E-ISSN:2456-3110

Case Report

Venous Ulcer

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 7 August
Publisherwww.maharshicharaka.in

Application of Katupila Rasakriya for Vrana Shodhana in Venous Ulcer: A Case Study

Lakshmi R.1*, M Sweta K.2, Surendranath D.3
DOI:

1* R Lakshmi, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

2 K M Sweta, Professor & HOD, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

3 Dhyan Surendranath, Associate Professor, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.

Katupila (Seccurinega leucopyrus (Wild.) Muell) is a dessert climate plant widely known in Sri Lanka as a traditional folk remedy for treating / addressing acute, chronic, and non-healing wounds. Majority of the chronic leg ulcers arises from venous ulcers, which occurs due to abnormal venous hypertension in the lower third of the leg, ankle and dorsum of foot. The study aims to explore the potential benefits of Katupila Rasakriya for Vrana Shodhana in venous ulcer. It is a case report of a 54 year old male patient who presented with the chief complains of a non-healing ulcer above right lateral malleolus since 2 months. Associated with pain, burning sensation, seropurulent discharge with unpleasant odour. He was examined and diagnosed as venous ulcer. The wound was dressed with Katupila Rasakriya twice for a period of 14 days. Significant healing in wound was observed within 2 weeks of treatment. Healing of Venous ulcers are a major clinical challenge. In spite of the fact that the healing of vrana is a natural process, it should be protected against Dosha Dushti, and micro-organisms which may delay the healing process. Thus, before initiating Ropana, It is important to focus on making a Vrana Sudha. In the present study, Katupila Rasakriya demonstrated promising results in the better management of venous ulcer. Further clinical study is needed to evaluate the effectiveness in larger sample.

Keywords: Seccurinega leucopyrus (Wild.) Muell, Katupila, Rasakriya, Venous ulcer, Vrana Sodhana

Corresponding Author How to Cite this Article To Browse
R Lakshmi, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bengaluru, Karnataka, India.
Email: 		R Lakshmi, K M Sweta, Dhyan Surendranath, Application of Katupila Rasakriya for Vrana Shodhana in Venous Ulcer: A Case Study. J Ayu Int Med Sci. 2022;7(7):177-180.
Available From
https://www.jaims.in/jaims/article/view/1998

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-06-28 2022-06-30 2022-07-07 2022-07-14 2022-07-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

© 2022by R Lakshmi, K M Sweta, Dhyan Surendranathand 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].

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Lakshmi R et al: Katupila Rasakriya for Vrana Shodhana in Venous Ulcer

Introduction

Venous ulcer or stasis ulcer accounts for about 60-80% of chronic leg ulcers. It occurs due to the abnormal venous hypertension in the lower third of leg, ankle and dorsum of foot.[1] The ulcer is usually ovoid, single in number with irregular, thin blue margin and pale granulation tissue in the floor.[2] The prolonged inflammatory phase in chronic ulcers blocks the progress toward the next phase, thereby preventing wound closure. It can lead to several complications, including cellulitis, infections, reduced quality of life, etc.[3] Healing a chronic ulcer is quite a challenge, though a good number of the treatment principles are mentioned and practiced.

In Ayurveda it is considered as Dusta Vrana. Acharya Sushruta has 60 measures for the management of Vrana, which shows the unique therapeutic approach for management of wounds. Among the Shashtiupakrama's, Rasakriya refers to a measure used to treat non healing wounds located in muscle and have slough.[4]      

Katupila (Seccurinega leucopyrus (Wild.) Muell) is a dessert climate plant widely known in Sri Lanka as a traditional folk remedy which is used topically as paste for addressing acute, chronic, non-healing wounds and for other various disorders. It is known as Humari or Panduraphalika in India, also called as Spinous fluggea in English. Its practices are available in the Saurashtra region of India.[5] It possess potent antimicrobial action along with its inherent property to directly facilitate wound healing process. Pharmacognostic study of Katupila shows the presence of calcium oxalate, tannin, and oil which is necessary for wound healing.[6]

Thus, this case study was conducted to assess the role of Katupila in the form of Rasakriya as a Vrana Shodakha Dravya, thus facilitating healing in venous ulcers. For the study, the drug was procured from an authentic source in Sri Lanka and the Rasakriya was prepared by classical method and was stored in a glass container in a cool and dry place.

Case Report

A 54 year old male patient presented to OPD complaints of a non-healing ulcer above right lateral malleolus since 2 months. Associated with pain, burning sensation, seropurulent discharge

with unpleasant odour. The pain was around the ulcer and also he noticed dragging pain in right leg and it worsens when he stand for long time. It was gradual in onset and was progressive. At first it was small and gradually increased in size as time progressed. There is no history of night cramps. There is no history of any chronic illness such as diabetes mellitus and hypertension.

Study was done after obtaining an informed consent from the patient.

Intervention

He was treated by wound dressing with Katupila Rasakriya. The wound was cleaned with normal saline. Katupila Rasakriya is mixed with honey and applied. Wound is closed with sterile gauze. Dressing was done for a period of 2 weeks.

Result

jaims_1998_01.JPG

Fig. 1: Before Treatment

jaims_1998_02.JPG

Fig. 2:On application of Rasakriya


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JAIMS_1998_03.JPG

Fig. 3:On 7th day

JAIMS_1998_04.JPG

Fig. 4:On 14th day

jaims_1998_05.JPG

Fig. 5: After Treatment


Discussion

In chronic leg ulcer that which accounts most is the venous ulcer. Venous incompetence and associated hypertension are thought to be primary mechanism for ulcer formation. The diagnosis of venous ulcer is generally clinical. A venous ulcer usually has a gently sloping edge. The floor contains granulation tissue covered by a variable amount of slough and exudate. Severe complications include cellulitis, osteomyelitis, malignant change and can affect the quality of life.[2]

This can be considered as Dusta Vrana in Ayurveda. Acharya Susrutha has quoted sixty Upakramas for Vrana.[4] Major emphasis is given for the essentiality of adopting the principle of Vrana Shodana and Vrana Ropana property for its management. Ropana procedure is always associated with Shodhana procedure because a wound cannot be healed if it is not clean. Rasakriya one among the Shashti Upakrama is used in condition of Vrana which is difficult to convert to Sudha Vrana, even after the use of Taila. And is indicated in Sthira Mamsa.[7]

The concept of essential medicines is that it incorporates the need to regularly update medicines selections to reflect new therapeutic options and changing therapeutic needs.[8] Katupila (Seccurinega leucopyrus (Wild.) Muell) is a folklore medicine widely used in Sri Lanka for the management of acute, chronic and non-healing wounds. Katupila extract have a broad spectrum anti-microbial activity. The pharmacognostic study of Katupila shows the presence of tannins, calcium oxalate and other essential constituents which promote wound healing.[5] In a four day period, discharge was significantly reduced and there is considerable change in odour and slough over the floor. The wound became fresh having healthy granulation tissue within 14 days. Thus, Katupila renders Shodhana (Cleansing / Purification) action by virtue of its Kashaya and Tikta Rasas, Laghu, Ruksha, Tikshna Gunas, Ushna Veerya and Katu Vipaka.[6]

Conclusion

Katupila is used in the form of Kalka for the management of diabetic wound.[9] In the indication of Rasakriya it has been told that, it can be used in case of Sthira Mamsa and if not underwent Sodhana


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by the use of Kalka and Taila.[7] Along with that the antioxidant activity due to the presence of flavonoids and tannins in abundance in Katupila, it has proven to promote wound healing. As the drug contain the active principles, we can expect it to have better result.[5] In the present case, Katupila rasakriya has shown promising results in challenging conditions like a venous ulcer. Thus, it can be stated that Katupila rasakriya is effective in chronic venous ulcers. Further clinical studies on larger sample may be needed to evaluate the effectiveness of Katupila Rasakriya.

Reference

1. Biju Vasudevan. Venous leg ulcers: Pathophysiology and Classification. National Library of Medicine Jul-Sep 2014[Internet] [cited 2020 Jan 18]; 5(3): 297-330.

2. Sriram Bhat M. SRB’s Manual of Surgery. Wounds and wound healing: chapter 1A. 4th ed. New Delhi: Jaypee Brothers Medical Publishers: 2013; p. 3-6.

3. F. Charles Brunicardi. Schwartz’s Principles of Surgery. Wound healing; chapter 9. 10th ed. New York: MC Graw Hill Education: 2015; p. 242-246.

4. YT Acharya, editor, Susruta Samhita of Susruta. with Nibandhaangraha commentary by Dalhana. Chikitsasthana. Dvivraneeya Chikitsitam Adhyaya: Chapter 1, Verse 138,139. reprint ed. Varanasi: Chaukamba Sanskrit sansthan: 2009; p. 408.

5. Dudhamal T, Mahanta V, Gupta S, Ajmeer A. Topical application of Katupila (Securinega leucopyrus) in Dushta Vrana (chronic wound) showing excellent healing effect: A case study. AYU (An International Quarterly Journal of Research in Ayurveda) [Internet]. 2014 [cited 2020 Feb20];35(2):175.

6. Sweta K M, Aswin J S, P Bhat Ramesh. Evaluation of Katupila Arka in Post-Operative Fistulotomy Wound Management: A Case Report. J. Adv.Res.in Ayurveda, Yoga, Unnani, Sidhha & Homeopathy [Internet]. 2020 [2020 Feb 20];6(3&4 - 2019):14-6.

7. YT Acharya, editor, Susruta Samhita of Susruta. with Nibandhaangraha commentary by Dalhana. Chikitsasthana. Dvivraneeyachikitsitam adhyaya: Chapter 1, Verse 138,139. reprint ed. Varanasi: Chaukamba Sanskrit sansthan: 2009; p. 408.

8. Sitanshu Sekhar Kar, Himanshu Sekhar Pradhan, Guru Prasad Mohanta. Concept of Essential Medicines and Rational Use in Public Health. Indian J Community Med. [Internet]. 2010 Jan; 35(1): 10–13.

9. Ahamed Shahan Ajmeer, Tukaram S. Dudhamal, Sanjay Kumar Gupta Management of Madhumehajanya Vrana (diabetic wound) with Katupila (Securinega leucopyrus [Willd] Muell.) Kalka. Ayu. 2015 Jul-Sep; 36(3): 351–355.


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