Avabahuka (Frozen Shoulder) in Ayurveda: A Critical Review With Special Reference to Marma Chikitsa and Clinical Outcomes

Avabahuka is a Vata Vyadhi characterised by pain, stiffness, and restricted movements of the shoulder joint. Classical Ayurvedic texts describe the condition as resulting from aggravated Vata localised in the Amsa Pradesh, causing shoshana of Amsa Bandhana and akunchana of sira, leading to Bahupraspandahara. Contemporary medicine primarily associates Avabahuka with adhesive capsulitis (frozen shoulder). The present review critically evaluates classical Ayurvedic concepts of Avabahuka along with Nidana Panchaka, Samprapti, Marma involvement, and therapeutic principles. Special emphasis is placed on Marma Chikitsa and its clinical outcomes in Avabahuka. A clinical study involving 30 patients treated with stimulation of Amsa, Ansaphalaka, and Brihati Marmas demonstrated statistically highly significant improvement in pain and range of motion parameters. Pain reduced by 70.51%, abduction improved by 62.5%, flexion by 70%, and extension by 56.7% (p < 0.001). The probable mode of action of Marma therapy has also been explored through integrated Ayurvedic and neurophysiological perspectives. This review highlights the therapeutic potential of Marma Chikitsa as a safe, non-invasive, and functionally restorative intervention in frozen shoulder and emphasises the need for evidence-based integrative musculoskeletal research.