Dept of Post Graduate Studies in Shalya Tantra

From, Dr. Prem Chandra, Preliminary M.S (Ayu) Scholar, Dept of Post Graduate Studies in Shalya Tantra S.D.M. College of Ayurveda and Hospital Hassan- 573201.

To, The Registrar Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

Through, The Principal and Head of the department of P.G. Studies in Shalya Tantra, S.D.M. College of Ayurveda and Hospital, Hassan

Respected Sir,

Subject: Submission of completed Proforma for Registration of subject for Dissertation

I hereby request you to kindly register the above mentioned subject on my name for the submission of Dissertation to the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore for partial fulfillment of M.S.(Ayurveda).

Title of the Dissertation:

“EFFECT OF HINGULAMRUTADI MALAHARA IN THE MANAGEMENT OF DUSHTA VRANA”

Here with, I am enclosing completed Proforma of Synopsis for Registration of subject for Dissertation.

Thanking You,

Yours faithfully, Place: Hassan

Date: 15 -04-2011 (PREM CHANDRA) RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE

ANNEXURE – II

COMPLETED PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE : DR. PREM CHANDRA AND ADDRESS PRELIMINARY M.S. (AYU) SCHOLAR, (IN BLOCK LETTERS) DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL HASSAN – 573 201

PERMANENT ADDRESS : DR.PREM CHANDRA S/O DR.RAMESHWAR DAYAL PREM MEDICALS LALPUR KARAUTA PO. SURATGANJ DIST-BARABANKI, UTTAR PRADESH

2. NAME OF THE INSTITUTE : S.D.M. COLLEGE OF AYURVEDA AND HOSPITAL, HASSAN – 573201

3. COURSE OF STUDY IN : M.S. (AYU) SHALYA TANTRA SUBJECT

4. DATE OF ADMISSION TO : 25 SEPTEMBER 2010 THE COURSE

5. TITLE OF THE DISSERTATION : “EFFECT OF HINGULAMRUTADI MALAHARA IN THE MANAGEMENT OF DUSHTA VRANA” 6. BRIEF RESUME OF THE STUDY

6.1 Need For The Study: Dusta Vrana is a common and oftenly encountered problem faced in surgical practice. The presence of Dushta Vrana worsens the condition of the patient with different complications and may become fatal. Local factors of wound like slough, infection and foreign body, affect the normal process of healing. A healthy wound in a normal body heals earlier with a minimum scar as compared to a contaminated wound. Therefore in the present concept all efforts are directed to keep the wound clean during the various stages of its healing. Good wound healing with minimal scar formation with least pain effectively is the prime motto of every surgeon. Sushruta1a, Charaka2, Vaghbhata3, Madhavakar4 and Sharangdhara5a have clearly mentioned the Lakshanas of Dushta Vrana as foul smelling, continuously flowing pus along with blood, with cavity, since long time etc, which can be correlated to non-healing or contaminated wound. There have been many studies on Vrana Prakshalana, Pichu, Lepa, Ghrita,Taila, Rasakriya, Avachurna for Dushta Vrana by various Research Centers in India. But till now no study has been carried out on Malahara. So there is need to evaluate Effect of Hingulamrutadi Malahara in Dusta Vrana Hingulamrutadi Malahara contains drugs like Hingula, Rasa Karpura, Sphatika, Siktha, Tankana, Panchavalkala Kashaya, Nirgundi Svarasa, Tila Taila, Haridra and Arka, which are having properties like Sarvadoshahara, Vranashodhana, Lekhana, Kandughna, Sravarodhaka Vranaghna, Krimighna, Bhutavishapaha, Puyanirharna and Vrana Shodana and Ropana in different types of Vrana6 In this present study, the formulation of Hingulamrutadi Malahara has been taken by adding drugs mentioned above, having Shodhana and Ropana properties and is mentioned in the Rasa Tarangini and its efficacy will be clinically evaluated by administering it as a local application in patients of Dusta Vrana. . 6.2 Review of literature:  Sushruta has mentioned the Lakshanas of Dushta Vrana1a, like Ati-Vivruta, Ati- Ushna, Puya-Srava, Puti-Gandha, Daha, Raga, Vedana and Paka Yukta.  There are 6 types of Dushta Vrana1a classified based on the involment of Dosha’s.  Sushruta has indicated use of Shodana and Ropana Tailas in the treatment of Dushta Vrana1b.  Due to various way of the manifestation of Vrana, the various recipes of external application and internal administration are available. In case of external application various formulations for debridement are mentioned such as Kwatha, Kalka, Choorna, Rasakriya, Varti, Taila, Ghrita and Malahara depending on the Avastha of Vrana and Dosha involved.

Research Works Conducted: Sharma7 (1978): Study on Vrana Shodhana drugs in the Management of DushtaVrana. Singh Santosh8 (1983): Role of Kshara Pichu in management of DushtVrana. Shetty9 (1987): Effect of Kshara Taila in Dushta Vrana. Mashetti 10(1989): Effect of Kaseesadi Taila in treatment of Dushta Vrana. Choudhari A R 11(1991): Role of Shodhana and Ropana drugs in Management of Dushta Vrana. Sunil Kumar 12(1999): Role of Jatyadi Varti in the management of Bhagandara. Bhat Rajesh13 (2000): Effect of Nimbadi Taila in Dusta Vrana

14 A.Siddaiah (2001) Effect of Doorvadi Ghrita on Madhumehaja Vrana Biradar Vijay kumar15 (2002): Management of Dusta Vrana wsr to Virechana T.Madhu16 (2004): Effect of Jatyadi Taila in Management of Dushta Vrana Behl Varun17 (2008): Role of Surasadi Taila in Kaphaja Dusta Vrana as Shodhana Effect 6.3 Objectives of the study: 1. To Evaluate the Shodhana and Ropana effect of Hingulamrutadi Malahara in Dushta Vrana 2. To compare the Efficacy of Hingulamrutadi Malahara and Jatyadi Ghrita in the management of Dusta Vrana.

7. Materials and Methods: Method of preparation of Hingulamrutadi Malahara

Ingredients: Hingula - 1 part Siktha - 2 parts Tankana - 1/6 parts Rasa Karpura - 1/6 parts Spatika - 1/6 parts

Ingredients for Taila Paka: Pancha Valkala Kashaya - 8 parts Nirgundi Svarasa - 8 parts Tila Taila - 4 parts Kalka of Arka - ½ part Kalka of Haridra - ½ part

With the Pancha Valkala Kashaya, Nirgundi Svarasa, Tila Taila, Kalka of Haridra and Arka the Taila Paka is done.To this 24 gm of Siktha is added and stirred well till it becomes homogenous mixture .To this fine powders of Hingula, Tankana, Rasa Karpura, Spatika, are added and mixed well and kept in air tight container.

7.1 Source of Data: Cases of Dushta Vrana will be selected from Out Patient and In Patient Departments of P.G Studies in Shalya Tantra, S.D.M. College of Ayurveda and Hospital, Hassan.

7.2 Methods of Collection of Data: Patients will be examined in detail with the help of Research Proforma as prepared for the study.

Diagnostic Criteria: Diagnosis will be made on the basis of Lakshanas of Dushta Vrana like  Deergha Kaleena  Pooti Pooya  Ateeva Vedana  Daha  Kandu Shopha  Shonita Srava

Inclusion Criteria:  Patients suffering from Dushta Vrana of all types  Dushta Vrana within size of 7x7 cm(length x breadth)

Exclusion Criteria . Patients with disorders like Leprotic ulcer, Tubercular ulcer, HIV, HBsAg Positive patient will be excluded.

Groups of Treatment: 40 patients of Dushta Vrana will be randomly categorized into 2 groups, of each comprising 20 patients Hingulamrutadi Malahara Group (H Group): The patients of this group will be applied by Hingulamrutadi Malahara once a day and bandaged. Jatyadi Ghrita Group (J Group): The patients of this group will be applied by Jatyadi Ghrita, once in a day and properly bandaged.

Procedure for Application of Hingulamrutadi Malahara: Vrana will be cleaned with normal saline. Then sterile gauze impregnated with Hingulamrutadi Malahara will be applied on Dusta Vrana once in a day over it a sterile pad will be placed and dressing will be done. This procedure will be done until the proper healing is achieved.If the bandage becomes wet completely before 24 hours re-bandaging will be carried out.

Assessment Criteria: The patients will be assessed on the basis of subjective and objective parameters before and after treatment.

Subjective parameters:  Vrana Vedana  Daha  Kandu

Objective parameters:  Vrana Gandha  Vrana Varna  Vrana Srava  Vrana Akruti

Duration of Treatment: Duration of treatment will be till wound heals or up to 21 days whichever is earlier.

Follow-up of Study: Follow up patients will be asked to come at the interval of one week for a period of two months.

7.3. Laboratory Investigations: Blood  Haemoglobin %  Total Leucocyte count  Differential count  Erythrocyte Sedimentation Rate  FBS / PPBS

Urine  Urine Routine & Microscopy  FUS / RUS

Other Investigations . Culture and Sensitivity test of wound discharge (If necessary) . Histopathological Examination (If necessary)

7.4 Has ethical clearance been obtained from your institution? Yes

8. LIST OF REFERENCES: 1. Sushruta: Sushruta Samhita with the Nibandhasangraha, commentary of Sri Dalhanacharya, edited by Vaidya Yadhavji Trikamji Acharya, Chaukhambha Orientalia,Varanasi. 7th edition 2002. 1a-Sutrasthana: 22:7 1b-Chikitsasthana: 35:11. 1b-Chikitsasthana: 1:8

2. Charaka: Charaka Samhita of Agnivesha elaborated by Charaka and Dridabala Vol-2 with Charaka –Chandrika commentary, edited by Dr. Gangasahaya Pandey , Publised by Chaukhambha Publication.7th edition 2002 , Chikitsasthana 25:8

3. Vaghbhata: Astanga Hrudaya.with the commentaries Sarvanga Sundari of Arundatta and Ayurveda Rasayana of Hemadri edited by Harishastri Padakara Vaidya, Krishnadas Academy, Varanasi .Reprint 2000. Utthara Tantra : 25:2

4. Madhavakara: Madhava Nidana of Shri Madhavakara vol-1 with Madhukosh commentary by Vijayrakshita and Srikantadatta edited with Hindi commentary by Brahmanand Tripathi, 2nd edition 1998, Chaukhamba Publication. Varanasi- 42:7

5. Sharangdhara:Sarangdhara Samhita with Adhamalla’s Dipika & Kasirama’s Gudartha Dipika.. Publised by Chaukhambha Orientalia.5a Purvakhanda: 7:71-75

6. Rasa Tarangini 9th Taranga 27-31 Shloka page no 205 by Pranacharya Sree Sadananda Sharmana Virachuta Hindi commentary by Pandit Kasinatha Sastri published by Mothilal Banarasidhas, 11th edition 2000. 7. Sharma S.K:Studies on Vrana Shodhana Drugs in the management of Dushta Vrana I. M S, Banaras Hindu University U.P -1978. 8. Singh Santosh: Role of Kshara Pichu in management of Dushta Vrana. I M S, Banaras Hindu University U.P -1983 9. Shetty Narayana: Effect of Kshara Taila in DushtaVrana. Govt Ayurvedic College, Bangalore R.G.U.H.S. Banglore.1987. 10. Mashetti: Effect of Kaseesadi Taila in Dushta Vrana. Govt. Ayurvedic College, Bangalore R.G.U.H.S. Banglore. 1989. 11. Choudhari A R: Role of Shodhana and Ropana drugs in Management of Dushta Vrana. Gujarat Ayurvedic University, Jamnagar Govt Ayurveda College ,Vijayawada , A.P 1994. 12. Sunil Kumar: Role of Jatyadi Varti in the management of Bhagandara Govt P.G Institute of Ayurveda Shimla, H.P 1999. 13. Bhat Rajeh : Effect of Nimbadi Taila in Dusta Vrana I. M S, Banaras Hindu University U.P 2000 14. A.Siddaiah; Effect of Doorvadi Ghrita on Madhumehaja vrana S.D.M College of Ayurveda Hassan R.G.U.S.H Bangalore 2001

15. Biradar Vijay Kumar: Management of Dusta Vrana wsr to Virechana S.D.M College of Ayurveda Hassan R.G.U.H.S.Bangalore 2002 16. T.Madhu : Effect of Jatyadi Taila in the management of Dushta Vrana S.D.M College of Ayurveda Udupi R.G.U.H.S. Bangalore 2004 17. Behl Varun : Role of Surasadi Taila in Kaphaja Dusta Vrana as Shodhana Effect S.D.M College of Ayurveda Hassan R.G.U.H.S.Bangalore 2008 9. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE :

11. NAMES AND DESIGNATION OF :

11.1. GUIDE : DR.GOPIKRISHNA. B. J M.S. (AYU), (PhD) ASST.PROFESSOR, DEPARTMENT OF P.G. STUDIES IN SHALYATANTRA, S.D.M.COLLEGE OF AYURVEDA AND HOSPITAL, HASSAN

11.2. SIGNATURE :

11.3. CO-GUIDE : DR. PRATIBHA K. M.S. (AYU) LECTURER DEPT OF P.G.STUDIES IN SHALYA TANTRA, S.D.M COLLEGE OF AYURVEDA AND HOSPITAL – HASSAN

11.4. SIGNATURE :

11.5. H.O.D. : Dr. P.HEMANTH KUMAR

M .S (AYU) IMS, BHU Ph.D PROFESSOR AND HOD DEPT OF P.G. STUDIES IN SHALYA TANTRA, S.D.M.COLLEGE OF AYURVEDA AND HOSPITAL, HASSAN

12. SIGNATURE :

12.1. REMARK OF CHAIRMAN AND PRINCIPAL :

12.2. PRINCIPAL : Dr. PRASANNA.N. RAO M.S(AYU) IMS, BHU, Ph.D S.D.M.COLLEGE OF AYURVEDA AND HOSPITA, HASSAN – 573201

12.3 SIGNATURE :