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Introduction

Avabahuka, a condition described in classical Ayurvedic texts, is a Vata-dominant disorder affecting the shoulder joint. The term "Avabahuka" is derived from two Sanskrit words: Ava and Bahuka.1 The prefix Ava signifies dysfunction, separation, or deterioration, while Bahuka refers to the upper limb or shoulder, one of the Shadangas (six major body parts). In some texts, such as Astanga Sangraha2 and Sharangdhar Samhita3, the prefix Apa is used interchangeably with Ava, both conveying the same meaning of dysfunction or deterioration.
The term Avabahuka thus implies dysfunction or stiffness in the shoulder joint. According to Ayurvedic literature, it is characterized by Viyoga (dysfunction) and Vikratau (deformity or stiffness), leading to restricted movement and pain in the shoulder.4
Avabahuka is caused by the vitiation of Vata Dosha (Kupita Vata), which localizes in the Amsa Pradesa (shoulder region). The aggravated Vata leads to the Shoshana (drying up) of the Amsa Sandhi (shoulder joint) and causes Akunchana (contraction) of the Sira (blood vessels and ligaments) in the affected area. This results in Bahupraspanda Haratwam (loss of movement in the upper limb), manifesting as pain, stiffness, and restricted mobility of the shoulder joint.5,6
In modern medicine, Avabahuka closely correlates with frozen shoulder or adhesive capsulitis, a condition characterized by inflammation and fibrosis of the shoulder capsule, leading to pain and loss of range of motion. The pathophysiology of frozen shoulder aligns with the Ayurvedic concept of Vata vitiation, where Vata imbalance causes dryness, stiffness, and impaired function of the joint.7,8
 

Dalhana opines that the Amsa means Bahu Shira, Amsa Pradesha means around the Bahu Shira, and Amsa Bandanam means the Shleshaka Kapha which resides in the joints. Nyaya Chandrika quotes that the Vata Kopa due to Dhatukshaya Nimitta further causes the Amsa Bandhana Shoshana and exhibits the Avabahuka. Madhukosha Vyaakhya classifies Avabahuka as of two types: Vatajanya and Kaphajanya. Considering all the above Lakshanas, Avabahuka can be categorized as a Sthanika Vikara rather than Sarvadaihika Vikara and its cardinal features are as below:9
1.    Bahupraspandihara
2.    Amsabandhana Shosha
3.    Sira Akunchana / Stambha
4.    Shoola
The word Bahupraspandahara has three terms: Bahu, Praspandana & Hara where the word Bahu has different meanings like Urdhva Shaka (whole upper limb, shoulder). Dalhana’s commentary suggests that the word Praspandana means Chalana or movement which is considered as Samanya Karma of Vyana Vata.10 It also conveys that the word Praspandana means Chesta meaning Akunchana, Prasaranadi Karma. This Karma is maintained by Vyana Vata in the limbs. The word Hara means impaired/loss/difficulty. Thus, in the present context, Bahupraspandahara may be taken up as difficulty in the movement or impaired or loss of movement of the upper limb and the function of the Sandhi like Utkshepana, Prasarana, and Akunchana will be affected in Avabahuka. The word Amsa has different meanings like Skanda, Marma, Bahushira. The word Amsabandhana is considered as Amsagata Shleshma or Sira present around the Amsa Pradesha. The Shoshana of these is termed as Amsabandhana Shosha, which is a major Lakshana of Avabahuka. Siras are the Upadhatu of Rakta Dhatu and form Snayu by combining with Snehamsa of Medas. They are responsible for the Akunchana and Prasarana of the Sandhi. The word Akunchana means Sankocha. So, Sankochana of the Siras around the Amsa Sandhi leads to Avabahuka. The word Sthamba means Nishkriya or Nischala, Sankocha, which is the main feature of Avabahuka.
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 as nothing but ‘Samprapti Vighatana’. No specific Samprapti has been explained for Avabahuka. So, it can be said that Samprapti of Avabahuka is the same as that of general Samprapti of Vatavyadhi.11
Etiological factors lead to the vitiation of Vata Dosha. This morbid Vata Dosha in turn fills the Riktata of the Srotas (fills up the empty channels). This unique pathology may involve the whole body or a part of it, thus establishing Vata Vyadhi. This is the Samanya Samprapti of Vatavyadhi and holds good even for Avabahuka. Indulgence in various etiological factors leads to the accumulation of the Vata Dosha in the Amsa Pradesha and causes the Shoshana of the Amsa Bandhan or Sira Akunchana, later leading to the manifestation of Kevala Vatajanya Avabahuka. Furthermore, the Dhatu Kshaya causes the Vata Prakopa and then leads to the Amsa Shosha. This unique pathology is described as Dhatukshayajanya Avabahuka. Sometimes due to Kaphakara Nidana, the Kapha gets aggravated in the Sandhi, which impedes the Chala Guna of the Vata leading to the occurrence of Avabahuka. This distinct pathology is referred to as Kaphavruta Vatajanya Avabahuka.
 

1 Samprapti ghataka:

• Doshas     Vata & kapha 

• Dushyas     Sira, Snayu, Khandaras, Rasa,Rakta, Mamsa, Asthi 

• Srotasas     Rasa, Rakta, Mamsa, Meda &Asthi 

• Srotodusti     Sanga 

• Udhbhavasthana     Amashaya & Pakwashaya 

• Sancharasthana     Sira,snayu,khandaras 

• Adhisthana     Amsapradesha 

• Vyakta     Baahu praspandana hara 

• Rogamarga     Bahya & madhyama. 

Dashmool and Masha Kwath: An Ayurvedic Perspective12,13,14 
Dashmool and Masha Kwath are well-known formulations used in Ayurveda for their Vata-balancing properties.
1. Dashmool
Dashmool is a combination of ten medicinal roots, divided into Brihat Panchamoola (large tree roots) and Laghu Panchamoola (small shrub roots). These include:
•    Brihat Panchamoola: Bilva (Aegle marmelos), Agnimantha (Premna mucronata), Shyonaka (Oroxylum indicum), Patala (Stereospermum suaveolens), and Gambhari (Gmelina arborea).
•    Laghu Panchamoola: Shalaparni (Desmodium gangeticum), Prishnaparni (Uraria picta), Brihati (Solanum indicum), Kantakari (Solanum surattense), and Gokshura (Tribulus terrestris).
Dashmool acts as an anti-inflammatory, analgesic, and neuroprotective agent. It alleviates Vata disorders by restoring normal functioning of joints and nerves.
2. Masha Kwath
Masha (Phaseolus mungo), or black gram, is a highly nourishing and strengthening legume mentioned in Ayurveda for treating Vata disorders. It is Guru (heavy), Snigdha (unctuous), and Madhura (sweet), which counteracts the dryness and degeneration caused by aggravated Vata in Avabahuka.

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Discussion

In Ayurveda, Avabahuka is classified as a Vata Vyadhi (disorder caused by aggravated Vata Dosha), leading to Amsa Sandhi Shosha (degeneration of the shoulder joint) and Sira Akunchana (contraction of ligaments and blood vessels). The treatment approach emphasizes Vata Shamana (pacification of Vata Dosha) and Sandhi Balya (joint strengthening).
 

Dashmool Kwath – Ayurvedic Mode of Action16
Dashmool is a combination of ten potent roots, divided into Brihat Panchamool (large tree roots) and Laghu Panchamool (small shrub roots). It has the following therapeutic actions in Avabahuka:
1.    Vata-Kapha Shamana – The herbs in Dashmool possess Vata-Kapha Hara properties, which help in reducing pain, stiffness, and inflammation in the shoulder joint.
2.    Shothahara (Anti-inflammatory Action) – Herbs like Bilva (Aegle marmelos) and Agnimantha (Premna mucronata) help in reducing inflammation in the affected area.
3.    Vedanasthapana (Analgesic Effect) – Patala (Stereospermum suaveolens) and Gambhari (Gmelina arborea) act as natural pain relievers, helping to alleviate the chronic pain associated with frozen shoulder.
4.    Balya and Rasayana (Tissue Rejuvenation) – Shalaparni (Desmodium gangeticum) and Prishnaparni (Uraria picta) aid in strengthening the joint, promoting tissue repair, and preventing degeneration.
5.    Deepana-Pachana (Digestive and Metabolic Actions) – Proper digestion and metabolism improve the absorption of nutrients required for joint health.
By acting at both systemic and local levels, Dashmool Kwath supports musculoskeletal health and alleviates Vata Vyadhi symptoms.
 

Masha Kwath – Ayurvedic Mode of Action
Masha (Phaseolus mungo), commonly known as black gram, is highly revered in Ayurveda for its Vata-Hara and Brimhana (nourishing) properties.
1.    Vata Shamana and Balya – Masha pacifies Vata Dosha, providing strength and lubrication to the joints.
2.    Snigdha Guna (Unctuous Property) – This quality counteracts the Ruksha Guna (dryness) of Vata, preventing joint stiffness.
3.    Shula Prashamana (Pain Relief) – Masha Kwath acts as a natural analgesic, relieving pain and discomfort.
4.    Sandhigata Ojasvardhaka (Joint Rejuvenation) – It promotes synovial fluid production, enhancing joint mobility and flexibility.
5.    Mamsa Dhatu Poshan (Muscle Nourishment) – Masha is Brimhana and strengthens the muscles surrounding the shoulder joint.
Modern Mode of Action of Dashmool and Masha Kwath
From a modern medical perspective, Dashmool and Masha Kwath exhibit pharmacological actions that align with the treatment of Frozen Shoulder:
1.    Anti-inflammatory Action – Studies indicate that Dashmool contains bioactive compounds like flavonoids and alkaloids, which inhibit inflammatory mediators like prostaglandins and cytokines, thereby reducing pain and swelling.
2.    Analgesic Effects – The presence of phytochemicals such as tannins and terpenoids in Dashmool helps in modulating pain perception.
3.    Muscle Relaxant Properties – Masha Kwath contains proteins, amino acids, and essential fatty acids that aid in muscle relaxation and prevent fibrosis in the shoulder capsule.
4.    Antioxidant and Tissue Regeneration – The polyphenols in Dashmool and Masha combat oxidative stress, reducing free radical damage to joint tissues and promoting healing.
5.    Neuroprotective Effect – Since Vata disorders have a neurological component, Dashmool and Masha support neuromuscular coordination, reducing nerve compression and improving movement.
 

Conclusion

Both Dashmool Kwath and Masha Kwath play a crucial role in the Ayurvedic management of Avabahuka (Frozen Shoulder) by addressing Vata-Kapha imbalances, reducing inflammation, and promoting joint health. Their modern pharmacological effects further support their efficacy as anti-inflammatory, analgesic, and muscle-relaxant agents. Integrating these Ayurvedic formulations with physical therapy can enhance recovery outcomes for Avabahuka, making them a valuable alternative or complementary approach in musculoskeletal disorders.