A Comprehensive Phytochemical, Pharmocological and Clinical Review of Anti-Fibrotic, Anti Inflammatory and Analgesic Effect by Combined Asitakadi Churna With Koladi Churna Lepa in the Management of Avabahuka With Special Reference to Adhesive Capsulitis

Background: Avabahuka is a Vata-predominant disorder of the Amsasandhi (shoulder joint) described comprehensively in Ayurvedic classical texts, presenting with Bahushula (shoulder pain), Bahustabdata (stiffness), Bahuspandanahara (restricted movement), and Amsabandana shosha (muscle wasting). Its clinical manifestations closely parallel adhesive capsulitis (frozen shoulder), which affects 2-5% of the general population and up to 25% of diabetic patients, with peak incidence between 40 and 60 years.1,2 Objective: This review critically synthesises the Ayurvedic classical textual basis, phytochemical constituents, pharmacokinetic and pharmacodynamic profiles, pharmacological activities, and available clinical evidence for Asitakadi Churna (internal administration) and Koladi Churna Lepa (external application) in Avabahuka/Adhesive Capsulitis, comparing them with Trayodashanga Guggulu as reference standard. Methods: A comprehensive literature search was conducted in PubMed, DHARA, AYUSH Research Portal, and all major Ayurvedic classical texts including Charaka Samhita, Sushruta Samhita, Ashtanga Hrudaya, Ashtanga Sangraha, Vangasena Samhita, Bhavaprakasha, Bhaishajya Ratnavali, and Sharangadhara Samhita. Pharmacological studies and clinical trials related to constituent drugs were reviewed. Results: Koladi Churna Lepa (Vangasena Samhita, Vatavyadhi Adhikara, verse 112)4 comprises eleven drugs with potent local analgesic, anti-inflammatory, Vata-shamaka, and transdermal penetration-enhancing properties. Asitakadi Churna (Bhavaprakasha, Amavata Prakarana, verses 75-77)5 provides systemic Vatakaphahara, Ama-nashana, anti-fibrotic, immunomodulatory, and Brimhana activities through its seven-drug combination. Trayodashanga Guggulu (Bhaishajya Ratnavali, Vatavyadhi Adhyaya, verse 98-101)23 provides the comparator standard through Guggulsterone-mediated NF-kB suppression and anti-inflammatory activity. Conclusion: Combined Asitakadi Churna and Koladi Churna Lepa offers a multi-modal Ayurvedic therapeutic strategy with mechanistic advantages in anti-fibrotic, anabolic, Ama-nashana, and transdermal delivery properties over Trayodashanga Guggulu. Randomised controlled trials with validated SPADI and goniometric ROM outcome measures are warranted.