E-ISSN:2456-3110

Review Article

Ayurvedic diagnostic approach

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 3 March
Publisherwww.maharshicharaka.in

Essential Ayurvedic diagnostic approach of Vrana - A Conceptual Study

B Padvi S1*, Sharma R2, S Shah H3
DOI:10.21760/jaims.9.3.27

1* Sejal B Padvi, Post Graduate Scholar, Dept of Shalya Tantra, Government Akhandanad Ayurveda College, Ahmedabad, Gujarat, India.

2 Rajeshkumar Sharma, Professor and HOD, Dept of Shalya Tantra, Government Akhandanad Ayurveda College, Ahmedabad, Gujarat, India.

3 Harshit S Shah, Professor, Dept of Shalya Tantra, Government Akhandanad Ayurveda College, Ahmedabad, Gujarat, India.

Vrana is an interruption of tissue caused by physical, microbial, chemical or immunological or typically associated with loss of function. The rupture of the continuity of body tissue or part of body Skin is also called as a Vrana. Normally wound factors delay wound healing. The presence of infection is one of the important factors which delay the wound healing process. Vrana is a common problem observed in surgical practice nowadays. It is one of the fundamental aspects of Shalyatantra, as a trauma and after surgical procedures (Abhighataj Vrana and Postoperative Vrana) surgeon thinks about healing of wound, so it is important to know about wound and wound healing. Acharya describes Vrana as its different aspects; cause symptoms etc. Vranitagara, method of Vranaraksha Vidhi, various type of Vrana Srava, Dustavrana and Sudhdha Vrana in detail. Sushruta also mentioned Aragwadhadi Gana to treat many types of Dustavrana. Panchendriya Pariksha and Vranasrav with Doshik involvement should be applied to diagnostic purposes. The 6 stages of Vrana as Shat Kriya Kala are helpful for diagnostic assessment. Samprapti is the reason for Roga Gyan and Chikitsa Gyan. That’s the only reason to know detail about Samprapti in Ayurveda. Dustavrana are of 20 types. Also, presence of Dushtavrana can damage the condition of the patient with different complications and may become fatal for him/her.

Keywords: Ayurveda, Vrana, Dustavrana, Samprapti, Shat Kriyakala

Corresponding Author How to Cite this Article To Browse
Sejal B Padvi, Post Graduate Scholar, Dept of Shalya Tantra, Government Akhandanad Ayurveda College, Ahmedabad, Gujarat, India.
Email: 		B Padvi S, Sharma R, S Shah H, Essential Ayurvedic diagnostic approach of Vrana - A Conceptual Study. J Ayu Int Med Sci. 2024;9(3):178-180.
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https://jaims.in/jaims/article/view/3004

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-01-12 2024-01-23 2024-02-02 2024-02-12 2024-02-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None declared Nil Yes 20.89

© 2024by B Padvi S, Sharma R, S Shah Hand 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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Sejal B. Padvi et al. Essential Ayurvedic diagnostic approach of Vrana - A Conceptual Study

Introduction

Vran Gatravichurnane, Vranayati Iti Vranah. Gatra means body tissue or Part of body; Vichurnane means Destruction, break, rupture or discountinuity of the body tissue. Vrana is healed by three-way primary intention, secondary intention and tertiary intention. Sometimes wound refuses to heal and this type of wound is known as non healing wound / Ulcer. The wound healing process depends on both local and general factors. Wound healing is the normal phenomenon of the body that involves the sequential process of phagocytosis. But at times when the infection is massive surface area of the wound is a very large necrotic area and sloughs are formed in very large amounts due to which auto cleansing activity of the body becomes inadequate.[1] Slough formation, pus discharge, foul smell, edema, and chronicity of wound are the main clinical features of Dushtavrana.

Aim and Objective

To determine the diagnostic criteria of Vrana with classical science and application to break down the etiopathogenesis.

Methodology

Acharya describes Vrana as its different aspects, cause etc. Vranitagara, method of Vrana Raksha Vidhi, various type of Vrana Srava, Dustavrana and Sudhdha Vrana in detail. Sushruta also mentioned Aragwadhadi Gana to treat many types of Dustavrana. As per types, Nija is due to the involvement of pathological imbalance of Shrira Dosha, Dhatu and Mala, Agantuja is due to external causes and it becomes ultimately Nija after certain periods of time. Panchendriya Pariksha and Vranasrav with Doshik involvement should be applied to diagnostic purposes. Samprapti is the reason for Roga Gyan and Chikitsa Gyan. That’s the only reason to know detail about Samprapti in Ayurveda.

Dushta Vrana (chronic wounds) or non healing ulcer, which is difficult to heal. Dushta is one in which there is localization of Dosha Vata, Pita and Kapha. Vrana, which had a bad smell, has abnormal color, with profuse discharge, intense pain and takes a long period to heal. Dushta Vrana is a long-standing ulcer where removing debris

and enabling the drug to reach healthy tissue is more important. The wound which is contaminated and the healing process is very slow is known as Dushta Vrana.

Examination of Vrana & patient suffering from this ailment is to be carried out in three different ways as Ayurveda mentioned Trividha Pariksha, by Acharya Charak; Darshana, Sparshana and Prashna. Darshana: By Darshana Pareeksha age of the patient, site of Vrana, Akruti of Varna, condition of Vrana, etc. can be elicited. Sparshana: It helps in eliciting the hardness or softness of Vrana, increase or decrease of local temperature, tenderness, bleeding, etc. Prashna: By Prashna Pareeksha the cause for Vrana, type of Vedana, Agni Bala, Saatmya etc. are to be examined. Sushruta mentioned Shadvidha Pareeksha for the diagnosis. Darshana and Sparshana should be done by Panchaindriya Pareeksha and others are like Ghranendriya, Karnendriya Pariksha. The exception is, Rasnendriya Pariksha can’t be performed in Vrana Pariksha.

Vranayati means discolouration.

Vranavastu or Scars of a Vrana never disappear after complete healing and it stays lifelong.

Assessment of role for Nidaan in Vranavigyana

Nidan (Cause): Nidan similar in Guna, Karma and Dosha. As Samanyam Vrudhdhi Karanam.

Dosha: Prakupta Dosha attains circulation with the site of Kha Vaigunya/site of a body part and leads to the state of Sanga / Obstruction. This leads to Dhatu and Mala Dushti.

Acharya Sushruta mentioned Dosha provoked by various Ahar Vihar and climate changes in Vrana.

Dushya: As per Vranvastu (8): Twak, Mamsa, Sira, Snayu, Asthi, Sandhi, Kostha, Marma.

Shat Kriyakala[2]

1. Sanchaya: Dosha accumulated in its own place

Symptomatology is tissue inflammation activity with heaviness, mild pain, and redness (As Ama Avastha of Vranashopa)

2. Prakopa: It gives rise to symptoms if not treated.

Symptomatology is pain and swelling gradually


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Sejal B. Padvi et al. Essential Ayurvedic diagnostic approach of Vrana - A Conceptual Study

increases, also can observe vitiation of local Twak and Mamsa Dhatu like “Pachyaman Avastha” of Vranashopha.

3. Prasara: Excited Dosha will overflow at their own space. Vata Dosha possesses the power to initiate movement and get associated with other

Symptomatology is Inflammation with Heaviness and Mild pain in Vranashoth.

4. Sthansamshraya: Purvarupa of disease become manifested. Doshas get localised.

Symptomatology is Pain and swelling increases gradually.

Localization of Prakupita Dosha takes place due to Srotovaigunya i.e. Pathological Impairment of related Srotas and leads to “Dosha Dushya Sammurchana”.

5. Vyakti: All characteristic symptomatology includes.

Dushti of Twak and Mamsa Dhatu occurs with Doshik involvement.

Due to Bursting of Shopha + formation of Vrana, Gatra Vichurnana (Destruction) of tissue takes place.

Symptomatology is as below,

Pain, tenderness occurs because of Vata Dosha,

Redness and burning is more due to Pitta Dosha,

Excessive swelling, Pus formation, itching due to Kapha Dosha.

6. Bheda: Disease becomes chronic and incurable with Vrana symptoms with structural changes.

If it is not treated at this stage various complications may occur.

Complications like Lakshans of Vrana and Vranita.

Vimlapan, Avasechan, Upanah, Patana, Sodhan, Ropana, Vaikritapaham are mentioned by Acharya and also gave 60 Upakramas for Vrana.[3]

Discussion

Wound healing is completed in three phases: Inflammatory, proliferative and remodelling. Granulation, collagen maturation and scar formation are some of the other phases of wound healing

but are independent of each other. Ropana is always associated with Shodhana in Ayurveda because a wound cannot be healed if it is not Shuddha, so healing is only possible factor if Vrana is clean. Even though healing is a natural process, it is inhibited by various factors. Dushta Vrana is one of the Vranas which needs time taken treatment for its healing, to achieve the main goal of healing, it is necessary to remove the maximum Dushti by virtue of Shodhana and Vrana Ropana.

Conclusion

The Vrana should be protected from Dosha Dusthi and from various micro- organisms, which may afflict the Vrana and delay the normal healing process. For the early and uncomplicated healing of Vrana, treatment is necessary. A number of patients were having Dushtavranas on lower extremities than any other parts of the body so adequate care is needed to lower limbs for any type of Vrana before it’s converted into Dustavrana. Before starting the treatment, we must assess which type of Vrana, level of Dusthi, predominance of Dosha, involvement of Dhatu, Samprapti of Dustavrana, site and size of the Vrana, Sadhyaasadhyata of Vrana. When the wound will be completely free from discharge, pain becomes very less, free from Tridosa Dushti; achieved “Sudhdha Vrana Lakshanas” then healing can be very well.

References

1. Norman S Williams, Cristopher J.K Bulstrode and P.RonanO conell in Bailey and Love Short Practice of Surgery.

2. Acharya Sushruta, Sushruta Samhita, Sutra sthana 21/12, hindi translation by ambikadutt shashtri, Varanasi, Chaukhambha Sanskrit Sansthan: reprint 2014.

3. Acharya Sushruta, Sushruta Samhita, Chikitsa sthana 1/6, hindi translation by ambikadutt shashtri, Varanasi, Chaukhambha Sanskrit Sansthan: reprint 2014.


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