A Randomised Comparative Clinical Study To Evaluate The Effect Of Conduction Method Of Agnikarma With Panchaloha Shalaka And Swarna Shalaka In The Pain Management Of Avabahuka With Special Reference To Frozen Shoulder

Avabahuka is mentioned as one among the Vataja Nanatmaja Vyadhi by Acharya Sharangadhara. It affects the normal functioning of upper limbs, which in turn causes much inconvenience to normal routine lifestyle of an individual. The prevalence of Frozen shoulder in the general population is reported to be 2% and prevalence of 11% in unselected individuals with diabetes. It is peak in the age group of 40-60 years and is more common in women.

Avabahuka is caused mainly by the Vyana Vata vitiation and gets Sthana Samshraya in the Amsa Pradesha. There it does the Shoshana of Shleshaka Kapha, Mamsa, Sira and Snayu, leading to Bahupraspanditaharatwam (restricted movement of affected shoulder) due to Stambha (stiffness) in Amsa Pradesha and Shoola (pain). These clinical features closely resemble with painful stiffness and loss of motion of shoulder. Hence it can be correlated with Frozen Shoulder as described in modern system of medicine.

Frozen Shoulder is an idiopathic condition which manifests clinically as shoulder pain with progressive restricted movement, both active and passive along with normal radiographic scans of glenohumeral joint. It can affect activities like eating, dressing, personal hygiene and other works. Thus, life of such a patient becomes miserable. It can also disrupt sleep and reduce the overall quality of life due to persistent discomfort and stiffness.

In modern science, treatment modalities like analgesics, local intra articular injections of corticosteroids in glenohumeral joint followed by physiotherapy are adopted.

Treatment of Avabahuka includes Snehana and Nasya. In the pathological process of Avabahuka, Vatavridhi occurs, which does Shoshana of Sthanika Kapha which leads to the features of Sandhigatavata. Agnikarma is one among the para- surgical procedures and is the most effective intervention in the management of painful conditions, especially musculoskeletal disorders. Our classics have mentioned Agnikarma in Sira, Snayu, Sandhi, Asthi Gata Vata with Ugra Ruja. In Agnikarma burn with special tools is done on specific sites. Different Dahanopakaranas have been mentioned by Acharyas such as Pippali, Godanta, Shalaka etc. and is indicated for Twak, Mamsa, Sira, Snayu, Asthi and Sandhigata Vyadhi. Agni being Ushna act against the qualities of Vata and Kapha doshas, hence Agnikarma has curative effects on Vataja and Kaphaja disorders, according to Acharya Dalhana. Agnikarma increases local Dhatwagni and thus helps curing diseases as well as reducing the chance of recurrence.

Agnikarma will be carried out with the help of Panchaloha Shalaka and Swarna Shalaka. Panchaloha Shalaka will be made up of Kamsya, Tamra, Pithala, Loha, Naga, in 1:1:1:1:1 ratio11. The Shalaka prepared by combination of these Panchaloha retains heat for longer period. This facilitates proper Agnikarma and desired effects are obtained. Acharya Dalhana mentions Swarna to be one among the superior metal for the manufacturing of Yantras. Gold remains conductive for a longer time as compared to copper and silver, also gold does not corrode.

Hence, an effort is made to evaluate the effect of conduction method of Agnikarma with Panchaloha Shalaka and Swarna Shalaka in the pain management of Avabahuka with special reference to Frozen Shoulder.