A study on Apabahuka (frozen shoulder) and its management by Laghumasha taila nasya.

Apabahuka is a disease that usually affects the Amsa sandhi (shoulder joint).It 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 Vataja vikara. Amsa shosha (wasting of the shoulder) can be considered as the preliminary stage of the disease, where loss or dryness of sleshaka kapha from amsa sandhi occurs. For the present study, Marsha nasya with Laghumasa Taila was administered to 15 patients for seven days, and the following results were obtained. After treatment, 53.33% relief was found on Bahupraspandita hara, 26.66% on Shoola, 30.00% on Stambha, 60.00% on Atopa, and 37.50% on wasting of muscles. On the overall effect of therapy alone, one (6.60%) patient got marked improvement, eight (53.33%) got moderate improvement, four (26.66%) were improved, and two (13.33%) patients remained unchanged.

Introduction

Vata is considered as a chief factor for the physiological maintenance of the body. Factors provoking Vata result in the instantaneous manifestation of diseases, which can even prove to be fatal. Therefore, the Vataja nanatmaja vyadhis are of utmost importance, rather than the vyadhis produced by the other two doshas. Contradictory approaches to pacify this vitiated state have to be restored to, to maintain the equilibrium.

In the modern point of view, the diseases involving the neurological, musculoskeletal, psychosomatic, and gastrointestinal system disorders have more similarity with the Vata vyadhi. It indicates the wide ranging involvement of Vata in various systems of the body.

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 Vata vyadhi is one among the Ashta maha gada,[1] is itself 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 disease Apabahuka manifests due to the depletion of tissue elements (dhatu kshaya) as well as Samsrushta dosha.

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.[2] 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. The next stage, that is, Apabahuka, occurs due to the loss of Shleshaka Kapha and symptoms like shoola during movement, restricted movement, and so on, are manifested. Even as this is commented on in the Madhukosha teeka, it is mentioned that Amsa shosha is produced by dhatukshaya, that is, shuddha Vata janya, and Apabahuka is Vata Kapha janya.[3]

Etiopathogenesis

Etiology (Nidana)

The causes (hetu) of Apabahuka may be classified into two groups. (i) Bahya hetu — Causing injury to the vital parts of the body (marma) or the region surrounding the amsa sandhi, which is also known as bahya abhigataja that manifests the vyadhi or disease first; (ii) Abhyantara hetu — Indulging in the etiological factors that aggravate Vata leading to the vitiation of vata in that region and is also known as dosha prokopajanya (Samshraya), which in turn leads to karmahani of bahu. The descriptions of Nidana are given below:

Aharaja

Katu, Tikta, kashaya rasas, laghu sukshma, and sheeta guna cause vitiation of the Vata.

Viharaja

The exercises directly or indirectly influencing the shoulder or amsa desha should be considered here:

Plavana

Results in Vata kopa due to overexertion in the joint.

Bharavahana

Carrying heavy loads over the shoulders will cause Vata prakopa and deformity in the joint capsule. This leads to disease formation.

Balawat Vigraha

Wrestling with a person who is more powerful will cause agahata to the amsapradesha and Vataparkopa takes place. This manifests the disease.

Dukkha Shayya

Improper posture that creates a great amount of more pressure on the amsasandhi will disturb the muscular integrity, and provokes vata. This manifests the disease. Other viharaja nidanas as reported in the Vatavyadhi context may influence the condition by provocating Vatadosha. Even though a specific bahya hetu (external cause) has not been mentioned for Apabahuka, the general factors reported for Vata prakopa have to be analyzed and elicited.

To summarize, the above-mentioned nidanas, under vihara, especially involving the amsa sandhi and marmabhighata to amsa, lead to the development of Apabahuka.

Samprapti

In case of Apabahuka, two ways of vitiation of the vata can be considered. The etiological factors like ruksha, laghu and so on, and atibharavahana and the like cause vitiation of the vata directly. In another way, Kapha prakopaka nidanas like taking of atisnigdha, atiguru dravya, and so on cause an increase in the vikruta Kapha, which produces the Kaphavrita-vata condition. In both ways, the vikruta vata dosha gets accumulated in the bio channels (srotas) and manifests symptoms like the stabdha poorna kosthata. In the prakopa avasta, the Vata produces symptoms like koshtha toda and sancharana and prasara avastha symptoms like atopa may also be produced. However, Ashukaritva being one among the symptoms of Vata, the symptoms produced by it are very quick in onset, and hence, the dosha kriyakalas of the vyadhi are ill-defined and cannot be observed properly.

Sthana samsraya avastha of the vyadhi occurs with the localization of the aggravated Vata in the specific dhatu, that is, dosha dushya sammurachana, which occurs in the specific organ of the body where kha vaigunya has previously taken place by the specific part of the nidanas, simultaneously with the dosha vikruti. Shiro marma is considered as the uttamanga and is mentioned as the seat or moola of all indriyas. Shiro marma performs all types of cheshta in the presence of the normal vata because, among the three doshas, only the Vata is responssible for all types of cheshta. The Charaka samhita has mentioned that when shiro marma gets affected, it produces symptoms like chestahani. In this case, the sthana samshraya of the dosha can be taken, as in siro pradesha. Usually in the sthana samshraya avasta, the poorvaroopa of the vyadhi are manifested.

As Apabahuka is considered as a vata vyadhi, and Vata has the ashukari guna, the poorvaroopas like bahupraspandita hara and shoola may manifest mildly or are totally absent. However, the above-mentioned symptoms are clearly manifested in the vyaktha avastha or in the roopa avastha of the vyadhis in the vyakta sthana, that is, in the amsa pradesha. In this stage the amsa pradesha gets affected by the aggravated Vata, on account of which Amsashosha occurs in the initial stage by the decrease of the Shleshaka Kapha, which further leads to the manifestation of Apabahuka, with symptoms like bahupraspandita hara and shoola. Therefore, in the Madhukosha commentary of Madhava nidana it is mentioned that amsa shosha and Apabahuka are the two stages of the vyadhi.

Marma abhighata

Morbid vyana Vata in another way may cause abhyantara marmabhighata or any external trauma to amsapradesha may also cause bahya marmbhighata to the amsa marma present in amsadesha. As amsa marma is a snayu and vaikalyakara marma, afflicting snayu will manifest bahupraspanditahara.

Even in modern medical science, the partial loss of blood supply in the area of insertion of tendons or some idiopathic cause can produce localized degeneration of the collagen. This induces an autoimmune response and cause a tear or distortion of the tendinous sheaths and ligaments. This obliterates the integral stability of the joint and results in restricted movement with painful and stiffened joints.

Chikitsa

The general line of treatment mentioned for Vatavyadhi in Ayurvedic classics include Snehana (both internal and external), Swedana, Mrudusamshodhana, Basti, sirobasti Nasya, and so on. Charaka further states that, depending on the location and dushya (tissue element vitiated by Vata) each patient should be given specific therapies. Vagbhata has mentioned Nasyakarma in the jatroordhva Vatavikaras.[4] Three major approaches are followed in the management of Vatavyadhi.

Treatment of Kevala Vata

Treatment of Samsrusta Vata

Treatment of Avruta Vata

Ayurvedic classics explain the chikitsa of Apabahuka as follows.

Nasya and uttarabhaktika Snehapana are useful in the management of Apabahuka.

Astanga Sangraha mentions Navana Nasya and sneha pana for Apabahuka.

Sushrutacharya advises Vatavyadhi chikitsa for Apabahuka, except siravyadha.

Chikitsa sara sangraha advises Nasya, Uttara bhaktika Snehapana, and Sweda for the treatment of Apabahuka.

Brumhana nasya is indicated in Apabahuka by Vagbhata.

By considering the above references, the following can be stated as the line of treatment of Apabahuka.

Nidana parivarjana

Abhyanga

Swedana

Uttarabhaktika snehapana

Nasyakarma

Shamanoushadhi

Modern description

There are some clinical conditions of modern science, which may be compared with that of Apabahuka. These may be categorized as follows:

Periarthritis, frozen shoulder or adhesive capsulitis

Subacromial or subdeltoid bursitis

Subcoracoid bursitis

Painful shoulder

Bicipital tendinitis

Osteoarthritis of shoulder joint

Brachial plexes neuropathies

However, in this study, the clinical condition, namely, periarthitis or frozen shoulder or adhesive capsulitis has been taken to correlate with Apabahuka.

Periarthitis or frozen shoulder or adhesive capsulitis[56]

This is a descriptive term used to indicate a clinical syndrome wherein the patient has a restricted range of active and passive glenohumeral motion. The Simmonds have reported on the tight inelastic tissues around the shoulder joint. They believed that the pathological changes in frozen shoulder were due to degeneration and focal necrosis of the supraspinous tendon. With revascularization, the tendon pathology could resolve. With inadequate vascular response, the tendons would continue to degenerate, developing tears of varying size, or a secondary biceps tendinitis could develop. In this condition, pain and stiffness of the shoulder joint are the cardinal symptoms leading to inability or loss of function of the affected upper limb. This may be achieved in three phases.

Painful phase

Stiffening phase

Thawn / Resolving phase

The patient gives a history of having noticed a slight painful catch in the region of the shoulder and upper arm for several months, gradually becoming aware of the inability to perform certain tasks, because of stiffness of the arm. Night pain, often awakening him after he has fallen asleep, is a common complaint. Frequently it radiates down the arm to the hand without being localized to any nerve distribution. Stiffness of the shoulder increases until all movements are lost.

In Ayurveda, therapies like abhyanga, swedana, snehapana nasya karma, vasti karma, and shamana Aushadhi are mentioned to combat the Vata vyadhi. In the present study nasyakarma with Laghumasha taila, in the form of Marsha nasya have been advised for patients suffering from Apabahuka. Laghumasha taila contains drugs like Kapikacchu, Bala, Shatavari, Sita, Punarnava, Saindhava, Jingini, Sarshapa taila, and Masha.[7]

Aims and Objectives

To study the effect of Laghumasha taila Marsha nasya in Apabahuka.

To study the literature of the disease in view of Ayurveda and Modern medical science.

Materials and Methods

Source of data

Patients of either sex diagnosed with Apabahuka from the OPD and IPD of the ALN Rao Memorial Ayurvedic Medical College and Hospital, Koppa, were selected for the study. Out of the 18 patients, three patients were dropped in the initial stages of the study and 15 patients completed the course of treatment.

Criteria for selection of the patients

The patients presenting with the signs and symptoms of Apabahuka according to Ayurvedic texts were selected for the study. Patients of both sexes in the age group of 20 – 60 years were selected. The main criteria for diagnosis was the presence of clinical symptoms of Apabahuka, that is, Bahupraspandita hara and shoola. The symptoms of Srotodushti were also assessed along with the main symptoms for the selection of the patients.

Inclusion criteria

Apabahuka diagnosed according to the classical signs and symptoms described in Ayurveda.

Patients of both sexes within the age group of 20 – 60 years.

Exclusion criteria

Systemic diseases presented with Apabahuka as a complication

Patients with a history of fracture of the affected hand

Pregnancy and lactating women

Laboratory investigations

The modern laboratory investigations included for the clinical study are Blood for Hemoglobin %,Total count,Differential count, Erythrocyte sedimentation rate, Random blood sugar as routine investigations; Urine for sugar, albumin, and microscopic test; and X-Ray Shoulder joint — Anterio-posterior, lateral view — to rule out the history of fracture.

Study design

A randomized standard single blind clinical study has been adopted.

Treatment schedule

After diagnosis, the randomly selected patients were treated with Marsha nasya with Laghumasha taila in doses of 6, 8, or 10 drops, as required by the patients, for seven days. Out of the 18 selected patients, three patients were dropped from the study and the remaining 15 patients completed the course of the study.

Pratimarsha / Marsha nasya

When the nasya dravya is used in the minimum quantity (two bindus), it is called Pratimarsha. Usually the sneha dravyas are used. This is different from marsha nasya where in the quantity used will be 6, 8, or 12 bindus.

Method of Nasya Karma

Nasya Karma can be explained in the following three headings as reported in the classics.

Poorva Karma

This encompasses the following points like Oushadhi sangraha, Nasya yantra, Atura vaya, Kala, Atura siddhata, and so on. The patient is instructed not to suppress the natural urges and go through the normal routine. Before taking the Nasya Karma he should not have any food. Subsequently, the patient is taken to a comfortable room, which is without dust, extreme breeze or sunlight. Bahyasnehana in the form of mrudu Abhyanga is performed to the shiras first and then over the gala, kapola, lalata, and karna. After snehana, a mild swedana is performed to the part of the body above the shoulders. The eyes of the patient should be taken care of by closing them with a band of cloth.

Pradhana Karma

Once the poorva karma is completed, the patient is made to lie down on the table in the supine position with legs slightly raised. Eyes should be covered with a cloth. With the help of tepid medicine, panitapa sweda is performed over the parts of the body above the shoulder, excluding the patient's eyes. The head of the patient is then highly raised and medicine is poured in each nostril one after the other. The other nostril should be closed while administering the medicine in one nostril. The medicine should be slowly instilled in an uninterrupted manner called ‘Avicchinna dhara’. The patient is advised to inhale the medicine slowly and forcefully. The same procedure is repeated in both the nostrils. Care should be taken not to shake the head during the procedure. Tapasweda can be repeated conveniently.

Aftera administration of the medicine, the patient is strictly advised not to swallow the medicine, but to spit it out. The spitting can be done after the smell and taste of the medicine disappears from the throat. Next, the patient is allowed to relax in the same posture for 100 matra kalas (30 – 32 seconds), without going to sleep.

Paschat karma

Pradhana karma is followed by dhoomapana, gandoosha, and kavala graha. The patient is advised to follow certain rules and regimen.

Criteria for assessment of the study

The improvements in the patients were assessed on the basis of relief in the signs and symptoms of the disease. To analyze the efficacy of the drug, scores were given for each symptom. According to the severity of the symptoms, the grading was given, as mentioned herewith:

Scoring pattern

The improvement is documented through statistical significance. The subjective and objective parameters are assessed by means of interrogation and by ascertaining the signs and symptoms before and after the treatment. The response of the drug is assessed weekly through interrogation, signs, and symptoms.

Statistical analysis

For assessing the improvement of symptomatic relief and to analyze it statistically, the observations were recorded before and after the treatment. The mean, percentage, SD, SE, and t-value (paired t-test) were calculated from the observations recorded.

Criteria for assessment of the overall therapy

Complete relief

One hundred percent relief in the complaints of patients, along with elevation of shoulder joint up to 180° and flexion and abduction of the joint up to 90°.

Marked improvement

More than 75% relief in the complaints as well as significant improvement in the elevation of joint up to 135°, and flexion and abduction up to 60°.

Moderate improvement

More than 50% relief in the complaints along with improvements in elevation of joint up to 90° and flexion and abduction of joints up to 30°.

Improvement

Twenty-five to fifty percent relief in the complaints.

Unchanged

Patients with less than 25% relief in their complaints were regarded as unchanged.

Observations

The observations made of the 18 patients with Apabahuka were as follows:

Maximum number of patients were obtained in the age group of 31 – 40 years, that is, 33.33%, followed by 26.66% patients in the age group of 41 – 50 years, and 20% patients in the age groups of 51 – 60 years and 20 – 30 years each. Most of the patients were male (60%). Most of the patients, that is, 47%, were from the Hindu community, followed by 29% from the Muslim community, and 24% from the Christian community. Most of the patients (38%) were laborers, followed by housewives (25%); the maximum number of patients (40%) were from the lower socioeconomic status group; maximum number of patients (58%) were nonvegetarian, followed by 42% who were vegetarian.

Results

The drug Laghumasha taila Nasya provided a moderately significant effect (P < 0.01) on the symptom Bahupraspandita hara (53.33%) and a mildly significant effect (P < 0.05) on Shoola (26.66%) [Table 1]. On atopa the therapy showed 60% relief, followed by 37.5% relief on wasting of muscles, and 30% relief on stambha [Table 2]. The therapy was mildly significant on both Asthivaha and Majjavaha Srotodushti (P < 0.05) and moderately significant on Medovaha srotodushti (P < 0.02) [Table 3]. Most of the patients, that is, 53.33% were moderately improved, followed by 26.66% improved, and 6.60% were markedly improved after completion of the therapy [Table 4].

Table 1

Effect of the therapy on main symptoms in 15 patients with Apabahuka

Table 2

Effect of the therapy on associated symptoms of Apabahuka in 15 patients

Table 3

Effect of the therapy on srotodushti in 15 patients of Apabahuka

Table 4

Overall effect of the therapy

Discussion

The present drug formulation Laghumasha taila contains drugs like Kapikacchu, Bala, Shatavari, Sita, Punarnava, Saindhava, Jingini, Sarshapa taila, and Masha.

Mode of action

Laghu masha taila

Kapikacchu(Mucuna prurita Hook) : Different varieties are available, with their potent action as Vata hara and qualities such as, snidha, madhura, and ushna. Dravya is well known for its anti-parkinsonism effect (Kampavata hara) as it contains dopamine, and its seeds are rich in protein (Kerala or Tamilnadu germplasm), hence, it is utilized internally as a taila, which tones the muscle and acts as a nervine tonic, which is the most important requirement in Apabahuka.

Bala (Sida cordifolia Linn) : It is generally considered as a nervine stimulant or nervine tonic. A better term can be given as a nervine stimulant. The term ‘Bala’ is applied because of its balya property of moola. In the Laghu masha taila, this serves the purpose of generating sufficient energy to the muscle tissue, and also by its effective supporting factors such as madhura rasa and madhura vipaka as a Vata hara.

Shatavari (Asparagus racemosus Willd): This fasciculated tuberous root is utilized in different ailments, as it has the Vata hara property. The absorption level of this drug through the taila during nasya karma is found to be excellent.

Sita Serves the function of enhancing the energy of the other dravyas and nourishes the mastishka.

Purnarnava (Boerhavia diffusa Linn) : ‘Dhatu punarnavatwam,’ a drug that brings new tissues in the body, helps in preventing the degeneration of tissues. In other words, it achieves the regeneration of sapta dhatus with its specific activities on muscle tissues.

Saindhava During nasya, the taila used has a fixed oil base. Therefore, the ideology of formulating the taila for its easiest absorption in the procedure of Nasya karma has been balanced by the addition of Saindhava lavana. Saindhava lavana has the potent action of facilitating easy absorption of the taila through its effective properties.

Jingini (Odina wodier): By its madhura rasa and ushna virya acts as Vata hara, but katu vipaka helps in the easy digestion of the taila through the nasya karma.

Sarshapa taila (Brassica comprestris Linn): Acts as a base for the dravyas of the Laghu masha taila, and is helpful through its easy absorption activity due to the teekshna, katu, and ushna properties.

Masha kwatha (Phaseolus mungo Linn): A potent dhatu vardhana dravya, is supportive as a Vata hara with its dominant madhura rasa and ushnadi gunas.

By observing the above-mentioned ingredients and their actions, it is evident that Kapikacchu, Bala, Shatavari, and Masha are the main ingredients which give the balya bruhmana effects. Sita in a combination that acts as an energy enhancer by virtue of its madhuratwa (glucose). Punarnava with its shotha hara and Rasayana karmas rejuvenates the brain functions, and Saindhava lavana acts a Kapha vilayana kari and sroto mukha vishodhana.

The Katu taila is the main base ingredient for the other drugs (oil soluble). Katu taila is a yoga vahi and carries all essential ingredients into the system by virtue of its teekshna, sukshma, and ashukari guna.

Mode of action of the Nasya karma

Nasya karma is one of the therapeutic procedures of the pancha karma, wherein the drug is administered through the nasal route. This is one of the pancha karma procedures that not only alleviates the vitiated doshas, but also causes complete eradication of the vitiated dosha and the disease. The same is applicable to the nasya karma also. The Nasya karma especially exerts its effects on the urdhvajatrugata pradesha. Acharya Vagbhata has stated that, the ‘Nasa hi shirasodwaram,’ that is, the nose, is the easiest and closest opening for conveying the potency of medicines to the cranial cavity. He is the first person to narrate the mode of action of drugs by Nasya karma. The drugs administered will reach the Shringataka marma and spread through the opening of the shiras of the eyes, ears, throat, and so on, to the head.

Acharya Sushruta opines that the Shringhataka marma, is a sira marma, situated at the site of the union of the siras, supplying to the nose, ear, eye, and tongue. Acharya Charaka, while explaining the indication for nasya in siddhisthana, has emphasized that the nasya drug usually acts through absorption by the Shringataka marma. After absorption of the drug, it acts on the diseases of Skanda, Amsa, and Greeva and the doshas are expelled from the shira pradesha.

The absorption of the drugs is carried out in three media. They are;

1. By general blood circulation, after absorption through the mucous membrane

2. By direct pooling into the venous sinuses of the brain via the inferior ophthalmic veins

3. By direct absorption into the cerebrospinal fluid

Apart from the small emissary veins entering the cavernous sinuses of the brain, a pair of venous branches emerging from the alae nasi will drain into the facial vein. These ophthalmic veins on the other hand also drain into the cavernous sinuses of the meninges, and in addition, neither the facial vein nor the ophthalmic veins have any valves. Therefore, there are more chances of the blood draining from the facial vein into the cavernous sinus in the lowered head position.

The nasal cavity directly opens into the frontal, maxillary, and sphenoidal air sinuses. The epithelial layer is also continuous throughout the length. The momentary retention of the drug in the nasopharynx and the suction, causes oozing of the drug material into the air sinuses. These sites have rich blood vessels entering the brain and meninges through the existing foramens in the bones. Therefore, there are better chances of drug transportation via this path. The shringataka marma has been explained by recent authors as the middle cephalic fossa of the skull consisting of paranasal sinuses, meningial vessels, and nerves. One can see the truth of the narration made by Vagbhata here — the drug administered enters the paranasal sinuses,[7] that is, the Shringataka, where the ophthalmic vein and the other veins spread out. The sphenoidal sinuses are in close relation with the intracranial structures. Thus, there may be a so far undetected root between the air sinuses and the cavernous sinuses, establishing the transudation of fluids as a whole. The mentioning of the Shringataka in this context seems to be more reasonable.

As the procedure of nasya itself involves massaging and fomenting over maybe the marmas existing on the face and head, this also helps in the alleviation of marmaksobha and Vatashamana.

The action of nasya karma depends upon the dravya used in it. Based on these, it is divided into shodhana, shamana, and Brumhana. In case of the shamana nasya, it alleviates the dosha and helps in reducing the kshobha of the marma and indriya caused by the vitiated dosha. Brihmana nasya provides nourishment to the shiroindriya and other organs and alleviates the vitiated Vata. Hence, it is useful in Vatajanya ailments.

The following paragraph explains why Ayurveda has mentioned medicated sneha dravya (siddha sneha) in a majority of the nasya karmas. The nose is a highly vascular structure and its mucous membrane provides a good absorbing surface. Hence, siddha sneha, on their administration, spread along the nasal mucous membrane. An active principle along with sneha gets absorbed inside the olfactory and respiratory mucosa and from there is carried to different places. Sneha provides nourishment to the nasal structures and other organs of the head also. The networks of nasal blood and lymph vessels have many communications with those of the subdural and subarachnoid spaces. This fact is one of the important factors contributing to the extension of the mentioned drugs from the nose into the cranial cavity.

The myelin sheath is the first covering of the nerve fiber. Neurolemma being the second. The myelin sheath is composed of lipid material. The blood–brain barrier is highly permeable for lipid substances and substances that are fat-soluble. Therefore, these substances can pass easily through the blood–brain barrier and can exert their actions. Certain lipids are used for providing energy to the nervous tissue. The lipid contents of the ‘Laghumasha taila’ may pass through the blood-brain barrier easily due to their transport. Some of the active principles may reach certain levels in the nervous system where they can exert their Vataghna property. Laghumasha taila provides nourishment to the nervous system and helps in removing the irritation. It may act as an anti-inflammatory agent also. On its nasal administration, it reaches different shirogata indriya and causes Vatashamana and Brumhana.

To conclude, nasya karma helps in Apabahuka by its Vatashmana and Brumhana karma. In other words, the Laghumasha taila acts as an anti-inflammatory nutritive and provides nourishment to the nerves.

Conclusion

The following conclusions can be drawn from the observations of the present study:

Strenuous physical work and direct injury are the predisposing factors in the manifestation of the disease Apabahuka

Maximum incidence of this disease was seen in the age group of 30–40 years

>Laghumasha taila having a Brimhana effect, when used as Marsha nasya, brought out a moderate significant result in Bahupraspandita hara and a mild significant relief in Shoola

The size of the sample was small to draw a generalized conclusion. Therefore, the therapy can be tried in a large sample for an appropriate duration, to observe its proper efficacy.