E-ISSN:2456-3110

Case Report

Diabetic Ulcer

Download The Housemaid Aka Hanyo | -2010- Hindi

2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

To evaluate the role of Lakshadi Avachoornana in the management of Dushta Vrana with special reference to Diabetic Ulcer: A Case Study

C Nair S.1*, M Sweta K.2
DOI:

1* Swathi C Nair, Post Graduate Scholar, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.

2 K M Sweta, Professor & HOD, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.

The global prevalence of diabetics is estimated to increase from 4.0% in 1995 to 5.5% by the year 2025. The chances of secondary infection are more in diabetics as the immunity of the patients is compromised and needs prolonged hospitalization, psychological and social problem for the patients and family. In Madhumehi the vessels of lower limb become weak and is unable to expel the Doshas (along with other Dushyas) leading to Prameha Pidakas more in lower extremities, which eventually burst open precipitating an ulcer. Avachoornana is one among the Shashti Upakrama, explained by Acharya Sushrutha for management of Vrana. Numerous studies are done in the management of Dushta Vrana with the internal medication and external therapies. Here a preliminary attempt to study the effect of Avachoornana with Lakshadi Choorna in the management of the same was taken for the study.

Keywords: Dushta Vrana, Avachoornana, Diabetic Ulcer, Lakshadi Choorna

Corresponding Author How to Cite this Article To Browse
Swathi C Nair, Post Graduate Scholar, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.
Email: Download The Housemaid AKA Hanyo -2010- Hindi
Swathi C Nair, K M Sweta, To evaluate the role of Lakshadi Avachoornana in the management of Dushta Vrana with special reference to Diabetic Ulcer: A Case Study. J Ayu Int Med Sci. 2022;7(9):196-205.
Available From
https://www.jaims.in/jaims/article/view/2093
Download The Housemaid AKA Hanyo -2010- Hindi

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-29 2022-08-31 2022-09-07 2022-09-14 2022-09-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

Download The Housemaid AKA Hanyo -2010- HindiDownload The Housemaid AKA Hanyo -2010- Hindi © 2022by Swathi C Nair, K M Swetaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Download The Housemaid Aka Hanyo | -2010- Hindi

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    Case Study

    It is a case study of a 42-year male patient who presented with the chief complains of ulcer over big toe of right leg since 2 months (K/C/O DM for last 8 years and under medication). He was being treated with oral medications and dressings. Study was done after obtaining an informed consent from the patient. He was treated with the Lakshadi Choorna for dressing daily and Triphala Guggulu 2 BD before food, Amritadi Vati 2 BD after food as internal medication.

    Intervention: Lakshadi Choorna was prepared with all aseptic measures, as per the classical reference of Choorna Kalpana. After proper cleaning the drugs, it made into small pieces by chopping. Using pulveriser it was made into fine powder with mesh size of 80 to 120 range. Packing done under aseptic precaution and sterilization done under UV for 20 minutes.

    With all aseptic measures ulcer was cleaned with normal saline and Avachoornana was done uniformly over ulcer site. Dressing was done with sterile gauze and pad. Avachoornana was done with the Lakshadi Choorna once daily and observations were done on 7th, 14th, 21st and 40th day of the treatment.

    Figure 1: The method of Lakshadi Choorna preparation.

    jaims_2093_01.JPGRaw drugs for Lakshadi Avachoornana


    jaims_2093_02.JPG

    jaims_2093_03.JPG

    Final product

    Figure 2: The method of Lakshadi Avachoornana

    jaims_2093_04.JPG


    jaims_2093_05.JPG

    jaims_2093_06.JPG

    0th Day

    jaims_2093_07.JPG

    Avachoornanam

    jaims_2093_08.JPG

    7th Day

    jaims_2093_09.JPG

    14th Day

    jaims_2093_10.JPG21st Day


    jaims_2093_11.JPG
    40th Day

    jaims_2093_12.JPG
    Follow-up

    Table 2: Subjective symptoms assessed on 0th, 7th, 14th, 21st, 40th day.

    Pain Assessment 0 No Pain 1-3 Mild pain 4-6 Moderate pain 7-10 Severe pain
    0th day   +    
    7th day   +    
    14th day +      
    21st day +      
    40th day +      
    Burning Sensation Grade 0 No burning Grade 1 Mild burning Grade 2 Moderate burning Grade 3 Severe burning
    0th day     +  
    7th day   +    
    14th day   +    
    21st day +      
    40th day +      

    Table 3: Objective symptoms assessed on 0th, 7th, 14th, 21st, 40th day.

    Item Assessment 0th day Score 7th day Score 14th day Score 21st day Score 40th day Score
    1. Size  1 = Length x width <4 sq. cm 2 = Length x width 4--<16 sq. cm 3 = Length x width 16.1--<36 sq. cm 4 = Length x width 36.1--<80 sq. cm 5 = Length x width >80 sq. cm 3 3 3 3 2
    2. Depth  1 = non-blanchable erythema on intact skin 2 = Partial thickness skin loss involving epidermis &/or dermis 3 = Full thickness skin loss involving damage or necrosis of subcutaneous tissue; may extend down to but not through underlying fascia; &/or mixed partial & full thickness &/or tissue layers obscured by granulation tissue 4 = Obscured by necrosis 5 = Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures 3 3 3 3 3
    3. Edges  1 = Indistinct, diffuse, none clearly visible 2 = Distinct, outline clearly visible, attached, even with wound base 3 = Well-defined, not attached to wound base 4 = Well-defined, not attached to base, rolled under, thickened 5= Well-defined, fibrotic, scarred or hyperkeratotic 2 2 2 1 1
    4.Undermining   1 = None present 2 = Undermining < 2 cm in any area 3 = Undermining 2-4 cm involving < 50% wound margins 4 = Undermining 2-4 cm involving > 50% wound margins 5 = Undermining > 4 cm or Tunnelling in any area 1 1 1 1 1
    5.Necrotic Tissue Type   1 = None visible 2 = White/grey non-viable tissue &/or non-adherent yellow slough 3 = Loosely adherent yellow slough 4 = Adherent, soft, black eschar 5 = Firmly adherent, hard, black eschar 3 3 2 2 1
    6.Necrotic Tissue Amount   1 = None visible 2 = < 25% of wound bed covered 3 = 25% to 50% of wound covered 4 = > 50% and < 75% of wound covered 5 = 75% to 100% of wound covered 2 2 2 2 1
    7.Exudate Type   1 = None 2 = Bloody 3 = Serosanguineous: thin, watery, pale red/pink 4 = Serous: thin, watery, clear 5 = Purulent: thin or thick, opaque, tan/yellow, with or without odour 3 3 1 1 1
    8.Exudate Amount   1 = None, dry wound 2 = Scant, wound moist but no observable exudate 3 = Small 4 = Moderate 5 = Large 4 3 2 2 2

    9.Skin Colour Surrounding Wound  1 = Pink or normal for ethnic group 2 = Bright red &/or blanches to touch 3 = White or grey pallor or hypopigmented 4 = Dark red or purple &/or non-blanchable 5 = Black or hyperpigmented 1 1 1 1 1
    10.Peripheral Tissue Edema 1 = No swelling or edema 2 = non-pitting edema extends < 4 cm around wound 3 = non-pitting edema extends > 4 cm around wound 4 = Pitting edema extends < 4 cm around wound 5 = Crepitus and/or pitting edema extends >4 cm around wound 2 2 1 1 1
    11.Peripheral Tissue Induration 1 = None present 2 = Induration, < 2 cm around wound 3 = Induration 2-4 cm extending < 50% around wound 4 = Induration 2-4 cm extending > 50% around wound 5 = Induration > 4 cm in any area around wound 2 1 1 1 1
    12.Granulation Tissue   1 = Skin intact or partial thickness wound 2 = Bright, beefy red; 75% to 100% of wound filled &/or tissue overgrowth 3 = Bright, beefy red; < 75% & > 25% of wound filled 4 = Pink, &/or dull, dusky red &/or fills < 25% of wound 5 = No granulation tissue present 3 2 2 2 2
    13.Epithelialization   1 = 100% wound covered, surface intact 2 = 75% to <100% wound covered &/or epithelial tissue extends to > 0.5cm into wound bed 3 = 50% to <75% wound covered &/or epithelial tissue extends to <0.5cm into wound bed 4 = 25% to < 50% wound covered 5 = < 25% wounds covered 5 5 5 4 3
    Total Score 34 31 26 24 20

    Results

    Reduction of Symptoms of ulcer was achieved within 14-21 days of Lakshadi Avachoornana and later complete healing was achieved without any other complications.

    Discussion

    Lakshadi Gana with the properties of Tikta Kashaya Rasa, Laghu Rooksha Guna, Ushna Veerya, Katu Vipaka, Kaphapittahara and Arthi Nashanam is indicated in Dushta Vrana, Kushta and Krimi. Acharya Susrutha has included this Gana in Dravya Sangrahaneeya Adyaya and indicated in Dushta Vrana. In the present situation, due to hampered foot habits and physical exertion, life style disorders are more along with its complications. Lakshadi Avachoornana helps in reducing the symptoms of Dushta Vrana, thereby helps in getting desired

    result. Tikta Kashya Rasa helps in promoting healing of wound and it has Pittahara property, thereby helps in reducing the burning sensation.

    Due to its Usha Veerya, it helps in Vatashamana, thereby reducing the pain. This Gana also possess, Krimighna, Kushtagna property, hence its Vranasodhana and Ropana nature in Dushta Vrana is highlighted.

    Further clinical study is needed to evaluate the effectiveness in larger sample.

    Conclusion

    Significant relief on symptoms of Dushta Vrana including Poothi Pooya, Srava, Athigandha etc was being observed in the course of treatment. There was better healing and sustained symptomatic relief in this patient with the Lakshadi Avachoornana. Due to its easy and convenient mode of application it makes the procedure significant.

    Reference

    1. Amit Jain’s triple assessment for foot in diabetes- a rapid screening tool (Internet). Clinical practice. 2018 November;

    2. Chiranth Kumar R, Syeda Ather Fathima, A study on the efficacy of nishadi yoga a study on the efficacy of nishadi yoga avachoornana in the avachoornana in the management of dusta vrana W.R.S. to diabetic ulcer,2018, vol8, ISSN 2320 5091 [Internet].Iamj.in.

    3. Das.S, A Concise Textbook of Surgery, 9th ed.Ch. 11. Kolkata: Dr. S. Das.13;2016. p.161-2.

    4. Das S, A manual on clinical surgery. Kolkata: Dr.S.Das; 2018.p.61-75.

    5. Sushruta, Sushruta Samhita, Vaidya P V Sharma, Nidanasthana, Ch6. Ver27. Reprint. Varanasi: Choukamba Orientalia;2018 reprint.p.46.

    6. Sharma PV (Ed). Sushruta, Sushruta Samhita, Nidanasthana, Ch6.Ver14. Reprint. Varanasi: Choukamba Orientalia;2018. p.46.

    7. Sharma PV (Ed). Sushruta, Sushruta Samhita, Chikitsasthana, Ch-12. Ver4. reprint. Varanasi: Choukamba Orientalia;2018. p.392.

    8. Aacharya Jadavaji Trikamji, (Ed). Sushruta Samhita, Chikitsasthana: Dwivraneeyaadhyayam; Varanasi: Chaukambha Orientalia; 2014. p.403.


    9. Singh J. Laksha (Lac) - LacciferLacca [Internet]. Ayurtimes.com. 2015 [cited 2021 Jul 4]. Available from: https://www.ayurtimes.com/lac-laccifer-lacca-health-benefits-uses-side-effects.[accessed on 2021-7-1]

    10. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.200-4.

    11. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.328-33.

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    13. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.958-9.

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    15. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.54-6.

    16. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.123-7.

    17. Sastry, JLN. Dravyaguna Vijnana, Varanasi: Chaukamba orientalia; 2012.p.325-7.

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