Introduction:
Ever
since man has discovered the fire by accidental friction of stone, he is
experiencing both advantages and disadvantages of its utility. On one side it
is used as main source of energy on the other side it can cause most disastrous
effect.
In
India more than 10000 burn cases are associated with deaths and over one
million moderate to severe burns occur each year. Each year more than 4,000
Americans die as a result of fires and more than 23,000 are injured seriously
enough to require hospitalization.
In
major burn injuries systemic treatment is given more importance than local,
where as in minor burn injuries it is always the local treatment.
The
available topical antimicrobial applications in the management of minor burn
injuries do not give satisfactory relief to the associated features like pain,
burning sensation, over whelming exudation etc and none of them influence on
rate of healing.
‘Chandanadi
yamakam’ is compound Ayurvedic preparation described as useful in all types of
burn injuries in classical texts like “Chakradatta” and “Yogaratnakara”.
The
drugs explained in the preparation has anti-bacterial, anti-inflammatory,
anti-pyretic and anti-exudative properties and also useful in wound healing,
getting normal pigmentation of the skin, cooling and retaining normal
vascularisation by checking the bleeding.
Materials and methods:
Patients
with complaint of burn wounds available from O.P.D and I.P.D of burns ward,
Mysore medical college, Mysore, O.P.D and I.P.D of Govt. Ayurvedic medical
college and Hospital, Mysore, and O.P.D and I.P.D of J.S.S Ayurvedic medical
college, Mysore after the registration and initial management on the day of
burn with clearance of medico-legal aspects were selected for the study.
Patients were selected randomly irrespective of their sex, occupation,
socio-economic group and religion.
Patients
with the history of burn wounds caused by dry heat, open flame and scalds, age
group between 5yrs-55yrs, having burns of T.B.S.A. (Total Body Surface Area) of
below15% and presenting features of 2nd degree burn, involving upper
limbs, lower limbs, trunk and face were selected for the study.
Burns
caused due to electricity, chemicals, oils and fats, cold and irradiation,
patients with systemic diseases, patients showing signs and symptoms requiring
emergency care were excluded from the study.
Informed
consent was obtained from the patients or from the patient’s parents, if they
were children.
Drug review: (Figures 8-11)
The drugs used in this preparation are Pterocarpus
santalinus (Raktha chandan) , Glycirrhiza glabra (Yasti
madu), Rubia cardifolia (Manjista), Woodordia fruticosea
(Dhataki pushpa), Caesalpinia
sappan (Patranga), Ficus bengalensis (Vata
shringa), Nelumbo nucifera (Prapondarika), Cynodon dactylon (Doorva), Cows ghee (Go gritha), Mustard oil (Tila
taila), Cows milk (Go
ksheera) and Water.
Preperation:
All
the drugs which are collected from local market and some are freshly collected
were made authenticated for its identity and genuinity from Regional research
center, Bangalore.
All
the drugs were weighed properly one by one and pulverized in to course powder
and sewed in a mesh of 1/20 size and weighed again separately.
Powdered ingredients were mixed properly one by one and taken in mortar and
triturated with water to obtain fine paste, this is mixed with cow’s ghee and
mustard oil each 2 parts and to this mixture 16 parts of water and 32 parts of
milk was added and heated in mild flame. This procedure was carried out for
three days, on each day it was boiled for 2-3 hrs. The heating was continued
until all the water molecules were evaporated.
Physical and Chemical Analysis of Chandanadi Yamakam
(Figures
12)
Physical
and chemical analysis was done in ‘Central pharmacy’, Bangalore.
Ingredients:-
Pterocarpus santalinus, Glycyrrhiza glabra, Rubia cardifolia, Cynodon dactylon,
Woodfordia fruticosa, Nelumbo nucifera, Caesalpinia sappan, Ficus bengalensis,
Sesamum oil, Ghee and Milk.
Description:
- A yellowish-brown coloured oily liquid of pleasant odour
|
Loss
on drying at 1100C
|
:
|
Round
0.5c/o w/w
|
|
Refractive
index at 400C
|
:
|
1.4680
|
|
Acid
value
|
:
|
206.2656
|
|
Iodine
value
|
:
|
91.7095
|
|
Ester
value
|
:
|
201.1280
|
|
Wt.
per .ml
|
:
|
0.9106
Gms
|
Methodology:
Initially
patient was given wash with tap water and pears soap on the first day of
treatment over the affected area. Then the surrounding part of the wound was
cleaned with savalon liquid and then it was wiped with dry cotton. Sufficient
quantity of Chandanadi yamakam was applied over the wound with the sterile
cotton swab held by sterile artery forceps and ensured that it spreads
uniformly all over the surface of the wound.
Patient
was advised to apply Chandanadi yamakam twice daily once in the morning and
once in the evening. Patient was instructed to fallow the same method employed
on the first day of treatment in the hospital.
After
the application of Chandanadi yamakam over the wound, patients were advised to
keep the wound uncovered but not to expose the wound to dirty surroundings or
contact with any materials like soil, dust etc.
Patients
were advised to have normal diet and habits. Observations on the subjective and
objective changes with the treatment were made once in three days for 21 days.
Observations were recorded in the proforma of the case sheet prepared for the
study. Fallow up observation of 45 days
for the development of any post burn complications at the site of lesion like
formation of hypertrophied scar and contractures were made.
Criteria for the assessment of result
Subjective Parametrs
1.
Pain
The
changes in the pain with the treatment were considered as follows.
The
pain which was intolerable, constant and makes to seek medical help as early
possible was considered as severe and denoted as- III
Constant,
tolerable pain and subject can wait even for some days in seeking medical help
was considered as moderate and denoted as –II
The
pain which was tolerable, negligible considered as mild and was denoted as –I
The
absence of pain is considered as nil and denoted as - 0
2.
Burning
sensation
The
change in the burning sensation during the treatment was considered as fallows.
The
burning sensation which was intolerable, constant and makes the patient seek
medical help as earlier possible is considered as severe and denoted as
-III
The
burning sensation which was constant and tolerable and subject can even for
some days in seeking medical help is considered as moderate and denoted as- II
The
burning sensation which was tolerable, negligible is considered as mild and
denoted as-I
The
absence of burning sensation is considered as nil and denoted as - 0
OBJECTIVE PARAMETERS
1. Oedema
Presence
of oedema was denoted as- I
Absence
of oedema was denoted as-0
2. Discharge
Presence
of discharge was denoted as – I
Absence
of discharge was denoted as-0
3. Wound healing
Presence
of the raw surface of the wound was denoted as – III
Formation
of the crust has been denoted as-II
Separation
of the crust and appearance of the granulation tissue was denoted as – I
Complete
healing with flat scar was denoted as-0
Response
in the healing was considered as fallows
1.
Good healing (G)-Complete healing observed within 15 days
2.
Fair healing (F)-Complete healing observed within 21 days
3.
Poor healing (P) - Incomplete healing even after 21 days
Statistical analysis:
At 29 degree of
freedom, 5% significant limit of‘t’ is 2.05.
The observed ‘t’ value is 10.04 times the standard error. This indicates
that ‘CHANDANADI YAMAKAM’ is effective in the management of burn injuries.
Discussion:
Pain was observed in all 30
patients selected for the study before the treatment. All the 30 patients were
relieved from pain with in the duration of 21
days of treatment. Regressal of pain may
be due to presence of sneha dravya in the preparation. Thus it can be known that
use of CHANDANADI YAMAKAM is effective in reducing pain. All the 30 patients
had burning sensation on the day of arrival, gradually there was reduction in
the burning sensation and came down to nil by 9th day of treatment.
CHANDANADI YAMAKAM contains dravyas which have sheetha veerya and so they are useful
in reducing burning sensation. Discharge was observed in 20 patients out of 30
selected for the study. By the end of 9th day of treatment course
the discharge came down to nil in all 20 patients. It shows CHANDANADI YAMAKAM
is effective in reducing discharge from the wound surface. Among the 30
patients who had got the burn wounds 28 (93.33%) patients got completely healed
by the treatment at the end of 21st day. All ingredients of
CHANDANADI YAMAKAM have got healing property which might have influenced in
healing the burn wounds.
Summary
and Conclusion:
The clinical trail was
conducted to study the efficacy of “Chandanadi yamakam” in the management of
‘Burn wounds’. Management was done by exposure method.
Essential Ayurvedic references
were compiled under the chapter “Review of literature” along with the suitable
references the modern medical science. Materials and methods for the clinical
study were fixed suitable to study and understand the effect of CHANDANADI
YAMAKAM in the management of burn wounds.
A preliminary attempt had been
made in the present study to evaluate the efficacy of compound preparation
CHANDANADI YAMAKAM.
It was observed that management
of Burn wounds by CHANDANADI YAMAKAM is very effective with 40% of good result
and 53.3% of fair results. The result of the treatment with CHANDANADI YAMAKAM
is significant and shows authenticity of classical references which mentions
that CHANDANADI YAMAKAM is very much useful in the management of burn injury.
Following conclusions were drawn from the
clinical study.
1. ‘Chandanadi
yamakam’ is very much effective in the management of burn injuries. Since complete healing with flat scar
was formed in 93% of patients during the study period.
2. The
raw materials required for the preparation of CHANDANADI YAMAKAM are easily
available in very less cost.
3. This
method is very simple, economical, and free from side effects and can be
carried in OPD.
4. Use
of Chandanadi yamakam has given very good aesthetic outcome with very less
post-burn complications like wound contracture and hypertrophied scar.
5. Chandanadi
yamakam is very effective in reducing the associated complaints like pain,
burning sensation and overwhelming exudation.
References:
1.
Subrahmanyam M, Topical
application of honey in treatment of burns, British Journal of Surgery, April
1991; 78(4); 497-498
2.
Artz and Curtis P, Burns update, The Journal of trauma
Injury infection and Critical care, 1976; 16(1); 3-15
3.
Yamauchi K, Tomita M, Gielh T J and Ellison R T, Anti
bacterial activity of lactoferrin and pepsin derived lactoferrin peptide
fragment, Infection and immunity, American society of Microbiology, 1993; 61(2); 719-728
4.
Antarkar DS, Chinwalla Tasneem, Bhatt Narendra, Anti-inflammatory
activity of Rubia cordifolia Linn in rats, Indian Journal of Pharmacology, 1983; 15(3); 185-188
5.
Shivakumar, An
experimental study on the efficacy of Madhuchistadi Ghritha and Madhu in the
management of Dagdha vrana, Dept of P G studies in dept. of Shalya tantra, 1992,
Thesis work, G C I M, Banglore.
6.
Mamatha murthy, A clinical study on the efficacy
of Madhuchistadi gritha and madhu in the management of Dagdha vrana, Dept of P G
studies in dept. of Shalya tantra, 1993, Thesis work, G C I M, Banglore.
7.
Guruprsad, Woud healing activity of certain indigenous
drugs, Dept of pharmacognacy, 1997, Thesis work, P.G
Studies Govt college of pharmacy, Bangalore
8.
Andrew T Rastery, Text book of surgery, Churchill
livingstone, 2nd Edition.
9.
Burns trauma procedures, Clinical care by Chrissie Boswarth,
1st Edition, London; Whurr publishers; 1998,
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