a comparative clinical study of nasyakarma and
TRANSCRIPT
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Aramani et al. World Journal of Pharmacy and Pharmaceutical Sciences
A COMPARATIVE CLINICAL STUDY OF NASYAKARMA AND
UTTARABHAKTIKA SNEHAPANA IN APABAHUKA
Rohini A. Aramani1*
, Srinivas P.2, Prameela Devi K.
3, Ramakrishna Allam
4, Kasthuri
5,
G. K. Swamy6
*1, 4, 5
Senior Research Fellow, 2,3
Research officer, Scientist 2, 6Assistant Director, Scientist 4.
Dr. A. Lakshmipathi Research Centre for Ayurveda, (CCRAS), Chennai, Tamilnadu, India.
ABSTRACT
Nasyakarma & Snehapana are among Panchakarma, specially
indicated in Urdhwajatrugata vataja vikaras.[1]
Brimhana nasya and
Brimhana snehapaana are found effective in vatavyadhi.[2]
Apabahuka
is one among vatavyadhi‟s which hampers the normal function of
upper limb due to Vataprakopa. Shoola and Bahupraspandahara are
the clinical features of Apabahuka. Nasyakarma and Uttarabhaktika
Snehapana have great significance in the treatment of Apabahuka.[3]
It
is a comparative clinical study conducted to assess the efficacy of
Nasyakarma and Uttarabhaktika Snehapana in Apabahuka. As per the
inclusion and exclusion criteria, the subjects were selected randomly &
divided into two groups. Group A- 15 Patients were received
Nasyakarma. Group B- 15 Patients were received Uttarabhaktika
snehapana. The treatment modalities used in this clinical study are Nasya and Uttarabhaktika
snehapana, which includes Pachana-Deepana with Ajamodadi choorna, Abhyanga with
Moorchita Tila Taila, Swedana with Dashamoola bashpa, Nasya and Uttarabhaktika
Snehapana with Masha taila and follow up for 14 days. In Group A, out of 15 patients, 9
(60%) got moderate improvement and 6 (40%) patients got mild improvement. In Group B,
out of 15 patients, 3 (20 %) got marked improvement and 12 (80%) patients got moderate
improvement. Both the procedures show statistically highly significance. Among these
groups, Uttarabhaktika Snehapana is establishing more effective clinically.
KEYWORDS: Brimhana Nasya, Uttarabhaktika Snehapana, Apabahuka.
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
SJIF Impact Factor 5.210
Volume 4, Issue 11, 1619-1630 Research Article ISSN 2278 – 4357
Article Received on
07 Sept 2015,
Revised on 01 Oct 2015,
Accepted on 25 Oct 2015
*Correspondence for
Author
Rohini A. Aramani
Senior Research Fellow,
Dr. A. Lakshmipathi
Research Centre for
Ayurveda, (CCRAS),
Chennai, Tamilnadu, India.
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Aramani et al. World Journal of Pharmacy and Pharmaceutical Sciences
INTRODUCTION
Ayurveda plays a significant role for the maintenance of harmony in today‟s busy professions
and changing lifestyle. Beauty of Ayurvedic literature is mentioning the guidelines in the
sootra roopa (quotation) and leaving everything to the interpretation (Yukti) of Physician.
The economy of the country relies on its work force. Apabahuka is one such disease that
hampers the day-to-day activity of an individual. The fact that „Vatavyadhi’ is one among
the major diseases mentioned in the Ayurveda (Ashta maha gada)[4]
and is self explanatory,
with regard to the consequences caused by Apabahuka. Even though a definite factor
responsible for the manifestation of this disease is not mentioned, a set of etiological factors
can be interpreted. On analyzing the etiopathology, it may be interpreted that the depletion of
tissue elements (dhatu kshaya) as well as Samsrushta dosha( associated with other doshas).
Apabahuka is considered to be a disease that usually affects the shoulder joint (amsa sandhi)
and is produced by the Vata dosha. Even though the term Apabahuka is not mentioned in
the nanatmaja vata vyadhi, Acharya Sushruta and others have considered Apabahuka as
a Vata vyadhi.[5]
Amsa shosha can be considered as the preliminary stage of the disease where
loss or dryness of the Shleshaka Kapha from the shoulder joint occurs. In the next stage, pain
(shoola) during movement will occurs due to the loss of Shleshaka Kapha and symptoms
like, restricted movement, and so on, are manifested. In the literature, it has given
importance, while describing Shodhana & Shamana chikitsa (Panchakarma), which is a
unique therapeutic procedure because of its preventive, primitive, prophylactic & rejuvinative
properties. Nasya karma & Snehapana is among Panchakarma specially and indicated in
Urdhwajatrugata vataja vikaras. Uttarabhaktika Snehapana is one type of Brihmana i.e.
Snehapana done after intake of food which is useful in the disorders of vyana vata.[6]
Hence,
Brimhana nasya and Brimhana snehapaana are found effective in vatavyadhi. In present study
Nasyakarma and Uttarabhaktika Snehapaana with Masha taila were taken as the comparative
study of Apabahuka.
OBJECTIVES OF THE STUDY
To evaluate the efficacy of Nasya Karma and Uttarabhaktika Snehapana in Apabahuka
individually as well as compare the results.
MATERIALS AND METHODS
The materials required for the study
1) For Nasyakarma: Ajamodadi choorna for pachana-deepana.
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Moorchita tila taila for abhyanga.
Dashamoola kwatha for bashpasweda.
Masha taila 8ml daily.
2) For Uttarabhaktika Snehapana: Ajamodadi choorna for pachana-deepana. Masha taila
24ml daily.
Preparation of Masha taila
Contents of Masha taila: Masha Kwatha, Saindhavalavana kalka, Moorchita Tila Taila.[7]
Taila is prepared according to Madhyama Taila Paaka Vidhi mentioned by Ayurvedic
classics.(Sharangadhara Samhita).[8]
DIAGNOSTIC CRITERIA
The diagnosis of the disease is mainly based on the signs and symptoms mentioned in
classics and modern text as follows:
Shula in the shoulder joint.
Bahupraspandahara in the shoulder joint.
Drop arm sign.
INCLUSION CRITERIA
Patients between the age group of 30-60 years were selected.
Patients fit for Nasya karma and Snehapana.
Patients irrespective of sex, occupation, religion, socio economic status were selected.
The cases of Apabahuka with the features mentioned in the method of collection of data
were included.
EXCLUSION CRITERIA
Patients below 30 years & above 60 years were excluded from the study.
Patients not fit for Nasya karma and Snehapana.
Patients with any disorders other than which interfere the line of treatment of Apabahuka.
Patients of shoulder joint dislocation/fracture.
STUDY DESIGN
This Clinical Study conducted on 30 Patients who attended the OPD and IPD of Shri
Jayachamarajendra Institute of Indian Medicine Hospital, Bangalore after fulfilling the
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inclusion criteria were randomly divided into 2 Groups, Group A and Group B each
consisting of 15 patients.(table no 1).
Group A – In this group 15 patient were given Nasya with Masha taila for 7 days.
Group B - In this group 15 patients were given Uttarabhaktika Snehapana with Masha taila
For 7 days.
Table No 1: Study design.
Group A (Nasya karma) Group B (Uttarabhaktika Snehapana)
Poorvakarma
Deepana pachana with Ajamodadi
churna 3 – 5 gms BD with hot water
till nirama lakshanas.
Deepana pachana with Ajamodadi churna
3 – 5 gms BD with hot water till nirama
lakshanas.
Pradhanakarma
Nasya with Masha Taila, 8 drops
(bindu) in each nostril in continuous
flow (Avichinnadhara) for 7 days.
Uttarabhaktika Snehapana with
Mashataila 12ml after Pratah (morning
breakfast) and Sayam bhojana (Dinner)
for 7 days.
Pashchatkarma Gandusha with ushna jala Ushna jalapana
Follow up: after 14 days & Study duration 24 days in each group.
PROCEDURE OF UTTARABHAKTIKA SNEHAPANA
The patient is advised to complete morning regimens and asked to take food when hungry.
Immediately after food 12 ml of luke warm Masha Thaila along with Milk (ksheera) taken in
a Steel glass, advised the patient to close eyes and nostrils if any aversion towards smell and
sight of taila. After taking taila ask the patient to smell the lemon to avoid nausea. In
between patient may drink hot water, and to take food at evening (dinner) only. Then the
same procedure should repeat after food. This will be administered for 7 days.
ASSESSMENT CRITERIA
Patients were assessed before, after the completion of treatment and on follow up. The
following parameters were considered while assessment and they were graded and scores
were given as follows.
A.SUBJECTIVE PARAMETERS.
1) Shula
Pain Grade
1)No pain. 0
2)Mild pain particularly on moving the
shoulder but able to continue routine work
without difficulty.
1
3)Moderate pain felt on movement 2
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and,interfere routine works.
4)Severe pain felt on movement and also at
rest,disturbing sleep, unable to carry most of
the routine work.
3
2) Bahupraspandahara.
Stiffness Grades
1) No stiffness. 0
2) Mild stiffness particularly during shoulder
movement able to continue routine work
without difficulty.
1
3) Moderate stiffness felt on movement and
unable to continue work. 2
4) Severe stiffness particularly during
shoulder movement and also at rest,
interfering routine work.
3
OBJECTIVE PARAMETERS
Range of shoulder movements (Goniometric examination)
1)Ant.Elevation
G0: >160 & <180
G1: .>120 & <160
G2: >60 & <120
G3: >0 & <60
2)Int.Rotation
G0 : No pain or stiffness can touch upto midscapular region.
G1 : Mild pain and stiffness , can touch upto infrascapular region.
G2 : Moderate pain and stiffness , can touch upto lower lumbar Vertebrae.
G3 : Severs pain and stiffness, cant move the joint.
3) Ext.Rotation
G0 : No pain or stiffness can touch upto infrascapular region.
G1 : Mild pain and stiffness , can touch upto midscapular region.
G2 : Moderate pain and stiffness , can touch upto suprascapular Region.
G3 : Severs pain and stiffness, cant move the joint.
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ASSESSESMENT OF CLINICAL IMPROVEMENT
The sum point of all the parameters of assessment before, after and at follow up day was
taken into consideration to assess the total effect of the treatment as follows.
STASTICAL ANALYSIS: Data were collected from sample before, after and post follows
up treatment. Statically analyzed by using student “t” test in consultation with Bio-
statistician0.
OBSERVATIONS
Among 30 patients more patients were from 51-60 years age group i.e. 11 (36.66%), male
17(56.66%), 19 (63.33%) patients were having vishamagni, 18 (60%) of madhyama koshta
and more of vata kaphaja prakruthi i.e. 20 (66.67%).
Considering the aharaja nidanas 17 patients were consuming katu kashaya rasa pradhana
ahara, 17 (56.66%) were taking ruksha sheeta pradhana ahara and 15 (50%) were taking
pramitashana. In Viharajas nidanas, 22 (93.3%) were during Ativyayama, 18(60%) had
Vegadharana and 20 (66.7%) had Atiyaanadi. Considering the duration of disease more
patients i.e. 18 (60%) were in between 4-6 months, in duration of treatment, 16 patients took
pachana-deepana for 3 days and 14 patients for 4 days.
In Group A, out of 15 patients, Sukhochwasa was found in 11(73.3%), Sukha swapna
prabodha in 13 (86.7%) patients and Akshapatavam in 12(80%) patients.
In Group B, out of 15 patients, Deeptagni was found in 12(80%) patients, Parishuddhakoshta
in 13(86.7%) patients, Pratyagra dhatu balavarnayukta in 13 (86.7%) patients and
Vyadhyupashamana in 12(80%) patients.
RESULTS
The results thus obtained before, after and during follow up of the treatment were analyzed
statistically. The results were statistically interpreted based on subjective and objective
parameters.
Marked improvement > 75%
Moderate improvement 50-75%
Mild improvement 25-50%
No improvement < 25%
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Table No 2: EFFECTS OF NASYA (Group-A)
Effect of Nasya Therapy on Subjective and Objective Parameters in Group A.
Table No 3: EFFECT OF UTTARABHAKTIKA SNEHAPANA (Group-B)
Effect of Snehapana Therapy on Subjective and Objective Parameters in Group B.
Table No 4: COMPARATIVE RESULTS OF GROUP-A and GROUP-B
Characteristics GROUP-A GROUP-B
Signs and Symptoms Mean score % of
relief
Mean score % of relief
BT FU BT FU
Shoola 2.27 0.94 59% 2.07 1.20 42%
Bahupraspandahara 2.20 1.26 43% 2.27 0.27 88%
Anterior Elevation 2.06 1.06 49% 2.27 0.40 82%
Internal Rotation 2.20 0.94 57% 2.07 0.74 64%
External Rotation 2.20 0.94 57% 2.00 0.67 67%
Drop Arm Sign 1.00 0.07 93% 1.00 0.07 94%
Symptoms
Measures
% S.D
(+-)
S.E
(+-)
t
value
p
value BT BT-
AT
Shoola 2.27 AT 1.20 1.07 47.13 0.703 0.181 5.87 <0.0001
FU 0.94 1.33 58.59 0.723 0.186 7.135 <0.0001
Bahupraspandahara 2.2 AT 1.40 0.80 36.36 0.414 0.106 7.483 <0.0001
FU 1.26 0.94 42.72 0.457 0.118 7.897 <0.0001
AT 1.26 0.80 38.83 0.414 0.106 7.483 <0.0001
Anterior Elevation 2.06 FU 1.06 1.00 48.54 0.534 0.138 7.246 <0.0001
Internal Rotation 2.2 AT 1.2 1.00 45.45 0.654 0.169 5.916 <0.0001
FU 0.94 1.26 57.27 0.703 0.181 6.971 <0.0001
AT 1.14 1.06 48.18 0.593 0.153 6.959 <0.0001
External Rotation 2.2 FU 0.94 1.26 57.27 0.593 0.153 8.264 <0.0001
AT 0.14 0.86 86 0.351 0.090 9.5 <0.0001
Drop Arm Sign 1.00 FU 0.07 0.93 93 0.258 0.067 14 <0.0001
Symptoms
Measures
% S.D
(+-)
S.E
(+-)
t
value
p
value BT BT-
AT
Shoola 2.07 AT 1.34 0.74 35.74 0.593 0.153 4.785 <0.0001
FU 1.20 0.86 41.54 0.516 0.133 6.500 <0.0001
Bahupraspandahara 2.27 AT 0.60 1.67 73.56 0.816 0.210 7.906 <0.0001
FU 0.27 2.00 88.10 0.845 0.218 9.165 <0.0001
AT 0.74 1.53 67.40 0.915 0.236 6.487 <0.0001
Anterior Elevation 2.27 FU 0.40 1.86 81.93 0.833 0.215 8.671 <0.0001
Internal Rotation 2.07 AT 1.07 1.00 48.30 0.654 0.169 5.916 <0.0001
FU 0.74 1.33 64.25 0.488 0.126 10.58 <0.0001
AT 1.00 1.00 50.0 0.654 0.169 5.916 <0.0001
External Rotation 2.00 FU 0.67 1.33 66.5 0.617 0.159 8.367 <0.0001
AT 0.07 0.93 93% 0.258 0.067 14 <0.0001
Drop Arm Sign 1.00 FU 0.07 0.94 94% 0.258 0.067 14 <0.0001
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Table No 5: ASSESSMENT AND TOTAL EFFECT OF THERAPY
Remarks Group A % Group B % Total %
Marked relief
Above 75% 00 00% 03 20% 03 10%
Moderate relief
50-75% 09 60% 12 80% 21 70%
Mild relief
25-50% 06 40% 00 00% 06 20%
No relief
Below 25% 00 00% 00 00% 00 00%
In Group A, out of 15 patients, 9(60%) got moderate improvement and 6 (40%) patients got
mild improvement. In Group B, out of 15 patients, 3(20 %) got marked improvement and 12
(80%) patients got moderate. In total out of 30 patients, 3(10%) got marked improvement,
21(70%) got moderate improvement and 6(20%) mild improvement.
EFFECTS OF NASYA (Group-A) Statistically highly significant (p <0.0001) results were
observed i.e 58.59% relief in shula, 42.72% relief in bahupraspandahara, 48.54% relief in
anterior elevation,57.27% relief in internal rotation,57.27% relief in external rotation and
93% in drop arm sign.
EFFECT OF UTTARABHAKTIKA SNEHAPANA (Group-B):Statistically highly
significant results (p <0.0001) were observed i.e 41.54% relief in shula, 88.10% relief in
bahupraspandahara,81.93% relief in anterior elevation,64.25% relief in internal
rotation,66.50% relief in external rotation and 94% in drop arm sign.
Comparison of total effect of two groups had analysed. However there was 60%
improvement in Group A and 73% improvement in the Group B. The difference in treatment
was 13%.But clinically Group B, Uttarabhaktika Snehapana has got highly significance than
Group A Nasya.
DISCUSSION
Nasya karma is one of the major Brimhana and Shodhana Modality specially indicated for
vitiated dosha and the diseases situated in jatru urdhwa pradesha, as nasa is told as dwara for
shiras which is a uttamanga and considered as moola of human body which has coated since
Vedic Ages.[9]
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Snehana is the measure adopted (Bahya & Abhyantara) to bring about Snigdhata in the body.
Charaka defines Snehana as, the procedure by which Snigdhata, Vishyandana, Mardavata and
Kledana are produced in the body.[10]
The administration of Sneha along with Mamsa Rasa,
Madya, Kshira etc., are known as Brimhana Snehana. If it is given before food, will cures
Adhobhaga rogas, in the middle it cures Madhyamabhaga rogas and after food cures
Urdhwabhaga rogas and strengthens the body.[11]
Apabahuka is a disease caused by kupita vata dosha, localizing around the amsa pradesha
causing the shoshana of amsa sandhi, there by leading to akunchana of sira at that site and
giving rise to bahupraspandaharatwam which means restricted movement of bahu.[12]
Vyanavata and siras are responsible for all types of motor functions namely prasarana,
aakunchana, vinamana. The kapha present as lubricating material within the sandhi aids in
the movements such as prasarana, aakunchana etc. Shoshana of kapha or kshaya in the
quantity of kapha leads to impaired range of movements. In Apabahuka Vatahara and
Brimhana Dravyas are useful in the form of Nasya and Snehapana. As aushadha kala of
Vyana and Udanavata is adhobhakta, Uttarabhaktika Snehapana is useful.
As in Apabahuka rookshadi gunas are dominant, vipareeta gunas like Snigdhadi are required,
hence Mashataila is selected. As Masha is having Snigdha, Ushna and Guru guna do the
shamana of Vataja gunas like ruksha, sheeta, laghu and also Bala and Shleshmakaraka.
For Shareeraja doshas, taila, ghrita and madhu are respectively paramaushadhas in vata, pitta
and kapha vyadi. Hence taila is selected in Apabahuka (vatavyadhi). Taila is having Ushna,
Snigdha gunas and Madhura vipaka, which are vata shamaka properties.[13]
Mode of action of Masha taila in Shoola: Masha is having ushna guna. Shoola and sheeta
are interrelated. All painful vatavyadhi get aggravated by shayithyatha. If we give hot
fomentation i.e. ushna the pain subsides. It suggests that due to ushna guna Masha helps in
subside pain of apabahuka.
Mode of action of Masha taila in Bahupraspandahara: Bahupraspandaharatwa is having
sheeta as well as ruksha guna. Masha taila is having ushna and snigdha guna. Ushna guna
subsides the sheetha (sthabthatha) of Apabahuka, and Snigdha guna subsides the rukshatha
(sthabthatha) of Apabahuka.[14]
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Brimhana action
Vatettu Brimhanam Kuryat, Pittettu Parishodhanam |
Kaphettu Prachchardhanam Sadhu Sannipate Virechanam ||
(Bhe.Su 25/6)[15]
Masha taila has madhura vipaka. Due to the madhura vipaka it does the Brimhana effect.
Brimhana is the one, which is done or used for the nourishment. In the present context of
Apabahuka the vitiated vata due to its Rookshadi qualities does the vitiation of Shleshaka
Kapha and Siras which is present in the amsa Sandhi. To reduce this Rooksha quality and to
normalize the Siras & Shleshaka kapha qualities, Brimhana Nasya and Snehapana is given.
CONCLUSION
Based on the conceptual analysis and observations made in the clinical study, the following
conclusions can be drawn. Present study revealed that the bharavahana, ati yaana, rooksha,
alpa ahara and vegadharana, ativyayama are the most incident causes for the manifestation of
disease Apabahuka. Vyana vayu prakopa is the prime pathology of Apabahuka. This can
happen either due to dhatuksaya or kapha avarana (vata dosha encircled with kapha).
Masha taila Nasya and Uttarabhaktika Snehapana can be practiced safely without any adverse
effect. Nasyakarma and Uttarabhaktika Snehapana are effective in eliminating Shula and
Bahupraspandahara and to improve functional ability of patient.
In both the groups subjective and objective parameters shows statistically Highly
Significance result (P< 0.0001). Group B is more effective than Group A in all parameters
except Shula, as Snehapana is best Vatashamaka and gives Ashu Bala and do the Ashu dhatu
poshana.
Overall the Group B is more effective clinically and statistically than Group A in almost all
the parameters. Being this study is done with very minimal resources (subjects, parameters
etc.), we feel it requires a large scale clinical trial to establish the effect.
ACKNOWLEDGEMENT
I have no word to express my feelings to appraise my whole hearted gratitude and deep sense
of indebtedness to my respected guide Dr. Shalini Eli– HOD and Professor, Dept. of
Panchakarma for her motherly affection, guidance, care and valuable suggestions throughout
the course of my study have helped in completing this work successfully.
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