A case study of Dushta Vrana treated with Vrana Lepa w.s.r. to Sahasrayoga

Ritheka B Rao; AC Shivani; Prasanna N Rao

The destruction/ break/ rupture/ discontinuity of body tissue/ part of body, is called Vrana.[1] Dushta Vrana is an issue that is frequently seen in surgical practice. The presence of Dushta Vrana (Non-healing ulcer) can harm the patient's state, causing various complications and even death. Slough, infection, and foreign bodies are all factors that might cause a wound to take longer to heal. In comparison to an infected wound, a healthy wound heals faster. As a result, it is critical to maintain the wound clean throughout its healing process. Every surgeon's main goal is to achieve good wound healing with little scarring and the least amount of pain. Acharya Sushruta has ornately explained six forms of Dushta Vrana[2], and Dushta Vrana treatment is comprised of a variety of medications, which are roughly classed as Vrana Shodhana and Vrana Ropana. Sushruta has mentioned regarding Shashti Upakrama (60 modalities of wound management) for Vrana Chikitsa.[3] In present study, Vranalepa is selected as topical application for Vrana Shodhana action. A case report of 34 year old man, who presented an open ulcer on the posterior aspect of the right thigh associated with pain, discharge, slough and foul smell has been presented here.

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Ritheka B Rao, Final Year Post Graduate Scholar, Department of Shalya Tantra, Shri Dharmasthala Manjunatheshwar College of Ayurveda and Hospital, Hassan, Karnataka, India.
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Ritheka B Rao, AC Shivani, Prasanna N Rao, A case study of Dushta Vrana treated with Vrana Lepa w.s.r. to Sahasrayoga. J Ayu Int Med Sci. 2022;7(8):191-194.
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2022-07-30

2022-08-01

2022-08-08

2022-08-15

2022-08-22

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Introduction

In Ayurveda, particularly Sushruta has mentioned various types of Vrana and their management, which is of prime importance in any surgical practice / procedure. In recent past, brilliant progress of surgery in various fields has immensely reduced the incidence of wound infection by decreasing the impediments associated with wound healing to certain limits. Still wound management continues to be a matter of speculation. Healing of Vrana is a natural process but due to the interference of vitiated Doshas, Vrana becomes Dushta and normal healing process gets delayed. Achieving better wound healing with minimal scar and controlling pain effectively are the prime motto of every surgeon.

Wound infection is one of the most important factors which delays healing and is also responsible for the formation of Dushta Vrana. In order to accomplish satisfactory healing of Dushta Vrana, it is necessary to get rid of infection. Sushruta was well aware about this type of complications. In the sixty procedures of Vrana management (Shashti Upakramas), he has explained various procedures for Vrana Shodhana and Vrana Ropana.

In the concept of wound management, all efforts have been made to keep the wound clean during the various stages of healing. Such cleaning process is called Vrana Shodhana. An ideal debriding agent should not damage to surrounding healthy tissue of a contaminated wound, should not have any undesirable effect and at the same time should be capable of performing debridement effectively. Lepana and Vrana bandhana are one among the Shasti Upakrama.

Different forms of external applications are described for the convenience of treatment of different diseases like Lepa Kalpana,^[4] Upanaha, Malahara kalpana etc. Lepa Kalpana is the herbo-mineral preparation used for external use. In Ayurveda, Lepa Kalpana is mainly described in Sharangadhara Samhita, Sushruta Samhita and Vaghbhata Samhita. The main basic concept of Lepa is that, wet drugs are pounded into fine paste form and dry drugs are pounded to fine powder form and mixed with any of the liquid media like Swarasa, Kwatha, Ghrita, Taila, Godugdha, Gomutra, Jala etc. according to demands of particular disease condition or need.

Lepana does Shodhana, Utsadana, Ropana and is Shophagna in nature. Here, for the current study, a Lepa named Vrana Lepa mentioned in Lepa Yoga Prakarana in Sahasrayoga is the formulation chosen. It comprises of Karpura (Cinnamomum camphor), Sindura (Red Oxide of Mercury), Tutha (Blue Vitriol), Yashtimadhu (Glycyrrhiza glabra), Bakuci (Psoralea corylifolia), Karanja (Pongamia pinnata), Jambeera swarasa (Citrus medica) and Ghrita.

The amount of research works done using Alepa as Upakrama are very few in number and hence the need for this study.

Methodology

Preparation of Vranalepa^[5]

Ingredients	Part Used	Proportion
Karpura	Camphor – resinous extract	1 part
Shodita Sindhura	Powder	2 parts
Shodita Tutha	Powder	3 parts
Yashtimadhu	Mula	4 parts
Bakuci	Beeja	5 parts
Karanja	Twak	6 parts
Jambira	Swarasa	Q.S
Ghrita		Q.S

Fine powder of all ingredients are taken and mixed thoroughly.

Before application of medicine, Vranalepa is mixed with Ghrita and Jambira Swarasa.

For 5gms of Vranalepa, 2ml of Jambira Swarasa and 3ml of Ghrita is required to make it into a Kalka / paste form.

Application: The wound is cleaned with normal saline. After drying with sterile gauze, Vranalepa is applied over the wound followed by sterile pads as absorbent layer. The dressing is secured with bandages without compromising the circulation. The dressing is removed in the evening and the wound is cleaned again with normal saline.

Case Report

A 34 yrs old male patient presented with a non-healing ulcer over posterior aspect of right mid-thigh associated with pain and pus discharge since 30 days. He consulted a local doctor and was treated with Povidone iodine ointment for dressing but no improvement was noticed.

Discussion

Effect on Vrana Vedana: Pain and tenderness was gradually reduced by the end of 2^nd week of treatment. Vedana is a predominant feature of Vata. Contents of Vranalepa such as Karanja and Jambira Swarasa were Ushna virya thus Vedanasthapana by pacifying Vata and Gritha by its virtue reduces pain.

Effect on Vrana Srava: Vranalepa can be considered to have Krimighna properties due to Karpura and Bakuchi, which helps reduce the microbial load in Vrana. Purulent discharge present at the beginning was gradually reduced at the end of 1^st week. This may due to Lekhana, Kushthghna, Shoshana properties present in Vranalepa.

Effect on Vrana Gandha: The Krimighna, Vishaghna, Kushthghna property of Karpura, Tuttha and Bakuci in Vranalepa nullifies the bad odours emitting from the wound.

Effect on Vrana Aakriti: By 30^th day, Vrana was completely healed, this may be due to the Vrana Shodhana and Vrana Ropana properties present in Vranalepa.

Conclusion

Vranalepa can be used effectively in the management of Dushta Vrana. It helps avoid the painful procedure of debridement of slough in those who are unable to tolerate pain. It also does the action of Shodhana and Ropana. It removes only the unhealthy granulation tissue; hence wound size does not increase.

There is further need in the research of the Shashti Upakramas mentioned by Sushruta in order to validate their efficacy and broaden the scope of Ayurveda in wound management.

Reference

1. Sushruta. Chi 1/6. In: Y T Acharya (eds.) Sushruta Samhita. Varanasi: Chaukhambha Publications; 2006. p396

2. Sushruta. Su 23/3-2, Su 23/18. In: Y T Acharya (eds.) Sushruta Samhita. Varanasi: Chaukhambha Publications; 2006. p111

3. Sushruta. Chi 1/13. In: Y T Acharya (eds.) Sushruta Samhita. Varanasi: Chaukhambha Publications; 2006. p400

4. Bhaava prakaasha, Vidyotini Teeka by Shree Harihara Prasad Pandey, Chaukhambaa Sanskrita Bhavan, Eleventh edition 2009

5. Sahasrayoga, Dr. G. Prabhakar Rao, Chaukhambaa Sanskrita Sansthana, Varanasi, 1st Edition 2016, pg341

Case Report

Dushta Vrana

Journal of Ayurveda and Integrated Medical Sciences