wjpmr, 2018,4(4), 196 -199 SJIF Impact Factor: 4.639 Case Report WORLD JOURNAL OF PHARMACEUTICAL Chauhan et al. World Journal of Pharmaceutical and Medical ResearchISSN 2455 -3301 AND MEDICAL RESEARCH www.wjpmr.com WJPMR

EFFECTIVENESS OF MADHUKADI IN THE MANAGEMENT OF DUSTA VRANA W.S.R. TO BEDSORES IN PARALYZED PATIENTS – A CASE STUDY

Dr. Priyanka Chauhan*1, Dr. Ankit Vasava2, Dr. Pashmina Joshi3

1Lecturer, Shalya Tantra Department, Gulabkunverba Ayurved Collage, GAU, Jamnagar Gujarat. 2Phd Scholar, IPGT & RA, GAU, Jamnagar. 3Associate Professor, Shalya Tantra Department, Gulabkunverba Ayurved Collage, GAU, Jamnagar Gujarat.

*Corresponding Author: Dr. Priyanka Chauhan Lecturer, Shalya Tantra Department, Gulabkunverba Ayurved Collage, GAU, Jamnagar Gujarat.

Article Received on 06/02/2018 Article Revised on 27/02/2018 Article Accepted on 19/03/2018

ABSTRACT

Ulcer is a break in skin and necrosis of epithelial tissue with often pus. Bedsores are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. Bedsores most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone. In classics Sushruta has explained details of Vrana and its management by many different formulations like Jatyadi Taila, Panchvalkal Kwatha, Yastimadhu, Madhukadi Yoga and other Ropak Ghrita. This formulations have potential wound healing properties. In this study we have reported paralyzed patient from Panchkarma department of Gulabkunverba Ayurved Collage. This patient was suffering from bedsore since long time. We had locally applied Madhukadi Yoga to the patient regularly. Ulcer was completely healed within 25 days in both the patients. This case study suggested that application of Madhukadi yoga is carrying out good results in patients of bedsores.

KEYWORDS: Bedsores, pressure ulcer, Decubitus ulcers, Madhukadi Yoga, Trophic ulcers, Wound management.

INTRODUCTION intense pain and takes a long period to heal. In Sushruta Samhita Acharya Sushruta has mentioned the concept of An ulcer is a discontinuity or break in a bodily different types of Vrana along with 60 Upakramas for membrane that impedes the organ of which that Vrana Chikitsa. Sushruta has also commented for membrane is a part from continuing its normal functions. definition, causes, features, prognosis, progress stages According to Robins pathology, "Ulcer is the breach of and different treatment modalities in Vrana. Nija - the continuity of skin, epithelium or mucous membrane Agantuja, Dushta - Shuddha, Sadhyo Vrana dusta vrana caused by sloughing out of inflamed necrotic tissue.[1] etc are mainly classified and described under the title of They happen when you lie or sit in one position too long Vrana, which includes local as well as the systematic use and the weight of your body against the surface of the bed of different drugs and treatment modalities. Vrana which or chair cuts off blood supply. You might get them if has foul smell, continuously flowing putrefied pus along you’re on bed rest or in a wheelchair.[2] Friction burns on with blood, with cavity, since long time and has smell the skin may damage the outermost layer of skin cells. etc, Vranalakshanas are high in intensity, and which is This layer is called the epidermis. Wearing soiled almost opposite to ShuddhaVrana is DushtaVrana. In this clothing or undergarments for long periods of time may context we can understand it as a non-healing or create open sores on the skin. This may irritate the contaminated wound. Dusthavrana Dushta Vrana is a delicate outer skin layer. It’s an open wound on your long standing ulcer where removing debris, decreasing skin. Bedsores often occur on the skin covering bony toxicity and enabling drug to reach healthy tissue is more areas. The most common places for a bedsores are hips, important. Acharya Madhava has also described the back, ankles, buttocks. This condition is common in futures of Dushta Vrana very specifically.[4] Ayurveda, elderly people, people with decreased mobility, people gives more importance to preventive measures and who spend long periods in bed or a wheelchair, people complete curing of a disease with a minimum chance of who can’t move certain body parts without help, people recurrence. Madhukadi Yoga (Madhu, Ghrita, Til Kalka, with fragile skin.[3] I In Ayurveda, these types of etiology Nimba Patra Swarasa) is a known Vrana Ropana can be consider under Dusta Vrana, which is difficult to formulation.[5] Hence considering the wound healing heal. Dushta is one in which there is localization of activity the drug it has been tried in this case and found Dosha vata, pita and kapha. Vrana, which had a bad effective in bedsores. smell, has abnormal color, with profuse discharge,

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AIMS AND OBJECTIVES Drug: (Madhukadi yoga). Goghrita () - 1 part. To evaluate the role of Madhukadi yoga in the Madhu (honey) - 1 part. management of dushta vrana w.s.r. to Bedsores. Krisha tila bij powder (black sesam seed powder) 1 part.

Nimba Patra ( of azadiracta indica) swaras – 1 CASE REPORT part. A 56 years old female patient suffering from hemiplagia, was admitted for Panchkarma treatment in panchakarma Thus Madhukadi Yoga is a combination of Madhu, department of Shree Gulabkunverba Ayurved Ghrita, Nimbapatra Swaras and Tila kalka. We had taken chikitsalaya, Jamnagar. She was having pressure sore all above mentioned drugs in equal quantities (1 Part) over left hip region due to long period of bed ridden and mixed well and made a paste form. Fresh paste was condition. This pressure sore was too much painfull and prepared every day before using in ulcer. since 3 months it was persisting there and not healing with all attempts of modern medicine so patient Methodology approached to Ayurveda hospital. Patient was unable to Bedsore was cleaned daily with Panchwalkal Kwatha. bear the pain. Patient had no previous history of diabetes After cleaning of ulcer, Madhukadi Yoga was applied mellitus (DM). Patient was examined and found bed sore and covered with sterile gauze pieces and bandaged daily over left hip with tendency of skin discoloration, severe once in the morning hours. The assessment of ulcer was pain, tenderness. The ulcer was deep with a red-pink done on the basis of relief in symptoms i.e. pain, wound bed. There was something that looks like pus in tenderness, size of wound and discharge. the sore. The diagnosis was made as Decubitus ulcer. Assessment of wound MATERIAL AND METHOD Assessment of wound was done by observing the relief in sign and symptoms and decreasing size of wound day Patients: In this study we had registered one 56 years by day. old paralyzed female from IPD of panchakarma department, of shree gulabkunverba ayurved cikitsalaya.

CASE REPORT

Fig-1. Fig-2. Fig-3.

Fid-4. Fig-5.

RESULTS clinical features of dushta vrana (Decubitus ulcer) were improved within 15 days (fig 3). Size, sign and The patient came with painfull and sloughy wound (fig symptoms were reduced within 20 days after treatment 1). After debridement and application of Madhukadi (fig 4). The wound was healed completely within 25 yoga (fig 2) wound became clean within 7 days. The days (fig 5) leaving only a minimal scar. www.wjpmr.com 197 Chauhan et al. World Journal of Pharmaceutical and Medical Research

DISCUSSION proved its antibacterial[14] and wound healing activity.[15] Treatment of decubitus will depend on the stage of your 5. Cow ghrtia has a soothing property. It forms a thin ulcer. Treatment can include medications, therapies, or film over them and that allows early epithelization surgery. A process to remove dead tissue called of wound. It also protects wound from invasion of debridement is an option for cleaning your wound. any microbes. Madhu is a very good Vrana Keeping the site clean and free of debris is important to shodhaka. Due to its sukshmat it enters very small promote healing.[6] Healing is a natural process, it is pores around the wound site and does not allow any inhibited by various factors. Wound healing process infections to enter the site. When cleansed it also starts from the moment of tissue injury and can be does disloughing of the wound.[16] continued for varying periods depending upon the extent

of wounding.[7] The process of wound healing is broadly CONCLUSION categorised in 3 phases. Phase of inflammation, phase of proliferation (granulation tissue formation), phase of These both case study highlighted the topical application differentiation (scar tissue formation).[8] The objective in of Madhukadi yoga following Panchavalkala wound healing and its management is to establish prakshalana is having very good results in healing in a healing in the shortest possible time, with minimal pain, case of Dushta Vrana especially Decubitus ulcers that is discomfort and scarring. Improving the process of wound originated from long term bed ridden position in healing and tissue repair offers tremendous opportunities specially the patient who are suffering from paralysis. to enhance the quality of life for trauma and burns There is not any side effect found during treatment. So patients. Dushta vrana is one of the Vranas which needs this study needs further more data. treatment for its healing, to achieve the main goal of healing, it is necessary to remove the maximum Dushti REFERENCES by the virtue of Shodhana, Sravahara, Dahahara and 1. https://en.wikipedia.org/wiki/Ulcer. Vrana ropana. Drugs should be Amapachaka, 2. https://www.webmd.com/skin-problems-and- Tridoshahara, Krimihara, Vishahara. Puyanirharana. treatments/pressure-sores-4-stages#1. 1. Panchavalkala the premedication drug decoction is 3. https://www.healthline.com/health/pressure-ulcer. having tennin agent and wound clensing properties. 4. Madhava Nidana, edited by Yadunandana Upadhyya From Ayurveda view it can be stated that with Adhyaya 42. Ruksha, Shita, Kashaya and Laghu properties’[9] 5. Acharya YT. Sushruta Samhita, Nibandhasangraha combining with concentrated decoction preparation commentary, Chikitsa Sthana, Chapter 1/ by Agnitoya Samsakara perform Vrana Prakshalana Chaukambha Surabharati Prakashan, Varanasi, and establish Vrana Parimarjana (debridement), Reprint-2010 P-3. Vrana Shodhana (cleaning) and Kleda Shoshaka[10] 6. https://www.healthline.com/health/pressure- Karma in Dushta Vrana by Prakshalana. ulcer#treatment. 2. The effect of Madhu in promoting Vranaropana is 7. Burn wound healing potential of jatyadi attributed to its Madhura, Kashaya Rasa and formulations in Rats a research work published by Pichhila, Sheeta, Laghu Guna. Madhura Rasaof Dhande Priti p, Raj Simpy, Kureshee Nargis I, honey exerts direct nutrient effect on regeneration of Sanghavi Dhara R and Pandit Vijaya A, Bharati tissue because it contains a wide range of amino vidhyapith deemed university, pune, researxh acids, vitamins, and trace elements in addition to journal on pharmaceutical, Biological and Chemical large quantities of readily assimilable sugars. Science, RJPBCS, October December 2012; 3(4): Kashaya Rasa cleanse the wound surface and 748. removes foul smell from wounds by destroying the 8. Bailey and love short practice of surgery, twenty bacteria which produce ammonia. Sheeta Guna is first edition, chapter 1, healing and management of correlated as anti-inflammatory action of honey wounds by Anthony goode, page number 3-4. which soothes and promotes healing by reducing 9. Description of Vata ( Bangalensis), Ashwattha pain and inflammation. Pichhila Guna acts as moist (Ficus religiosa), Parisha (Thespesia populnea Solan retentive as moist wound environment is less ex Correa), Udumbar (Ficus glomerata Roxb.), painful, requires fewer dressing changes, and Bhavaprakasha Nighantu, by Bhavamishra, produces better cosmetic results.[11] commented by K.C. Chunekar, Vatadi Varga, page 3. Tila Kalka is soothing and instant pain relieving number 501-505. since it pacifies vata. Seasemol a chemical present in 10. Ruksh Shoshne - quoted by Hemadri on Ashtang tila has a phenol ring and acts as an anti Hridaya, by Vagbhattacharya, Hemadri inflammatory drug.[12] commentary, published by Chaukhamba Sanskrit 4. Nimba Patra Kalka (neem paste) can be used academy, Adhyaya 1, Aayushkaamiya; Sutra 1/20. externally because of its Pitta Shamaka property and 11. Kumari K V, Nishteswar K. Wound healing activity it is indicated for Vrana (wound), Krimi(worms), of honey: A pilot study. AYU, 2012; 33: 374-7. Kushtha (skin diseases), and Visha (poison) in 12. Clinical Efficacy of Madhukadi Yoga in the Ayurvedic classics.[13] Recent researches have management of Dusta Vrana (Post surgical non

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healing wound) - A rare case report. International Journal of AYUSH Case Reports, Oct-Dec 2017; 1(2). 13. Chunekar KC, Pandey GS. Bhavaprakasha Nighantu. 10th ed. Varanasi: Chaukhamba Bharati Academy, 2006; 329–31. 14. Koona S, Budida S. Antibacterial Potential of the Extracts of the Leaves of Azadirachta indica Linn. Not Sci Biol, 2011; 3: 65–9. 15. Thakare VM, Chaudhari RY, Patil VR. Promotion of cutaneous wound healing by herbal formulation containing Azadirachta indica and Cynodon dactilon extract in wistar rats. International Journal of Pharmaceutical Research & Development, 2011; 3: 80–6. 16. Clinical Efficacy of Madhukadi Yoga in the management of Dusta Vrana (Post surgical non healing wound) – A rare case report. International Journal of AYUSH Case Reports, Oct-Dec 2017; 1(2).

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