E-ISSN:2456-3110

Case Report

Efficacy of Nirgundi

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 4 April
Publisherwww.maharshicharaka.in

A study to evaluate the efficacy of Nirgundi (Vitex negundo Linn.) Patra Arka in the management of Post-Operative Fistulotomy Wound - A Case Report

V Sonawala K1*, Bhat P2, KM Sweta3
DOI:10.21760/jaims.9.4.46

1* Keya V Sonawala, Post Graduate Scholar, Department of Pg Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

2 Padma Bhat, Associate Professor, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

3 KM Sweta, HOD and Professor, Department of PG Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.

Fistulotomy is considered the standard treatment modality for fistula-in-ano and is the most widely performed procedure in an average of 55.6% of cases. A post-operative fistulotomy wound is a contaminated wound and is more prone to further contamination by faeces, which may lead to secondary infections or delayed wound healing. Management of these wounds have been a challenging task, due to their anatomical position and patient’s minimal resting period, hence delaying its healing. Thus, these wounds are co-related to Dushta Vrana in Ayurveda which requires Vrana Shodhana and Vrana Ropana for management. Nirgundi Patra Arka has shown promising results by the virtue of its Vrana Vishodhana, Vrana Ropana, Shoolahara and Kandughna property and is considered a novel approach for the same. Therefore, a patient aged 25 years/ male with a post-operative fistulotomy wound was subjected to dressing with Nirgundi Patra Arka twice a day for a period of 14 days. Complete healing of the wound was observed in 21 days and findings as per VAS score and Bates - Jensens criteria for wound assessment tool were documented.

Keywords: Nirgundi Patra, Fistulotomy, Dushta Vrana, Vrana Shodhana, Vrana Ropana, Arka, Post- Op Fistulotomy Care

Corresponding Author How to Cite this Article To Browse
Keya V Sonawala, Post Graduate Scholar, Department of Pg Studies in Shalya Tantra, Sri Sri College of Ayurvedic Science and Research Hospital, Bengaluru, Karnataka, India.
Email: 		V Sonawala K, Bhat P, KM Sweta, A study to evaluate the efficacy of Nirgundi (Vitex negundo Linn.) Patra Arka in the management of Post-Operative Fistulotomy Wound - A Case Report. J Ayu Int Med Sci. 2024;9(4):283-286.
Available From
https://jaims.in/jaims/article/view/3098

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-02-17 2024-02-27 2024-03-07 2024-03-17 2024-03-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 20.12

© 2024by V Sonawala K, Bhat P, KM 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].

J Ayu Int Med Sci 2024;9(4)283
Keya V Sonawala et al. Efficacy of Nirgundi Patra Arka in Post-Operative Fistulotomy Wound

Introduction

Anal fistulotomy, the unroofing of the entire tract from the external to the internal opening and is considered as the standard treatment modality for fistula-in-ano.[1] It is the most widely performed procedure in about an average of 55.6% cases.[2] Post-operative fistulotomy wound is a contaminated wound and is more prone to further contamination by faeces, which may lead to secondary infections or delayed wound healing.[3] Management of these wounds have been a challenging task, due to its anatomical position and the patient’s minimal resting period, hence delaying its healing.[4] These wounds have been co-related to Dushta Vrana in Ayurveda. So, a drug possessing Vrana Vishodhana, Vrana Ropana, Shoolahara and Kandughna property is needed for the better management of the same.[5,6] Nirgundi (Vitex negundo Linn.) is a medicine widely used for the management of infected wounds. Nirgundi (Vitex negundo Linn.) leaf extract has a broad spectrum of anti- microbial activity.[7]

Case History

Patient information: Patient aged 25 years/ male adult with no co-morbidities approached the OPD with c/o swelling over the peri-anal region associated with pus discharge since 1 month.

Clinical findings: On clinical evaluation, a low-level sub-cutaneous fistula with external opening at 6 o’ clock position, distanced at approximately 2.5 cm from the anal verge was observed. On DRE - internal opening was palpable at 6 o’ clock position in the lower 1/3rd of the anal canal.

Materials and Methods

Materials Required

Nirgundi Patra Arka

Normal saline

Mosquito forceps

Sterile gauze

Sterile gloves

Micropore

Method of Preparation

  • 1 part of Nirgundi Patra - is taken and soaked in 6 parts of water for 24 hours, followed by extraction of Arka with Classical Arka Preparation method at a temperature of 60° Celsius.

Procedure

  • Post operative Fistulotomy wound will be cleaned with normal saline under aseptic precautions.
  • Nirgundi Patra Arka soaked in sterile gauze piece will be placed over the wound and dressing will be done twice daily for 14 days.

Duration of Treatment: 14 Days

Therapeutic Intervention

Informed surgical consent was taken and pre- operative assessments were performed, which were within normal limits. Under local anesthesia, fistulotomy was performed. The wound was subjected to dressing twice daily with gauze soaked in Nirgundi Patra Arka for a period of 14 days. Assessment was done on Day 1, Day 7, Day 14 and Day 28 as per VAS Score[8] and Bates- Jensens criteria for wound assessment tool.[9]

jaims_3098_05.JPG

Result

Complete wound healing was observed on Day 28, with no associated complications and minimal scarring.

  • VAS Score grading reduced to 0 from 8.

J Ayu Int Med Sci 2024;9(4)284
Keya V Sonawala et al. Efficacy of Nirgundi Patra Arka in Post-Operative Fistulotomy Wound
  • BJWAT grading was observed to reduce from 39 to 11.

Follow-up and Outcomes

Table 1: VAS Score for Pain Assessment.

Day 1Day 7Day 14Day 28
8410

Table 2: BATES - JENSENS Criteria for Wound Assessment Tool

Day 1Day 7Day 14Day 28
39231711

jaims_3098_06.JPG

Discussion

Acharya Sushruta has quoted Vrana in an elaborate manner, from his keen observations. He has proposed Shashti (sixty) Upakramas for the management of Dushta Vrana.[5] Due to its susceptibility to fecal contamination and the potential for secondary infections that can cause delayed wound healing and recurrent fistulae, a post- operative fistulotomy wound can be considered a Dushta Vrana, thereby making Vrana Shodhana and Vrana Ropana necessary.[3,6]

Nirgundi (Vitex negundo Linn.) is a medicine widely used for the management of infected wounds. The pharmacognostic study of Nirgundi (Vitex negundo Linn.) shows the presence of phlobatannins, carbohydrates, tannins, glycosides, volatile oils, resins, balsams, flavonoids and saponins owing to its broad – spectrum of anti – microbial activity.[7]

Katu-Tikta Rasa of this drug helps in wound healing by its properties of Kledshoshana, Krimighna and Shodhana Karma. It has an anti-inflammatory & analgesic action due to its flavonoid content which is known to act through inhibition of

prostaglandin biosynthesis and helps in strengthening the new generating vessels.[10]

Arka Kalpana is adopted as an alternative method here due to its longer shelf life, cost- effectiveness and lack of preservatives. Arka contains volatile active substances hence having a greater potency even in minimal doses, easy absorption and easy applicability.[11]

Faster wound contraction is expected due to the active principles present in it. It is also observed that Nirgundi Patra Arka has a pleasant odour and causes no mucosal burning sensation in the patients.

Lankadhipati Ravana mentioned about Arka preparation in detail in his book called Arka Prakasha. He included it under Panchavidha Kashaya Kalpana. He has mentioned indications of Nirgundi Arka in Krimiroga, Vrana and Kushtha and hence was chosen for this study.[12,13]

Conclusion

It was observed that Nirgundi Patra Arka due to its - Vrana Vishodhana, Vrana Ropana, Shoolahara and Kandughna property accelerated the process of wound healing of the post - operative fistulotomy wound. Furthermore, its established anti- microbial activity prevented the development of any secondary infections with no recurrence of fistulae. It was also observed that Nirgundi Patra Arka did not cause any skin irritation like - rashes, burning sensation, etc. and was both - easy to prepare and easy to apply. The Vedanahara action of Nirgundi is already well known but the usage of this Arka showed significant reduction in the post - operative pain which was assessed and documented as per VAS Scale, proving that Nirgundi also possesses Vrana Shodhana and Vrana Ropana property.

References

1. Pastor C, Hwang J, Garcia-Aguilar J. Reprint to: Fistulotomy. In Seminars in Colon and Rectal Surgery 2018 Dec (Vol. 29, No. 4, pp. 183-187). WB Saunders.

2. Fugita F, Santos C, Ribeiro C. Epidemiological profile of patients with fistula in ano. Journal of Coloproctology [Internet]. 2020 [cited 2020 Feb 20];40(1):1- DOI: 10.1016/j.jcol.2019.09.009


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Keya V Sonawala et al. Efficacy of Nirgundi Patra Arka in Post-Operative Fistulotomy Wound

3. Sweta KM, Shetty AJ, Ramesh PB. Evaluation of Effect of Katupila Arka in Post-Operative Fistulotomy wound Management: A Case Report. Journal of Advanced Research in Ayurveda, Yoga, Unani, Siddha and Homeopathy (ISSN: 2394-6547). 2019;6(3&4):14-6. DOI: https://doi.org/10.24321/2394.6547.201909

4. Bhat M. S. SRB's Manual of Surgery. 3rd ed. New Delhi: Jaypee Brothers Medical Publishers (P) ltd; 2016

5. Sushruta, Sushruta samhita. edited by Vaidya Jadavji Trikamji Acharya, Narayan Ram Acharya ‘kavyatirtha’. Sootrasthana. Ch. 22, Ver. 7. reprint2017 edition, Varanasi: Chaukamba Sanskrit Sansthan; 2017. p. 108.

6. R Lakshmi, KM Sweta, Dhyan Surendranath. A clinical trial to evaluate the efficacy of Katupila Arka in post operative fistulotomy wound. J Ayurveda Integr Med Sci [Internet]. 2022Aug.12 [cited 2022Sep.20];7(6):23 -27.

7. Maurya H, Rao V. The favorable role of alkaloids from Vitex negundo in the management of human ailments. Annals of Clinical Pharmacology & Toxicology. 2019;1(2):1007. Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006;15 Suppl 1(S1): S17-24

8. Wound Assessment and Measurement Content Creators: Members of the South West Regional Wound Care Program’s Clinical Practice and Knowledge Translation Learning Collaborative [Internet]. [cited 2020 Feb 20]. 2015 08

9. Rasale P, Pandey S. Clinical evaluation of nirgundi oil used in ancient Indian medicine–in the management of non-healing ulcers. World Journal of Pharmaceutical Sciences. 2017 Mar 30:66-9.

10. Shaikh SR, Chondikar S. A Critical Review on Arka Kalpana. International Journal of Research in Ayurveda and Medical Sciences.;3:79-82.

11. Tripathy Indradev, Commentator. Arkaprakasha of Lankapati Ravana, Dwithiya Shatakam. Ver.3-6. 1st ed, Varanasi: Krishnadas Academy; 1995. p.20.

12. Tripathi D. Arkaprakasha of Lankapati Ravana with Hindi teeka and notes. Tritiya Shatakam. Ver. 59. 1st ed. Varanasi: Chowkhamba Sanskrit Series Office; 1995. p48.


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