APABAHUKAM

(Clinical Notes on Shoulder Pathologies)


APABAHUKAM



1.FROZEN SHOULDER

Observations:
•Amsa sandhi gata vata
•Chala guna kshaya
•Manda,sthabdha guna vridhi

Vital diagnostic points

•Pain and stiffness.
•Decreased range of  movements.
•Cannot raise arm beyond certain point due to stiffness and pain.
•Physical evaluation of joint and scapula(~winging) helps in primary diagnosis.
•Usually non-edematous.
•Usually presenting age group will be young adults/mostly male.

Underlying causes:-

1.Cervical disc diseases of neck.(directs =>to cervical pathologies)
2.Shoulder injury.
3.Diabetes mellitus.

Suggestive investigations
Blood RE
X-Ray
MRI (not essential in preliminary evaluation)

Line of Rx

Consider jadaragni,ama at dhatu level and other kaphanubandha lakshana.
Snigdha/Ushna chikitsa.

Rx Choices:-

Internal medicines:
1.Vaishwanara ch./Hingu vachadi tab(bipha)
2.Ashtavarga ksm
3.Mustharishtam
4.Dhanwantharam ksm/tab.
5.Snehana.
6.Prasaranyadi ksm


(Guggulu/Sallaki preperations not a must and can be safely avoided.Panion tab/Painoff not a good choice here.)
Stifain tab may be reserved for a later suggestion.

External treatment.

1.Exercise suggestions is a must.[Physio suggestions]Stretching over a wall,step wise raising on window rods.Abduction.Try to improve the comfort zone movement rather than trying for increasing range of movement.

2.Nasyam Karpasasthadi.(5-8drops max.)
3.Rooksha sweda followed by Abhyangam+Ushma Swedam.(Prasaranyadi thaila/ Karpasasthyadi thaila)
4.Jambeerapinda sweda/Patrapotala sweda.

A moderately build young male/29y presented with rt shoulder stiffness was managed in this treatment line.With 7days E/Rx. symptoms subsided with 90% improvement in r.o.m.
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2.GLENOHUMERAL ARTHRITIS

Observations:
•Vata vridhi in kapha sthana(sandhi)

Vital diagnostic points:

•Progressive shoulder pain.
•Stiffness and loss of motion.
•night pain,mostly postural.

Underlying causes
•O.A ; R.A
•Post trauma.

Suggested investigations:
•Blood routine
•X-Ray
•MRI

Line of treatment:
Vatakapha hara.
Ushna pradhana.
Abhayanthara Snehana.

Rx suggestions

Consider agni/dhatu gata ama before Rx

Internal medicines
1.Rasna saptakam ksm
2.Maharasnadi ksm
3.Aaba guggulu.
4.Gandha tailam Cap.
5.Ksheerabala.
6.Rasonadi ksm.

Ext Rx.
1.Nasyam -Karpasathyadi.
2.Dhanyamla dhara local.
3.Abhyanga with vathahara thailas like Dhanwantharam/Ksheerabala etc.

PINDA TAILAM IS PREPARED IN 3 WAYS

"Sa madhoochishta sa Manjishta Sa sarjarasa Sariba

Pindatailam tadabhyangad Vatharaktha ruchapaham"

The major ingredients of this oil are Rubia cordifolia, sesame oil, bee wax, Hemidesmus indicus, and Rhododendron lepidotum.

It is prepared from the Indian plants Manjishta and Shariba, and is highly therapeutic, as it contains pitta reducing herbs. While Manjistha is known to possess anti-rheumatic properties, Shariba is a perfect body relaxant.

HOW PREPARE PINDA THAILAM

Do you know the preparation of pindathailam?........Yes.

Take tila thailam in a pan and add four times of water (as drava) and a quarter of Manjishta & Sariba (as Kalka). Then boil till 'Khara paaka'. When the paaka attains, sieve it through a net to a vessel. Add Sarjarasa (as powder form) & Bee wax (as pieces) as 'paathra paaka'.

Pinda Thailam (also known as Pinda oil) is a cooling massage oil, and mostly used by Pitta individuals, who particularly suffer from skin problems like rashes and eruptions.

OTHER PREPARATORY METHODS

1

According to some ayurveda classical texts like 'Sahasra Yoga', a kashaya should prepare by Sariba as drava, Manjishta is used as kalka, Sarjarasa and Bee wax are used as paathra paaka.

This method was followed by some ancient Vaidyas in Kerala.

2

Another method as follows is used by some manufacturing units of ayurveda medicines in Kerala. And is available in some Government Dispensaries in Kerala. The method is shown below

Taila:  Tila thailam (3/4 th part) + Eranda thailam (1/4 th part)

Drava:  Dhanyamlam + Water

Kalkam: Manjistha + Sariba + Bee wax + Sarjarasam

No one know the reference of this preparation method. I asked this to the Charge doctor in Quality Control department of the firm, then she replied me that; "Every firm have its own formulary, and in this firm this method used".

Here Sarjarasa and bee wax is added to the pan when the thailam get its khara paakam.

VIPAKA

Vipaka

Vipaka is the rasa originated from a food after digestion. When we eat or drink a substance it comes in the contact with jathar Agni (digestive fire). If the jatharagni is in its normal state it is able to digest (pachan) the substance eaten. During this digestion the food undergoes many bio transformational changes. In this process of paak (physiological condition of digestion) due to different degrees of digestion, the transformation of rasa takes place. This changing of rasa of the substance into a certain similar or dissimilar rasa is called vipaka. After completion of digestion, the substance or the food ingested would produce certain action by which we can know the process under which the substance has undergone. Hence vipaka is judged by anumana (inference made after observation). The effects of vipaka commences after the full digestion is completed. These vipaka are of there types.

1. Madhur vipaka
2. Aamla vipaka
3. Katu vipaka

"Swaadu paduscha madhuram amlo amlam pchyathe rasa:

tikthoshana kashayascha vipaka: prayasa: kadu"

Madhura and Lavana - Madhura

Amlam - Amlam

Tiktham,Kadu and Kashaya - Kadu

running nose

running nose can be treated by applying
Rasnadi choorna over head
Vasarishta+Amruthaarishta


after that some lehya should be given