuttejaka.

INDICATIONS

Abyantara

Vatavyadhi, Aruchi,Hrllasa, Chardhi, Mukhavairasya, Agnimandya, Ajirna,

Adhmananaha, Udararoga, Sula, Kosthabaddhata, Arsa, Pandu, Kamala,

DRUG LATIN NAME RASA GUNA VEERYA VIPAKA DOSHAKARMA

Nagara Zingiber officinale

Rosc

Katu Laghu,

Snigdha

Tikshna

Usna Madhura Kaphavatasamaka



Hrddourbalya, Hrcchula, Sotha, AmaVata, Slipada, Sitapitta, Kasa, Swasa, Hikka,

Pratisaya, Jwara.

Bahya

Amavata, Sandhisotha, Karnashoola, Shirasjoola

CHEMICAL COMPOSITION

Rhizome contain volatile oil 1-5%, gingerol, gingerin (oily resinous substance

main active principle), gingerenone, ginger glycolipids A, B, & C, citronellol,

geraniol, starch and other contents.

TILA TAILA:167

The base of Nagara Taila is Tila taila. The properties of Tila are

Table No 17: Showing Guna-Karma of Tila:

S.No Tila

01 Latin name Sesamum indicum Linn.

02 Family Sesamum

03 Sanskrit Tila

04 Rasa Madhura

05 Anurasa Kashaya-Tikta

06 Guna Guru, Snigda

07 Veerya Ushna

08 Vipaka Madhura

09 Doshakarma Tridosha Shamaka

10 Composition

(Beeja)

Moisture – 4.1-6.5%

Oil – 43-56.8%

Protein – 16.6-26.4%



Fibers – 2.9-8.6%

Carbohydrate – 9.1-25.2%

Minerals – 4.1-7.4%

Calcium – 1.06-1.45%

Phosphorus – 0.47-0.62%

11 Parts used Beeja, Taila

Tila Taila Murchana:

Moorchita tila taila was prepared in the department of Rasashastra and

Bhaishajya kalpana, K V G A M C, Sullia. And taila paka was done according to

Sharngdhara Samhita14

.

Tila taila Murchana procedure168

:

For the taila Murchana 1/16th

part of Manjistha, 1/64th

part of Haritaki

,Vibhitaki, Amalaki, Mustha, Haridra, Lodra, Vatankura, Hrivera, Nalika,

Ketakipushpa,1 part of Tila taila, and 4 parts of jala was taken and done paka in

mandagni till Taila paka siddhi lakshana

NAGARA TAILA PREPARATION

Ingredients of Nagara Taila

(1) Kalka & Swarasa prepared out Nagara (Zingiber officinale Rosc)

(2) Tila Taila.

Taila will be prepared according to Mrdu Taila Paaka Vidhi mentioned in

ayurvedic classics169

.



Drugs were taken in the following proportion,

Nagara Swarasa- 8 litres (16 parts)

Nagara Kalka –250 gms(1/8 parts)

Tila Taila – 2 litres (4 parts)

Rhizomes (fresh) of Nagara was collected (30 kg) from surrounding areas

(locally) and cleaned properly. Then it was chopped into small pieces and taken in a

vessel. It was grinded and made into paste. The paste was squeezed through a cloth to

take the Swarasa. This Swarasa (8 litters) was added to 2 liters of Tila Taila and kept

over mild flame. Nagara Kalaka (250 gms) was also added to it and was kept over

mild flame till it attained Mrdu Paka Lakshana.

The Taila paka Lakshanas are170

Phenotgama in Taila, Vartivat shape Kalka will be got, when a small quantity

of Kalka is taken from the boiling Taila and is rolled in between the fingers., Shabdha

Heena, when it is thrown on fire.

Then it is cooled, measured and stored in a dry, air tight container.

PROPERTIES OF INGREDIENTS OF KARPASASTHYAD TAILA.

Karpasasthyadi Taila described in Tailayoga Adhikara of Sahasrayoga is

generally practiced in the treatment of Avabahuka171

. The ingredients of

Karpasasthyadi Taila are.

Table 18: Kasaya Dravyas of Karpasasthyadi Taila 172,173.

.

DRUG LATIN NAME RASA GUNA VEERYA VIPAKA DOSHA

KARMA

Karpasa Gossypium

Herbaceum

Madhura

(Seed)

Laghu,

Teekshna

Anushna

Katu Vata Pitta

Shamaka



Rasna Sida

Rhombifolia

Madhura Guru,

Snigdha,

Pichila

Sheeta

Madhura Vata

Pitta

Shamaka.

Masha Vigna Mungo Madhura

Guru,

Snigdha

Ushna

Madhura

Vata

Shamaka,

Pitta

Kapha

Kara

Kulattha Macrotyloma

Uniflorum

Kashaya,

Madhura

Laghu,

Teekshna,

Ushna

Ushna

Katu Vata

Kapha

Hara

Table 19: Kalka Dravyas of Karpasasthyadi Taila.

DRUG LATIN

NAME

RASA GUNA VEERYA VIPAKA DOSHAKA

RMA

Devadaru Cedrus

Deodara

Tikta,

Katu

Laghu,

Snigdha

Ushna

Katu

Kapha

Vatahara

Bala Sida

cordifolia

Madhura Guru,Snigd

ha, Picchila

Sita Madhura Vata Pitta

Shamaka

Rasna Alpinia

Galanga

Tikta

Guru Ushna Katu Kapha Vata

Shamaka

Kustha Sausseria

Lappa

Tikta,

Katu,

Madhura

Laghu,

Rooksha,

Teekshna

Ushna

Katu

Kapha.

Vata

Shamaka

Sarshapa Brassica

Juncea

Katu,

Tikta

Teekshna,

Ruksha,

Snigdha

Ushna ��

Kapha Vata

Nashaka,

Pitta

Vardhaka



Nagara Zingiber

Officinale

Katu

Tikta

Laghu

Snigdha

Ushna Madhura Kapha Vata

Shamaka

Shatapus

hpa

Anethum

Graveolens

Katu,

Tikta

Laghu,

Ruksha,

Teekshna

Ushna

Katu

Kapha Vata

Shamaka

Pippali

Moola

Piper

Longum

Katu Laghu,

Rooksha

Ushna Katu Vata Kapha

Shamaka,

Pitta

Vardhaka

Chavya Piper

Brachystachy

cum

Katu Laghu,

Rooksha

Ushna Katu Kapha Vata

Shamaka

Shigru Moringa

Olifera

Katu,

Tikta

Laghu,

Rooksha,

Teekshna

Ushna Katu Kapha Vata

Shamaka

Punarnav

a

Boerhaavia

Diffusa

MadhuraT

ikta,

Kashaya

Laghu,

Rooksha

Ushna Madhura Tridoshahar

a

Aja

Ksheera

- Madhura Drava,

Pichila,

Sara,

Manta,

Sukshma,

Teekshna

Ushna Madhura Vata

Pittagna

Tila Taila Seasamum

indicum Linn

Madhura Guru,

Drava,

Pichila,

Sara,

Manta,

Sukshma,

Teekshna

Ushna Madhura Vata

Pittagna



Method of preparation of Karpasasthyadi Taila:

Drugs for Kasaya – Karpasa Beeja – 500 mg

Bala - 500 mg

Masha - 500 mg

Kulattha - 500 mg

Quantity of Kasaya – 8 ltrs

Kalka Dravyas - Devadaru – 5 grms

Bala - 5 grms

Rasna - 5 grms

Kusta - 5 grms

Sarshapa - 5 grms

Nagara - 5 grms

Shatapushpa- 5 grms

Pippalimoola- 5 grms

Chavya - 5 grms

Shigru - 5 grms

Punarnava - 5 grms

Taila for preparation – Tila Taila - 2 ltrs

Ksheera - 2 ltrs

Kasaya was prepared by adding 3.2ltrs of water reduced to 800 ml after adding

the Kasaya Dravyas. Moorchita Tila Taila was prepared.To this, Kasaya was added

and boiled over mild fire.The Kalka Dravyas are prepared by making a paste and

added to the oil. Ksheera is added to the boiling oil and stirred thoroughly over mild

fire till the Paaka Siddhi Lakshanas are obtained. Then cooled and filtered into air

tight container and stored.

Materials and Methodology


4. MATERIALS AND METHODOLOGY

CLINICAL STUDY

Methodological approach is the backbone of research. Utmost care is taken in

designing a methodology for conducting a research. Clinical research involves the

experimentation of a drug/therapy on a population and recording the feedback based

on which postulations are made regarding the usefulness of the drug/therapy in the

disease. Hence, in this section, the researchers put forward the systemic procedures,

which are followed by the researcher’s right from the identification of the problem to

the final conclusion.

Research Approach

In this clinical study, the objective was to. The “A comparative clinical study

on the effect of Nasya with Karpasasthyadi Taila and Nagara Taila in the management

of Avabahuka ”. Efficacy of this was determined by finding of base line data of the

parameters before and after the treatment of Nasya Karma with Karpasasthyadi Taila

and Nagara Taila.

Materials and Methods

Study Design

It is a comparative clinical study. Total patients were made in to two Groups

A and B. Group A had received Nasya with Karpasasthyadi Taila and Group B

received Nasya with Nagara Taila.



a). Source of Data

Patients:- Patients with classical features of Avabahuka had been

selected from OPD/IPD dept in KVG Ayurvedic Medical College &

Hospital, Sullia.

b). Literary ;-literary aspect of the study had been collected from

classical Ayurvedic texts, recent medical journals and internet

c). Therapy:

Nasya Karma –with Karpasasthyadi Taila

Nasya Karma –with Nagara Taila.

d). “Selection of drug”- the trial drug collected from the surrounding

area and local market after being properly identified.

e). Preparation of medicine:-according to Sneha Paka mentioned in

classics. Medicine was prepared in K.V.G Ayurveda pharmacy,

Sullia

1. Karpasasthyadi Taila

Karpasasthyadi Taila is used for Nasya in group A.

Contents of Karpasasthyadi Taila.

Drugs for Kasaya - Karpasa Beeja, Bala, Masha, Kulattha.

Kalka Dravyas - Devadaru, Bala, Rasna, Kusta, Sarshapa, Nagara,Shatapushpa,

Chavya, Shigru, Punarnava. Ksheera.

Tila Taila



Ksheera

Taila was prepared according to Mrdu Paka Vidhi mentioned by Ayurvedic

classics.(Sharangathara Samhiha) .

Method of preparation of Karpasasthyadi Taila

Kasaya was prepared by adding 3.2ltrs of water reduced to 800 ml after adding

the Kasaya Dravyas. Moorchita Tila Taila was prepared. To this, Kasaya was added

and boiled over mild fire. The Kalka Dravyas are prepared by making a paste and

added to the oil. Ksheera is added to the boiling oil and stirred thoroughly over mild

fire till the Paaka Siddhi Lakshanas are obtained. Then cooled and filtered into air

tight container and stored.

2. Nagara Taila

Nagara Taila is used for Nasya in group B.

Contents of Nagara Taila.

(1) Kalka & Swarasa prepared out Nagara (Zingiber officinale Rosc)

(2) Tila Taila.

Method of preparation of Nagara Taila.

Rhizomes (fresh) of Nagara was collected (30 kg) from surrounding areas

(locally) and cleaned properly. Then it was chopped into small pieces and taken in a

vessel. It was grinded and made into paste. The paste was squeezed through a cloth to

take the Swarasa. This Swarasa (8 litters) was added to 2 liters of Tila Taila and kept

over mild flame. Nagara Kalaka (250 gms) was also added to it and was kept over

mild flame till it attained Mrdu Paka Lakshana. Then it is cooled, measured and stored

in a dry, air tight container.



Sample Size & Grouping

30 Patients equally distributed in each groups.

Group A - Nasya with Karpasasthyadi Taila

Group B – Nasya with Nagara Taila.

Selection criteria

The cases were selected strictly as per the pre-set inclusion and exclusion of

criteria.

Inclusion Criteria

• Patients having the classical Lakshanas of Avabahuka which is mentioned in

diagnostic criteria was selected.

• Patients of both genders who were Nasya Yogya according to Ayurveda

classics irrespective of chronicity, occupation and socio-economic status were

selected

• Patients in between 20 years and 70 years of age was selected.

Exclusion Criteria:

1. Patients with the history of fracture and dislocation of affected

shoulder joint were Excluded..

2. Patients who were Nasya Ayogya according to Ayurveda classics.

3. Patients with the association of other systemic disorders.

4. Patients below the age 20 and above 70 were excluded in this study.

Duration of the study

• Totally the course of treatment along with placebo intake for late

assessment (follow up ) was 22 days



Observation Period

1. Initially on the first day before treatment.

2. On the 7th

day after treatment.

3. On the 14th

day.

4. 22nd

day for the last assessment.

Posology ( for a single use )

Nasya– 6 Bindhus in each nostrils.

Placebo:

Placebo in the form of rice flour tablets will be given twice a day from 8th

day for a

period of 15 days till 22nd

day for late assessment.

Data Collection

Patients were thoroughly examined both subjectively and objectively. Detailed

history pertaining to the mode of onset, previous ailment, previous treatment history,

family history, habits, Astavidhapareeksha and Dashavidhapareeksha and physical

examination findings were noted.

Assessment criteria

Assessment of the condition was done based on the detailed Proforma

adopting standard method of scoring of subjective and objective parameters which

will be analysed statistically.



Procedure

Nasya Karma

Preparation of Patient

• Patient was selected after fulfilling the criteria's. The patient were briefed

about the intended procedure.

• Room for Nasya was prepared which was free from atmospheric effects like

direct blow of air or dust and it was lighted properly. The patient for the Nasya

karma ,should have passed his natural urges like urine and stool. Light

breakfast prior (1 hour) to Nasya karma was advised.

• After preparation of patient by above said regimens, Snehana and Swedana

were done. Here, Snehana means, Mridu Abhyanga. It should be done on

scalp, forehead and neck for 3 to 5 minutes . After Abhyanga, Mrudu Swedana

was done on Shira, Mukha, Nasa, Manya, Greeva and Kantha.

Pradhana Karma

Posture of The Patient :

Patient was made to lye down in supine position on Nasya table. The head of

the patient was lowered (Pravilambita). Eyes were covered with a clean cloth.The tip

of patients nose was drawn upward by the left thumb , at the same time with the right

hand 6 drops of lukewarm oil (Karpasasthyadi Taila or Nagara Taila) was installed

in both the nostrils, alternately, with the help of proper instrument like Pichu, dropper,

The drug should be proper in dose and temperature. The patients was advised

to remain relaxed at the time of administration of Nasya and asked to avoid speech,

anger, sneezing, laughing and shaking his head.



Pashchat Karma

Patient in lying position is asked to count up to 100 matra i.e. approximately 2

minutes. After administration of Nasya feet, shoulders, palms and ears should be

massaged. Again mild fomentation was done on forehead, cheeks and neck. The

patient was asked to expel out the drug which comes in oropharynx. Care was taken

that no portion of medicated oil is left behind. Medicated Dhumpana two puffs were

advocated to expel out the residue mucous lodged in Kanta.

Pathya during treatment period & Pariharakala

Patient was advised to stay in a windless place. A light meal and lukewarm

water were advised. Patients were also advised to avoid dust, smoke, sunshine, hot

bath, anger, riding vehicles, excessive intake fat and liquid diet, day sleeping and

should not use cold water for any purpose like Pana, Snana, etc. The Pathyacharana is

an important factor which was followed for 14 days including the treatment period &

Pathyacharana.

Photograph No 1.Showing Procedure of Nasya Karma



Methods of Assessment of clinical response.

SUBJECTIVE CRITERIA

Shoola:

This was evaluated by subjective parameters mainly based on critical

observation and by giving grading as follows.

1.SHOOLA.

1) Pravara - Grade 3 – (100 – 60 %) Severe and persistent pain with disturbing

sleep. Here normal routine activities will be completely hampered.

2) Madhyama - Grade 2 – (60 -30%) Pain increases on little work involving joint

movement. But get relived by rest. Normal activities will be slightly hampered.

3) Avara - Grade 1 – (30 – 1 % )Pain on excessive work with joint involvement.

Normal routine activities will not be hampered.

4) Absent - Grade 0 – No Shoola

OBJECTIVE CRITERIA

It can be considered as restricted movement of shoulder joint. This can be

observed in Unnamana, Avannamana, Akunchana, Prasarana and Triyakgamana of

shoulder joint. The degree of movement was considered for assessment criteria.

Using goniometry, the degree was measured and recorded. Here different

grading were given depending upon the degree of individual patients, before and after

the treatment.

Abduction (Unnamana).

160 0-180

0 ………0

80 0-160

0 ………1

100 - 80

0 ............2

Cannot abduct ………3



Adduction (Avannamana).

200 - 30

0 ………0

100 - 20

0 ………1

00 - 10

0 ………2

Cannot adduct ………3

Flexion (Akunchana).

160 0-180

0 ………0

80 0-160

0 ………1

100 - 80

0 ............2

Cannot flex ………3

Extension (Prasarana).

400 - 60

0 ………0

200 - 40

0 ………1

00 - 20

0 ………2

Cannot extend ………3

Circumduction (Triyakgamana).

Normal .………0

Pain on Circumduction .………1

Circumduction not possible due to stiffness ...……..2

Overall Assessment Of Clinical Response.

Clinical improvement of patients was made based on improvement in the

clinical findings and reduction in the severity of the symptoms of the disease, grading

for the clinical improvement for individual variables. Grading for the clinical

improvement for individual variables.

1. �� – 100% relief in signs and symptoms considered.

2. ��-�60 - 99% relief in signs and symptoms were considered.

3. �� – 30-60% relief in signs and symptoms were considered.



4. �� – 1-30% reduction in signs and symptoms.

5. �� –�� .

Stastical analysis:

Data were colleted from sample before, after and post follows up treatment.

Statically analyzed by using students “t” test in consultation with Bio-statistician.

Observation and Results


5. OBSERVATION AND RESULTS

Statistical analysis

Statistical results of Karpasasthyadi Taila Nasya� in Group A and Group B

patients witn Nagara Taila Nasya before and after treatment were analyzed

statistically.�

Total 30 patients were registered in this study. Out of that all 30 patients were

studied in this project. 15 patients were in group A while 15 were in B group. Each

patient was observed thoroughly and noted neatly. The observations are recorded and

necessary charts and graphs were made.

DISTRIBUTION OF PATIENTS BASED ON SEX

Table No.20 Distribution of Patients Based on Sex

No. of Patients and Percentage

Sex

Group A Group B Total

Male 09 60% 08 53.33 % 17 56.67%

Female 06 40% 07 46.67% 13 43.33%

Sex wise: Out of 30 patients in group A and Group B, 17 patients were male while 13

patients were female. It means total 56.67% were male as compared to 43.33% were

female.

Group wise division: Group A has 60% male while 40% females respectively. In

Group B male were 53.33% and female were 46.67%.



Figure 5 showing Incidence of sex

DISTRIBUTION OF PATIENTS BASED ON AGE:

Table No. - 21 Distribution of Patients Based on Age


Age in years


21-30 3 20% 5 33.33% 8 26.67%

31-40 3 20% 1 6.67% 4 13.33%

41-50 4 26.67% 4 26.67% 8 26.67%

51-60 4 26.67% 3 20% 7 23.33%

61-70 1 6.67% 2 13.33% 3 10%

Age wise: Out of total 30 patients in group A and group B, maximum patients were in

age Group 41-50 and 21-30 years followed by age 51-60 years. They were 26.67%,



26.67% and 23.33% respectively. Group wise division: They were 26.67%, 20% and

26.67%, 33.33% respectively in A and B Group.

Figure 6 showing Incidence of age

DISTRIBUTION OF PATIENTS BASED ON OCCUPATION:

Table No.22 Distribution of Patients Based on Occupation:


Occupation


BUSINESS 2 13.33% 1 6.67% 3 10%

AGRICULTURIST 3 20% 2 13.33% 5 16.67%

ELECTRICIAN 1 6.67% 0 0% 1 3.33%

HOUSEWIFE 5 33.33% 5 33.33% 10 33.33%

DRIVER 1 6.67% 0 0% 1 3.33%

DOCTOR 3 20%� 0 0%� 3 10%



COOLIE 0 0%� 2 13.33%� 2 6.67%

THERAPIST 0 0%� 1 6.67%� 1 3.33%

STUDENT 0 0%� 3 20%� 3 10%

TEACHER 0 0% 1 6.67% 1 3.33%

Occupation wise: Out of total 30 patients in Group A and Group B, maximum patients

were found in Housewife followed by Agriculturist. They were 10 (33.33%) and 05

(16.67%) Respectively.

Group wise division: In, Group A, they were 33.33% and 20% respectively. In, Group

B they were 33.33% and 13.33% respectively.

Figure 7 showing Occupation incidences



DISTRIBUTION OF PATIENTS BASED ON RELIGION INVOLVED:

Table No.23 Distribution of Patients Based on Religion Involved:


RELIGION


CHRISTIAN 02 13.33% 04 26.67% 06 20%

HINDU 11 73.33% 11 73.33% 22 73.33%

MUSLIM 02 13.33% 0 0 02 6.67%

Out of total 30 patients in group A and Group B, maximum patients were of

Hindu religion (73.33%).

Group wise division: In, Group A they were 73.33% of Hindus, 13.33% of Muslims

and 13.33% Christians, while in Group B they were 73.33% of Hindus and 26.67%

Christians.

Figure 8 showing Incidence according to the religion



DISTRIBUTION OF PATIENTS BASED ON SOCIO ECONOMIC

STATUS INVOLVED:

Table No.24 Distribution of Patients Based on Socio Economic Status.

Out of thirty patients 01 (3.3%) was poor, 14 (46.6%) were of lower middle

class, 13 (43.3%) were of upper middle class and 02 (2.8%) were rich class.

Group wise division: In, Group A, upper middle class class are 46.67% and lower

middleclass are 46.67%. In, Group B , Upper middleclass are 40% and lower class are

46.67%.


Socio Economic Status


RICH 0 0 1 6.67 1 3.33%

UPPER 7 46.67 6 40 13 43.33

LOWER 7 46.67 7 46.67 14 46.67%

POOR 1 6.67 1 6.66 2 3.33%

Figure 9 showing distribution of patients by socio economic status.



DISTRIBUTION OF PATIENTS BASED BY EDUCATION��

Table No 25 Showing distribution of patients by Education:

In the study as a total 30 patients, 12 patients had Graduation (40%), 01

patient had Secondary education (3.33%), 11 patients had Primary education

(36.67%), 06 patients were uneducated (20%).

Among the 15 patients in group A, 05 patients had Graduation (33.33%), 01

patient had Secondary education (6.67%), 05 patients had Primary education

(33.33%), 04 patients were uneducated (26.67%). Among the 15 patients in group B,

7 patients had Graduation (46.67%), 06 patients had Primary education (40%), 02

patients were uneducated (13.33%).

Figure 10 showing distribution of patients by Education

�

No. of Patients and Percentage EDUCATION


GRADUATION 05 33.33% 07 46.67% 12 40%

SECONDARY 01 6.67% 0 0% 01 3.33%

PRIMARY 05 33.33% 06 40% 11 36.67%

UNEDUCATED 04 26.67% 02 13.33% 06 20%



DISTRIBUTION OF PATIENTS BASED BY MARITAL STATUS��

Table No 26 Showing distribution of patients by Marital Status :

No. of Patients and Percentage MARITAL

STATUS Group A Group B Total

Married 13 86.67% 12 80% 25 83.33%

Unmarried 02 13.33% 03 20% 05 16.67%

�

In the study as a whole 30 patients, 25 patients were married (83.33%), 05 patients

were unmarried (16.67%). Among the 15 Patients in group A, 13 patients were married

(86.67%), 02 patients were unmarried (13.33%). Among the 15 Patients in group B, 12

patients were married (80%), 03 patients were unmarried (20%).

Figure11 showing distribution of patients by Marital Status

�



DISTRIBUTION OF PATIENTS BASED ON DIETRY HABIT:

Table No.27 Distribution of Patients Based on Dietary Habit:


Dietary Habit


VEGETARIAN 04 26.67% 06 40% 10 33.33%

MIXED 11 73.33% 09 60% 20 66.67%

Out of total 30 patients in Group A and Group B, maximum patients’ dietary

habits were mixed ie: 20 (66.67%).

Group wise: In, Group A, maximum patients dietary habits were mixed 73.33% and

Vegetarian were 26.67%. In, Group B, maximum patients habits were Mixed 60% and

Vegetarian were 40%.

Figure 12 showing Incidence of Dietary habits



DISTRIBUTION OF PATIENTS BASED BY AGNI:

Table No.28 Distribution of Patients Based on Agni:

�

In the study as a total 30 patients, 12 patients were having Samagni (33.33%),

8 patients were having Teekshnagni (26.67%), 8 patients were having Manthagni

(26.67%) and 4 were having Vishamagni(13.33%).

Among the 15 patients in group A, 04 patients were having Samagni

(26.67%), 2 patients were having Teekshnagni (13.33%), 5 patients were having

Manthagni (33.33%) and 4 were having Vishamagni(26.67%). Among the 15 patients

in group B, 6 patients were having Samagni (40%), 6 patients were having

Teekshnagni (40%) and 3 patients were having Manthagni (20%).

Figure13 showing Incidence of Agni

�

No. of Patients and Percentage Agni


TEEKSHNAGNI 2 13.33% 6 40% 8 26.67%

MANTHAGNI 5 33.33% 3 20% 8 26.67%

SAMAGNI 4 26.67% 6 40% 10 33.33%

VISHAMAGNI 4 26.67% 0 0% 4 13.33%



DISTRIBUTION OF PATIENTS BASED BY KOSHTA��

Table No. 29 Distribution of Patients Based on Koshta:

No. of Patients and Percentage KOSHTA


KRURA 4 26.67% 05 33.33% 09 30%

MADYAMA 10 66.67% 10 66.67% 20 66.67%

MRUDU 1 6.67% 0 0% 1 3.33%

�

��In the study as a total 30 patient, 20 patients were having Madhyama

koshta (66.67%), 9 patients were having Krura koshta (30%), and 1 patients were

having Mrudu koshta (3.33%). Among the 15 patients in group A, 10 patients were

having Madhyama koshta (66.67%), 4 patients were having Krura koshta (26.67%),

and 1 patients were having Mrudu koshta (6.67%). Among the 15 patients in group B,

10 patients were having Madhyama koshta (66.67%) and 5 patients were having

Krura koshta (33.33%).

Figure 14 showing Incidence of Koshta

�



DISTRIBUTION OF PATIENTS BASED BY PRAKRUTI��

Table No. 30 Showing distribution of patients by Prakruti :

No. of Patients and Percentage Prakruti


VATAPITTA 9 60% 12 80% 21 70%

VATAKAPHA 6 40% 3 20% 9 30%

�

Out of total 30 patients in Group A and Group B, maximum patients were

found Vatapitta prakruthi followed by vatakapha prakruthi. They were 21 (70%) and

09 (30%) Respectively.

Group wise division: In, Group A, they were 60% and 40% respectively. In,

Group B they were 80% and 20% respectively.

Figure 15 showing distribution of patients by Prakruti

�



DISTRIBUTION OF PATIENTS BASED BY DURATION OF ILLNESS��

Table No. 31 Showing distribution of patients by Duration of illness:

No. of Patients and Percentage Duration of

illness Group A Group B Total

BELOW 1 YEAR 09 60% 11 73.33% 20 66.67%

1 YEAR ABOVE 06 40% 04 26.67% 10 33.33%

In the study as a whole (30 patients) 20 patients fall under below 1 year

(66.67%) and 10 patients fall under 1yrs-and above (33.33%).

Among 15 patients in group A, 09 patients fall under below I year (60%), and

6 patients fall under 1 yrs-and above (40%). Among 15 patients in group B, 11

patients fall under below 1 year (73.33%) and 04 patients fall under 1 yrs-and above

(26.67%).

Figure 16 showing distribution of patients by Duration of illness:

�



DISTRIBUTION OF PATIENTS BASED BY VYSANA��

Table No.32 showing distribution of patients by Vysana:

No. of Patients and Percentage VYSANA


ALCOHOL 02 13.33% 03 20% 05 16.67%

TOBACCO 05 33.33% 01 6.67% 06 20%

SMOKING 0 0% 01 6.67% 01 3.33%

NONE 08 53.33% 10 66.67% 18 60

�

Out of total 30 patients in Group A and Group B, maximum patients Vyasana

were none followed by Tobacco. They were 18(60%) and 06 (20%) respectively.

Group wise division: In, Group A, they were 53.33% and 33.33% respectively.

In, Group B they were 66.67% and 6.67% respectively.

Figure 17 showing distribution of patients by Vysana

�



DISTRIBUTION OF PATIENTS BASED OF RASA:

Table No. – 33 Distribution of Patients Based on Rasa


RASA


KATU 07 46.67% 08 53.33% 15 50%

TIKTA 06 40% 05 33.33% 11 36.67%

KASHAYA 02 13.33% 02 13.33% 04 13.33%

Out of total 30 patients in group A and Group B, maximum patients Rasa are

Katu and Tikta. They were 15(50%) and 11 (36.67%) respectively.

Group wise division: In, Group A, they were 46.67% and 40% respectively. In,

Group B, they were 53.33% and 33.33% respectively.

Figure 18 showing showing distribution of patients by Rasa



DISTRIBUTION OF PATIENTS BASED ON ONSET:

Table No.34 Distribution of Patients Based on Onset


Onset


SUDDEN 01 6.67% 02 13.33% 03 10%

GRADUAL 08 53.33% 08 53.33% 16 53.33%

INCIDIOUS 06 40% 05 33.33% 11 36.67%

Out of total 30 patients in group A and Group B, maximum patients are in

gradual 16 (53.33%).

Group wise division: In, Group A out of 15 patients gradual is 53.33%, Insidious is

40% and Sudden is 6.67%. In, Group B, out of 15 patients gradual is 53.33%

Insidious is 33.33% and Sudden is 13.33%.

Figure 19 showing showing distribution of patients by Onset



DISTRIBUTION OF PATIENTS BASED ON VIHARA:

Table No.35 Distribution of Patients Based on Vihara


VIHARA


HARD 04 26.67% 02 13.33% 06 20%

MODERATE 09 60% 13 86.67% 22 73.33%

SEDENTARY 02 13.33% 0 13.33% 02 6.67%

Out of total 30 patients in group A and Group B Hard Vihara patients are 20%,

Moderate Vihara patients are 73.33% and Sedentary Vihara patients are 6.67%.

Group wise division: In, Group A, Hard Vihara patients are 26.67%, Moderate Vihara

patients are 60% and Sedentary Vihara patients are 13.33%. In, Group B, Hard Vihara

patients are 20%, Moderate Vihara patients are 73.33% and Sedentary Vihara patients

are 6.67%.

Figure 20 showing distribution of patients by Vihara



DISTRIBUTION OF PATIENTS BASED ON SATVA:

Table No.36 Distribution of Patients Based on Satva


SATVA


AVARA 5 33.33% 6 40% 11 36.67%

PRAVARA 2 13.33% 9 60% 11 36.67%

MADHYAMA 8 53.33% 0 0% 8 26.67%

Out of total 30 patients in group A and Group B, Maximum patients were in

Avara and Pravara ie, 36.67% and 36.67% respectively.

Group wise division: In, Group A, Maximum patients were in Madhyama 53.33%

followed by Avara 33.33%. In, Group B, Maximum patients were in Pravara 60%

followed by Avara 40%.

Figure 21 showing distribution of patients by Satva



DISTRIBUTION OF PATIENTS BASED ON VYADHI BALA:

Table No.37 Distribution of Patients Based on Vyadhi Bala


Vyadhi Bala


MADHYAMA 15 100% 15 100% 30 100%

Out of total 30 patients in group A and Group B, All patients Vyadhi Bala

were Madhyama.

Figure 22 showing distribution of patients by Vyadhi Bala

DISTRIBUTION OF PATIENTS BASED ON HABITAT:

Table No. 38 Distribution of Patients Based on Habitat


Habitat


URBAN 06 40% 06 40% 12 40%

RURAL 09 60% 09 60% 18 60%



Out of total 30 patients in group A and Group B, maximum patients habitat is

Rural 18(60%) followed by Urban Habitat 12(40%).

Group wise division: In, Group A, maximum patients Habitat is Rural

09(60%) followed by Urban Habitat 06(40%). In, Group B, maximum patients

Habitat is Rural 09(60%) followed by Urban Habitat 06(40%).

Figure 23 showing distribution of patients by Habitat

DISTRIBUTION OF PATIENTS BASED ON NIDRA:

Table No.39 Distribution of Patients Based on Nidra


NIDRA


DISTURBED 10 66.67% 10 66.67% 20 66.67%

NOT DISTURBED 05 33.33% 05 33.33% 10 33.33%



Out of total 30 patients in group A and Group B, maximum patients Nidra is

Disturbed 20(66.67%) followed by Not Disturbed 10(33.33%).

Group wise division: In, Group A, Maximum patients Nidra is Disturbed

10(66.67%) followed by Not Disturbed 5(33.33%). In, Group B, Maximum patients

Nidra is Disturbed 10(66.67%) followed by Not Disturbed 5(33.33%).

Figure 24 showing distribution of patients by Nidra

DISTRIBUTION OF PATIENTS BASED ON JOINT:

Table No.40 Distribution of Patients Based on Joint


JOINT


RIGHT 07 46.67% 09 60% 16 53.33%

LEFT 08 53.33% 06 40% 14 46.67%

Out of total 30 patients in group A and Group B, maximum patients Joint is

Right 16(53.33%) followed by Left Joint 14(46.67%).



Group wise division: In, Group A, Maximum patients Joint is Right

07(46.67%) followed by Left Joint 18(53.33%). In, Group B, Maximum patients Joint

is Right 09(60%) followed by Left Joint 06(40%).

Figure 25 showing distribution of patients by Joint

RESULTS

Effects of Karpasasthyadi Taila (Group-A)

Table No.41 Effect of Group-A on Shoola of Avabahuka

Effect on Shoola

In this work of 15 patients studied in Avabahuka with Group-A Shoola

revealed are given in detail in Table No.41. Statistical analysis showed that the mean

score which was 2.87 before the treatment was reduced to 1.47 (49%) after the

Mean score

SYMPTOM

BT

BT-

AT

%

S.D

(±)

S.E

(±)

t value p value

AT 1.47 1.40 49 0.736 0.190 7.35 <0.001

SHOOLA

2.87

FU 0.27 2.60 91 0.507 0.131 19.85 <0.001



treatment and after follow up it became .27 with 91% improvement and there is a

statistically highly significant. (P<0.001) results are graphically represented in figure

no 26:

Table No.42, Effect of Group-B on Shoola of Avabahuka

Effect on Shoola

In this work of 15 patients studied in Avabahuka with Group-B on Shoola

revealed are given in detail in Table No.42. Statistical analysis showed that the mean

score which was 2.47 before the treatment was reduced to 1.20 after the treatment and

after follow up it became .47 with 81% improvement and there is a statistically

significant change. (P<0.001) results are graphically represented in figure:

Figure 26 showing Effect ofGroup A and Group-B on Shoola

Mean score

SYMPTOM

BT BT-AT

%

S.D

(±)

S.E

(±)

t value p value

AT 1.20 1.27 51 0.799 0.206 6.14 <0.001

SHOOLA

2.47

FU 0.47 2.00 81 0.925 0.239 8.36 <0.001



Table No 43 Effect of Group-A Unnamana of Avabahuka

Mean score

SYMPTOM

BT BT-AT

%

S.D

(±)

S.E (±) T value

p

value

AT 1.47 1.06 42 0.258 0.066 16.00 <0.001

UNNAMANA 2.53

FU 0.87 1.66 66 0.617 0.159 10.45 <0.001

Effect on Unnamana

An assessment of Unnamana in patients of Avabahuka before and after the

treatment with Group-A showed reduction in the mean score from 2.53 to 1.47 after

the treatment and after follow up it became 0.87 with 66% improvement. It is found to

be statistically highly significant (P<0.001). The details are shown with statistical data

in Table No.43 and graphically represented in figure:

Table No.44 Effect of Group-B on Unnamana of Avabahuka

Mean score

SYMPTOM

BT BT-AT

%

S.D

(±)

S.E (±) T value

p

value

AT 1.67 0.86 34 0.516 0.133 6.50 <0.001

UNNAMANA 2.53

FU 0.93 1.60 63 0.632 0.163 9.79 <0.001

Effect on Unnamana

An assessment of Unnamana in patients of Avabahuka before and after the

treatment with Group-B showed reduction in the mean score from 2.53 to 1.67 after



the treatment and after follow up it became 0.93 with 63% improvement. It is found to

be statistically significant (P<0.001). The details are shown with statistical data in

Table No.44 and graphically represented in figure:

Figure 27 showing Effect ofGroup A and Group-B on Unnamana

Table No 45, Effect of Group-A Avannamana of Avabahuka�

Mean score

SYMPTOM

BT BT-AT

% S.D (±) S.E(±) t value p value

AT 1.40 1.07 43 0.258 0.067 16.00 <0.001

AVANNAMANA 2.47

FU 0.40 2.07 84 0.258 0.067 8.67 <0.001

Effect on Avannamana of Avabahuka

Magnitude of Avannamana in patients of Avabahuka before and after the

treatment was assessed and analyzed statistically. In patients registered in GROUP-A

group showed highly significant improvement (P<0.001). The mean score which was

2.47 before treatment reduced to 1.40 after the treatment and after follow up it

become 0.40 with 84% improvement. Further the particulars are tabled below in Table

No.46 and graphically represented in figure :



Table No.46, Effect of Group-B on Avannamana of Avabahuka�

Mean score

SYMPTOM

BT BT-AT

% S.D (±) S.E(±) t value p value

AT 1.73 0.74 30 0.593 0.153 4.78 <0.001

AVANNAMANA 2.47

FU 0.60 1.87 76 0.516 0.133 14.00 <0.001

Effect on Avannamana of Avabahuka

Magnitude of Avannamana in patients of Avabahuka before and after the

treatment was assessed and analyzed statistically. In patients registered in GROUP-B

group showed statistically significant improvement (P<0.001). The mean score which

was 2.47 before treatment reduced to 1.73 after the treatment and after follow up it

become 0.60 with 76% improvement.

Figure 28 showing Effect ofGroup A and Group-B on Avannamana



Table No. 47 Effect of Group-A on Akunchana

Mean score

SYMPTOM

BT BT-AT

%

S.D

(±)

S.E

(±)

t

value

p

value

AT 1.47 0.93 39 0.258 0.067 14.00 <0.001

AKUNCHANA 2.40

FU 0.47 1.93 81 0.258 0.067 29.00 <0.001

Effect on Akunchana

By the treatment, in GROUP-A Akunchana was observed with a mean

reduction of score from 2.40 to 1.47 after treatment and after follow up it again

reduced to 0.47 with 81% improvement. Analysis of this data shows statistically

significant improvement (P<0.001).

Table No.48, Effect of Group-B on Akunchana

Mean score

SYMPTOM

BT BT-AT

% S.D (±)

S.E

(±)

t

value

p

value

AT 1.60 0.73 31 0.593 0.153 4.78 <0.001

AKUNCHANA 2.33

FU 0.73 1.60 69 0.507 0.131 12.22 <0.001

Effect on Akunchana

By the treatment, in GROUP-B Akunchana was observed with a mean






Figure 29 showing Effect of Group A and Group-B on Akunchana

Table No 49, Effect of Prasarana on Group-A

Mean score

SYMPTOM

BT BT-AT

%

S.D

(±)

S.E

(±)

t

value

p

value

AT 0.80 1.27 61 0.458 0.118 10.71 <0.001

PRASARANA 2.07

FU 0.27 0.80 87 0.414 0.107 16.83 <0.001

By the treatment, in GROUP-A Prasarana was observed with a mean reduction

of score from 2.07 to 0.80 after treatment and after follow up it again reduced to 0.27

with 87% improvement. Analysis of this data shows statistically significant

improvement (P<0.001).

Table No 50, Effect of Prasarana on Group-B

Mean score

SYMPTOM

BT BT-AT

%

S.D

(±)

S.E (±) t value p value

AT 1.13 0.87 43 0.834 0.215 4.02 <0.001

PRASARANA 2.00

FU 0.40 1.60 80 0.828 0.214 7.48 <0.001



By the treatment, in GROUP-B Prasarana was observed with a mean




Figure 30 showing Effect of Group A and Group-B on Prasarana

Table No.51 Effect of Triyakgamana on Group-A

Mean score

SYMPTOM

BT

BT-

AT

% S.D(±) S.E (±) t value p value

AT 0.80 1.20 60 0.560 0.145 8.29 <0.001

TRIYAKGAMANA 2.00

FU 0.47 1.53 77 0.640 0.165 9.27 <0.001

By the treatment, in GROUP-A Triyakgamana was observed with a mean






Table No 52 Effect of Triyakgamana on Group-B

Mean score

SYMPTOM

BT

BT-

AT

%

S.D

(±)

S.E (±) t value p value

AT 1.33 0.73 35 0.703 0.182 4.03 <0.001

TRIYAKGAMANA 2.07

FU 0.73 1.34 65 0.723 0.187 7.03 <0.001

By the treatment, in GROUP-B Triyakgamana was observed with a mean




Figure 31 showing Effect of Group A and Group-B on Triyakgamana.



ASSESSMENT OF TOTAL EFFECT OF THERAPY

Table No 53. Overall effect of Karpasasthyadi Taila Group-A

EFFECT OF TREATMENT IN GROUP - A

Class Grading No of patients

100 �� 0

61-99 �� 15

31-60 �� 0

1-30 �� 0

0 �� 0

Figure 32 showing Result on Group A



Effects of Nagara Taila (Group-B)

ASSESSMENT OF TOTAL EFFECT OF THERAPY

Table No.54 Overall effect of Group-B

EFFECT OF TREATMENT IN GROUP - B

Class Grading No of patients

100 �� 0

61-99 �� 13

31-60 �� 2

1-30 �� 0

0 �� 0

Figure 33 showing Result on Group B



Table No.55 Comparative results of Group-A and Group-B

Result of group A

The percentage of improvement in Group A on Shoola is 91%, Unnamana is

66%., Avannamana is 84%, Akunchana is 81%, Prasarana is 87%, and Triyakgamana

is 77%.

Characteristics Group-A Group-B

Mean score Mean score

Signs and Symptoms

BT FU

Percentage of

relief BT FU

Percentage of

relief

SHOOLA 2.87 0.27 91 2.47 0.47 81

UNNAMANA 2.53 0.87 66 2.53 0.93 63

AVANNAMANA 2.47 0.40 84 2.47 0.60 76

AKUNCHANA 2.40 0.47 81 2.33 0.73 69

PRASARANA 2.07 0.27 87 2.00 0.40 80

TRIYAKGAMANA 2.00 0.47 77 2.07 0.73 65



Result of group B

The percentage of improvement in Group B on Shoola is 81%, Unnamana is 63%.,

Avannamana is 76%, Akunchana is 69%, Prasarana is 80%, and Triyakgamana is

65%.

Comparative results of Group-A and Group-B –

In case of Avabahuka, Group A overall result is 81% and Group B overall

result is 73%

Figure 34 showing Comparative results of Group-A and Group-B

Table No 56 Comparative Results of Group A and Group B

Group A Group B Mean

Difference

SE (±) T value P value

81.16 72.77 8.39 5.44 1.54 >0.001



Comparison of total effect of two groups had analyased statistically through Paired t

test. The test revealed that Group A Nasya with Karpasasthyadi Taila had got highly

significant result than Group B Nasya with Nagara Taila. Details are given in the

table above.

Table No 57 Overall results of the Patients

Srl No. Group A Group B

1 87.50 73.33

2 80.00 84.62

3 72.22 86.67

4 91.67 84.62

5 81.25 25.00

6 81.25 53.85

7 81.25 91.67

8 92.31 80.00

9 92.31 81.25

10 92.31 62.50

11 78.57 90.91

12 76.92 45.45

13 69.23 62.50

14 69.23 84.62

15 71.43 84.62

Statistical analysis proved that the group-A is more effective than group-B.

Discussion


6. DISCUSSION

Avabahuka has been described as one among the Nanatmaja Vyadhi caused by

Vata Dosha. The Morbid Vata, which gets lodged in Amsa Moola, will cause the

Sirasankochana (constriction of the Sira) locally and produces Bahupraspandahara

(restricted movement), manifesting Avabahuka. Also in this condition Vyanavata

combines with Sleshakakapha and leads to Gatisanga (restricted movement) and

produces Avabahuka.

There are many clinical conditions described in the medical texts, which

involves the shoulder joint, from which the most common condition is Adhesive

Capsulitis or Frozen shoulder. Frozen shoulder is a condition that causes restricted

range of active and passive glenohumeral motion in the shoulder joint.

The capsule surrounding the shoulder joint contract and form scar tissue called

adhesions. Contraction of the capsule surrounding Shoulder joint and the formation

of the adhesions cause the shoulder to become stiff and cause movements, more

painful. There is also lack of synovial fluid, which normally lubricates the gap

between arm bone and socket to help shoulder joint move. In this condition pain and

stiffness of the shoulder joint are the cardinal symptom leading to inability of affected

upper limb.

In contemporary medical science potent Analgesics, Anti-inflammatory drugs

and also Corticosteroids are prescribed for this type of condition. These drugs do

posses increased risk of gastric erosion, hepatic and nephron-toxicity type of adverse

effects.

The treatment modalities told in Ayurveda for the management of Avabahuka

has got a greater role to play in the treatment and prophylactic care

Discussion


Discussion about conceptual study:

The clinical trial is a comparative study between Nasya with Karpasasthyadi

Taila and Nagara Taila in management of Avabahuka. Diagnostic criteria of

Avabahuka are based on the Prathyatma Lakshanas which are explained in texts as

Bahupraspanda Hara and Shoola. In the present clinical study total number of 30

patients was selected randomly and irrespective of their sex, cast or creed and

chronicity of the diseases, from the out patient and in patient department of K.V.G

College of Ayurveda Hospital, Sullia. The first group named Group-A Nasya with

Karpasasthyadi taila included 15 patients and the second group named Group-B

Nasya with Nagara Taila consisted of 15 patients were studied.

The History taking, Examination and Investigations were done according to

the specially prepared proforma. The patients with Fractures and Dislocations of the

joint are excluded where the line of treatment is different form the present line of

treatment.

Discussion on Nasyakarma:

Route of administration always has its own importance in management

of any disease. Nasya is a term to be applied generally for medicines or medicated

oils administered through the nasal passage as stated by Acharya Sushruta.

According to Ayurvedic classics in Urdhwajatrugata Vikara Nasya therapy is

most favorable. Avabahuka is one among them.

Mode of action of Nasya karma

In Ayurvedic classics, the mode of action of Nasya Karma is explained indirectly.

According to Charaka Samhita, the drug administered through the nose enters

in the Uttamanga and eliminates the morbid Doshas residing there.

Discussion


According to Vrudda Vagbhata :

Drug administered through nose -the doorway to Shira

Reaches the Shringataka Marma of Head (Shira), which is a Sira Marma and

formed by the Siras of nose, eyes, Kantha and Shrotra

The drug spreads by the same route

Scratches the morbid Doshas of Urdhwajatru and extracts them from the

Uttamanga

Indu, the commentator of Ashtanga Sangraha, opined that Shringataka is the

inner side of middle part of head i.e. “Shiraso Antar Madhyam”.

In this context Sushruta has clarified that Shringataka Marma is a Siramarma

formed by the union of Siras (blood vessels) supplying to nose, ear, eye and tongue.

Thus we can say that drug administered through Nasya may enter the above Sira and

purifies them. Under the complications of Nasya Karma, Sushruta has mentioned that

excessive eliminative errhine may cause Mastulunga Strava (flow of cerebrospinal

fluid out to the nose). Which suggest the direct relation of Nasal pathway to brain.

All ancient Acharyas have said considered Nasa as the gate way of Sheera. It

does not mean that any channel directly connects brain and nose, but it may be

suggestive of any connection through blood vessels, lymphatics and nerve.

Drug absorption and Transportation :

Keeping the head in lowered position and retention of medicine in

nasopharynx help in providing sufficient time for local drug absorption. Any liquid

Discussion


soluble substance has greater chance for passive absorption directly through the cell

of lining membrane. On other hand, massage and local fomentation also enhances the

drug absorption. The later course of drug transversion can occur in two ways.

(i) By systemic circulation (ii) Direct pooling into the intracranial region.. This

direct transportaion can be assumed again in two paths, viz. (a) By vascular path, (b)

Lymphatic path. Vascular path transportation is possible through the pooling of nasal

veinal blood to the facial vein, which naturally occurs. Just of the opposite entrance

the inferior ophthalmic veins also pool into the facial vein. Interestingly, both facial

and ophthalmic veins have no veinal valves in between. So that, blood may drain on

either side, that is to say the blood from facial vein can enter cavernous venous sinus

of the brain in reverse direction. Thus, such a pooling of blood from nasal veins to

venous sinuses of the brain is more likely in the head lowered position due to gravity.

On this lines, the absorption of drug materials into meninges and related parts of

intracranial organs, is a worth considering point. Moreover the modern scholars have

noted that the infective thrombosis of the facial vein may lead to infection of the

meninges easily through this path Pooling of blood from paranasal sinuses also

possible in the same manner. Vaghbhatta;s notation of Shringataka Srotas (anterior

cranial fossa) seems to relation with the above explanation.

The lowering of the head, elevation of lower extremities and fomentation of

face, seem to have an impact on blood circulation of the head and face. As the efferent

vasodilator nerves are spread out on the superficial surface of the face, receive

stimulation by fomentation and it may engender the increased blood flow to the brain.

Discussion on Dose of Nasya

The amount of liquid that flow, down after immersing two digits of index

finger in any liquid and taking the finger out is (forms) one Bindu (drop).Acharya

Discussion


Vaghbhata, had told that ten, eight, six Bindus are the maximum, medium, minimum

doses, respectively of Marsha Nasya. Since the taila used is Theekshna Avara Matra

have been considered i.e. 6 Bindhus is taken for Nasya.

Discussion Mode of action of Karpasasthyadi Tail

Karpasasthyadi Taila comprises mainly Karpasa, Masha, Kulattha, Bala,

Pippalimoola, Sigru, Nagara etc.and Taila having the properties like Snigdha Guna,

Ushna Veerya and Vata-Kapha Shamaka and acts as Vedana Shamaka, Shothahara

and Brumhana. Thus provides significant effect on symptoms of Avabahuka.

Avabahuka is Vata predominated disease. Karpasasthyadi Taila is having

Vatahara property. Most of the contents of Karpasasthyadi Taila has Katu Rasa, this

Katu Rasa even though aggravates Vata Vyadhi, but with the influence of Snigdha,

Guru Guna of Taila, Usna Guna and Veerya of the ingredients it subsides the

aggravated Vata in Avabahuka .The Usna Guna of the ingredients of Karpasasthyadi

Taila subsides the Sheeta Guna of Vata to subside the Shoola and Sthabthatha in

Avabahuka.

Discussion Mode of action of Nagara Taila

Nagara

Avabahuka is Vata predominated disease .The Ushna Guna of Nagara

subsides Sheeta Guna of Vata to subside the Shoola and Sthabthatha in Avabahuka.

Taila

Taila is having Ushna, Teekshna, Guna etc . Avabahuka is Vata predominant

disease. Due to the Vata Hara properties and Usna Guna we are getting a good

result.

Discussion


Taila is having Mrudhukara Bhavas (softening property) .In Avabahuka

Akunchana (constriction) is there. This Akunchana is relieved by the Mrudhukara

Bhavas of the Taila.

Mode of action of Nagara taila in Shoola and Sthabdhatha

Shoolahara Dashemani Drayas is having Ushna Verya. Nagara is having Usna

Guna. Shoola and Sheeta are inter related. All painful Vatavyadhi get aggravated by

cold (Shayithyatha).If we give hot fomentation i.e. Usna the pain subsides. This part

suggests that Nagara due to it Usna Guna subsides the Shoola of Avabahuka.

Sthabdhatha is produced due to Sheeta as well as Rooksha Guna. Nagara taila

is having Usna and Snigdha Guna.Usna Guna of Nagara subsides the Sheetha

(Sthabthatha) of Avabahuka.

Snigtha Guna of taila subsides the Rookshatha (Sthabthatha) of Avabahuka.

Nagara is having Madhura Vipaka. Due to the Madhura Vipaka it does the

Bruhmana effect. Brumhana is the one, which is done or used for the nourishment.

In the present context of Avabahuka the vitiated Vata due to its Rookshadi qualities

reduces the Snigdhata of Amsa Pradesha (Snayu, Sandhi). To subside this Rookstha

and to strengthen the amsa Pradesha Nasya with Nagara Taila is advised.

Discussion on observations of the clinical study & Results

Age

Incidence of 30 patients suffering from Avabahuka showed more number of

patients between the age group of 41-50 (26.67%) and 21-30 (26.67%) years followed

by age 51-60 years (23.33%) i.e. more number of patients is between the age group of

20-50. This suggests that disease is more common in middle age group. Maximum

number of patients belonged to the age group of 41-50 (26.67%) and 21-30 (26.67%)

and less in 61-70years (10%). The reason behind this may be because this group of

Discussion


adults are under strong working pressure in today’s modern lifestyle which leads to

irregular exercise, abnormal postures and working for long time without taking proper

rest.

The age group of 41-50 (26.67%),, 4th

and 5th

decade of life, According to

modern science, there is progressive decrease in the degree of hydration of joint

space, with age that leads to the cycle of degeneration.

Sex

In the sample taken for the study, 56.67% of males were registered in

comparison to 43.33% of females. This suggests incidence of disease is come more

common in male. Strenuous work schedule like carrying heavy loads, working with

upper limb to perform different agricultural works driving ,etc, may be a causative

factor in the predominance. All the females in the study were housewives having

excessive work in house like washing cloths, dishes, sweeping , etc, this reflects that

their habit of work is having a direct influence in aetiopathogenesis of Avabahuka.

Among males most of them were in Agriculture and Labour Work which is having

direct impact on this disease.

Marital status

83.33% patients registered in the study were married and 16.67 % were

unmarried. As this disease more common in age group of above 20 years & most of

people get married.

Education:

In the study as a total 30 patients, 12 patients had Graduation (40%), , 11

patients had Primary education (36.67%), 06 patients were uneducated (20%) and 01

patient had Secondary education (3.33%). This data reflects that physical strain

Discussion


activities and inadequate health care due to busy lifestyle , may contribute in the

manifestation of the disease Avabahuka.

Socio-economic status

Out of thirty patients 01 (3.3%) was poor, 14 (46.6%) were of lower middle

class, 13 (43.3%) were of upper middle class and 02 (2.8%) were rich class. About

socio-economic status of patients, maximum number of patients was of Lower middle

class, followed by upper middle class and Rich class indicates that this disease

incidence is common in lower middle classes

According to Acharya Vagbhata consuming insufficient quantity of food does

not help in improvement of strength, growth and vigour, it becomes a cause for all

diseases of Vata orgin.(AH.Su.8/3).

The lower middle classes, who depend on hard work for their daily expenses

and have a under nourished diet indicates that the diseases has a direct relation with

the Socio-economic status of the patient.

Occupation

Out of total 30 patients in Group A and Group B, maximum patients were

Housewife followed by Agriculturist. They were 10 (33.33%) and 05 (16.67%)

Respectively. Group wise division: In, Group A, they were 33.33% and 20%

respectively. In, Group B they were 33.33% and 13.33% respectively.

Strenuous work schedule may be a causative factor in the predominance. All

the females in the study were housewives having excessive work in house and this

reflects that their habit of work is having a direct influence in aetiopathogenesis of

Discussion


Apabahuka. Among males most of them were in Agriculture and Labour Work which

is having direct impact on this disease.

Habitat

Out of total 30 patients in group A and Group B, maximum patients habitat is

Rural 18(60%) followed by Urban Habitat 12(40%). This once again suggests

Avabahuka is more common in peoples of rural area as they come from low socio

economic status.

Dietary Habit

Patients in this group does not exhibit much preponderance of either

vegetarian or mixed food habits in the causation of this illness. As this study showed

66.67 % of patients had the habit of mixed diet, in comparison to 33.33 % of patients

restricted only to vegetarian dietary habits. The study exhibited that 66.67% of the

patients were non-vegetarians (mixed) consumption of more spicy food, this may

cause further vitiation of Vata causing Avabahuka.

Intake of Dominent Rasa:

Majority of patients had a diet of consuming Katu Rasa Pradana Ahara 50%.

Katurasa is one of Nidana for Vata Prakopa.36.67 % prefers Tiktha Rasa Pradhana

Ahara and 13.33% consuming Kashayarasa Pradhana Ahara. These are the some

factors explained in the Samanya Vatavyadhi Nidana. This supports and validates the

presumption that made earlier that Vatavyadhi Samanya Nidana can be taken as

Nidana for Avabahuka.

Discussion


Agni

Majority of the patients 33.33 % were having Samagni followed by

Teekshnagni in 26..67 % and Mandagni is found to be in 26.67 % and Vishamagni in

13.33 % of the patients and Vishamagni. The Roga Marga in Avabahuka is

Madhyama, so herethere is no role of Agni in the maniefestation of the diseases.

Nidra

It is quite obvious that, a disease, dominant with pain will disturbs the sleep

pattern. In the present study , out of thirty patients 20(66.67 %) complained that, they

had disturbed sleep and 10 (33.33 %) sleep was not disturbed. In the present study

maximum number of patients i.e. 33.33 % had a Normal sleep where as 66.67 % of

people had a disturbed sleep. It indicates that more number of patients had the Anidra

as an aetiological factor for the Prokopana of Vata.

Vyasana

Out of total 30 patients in Group A and Group B, maximum patients 18 (60 %)

Vyasana were none followed by Tobacco 06 (20%) respectively. The Study reveals

that Tobacco Smoking, Chewing and alcoholism may not have effect on this disease

as 40 % of patients were having addiction and 60 % were not having any addiction. It

shows the present trend of life.

Satvabala

Out of thirty patients, 11 (36.67%) had Avara Satvabala and Pravara

Satvabala. 8 (26.67 %) patients had Madyama Satvabala.

Discussion


Prakruthi:

Majority of patients were belong Vatapitta Prakruthi ie 70 %.Vatakapha

Prakruthi persons are 30 %. Avabahuka is a disease in which Vata have a

predominant role ie Vatika Purushas were more afflicted by Vataja disorders. That

may be the reason for longstanding nature of the disease.

Chronicity (Duration of illness):

In the study as a whole (30 patients) 20 patients fall under below 1 year

(66.67%) and 10 patients fall under 1yrs-and above (33.33%).In Yogaratnakara it is

clearly mentioned that Kaalathikranmethethu kashtam bhavathi durjaram. So

Avabahuka is a chronic disease if it is > 1 years. From this it is also clear that patients

consults for this disease in early stages.

Vyadhibala:

Vyadhibala had assessed considering Nidana Panchaka,Chronicity and

Severity of the disease. Out of total 30 patients in group A and Group B, All patients

Vyadhi Bala were Madhyama.

Mode of Onset

Out of total 30 patients in group A and Group B, maximum patients are in

gradual 16 (53.33%), 11 (36.67 %) were had incidious onset and 03 (10%) had

sudden onset.

Discussion


Joint involvement

Out of total 30 patients in group A and Group B, maximum patients Joint is

Right 16(53.33%) followed by Left Joint 14(46.67%). This may be because most of

the patients were right handed.

Effect of therapy on signs and symptoms:

Based on the feature’s of Avabahuka as explained in the classics, which are

Shoola and Bahupraspanda Hara (Sthabthatha) , it was observed in the study that all

the patients were presented with the same feature. All the patients complained with

decreased strength in the affected shoulder joint

All the 30 patients complained about difficult in Throwing , Pulling any

heavy things, Carrying weight, Keeping up the objects in shelf, scratching the back

during bath and finally by doing these the pain get aggravates which leads to

disturbed sleep. Also the 30 patients noticed that the pain aggravates in night hours,

relieves in day hours, with rest and by giving support to the affected shoulder joint.

This shows the relation between the etiological factors and symptoms. Symptoms also

show the effect of Kala on the disease which supports that Avabahuka is of Vataja

and Kaphaja variety.

The effect of therapy was assessed on each signs and symptoms of Avabahuka

by standard questionnaires. The functional ability score before and after treatment

were assessed statistically to see the significance. The details are as follows:

Discussion


Group A-Karpasasthyadi Taila

Effect on Shoola:

a) After completion of Nasya :

The intensity of the pain was markedly decreased just after the Nasya Karma.

Statistical analysis showed that the mean score which was 2.87 before the treatment

was reduced to 1.47 with 49 % improvement. This means the Nasya i.e.

Karpasasthyadi Taila reduces the intensity of the Shoola, in the patients of

Avabahuka.

b) After Follow up of Treatment:

A highly significant change in the severity of Shoola was observed after

follow up of up of treatment. Mean score which was 2.87 before the treatment was

reduced to 1.47 after the treatment. and after follow up it became 0.27 with 91%

improvement and there is a statistically highly significant

This means the Nasya with Karpasasthyadi Taila is effective in reducing the

intensity of the pain.

Effect on Bahupraspandahara (Unnamana -Abduction):

a) After completion of Nasya:

In group, after Nasya highly significant changes were observed. The

Abduction initial value of Goniometric reading was 2.53 and reduced to 1.47 with

improvement of 42%. After treatment the mean score reduced to 1.47 which was

Discussion


statistically significant. This shows improvement in degree of movement by,

statistically significant as assessed by paired ‘t’ test.

After follow up of Treatment:

The difference in mean score of abduction after follow up of treatment showed

improvement in degree of movement to 0.87 with 66% improvement, as compared to

before treatment. On statistical analysis by paired‘t’ test the difference was highly

statistically significant.

The improvement may be because of the drugs used, which help in pacifying

Vyanavata.

Effect on Bahupraspandahara (Avannamana -Adduction):


In the group, after Nasya highly significant changes were observed. The

Adduction initial value was 2.47 and reduced to 1.40 with improvement 43%. After

treatment the mean score reduced to 1.40 which was statistically significant. This

shows improvement in degree of movement , statistically significant as assessed by

paired ‘t’ test.


The difference in mean score of adduction after follow up of treatment showed

improvement in degree of movement to 0.40 with 84% improvement as compared to

before treatment. On statistical analysis by paired‘t’ test the difference was

statistically highly significant.

Discussion


Effect on Bahupraspandahara (Akunchana -flexion):


In group, after Nasya highly significant changes were observed. The flexion

initial value was 2.40 and reduced to 1.47 with 39% improvement. After treatment the

mean score reduced to 1.150 which was statistically significant. This shows

improvement in degree of movement by 39%, statistically significant as assessed by



The difference in mean score of flexion after follow up of treatment showed

improvement in degree of movement to 0.47 ie 81 % as compared to before treatment.

On statistical analysis by paired‘t’ test the difference was statistically highly

significant.

Effect on Bahupraspandahara (Prasarana - extension):


In group, after Nasya highly significant changes were observed. The extension

initial value was 2.07 and reduced to 1.27 with 61 % improvement. After treatment

the mean score reduced to 0.80 which was statistically significant. This shows


paired‘t’ test.

Discussion



The difference in mean score of extension after follow up of treatment showed


On statistical analysis by paired‘t’ test the difference was statistically highly

significant.

Effect on Bahupraspandahara (Circumduction-Triyakgamana):

In group, after Nasya highly significant changes were observed. The

Circumduction initial value was 2.00 and reduced to 0.80 with 60 % improvement.

After treatment the mean score reduced to 0.80 which was statistically highly

significant. This shows improvement in degree of movement by 60 %, statistically

significant as assessed by paired‘t’ test.


The difference in mean score of Circumduction after follow up of treatment

showed improvement in degree of movement to 0.47 ie 77 % as compared to before

treatment. On statistical analysis by paired‘t’ test the difference was statistically

highly significant.

Overall Assessment: Analysis of over all effect of the treatment in the patients of

Avabahuka showed good improvement.

The treatment was given with seven days of Nasya with Karpasasthyadi taila

which was highly significant. None of the patients develop any complications, or any

untoward symptom or any side effects during the course of treatment in the study

group and therefore the treatment modalities is safe and is of therapeutic value. Here

Discussion


when we compare with Nasya with Nagara Taila group B, group A got very good

improvement after the follow up than after treatment.

The above said observations indicate that patients have shown improvement in

all the criteria of assessment of Avabahuka. The therapeutic effects like Vedana

Sthapak, Stambha hara etc. are achieved, by relieving shoola and improvement in the

movement of Bahu. The ultimate effect will be in reducing the intensity of the shoola

and controlling the vitiated vata as the basic management of Avabahuka. Along with

this therapeutic effect, Balya and Rasayana are achieved in these modalities.

Group B-Nagara Taila

Effect on Shoola:

c) After completion of Nasya :

The intensity of the pain was markedly decreased just after the Nasya Karma.

Mean score of Shoola was 2.47 before treatment which was reduced significantly to

1.20 after treatment with 51 % improvement. After treatment the mean score reduced

to 1.20 which was statistically significant. This means the Nasya with Nagara Taila is

very effective in reducing the intensity of the shoola, in the patients of Avabahuka.

d) After Follow up of Treatment:

A highly significant change in the severity of Shoola was observed after

follow up of up of treatment. Mean score of Shoola was 2.47 before treatment, which

was reduced highly significantly to 0.47 after follow up with 81 % improvement.

After post follow up the mean score reduced to 0.47 which is statistically highly

significant.

Discussion


This means the Nasya with Nagara Taila is effective in reducing the intensity

of the pain.

Effect on Bahupraspandahara (Unnamana-Abduction):


In group, after Nasya significant changes were observed. The Abduction

initial value of reading was 2.53 and reduced to 1.67 with 34 % improvement. After

treatment the mean score reduced to 1.67 which was statistically significant. This

shows improvement in degree of movement by 34 %, statistically significant as

assessed by paired ‘t’ test.


The difference in mean score of abduction after follow up of treatment showed


On statistical analysis by paired ‘t’ test the difference was statistically significant.

The improvement may be because of the drug used, which help in pacifying

Vyanavata.

Effect on Bahupraspandahara (Avannamana-Adduction):


In group, after Nasya significant changes were observed. The Adduction initial

value was 2.47 and reduced to 1.73 with 30% improvement. After treatment the mean

score reduced to 01.73 which was statistically significant. This shows improvement in

degree of movement by 30%, statistically significant as assessed by paired ‘t’ test.

Discussion



The difference in mean score of adduction after follow up of treatment showed

improvement in degree of movement to 0.60 i.e. 76 % as compared to before

treatment. On statistical analysis by paired‘t’ test the difference was statistically

significant.

Effect on Bahupraspandahara (Akunchana-flexion):


In group, after Nasya significant changes were observed. The flexion initial

value was 2.33 and reduced to 1.60 with 31% improvement. After treatment the mean

score reduced to 1.60 which was statistically significant. This shows improvement in

degree of movement by 31%, statistically significant as assessed by paired ‘t’ test.


The difference in mean score of flexion after follow up of treatment showed


treatment. On statistical analysis by paired ‘t’ test the difference was statistically

significant.

Effect on Bahupraspandahara (Prasarana-extension):


In group, after Nasya highly significant changes were observed. The extension

initial value was 2.00 and reduced to 1.13 with 43 % improvement. After treatment


Discussion





The difference in mean score of extension after follow up of treatment showed



highly significant.

Effect on Bahupraspandahara (Circumduction-Triyakgamana):

In group, after Nasya significant changes were observed. The Circumduction

initial value was 2.07 and reduced to 1.33 with 35% improvement. After treatment


improvement in degree of movement by 35 %, statistically significant as assessed by



The difference in mean score of Circumduction after follow up of treatment

showed improvement in degree of movement to 0.73 i.e. 65 % as compared to before


significant.

Overall Assessment: Analysis of over all effect of the treatment in the patients of

Avabahuka showed good improvement.

Discussion


The treatment was given with seven days of Nasya with Nagara Taila which

was significant. None of the patients develop any complications, or any untoward

symptom or any side effects during the course of treatment in the study group and

therefore the treatment modalities is safe and is of therapeutic value. But the patients

of group B shows more improvement after treatment when comparing with the group

A .This may be due the fast action of Nagara Taila. On the same time Nasya with

Nagara Taila has less improvement after follow up when comparing with the Nasya

with Karpasasthyadi Taila.

The above said observations indicate that patients have shown improvement in

all the criteria of assessment of Avabahuka. The therapeutic effects like Vedana

Sthapak, Stambha hara etc. are achieved, by relieving Shoola and improvement in the

movement of Bahu. The ultimate effect will be in reducing the intensity of the Shoola

and controlling the vitiated Vata as the basic management of Avabahuka. Along with

this therapeutic effect, Balya and Rasayana are achieved in these modalities.

Discussion on Efficacy of Thaila and Procedure:

Present study shows good results in the Avabahuka. But in Chronic condition

it is not getting much result. It may be due to the long standing nature of the disease.

Karpasasthyadi Taila Nasya and Nagara Taila Nasya given for the seven days gives

good changes in Avabahuka. So we can say that both are effective in different stages

of Avabahuka. This may be due to the action of Nasya in the Jathrupredesa.

Avabahuka is a disease of Jathrupredesa. If the study has done for more duration of

treatment then we can achieve a better result.

Discussion


Nasya with Karpasasthyadi Taila had got more result compared to Nasya with

Nagara Taila. This may be because Karpasasthyadi Taila is processed with more

Vatakaphahara drugs and the Taila is having more Usna Veerya, and Brihmana nature

compared to Nagara taila.

Table No.58 Comparative results of Group-A and Group-B

Characteristics GROUP-A GROUP-B

Mean score Mean score Signs and

Symptoms BT FU

% of

relief BT FU

% of

relief

Shoola 2.87 0.27 91% 2.47 0.47 81%

Unnamana 2.53 0.87 66% 2.53 0.93 63%

Avannamana 2.47 0.40 84% 2.47 0.60 76%

Akunchana 2.40 0.47 81% 2.33 0.73 69%

Prasarana 2.07 0.27 87% 2.00 0.40 80%

Triyakgamana 2.00 0.47 77% 2.07 0.73 65%

Table No 59 Comparative Results of Group A and Group B.

Group A Group B Mean

Difference

SE (±) T value P value

85.71 73.93 11.78 5.45 2.15 >0.001

Discussion


Comparison of total effect of two groups had analyased statistically through

Unpaired t test. The test revealed that Group A Nasya with Karpasasthyadi Taila had

got highly significant result than Group B Nasya with Nagara Taila. Details are

given in the table above.

Statitical conclusion

Statistical analysis proved that the group-A is more effective than group-B.

Table No 60 Overall results of the Patients

Srl No. Group A Group B

1 87.6 73.2

2 80.2 84.6

3 72.3 86.7

4 100 85.2

5 81.2 25.4

6 80.6 54.3

7 80.7 100

8 91.7 80.2

9 92.2 80.1

10 91.7 63.2

11 86.2 100

12 84.7 45.3

13 85.1 63.2

14 84.1 85.2

15 85.3 84.7

Conclusion


7. CONCULSION

The following conclusions may be drawn based on the analysis of the

conceptual part and observations made in the clinical study.

1. The disease is named after the site of illness as well as leading clinical

presentation.

2. Present study revealed that the Bharavahana, Dukshashaya, Rooksha, Alpa

Ahara are the most occurring causes for the manifestation of disease

Avabahuka.

3. Nasya Karma is considered as very effective and easy procedure adopted in

treatment in Avabahuka.

4. Karpasasthyadi Taila and Nagara Taila Nasya can be practiced safely without

any adverse effect.

5. The present study shown highly significant results which indicate that

therapeutic effects like Shoolahara and Sthambhara, i.e. improvement in degree

of shoulder joint movement without pain which is achieved to great extend by

Nasya karma.

6. Karpasasthyadi Taila is more beneficial in the form of Nasya karma in the

management of Avabahuka due to its Vatahara properties.

7. Nasya with Nagara Taila showed more Shoola Hara property after the treatment.

But after follow up the percentage of improvement was less as compared to

Karpasasthyadi Taila.

8. In chronic stage giving Karpasasthyadi Taila is more beneficial compared to

Nagara Taila, but treatment for seven days is not enough.

Conclusion


9. We can give treatment in O P D level itself. So that it is convenient for the

patient.

10. The medicine and Procedure are cheaper and cost-effective.

11. Overall the group A is more effective clinically and statistically than group B in

almost all the parameters.

Suggestions for the future study :

1) Study on large sample is required.

2) In the present study, Patients with Fractures, dislocation and injury to

the shoulder joint were excluded. Evaluation of the effect of the

therapy should be done in these conditions also.

3) Studying on repeated application of these treatment procedures and

interchanging the samples from one group to the other may be

conducted to evaluate further.

Summary


8. SUMMARY

“A comparative clinical study on the effect of Nasya with Karpasasthyadi taila

and Nagara taila in the management of Avabahuka”. is the title of the present

dissertation work. It consists of Introduction, Objectives, Review of Literature,

Material and Methodology, Observations and Results, Discussion and Conclusion.

Introduction briefs selection of Upakarma i.e. Nasya Karma and its utility in

the diseases Avabahuka.

The study is presented in two parts, first part of the work deals with the

disease Avabahuka review presented from Paribasha, Shareera Vivechana, Nidana

Panchaka, Sadhyasadhyata, Sapkesha Nidana, Updrava, Chikitsa Vivechana,

Pathyapthya and Drug Review. Then review of literature comprising of Nasya

Nirukti, Synonymous, Historical background, Classifications, Indications, and

Contraindications, Time duration, Dosage, Drug mentioned, Procedure, Samyaka,

Ayoga, Atiyoga, Vyapad.

The second part of the work is dedicated to clinical trial i.e. “A comparative

clinical study on the effect of Nasya with Karpasasthyadi taila and Nagara taila in the

management of Avabahuka”. It includes inclusion and exclusion criteria, diagnostic

and assessment criteria and treatment schedule. Data analysis, discussion on these

points and observations in different stages are dealt in detail.

The study was conducted by randomly selecting the patients into two groups.

The cases were assessed for all the signs and symptoms. Grading was given to all the

parameters like Shoola, Bahupraspanditahara (movements), was assessed by using

Goniometry.

Summary


Response to the treatment was assessed based on the above said parameters

before, after and after follow up of the treatment. The effect of the treatment

statistically, variables were subjected for paired‘t’ test. At the end of the study, it was

concluded that Nasya with Karpasasthyadi provided better and more effective results

as highly significant result were obtained after follow up.

Conclusion was drawn on the basis of discussion on Avabahuka, Nasya

Karma, mode of action of the drug, Observation and Results.

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111. a) Pandit Parashuram Shastri edited, Sharangadhara Samhita Uttarakhanda

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Varanasi p no 341.

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112. Satyanarayana Shastri edited, Charaka Samhita Siddisthana chapter 9,shloka

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113. Kaviraj Dr.Ambikadatta Shastri edited, Sushruta Samhita Chikitsa sthana

chapter 40 shloka -23 Reprint 2OO5 Choukambha Sanskrit Sansthanai

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114. Prof. Shrikantha Murthy edited, Ashtanga Hrudaya Sutra Sthana chapter 2O,

shloka .2 Reprint 1996, Choukambha Krishna das academy Varanasi ,p

no.255.

115. Dr. Govardhan Sharma edited, Ashtanga Sangraha Sutrasthana chapter

29.shloka 5 Reprint 2OO5 , , Choukambha Sanskrit Sansthanai

Varanasi p no.262.



117. Kaviraj Dr.Ambikadatta Shastri edited, Sushruta Samhita Chikitsasthana

chapter 40 shloka -22, Reprint 2OO5 Choukambha Sanskrit Sansthanai

Varanasi p no.182.

118. Prof. Shrikantha Murthy edited, Ashtanga Hrudaya Sutra Sthana chapter

20,shloka no.3 , Reprint 1996 Choukambha Krishna das academy Varanasi

,p no.255.



119. Dr. Govardhan sharma edited, Ashtanga Sangraha Sutra Sthana chapter

29.shloka 6 ,Reprint 2OO5 , Choukambha Sanskrit Sansthana Varanasi p

no.263.

120. Satyanarayana Shastri edited, Charaka Samhita Siddhisthana chapter 2,shloka


121. Kaviraj Dr.Ambikadatta Shastri edited, Sushruta Samhita Chikitsa Sthana

chapter 40 shloka -47 ,Reprint 2OO5 Choukambha Sanskrit Sansthana

Varanasi p no. 184.


29.shloka 11 Reprint 2OO5 , Choukambha Sanskrit Sansthana Varanasi p

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23 Reprint 1998 Choukambha Bharati Academy Varanasi p no.986.

124. Kaviraj Dr.Ambikadatta Shastri edited ,Sushruta Samhita Chikitsa Sthana

chapter 40 shloka -24 ,Reprint 2OO5 Choukambha Sanskrit Sansthana

Varanasi p no. 182.

125. Pandit Parashuram Shastri edited, Sharangadhara Samhita Uttarakhanda

chapter 8 shloka 3 , 3rd edition,Reprint 1983 Choukambha Orientalia

Varanasi , p no 339.


29.shloka 17 Reprint 2OO5, Choukambha Sanskrit Sansthana Varanasi p

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127. Kaviraj Dr.Ambikadatta Shastri edited, Sushruta Samhita Chikitsa Sthana

chapter 40 shloka -42 ,Reprint 2OO5 Choukambha Sanskrit Sansthanai



Varanasi p no. 184.

128. Prof. Shrikantha Murthy edited, Ashtanga Hrudaya Sutrasthana chapter

20,shloka.9 Reprint 1996, Choukambha Krishna das academy Varanasi ,p

no.257.


Commentary by Dalhana on Chikitsa Sthana, Chapter 40, Shloka no 25,

Edition : Reprint, 2009, Pub : Chaukhambha Sanskrit Sansthan, K.37/116,

Gopal Mandir Lane, Varanasi, Page no.555













Sthana, Chapter 9, Sloka No.106-110, Edition: Reprint 2008, Pub:

Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box

No.1129, Varanasi (UP), Page no.723




2O,shloka 22 Reprint 1996 Choukambha Krishna das academy Varanasi p

no.259.






2O,shloka 22 Reprint 1996 Choukambha Krishna das academy Varanasi p

no.259.







Sthana, Chapter 9, Sloka No.106-110, Edition: Reprint 2008, Pub:

Chaukhamba Surbharati Prakashan, K.37/117, Gopal Mandir lane, Post box

No.1129, Varanasi (UP), Page no.723


Commentary by Dalhana on Chikitsa Sthana, Chapter 40, Shloka no 7, Edition


Mandir Lane, Varanasi, Page no.553













29.shloka 18,Reprint 2OO5 , Choukambha Sanskrit Sansthana Varanasi p

no.262.

142. a) Satyanarayana Shastri edited, Charaka Samhita Siddhisthana chapter 1,

shloka 51, Reprint 1995 Choukambha Bharati Academy Varanasi p

no.974.

b) Kaviraj Dr.Ambikadatta Shastri edited, Sushruta Samhita Chikitsasthana

chapter 40 ,shloka -33,Reprint 2OO5 Choukambha Sanskrit Sansthana

Varanasi p no.183.

c) Prof. Shrikantha Murthy edited, Ashtanga Hrudaya Sutrasthana chapter 2O,

shloka.23, Reprint 1996, Krishna das academy Varanasi ,p no.259.

d) Pandit Parashuram Shastri edited, Sharangadhara Samhita Uttarakhanda

chapter 8 shloka 58, 3rd edition ,Reprint 1983 Choukambha orientalia

Varanasi , p no 345.


chapter 8 shloka 6O , 3rd edition, Reprint 1983 Choukambha Orientalia

Varanasi p no 345.



143. a) Satyanarayana Shastri edited, Charaka Samhita Siddhisthana chapter

1,shloka 52 Reprint 1995 Choukambha Bharati Academy Varanasi pg

no974.


chapter 40 ,Shloka -35, Reprint 2005 Choukambha Sanskrit Sansthana

Varanasi p no.183.

c) Prof. Shrikantha Murthy edited, Ashtanga Hrudaya

Sutrasthana chapter 20,shloka.23 Reprint 1996,,Krishna das academy

Varanasi ,p no.260.

d) Pa ndit Parashuram Shastri edited, Sharangadhara Samhita Uttarakhanda

chapter 8 Shloka 59 , 3rd edition,Reprint 1983 Choukambha orientalia

Varanasi p no 345.

144. a) Satyanarayana Shastri edited, Charaka Samhita Siddisthana chapter

1,shloka 52 Reprint 1995 Choukambha Bharati Academy Varanasi p

no974.


chapter 40,Shloka -34, ,Reprint 2005 Choukambha Sanskrit Sansthana

Varanasi p no. 183.

c) Prof. Shrikantha Murthy edited, Ashtanga Hrudaya Sutrasthana chapter

20,shloka.24, Reprint 1996 Krishna das academy Varanasi p no.260.


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Shloka no 11,Page no 33, 4th edition 1994,Pub: Chaukamba Sanskrit series

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�

Annexure


10. ANNEXURE

DEPARTMENT OF P.G. STUDIES IN PANCHAKARMA

K.V.G. AYURVEDA COLLEGE AND HOSPITAL, SULLIA

CASE PROFORMA FOR AVABAHUKA

Title:

A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF NASYA WITH

KARPASASTHYADI TAILA AND NAGARA TAILA IN THE

MANAGEMENT OF APABAHUKA

GUIDE : Dr. KRISHNA PRAKASH M. K. M.D. (AYU.)

CO-GUIDE : Dr. SANATH KUMAR D.G. M.D. (AYU.)

SCHOLAR : Dr. FEBIN. P.JOSE

Rugna nama : SR No. :

Vaya : OPD No. :

Linga : M /F IPD No. :

Jati : H /M /CH /O Bed No. :

Vyavasaya : Date :

Marital status : M / UM / W / D Group A / B :

Samajika avam arthik sthiti : P / LM / UM / R Date of Completion of trial:

Education : Un / Pr / Sec / Gr

Nivas : 1 Follow Up :

Consent: I here by agree that, I have been fully educated with the disease and

treatment, here by satisfied whole heartedly, and accept the medical trial over me.

Patient’s Signature

Annexure


1) ROGA PAREEKSHA

I) VEDANA (Complaints)

Kalavadhi Bahu (Dakshina/Vama)

Shoola.

Sthabdatha.

II) TRIVIDHA PARIKSHA

A) Darsana :

• Sthabdatha:

B) Sparsana :

C) Prasana :

• Shoola:

Annexure


III) KULA VRUTTANTHA :

IV) PURVOTPANNA VYADHI VRUTTANTHA :

V) PURVA AUSHADHI VRUTTANTHA :

2) ROGI PAREEKSHA

VI) NIDANA PANCHAKA :

a) Nidana (Bahya Nidana)

AAHARA VIHAARAJA KALAJA

Katu Rasa Ativyaayaama Greeshma

Tikta Rasa Prajagara Varsha

Kashaya Rasa Asrksravana Sheetakaala

Alpa Ahara Abhighaata

Abhojana Dhatukshaya

Rooksha Bhojana Vishama Upachara

Mudga Yana

Nishpava Athibhaya

Shuskashaka Athishoka

Masura Athichintha

Annexure


b) Poorva Roopa:

c) Roopa:

Symptoms Pravara Madhyama Avara

Shoola

Sthabdatha

VYADHI BALA :- Pravara\Madhyama\Avara

d) Upashaya / Anupashaya :

Vyaayaama ( ) Seetha Kala ( )

Avyaayaama ( ) Ushna Kala ( ) Sneha Abhyanga ( )

e) SAMPRAPTI

�� !��"��#$%�� &�

��'�( ��)��*��"��#�+��,��

�� !��"��#$%�� &�

��#$%��! ��-#�+��!� �� &�

�'��.�� )��*��"��#�+�� ,��

SAMPRAPTI GHATAKA

Dosha - Vata (vyana vata)

Kapha (sleshaka)

Dushya - Dhathu -Mamsa

Upadhathu - sira, sandhi.

Rogamarga - Madhyama

Adhisthana - Amsadesha

Vyaktasthana - Vama Bahu / Dekshina Bahu

Annexure


VI1) VYADHI VINISCHAYA :- APABAHUKA

VIII) PRAKRUTHI :-

VATA PITHA KAPHA VP VK PK SAMA

IX) SADHYA ASADYADHATHA

Sukhasadhya( ) / Kruchasadhya( ) / Yapya ( ) / Anupakrama ( )

X) Investigations

B.T. A.T.

1 Pulse /min /min

2 Resp. rate /min /min

3 Blood Pressure mm of Hg mm of Hg

4 Body Temp F F

5 Body weight Kgs. Kgs.

X1) LABORATORY INVESTIGATION: (if necessary )

1. Haematological Investigation :

Hb :

TC: DC: N __ %, L__ %, B__ %, E__ %, M__ %

ESR: __ mm after one hour Blood Sugar level: RBS ___gms /dl.

2. Routine Urine Investigation: Alb

Sugar

3. X-ray : Shoulder Joint. : AP, Lateral

Annexure


X1I) Examination of the Shoulder Joint :

Movements at Shoulder joint Grade

DAKSHINA VAMA

Akunchana

Prasarana

Unnamana

Avannamana

Triyakgamana

XIII) CHIKITSA : TREATMENT PROTOCOL

Group A Group B

� Group A :-– Nasya with Karpasasthyadi Taila.

� Group B :- Nasya with Nagara taila.

Day Time Dose Observation Advise

1

2

3

4

5

6

7

Annexure


XIV) PATHYA / APATHYA :-

XV) RESULT :-

��

XVI) ASESSMENT CRITERIA:

Involved part:

Dakshina Bahu Vama Bahu

B.T A.T F.U 22st day

Shoola�

Sthabdatha

B.T A.T F.U 22st day

Unnamana

Avannamana

Akunchana

Prasarana

Triyakgamana

Signature of the Scholar : Signature of the CO-GUIDE :

Dr. FEBIN.P.JOSE BAMS Dr. SANATH KUMAR.D.G. M.D (Ayu.)

Signature of the GUIDE : Signature of the HOD :

Dr.KRISHNAPRAKASH M.K M.D (Ayu.) Dr. N.S. SHETTAR. M.D (Ayu.)

Health & Medicine

“A COMPARATIVE CLINICAL STUDY ON THE EFFECT OF NASYA WITH KARPASASTHYADI TAILA AND NAGARA TAILA IN THE MANAGEMENT OF AVABAHUKA”