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Introduction

Sushrutha the father of Indian surgery has systematically and scientifically explained the principles of management of wound healing which are valid even today. For susrutha health was not merely a freedom from disease, but a normal state of mind, body &soul. Thus it may well said that the management which was told by Ayurveda were well thorough than even conceived today. The wound is defined as a disruption of anatomical structure and function of an organism or its parts. The main purpose of wound healing measure is to minimize tissue damage, remove dead tissue and to ensure blood supply, so that adequate oxygen and nutrition is provided to the tissue. 1

 Today wound is said to have healed when epithelisation is complete. But the treatments like Vaikruthapaham can bring back the colour, surface & hairs. Infection of the wound had been the major complication till the advent of antibiotics. Scar tissue formation, contraction, disfigurement of wounded area etc constitute the other challenges in the treatment of wounds.

  The mission of the wound healing is to increase our basic understanding of the molecular and cellular events of the cellular repair and wound healing processes. So that this information can be used for the basis of the new developing therapies which can minimize the adverse consequences of wound injuries. Such novel therapies could enhance cellular repair, promote rapid wound closure, and minimize hypertrophic scarring. The Vrana is the disease entity according to the system of Ayurveda where as the Modern medicine system may not accept vrana (wound) as a disease. Ayurveda has systematically and scientifically explained the principles of management of wound healing which are valid even today. Vedana, Varna, Strava & Gandha  are main clinical symptoms  of  vrana.  The  pathologically  it  is  believed that etiological factors leads destruction in mamsa dhatu which  causes  rakta  dushti  and  resulted  Dushtavrana.2

      Many good and effective remedies are told in ayurvedic classics to manage such complications. Charaka clearly mentioned that dhatus whether in the state of equilibrium or lack of it, always perish in nature without involvement of any other agent. Hence, wound healing is a natural phenomenon and the suggested measures help in hastening the process of wound healing. The ayurveda also suggests use of drugs which offer properties such as; Amapachaka, Tridoshahara,  Krimihara  &  Vishahara.  Ayurveda  also recommended that Sodhana Chikitsa followed by Ropana  Cikitsa  helps  to  cure  Vrana  completely.  Drugs

which  offer  Katu,  Tikta,  Madhura  and  Kashaya  Rasa offer beneficial effects in Vrana.3 For vrana Ropana Bhallataka taila is mentiend bhaishyajya ratnavali.4 Bhallataka is a very teekshna drug and it may cause allergy if not handled carefully. So it should be used only after proper sodhana. Bhallatakadyam tailam are - Bhallataka, Arka, Maricha, Saindhavalavana, Vidanga, Haridra, Daruharidra, Chitraka, Markava and Tila taila.

Materials and methods

Grahya Pareeksha: (6) 1 litre water was taken in a vessel and the Fruits of Bhallataka were put on water. The fruits which sunk on water are considered as best and that was taken for preparation. The floated fruits were discarded.

Shodhana: The Bhallataka was taken and its vrintha bhaga is cut with the help of a knife. Then it was cut in to 2-3 pieces. A pit was made in the land and the fresh cowdung is spread on the pit. The pieces of Bhallataka were placed over the cowdung. Again the cowdung was placed over the Bhallataka and the pit was covered with mud. It was kept undisturbed for 3 days. Fourth day it was taken out and washed properly with tender coconut water till the whole oil content in it is washed off. Then the sodhita Bhallataka was taken and kept in sunlight for drying.

Preparation of Taila [7]

Apparatus Required: Weighing machine, wide mouthed vessel,Khalwa yantra,Darvi,clean cloth, Chullika,Kalka nishpeedana yantra.

Materials                           

1. Tila Taila (sneha dravya): 1.5 kgms

2. Bhrungaraja swarasa (Drava dravya):  6 liters

3. Jala ( Drava dravya):  6 liters

 Kalka Dravyas (dry powder)

1. Bhallataka : 24gms                                          

2. Arka : 24gms                                                       

3. Maricha : 24gms                                                

4. Chitraka : 24gms                                

5. Saidhava lavana : 24gms

6. Vidanga  : 24gms

7. Daruharidra            : 24gms

8. Haridra : 24gms

All the dry powder are taken together and made in to small bolus by adding water. It is made in to kalka by   macerating with water on a khalva. Swarasa of Bhrungaraja was prepared. The raw oil i.e., Amoorchita Tila Taila was heated on mandagni in a wide mouthed vessel. Then dravadravya (Bhrunga raja swarasa and water) was added in to the vessel and heated. Then Kalkas were added to it. It was stirred constantly till the Sneha Siddha Lakshna were attained. After attaining the sidhi laksanas, just before taking from the fire, fine powder of saindhava lavana was added. The oil was taken from fire and filtered and stored in a vessel. The filtrate i.e., the kalka was put in the manual press and the oil was completely squeezed out, and the oil thus obtained was added to the vessel.

Discussion

Probable mode of action based on Rasa:8,9 As per the references available in various Nighantus regarding the GunaKarmas of trial drugs we can derive at a conclusion that both the drugs are Katu Rasa pradhana dravyas with Tikta and Kashaya rasas. When we critically study about the Guna karmas of Katu rasa as mentioned in our classics we end up with a term Vranam Avasadayati in Charaka Sutra & Ashtanga Sangraha Sutra. Also the properties like Mamsa Lekhana, Shodana, Chedana mentioned in the Context of Katu rasa implies that it does the Chedana & Lekhana of dushta mamsa (Unhealthy tissue) formed at the site of Vrana, thus does the shodana of vrana (removes sluff formation). The krimighna and Kandughna property of katu rasa helps to kill the germs and prevents itching. Tikta rasa does the shoshana of Kapha, Puya srava & Kleda. Twak mamsa Sthirikarana property mentioned for tikta rasa helps in providing strength to the tissues. Thiktha rasa has the visada guna, which acts as lekhana and vishoshikari. It plays a major part in vranashodana by keeping the wound area clean, by the lekhana property. Prevents the growth of microbes and thus provides a shield against infection by its krimigna property, and helps in wound contraction by its vishoshikari nature.

 Kashaya rasa helps in Sthambana (styptic action) & both Tikta and Kashaya rasas does Shoshana thus maintaining a dry locality at the site of Vrana, which prevents the invasion of Krimis. Sandhaniya karma of Kashaya rasa fastens the process of contraction and Ropana karma helps in formation of healthy granulation tissue thus facilitating the Wound healing Process.

Probable mode of action based on Guna:

1.  Most of the drugs of Bhallatakadyam tailam are having Laghu,Rooksha,and Teeksna gunas.

2.  Laghu guna by nature is kaphagna and sroto shodana, by this quality it helps in repairing all the blocked channels and aid in the proliferation of surrounding connective tissue elements and capillaries, which migrate in to site to be repaired.

3.  Ruksha guna helps in drying up the raw area and helps in wound contraction. Theekshna guna helps the drug to act fast, spreading in to deep and entire wound area.It is the guna which is responsible for the quick activity of the drug.It does the sodhana also( Sodhane teekshna)

Probable mode of action based on karma: 10,11

1. To achieve the main goal of healing, it is necessary to remove the maximum local dushti or debridement at the site of vrana by the virtue of lekhana, dahahara, kanduhara, soolahara, jantuhara, krimihara, vranaropana, vranashodana, avasadana properties of the trial drugs.

2.  The classical references show that tailam is Twachyam or good to skin

3.  According to Susruta81, Tila taila is a best drug for all types of sadhyo vranas.

4. Because of its vyavayi and sookshma guna it enters even through minute pores and spread throughout the body very quickly.It dothe twak prasadana,varnya,balya and lekhana (helps to do the vrana sodhana).It is krimighna(kills the worms),soola prasamana (acts as analgesic) and vrana ropana.Tila taila is best suited for parisheka,Abhyanga,Avagaha etc in conditions such as china,bhinna,vidha vranas,khsra agdagdha vrana,vislishta ,durbhagna(complicated fractures),Mruga vyaladi vidashta (bites by wild animals)etc.

5. Acc.to Yogaratnakara tailaprakarana tila taila guna told as, Jantuhara, vranaropana, kandunashana, kanthivardana etc.

6.  Recent research shows that tila taila is good for wound healing; on external application, toxic principles are attracted towards sesame oil molecules and can be washed out easily with warm water. It has been proved active antibacterial against staphylococcus and streptococcus. These were the main reason, which prompted to take tila taila as the base for the preparation. Also reference in classics that tila taila is to be taken in places were particular oil is not specified.

7.  Lekhana and Sodhana property of Saidhava lavana and Bhallataka helps for vrana sodhana by removing the unhealthy granulation tissue in the wound.

8.  Vrana Ropana action of Bhallataka, Arka, Haridra, Saindhava lavana and Daruharidra promotes the wound healing process.

9.  Sothaghna property of Chitraka and Arka helps to reduce the local inflammation.

10.  Krimihara property of Bhallataka, Arka, Maricha, Saindhva lavana, Vidanga, Chitraka and Bhringa raja helps to sweep out the infections from the wound.

11.  Kandughna property of Arka,Daruharidra,Haridra and Markava helps to controll the itching on the wounded area.

12.  Sheeta, Soolahara, Dahaprashamana properties of trial drug helped to reduce the tenderness, pain and burning sensation.

13.  Saindhava lavana increases the lymphatic drainage and also promotes the production of wbc cells which are very essential for phagocytosis. It also cleanses the wound.It is also having an anticeptic action which helps for fast wound healing.

14.  Varnya property of Haridra and Daruharidra helps to remove the scars.

15.  Calcium present Tila Taila is considered as important factor for the granulation tissue development.

16.  Vitamin C present in the Tila Taila is helpful for the maturation of collagen. Thus by considering all the above facts about the rasas, gunas and karmas it can be concluded that, the Tila Taila processed by these drugs promoted wound healing and this explains the probable mode of action of the drug.

Conclusion

As per classical literatures, Bhallatakadyam tailam, which contains dravyas namely Bhallataka, Arka, Maricha, Saindhava lavana, Vidanga, Haridra, Daruharidra, Chitraka and Markava have good action as Vrana ropana. More over Majority of the drugs have the actions like Krimighna, Sothahara, Varnya and Kandughna which has supported Vranaropana action.