A Clinical study to evaluate the effect of Marma Chikitsa

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A Clinical study to evaluate the effect of Marma

Chikitsa in Apabahuka Dr Chithira Ambu1, Dr Dharmapal S L2 MS (ayu),Dr Mamtha H M3 MD (Ayu)

P G Scholar1 Department of PG studies in Shalya Tantra,

Ashwini Ayurvedic Medical College Hospital and Research Centre Ring Road Maraluru, Tumkuru, Karnataka,

India, Pin:572-105

Professor2 Department of PG studies in Shalya Tantra,


India, Pin:572-105

HOD3 Department of PG studies in Shalya Tantra,


India, Pin:572-105

ABSTRACT

In the fast-developing technological era, most of the diseases may not be life threatening but hamper day

to day life and human productivity.

Apabahuka is one among those diseases which is painful and affects the normal routine life of an

individual. It is one among the Vata vyadhi1 which affects the normal functioning of the upper limbs. One

of the nidhana for apabahuka is marma abhigata 2. In apabahuka, vitiated vata resides in amsadesha

leading to shoola, stamba, shosha and bahupraspanda hara3.

Frozen shoulder is a condition of varying severity characterized by the gradual development of limitation

of active and passive shoulder motion. The lifetime prevalence of frozen shoulder is estimated to be 2-5%

of population. Most common in 5th and 6th decade of life. Females are 4 times more effected than male.

Patients with diabetes mellitus are at greater risk of developing frozen shoulder. Treatment modalities

include physiotherapy, oral cortical steroids, surgery etc4.

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When compared to contemporary treatment there is a need to find a treatment which is easily available,

safe and cost effective in treatment of apabahuka.

In apabahuka, the vitiated vata get sthanasamsraya in amsadesha5. In amsadesha we have amsa marma6

and amsaphalaka marma7, which is a type of snayumarma8 and asthimarma9 respectively. Any abhigata

to these marma shows same lakshanas as that of apabahuka10.

Marmavijyaniyum is an extra ordinary and dynamic part mentioned in Ayurvedic text that has tremendous

value while performing any surgical treatments. Marma is the place where prana resides11.Any injury to

these marma can leads to marana or marana sadrishya dukha12. Marmachikitsa is mainly practiced by

traditional vaidyas in kerala. Marmachikitsa has dual benefits of disease control with instant symptomatic

response and permanent cure without side effects. Marmachikitsa is not merely the massage, its

multiprocedure which includes vimardana, bandhana, lepana, pidana, mardhana, abhyanga etc. In

marmachikitsa, marma points are chosen near by the painful area or on corresponding marma point in other

part of the body and is stimulated with mild or deep pressure. The pressure is applied according to the

condition, type of marma present and pain bearing threshold of the patient.

According to Susrutha Acharya, one of the treatments of snayu sandhi asthi gata vata is unmardhana13,

which can be considerd as a marmachikitsa. And in sahasrayoga the application of marmagutika lepana is

explained for all the marma vikaras14.

Hence single blind study is conducted “to evaluate the effect of marma chikitsa in apabahuka”

keywords: marma chikitsa, marma gutika, apabahuka.

INTRODUCTION

Ayurveda is India’s traditional science of life, which is originated in India more than 5000 years ago.

Ayurveda have observed, studied and analyzed all aspects related with human beings. According to

Acharya Charaka, combination of shareera, indriya, satwa and atma constitute life15.The definition for

perfect health according to Ayurveda is balance in these four entities. So, it is very important to know about

each of these constituents in detail. In all the Brihatrayis these four entities are explained. Among them

shareera is emphasized more by our acharyas, that is why one sthana itself is dedicated for shareera. One

of the unique and unexplored part in shareera is marma shareeram.

Marma vijyaniyum is an extra ordinary and dynamic part mentioned in Ayurvedic text that has tremendous

value while performing any surgical treatments. Marma is the place where prana resides16.Any injury to




these marma can leads to marana or marana sadrishya dukha. Acharya Charaka has explained in detail

about definition of marma, marma abhighata lakshana, and chikitsa in Trimarmaniya sidhi17and

trimarmaniya chikitsa18.According to Susrutha Samhita, Marma is the combination of mamsa, sira, asthi,

snayu and sandhi where the prana resides19. Even minor injuries to these marmas can be fatal comparing

with other major injuries at anywhere else in the body.

Marma chikitsa is mainly practiced by traditional vaidyas in kerala and also by siddha vaidyas, were the

nomenclature for marmas are varma or adankal. There are different types of marma chikitsa that are

followed in kerala. Some of them are thirumoolar marmam, chintarmani marmam etc. Even though

different names are given, the marma stana is almost same. According to siddha varma, disease occurs due

to obstructed prana vayu. So, by marma chikitsa we are clearing this blockage of prana and thus nourishing

the marma.

Marma chikitsa has many benefits, some of them are- instant symptomatic relief, permanent cure without

side effects etc. Marma chikitsa is not merely the massage, its multiprocedure which includes vimardana,

bandhana, lepana, pidana, mardhana, abhyanga etc. Different methods are practiced like oothu marmam,

thatu marmam, nooku marmam etc. In this study we are following vimardana. In marmachikitsa, marma

points are chosen near by the painful area, or the corresponding marma point is selected and is stimulated

with deep pressure. The pressure is applied according to the condition and pain bearing threshold of the

patient and type of marma.In the fast-developing technological era, most of the diseases may not be life

threatening but hamper day to day life and human productivity. Apabahuka is one among those diseases

which is painful and affects the normal routine life of an individual. The patient is present with pain,

stiffness or loss of activity of upper limb especially shoulder joint. It is one among the Vata vyadhi which

affects the normal functioning of the upper limbs.

One of the nidhana for apabahuka is marma abhigata, which leads to shoola, stamba, shosha and bahu

praspanda hara20.The marmas which are present in amsadesha are amsa and amsaphalaka marma. Any

abhigata to amsa7 and amsaphalaka marmas8 will also have the same lakshanas as that of

Apabahuka9.Thus we are adopting marma chikitsa in the treatment of apabahuka.

According to Acharya Susrutha, Amsamarma is located between bahu, moordha and greeva. 1/3 anguli

size. It is a type of pristagata marma, snayugata marma, and vaikalyakaramaram. Any injury to this marma

will leads to stabdha bahuta and kriya hani21. Amsaphalakamarma is located in bahumoola, it is an asthi




marma and vaikalyakara marma. Any injury to this marma will leads to bahushoonyatha, stabdhata and

shosh22.

Considering the prevalence & incidence rates of apabahuka, need arises to treat the same with less cost &

least side effects. Marmachikitsa can emerge as a promising option and can prove to be a boon for patients

suffering from this disease. To counter the condition of Apabahuka, Acharya Susrutha has mentioned utility

of unmardhana23 which can be considered as a marma chikitsa. In Sahasrayoga, for all marma vikaras,

marma gutika application is indicated24.So for the management of Apabahuka, we are utilizing these two

methods of marma chikitsa i.e unmardana and lepana. This study is a humble effort to address the utility

of understanding traditional marma chikitsa, which are practiced in different part of kerala. Since no other

study is done on marma chikitsa, no control group has been taken.Hence single blind study is selected to

evaluate the effect of marma chikitsa in management of apabahuka.

OBJECTIVE OF STUDY:

1. To review the literature of apabahuka in detail according to Ayurveda

2. To review the literature of marma chikitsa in detail according to Ayurveda

3. To evaluate the role of marma chikitsa in management of apabahuka

4. To review the modern aspect related to apabahuka.

MATERIALS

The clinical study to evaluate the effect of marma chikitsa in apabahuka was carried out in Ashwini

Ayurveda medical college Hospital, Tumkur, patients suffering from apabahuka were selected from OPD

and IPD.

SOURCE OF DATA

Literary source: -

All the classical Ayurveda texts, modern literature, journals and contemporary tests including the

website about the disease and treatment are reviewed and documented for the intended study.

Sample source: -

Patient attending OPD and IPD, Department of shalyatantra, Aswini Ayurvedic Medical College

Hospital and Research Centre, Tumkur, are randomly selected.




Drug source: -

Marma gutika is purchased from ashwini ayurveda medical college pharmacy for the study purpose.

METHOD OF STUDY

A. MATERIALS REQUIRED

Minimum of 30 patient suffering from avabahuka are randomly selected, and

Marma gutika lepa for application

B. DIAGNOSTIC CRITERIA

A clinical study with minimum of 30 patient fulfilling the criteria is selected

The diagnosis of the disease is mainly based on the signs and symptoms mentioned in classic:

1. SandhiShoola-Pain in the shoulder joint.

2. Stambha or graham-Stiffness in the shoulder joint.

3. Bahupraspandahara-restricted movement.

4. Amsashosha

C. INCLUSION CRITERIA

1. Patients between the age group of 20-70 years will be selected.

2. Patients irrespective of sex, occupation, religion, socio economic status will be selected.

3. The cases of Apabahuka with the features mentioned in the method of collection of data will be

included.

4. Patient fit for the treatment

D. EXCLUSION CRITERIA

1. Patients below 20 years & above 70 years are excluded from the study.

2. Patients with any disorders, which interfere the line of treatment of Apabahuka like OA,CA,Gout

etc

3. Patients of shoulder joint dislocation/fracture.

4. Auto immune disorder like SLE, RA

E. PLAN OF TREATMENT

STUDY DESIGN:30 patients who fulfill the inclusion criteria is selected.




1. POORVA KARMA: - patient is made to sit in a comfortable position

2. PRADANA KARMA: -Unmardana is done on amsa marma and amsa phalaka marma for 20

min each. which will help in stimulating the marmasthana.

3. PASCHAT KARMA: -External application of marmagutika for effected area

F. STUDY DURATION:

First unmardhana is done. Then marma gutika lepa is applied on amsa pradesha. This is

continued for 7consecutive days. Lepa is washed off when it is dried. Follow up is asked on 9th

day and Patient will be assessed clinically.

G. CRITERIA FOR ASSESSMENT OF RESULTS:

The subjective and Objective parameters of base line data, to post medication data is compared

for assessment of the final results after 7days. All the results are analysed statistically for

Signification by using suitable tests.

SUBJECTIVE PARAMETER:

1. Sthamba

2. BahuShoola.

OBJECTIVE PARAMETER

1. Bahupraspanditahara

2. AmsaShosha

H. ASSESSMENT CRITERIA:

The objective and subjective parametric readings are recorded on 1st 7th and 9th day of the treatment.

ASSESSMENT OF VARIABLES- Clinical assessment was made for the severity of the disease.

Regarding the severity of individual symptoms, clinical assessment is framed as Follows-




ASSESSMENT OF SUBJECTIVE PARAMETERS:

CRITERIA SCORE 0 SCORE 1 SCORE 2 SCORE 3

Sthamba No stiffness

Mild, has difficulty

in moving the

joints without

support

Moderate, has

difficulty in

moving, can lift

only with support

Severe,

unable to lift

even with

support.

BahuShoola.

No pain at

all vas

scale- 0

Mild pain can do

strenuous work

with difficulty. Vas

scale 1-5

Moderate pain

can do normal

work with great

difficulty. Vas

scale 6-8

Severe pain,

unable to do

any work at all.

Vas scale 9-10

TABLE NO: 24

ASSESSMENT OF OBJECTIVE PARAMETERS:

CRITERIA SCORE 0 SCORE 1 SCORE 2 SCORE 3

Bahupraspandana

Can do work

unaffectedly

goniometric

ROM 180

Can do

strenuous

work with

difficulty

Goniometric

ROM-900 to

1790

Can do daily

routine work

with great

difficulty

goniometric

ROM -450 to

890

Cannot do any

work

goniometry

ROM-00 to 450

AmsaShosha. No wasting

,

Mild wasting,

Moderate

wasting

Severe

wasting,




TABLE NO: 25

Grading

SCORE

GRADING

9-12

Poor

5- 8

Good

1-4

Very Good

0

Excellent

TABLE NO: 26

Criteria for assessment of the overall therapy

Complete relief One hundred percent relief in the complaints of

patients

Marked Improvement More than 75%-99% relief in the complaints

Moderate Improvement More than 50%-74% relief in the complaint

Slight Improvement 25%-49% relief in the complaints

Unchanged Patients with less than 25% relief in their

complaints

TABLE NO: 27




OBSERVATION AND RESULTS

OBSERVATION

Thirty patients were selected randomly for the project work. All the selected patients were thoroughly

examined and diagnosed, and they are selected based on the exclusion and inclusion criteria. Each patient

was observed thoroughly and noted neatly. The observations are recorded and necessary charts and

graphs were made. The following criteria is considered for statistical analysis.

Sex

Age

Religion

Socio economic status

Marital status

Occupational status

Diet

Observation table sex wise distribution

In the present study both sex group were selected

Table No.1

SEX Total No-30 Percentage of total

patients

MALE 12 40

FEMALE 18 60

In the sample taken for the study, 12(40%) males were registered in comparison to 18 (60%) females.

Details of the sex incidence are given table no-01and graphically represented in graph no-01




GRAPH NO: 1

Observation table age wise distribution

In the present study all the age group of patients are selected

Table No.02

Age Group

(Years)

Total No-30 Percentage of total patients

20-30 Years 6 20

31-40 Years 6 20

41-50 Years 9 30

51-60 Years 7 23.33

61-70 Years 2 6.66

Analysis of age incidence of 30 patients suffering from apabahuka there was 6 cases from age group 20-

30 years, and 31- 40 years, 9 cases from 41 – 50 years, 7 cases from 51-60 years and 2 cases from 61-70

years. This showed age group between 41-50 years showed a greater number of patients i.e. 30% Details

of the age incidence are given Table no 02 and graphically represented in graph no- 02

0

2

4

6

8

10

12

14

16

18

20

MALE FEMALE

sex wise distribuion of patients

Total No-30




GRAPH NO 2

Observation table religion wise distribution

In the present study, patient from all religion were selected

Table No.03

RELIGION Total No-30 Percentage of total

patients

HINDU 17 56.66

MUSLIM 5 16.66

CHRISTAIN 8 26.66

Analysing the incidence of religion in 30 patients suffering from apabahuka 17 cases were Hindu, 5 cases

were muslim and 8 cases were christain. The study showed a greater number of Hindu patients i.e. 56.66%

Details of the incidence according to religion are given Table no 03 and graphically represented in graph

No-03

0

1

2

3

4

5

6

7

8

9

10

20-30 Yrs 31-40 Yrs 41-50 Yrs 51-60 Yrs 61-70 Yrs

Age wise distribution of patients

Total No-30




GRAPH NO: 3

Observation table according to socio economic status

Table No.04

Socio Economic

Status

Total No-30 Percentage of total

patients

Upper middle class 9 30

Middle class 14 46.66

Lower Middle

class 7 23.33

Out of the 30 patients, 9(30%) cases are from upper middle class, 14(46.66) patients are from middle class

and 7(23.33%) patients are from lower middle class in Socio Economic Status. Distributions of patients

according to the Socio-Economic Status are given in table no-04 and graphically represented in graph no-

04

0

2

4

6

8

10

12

14

16

18

HINDU MUSLIM CHRISTAIN

Religion wise distribution of patients

Total No-30




GRAPH NO: 4

Observation table according to marital status

Table No.05

Marital Status


patients

Married 26 86.66

Single 4 13.33

Out of 30 patients, 26 (86.66 %) patients were married and 4 (13.33%) patients were unmarried. Details

of incidence of marital status are given Table no 05 and graphically

GRAPH NO: 5

0

2

4

6

8

10

12

14

16

Upper middle class Middle class Lower Middle class

Socioeconomic wise distribution of patients

Total No-30

0

5

10

15

20

25

30

Married Single

Marital status wise distribution of patients




Observation table according to occupation

Table No.06

Occupation Total No-30 Percentage of total patients

Housewife 10 33.33

Engineer 4 13.33

Driver 1 3.33

Businessman 6 20

Carpenter 4 13.33

Accountant 1 3.33

Teacher 4 13.33

Out of 30 patients 10(33.33%) of patients were housewife, 4(13.33%) were engineers, teacher and

carpenter, 1 (3.33) % was driver and accountant, 6 (20%) were businessman. Detailed description of

Occupation of the patients are given in Table no.06 and graphically represented in graph No 06

GRAPH NO: 06

0

2

4

6

8

10

12

Occupation wise distribution of patients




Observation table according to diet

Table No.07

Diet


patients

Mixed 18 60

veg 12 40

Out of 30 patients 18(60%) patients’ diet were mixed and 12(40%) patients were vegetarian. Details of

incidence of diet are given Table no 07and graphically represented in Figure No 07

GRAPH NO: 07

resultS

The basis of the assessment of result is the response shown by the patients to marma chikitsa. The overall

effect of the procedure as well as individual symptom is assessed. The results observed are arranged in a

systemic way in form of tables and graph.

0

2

4

6

8

10

12

14

16

18

20

Mixed veg

Diet was distribution of patients




TABLE SHOWING SYMPTOM WISE RESULT

SL NO SYMPTOM TOTAL VALUE

BT AT FU

1 Stambha 65 28 28

2 Shoola 68 30 30

3 Bahupraspanda hara 60 28 28

4 Amsa shosha 19 18 18

TABLE NO: -8

Since no difference in after treatment and followup, only after treatment values are shown further.

GRAPH NO:08

ASSESSMENT OF STAMBA

Descriptive Statistics of Stambha

Stambha N Mean StDev SE Mean

Before 30 2.167 0.834 0.152

After 30 0.933 0.907 0.166

TABLE NO: 09

65 6860

1928 30 28

18

01020304050607080

Stambha Shoola Bahupraspanda hara Amsa shosha

1 2 3 4

SYMPTOM WISE RESULT

BT AT




Estimation for Paired Difference

Mean StDev SE Mean

95% CI for

μ_difference

1.2333 0.5040 0.0920 (1.0451, 1.4215)

TABLE NO: 10

µ_difference: mean of (Before - After)

Test

Null hypothesis H₀: μ_difference = 0

Alternative hypothesis H₁: μ_difference ≠ 0

T-Value

P-Value

13.40 0.000

There is significant result in stamba

ASSESMENT OF SHOOLA

Descriptive Statistics of Shoola

Shoola N Mean StDev SE Mean

Before 30 2.267 0.740 0.135

After 30 1.000 0.830 0.152

TABLE NO: 11


Mean StDev SE Mean

95% CI for

μ_difference

1.2667 0.5208 0.0951 (1.0722, 1.4611)

TABLE NO: 12





Test



T-Value P-Value

13.32 0.000

BAHUPRASPANDAHARA

Descriptive Statistics of BAHUPRASPANDHAHARA

Bahupraspandhahara N Mean StDev SE Mean

Before 30 2.000 1.017 0.186

After 30 0.933 0.907 0.166

TABLE NO: 13


Mean StDev SE Mean

95% CI for

μ_difference

1.0667 0.5208 0.0951 (0.8722, 1.2611)

TABLE NO: 14


Test



T-Value P-Value

11.22 0.000




SHOSHA

Descriptive Statistics of AMSA SHOSHA

Amsa Shosha N Mean StDev SE Mean

Before 30 0.633 0.928 0.169

After 30 0.600 0.894 0.163

TABLE NO: 15


Mean StDev SE Mean

95% CI for

μ_difference

0.0333 0.1826 0.0333 (-0.0348, 0.1015)

TABLE NO: 16


Test



T-Value P-Value

1.00 0.326




TABLE SHOWING OVERALL RESULT

OVERALL EFFECT OF TREATMENT

Grading Relief in

Percentage

Relief in

Patients

Poor Improvement 10% 3

Good Improvement 26.66 % 8

Very good Improvement 33.33% 10

Excellent Improvement 30 % 9

TABLE NO: 17

GRAPH NO: 09

DISCUSSION

In this section the discussion is about apabahuka and marma chikitsa. Especially the effect of treatment,

result, probable mode of action and their interpretation are discussed.

Apabahuka is one among those diseases which is painful and affects the normal routine life of an individual.

The patient is present with pain, stiffness or loss of activity of upper limb especially shoulder joint. It is one

among the Vata vyadhi which affects the normal functioning of the upper limbs.

Acharya Charaka has explained in detail about definition of marma, marma abhighata lakshana, and

chikitsa in Trimarmaniya sidhi and trimarmaniya chikitsa.According to Susrutha Samhita, Marma is the

Poor Improvement

10%

Good Improvement

27%

Very good Improveme…

Excellent Improvement

30%

OVERALL RESULT

Poor Improvement Good Improvement

Very good Improvement Excellent Improvement




combination of mamsa, sira, asthi, snayu and sandhi where the prana resides. Even minor injuries to these

marmas can be fatal comparing with other major injuries at anywhere else in the body.

One of the nidhana for apabahuka is marma abhigata, which leads to shoola, stamba, shosha and bahu

praspanda hara.The marmas which are present in amsadesha are amsa and amsaphalaka marma. Any

abhigata to amsa and amsaphalaka marmas will also have the same lakshanas as that of Apabahuka.Thus

we are adopting marma chikitsa in the treatment of apabahuka.

Marma chikitsa is mainly practiced by traditional vaidyas in kerala. Marma chikitsa has many benefits,

some of them are- instant symptomatic relief, permanent cure without side effects etc. Marma chikitsa is

not merely the massage, its multiprocedure which includes vimardana, bandhana, lepana, pidana,

mardhana, abhyanga etc.Considering the prevalence & incidence rates of apabahuka, need arises to treat

the same with less cost & least side effects. Marmachikitsa can emerge as a promising option and can prove

to be a boon for patients suffering from this disease.

In this study we are utilizing two methods of marma chikitsa i.e unmardana and lepana Acharya Susrutha

has mentioned unmardhana as a treatment for apabahuka. Since apabahuka and snayu marma vidha

lakshana are same, we are considering cause of apabahuka as marma abhigata. Here we are doing

unmardana mainly on amsa marma and amsaphalaka marma. In Sahasrayoga, for all marma vikaras,

marma gutika application is indicated. So, for the management of Apabahuka we are giving the lepana of

marma gutika after doing unmardana.

So, for the management of Apabahuka, we are utilizing these two methods of marma chikitsa i.e unmardana

and lepana.This study is a humble effort to address the utility of understanding traditional marma chikitsa,

which are practiced in different part of kerala. The study was conducted for 9 days. The signs and symptom

like shola, stamba, bahupraspandanahara, shosha are studied and analysed.

Here single blind study is followed. No control group can be taken, as no similar study is done before. This

is a single blind study on marma chikitsa.

ANALYSIS OF RESULT

OBSERVED INCIDENCE

SEX In the sample taken for the study, 12(40%) males were registered in comparison to 18 (60%) females.

Details of the sex incidence are given in table no-01and graphically represented in graph no-01.




This shows that females are more prone to apabahuka

AGE

Analysis of age incidence of 30 patients suffering from apabahuka there was 6 (20%) cases from age group

20-30 years, and 31- 40 years, 9 (30%) cases from 41 – 50 years, 7 (23.33%) cases from 51-60 years and 2

(6.66%) cases from 61-70 years. This showed age group between 41-50 years showed a greater number of

patients i.e. 30% Details of the age incidence are given Table no 02 and graphically represented in Graph

no- 02.

This shows people aged between 41-50 years are more prone for apabahuka

RELIGION

Analysing the incidence of religion in 30 patients suffering from apabahuka 17 cases were Hindu, 5 cases

were muslim and 8 cases were christain. The study showed a greater number of Hindu patients i.e. 56.66%

Details of the incidence according to religion are given Table no 03 and graphically represented in Graph

no-03

This shows patients from Hindu community are more prone for apabahuka

SOCIO-ECONOMIC STATUS

Out of the 30 patients, 9(30%) cases are from upper middle class, 14(46.66%) patients are from middle

class and 7(23.33%) patients are from lower middle class in Socio Economic Status. Distributions of

patients according to the Socio-Economic Status are given in table no-04 and graphically represented in

graph no-04

This shows patients from middle class community are more prone for apabahuka

MARITAL STATUS

Out of 30 patients, 26 (86.66 %) patients were married and 4 (13.33%) patients were unmarried. Details of

incidence of marital statusare given Table no 05 and graphically represented in graph no 5




This shows incidence of apabahuka are more in married patients

OCCUPATIONAL STATUS

Out of 30 patients 10(33.33%) of patients were housewife, 4(13.33%) were engineers, teacher and

carpenter, 1 (3.33) % was driver and accountant, 6 (20%) were businessman. Detailed description of

Occupation of the patients are given in Table no.06 and graphically represented in Graph no 06

This shows that housewives are more prone for apabahuka

DIET

Out of 30 patients 18(60%) patients’ diet were mixed and 12(40%) patients were vegetarian. Details of

incidence of diet are given Table no 07and graphically represented in Graph no 07

This shows that mixed diet patients are more prone for apabahuka

OBSERVATION DURING TREATMENT

During the duration of study, we have analyzed all symptoms in apabahuka separately. All the objective

and subjective parameters are analyzed statistically. In table no: 8 the comparative study of symptoms

before and after treatment is analysed

STAMBA

It has been demonstrated in table 8,9 and 10 the effect of marma chikitsa for stamba. It is seen that the total

value before treatment in 30 patients was 65 and after treatment was 28. The p value is 0.000. This shows

that the treatment has shown a significant result in stamba.

During treatment we are able to notice that the stiffness of the limb was gradually reducing. The patient

was able to move the limb with ease as the day progress

SHOOLA

It has been demonstrated in table 8,11 and 12 the effect of marma chikitsa for shoola. It is seen that the

total value before treatment in 30 patients was 68 and after treatment was 30. The p value is 0.000. This

shows that the treatment has shown a significant result in shoola.

During treatment there was slight increase in pain while doing unmardana. But after the application of

marma guika the pain gets reduced. In starting days there was no much significant change in pain. Gradually

the pain start to reduce and patient was able to move the limb without pain.




BAHUPRASPANDAHARA

It has been demonstrated in table 8,13and 14 the effect of marma chikitsa for bahupraspandha hara. It is

seen that the total value before treatment in 30 patients was 60 and after treatment was 28. The p value is

0.000. This shows that the treatment has shown a significant result in bahupraspandhahara. The main

complaint patient approach opd was because they cannot to do daily routine work. Once the stamba and

shoola was under control, patient was slowly able to do routine work.

AMSASHOSHA

It has been demonstrated in table 8,9 and 10 the effect of marma chikitsa for amsa shosha. It is seen that

the total value before treatment in 30 patients was 19 and after treatment was 18. The p value is 0.326. This

shows that the treatment has not shown a significant result in amsa shosha. Even in sadhya asadhyatha it

is told that once shosha happens it will become asadhya for treatment. Even marma chikitsa had not shown

much result. So, we have to cooperate some other treatment modality to overcome shosha.

OVERALL RESULT

It has seen that 10% of patient has poor improvement, 26.66% has good improvement, 33.33% has very

good improvement, 30% of patient has excellent improvement. By analyzing this It has seen that patient

came with amsa shosha has shown poor improvement in the treatment and the patient whose has

approached us within short day of onset has shown excellent improvement.

FINAL RESULTS:

From the comparative evaluation of results, it has been observed that though there

were variations in cured and moderate results, but poor results (no improvement)

never occurred by using marma chikitsa.

There was excellent result if the onset of disease was recent.

There was no much result in cases with amsa shosha

PROBABLE MODE OF ACTION OF MARMA CHIKITSA

Unmardhana and lepana are the two marma chikitsa what we are followed in this study

Since apabahuka is vatavyadhi by doing unmardana there will be vata hara, shoola hara etc.

By doing unmardana the blood supply to that area increases, thus the healing process fasten.

The kapha kshaya in the sandhi also treated by doing unmardana




one of the nidhana for apabahuka is marma abhigata so we are mainly focusing on amsa and

amsaphalaka marma while doing unmardhana.

Unmardhana helps in clearing the channel, so that the prana flow is corrected. Thus, the prana

blocked due to marma abhigata is released.

Since to overcome marma abhigata we are giving lepana of marma gutika, this will act as shota hara

as well as shoola hara.

For all the marma vikaras marma gutika application is indicated. So here we are giving its lepana

Since the marma gutika contain drugs which are vata kapha hara in nature, there is reduction in shoola

and shotha.

INTERPRETATION OF THE OUTCOME OF THE STUDY

The most important outcome of the study is that, it helps in relieving the symptoms and there is no

recurrence within the study duration as well as follow up. This enables the patient to resume day today

activities during the treatment. Hence this study has a positive outcome and can be recommended as the

therapeutic procedures for apabahuka.

This shows that marma chikitsa has a good result in treating patient with apabahuka. There was good

improvement in all symptoms except amsa shosha. The patient was able to resume to do daily routine work

without difficulty.

CONCLUSION

Apabahuka is a disease which is commonly seen nowadays, mainly effecting middle age and old

age people.

Management of apabahuka with marma chikitsa has a good result

In all Samhita marmavijnaneeeyam is the core of shareera sthana, not only knowledge about

marma, but also about marma vidha lakshanas are also explained. But there is a lacking of how to

treat marma vidha lakshanas. So, to bridge the gap between them, in this study we have adopted

some techniques from keraleeya marma chikitsa

In this clinical study, importance was given to theoretical, practical and clinical point of view.

There is different method of marmachikisa like unmardhana, lepana, thadana, pada abyanga etc.




In chikitsa sootra of apabahuka, especially in snayugata vata chikitsa, unmardana is the line of

treatment along with other vatahara treatments.

In this study we are doing unmardhana especially focusing on marma points, especially amsa and

amsa phalaka marma along with lepana of marma gutika.

This treatment modality is cost effective, fast relieving and with minimum side effect and this

treatment can be easily done in OPD bases without any hospitalization

The main problem encountered in the procedure was the pain during unmardana, so patient should

be mentally supported during the treatment.

If the patient had approached us in the early stage of disease, complete cure was seen

By this treatment no change in bahu shosha grading was seen.

Female patients are more effected with apabahuka, especially in age group between 41- 50 yrs

There was significant result in treating stamba, shoola and bahu praspandha hara.

There was less significant result in treating amsa shosha

It has seen that 10% of patient has poor improvement, 26.66% has good improvement, 33.33% has

very good improvement, 30% of patient has excellent improvement.

There was no patient without any improvement

There was no recurrence of the condition during the study because follow up score was same as that

of after treatment

Thus, we can say that marma chikitsa has a good result in treating apabahuka

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A Clinical study to evaluate the effect of Marma Chikitsa