Introduction

Diabetic foot ulcer (DFU) is a serious and common complication of diabetes mellitus, often associated with neuropathy, peripheral vascular disease, and impaired wound healing due to chronic hyperglycemia. About 15–25% of diabetic people will have it at some point intheirlives,anditistheprimarycauseofnon-traumatic lower limb amputations globally.^[1] The pathogenesis of DFU involves a complex interplay of micro vascular and macro vascular damage, infection, and impaired immune response, contributing to delay wound healing and poor prognosis.^[2] In Ayurveda, chronic non-healing ulcers such as DFUs are classified under Dushta Vrana, which are described as wounds that do not heal easily, are foul-smelling, exudative, and often associated with systemic imbalances.^[3]

The Ayurvedic approach emphasizes a holistic treatment strategy incorporating Ubhayaparimarjana Chikitsa - a dual modality of internal and external purification and healing. This includes Shodhana Chikitsa (detoxification therapies), Shamana Chikitsa (palliative management), and local wound care using herbal decoctions and formulations.^[4] Ayurvedic interventions included Bahirparimarjana Chikitsa^[5] (external therapies) like Nimba Patra Kashaya for Padaprakshalana and Aragwadha Patra Kalka for local applications, along with Antarparimarjana Chikitsa (internal therapies) such as Panchatikta Pancha Prasritika Basti, Phalatrikadi Kwatha, Kaishore Guggulu, and Madhumehari Churna. The integrated approach led to significant clinical improvement and normalization of laboratory parameters.

Case Report

Patient Information

A 70-year-old male patient, a retired teacher visited the outpatient department of Kayachikitsa (OPD No.332023189099) National Institute of Ayurveda, Jaipur on 3^rd November 2023 with complaints of severe itching, burning, swelling and scaling, cracks, with mild bleeding, pus and watery discharge on bilateral lower limb With Associated complaints Pada Daha (burning sensation in feet). He was accidently diagnosed with type-2 Diabetes mellitus after investigation.

He had Madhyam (Medium) Satvam (Mental strength) Satmya (Homologation), Pramana (Body proportion), Samhanan (Body built or compactness), Sara (Purest body tissue), Aharashakti (Intake of food), further he had Avara Vyayama Shakti (Less physical activities) Jarana Shakti (Digestive fire) and Vayah (Age) of the patient were Vridhavastha^[6] (Old age). Madhyam Kostha (Bowel easy to purgate), Mandaagni (Loss of digestive fire) and Madham Bala (Moderate physical strength).

Diagnostic Assessment

Assessment criteria based on the effect of the intervention on subjective and objective parameters. The patient had raised blood sugar. The patient also presents cardinal features of Diabetes polyuria, polydipsia, Prabhoot Avil Mutrata with Poorvarupa (premonitory symptom) of Alasya (laziness), Shithilangata (flabbiness of the body), Karapada Daha and Suptata (burning and numbness over palm and sole), Mukha Talu Kantha Shosha^[7] (palate, throat, and mouth dryness) and bilateral calf muscular soreness.

Results

After 1 month 20 days of treatment in IPD level, the symptomatic improvement in subjective parameters like itching, burning, swelling and scaling, cracks, with mild bleeding, pus and watery discharge along with marked reduction in blood sugar level. For the next three months, Madhumehari Churna, Arogyavardhini Vati, Kaishore Guggulu and Haritaki Churna were continued for assessing the improvement in each follow-up on the basis of subjective and objective parameters. The clinical course showed progressive and sustained improvement. The patient’s FBS levels dropped from 212.4 mg/dl to 118 mg/dl and HbA1c from 10.5% to 5.24% over the course of treatment. Patient reported a good feeling for physically at the end of treatment. Ayurvedictreatment has given better results and improved the quality of life.

1st Day

After 3rd Month

Discussion

Diabetic foot ulcer (DFU) is a common and challenging complication of diabetes mellitus, often resulting from peripheral neuropathy, ischemia, and immune dysfunction due to long-standing hyperglycemia. It affects approximately 15–25% of diabetic patient during their lifetime and remains the leading cause of non-traumatic lower limb amputations globally.^[11,12] Modern management focuses on glycemic control, wound debridement, infection management, vascular assessment, and pressure offloading.^[13]

In Ayurveda, such chronic, non-healing, foul-smelling wounds are classified as Dushta Vrana, characterized by features like Krimiyukta (infected), Puyayukta (purulent), and Durgandha (foul-smelling) wounds that resist healing.^[14] In this case, the diagnosis of Madhumehjanya Dushta Vrana aligns with the chronic wound in a newly diagnosed type 2 diabetic patient, displaying classical symptoms like Pada Daha (burning feet), foul discharge, and blackish discoloration, indicating Kapha-Pitta vitiation and impaired Rakta-Meda metabolism. The Ayurvedic treatment protocol in this case followed the line of Ubhayparimarjana Chikitsa, combining both Bahirparimarjana (external purification and healing) and Antarparimarjana (internal purification and palliative treatment) approaches.^[15]

The application of Ubhayparimarjan Chikitsa, which combines both local and systemic therapies, not only aids in wound healing but also controls the underlying pathology of diabetes. The holistic Ayurvedic approach, combining systemic and local therapies such as Basti, herbal formulations, and wound care, led to significant improvement in the patient's symptoms and overall quality of life. This integrative strategy offers a promising complementary or alternative option alongside conventional diabetic foot ulcer management.

Declaration of Patient Consent: The authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the image and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published, and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

References