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CASE PRESENTATION
PRESENTER BY
DR. KAUSHAL SINHA
PG SCHOLAR
DEPARTMENT OF PANCHAKARMA
SDM COLLEGE OF AYURVEDA AND HOSPITAL
HASSAN
PATIENT DETAILS
Name : XXX
Age : 42 Yrs
Date of Admission : 11.07.2016
Ward No : SSW
Bed No : 174
Address : Shivmoga
 Occupation : LIC agent since 22 yrs
Religion : Hindu
CHIEF COMPLAINTS
Pain in nape of neck region radiating to Right hand till the finger
since 1 week.
Associated complaints: Numbness & weakness in right upper limb,
stiffness in arm.
Difficulty in performing routine works.
H/O PRESENT ILLNESS
 According to patient
Patient was said to be apparently healthy before 8 days. On 3 july
2016, he suffered from fever and pain in nape of neck radiating to
the right hand for which he consulted local clinic and took
medicine (Paracetamol) after which fever subsided .
 But neck pain still persisted. Pain was severe , agonizing , pricking
associated with numbness. He was unable to lift his right hand . He
consulted to a local hospital in shimoga but did not find any relief.
So he approached SDM hospital Hassan and was admitted on
11/7/16 for further management.
CHARACTERISTICS OF PAIN
Nature of pain : Pricking
Duration : Continuous
Severity : Severe & agonising
Radiation : From nape of neck to right upper hand
Aggravating factors : Activity
Relieving factors : Analgesics
Diurnal variation : More at night
H/O PAST ILLNESS
 MEDICAL HISTORY :- Patient experiences pain in right upper limb
once in 6 months since 3 years
Not a case of diabetes Mellitus/ Hypertensive, No history of any
accident or trauma
 SURGICAL HISTORY :-Nothing specific
PSYCHIATRIC HISTORY :- NAD
 TREATMENT HISTORY :- Pain used to get relieved by taking
analgesics
.
FAMILY HISTORY
No relevant family history contributing to the current condition of the
patient.
All members are said to be healthy.
PERSONAL HISTORY
 Diet -
 Break fast - Idli (5) – Sambhar, Coconut chatni, 1 Large mudde (Ragi ball) +
Rice (1 small bowl) with sambhar (occasionally).
 Lunch - No specific time, Sugarcane juice / Tender coconut / buttermilk
 Dinner – 1 Large mudde (ragi) with Sambhar, 2 chapati / Rice occasionally.
Curd + sugar before bed time
 Appetite - Good
Cont….
 Sleep : Disturbed due to pain
 Bowel habits : Twice in a day,
Habits :- 1 Beer once in 15 days or 1 month.
coffee / tea – 10-15 cups / day
Improper posture while watching TV and also
during sleep– uses 2-3 pillows.
PROFESSIONAL HISTORY
 Travel 100-150 km/day since 20 years.
 Working hours- 8am to 9 pm (12 hours)
 Travels in 2 wheeler in Rural area with speed of 50-60 km/hour
 Stress related work
 No proper food time
GENERAL EXAMINATION
Built Moderate
Pallor Absent
Icterus Absent
Cyanosis & Clubbing Absent
Lymphadenopathy Absent
Tongue coating Mild coated
Pulse rate 74/min
BP 130/90 mm Hg
SYSTEMIC EXAMINATION
 CVS - S1 S2 heard
 RS - NVBS , no added sounds
 P/A - No organomegaly and no tenderness
 CNS
Higher mental functions
Sensory system NAD clinically
Cranial nerves
HIGHER MENTALACTIVITIES
Consciousness Well conscious
Orientation Well oriented to Person, place, time
Memory Intact
Speech Normal
REVIEW OF SYSTEMS
 GENERAL CONDITION:-
 Weight: 68 kgs
 Height : 156 cm
 BMI: 27.98 kg/m2
 Recent weight changes-no
 Weakness:- Yes ( RIGHT UPPER LIMB )
 Fatigue:- Yes
FOCUSED EXAMINATION OF RIGHT
SHOULDER
GATI (RANGE OF MOVEMENTS) :
Shoulder joint - Flexion
Extension Painful and restricted
Abduction
Adduction
Internal rotation
External rotation
INSPECTION
 Swelling - Absent
 Redness – Absent
 Deformities – Absent
PALPATION.
 Tenderness – Present at Right scapular region
 Temperature – Present at Right shoulder & elbow joint
SPECIAL MANEUVERS
TO FIND LESION IN CERVICAL REGION:-
 SPURLING TEST - POSITIVE ( RIGHT SIDE)
 COMPRESSION TEST - POSITIVE ( RIGHT SIDE)
 TO LOCATE LESIONS AT ROTATOR CUFF:-
 APPLEY’S SCRATCH TEST :- POSITIVE ( RIGHT SIDE)
 DROPARM SIGN :- POSITIVE ( RIGHT SIDE)
 EMPTY CAN TEST :- POSITIVE ( RIGHT SIDE)
APPLEY’S SCRATCH TEST
ARM DROP SIGN
EMPTY CAN TEST
INVESTIGATION
 HB-12.2GM%
 Total W.B.C count -
14500 cells/ cmm
 E.S.R-18 mm/hour
OSTEOPHYTIC CHANGES
ASHTAVIDHA PAREEKSHA
 Nadi : Vatakapha
 Mutra : D/ N – 3 / 2 times
 Mala : Twice in a day
 Jivha : Aliptha
 Shabda : Prakrita
 Sparsha : Ushna sparsa in affected sandhi
 Druk : Prakrita
 Akriti : Madhyama
DASHAVIDHA PAREEKSHA
1) Prakruti - Vata-kapha
2) Vikruti -
Hetu - Ahara –Vatakara,kaphakara
Vihara - Atiyana (daily travel)
Manasika - Chinta
Dosha - Vata-kapha
Dushya - Rasa, asthi,rakta, mamsa ,snayu
Desha - Sadharana
Kala - Visarga
Bala - Madhayama
CONTD…….
3) Sara - Madyama
4) Samhanana - Madyama
5) Pramana - 68 kgs
6) Satva - Madyama
7) Saatmya - Nitya dahi sevana (kaphakara ahara)
8) Ahara shakti - Madyama
9) Vyayama shakti -Madyama
10) vaya - Madyama
NIDANA PANCHAKA
• NIDANA - Akala bhojana, Nitya Dadhi sevana,atiyana
• POORVARUPA- Shrama, Pain in right shoulder
• RUPA - Pain in nape of neck radiating to right upper
limb associated with numbness & weakness in
right upper limb, stiffness in right arm
• UPASHAYA - Oushadha
SAMPRAPTI
NIDANA
APABAHUKA
Bahupraspandana hara
Shoshana of Sleshaka Kapha, Mamsa, Sira,
Snayu & Kandara
Sthanasamsraya in Amsa
Vata prakopa
Vatakara
Kaphakara
Adhishthana in
Amsapradesha
Kapha Prakopa
Kaphavruta Vyana in
Sandhi
Sira Sankocha
SAMPRAPTI GHATAKA
Dosha : Vyana Vata, Shleshaka Kapha.
Dushya : Sira, Snayu, Mamsa, Kandara, Asthi.
Srotas : Mamsavaha, Asthivaha.
Sroto Dushti : Sanga, Vimargagamana
Roga Marga : Madhyama.
Udbhava Sthana : Pakwashaya.
Vyakta Sthana : Bahu.
Adhisthana : Amsa Pradesha.
Vyadhi Swabhava : Chirakari.
DIFFERENTIAL DIAGNOSIS
DIFFERENTIAL
DIAGNOSIS
INCLUSION CRITERIA EXCLUSION CRITERIA
1. एक ांग रोग हस्तं वा तोदशूलकृ त् पादं सङ्कोचयत्येकं हस्तं
(Voluntary activity affected
part is impaired or lost)
2. विश्ि ची
 बाह्यो: कर्म क्षयकरी तलं प्रत्यङ्गुलीनां या
कण्डरा बाहुपृष्ठतः
3. अांश शोष
दौबमल्य in अंससन्धि र्ांस क्षय , र्ांस शोष
4. अपब हुक अांसमूलस्थितो ि युुः
ससर ुः सङ्कोच्य तत्रग ुः
ब हुप्रथपस्दितहरां with
shoola and sthambha
DIFFERENTIAL
DIAGNOSIS
INCLUSION CRITERIA EXCLUSION CRITERIA
1.BURSITIS Joint tenderness. Pain during
movement
Pinching pain, redness
2.TENDENITIS Pain in shoulder and arm
stiffness
Loss of morbidity,
strength in the affected arm
3.ROTATOR CUFF
INJURY
Pain in shoulder, Joint
stiffness, muscle weakness
Loss of muscle, nerve
injury
4.CERVICAL
SPONDYLOSIS
Pain in neck and
shoulder,weakness in the right
upper arm
Neurological dysfunction
5.FROZEN SHOULDER Stiffness, pain and limited
range of movements.
Pain in shoulder during
movement.
Pain usually worsens at night.
DIAGNOSIS
APABAHUKA
{FROZEN SHOULDER}
Apabahuka
 One among vataja nanatmaja vyadhi
 Acharya Susruta, Vagbhata - Avabahuka a Vata Vyadhi.
 Not explained by Charaka , but word Bahu sosha had been used
instead.
 Avabahuka - Shleshaka Kapha Sosha + Shoola during movement,
restricted movement etc.
 Madhokosha :- two types( V and VK)
Definition
 Apabahuka is a disease characterized by morbid vata dosa localizing
around the amsa pradesa and there by causing soshana of amsa
bandha as well as akuncana of sira at this site leads to
bahupraspanda hara
LAKSHANA’S
 Apa means Vikruthi or Viyoga (Dysfuntion)
 Bahupratispanditahara (limitations of ROM)
 Sira Akunchana
 Stambha (stiffness)
FROZEN SHOULDER
Also known as adhesive capsulitis
Characterized by Stiffness, pain and limited range of movements.
Pain usually worsens at night.
Frozen shoulder occurs in about 2% of the general population.
It most commonly affects people between the ages of 40 and 60, and
occurs in women more often than men.
TREATMENT PLAN
TREATMENT ON 12 July 2016 (First day)
1- Sarvanga udwartana + parisheka with dhanyamla + dashmula kwatha
2- Nasya with K.B taila 101- 8-8 drops each nostrils.
3- Upanaha at Right upper arm with kolakulathadi churna + saindhava +
godhuma + karpasasthyadi taila
4- Shiropichu with Bramhi ghrita
5. V.M vati 2-2-2 (A/F)
On 13 July 2016 (Second day)
1- Sarvanga Udwartana + Parisheka
2- Nasya.
3- Upanaha same 1,2,3,4,5was the same
4- Shiropichu
5. V.M vati
Cap. Flexofen MR 1-0-1 (A/F)
On 14 JULY 2016 TO 15 JULY 2016
(3RD DAY TO 4TH DAY)
1- Sarvanga udwartana + parisheka
2- Nasya
3- Upanaha 1,2,3,4,5,6was the same
4- Shiropichu
5. V.M. vati
6- Cap. Flexofen MR
ON 16 JULY 2016 TO 18 JULY 2016
( 5TH DAY TO 7TH DAY)
 Sarwanga Abhyanga with Mahanarayana taila + Jambeera pinda sweda
 Sthanika Arka Patra sweda in upper limb
2.Nasya with K.B. taila 101
3.Upanaha Treatment was the same
4- Shiropichu
5- V.M. vati
6- Cap. Flexofen MR
19 JULY 2016 TO 22 JULY 2016
(11TH DAYS)
1. Sarwanga Abhyanga with M.N. taila + SSPS ( sasthika shali pinda sweda )
2.Nasya with K.B. taila 101
3.Upanaha Treatment was the same
4- Shiropichu
5- Cap. Flexofen MR
6. V.M vati
7. Sthanika arka patra sweda
RESULT
LAB INVESTIGATION
RANGE OF MOVEMENT:
JOINT FLEXION EXTENSION ABDUCTION ADDUCTION
RIGHT
SHOULDER
JOINT (0)
BT 60 30 30 35
AT 80 50 40 50
JOINT INTERNAL
ROTATION
EXTERNAL
ROTATION
RIGHT
SHOULDER JOINT
BT 20 20
AT 30 40
7/31/2016
47
DISCHARGE MEDICATION
ON 23 JULY 2016
 Cap. Flexofen MR 1-0-1 (A/F)
 Cap. Cervilon 1-0-1 (A/F)
 Ksheerbala 101 2-2-2 drops each nostrils
 Shirupichu with kalyanaka ghrita
 Kalyanaka Ghrita 2tsp-0-0 after food with milk
 Kolakulathadi churna-200gm + karpasthayadi taila + hot water in greeva lepa
Review after 2 month
DISCUSSION
CHIKITSA SUTRA
अिब हौ हहतां नथयां थनेहश्चोत्तरभस्ततकुः
(A.H.CHI.15/44)
SNEHANA
CHIKITSA
 BRUMHANA NASYA
 BRUMHANA SNEHAPANA
CONCEPT OF BRIHMANANGA
SHEHAPANA
 ब्रुंहणो रस मध्याध्यै: स भक्तोऽल्पोऽस्योहहत: स च।
(अ.ह्रर.सू.१६/२०)
sss
NASYA
BRIHMANA NASYA
 Its is a type of navana nasya in which medicated oil or ghee is used.
 Its also called Sneha nasya
 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.
 As the word sneha sugests, snehana nasya gives strength to all the
dhatu and is used as dhatuposhaka.
BENEFITS OF NASYA
तत्र यः स्नेहनार्थं शूधयशशरसां ग्रीि थकदधोरस ां च
बलजनन िं दृन्ष्िप्रसादजननार्थं वा स्नेहो वविीयते
(Su.chi.40/22)
WHY TO USE BRUMHANA NASYA AND
SNEHAPANA IN APABAHUKA
 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.
 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.
SWEDANA
Sweda
RUKSHA SWEDA IN
SAMAVASTHA. EG:-
PARISHEKA
SNIGDHA RUKSHA
SWEDA IN NIRAM
AVASTH. EG :-
PATRA PINDA
SWEDA
SNIGDHA SWEDA IF
PRAVRUDDHA AND
DHATU KSHAYA. EG:-
SHASTIKA SHAALI
PINDA SWEDA
WHICH SWEDA……?
RUKSHA SWEDA
 Administered in स म िथि of the disease
 Valuka sweda
 Choorna Pinda Sweda
 Pariseka Sweda / Drava sweda
 Upanaha Sweda(Ruksha)
SNIGDHA SWEDA
Administered in ननर मिथि of the disease
Jambeera pinda sweda
Shastika shaali pinda sweda
Arka patra sweda
ARKA PATRA SWEDA
PHYSICAL EXERCISE
Specific exercises will help restore motion.
These may be under the supervision of a physical therapist
or via a home program.
Therapy includes stretching or range of motion exercises
for the shoulder.
Sometimes heat is used to help loosen the shoulder up
before the stretching exercises
EXTERNAL ROTATION — PASSIVE
STRETCH.
 Stand in a doorway and bend
your affected arm 90 degrees
to reach the doorjamb. Keep
your hand in place and rotate
your body as shown in the
illustration. Hold for 30
seconds. Relax and repeat.
FORWARD FLEXION — SUPINE
POSITION
 Lie on your back with your
legs straight. Use your
unaffected arm to lift your
affected arm overhead until
you feel a gentle stretch. Hold
for 15 seconds and slowly
lower to start position. Relax
and repeat
CROSS OVER ARM STRETCH.
 Gently pull one arm across
your chest just below your
chin as far as possible without
causing pain. Hold for 30
seconds. Relax and repeat
CONCLUSION
 Avabahuka is one of the most common problems which effect mostly in
middle age group of patients
 Bharavahana, atiyana, rooksha, alpa ahara and vegadharana, ativyayama
are the most common 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).
 Brumhana Nasya and Uttarabhaktika Snehapana can be practiced safely .
Nasyakarma and Uttarabhaktika Snehapana are effective in eliminating
vyadhi.
विक रन म कु शलो न स्जह्रीय त् कि चन
न हह सिवविक र ण ां न मतोऽस्थत ध्रुि स्थिनतुः
स एि कु वपतो िोषुः समुत्ि नविशेषतुः
थि न दतरगतश्चैि जनयत्य मय न् बहून्
तथम द्विक रप्रकृ तीरधधष्ठ न दतर णण च|
समुत्ि नविशेष ांश्च बुद््ि कमव सम चरेत्
यो ह्येतस्त्त्रतयां ज्ञ त्ि कम वण्य रभते सभषक्
ज्ञ नपूिं यि दय यां स कमवसु न मुह्यनत
(CHA.SU.18/47)
 If a physician not able to name a disease, he should not feel ashamed because it
is not always possible to name (sarvaikara ) all type of disease in difinite terms.
 When dosha is aggravated,it may cause manifold disease depending upon
(samutthana )various etiological factors and sthana site of its manifestation.
.
 Hence the physician should start treatment after considering
vikarprakruti intimate cause for disaese location and etiological
factors.
 The physician who follows the above mentioned factors after
having the knowladge for the therapeutic properties will never fail in
his his attempt to cure the disease
Thank you

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CASE PRESENTATION ON APABAHUKA (FROZEN SHOULDER)

  • 1. CASE PRESENTATION PRESENTER BY DR. KAUSHAL SINHA PG SCHOLAR DEPARTMENT OF PANCHAKARMA SDM COLLEGE OF AYURVEDA AND HOSPITAL HASSAN
  • 2. PATIENT DETAILS Name : XXX Age : 42 Yrs Date of Admission : 11.07.2016 Ward No : SSW Bed No : 174 Address : Shivmoga  Occupation : LIC agent since 22 yrs Religion : Hindu
  • 3. CHIEF COMPLAINTS Pain in nape of neck region radiating to Right hand till the finger since 1 week. Associated complaints: Numbness & weakness in right upper limb, stiffness in arm. Difficulty in performing routine works.
  • 4. H/O PRESENT ILLNESS  According to patient Patient was said to be apparently healthy before 8 days. On 3 july 2016, he suffered from fever and pain in nape of neck radiating to the right hand for which he consulted local clinic and took medicine (Paracetamol) after which fever subsided .  But neck pain still persisted. Pain was severe , agonizing , pricking associated with numbness. He was unable to lift his right hand . He consulted to a local hospital in shimoga but did not find any relief. So he approached SDM hospital Hassan and was admitted on 11/7/16 for further management.
  • 5. CHARACTERISTICS OF PAIN Nature of pain : Pricking Duration : Continuous Severity : Severe & agonising Radiation : From nape of neck to right upper hand Aggravating factors : Activity Relieving factors : Analgesics Diurnal variation : More at night
  • 6. H/O PAST ILLNESS  MEDICAL HISTORY :- Patient experiences pain in right upper limb once in 6 months since 3 years Not a case of diabetes Mellitus/ Hypertensive, No history of any accident or trauma  SURGICAL HISTORY :-Nothing specific PSYCHIATRIC HISTORY :- NAD  TREATMENT HISTORY :- Pain used to get relieved by taking analgesics .
  • 7. FAMILY HISTORY No relevant family history contributing to the current condition of the patient. All members are said to be healthy.
  • 8. PERSONAL HISTORY  Diet -  Break fast - Idli (5) – Sambhar, Coconut chatni, 1 Large mudde (Ragi ball) + Rice (1 small bowl) with sambhar (occasionally).  Lunch - No specific time, Sugarcane juice / Tender coconut / buttermilk  Dinner – 1 Large mudde (ragi) with Sambhar, 2 chapati / Rice occasionally. Curd + sugar before bed time  Appetite - Good
  • 9. Cont….  Sleep : Disturbed due to pain  Bowel habits : Twice in a day, Habits :- 1 Beer once in 15 days or 1 month. coffee / tea – 10-15 cups / day Improper posture while watching TV and also during sleep– uses 2-3 pillows.
  • 10. PROFESSIONAL HISTORY  Travel 100-150 km/day since 20 years.  Working hours- 8am to 9 pm (12 hours)  Travels in 2 wheeler in Rural area with speed of 50-60 km/hour  Stress related work  No proper food time
  • 11. GENERAL EXAMINATION Built Moderate Pallor Absent Icterus Absent Cyanosis & Clubbing Absent Lymphadenopathy Absent Tongue coating Mild coated Pulse rate 74/min BP 130/90 mm Hg
  • 12. SYSTEMIC EXAMINATION  CVS - S1 S2 heard  RS - NVBS , no added sounds  P/A - No organomegaly and no tenderness  CNS Higher mental functions Sensory system NAD clinically Cranial nerves
  • 13. HIGHER MENTALACTIVITIES Consciousness Well conscious Orientation Well oriented to Person, place, time Memory Intact Speech Normal
  • 14. REVIEW OF SYSTEMS  GENERAL CONDITION:-  Weight: 68 kgs  Height : 156 cm  BMI: 27.98 kg/m2  Recent weight changes-no  Weakness:- Yes ( RIGHT UPPER LIMB )  Fatigue:- Yes
  • 15. FOCUSED EXAMINATION OF RIGHT SHOULDER GATI (RANGE OF MOVEMENTS) : Shoulder joint - Flexion Extension Painful and restricted Abduction Adduction Internal rotation External rotation
  • 16. INSPECTION  Swelling - Absent  Redness – Absent  Deformities – Absent PALPATION.  Tenderness – Present at Right scapular region  Temperature – Present at Right shoulder & elbow joint
  • 17. SPECIAL MANEUVERS TO FIND LESION IN CERVICAL REGION:-  SPURLING TEST - POSITIVE ( RIGHT SIDE)  COMPRESSION TEST - POSITIVE ( RIGHT SIDE)
  • 18.  TO LOCATE LESIONS AT ROTATOR CUFF:-  APPLEY’S SCRATCH TEST :- POSITIVE ( RIGHT SIDE)  DROPARM SIGN :- POSITIVE ( RIGHT SIDE)  EMPTY CAN TEST :- POSITIVE ( RIGHT SIDE)
  • 22. INVESTIGATION  HB-12.2GM%  Total W.B.C count - 14500 cells/ cmm  E.S.R-18 mm/hour
  • 24. ASHTAVIDHA PAREEKSHA  Nadi : Vatakapha  Mutra : D/ N – 3 / 2 times  Mala : Twice in a day  Jivha : Aliptha  Shabda : Prakrita  Sparsha : Ushna sparsa in affected sandhi  Druk : Prakrita  Akriti : Madhyama
  • 25. DASHAVIDHA PAREEKSHA 1) Prakruti - Vata-kapha 2) Vikruti - Hetu - Ahara –Vatakara,kaphakara Vihara - Atiyana (daily travel) Manasika - Chinta Dosha - Vata-kapha Dushya - Rasa, asthi,rakta, mamsa ,snayu Desha - Sadharana Kala - Visarga Bala - Madhayama
  • 26. CONTD……. 3) Sara - Madyama 4) Samhanana - Madyama 5) Pramana - 68 kgs 6) Satva - Madyama 7) Saatmya - Nitya dahi sevana (kaphakara ahara) 8) Ahara shakti - Madyama 9) Vyayama shakti -Madyama 10) vaya - Madyama
  • 27. NIDANA PANCHAKA • NIDANA - Akala bhojana, Nitya Dadhi sevana,atiyana • POORVARUPA- Shrama, Pain in right shoulder • RUPA - Pain in nape of neck radiating to right upper limb associated with numbness & weakness in right upper limb, stiffness in right arm • UPASHAYA - Oushadha
  • 28. SAMPRAPTI NIDANA APABAHUKA Bahupraspandana hara Shoshana of Sleshaka Kapha, Mamsa, Sira, Snayu & Kandara Sthanasamsraya in Amsa Vata prakopa Vatakara Kaphakara Adhishthana in Amsapradesha Kapha Prakopa Kaphavruta Vyana in Sandhi Sira Sankocha
  • 29. SAMPRAPTI GHATAKA Dosha : Vyana Vata, Shleshaka Kapha. Dushya : Sira, Snayu, Mamsa, Kandara, Asthi. Srotas : Mamsavaha, Asthivaha. Sroto Dushti : Sanga, Vimargagamana Roga Marga : Madhyama. Udbhava Sthana : Pakwashaya. Vyakta Sthana : Bahu. Adhisthana : Amsa Pradesha. Vyadhi Swabhava : Chirakari.
  • 31. DIFFERENTIAL DIAGNOSIS INCLUSION CRITERIA EXCLUSION CRITERIA 1. एक ांग रोग हस्तं वा तोदशूलकृ त् पादं सङ्कोचयत्येकं हस्तं (Voluntary activity affected part is impaired or lost) 2. विश्ि ची  बाह्यो: कर्म क्षयकरी तलं प्रत्यङ्गुलीनां या कण्डरा बाहुपृष्ठतः 3. अांश शोष दौबमल्य in अंससन्धि र्ांस क्षय , र्ांस शोष 4. अपब हुक अांसमूलस्थितो ि युुः ससर ुः सङ्कोच्य तत्रग ुः ब हुप्रथपस्दितहरां with shoola and sthambha
  • 32. DIFFERENTIAL DIAGNOSIS INCLUSION CRITERIA EXCLUSION CRITERIA 1.BURSITIS Joint tenderness. Pain during movement Pinching pain, redness 2.TENDENITIS Pain in shoulder and arm stiffness Loss of morbidity, strength in the affected arm 3.ROTATOR CUFF INJURY Pain in shoulder, Joint stiffness, muscle weakness Loss of muscle, nerve injury 4.CERVICAL SPONDYLOSIS Pain in neck and shoulder,weakness in the right upper arm Neurological dysfunction 5.FROZEN SHOULDER Stiffness, pain and limited range of movements. Pain in shoulder during movement. Pain usually worsens at night.
  • 34. Apabahuka  One among vataja nanatmaja vyadhi  Acharya Susruta, Vagbhata - Avabahuka a Vata Vyadhi.  Not explained by Charaka , but word Bahu sosha had been used instead.  Avabahuka - Shleshaka Kapha Sosha + Shoola during movement, restricted movement etc.  Madhokosha :- two types( V and VK)
  • 35. Definition  Apabahuka is a disease characterized by morbid vata dosa localizing around the amsa pradesa and there by causing soshana of amsa bandha as well as akuncana of sira at this site leads to bahupraspanda hara
  • 36. LAKSHANA’S  Apa means Vikruthi or Viyoga (Dysfuntion)  Bahupratispanditahara (limitations of ROM)  Sira Akunchana  Stambha (stiffness)
  • 37. FROZEN SHOULDER Also known as adhesive capsulitis Characterized by Stiffness, pain and limited range of movements. Pain usually worsens at night. Frozen shoulder occurs in about 2% of the general population. It most commonly affects people between the ages of 40 and 60, and occurs in women more often than men.
  • 39. TREATMENT ON 12 July 2016 (First day) 1- Sarvanga udwartana + parisheka with dhanyamla + dashmula kwatha 2- Nasya with K.B taila 101- 8-8 drops each nostrils. 3- Upanaha at Right upper arm with kolakulathadi churna + saindhava + godhuma + karpasasthyadi taila 4- Shiropichu with Bramhi ghrita 5. V.M vati 2-2-2 (A/F)
  • 40. On 13 July 2016 (Second day) 1- Sarvanga Udwartana + Parisheka 2- Nasya. 3- Upanaha same 1,2,3,4,5was the same 4- Shiropichu 5. V.M vati Cap. Flexofen MR 1-0-1 (A/F)
  • 41. On 14 JULY 2016 TO 15 JULY 2016 (3RD DAY TO 4TH DAY) 1- Sarvanga udwartana + parisheka 2- Nasya 3- Upanaha 1,2,3,4,5,6was the same 4- Shiropichu 5. V.M. vati 6- Cap. Flexofen MR
  • 42. ON 16 JULY 2016 TO 18 JULY 2016 ( 5TH DAY TO 7TH DAY)  Sarwanga Abhyanga with Mahanarayana taila + Jambeera pinda sweda  Sthanika Arka Patra sweda in upper limb 2.Nasya with K.B. taila 101 3.Upanaha Treatment was the same 4- Shiropichu 5- V.M. vati 6- Cap. Flexofen MR
  • 43. 19 JULY 2016 TO 22 JULY 2016 (11TH DAYS) 1. Sarwanga Abhyanga with M.N. taila + SSPS ( sasthika shali pinda sweda ) 2.Nasya with K.B. taila 101 3.Upanaha Treatment was the same 4- Shiropichu 5- Cap. Flexofen MR 6. V.M vati 7. Sthanika arka patra sweda
  • 46. RANGE OF MOVEMENT: JOINT FLEXION EXTENSION ABDUCTION ADDUCTION RIGHT SHOULDER JOINT (0) BT 60 30 30 35 AT 80 50 40 50 JOINT INTERNAL ROTATION EXTERNAL ROTATION RIGHT SHOULDER JOINT BT 20 20 AT 30 40 7/31/2016 47
  • 47. DISCHARGE MEDICATION ON 23 JULY 2016  Cap. Flexofen MR 1-0-1 (A/F)  Cap. Cervilon 1-0-1 (A/F)  Ksheerbala 101 2-2-2 drops each nostrils  Shirupichu with kalyanaka ghrita  Kalyanaka Ghrita 2tsp-0-0 after food with milk  Kolakulathadi churna-200gm + karpasthayadi taila + hot water in greeva lepa Review after 2 month
  • 49. CHIKITSA SUTRA अिब हौ हहतां नथयां थनेहश्चोत्तरभस्ततकुः (A.H.CHI.15/44)
  • 51. CHIKITSA  BRUMHANA NASYA  BRUMHANA SNEHAPANA
  • 52. CONCEPT OF BRIHMANANGA SHEHAPANA  ब्रुंहणो रस मध्याध्यै: स भक्तोऽल्पोऽस्योहहत: स च। (अ.ह्रर.सू.१६/२०)
  • 54. BRIHMANA NASYA  Its is a type of navana nasya in which medicated oil or ghee is used.  Its also called Sneha nasya  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.  As the word sneha sugests, snehana nasya gives strength to all the dhatu and is used as dhatuposhaka.
  • 55. BENEFITS OF NASYA तत्र यः स्नेहनार्थं शूधयशशरसां ग्रीि थकदधोरस ां च बलजनन िं दृन्ष्िप्रसादजननार्थं वा स्नेहो वविीयते (Su.chi.40/22)
  • 56. WHY TO USE BRUMHANA NASYA AND SNEHAPANA IN APABAHUKA  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.  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.
  • 58. Sweda RUKSHA SWEDA IN SAMAVASTHA. EG:- PARISHEKA SNIGDHA RUKSHA SWEDA IN NIRAM AVASTH. EG :- PATRA PINDA SWEDA SNIGDHA SWEDA IF PRAVRUDDHA AND DHATU KSHAYA. EG:- SHASTIKA SHAALI PINDA SWEDA WHICH SWEDA……?
  • 59. RUKSHA SWEDA  Administered in स म िथि of the disease  Valuka sweda  Choorna Pinda Sweda  Pariseka Sweda / Drava sweda  Upanaha Sweda(Ruksha)
  • 60. SNIGDHA SWEDA Administered in ननर मिथि of the disease Jambeera pinda sweda Shastika shaali pinda sweda Arka patra sweda
  • 62. PHYSICAL EXERCISE Specific exercises will help restore motion. These may be under the supervision of a physical therapist or via a home program. Therapy includes stretching or range of motion exercises for the shoulder. Sometimes heat is used to help loosen the shoulder up before the stretching exercises
  • 63. EXTERNAL ROTATION — PASSIVE STRETCH.  Stand in a doorway and bend your affected arm 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax and repeat.
  • 64. FORWARD FLEXION — SUPINE POSITION  Lie on your back with your legs straight. Use your unaffected arm to lift your affected arm overhead until you feel a gentle stretch. Hold for 15 seconds and slowly lower to start position. Relax and repeat
  • 65. CROSS OVER ARM STRETCH.  Gently pull one arm across your chest just below your chin as far as possible without causing pain. Hold for 30 seconds. Relax and repeat
  • 67.  Avabahuka is one of the most common problems which effect mostly in middle age group of patients  Bharavahana, atiyana, rooksha, alpa ahara and vegadharana, ativyayama are the most common 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).  Brumhana Nasya and Uttarabhaktika Snehapana can be practiced safely . Nasyakarma and Uttarabhaktika Snehapana are effective in eliminating vyadhi.
  • 68. विक रन म कु शलो न स्जह्रीय त् कि चन न हह सिवविक र ण ां न मतोऽस्थत ध्रुि स्थिनतुः स एि कु वपतो िोषुः समुत्ि नविशेषतुः थि न दतरगतश्चैि जनयत्य मय न् बहून् तथम द्विक रप्रकृ तीरधधष्ठ न दतर णण च| समुत्ि नविशेष ांश्च बुद््ि कमव सम चरेत् यो ह्येतस्त्त्रतयां ज्ञ त्ि कम वण्य रभते सभषक् ज्ञ नपूिं यि दय यां स कमवसु न मुह्यनत (CHA.SU.18/47)  If a physician not able to name a disease, he should not feel ashamed because it is not always possible to name (sarvaikara ) all type of disease in difinite terms.  When dosha is aggravated,it may cause manifold disease depending upon (samutthana )various etiological factors and sthana site of its manifestation. .
  • 69.  Hence the physician should start treatment after considering vikarprakruti intimate cause for disaese location and etiological factors.  The physician who follows the above mentioned factors after having the knowladge for the therapeutic properties will never fail in his his attempt to cure the disease

Editor's Notes

  1. A male patient by name chandramoli of age 42 years from shivmoga was a lic agent by occupation
  2. Presented with the complaints of
  3. Comin to her personal history Patient daily takes curd suger beff….
  4. N there was addiction for improp….. Curd + sugar before bed time PROFESSIONAL HISTORY
  5. GENERAL HISTORY
  6. SYSTEMIC HISTORY
  7. Nvbs normal vesicular sound heard REVIEW OF SYSTEMS
  8. Drop arm sign test is a test for rotator cuff tears specially of the supraspinatous tendon.  A sign seen in the absence of rotator cuff function or when there is a rupture of the supraspinatus tendon: the arm can be passively abducted without pain, but when support of the arm is removed and the deltoid contracts suddenly, the pain produced causes the patient to hunch the shoulder and lower the arm Rupture of the Supraspinatus Tendon Appley scratch test is a test special for supraspinatous muscle , the patient attemt to touch opposite scapula to test range of motion of the shoulder abduction external rotation and internal rotation
  9.  A sign seen in the absence of rotator cuff function or when there is a rupture of the supraspinatus tendon: the arm can be passively abducted without pain, but when support of the arm is removed and the deltoid contracts suddenly, the pain produced causes the patient to hunch the shoulder and lower the arm Rupture of the Supraspinatus Tendon
  10. The test is usually easier in sitting or standing. On the side to be tested the one of the examiner’s hands stabilizes shoulder girdle. The arm to be tested is moved into 90 degrees of forward flexion in the plane of the scapula (approximately 30 degrees of abduction), full internal rotation with the thumb pointing down as if emptying a beverage can.
  11. Lab investigation has been performed and it is found that esr has been raised.
  12. In XRAY HAS BEEN PERFORMED IN C5 – C6 WE CAN SEE THE OSTEOPHYTIC CAHNGES
  13. Adana shivgri Visrga vashe
  14. 28
  15. (CHA.CH I.28\55) Daignosis of apabahuka we can be correlated with manya…… Restricted movements of the shoulder joint, stiffness and pain Amsa shosha –but pain is not daignostic criteria in amsa shosha but mandatory in apabahuka and viswaachi Viswachi- typical presentation of radiating pain starting from upper arm to forearm and palm,pain is also sharp Severe lighting and intermittent but apabahuka contion pain in apabahuka does not radiate the pain is more or loss
  16. In differential daignosis amsa shosha was included as there was mamsa kshaya and shosha in shoulder region and excluded as there was no stiffness in muscle. Then ekanga roga was included as there was pain in hand …… and excluded as there was no voluntaryyyy Ekanga---Hasta va toda shula krut- means that pain in hand and sthambha Pada sankoch chay – consitriction in the vein of over hand Viswahi- baho karma kashya kari difficulty in the movement of arm,weakness in muscle of the arm Talam– deformity in the muscle of the movement of arm Apabahuka – constriction in the vein of shoulder joint and difficulty of movement of shoulder
  17. ACCORDING TO MODERN
  18. THE CASE WAS DIANOSED AS APABAUKA WHICH CAN BE CORRELATED FROZEN SHOULDER
  19. THE TREATMENT GIVEN WAS ON 1ST DAY SARWANG UD. FOLLOWED BY PARISHEKA AND DMQ BECAUSE THE PURPOSE OF RUKSHANA. BECAUSE s the patient was having more pain and stiffness the bahya karma that is upanaha was given The patient was having disturbed the sleep shiro pichu done the pt.with bramhi ghrita Kb101 it is used in all type of vata Shirupichu chs.si.9/6 Bramhi ghrita vata disoerder, sleeplessness stress, it can be applied morning and removed the evening
  20. Flexofen MR – shunthi, shilajatu, ashwagandha, shallaki,yogaraj, shuddha kupilu,abhrak bhasma Its the very effective in joint related disease Reduce the stiffness and muscle pain
  21. SAME CONTINOUE TREATMENT
  22. After rukhsna treatment of ud and parisheka then snigdha rukhsa treatment planned..and for these sr.abh. Jps done it is the shophahara rukhsa, tikshana As the patient was having svere pain, for the purpose of symptomatic relief arka patra swedana was done to the patient which was found very beneficial as it is vata hara ,,, shotha hara and shoola hara.
  23. After ruk and snigdharukhsa sweda the brumhana karma that is ssps was done to the pt. which is the snigdha sweda Ssps is very useful in sarwanga aaashrita balayuta vataroga it is also beneficial decrease the bala of sarira
  24. Range of movement— Normal Flexion- 165, extension 60, internal rotation – 70 , external rotation – 100 , adduction – 50 , abduction -170
  25. Chikitsha sutra of apabahuka… As par acharya charaka brumhana nasya and snehapana is the best treatment for apabahuka condition Nasyakarma and Uttarabhaktika Snehapana have great significance in the treatment of Apabahuka Acc to Astanga Sanghraha - Navana Nasya and Uttarbhaktika Snehapana. Acc to Sushrutacharya - Vatavyadhi chikitsa Acc to Chikitsa sara sangraha - Nasya, Uttarabhaktika Snehapana & Sweda. Acc to Vagbhata – Brumhana Nasya
  26. SNEHANAM SNEHA VISYANDA MARDAVA KLEDAKARKAM
  27. 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.
  28. Snehanartha in shunyashiras Bala jananartha for greeva, skandha. Uras Prasada jananartha for dusthi.
  29. nowLets see y this swedana karma was adopted in this patient Sthambha gauravam sheetaghanam swedanam swedakarkam. The procedure by which swedana is reduces the sthambha, heaviness, coldness is called as swedana
  30. swedana karma it is of 3 types. Ruksha sweda-When the patient is samavastha on has go for ruksha sweda and hence parisheka was given to the patient. Snigdha ruksha sweda- when the pt attian niramvastha on has go for snigdha ruksha sweda and for the purpose JPS given to the pt. Snigdha sweda- lastly for the purpose of brumhana karma ssps that is snigdha sweda was conducted to the patient
  31. Administered in Nirama Avasta of the disease
  32. Shveta Arka (Calatripis procera) patra latex possess Tikta Rasa majorly and little amount of Lavana Rasa, Singhdha and Laghu guna, Ushna Veerya­­­­13 and leaves are Laghu Ruksha and Tikshna in Guna and having Vatahara, Vishaghna, Rechana and Dipana properties.14 Saindhava is aleviator of all three dosas and does not cause burning sensation.15 Ghee alleviates Vata, Pitta, toxic conditions cold in potency and best of all the unctuous substances. Prepared Arka Patra bundle is cut from the base and are heated on a hot pan with ghee and Saindhava Lavana . Hot leaves are then tapped on Kati Pradesha. Once the temperature of the leaves is lost, again they are cut, heated and tapped. This procedure is to be repeated till the Samyak Svedana Lakshanas are seen or upto
  33. External rotation — passive stretch. Stand in a doorway and bend your affected arm 90 degrees to reach the doorjamb. Keep your hand in place and rotate your body as shown in the illustration. Hold for 30 seconds. Relax and repeat.
  34. Viswachi is a neurological disorder occur commonly due to Inflammation of lower motor neurons of the brachial plexus