A
Case discussion on Dushta Vrana
(Chronic Wound)
Case
report
Vijakumar B1*,
Prasanna N Rao2 ,
Hemantkumar P3
1. Asst. Professor
N.K.J.A.M.C. Bidar – Karnataka.
2. Principal, 3. H.O.D
Dept. of Shalya tantra, S.D.M.College of Ayurveda, Hassan, Karnataka, India
*Corresponding Author: Vijaykumar Biradar, Asst.
Professor, NKJAMC, Bidar, Karnataka, India
E-mail:
drvijugtri.com@rediffmail.com,
Mob.
No: 09845724774
Abstract
The
healing of wound or an ulcer is the natural response of the body. Naturally
wound will heal in one week if no doshic invasion or infection takes place. The vrana more
than a week called dushta vrana which
fail to heal for a long period and result into chronic wound (dheergha kalanubandhi dushta vrana), such vrana needs shodhana (Abhyantara) and ropana (Bahya) chikitsa. Virechana and Jatyadi ghruta application is the best line of management for vata-pitta pradushtaja dushta vrana. A case report
of 50 year – old men, who presented with complaints of an open ulcer on the
dorsum of the right foot associated with pain, discharge, slough, foul smell, oedema and discolouration of the
skin has been presented here.
Keywords:
Dushta vrana, Shodhana, Ropana, Virechana, Jatyadi ghruta.
Introduction:
As the sciences have advanced, newer
remedies are tried out for speedy recovery, but the oldest remedies still lead
the race. Wound healing procedures described by sushruta still holds its place
today. The faster the wound healing, the faster is the recovery of the patient
enabling him to resume his daily routine. These included various purification
therapies (shodhana)
and local applications (ropana)
of natural resources, which are available very easily and heal the wound faster
without any sepsis.
One
of such purification therapy explained by sushruta is virechana to eliminate the pravrudha doshas out
from the body, particularly in vata-pitta praduhtaja dushta vrana. Jatyadi ghruta is used as an external application in
combination with virechana.
Case report:
A 50 yr old male
presented with the complaint of an ulcer on the dorsum of the right foot,
associated with pain, discharge, slough, foul smell, oedema
and discoloration of the skin near by the ulcer since three months. Three
months back patient was alright , then while working
in the field a stone slips from his hand and fell down on his right foot ,
produced swelling with pain. After few days the swelling burst due to cellulitis and suppuration and resulted into wound. Wound
was treated with conventional antibiotic ointment by a local doctor but the
wound failed to respond, presumably because of wound contamination and movement
of the part. Treatment continued for a period of about three months, but the
wound became worst, so he visited us. There is no history of DM, HTN and on
local examination there is no varicosity in the affected limb.
The
family history was not suggestive of anything specific. The local examination
revealed an open oval shaped ulcer on the dorsum of the right foot (approximately
6x4 cm) associated with pain, discharge etc. There was tenderness near by the
lesion with elevated local temperature and surrounding indurations.
The
classical lakshanas
of dushta vrana such as
durgandhata, pooti puya sraava, vedana
etc were observed.(1) The adhisthana was mamsa with vata-pitta
predominance. Routine heametalogy (Hb, TC, DC, ESR, RBS) and urine
investigations were within normal limits. As Susrutha has describe the sixty manifold measures (shasti vrana upokarmas)
for a wound management from its manifestation to the normal rehabilitation of
the hair in the scar. And given foremost to, measures like shodhana and ropana in the management of dusthavrana. Shodhana
comprises two varieties of purification.
·
Internal purification (Antargata shodhana)
·
External purification (Bahirgata shodhana)
As the experts of the wounds
recommend virechana in wounds vitiated by predominant
vata and pitta dosha and which are chronic (2). So here
virechana
therapy selected to elimate these pravruddha doshas out from the body and jatyadi ghrita was
applied to dusthavrana.
The details of the virechana
procedure are explained in table-1.
Table
1: Procedure administered to the patient
|
Procedure |
Medication |
Dose |
Duration |
|
Deepana Pachana Aushadhi(Appetizer) |
Panchacola Phanta |
50 ml twice/day |
2 days |
|
Snehapana(drinking
medicated ghee) |
Panchatikta Guggulu Ghrita daily morning at 8am |
Day 1=30ml Day 2=60ml Day 3=90ml Day 4=120ml Day 5=150ml |
5 days |
|
(a)Sarvanga Abhyanga(whole body oil massage) and
(b)Sarvanga Bashpa Swedana (Sudation therapy) |
Murchita taila |
Day 6, 7 and 8 |
3 days |
|
Pradhana Karma (Main
Procedure) Virechana (Purgation
therapy) |
Trivrutta leha was
given in the morning by 8 am on the day 8th |
50
gm with 100 ml milk |
1
day |
|
Pashchatkarma (postprocedure)
Samsarjana Karma |
Rice
gruel |
One
glass on the day 9 Day 10 and 11 |
1st
day (when ever hungry) 2nd and 3rd day |
Locally every morning the wound was
cleaned with lukewarm water. After cleaning, jatyadi ghuta was applied in adequate quantity
with the help of the spatula and the wound was covered with sterile gauze and
loosely bandage.
Results:
The clinical features of dushta vrana were
improved at the end of second week and the wound was healed completely at the
end of 4th week leaving only a minimal scar Fig 6. With a follow up
for a period of one year, the patient has shown no signs of recurrence.
Fig.1.Before treatment Fig.2.During
treatment
Fig.3.During
treatment Fig.4.During
treatment
Fig. 5.During treatment
Fig.6.After treatment
DISCUSSION
ON EFFECT OF TREATMENT:
·
Effect
of treatment on varna:
Change in colour occured
when dushta vrana get
converted into shuddha,
which was due to elimination of doshas out from the body.
·
Effect
of treatment on sraava: The vitiated pitta
is responsible for paka kriya,
which by bitiating the rakta forms pooya. The virechana karma helps in elimination of
vitiated pitta from the body and thus controls upon
the paka kriya, which
results in the subsidence of sraava. Absence of sraava(pus)
suggestive of the wound is devoid of infection.
·
Effect
of treatment on vedana: Vedana pradurabhava
in dushta vrana is the
effect of vitiated vata and pitta dosha on the dhatus like rasa, rakta, mamsa etc. Virechana controls the vitiated vata and pitta. Thus virechana therapy not only expels
the vitiated pitta dosha but
also controls the vitiated the vata dosha by removing margaavarodha.
·
Effect
of treatment on Granulation tissue: Virechana not
only eliminates the doshas
but also helps in removing the impurities of jeeva shonita, dhatus, indriyas and oja, which results in formation of healthy granulation
tissue.
·
Effect
of treatment on Size of the wound: The virechana undertaken has helped for
proper perfusion (Circulation) to the wound and hence accelerated the wound
healing process. Thus it resulted in the reduction of size of the dushta vrana.
Mode
Action of Virechana
Virechana Dravya
eliminates Doshas due to
Saratva - Mobility
Sukshma - Minuteness
Tikshna - Sharpness
Ushna - Hotness
Vikasi - Loosening (dispersibility)
Saratva Guna - Does
Anulomana
of Dosha’s
Sukshma Guna - Spreads
in all minute channels of the body
Tikshna Guna - Brings
the Dosha’s
to the Koshta
Ushna Guna - Does
Vilayana
(Softening of abstracted Dosha’s)
Vikashi Guna - Does
the Dhatu shaithilyakarana.(3)
On the basis of
above refrence the probable mode of action described
as follow:
The
sneha GTG (Guggulu Tikta Ghrita) used for the Dosha Utklesha purpose, is of lipid binded protein mixed with medicaments enter the cells and
get mix up with toxins and waste products of metabolism.
Then the purgative drug is given (Trivrit Lehya) in
empty stomach when pyloric end is open. The drug passes quickly to the
intestine, where while passing through it, produces mild inflammation in it,
which increases the permeability of vessels of the intestine. Due to this the Vyavayi, Vikasi and Sookshma
properties of trivrit Lehya quickly reach up to cellular level
where the nexus of toxins with tissues exists. In order to break down the
complicated nexus, the Ushna property of drug
soften the chemical bonds of the toxins. There after they are broken
down by Teekshna
property, in to smaller and relatively less harmful molecules which can be
removed out of the cell. Thus released toxins and waste products of metabolism
are brought to the intestine, where due to purgation action they are thrown out
of the body.
So the Snehapana Dravya (GTG) and Trivrit Lehya are having target oriented
activity, which target the cells and cleans the body. And also increases
sensitivity of cells in the ulcer (Dushtavrana) sites towards the local application (Jatyadi Ghrita) and
hence accelerates the wound healing process.
-
The treatment of virechana along with local
application of jatyadi ghruta
resulted marked improvement in varna, vedana, sraava,
size of the wound and granulation tissue.
Conclusion:
¨ Virechana acts
through systemic correction and regulation of Doshas, which involves in the
formation of Dushtavrana.
¨ Virechana
improves potency of individual cell of the body, increases sensitivity of cells
in the ulcer site towards the local application i.e. Jatyadi Ghrita and hence accelerates the wound
healing. It has fast wound healing property.
¨ The combination of sodhana
(Virechana)
and ropana (jatyadi ghrita) resulted in proper and early healing of the dushta vrana.
Refrences:
1.
Vaidya Yadavji Trikamji acharya: Sushruta samhitha with Dalhanacharya Nibhandha sangraha and Gayadasacharya Nyaychandrika Panjika commentary edited by Krishnadas
Academy, Varanasi, Edition reprint in 1998. Sutrasthana
22:7 pp 108.
2.
Vaidya Yadavji Trikamji acharya,; Sushruta samhitha with Dalhanacharya Nibhandha sangraha and Gayadasacharya Nyaychandrika Panjika commentary edited by Krishnadas
Academy, Varanasi, Edition reprint in 1998. Chikitsa Sthana 1:32 pp 400
3.
Vaidya Yadavji Trikamji acharya,; Sushruta samhitha with Dalhanacharya Nibhandha sangraha and Gayadasacharya Nyaychandrika Panjika commentary edited by Krishnadas
Academy, Varanasi, Edition reprint in 1998. Chikitsa Sthana 33:33 PP519.
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