Dr. Laxman Shivalli

From, DR. LAXMAN SHIVALLI 1ST YEAR M.S. (Ayu), DEPT. OF P.G. STUDIES IN SHALYA TANTRA. GOVT. AYURVEDIC MEDICAL COLLEGE, BANGALORE – 09.

To, THE REGISTRAR, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

Through. The Principal and Head of the Department, P.G. Studies in Shalya Tantra, Govt. Ayurvedic Medical College, Bangalore – 09.

Respected Sir,

Sub : Submission of completed proforma for the Registration of subject for Dissertation.

I request you to kindly register the below mentioned subject against my name for submission of the dissertation to Rajiv Gandhi University of Health Sciences, Bangalore for partial fulfillment of M.S. (Ayurveda) in Shalya tantra.

TITLE OF THE DISSERTATION: “A STUDY ON THE EFFICACY OF JALAUKAVACHARANA IN THE MANAGEMENT OF APABAHUKA WITH SPECIAL REFERENCE TO FROZEN SHOULDER.”

Here with, I am enclosing completed proforma of synopsis for registration of subject for Dissertation.

Thanking You. Yours sincerely, Place : Bangalore Date: (DR. LAXMAN SHIVALLI)

1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE – 11

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE DR. LAXMAN SHIVALLI 1ST YEAR M.S. (Ayu), AND ADDRESS DEPT. OF P.G. STUDIES IN SHALYA TANTRA, GOVT. AYURVEDIC MEDICAL COLLEGE, BANGALORE – 09. 2. NAME OF THE INSTITUTE GOVERNMENT AYURVEDIC MEDICAL COLLEGE, BANGALORE – 09.

3. COURSE OF STUDY IN AYURVEDA DHANVANTARI, SUBJECT 1ST YEAR, M.S (AYURVEDA,) SHALYA TANTRA.

4. DATE OF ADMISSION TO THE 31-05-2008 COURSE 5. TITLE OF THE DISSERTATION “A STUDY ON THE EFFICACY OF JALAUKAVACHARANA IN THE MANAGEMENT OF APABAHUKA WITH SPECIAL REFERENCE TO FROZEN SHOULDER.”

2 6. BRIEF RESUME OF THE WORK:

6.1 Need for the study:  Apabahuka is a vatavyadhi which is commonly found in the clinical practice. The pathogenesis is due to aggravated vata which brings about the akunchana of the sira in the amsapradesha causing pain and stiffness of the bahu

 The earliest reference regarding Apabahuka is available in Sushruta samhita, later references are from Astanga Hrudaya and laghutrayees.

 Based on clinical features, Apabahuka can be co-related with frozen shoulder mentioned in Allopathic Medical Sciences, in which the features are painfull restriction of both active and passive shoulder movements. It has been described that signs of inflammation of synovial membrane are present.

 Prolonged activity causes, small scapular and biceps muscles to waste faster. Load on joint increases and degenerative changes sets in. Capsule is fibrosed and shoulder movements are decreased. The estimated prevalence of the same is 5 to 6% of the population evaluated by orthopaedicians.

 Though NSAIDS, Corticosteroids are found to be effective in relieving pain, they have many side effects.

If features of frozen shoulder do not improve by NSAIDS and corticosteroid therapy, then manipulation under general anesthesia is done to break up the adhesions. It carries the risk of breaking the arm bone (humerus fracture). The surgical approach requires good skills, sophistication and expensive equipment. Chances of post operative complications are like to be come acrossed with surgical procedures. All these have one or another drawback.

 Jalaukavacharana can over come the above problems because it doesn’t cause pain during procedure, it is cost effective; doesn’t have side effects.

 Sharangadhara while explaining the Raktasrava sadhya Rogas mentions that gnrS>o

XþO©¶os>{Zbo &

3 which means Raktasravana is indicated in vataroga where pain is a main feature.  It has been mentioned that Jalaukavacharana is effective in reliving pain, inflammation. Xþï>aº$mnJ‘mV² íd¶Wwe¡{Wë¶§ XmhamJeybmone‘íM &

 Jalaukavacharana is an important anusastra which is very popular even today. Research work on Jalauka proved that saliva of medical leech contains more than 100 bioactive substances which have anti–edematous, analgesic, anti–ischemic effect. It eliminates inflammation, restores normal function of tissues and organs, and helps in frozen shoulder.  Considering all the above factors, the study is taken up to try and establish the efficacy of Jalaukavacharana in the Management of Apabahuka. While carrying out the study, the Management of Apabahuka with Kolakulatthadi Upanaha with Rasanadi Guggulu internally has also been taken up, which is an established study.

6.2 Review of Literature. Vatavyadhi Samanya Nidana éjerVmënÜdÞì¶dm¶m{VàOmJa¡… & b“ZßbdZmË¶Üdì¶m¶m‘m{V{dMo{ï>V¡… & YmVyZm§ g§j¶m{ƒÝVm emoH$amoJm{V H$f©UmV² && Xþ…Ieæ¶mgZmV² H«$moYm{ÔdmñdßZmØ¶mX{n doJg§YmaUmXm‘mXm{^YmVmX^moOZmV² & ‘‘©KmVmÒOmoï´>míderK©¶mZmnV§ gZmV² &&

Vayu gets aggravated by the following:- Intake of ununctuous, cold, scanty and light food:

4 Excessive sexual indulgence Remaining awake at night in excess; Keeping fast in excess; Swimming is excess; Resorting to way faring, exercise and other physical activities in excess; Lose of dhatus (tissue elements) Excessive emaciation because of worry, grief and affliction by diseases; Sleeping over uncomfortable beds, and sitting over uncomfortable seats; Anger, Sleep during day time, fear and suppression of natural urges; Formation of ama and from trauma. Injuries to marmas ; Riding over an elephant, camel, horse or fast moving Vehicles and falling down from the seats and these animals and vehicles. 1 (Chi. Ch.28 Sl. 17 P23)

Apabahuka Lakshana : A§gXoepñWVmo dm¶w… emof{¶Ëdm§g~ÝYZ‘² & {gamíMmHw$#m VÌä¶mo OZ¶Ë¶d~mhþH$‘² &&

The Vayu which is situated at the amsapradesha causes Shoshana of the amsa bandhana and sira akunchana and then causes Apabahuka. 2 (Ni.ch.1 sl. 86 p17) A§gXoepñWVmo dm¶w… {gam… g§H$moÀ¶ VÌJm… & ~mhþ àñnpÝXVha§ OZ¶Ë¶d~mhþH$‘² &&

Vayu located at the root of shoulders constricts the veins there, and produces Apabahuka, which cause loss of movements of the bahu 3 (Ni.ch. 15 sl. 43 p 156)

Jalaukavacharana gnrS>o XþO©¶os>{Zbo &

5 Sharangadhara while explaining the Raktasrava sadhya roga’s, mention’s Raktasravana is indicated for vata roga which causes severe pain. 4 (U.ch. 12. sl. 14 p.254)

As Jalaukavacharana is one of the method of Rakta Sravana. It is selected for the treatment.

Z¥nmT>ç^régwHw$‘ma ~mbñW{daZmarUm‘g¥p½dòmdUm¶

Obm¡H$gmo ¶moO¶oV² &5 (Su.ch. 35. sl. 2 p.390)

Looking into the modern life style of the people, patients of Apabahuka can be considered as Sukumara where Jalaukavacharana is indicated. Xþï>aº$mnJ‘mV² íd¶Wwe¡{Wë¶§ XmhamJeybmone‘íM &

Jalauka removes Dushtarakta, Shotha, Daha, Raga Shoola and thus relieves the stiffness of the shoulder joint. 5 (Su.ch. 35. sl. 6 p.391) ñ¶mXdJmT>o Obm¡H$g… &

If dosha’s are deep seated, then it is to be removed with Jalaukavacharana. 5 (Su.ch. 35. sl. 7 p.392)

Kolakulatthadi Upanaha H$mob§ Hw$bËWm… gwaXmê$ amñZm ‘mfmVgr V¡b’$bm{Z Hw$ð>‘² & dMm eVmˆm ¶dMyU©‘åb‘wîUm{Z dmVm‘{¶Zm§ àXoh… && Kola kulatthadi Upanaha containing Kola, Kulattha, Suradaru, Rasna, Masha, Atasi, Tailaphala, Kushta, Vacha, Shatahva. Yavachurna, mixed with Kanji. Thus prepared ushna pradeha is having the effect over those suffering from vata vyadhi. 1 (Su.ch. 3. sl. 18 p.78)

6 Rasnadi guggulu6. (V.ch. Sl. 48 p 198)

Abbreviations: Chi – Chikitsa sthana Su – Sutra Sthana Ni – Nidana Sthana U – Uttara Khanda V. ch – Vata vadhi Chikitsa Prakarana Sl – Sloka Number. P- Page number

Modern View: Frozen shoulder is defined as a clinical syndrome characterized by painful restriction of both active and passive shoulder movements due to causes within the shoulder joint or remote (other parts of the body).

Causes Shoulder causes – Problems directly related to shoulder joint which can give rise to frozen shoulder are tendinitis of rotator cuff, bicipital tendinitis, fractures and dislocation around the shoulder, etc., Non shoulder causes – Problems not related to shoulder joint like diabetes, cardiovascular diseases with referred pain to the shoulder which keeps the joint immobile, reflex sympathetic dystrophy. Frozen hand shoulder syndrome, a complication of Colle’s fracture can all lead to Frozen shoulder. The reason could be prolonged immobilization of the shoulder joint due to referred pain, etc.,7 (p. 191)

Previous Work Done Ramesh. N – A Clinical study to evaluate the effect of upanaha and shamana chitiksa in the management of Apabahuka (Unpublished Postgraduate studies Dissertation, Rajiv Gandhi University of Health Sciences, Bangalore, 2006)

6.3 Objectives of the study :  To study the efficacy of Jalaukavacharana in the management of Apabahuka.  To study the efficacy of KolaKulattthadi upanaha with Rasnadi Guggulu internally in the management of Apabahuka.

7  To study the Significance of Jalaukavacharana by comparing it with the efficacy of KolaKulattthadi upanaha with Rasnadi Guggulu internally, in the management of Apabahuka which has been established in the earlier studies.

 Clinical features of Frozen shoulder is explained under different stages.

7 MATERIALS AND METHODS Source of Data: Patients attending the O.P.D and I.P.D department of S.J.I.I.M. Hospital, Bangalore will be selected for this study.

7.1 Method of collection of Data:

A total of 40 Patients of Apabahuka with the features namely pain and restricted movements of shoulder joint, will be selected for the study. A. Inclusion criteria :

Patients suffering from Apabahuka with the features of pain in the shoulder joint and restricted movements of shoulder joint shall be included. The cases which do not require surgical intervention shall be included. B. Exclusion Criteria: Fractures and dislocation. Shoulder joint having any other pathological conditions are excluded. The cases with chronicity of more than one year shall be excluded. Patients suffering from systemic disorders C. Plan of Treatment: 40 Patients who will be included are randomly divided into 2 groups namely Group – A and Group – B each consisting of 20 patients. Study design: Group–A Patients in this group will be treated with Jalaukavacharana for maximum of 4 sittings once in every week. Total period of treatment will be 28 days. Group–B

8 Patients in this group will be treated with kolakulatthadi Upanaha with Rasnadi Gugulu 1 t.i.d internally. for maximum of 28 days. The observations made regarding the changes with the treatment , before treatment on 7 th day, on 14th day and on 28th day shall be recorded in a proforma of case sheet prepared for the study.

In case where there will be total relief, a duration of 60 days shall be fixed for observing reoccurrence which shall also be recorded in a proforma of case sheet prepared for the study.

Assessment Criteria: The changes in the signs and symptoms with the treatment shall be assessed based on following parameters. Subjective parameters: Pain Restricted movements of the shoulder joint

Objective parameters: Range of movements of shoulder joint. Tenderness Total effect of therapy will be assessed as Complete improvement Marked improvement Moderate improvement Unchanged

7.3 Investigations: No specific Investigation is required for the present study.

7.4 Has ethical clearance obtained from your institution? Yes.

9 8. LIST OF REFERENCES

1. Charaka. Charaka Samhita – Text with English translation and critical exposition based on chakrapani Dattas Ayurveda deepika by. Dr. Ram karan Sharma. and Vaidya Bhagawan Dash. varanasi : Chaukamba Orientalia ; 2005. Vol. I. & V.

2. Sushruta. Sushruta Samhita – translated to English by Kaviraj Kunjalal Bhishagratna. Prologued and edited by Dr. Laxmidhar Dwivedi. 2nd ed. Varanasi : Choukambha Orientalia ; 2002.

3. Vagbhata. Astanga Hrudayam – translated to English by prof. K.R. Srikantha murthy. 2nd ed. Varanasi : Krishnadas acadmy : 1995 pp. 596.

4. Sharangadhara samhita – translated in English by Ayurveda Vidwan Prof. K.R. Sri. Kanthamurthy 5th ed. Varanasi : Chaukamba Orientalia ; 2003. pp. 254.

5. Vagabhta Ashtanga Sangraha - Induvyakhyasahita edited by Dr. D.V Pandithrao, Vaidya Ayodhya Pandey. New Delhi : Central council for Research in Ayurveda and Siddha ; 1991. pp. 659

6. Srichakrapanidatta virachita. Chakradatta. Mulamatram by Dr. Indradev Tripathi 1st ed. Varanasi : Chaukamba Orientalia ;1991. pp. 704

7. John ebnezar. Text book of orthopedics. 2nd ed. New Delhi, Jaypee brothers ; 2000. pp. 472.

9 SIGNATURE OF THE

CANDIDATE 10 REMARKS OF THE GUIDE

10 11 NAME AND DESIGNATION DR. R. VIJAYASARATHI. B.S. A.M., B.A.M.S., M.D. (AYU) OF THE GUIDE PROFESSOR, DEPT OF P.G STUDIES IN SHALYA TANTRA, GAMC, BANGALORE.

11.1 SIGNATURE 11.2 NAME AND

DESIGNATION OF THE CO-

GUIDE

11.3 SIGNATURE 11.4 HEAD OF THE DR. B.A. VENKATESH, B.S. A.M., B.A.M.S., M.D. (AYU) DEPARTMENT PROFESSOR AND HOD, DEPT OF P.G. STUDIES IN SHALYATANTRA, GAMC, BANGALORE. 11.5 SIGNATURE 11.6 REMARKS OF THE

PRINCIPAL 12 SIGNATURE