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Introduction

Bhujastambha is a disease that usually affects the Amsa sandhi (shoulder joint).It is produced by the Vata dosha.1 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.2 Prushtha Marma are 14 in number those are Katikataruna, Kukundara, Nitamba, Parshwasandhi, Brahati, Amsaphalaka and Amsa and the structures related to shoulder region are the most exposed area to common injuries. The activities like weight lifting, swimming, cricket, fall on the outstretched arm causes the rupture of ligaments and muscles of shoulder joint, leads to disability of the Amsa sandhi and bahu. Therefore selecting out this topic for study will be a needful exercise for the subject Shareera Rachana. Symptomology like stabdhabahuta or bahukriyahara is almost an uncovered area of study. Hence the surgical and anatomical evaluation of stabdhabahuta symptom under Amsa Marma will be need for research. Asma marma is vaikalyakar marma (Causing deformity). Vaikalyakara marma are dominated by  the  attributes  of  jala mahabhuta. Jal mahabhuta is stable and cooling. So, any injury to  this  marma  does  not  result  in  death  but  always  cause  a deformity that may persist forever.

Amsa marmaghat can be correlated with frozen shoulder due similarity in symptomology. Frozen shoulder (FS) mainly affects the older population, with a female predominance. The precise prevalence of FS is unknown, some studies have quoted prevalence of 2%–5% in the general population.3 Those with prolonged shoulder immobility (minor upper limb trauma, overuse injury, surgery, and/or neurosurgery) or systemic diseases (diabetes, thyroid disorders, osteoporosis, Dupuytren’s contracture, cardiovascular disease, and stroke) are at a higher risk.4

Bhujastambha: This term is mentioned in Sharirsthana while explaining about the Amsa marmabhighata, he says injury to the Amsa marma leads to the Stabdhabahuta, this also called as Avabahuka.Here the broad meaning of stabdhabahuta is “Bahukriyanasha” according to Ayurveda Shabdakosha that means loss of functions of the upper limb. According to Acharya Vagbhata traumatological effect of Amsa marma is ‘Bahukriyahara’ means same as that of the meaning of stabdhabahuta.5 Bhujastambha though is not mentioned in the eighty different nanatmaja vata vyadhi listed in the sutrasthana citation of bahu shosha is available.6  Further more the treatment of bahu shirsa gata vata is elaborated in the chikitsa sthana. Avabahuka is mentioned in Sushruta Samhita7 along with the samprapti and rupa in nidana sthana. Rakta mokshana and rooksha sweda are cited as treatment of choice for Avabahuka.8 In the nidana sthana of Astanga Hridaya9

 

Table no 1 The list of references in various texts regarding the Roopa is depicted in the below

Roopa	Sushruta	Vagbhata	Madhavakara	Kalyanakaraka	Vangasena
Bahupraspandhi Hara	+	+	+	+	+
Amsabandhana Sosha	+	+	+	+	+
Sthambha	+	+	+	+	+
Shoola	-	-	-	-	+

 

Samprapti:

The way in which the Dosha gets Vitiated and the course it follows for the manifestation of disease is called Samprapti A proper understanding of samprapti is vital for the treatment since Chikitsa is illustrated in the Ayurvedic text is nothing but ‘Samprapti Vighatana’ No specific Samprapti has been explained for Avabahuka. So it can be said that Samprapti of Avabahuka is same as that of general Samprapti of Vatavyadhi.10

Samprapti ghataka:11

1. Doshas :                 Vata & kapha
2. Dushyas:Sira,snayu,khandaras,rasa,rakta,mamsa,asthi
3. Srotasas :              Rasa,rakta,mamsa, meda &asthi
4. Srotodusti :         Sanga
5. Udhbhavasthana: Amashaya & pakwashaya
6. Sancharasthana: Sira,snayu,khandaras
7. Adhisthana:         Amsapradesha
8. Vyakta:                   Baahu praspandana hara
9. Rogamarga :       Bahya & madhyama.

OBJECTIVES

Primary Objectives :-   To study the Anatomical and structural changes of Amsa Marmghata  in Bhujastambha.

Other Objectives

1.Conceptual study of Amsa Marma Shareera according to Ayurveda as well as modern view.

2.To study the underlying structures of Amsa marma according to Ayurveda text and modern science.

3.To study the Stabdhabahuta in Amsa marmabhighata on modern parameters.

METHODOLOGY               

Study Design: Observational study.

Duration of Study: Approximately 2 years.

Setting and Study Population: The regular & camp patients coming to OPD of OPD of Dept. of Kayachikitsa & Shalyatantra Ayurved hospital and college was the population

Sampling technique: Non probability, convenient sample Hence sample size 30 patients has been taken for the study.

Methods of data collection relevant to objectives:

Informed, written and valid consent of the patient or relatives of the patient was taken prior to commencement of clinical trials and A proper and standard case record form was maintained. Total 30 patient of Bhujastambha were selected for the study to observe the Ayurvedic and modern parameters of Marma Ghata lakshana of Amsa marma like Shoulder Pain (Amsa Ruja), Restricted Movement. (Chestopaghata), Motor Weakness (Kriyahani), and  Tenderness (Sparshaasahatva).

Observations

In observational study of Bhujastambha, parameters like Shoulder pain (Amsa ruja) 50% patients shows mild pain, in Motor weakness (kriyahani) 60% patients shows contraction with gravity eliminated alone, and in Tenderness (sparshaasahatva) 53.3% patients shows on pressing pain appears on the face. Also Restricted movement (Chestopaghata), Up to 1350 flexion Restricted movement was present in 30% of patients. Up to 200 Extension Restricted movement was present in 40 % of patients. Up to 300  Internal rotation in degree was present in 50 % of patients. Up to 600  External rotation in degree was present in 66.7 % of patients. Up to 1350 Abduction movement was present in 63.33 % of patients and Up to 1350 Adduction movement was present in 56.6 % of patients. Also patient shows significant difference by applying Chi squared equals in Flexion Movement (P value equals 0.0341), Internal Rotation(P value equals 0.0202), External Rotation(P value equals 0.0002), Abduction (P value equals 0.0003) and Adduction (P value equals 0.0001) but nonsignificant difference was found in Extension Movement (P value equals 0.6703),  in the patient of Bhujastambha.

tables

Discussion

DISCUSSION

Amsa marma is a snayu marma structurally, traumatic effect on amsa marma (Snayu) leads to the functional deformity. So, it is known as Vaikalyakara Marma. Snayu marma leads to lakshanas viz. Koubjyam (Shortening), Sharir avayava saada i.e. svakarmanya asamrthyam (Loss of Functions), Kriyasvashaktiriti (Loss of movements like Abduction, Adduction, Flexion, Extension etc.), Ruja (Pain), Ayam, Akshep, Bhujastmbha. As per modern science three stages of progress of Frozen Shoulder are found mentioned viz.

1. Freezing stage

2. Frozen stage

 3. Thawing stage.

The shoulder joint and its ligament can be taken for the Amsa Marma as per Prof. D.G. Thatte in his book surgical anatomy of Ayurveda. The trapezius and latissimus dorsi muscles are also included in this Marma, because these muscles help in the movements of Bahu. Vd. R.R. Pathak, Dr. Ashutosh K. Pathak and Dr. Patil counted this Marma as to be the coraco-clavicular ligaments, conoid ligament, trapezoid ligament, superior acromioclavicular ligament and coraco-acromial ligaments. In modern science, on the back, the following structure found at the site of Amsa Marma - the shoulder joint, acromioclavicular joint, acromioclavicular ligament, coracoacromial ligament, Coracoclavicular ligament, coracohumeral ligament, rotator cuff muscles, subacromial bursa, and suprascapular nerve.

Conclusion

CONCLUSION

The location of Amsa Marma lies in between the deltoid prominency and root of the neck. That is where ligaments, subacromial bursa and rotator cuff tendons are present. the presence of ligaments at the site of Amsa Marma is indicative of Snayu Marma. The occurrence of Stabdhabahuta symptoms on injury to Amsa Marma indicates Vaikalyakar Marma. Also significant observations were found in Bhujastmbha in symptoms like Shoulder Pain (Amsa Ruja), Restricted Movement. (Chestopaghata), Motor Weakness (Kriyahani), and  Tenderness (Sparshaasahatva).