Introduction:
Healing of ulcers and wounds
from injuries represents a basic response of the living tissue. Because of different conditions of
wound, natural
pattern of healing of wounds is not uniform. Wound healing is retarded by local
factors and systemic diseases. Local factors such as infection, pus, slough, blood
supply, radiation, foreign bodies, site of wound, etc. hinder the process of
natural wound healing.
Similarly, systemic diseases like
tuberculosis, diabetes, malignant diseases, jaundice,
hypertension and various other systemic factors like aging, malnutrition and other factors like economic
status and occupation will have remote effect on the wound by retarding
the sequence of healing process.
According to Sushrut “The destruction /break /rupture /discontinuity
of body tissue / part of body, is called Vrana.” (Vrana Gatra Vichurnane,
Vranayati iti Vranaha.
Su.Ch1/6). Dusta means durbala (unhealthy) or Adhamah
(degraded), damaged, spoiled, injured, deprived etc. Classification of wounds, their prognostic evaluation and management was
most scientifically described in Sushruta samhita.
According to Acharya Sushruta the ulcer is
called as Dusta vrana when it has the following features (1) Viz. (Figure:3-6
to identify some of the features of Dushta vrana)
1
Ati
samvrutha - too narrow.
2
Ati vivrutha
- too wide.
3
Ati katina
- too hard.
4
Ati mrudu -
too smooth.
5
Utsanna -
elevated
6
Avasanna
-depressed.
7
Ati sita
-too cold.
8
Ati usna
-too hot.
9
Krishna,
Rakta, sukla, Bhairava (black, red, white, and looks ferocious).
10 Puti puya, mamsa, sira, snayu (pus with bad odor
due to vitiated muscular content of the wound).
11 Puti puya srava - foul smelling purulent discharge
12 Unmarga -spreading in different directions.
13 Utsanga -having deep base.
14 Amanojna gandha -foul smell.
15 Atyartha vedana -excessive pain.
16 Daha, paka, raga, kandu, sopha (burning
sensation, suppuration, redness, itching, inflammation).
17 Upadrava -associated with complications.
18 Atyartha dusta sonita srava - excessive oozing
of blood admixed with pus etc.
19 Deerga kalanubandhi –chronic.
Acharya Charaka described the dustavrana
features as following (2)
1
Shwetha - white
2
Avasanna
vartma - skin on the wound is not at the same level of the adjacent)
3
Sthula
vartma - skin over the wound is above the level of adjacent skin
4
Ati pinjara
- deep yellow coloured
5
Nila, shyava
- blue, brown coloured
6
Ati pidaka
- excessive blister formation
7
Rakta,
Krishna - red and black coloured
8
Ati putika
- having putrefied smell.
9
Kumbhi
mukha - opening of the wound is like a pot and also
10 Putighandha - rotten smell
11 Vivarna - pale/bad coloured
12 Bahusrava -excessive secretion
13 Mahruja -severe pain.
Based on the
above features dushta vrana of Ayurvedic literature can be correlated with
chronic infected ulcer of contemporary modern medicine.
Ayurvedic line of treatment
Upward and downward evacuation (Vamana and
virecana), fasting, de-saturating diet and blood letting are advised.
Decoction of Aragvadhadi and surasadi drugs are advised for washing the wound
and oil prepared with the decoction of the same drugs or with alkali water or
alkaline plants are indicated for cleansing the wound(3).
Selection of Drug:-
Many internal and
external drugs and
formulations are mentioned in classical Ayurvedic literatures for the treatment
of Dushtha vrana. Though many factors involve in etio- pathogenesis and healing
of the Dushtha vrana, interactions between epidermal and dermal cells and the
extra cellular matrix are considered to play an important role. Based on this
fact and after verifying both classical and contemporary literatures Dvi-avartita
Bhringaraja taila was selected for the present study as an external
application.
Rationale in selection of Drug
Externally it has sothahar (anti oedema/inflammatory),
vedanasthapan (analgesic), vranasothan (wound cleaning), vranaropan
(wound healing), savarnikaran (normalizing the colour/ turns the skin to
earlier normal colour) properties). (4)
It is considered anti-inflammatory and
pharmacologically it’s antiviral, antibacterial, analgesic, and anti
hemorrhagic properties were also proved (5).
Oil cooked with juice of Bhrungaraja (Eclipta alba Hassk) is indicated in
sinuses caused by kapha and vata scrofula and wounds (3).
According to Gada Nigraha, Bhrungaraja juice is
used for washing wounds (vranadhavana) in soft chancre (upadamsa) and
ulceration in venereal diseases (6).
As per Bhava prakash, Pancha nimba churna
impregnated in Bhrungaraja expressed juice is indicated in kushtha rogas
(obstinate skin diseases), eruptions (visphota), erysipelas (visarpa), cervical
adenitis (gandamala), fistula-in-ano (bhagandara), sinus (nadivrana) and
various other diseases (6).
According to Bhaishajaya Ranavali, Bhallatkadya
taila which contains Bhrungaraja svarasa (expressed juice of herbs) as a major
component is indicated in nadivrana (sinus), the oil, scrofula (apaci), wound
(vrana) and allied ailments (6).
The above descriptions clearly supports that
Bhrungaraja taila has definite wound cleansing (vrana shodhana) and healing
(vrana ropana) properties. Here in this study dvi avartita Bhrungaraja taila is
used to strengthen the properties of oil and to get fast results.
Mode of preparation of oil
Whole plant of Bhrungaraja (Eclipta
alba Hassk) (Figure 1) was washed with clean water to remove mud and other
physical particles. 4 liters of expressed juice of the whole plant was boiled
after mixing with 1 liter of sesame oil and 250 gm of same plant paste, till oil
remains. Thus obtained oil was once again boiled with same procedure to get
Dviavartita Bhrungaraja taila (Figure 2).
Materials and Methods
Aims and Objects
1.
To assess the overall efficacy of Dviavartita Bhrungaraja taila in curing the Dushta vrana
2.
To assess the efficacy of Dviavartita Bhrungaraja taila in curing various clinical signs and symptoms of the Dushta vrana
Criteria for Selection of the patient
As in modern medicine there are various types of chronic
infective ulcers, the patients for the present study were selected based on the
features of Dushta Vrana, mentioned in Ayurvedic classics. Irrespective of
their associated diseases and disorders based on the main clinical features the
patients were selected.
1.
Patients of
either sex in between 15-60 years of age
2.
Patients of
Dushta vrana with above 6 months chronicity
3.
Dushtha
vrana with features like inflammation, Discharge of pus, debris with foul
smell, excruciating pain and edema over surrounding area, Presence of slough
with no evidence of granulation tissue, spreading in nature with no defined
edges and floor.
Criteria for Exclusion
1.
Patients of
the age below 15 years and above 60 years of age.
2.
Patients of
Dushta vrana with below 6 months chronicity.
3.
Patients
with known history of Malignancy, venereal diseases and other chronic and
infective ailments.
Criteria for with
drawn
1.
Patients
left the treatment in between
2.
Suffered
from any serious illness during the treatment
Criteria for the assessment of the response after the
therapy:
Specific scores were denoted against each and every
parameter was recorded initially and during subsequent assessments i.e. every
15th day up to 60 days.
1. Pain
|
a.
|
Severe
|
–
|
3
|
|
b.
|
Moderate
|
–
|
2
|
|
c.
|
Mild
|
–
|
1
|
|
d.
|
No pain
|
–
|
0
|
2. Pus discharge
|
a.
|
Severe
|
–
|
3
|
|
b.
|
Moderate
|
–
|
2
|
|
c.
|
Mild
|
–
|
1
|
|
d.
|
No discharge
|
–
|
0
|
3. Foul smell
|
a.
|
Severe
|
–
|
3
|
|
b.
|
Moderate
|
–
|
2
|
|
c.
|
Mild
|
–
|
1
|
|
d.
|
No Foul smell
|
–
|
0
|
4. Oedema /
Induration
|
a.
|
Present
|
–
|
2
|
|
b.
|
absent
|
–
|
0
|
5. Reduction of
ulcer area
|
a.
|
before treatment
(total ulcer area)
|
–
|
20
|
|
b.
|
reduction of 25% to
50% ulcer area
|
–
|
15
|
|
c.
|
reduction of 51% to
75% ulcer area
|
–
|
10
|
|
d.
|
reduction of 76%
and above ulcer area
|
–
|
5
|
|
e.
|
reduction of 100%
ulcer area
|
–
|
0
|
Basing on the individual score of each finding
before and after treatments, the response of the treatment can be assessed.
Over all effect of the treatment in each individual patient can be assessed by
the below formula.
(Total score of all findings before treatment –Total score
of all findings after the treatment) X 100 / Total score of all
findings before treatment
Classification of
the Results:
i.
Good
Response: 75% or more relief in clinical symptomatology
ii.
Fair
Response: 50% to 75% relief in symptomatology.
iii.
Poor
Response: 25% to 50% relief in
symptomatology.
iv.
No
Response: Relief below 25% in symptomatology
Drug: Dviavartita Bhrungaraja taila.
Dosage: Sufficient quantity applied externally twice a
day and allowed for at least four hours either directly or dipping in a gauze
plug.
Duration of
treatment: 60 days
Type of the study:
open clinical trail
Investigations
Investigations of the following routine investigations were
done to all the patients before and during subsequent intervals, however
specific investigations were done to assess the condition of particular
individual patients wherever necessary. The results of investigations were not
included in the assessment of results as the Total study was planned on
Ayurvedic parameters.
Routine investigations:
a. Blood-CBP and ESR
b. Urine-Complete
analysis
c. Stool-Routine examination
Special investigations:
a.
Bio-chemical
– I) Blood sugar (ii) VDRL
b.
Bacteriological
- Cultural and sensitivity of discharge
c.
Histo-pathological
d.
Radiological-
Plain X-Ray films of the affected parts were taken according to the necessity.
History
A detailed history of the patient was recorded as per the
proforma
Observations
Total 15 patients were selected for the present
study. Among them 11(73.33%) are male and 4(26.67%) are female (table-2). Among
the different age groups majority patients (6 (40%)) belong to the age group of
30-39 years (table-1). Majority (10(66.67%) patients occupation is of sedentary
(table-3). Only 4 (26.67%) patients are smokers (table-4). Highest number
(6(40%)) of patients are with in the chronicity of 6-12 months (table-5). Only
2 (13.33%) patients are suffering from upper extremity ulcer and remaining 13
(86.67%) are suffering from lower extremity ulcers (table-6). 10(66.67%)
patients are having twak mamsa adhishthana ulcers and remaining 5 (33.33%) are
having mamsa medho adhishthana ulcers (table-7). 15 patients are suffering from
various sizes of ulcers and the average size of the wound of total patients is
6.433 squire centimeters (table-8). Majority of patients 9(60%)) ulcers are non
specific and remaining are diabetic, varicose and tropic (table-9).
