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Introduction

Since the beginning of time, humans have struggled with injuries and their healing processes. Every person's life begins with a little wound that remains visible as their umbilicus. Due to a variety of traumas, pathological insults, infections, physical and chemical exposures, and metabolic abnormalities, the frequency of nonhealing ulcers is horribly high. Regaining normalcy is the goal of mending a non-healing ulcer, and both modern and Ayurvedic medicine offer various care strategies to help achieve this. Even though there are many new advancements in the field of ulcer management in the modern era, Ayurvedic concepts regarding Vrana and Dushtavarana management have their own pre-eminent importance. It is now obligatory to elevate the effective methodologies and protocols mentioned in our science, spread better living conditions, and keep people healthy. Acharya Sushruta explained the characteristics of Dushtavrana, such as Atisamvruta, Ativivruta, Atikatina, Atimrudu, Utsannam, Avasannam, Pootipooyasrava, Atyartavedana, Daha, Paka, Kandu, and Deergakalanubandhi. Acharya Sushruta gave the Vrana and its management a higher place.These characteristics are exactly the same as those of chronic, nonhealing ulcers. Even though recuperating is a natural process, Dosha Dhatu Dushti, Dushtavrana causes it to be delayed. One of the main methods for clearing the wounds and promoting healing is debridement. Shashtiupakrama was for engrossed by Acharya Sushruta specifically to handle the various phases of Vrana. It aids in achieving appropriate Shuddhavastha and It helps achieve appropriate Shuddhavastha and Roodhavastha of Vrana with restoration of normalcy. It comprises many forms of Upakrama for Vranashodhana, Vranaropana, and Vaikrutapaha, such as medicinal, Panchakarma, surgical, and para-surgical therapies and use them as per pre-requisite. Acharya Sushruta has specically mentioned that Vrana with Utsanna Katinamamsa, Kandu, Chirothita should be cleaned and debridement of slough tissue should be done to promote quick healing.  

Case Study: A 60 years old male patient having the complaints of dushta vrana over left forearm associated with white slough, surrounding area with itching, for 4 days. He was working in field where he had some bite or contact with weed. After that itching with blister formation occurred. The blister ruptured and irregular wound over fore arm of dimensions about 16 cm in length and about 6-8 cm in breadth. He is K/C/O DM for 6 years on Anti-diabetic drugs. Taken skin specialist and surgeon opinion, where was advised skin grafting. But as he was our old patient visited with above complaints.

Local Examination: Lt forearm wound covering more than 3/4th area

Dimensions- 16cm × 6-8 cm × 0.2 cm as shown in figure below.

Investigation:

Laboratory - RBS - 436 mg/dl at first visit

Plan of Treatment-

                  -Daily dressing

                 -Controlling of Blood Sugar level

Methodology:

-Slough excised

- Wound cleaned with Panchavalkal qwath.

- Panchavalakala lepa applied over the wound.

- Sterile pad dressing done.

- Orally Glucomap (Ayurved Proprietory medicine) 1 cap twice apan kaal, Panchavalkala Cap 1 cap twice daily Bhojanottar

RESULTS:

-The clinical features of pain, itching, tenderness was reduced in 2-3 days,

- Slough reduced in 3-4 weeks

- Wound colour changed to Pinkish colour.

- Size of 6-7 weeks near to complete healing with central small area under process of healing.

- After 12 weeks of treatment complete wound healing is seen with vrana vastu.

Discussion

DISCUSSION ON DRUG: Preventing secondary infections in the Diabetic wounds with safe and efficacious anti-bacterial agents is must in the current scenario to enhance wound healing.Vrana Ropana is always followed by Vrana Shodhana by removal of Sthanika Dosha Dhatu Dushti; because it cannot be healed if it's in Dushtavastha. Here Panchavalkal Capsule, Glucomap Capsules along with Panchavalkal lepam was used for vrana ropana and controlling of Glucose level. Panchavalkal is combination of five kshiri vruksha valkal(skin) namely Vata (Ficus bengalensis), Udumbara (Ficus glomerata), Ashwatha (Ficus religiosa), Vetas (Salix caprea), Plaksha (Ficus lecor).

Properties of Panchavalkala-

* Rasa- Katu, tikta, kashaya

*Veerya- Ushna

* Vipaka- Katu

*Guna- Laghu, Ruksha, Teekshna

* Doshaghnata- Kaphapittaghna

* Karmukta- Vranashodhan, Ropan, Varnya, Raktapitta vinashak, Raktadaha shamak,

Vyanganashak.

DISCUSSION ON EFFECT OF TREATMENT:

Pain - Pain is mainly due to infection, destruction of the tissue, tension of tissue, collection of pus and tough slough. Due to vranashodhan the tissue tension is reduced.

Burning sensation- In delayed healing ulcers due to poor circulation there will be hypoxia to nerve endings that cause burning sensation. The removal of slough is by the Lekhana, Shodhana, raktapittaghna guna, kashaya ras which improved the circulation to the area of ulcer and reduces the burning sensation.

Itching- Itching is due to infective organisms, dead tissues and presence of pus. Lekhana, Shodhana and Shoshana properties of panchavalkal moistness in the wound is reduced, and as a result itching is reduced.

Discharge – The blood circulation to the area is increased, and reduce the exudates and inflammation by its Shoshana and Shodhana properties. Thus reduces the discharge.

Odour- Odour is mainly due to increased pus and slough tissues. Reduction in slough and pus odour is reduced.

Tenderness- Tenderness is mainly due to infections and tissue tension by ulcer. Lekhana, Shodhana, and raktapittghna properties of panchavakla, reduces infections and then reduce tissue tension and tenderness.

Floor of ulcer- Floor of the delayed healing ulcers contain pale granulation tissues with profuse slough. Kledahara, kashaya ras, Tridoshagna, Shodhana, and Ropana properties of kshara played a major role in scrapping out the debris and slough from the Vrana.

Size of the ulcer: Shodhana, Ropana, Shoshana, varnya, making a good environment for proper healing. Thus, the size (length, breadth, depth) of ulcer reduced and will be healed.

Conclusion

As per the analysis of Panchavalkal, it is phytochemically dominant in phenolic group components like tannins, flavonoids which are mainly responsible for its excellent activities like antiseptic, anti-inflammatory, immonomodulatory, anti-oxidants, antibacterial, antimicrobial, astringent and wound purifying and healing properties.

Panchavalkal qwath and lepa reduces pain, discharge, slough, redness, swelling, surface area and depth of wound and appreciate early healing.