EFFICACY OF JATYADI TAILA IN THE MANAGEMENT OF DUSHTA VRANA Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore,Karnataka in partial fulfillment of the regulations for the award of the degree of MASTER OF SURGERY (Ayu) By T. MADHU, B.A.M.S. GUIDE: DR. K. R. RAMACHANDRA, M.D. (Ayu) Professor& H.O.D. S.D.M. College of Ayurveda, Udupi.DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA S. D. M. COLLEGE OF AYURVEDA, UDUPI – 574 118 2004
EFFICACY OF JATYADI TAILA IN THE MANAGEMENT OF DUSHTA VRANA Dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, in partial fulfillment of the regulations for the award of the degree of MASTER OF SURGERY (Ayu) By T. MADHU, B.A.M.S. GUIDE: DR. K. R. RAMACHANDRA, M.D. (Ayu) Professor& H.O.D. S.D.M. College of Ayurveda, UdupiDEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA S. D. M. COLLEGE OF AYURVEDA, UDUPI – 574 118 2004
DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA S. D. M. COLLEGE OF AYURVEDA, UDUPI – 574 118 CERTIFICATE This is to certify that the dissertation work entitled “Efficacy of Jatyadi Taila inthe management of Dushta Vrana” has been carried out by Dr. T. Madhu, under mydirect supervision and guidance as a partial fulfillment for the award of degreeM.S.(Ayu). He has worked hard and sincerely in carrying out this work and established newconcepts in the management of Dushta Vrana along with bacteriological study of JatyadiTaila. This title has not been awarded degree, diploma associateship, fellowship orsimilar honours previously. Recommended the dissertation for evaluation by adjudicators. Dr. K. R. Ramachandra, M.D. (Ayu) Guide,Professor and Head of the Department,Place : Udupi Department of Post Graduate studies inDate : .02.2004 Shalya Tantra, S. D. M. College of Ayurveda, Udupi
CONTENTSList of abbreviationsList of tablesList of figuresList of color platesChapter No. Contents Page No. 1. Introduction 01 - 04 2. Review of literature 2.1. Ayurvedic review 05 - 12 2.2. Drug review 13 - 40 2.3. Modern review 41 - 81 3. Clinical study 3.1. Materials and methods 91 - 98 3.2. Observations 99 -129 4. Discussion 130 -141 5. Conclusion 6. Summary 142 -144 References Bibliography Appendix Case Proforma Master Chart
ABBREVIATIONSA.H. : Ashtaanga HrudayaA. Pr. : Ayurveda PrakaasaA.San. : Ashtaanga SangrahaAT : After TreatmentB. & L. : Baily & Love’s Short practice of surgeryB. Pr. : Bhaava PrakaashaB.R. : Bhaishajya RatnaavaliBT : Before TreatmentCh : CharakaChakra : ChakradattaChapt. : ChapterChi. : Chikitsaa SthaanaD : DaysDra. Vi. : Dravyaguna VijnaanaFU : Follow upG.N. : Gada NigrahaG : GroupK : KaphaKa. : KaashyapaM. Ni. : Maadhava NidaanaMad. Kh. : Madhyama KhandaM.M.S Manipal manual of surgeryNi. : Nidaana SthaanaP : PittaPo. Kh. : Poorva Khanda
Pg Page numberR : RaktaR.Sa RasayogasaagaraSha. : SharangadharaSam. : SamhitaS. : SushrutaS. Das. Surgery : S. Das concise text book of surgerySoo. : Sootra SthaanaUt. : Uttara SthaanaV : VaataY.R. : Yoga Ratnaakara
ACKNOWLEDGEMENTS I sincerely express my deep sense of gratitude to my Teacher and GuideDr. K.R.Ramachandra for the magnitude of his dynamic and untiresome guidancethroughout the study. I would like to put on record the affection and care with which myesteemed Guide directed me during the study. I am thankful to Dr. Muralidhar Sharma, Dr. Subramanya Bhat, Dr. RaghavendraAcharya, Dr. Jayakrishna Nayak, Dr.Jonah and Dr. Ramadevi for their help,encouragement and suggestions during the work. I wish to offer my sincere thanks to Prof. Dr. M. H. Rayabhagi, Principal andProf. Dr. D. Krishnamoorthy, Dean for the Post Graduate studies, S.D.M. College ofAyurveda, for their encouragement and support. I wish to express my gratitude to the authorities of S.D.M. Educational Society forproviding me all the requisite facilities to carry out this work. My gratitude due to Dr. Y. Narayana Shetty, Superintendent andDr. Deepak S. M., Deputy Superintendent of the S.D.M. Ayurveda Hospital, Udupi fortheir valuable support and encouragement. I express my gratitude to Dr. Mamatha Ballal, Professor, Microbiologydepartment, K.M.C. Manipal, and the H.O.D., Microbiology department, K.M.C.Manipal, for their contribution in the bacteriological study of Jatyadi Taila.
I am grateful to our Librarian Shri Harish Bhat, for providing me with the books Ineeded. I am thankful to my seniors Dr. Manjunath Bhat, Dr. Lodha Naresh, Dr. SatishB.G., Dr. Shilpa, Dr. A. Narayan Nambi and Dr. Ravishankar for their help throughoutthe study. I am indebted to my batch mates Dr. D. M. Patil, Dr. Nagaraj, Dr. Ashok M.L.,Dr. Vishwas, Dr. Ramachandra, Dr. B.V. Shetty, Dr. Mahesh C.D., Dr. Pradeep willforever remain in my memories for their tremendous compliance in compiling this study. I am thankful to my juniors Dr. Jayagopal, Dr. Sudheendra, Dr. Raghavendra, Dr.Pramod, Dr. Bhargav, Dr. Vinay, and Dr. Anil. My special thanks to for bringing out quality copies. Dr. T. Madhu
LIST OF TABLESTable No. Contents Page No. 1. Nidaana of Vrana 15 2. Lakshanas of Vaataja Vrana 16 3. Lakshanas of Pittaja Vrana 17 4. Lakshanas of Kaphaja Vrana 18 5. Lakshanas of Raktaja Vrana 19 6. Lakshanas of Dvidoshaja Vrana 19 7. Lakshanas of Tridoshaja and Sannipaataja Vrana 20 8. Lakshanas of Dushta Vrana 21 9. Lakshanas of Shuddha Vrana 22 10. Vrana Sthaana and its Lakshanas Acc. to Maadhavakara 22 11. Vrana Varna 23 12. Vrana Vedana 24 13. Vrana Sraava Acc. to involvement of Dosha 24 14. Vrana Sraava Acc. to Sthaana 15. Vrana Upakramas 25 16. Incorporation of 60 Upakramas among 7 Upakramas 26 17. Aagantuja Vrana Lakshanas 27 18. Description of ingredients of Jatyadi Taila 27 19. Ingredients of Triphala Guggulu 28 20. Types of edges 28 21. Classification of commonly used antiseptics 31
22. Gram -Positive cocci 3223. Gram-Negative bacilli 4024. Anaerobic organisms 4225. Distribution of 20 patients of Dushta Vrana Acc. to different age group 7726. Distribution of 20 patients of Dushta Vrana Acc. to sex 7827. Distribution of 20 patients of Dushta Vrana Acc. to occupation 7828. Distribution of 20 patients of Dushta Vrana Acc. to the religion 8329. Distribution of 20 patients of Dushta Vrana Acc. to socio-economic status 8430. Distribution of 20 patients of Dushta Vrana Acc. to marital status 8531. Distribution of 20 patients of Dushta Vrana Acc. to habitat 8632. Distribution of 20 patients of Dushta Vrana Acc. to dietary habits 8933. Analysis of chronicity in 20 patients of Dushta Vrana 89 34.34. Analysis of area involved by the Dushta Vrana in 20 patients 9935. Analysis of type of Dushta Vrana in 20 patients 10036. Classification of Dushta Vrana Acc. to Adhishtaana 10037. Analysis of Dushta Vrana Acc. to the cause 10138. Assessment of pain 11539. Efficacy of treatment on pain 11540. Result of treatment on Pain 11641. Assessment of Itching 117
42. Efficacy of treatment on Itching 118 43. Result of treatment on itching 118 44. Assessment of burning sensation 11645. Efficacy of treatment on burning sensation 11746. Result of treatment on burning sensation 11747. Assessment of length of the Ulcer 11948. Efficacy of treatment on length of the Ulcer 11949. Assessment of width of the Ulcer 12050. Efficacy of treatment on width of the Ulcer 12051. Assessment of depth of the Ulcer 12052. Efficacy of treatment on depth of the Ulcer 12153. Assessment of tenderness 12154. Efficacy of treatment on tenderness 12255. Result of treatment on tenderness 12256. Assessment of discharge 12357. Efficacy of treatment on discharge 12358. Result of treatment on discharge 12459. Assessment of smell 12460. Efficacy of treatment on smell 12461. Result of treatment on smell 12562. Assessment of surrounding area of ulcer 12563. Efficacy of treatment on surrounding area of ulcer 12664. Result of treatment on surrounding area of ulcer 126
65. Assessment of Floor & granulation tissue 12766. Efficacy of treatment on granulation tissue development 12767. Result of treatment on granulation tissue development 128
LIST OF FIGURESFigure No. Contents PageNo.1. Incidence of age 992. Incidence of Sex 1003. Occupation incidence 1014. Incidence according to the religion 1015. Incidence of socio-economic status 1026. Incidence according to marital status 1037. Incidence according to the habitat 1038. Incidence according to the dietary habits 1049. Incidence of chronicity 10410. Incidence of site of ulcer 10511. Incidence of type of Dushta Vrana 10612. Incidence according to the Adhishtaana 10713. Incidence according to the cause 10714. Effect on pain 10815. Effect on itching 10816. Effect on burning sensation 10917. Effect on length of ulcer 11018. Effect on width of ulcer 11019. Effect on depth of ulcer 11120. Effect on tenderness 11221. Effect on discharge 112
22. Effect on smell 11323. Effect on surrounding area of ulcer 11424. Effect on floor and granulation tissue 115
LIST OF COLOR PLATESPlate No. 1. Efficacy of treatment on healing of ulcerPlate No. 2. Observation on bacteriological study
History of medical science starts with wound healing. The earliest medicalwritings extensively consider wound care. In Edwin smith papyrus (1700B.C) wounds and their management was described. Empirically, the ancientphysicians of Egypt, Greece, India & Europe developed gentle methods oftreating the wounds.Treatment of wounds is probably the first medical problem faced by thehuman being. Frequency of injuries is more often than any other diseases.Many a times, non-healing nature of ulcers pose a problem in practice. Itmay due to various reasons. One of the reasons is improper debridement.Healing of Vrana is a natural process, but due to the interference of vitiatedDoshas, Vrana becomes Dushta and normal healing process gets delayed.So to treat such type of Vranas both internal medication as well as externalapplication is necessary.Dushta Vrana is a long standing ailment with profuse discharge and sloughwhere much importance should be given in removing the debris andenabling the proliferation of healthy tissue.Sushruta father of Indian surgery describes 60 therapeutic measureselaborately for the management of Vrana.For the purpose of Shodhana and Ropana 7 Kriyakalpas are mentioned.They are Kashaaya, Kalka, Varthi, Rasakriya, Avachoorna, Taila and Sarpi.Depending on the combination of drugs the Kriyakalpas may be ofShodhana or Ropana. Among these Taila is indicated in Vrana which hasUtsanna Maamsa, Alpa Sraava etc.Debridement is of three types i.e. surgical, chemical and mechanical. Insome conditions dead and devitalized tissue is removed by surgicalexcision, but by means of this chance of injuring healthy tissue will bemore. In case of chemical debridement various chemicals (like topical
agents i.e. povidone iodine, eusol, hydrogen peroxide etc.) are used in dayto day practice, but most of them are having limitations i.e. eusol has no rolein the treatment of open wounds that are clean, healing well with no signs ofinvasive infection. Povidone iodine should not be used in patients who aresensitive to it. In case of mechanical debridement flushing therapy orhydrotherapy etc. are used. Since the chemical substances used for thepurpose of dressing have their own setbacks, in the present study JatyadiTaila for external application is taken up to understand its efficacy in theShodhana and Ropana Karma.The patients selected for the trial were divided into two groups. Howeverboth the groups were given Triphala Guggulu & Gandhaka Rasayanainternally. The patients were observed during the course of treatment &follow up period as well. The observations and results were statisticallyanalyzed.From this study it becomes evident that the response in the trial group wasgood in terms of reduction of size of Vrana along with other features. Theresults are encouraging and it requires further study to explore new factsand figures.
The patients selected for the study were divided into two groups of 10 each.Group A was subjected to dressing with Jatyadi Taila and Group B withsterile dry gauze dressing. However both the groups were administeredTriphala Guggulu(450mg) 1tds & Gandhaka Rasayana(350mg) 1tdsinternally during the course of treatment. The course of treatment was 3months and follow up was done during the same period at weekly intervals.The observations made and salient features are as followsIncidence observations:i) Age: Out of twenty patients selected for the study, maximum incidence was seen in the age group between 41-60 years. It might be due to the reduced tissue vitality, immunity power and healing rate.ii) Sex: Maximum incidence of Dushta Vrana was seen in males.iii) Socio-economic status: Maximum incidence of Dushta Vrana was seen in lower middle class. It may be related to improper hygiene & malnutrition and this is yet to be established.iv) Area involved: Among 20 patients selected for the study, maximum incidence of area involved by the Dushta Vrana was seen in lower limbs. It might be because of less circulation (which plays important role in the healing) and lower limbs are more prone to trauma.v) Chronicity: Maximum incidence of chronicity was observed in the patients having duration upto one month.vi) Adhishtaana & Type of Dushta Vrana: Maximum incidence of Adhishtaana involved was Twak-Maamsa and most of them were diagnosed as Vaata-Pittaja, Vaata-Kaphaja Vranas.Discussion on the effect of treatment:
Observations were made in twenty patients before treatment and aftertreatment with Jatyadi Taila application in group A and sterile dry gauze ingroup B with regard to the different subjective and objective criteria listedin the study proforma. 1) Pain: Group A: All the patients were complaining of pain before treatment. The mean (pain) score was 1.5 and after treatment it was reduced to 0.2. Only two patients had mild pain at the end of the treatment. Among the types of Dushta Vrana i.e. Vaata- Pittaja & Vaata –Kaphaja, reduction of pain was observed in both the varieties without any significant variation. Among the causes of ulcers efficient reduction of pain in trial group was seen in varicose as well as traumatic ulcers without any significant variations. Group B: All the patients were complaining of pain before treatment. The mean (pain) was 2.1 & after treatment it was reduced to 0.6. At the end of the treatment 6 patients had mild pain. 2) Itching: Group A: Before treatment 6 patients were having itching and the mean (itching) score was 0.9. After treatment itching was reduced completely in 5 patients and the mean was reduced to 0.1.
Group B: Before treatment 6 patients were having itching and the mean(itching) was 1.1. After treatment itching was reduced completely in 3patients, in remaining patients it was reduced to grade 1&2 and the meanwas reduced to 0.4.3) Burning sensation:Group A: Before treatment 7 patients were having burning sensation andthe mean (burning sensation) was 1.1. After treatment in 6 patients it wasreduced completely, in 1 patient it was reduced to grade 1 and the meanwas reduced to 0.1.Group B: Before treatment 6 patients were having burning sensation andthe mean (burning sensation) was 1.1. After treatment in 4 patients it wasreduced completely, in remaining patients it was reduced to grade 1 andthe mean score was reduced to 0.2.4) Size of the ulcer:Group A: Out of 10 patients, ulcer was healed completely in 6 patients& in remaining 4 patients marked reduction was noticed. Beforetreatment the mean score was 7.55(length), 5.325(width) & 0.37(depth).After treatment mean was reduced to 1.67(length), 0.92(width) &0.04(depth).Among the cause of ulcer, reduction in the size of ulcer in trial group wasfast in traumatic ulcers, moderate in case of varicose ulcers and slow incase of pressure sore.Group B: Out of 10 patients, ulcer was healed completely in 3 patients.The mean score before treatment was 3.6(length), 2.35(width) &0.203(depth). After treatment the mean score was reduced to0.89(length), 0.505(width) & 0.0535(depth).5) Discharge:
Group A: Before treatment 9 patients were having discharge from theulcer & the mean (discharge) was 1.5. After treatment in 7 patientsdischarge was reduced completely, in remaining patients it was reducedto grade 1 and the mean score was reduced to 0.2.Group B: Before treatment 6 patients were having discharge from theulcer & the mean score was 1.2. After treatment in 4 patients dischargewas reduced completely, in remaining it was reduced to grade 1 and themean score was reduced to 0.2.6) Tenderness:Group A: Before treatment tenderness was present in 9 patients and themean (tenderness) score was 1.5. After treatment in 7 patients tendernesswas reduced completely, in remaining it was reduced to grade 1 andmean was reduced to 0.2.Group B: Before treatment tenderness was present in 10 patients and themean score was 1.9. After treatment in 6 patients tenderness was reducedcompletely, in remaining it was reduced to grade 2&1, mean was reducedto 0.5.7) Smell:Group A: Before treatment 3 patients were having smell from the ulcerand the mean score was 0.5. After treatment smell was reducedcompletely in 3 patients and the mean score was 0.Group B: Before treatment 3 patients were having smell from the ulcerand the mean score was 0.3. After treatment in 2 patients smell wasreduced completely, in remaining 1 patient it was reduced to grade 1 &the mean score was reduced to 0.1.8) Surrounding area of ulcer:
Group A: Before treatment 4 patients were having swelling and blackishdiscoloration (i.e. 3 patients with swelling & blackish discoloration and 1patient with blackish discoloration only) and the mean score was 1. Aftertreatment in 4 patients it was reduced to grade 1(only blackishdiscoloration with out swelling) and the mean was reduced to 0.4.Group B: Before treatment 8 patients were having swelling and blackishdiscoloration (1 patient with swelling & blackish discoloration, 4 patientswith swelling only, 3 with blackish discoloration only) and the meanscore was 1.4. After treatment in 3 patients swelling & blackishdiscoloration reduced completely, in remaining 5 patients it was reducedto grade 2,1( 4 with blackish discoloration, 1 patient with swelling) andthe mean score was reduced to 0.6.9) Floor & granulation tissue:Group A: Before treatment all 10 patients were having irregular floor,slough and unhealthy granulation tissue, the mean score was 2. Aftertreatment floor became healthy in 6 patients, in remaining 4 it becamesmooth, regular with pale granulation tissue and mean was reduced to0.4.Group B: Before treatment all 10 patients were having irregular floorwith pale granulation tissue and the mean was 2. After treatment in 3patients floor became healthy, in remaining patients it became smooth,regular with pale granulation tissue and the mean was reduced to 0.7.Follow up period:During the follow up period (2nd follow up) in a patient of varicose ulcerpain was aggravated associated with discharge. This can be attributed tothe unwholesome, unhygienic diets & regimen followed by the patient.
In both the groups even though aseptic & sterile precautions were takenduring dressing, sterile dry gauze dressing in group B may avoid theexternal contamination and may not be able to promote the growthpromoting factors of granulation tissue. In group A i.e. application ofJatyadi Taila in addition to aseptic & sterile precautions might causeproliferation of granulation tissue which can be assessed or evaluated interms of faster reduction in the size of ulcer, amount of discharge, smelletc.Probable action of drugs:Jatyadi Taila:Most of the ingredients of Jatyadi Taila are having Shodhana, Ropana,Vedana Sthaapana properties, Tikta, Katu, Kashaaya Rasas and Rooksha,Laghu Gunas.Kashaaya Rasa: It does Shoshana there by it might be helpful in VranaRopana.Tikta Rasa: It does Twak Maamsa Sthireekarana and Lekhana. It mighthelp in increasing tensile strength of wound & removal of slough.Katu Rasa: It has Vrana Shodhana & Avasaadhana properties.Tuttha: It is one of the ingredients of Jatyadi Taila having LekhanaKarma. So it may help in removing the slough. Even in current surgicalpractice CuSO4 is used in the removal of slough from the ulcers. SoTuttha is one which may have such sort of action.Tila Taila: It is used in the preparation of Jatyadi Taila and has Ushna,Teekshna, Madhura, Vaataghna, Vyavaayi, Vikaasi, Sookshma
properties. When it is treated with drugs it takes the properties of thosedrugs. So it might help (medicine) in reaching the minute spaces quicklyby means of its Sookshma, Vyavaayi, Vikaasi Gunas & helps in reducingVedana( because of Vaataghna property).Triphala Guggulu:Guggulu is one of the important ingredients of Triphala Guggulu. It ishaving Vedana Shaamaka, Lekhana properties. As Vedana is one of theimportant feature of Dushta Vrana, it might help in relieving Vedana.Triphala Guggulu has Vaataghna, Kaphaghna properties by means ofwhich it may reduce swelling and promotes the healing.Gandhaka Rasayana:It might facilitate the healing (by formation of healthy granulation tissue)by its Rasayana action and Kleda Hara Guna.So locally application might normalize the Doshas and Dhaatus in thatparticular region. For nourshing Dosha & Dhaatu in whole bodycombination of internal as well as local medicines is needed.Discussion on bacteriological study:From bacteriological study it becomes evident that Jatyadi Taila is havingmild antibacterial activity in case of Pseudomonas aeruginosa. For othervarieties it is not having antibacterial activity. After 15 days ofincubation, inhibition zone (11mm) was noticed and no contamination
was observed in case of pseudomonas aeruginosa, no zone of inhibitionwas observed in other varieties.Jatyadi Taila is not promoting the growth of bacteria. The wound healingproperty is not only limited to the antibacterial activity but other factorsare also responsible which have to be studied further.
From this study the following conclusions can be drawn.In the trial group the results are of significant value in symptomatologieslike size of ulcer, discharge, smell, burning sensation, tenderness, floor&granulation tissue, pain & itching.Even though statistically there is no much significant difference betweenthe two groups, but by seeing the effect on individual parameters(subjective&objective) and over all response Jatyadi Taila seems to beeffective when compared to dry gauze. It is having more of Ropanaqualities when compared to Shodhana.Jatyadi Taila is having slow inhibition zone for pseudomonas aeruginosaand not having inhibition zone in case of others (like e.coli, streptococcietc.). It is not promoting the growth of bacteria.Thus it can be concluded that Jatyadi Taila application externally alongwith Triphala Guggulu & Gandhaka Rasayana as oral medication areeffective in Dushta Vrana by their Shodhana, Ropana, Vedana Shaamaka,Rasayana properties etc.
With the introspection of the literature in the Prevedic & Vedic era,ample of references are found in the Vedas & in all the literatures later tothat.Sushruta the father of Indian surgery has given importance to Vrana andits management. He has mentioned two definitions for the word Vrana.One definition refers to the breach in the continuity whereas the otherrefers to the healing of Vrana with discoloration. The description ofVrana according to the predominance of the Dosha, Varna, Sraava,Gandha, Vedana, Aakruthi, Upadravas of Vrana & Vranitha are found inthe classics. For the management 60 therapeutic measures are describedin detail. If the Vrana is not treated properly it becomes vitiated due tothe involvement of Doshas and Dhaatus. The management of DushtaVrana can be carried out by Antahparimaarjana and Bahiparimaarjana.Among the Bahiparimaarjana various Kriyakalpas for Shodhana andRopana are mentioned. In the pain dominant Vrana Taila is mentioned asa superior Kriyakalpa among the others. Depending on the combinationof drugs it can be used either for Shodhana or Ropana.Ulcer is a defect produced due to the necrotization of the inflammatorytissue. The repair of injured tissue is an even more fundamental processthan inflammation. Healing is an aspect of repair but it suggests theclosure of some gap as in a wound or an ulcer. A wound of skin may healperfectly, but the new tissue is a scar lacking sweat glands, sebaceousglands and other specialized structures. The damaged or necrotized tissueliberates the chemical stimulus which in turn triggers the mechanism ofhealing. The process of healing is fundamentally the same in all the
wounds, but there are marked quantitative differences depending on theamount of tissue destruction and to a certain extent on the presence ofsepsis. Removal of inflammatory material and necrotic debris, whichmay be much or little replacement or reconstruction of the original tissueto as great a degree as possible. It involves the invasion and replacementof dyeing and dead tissue by immature mesenchyme for granulationtissue. The essential function of granulation tissue is to replace uselessmaterial by living mesenchyme.The process of conversion ofinflammatory debris into granulation tissue and finally into fibrous tissueis known as organisation. Under conditions of ordinary health repairproceeds at a uniform rate provided there is no local interference. Someof the general factors are age, diet, vitamin c deficiency and local factorsare ischaemia, local irritants and systemic effects of trauma inhibit theprocess of healing. The debridement of an ulcer can be carried out bysurgical, chemical and mechanical debridement to facilitate the healingprocess.In the present study Jatyadi Taila was used for local dressing of ulcer andTriphala Guggulu, Gandhaka Rasayana 1tds each was administeredinternally. In Jatyadi Taila majority of the ingredients posses the qualitiesof Katu, Tikta,Kashaaya Rasa, Rooksha, Laghu Guna etc. Probably thesemight have brought about the reduction in discharge, smell, removal ofslough and there by promote healing. Similarly in Triphala Guggulu andGandhaka Rasayana the attributes bring about the healing by theRasaadhi Panchakaas of the ingredients mainly Kashaaya, Katu Rasas,Laghu, Rooksha Gunas, Vaata & Kapha Hara properties. They produceVedana Shaamaka, Shotha Hara and Rasayana properties.
The patients diagnosed as Dushta Vrana were randomly selected anddivided into two groups i.e. group A & group B. In group A dressingwas done using Jatyadi Taila after taking all the aseptic precautions,whereas in group B after taking aseptic precautions dressing was doneusing dry gauze. However both the groups were internally administeredTriphala Guggulu and Gandhaka Rasayana 1tds each. The generalobservations were made on age, sex, occupation, socio-economic status,chronicity, Adhishtaana, type of Dushta Vrana, area involved by DushtaVrana along with subjective parameters (like pain, itching, burningsensation) and objective parameters(like size of ulcer, tenderness,discharge, smell, surrounding area of ulcer, floor & granulation tissue).All the observations were statistically analyzed.Duration of the treatment was for a period of 3 months and follow up wasdone at weekly intervals during this period.The following conclusions can be drawn from the study. Significanteffect was seen in trial group(group A) in symptomatologies like size ofulcer, discharge, smell, burning sensation, tenderness, pain, itching,granulation tissue etc. even though there is no much differencestatistically between the two groups. Jatyadi Taila is having slowinhibition zone for pseudomonas aeruginosa and it is not promoting thegrowth of bacteria. The results are encouraging and leave scope forfurther exploration in this field.
Ayurvedic review:Historical review:History of Vrana is as old as mankind. Professionals faced the problemon healing of wounds and ulcers. The review of literature makes itclear that constant research for new techniques and solutions to problemswas going on in the annals of history. Hence, the review of literatureregarding Vrana from Vedic to recent will not be out of context.Some of them are as follows:The literature can be studied under three headings:1) Prevedic era2) Vedic era3) Postvedic eraPrevedic era:During this period no direct references regarding Vrana are available.Vedic era:During this period Rigveda and Atharvaveda are considered as chiefsources of medical informationRigveda1:Many references are seen in Rigveda. Sandhaan karma done by AshwiniKumaaras in case of severed head of Yajna (Daksha), joining the limbof Vishpala the daughter of Khela are worth mentioning.
Atharvaveda2 :Ayurveda is Upaveda of Atharvaveda . Many references are availablelike administration of Rohini Aushadi in Kshata and Vrana,Sheetalajaladhaara for stoppage of bleeding in Sadhyovrana areimportant.Post vedic era:Agnipurana3: Surgical wounds are enumerated in Agnipurana.Mahavagga ( Buddhist tradition )4:Vrana with Pooya were drained and later they were treated withbandaging, dusting, fumigation etc.Kautilya Arthashaastra5:When Kautilya defined legal offences he has mentioned these acts aspunishable offences, they are1) Any injury which results in bleeding other than Dushta Vrana is punishable.2) Any injury which results in bleeding other than Dushta Rakta is punishable.Jaatakamala6:Dushta Vranas which are painful along with pocket full of pus, shouldbe carefully opened and drained. The wound becomes painful when itcomes in contact with salt.
Harshacharita7:References regarding the difficulty in management and arresting thebleeding in the wounds located in Hruth Pradesha, complications likeshock, collapse,and unconsciousness in case of fresh wounds with painand haemorrhage is mentioned. The bandaging was carried out with cottoncloth and in some cases need for fine bark of the trees to cover thewounds is also mentioned.Kaadambari8:Wounds were produced by constant friction and injury. Sometimesinjury was severe which produced disabilities in the organs and afterhealing of the wound there remained scar.Samhita kaala9:Detail description of Vrana with its management is mentioned inBrihatrayee and Laghutrayee.36 therapeutic measures were explained in Charaka where as Sushrutahas mentioned 60 therapeutic measures for Vrana .Description about Vrana is also mentioned in Bhela Samhita,Kaashyapa Samhita, Gadha Nigraha, Chakradatta, Yogaratnakara,Bhaishajya Ratnavali.Historical review:
that which exposes the interior of body.Classification3:Almost all the Acharyas have classified Vrana into two catagories i.e. Nijaand Aagantuja depending upon the causative factors.The Doshas get vitiated by their own causative factors or by theexternal agents.Nija or Shaareeraja vrana:Sushruta has specially mentioned these Nija Vranas to be due toVaataja , Pittaja, Kaphaja, Raktaja, and Sannipaataja.These are further classified into 15 types on the basis of permutation& combination of Tridoshas along with Rakta.Charaka has described Nija Vrana as only of 3 types i.e.due to Vaata, Pittaand Kapha.Aagantuja vrana:It is caused by trauma from Purusha, Pashu, Pakshi, Vyaala,Prapatana, Peedana, Prahara,Teekshnaoushadha, Agni, Kshaara, Visha,Kapaala, Shringa.Sushuruta classified Sadhyovrana into 6 types based on theirfeaturesThey are Chinna, Bhinna, Viddha, Kshata, Pichita & Ghrista.According to Astanga Sangraha Aagantuja Vrana is of 3 types i.e.Chinna, Viddha, Pichita.
Sadhyo Vrana are of 8 types according to Astaanga Hridaya i.e.Ghrista, Avakrutha , Vichinna , Pravilambita, Paatita, Viddha, Bhinna,Vidalitha.Description of Sadhyo Vrana in Maadhava Nidaana is similar to thatmentioned by Sushruta where as Shaarangadhara mentioned 8 types.Though Vaagbhata has also accepted classification given by Sushruta, buthas mentioned them along with specific clinical features.Charaka has classified Vrana into 20 varieties depending upon theirdistinctive features, they are4 Krutya, Akrutya, Dushta, Adushta,Marmasthita, Amarmasthita, Samvrutha, Vivrutha, Daaruna, Adaaruna,Sraavi, Asraavi, Savisha, Avisha, Vishamasthita, Samasthita, Utsangi,Anutsangi, Utsanna, Anutsanna.Sushruta and Charaka have also mentioned Vrana as Dushta and Shuddhabut not as a type of classification.Charaka has also described 12 characteristic features indicating the advancedstage of morbidity of Vrana.These morbid conditions are also classified into 24 categories dependingupon their causative factors like Snaayu Kleda etc.Shaarangadhara classified Vrana under 4 major groups they are Aagantu,Dehaja, Shuddha, Dushta. These are further classified into 15 types.
Depending upon the stages of healing Vrana is classified into RuhyamaanaVrana and Roodha Vrana5.Accordinrg to shape Sushruta classified Vrana into 4 types they are:Aayatha, Vrutha, Triputaka, Chaturasra.According to prognosis based on location, type of Vrana and dischargeVrana is classified as Sukhasaadhya, Kruchrasaadhya, Yaapya andAsaadhya.Schematic representation of classification of Vrana: Kaarana --- Nija, Aagantuja. Avastha- -- Dushta, Shuddha,Ruhyamaana,Roodha. Vrana--- Aakruthi--- Aayatha, Chathurasra, Vrutha,Triputaka. Saadhyasaadhyatha--- Sukhasaadhya, Kruchrasaadhya, Yaapya,Asaadhya. 6Nidaana of Vrana :Shareeraja Vrana:The causes for this are same as the causative factors reponsible for thevitiation of Doshas. These are classified as Aaharaja and VihaarajaKaaranas.Table No. 1DOSA KAARANAS AAHARAJA VIHARAJAVAATA Vaataprakopakaaharaasi.e. Balavat Vigraha,Ativyaama, suppresion Katu,Lavana, of Adhaarniya Vegas, etc. Laghuaahara,Sushkasaaka,Valloora, Uddhalaka etc.PITTA Pittaprakopakaahaaraas i.e.Katu, Amla, Krodha, Shoka,Bhaya,Maithuna,Aayasa Lavana, Ushna, Vidaahi, Teekshna, Upavaasa etc. Tila, Pinyaka, etc.KAPHA Kaphaprakopakaaahaaraas, i.e. Divaswapna, Avyayaama, Aalasya . Madhura, Amla, Lavana, Sheeta, Snigdha Aahara, Maasha etc.
Lakshanas7 :Features of Vrana are of 2 types :1)Saamanya : pain.2)Vishesha : consists of signs and symptoms caused by Doshas.Vishesha Lakshanas:Vaataja Vrana Lakshanas:Vrana caused due to Vaata is Stabdha, Katina has Shyaava or Aruna Varna,Alpa Sraava and Vedana Baahulyata.Table No. 2- Lakshanas according to various Acharyas8:Lakshan Sushruta Charaka Kashyapa A.San. A.H. M.Ni. as Shyaava, Shyaava, Krushna, Aruna, Aruna, Shyaava or Varna Shyaava - Krushna,Bh Bhasma Shyaava Aruna asma of kapotha or Asthi. Asthi Varna Stabdha, Stambha, Stabdha,Vartma Rooksha Kathina Kathina - - Kathina Todha, Teevra Sphuruna,T Bheda, Todha,Vedana Ruk, Maharuja odha, Bheda Maharuja Chatachataya Bheda etc. Sphurana etc. na etc Alpa sraava Alpasraav resembling a Sheeta,Picchi Mastu, resemblin Mandhasra Alpasraav Mandhasr Sraava la,Alpasraav Kshaara, g Mastu, ava a aava a Maamsa Maamsa, Dhaavana, Pulakaam Pulakodaka bu
etc.Pittaja Vrana Lakshanas : Vrana caused due to Pitta will be associatedwith Daaha, Paaka, Raaga, Jwara, Trishna, Moha etc. has Kshipra Utpattiwith Neela, Peeta Varna and Pootisraava.Table No. 3- Lakshanas according to various Acharyas9:Lakshas Sushruta Charaka Ka.S. A.San. A.H. M.Ni Peeta, Neela, Neela, Peeta, Haritha, Peeta, Varna - - - Neelabha Krushna, Kapila Pingala PingalaUtpatti Kshipra - - Kshipra Kshipra - Raaga, Daaha, Paaka Paaka, Trushna, Trushna, Jwara, Daaha, Raaga, pain Anya Raaga, Moha, Moha, Daaha, Paaka, resemblilakshana studded Jwara, Jwara, Moha, Jwara,Dhoomay ng Vrana s with Kleda, Sveda, Trushna ana, caused Peeta Daaha by Pidaka Kshaara Sraava is warm, Sraava large in large in Sraava qty. resembling qty resembli Gomootra, resembli ng Pootisraa Pootisraa solution of ng PootisraaSraava Kimshuk va va Bhasma, Kimshuk va a flower, Kimshuka or a, Taila Ushna. Mrudveeka or or Taila solution of BhasmaKaphaja Vrana Lakshanas: Vrana caused due to Kapha will have Paanduor Shwetha Varna associated with Ugra Kandu, Mandha Vedana, Shukla,
Sheeta, Pichila and Ghana Sraava.Table No. 4- Lakshanas according to various Acharyas10:Lakshanas Sushruta Charaka Ka.sam. A.Sam. A.H. M.Ni. Varna Paandu Paandu Paandu Paandu Paandu Paandu Sthoola, covered Sthoola, with Sthaimith Katina, Bahu Snigdha, Snigdha, Stabdha ya, covered piccha, Vartma Guru,Bah Katina, Sira Maardhav with Sira Guru, u piccha Sthoola Snaayu a Snaayu Snigdha jaala, Jaala Katina Mandha Mandha vedana, vedana, Mandha Mandha, Mandha, Anya severe Kandu, Alparuk, vedana, vedana, vedanalakshanas Kandu, Swaapa, Kandu Sthaimith Chirakaari Chirakaari feeling of Sthaimith ya heaviness ya Sraava Sraava resemblin Large Alpa g Shukla, qty. of Samkleda Alpa Navaneeta Sheeta, Atisraava Sveta , samkleda , Tila Saandra Ghana Chirapaak pishta, sraava i Naarikelo dakaRaktaja Vrana Lakshanas: In general this Vrana will have features similarto that of Pittaja Vrana, has Pravaala (Rakta) Varna, Raktasraava coveredwith network of Krishna Sphota, smells like Turanga or Vaajisthaana.Table No.5- Lakshanas according to various Acharyas11: Lakshanas Sushruta A.Sam. A.H. M. Ni. Pravaala Pravaala Varna Pravaala Dhala Nichaya Raktha (Raktha) (Raktha) Covered with Covered with network of Vartma Krushnasphota, - - Krushnasphota, Pidaka Pidaka
Smells like Smells like Smells like Turanga Vaaji Sthaana, Vaaji Sthaana, sthaana, Vedanaayuktha,Anyalakshanas has other has other - Dhoomayana Sheela and features of features of having features of Pitta Pitta Pitta Sarakthapooya Sarakthapooya Raktha Sraava Raktha Sraava Sraava Sraava SraavaTable No.6- Dvidoshaja Vrana Lakshanas12:Sushruta has explained the Lakshanas depending upon combination ofDoshas while Vaagbhata and Maadhavakara has also made the similarattempt.Lakshanas VP VK PK VR PR KR Ghrita Aakruthi - - - - - manda Meena Gandha - - - - dhaavana - toya Rakta, Varna Aruna, Peeta - - - Rakta Aruna Todha, Todha, Daaha, Todha, Vedana - Kandu Daaha,Dhoomayana Kandu Ushna Supta Sheeta, Peeta, Rakta, Ushna, Rakta, Sraava Peeta, Aruna Picchila, Paandu Aruna Krishna Paandu Alpa Rooksha, Guru, Anya Rooksha, Mridu, - Guru, Guru Picchila,Lakshanas Tanu Visarpa Dhaaruna SnigdhaTable No. 7- Tridoshaja and Sannipaataja Vrana Lakshanas13:Lakshanas VPR VKR PKR VPK VPKR Has Varna - - - Varna of - 3 types
Nirdahana, Sphurana, Has Nirmathana, Todha, Kandu, Sphurana, Daaha, Vedana Sphurana, Vedana Daaha, Chumachumayana Kandu of 3 Todha, Dhoomayana types Daaha, Kandu Paandu, Has Peeta, Tanu, Paandu, Ghana, Sraava Ghana, Sraava of Naana Varna Rakta Rakta Rakta 3 types Anya Paaka, - - - Paaka, Raaga Lakshanas RaagaDushta Vrana14: £dÎdQdy°dQje°d£ddy QgÞZ || A. ±da. D. 29/4 Qdy°dzTe¥deÝ£ddy QgÞZ...............|| A. Umµ. D. 25/2Dushta is one in which there is localization of Doshas or Dushta meansgetting vitiated by Doshas.Vrana which smells badly (foul odour), has abnormal color with profusedischarge, intense pain and takes long period to heal is said to be Dushta.The features of Dushta Vrana will vary according to the predominant Doshapresent in it.Lakshanas of Dushta Vrana15:Table No.8- Lakshanas depending upon the shape, discharge,consistency and chronicity according to various Acharyas:
Sushruta Charka A.S. A.H. M.Ni. Atisamvrutha Mentioned 12 Either Atisamvrutha Either Samvrutha Discharg or Ativivrutha characteristic or Ativivrutha, or Vivrutha, es Pooti Ati-katina or features indicating Atimrudu or Katina, Katina or Mrudu Sraava, Mrudu, the advanced stage of Atiutsaadha or Atiutsanna or or Dushta Utsanna or morbidity of Vrana. Avasaadha, Avasanna, Ashruk,hAvasanna. Ati Svetatva, Avasanna Atisheeta or Usna Atiushna or as sheeta or Vartmatva, Rakta, Krushna, or Atisheeta, Utsangi Usna, having Athisthoola- Paanduta, covered Raktatwa or (sinuses) one of the Vartmatva,Atipinjara with Pooti Maamsa, Paanduta,Dischar inside, colours tva, Neelatva, Sira,Snaayu, etc. ges Pooti Pooya ChirastitKrushna,Rakta Syaavatva, Dishcarges Pooti covered with ha, emits, Peeta, Shukla Atipidakatva, Rakta- Pooya, Daaha, Pooti Maamsa, Pootietc,Bhairava,fi Krushnatva Paaka, Sira, Snaayu, Gandha lled with Atipootitva, Kandu,Svayathu,Ve associated with & Pootipooya,M Ropyatva Kumbhi- dana Pitaka, etc. Atiruk, Daaha, doesn’t aamsa, Sira, Mukhatva,.Vranas appearing as Swayathu, Kandu posses Snaayu etc. with Pootigandha, Upadravas, Dheerga & other any Moving in Vivarna, Bahusraava, Kaalanubandha complications, features oblique track Maharuja Dheerga Kaalanu of (Unmargi) bandha Shuddha having Vrana Amanoghna Darshana, Atigandha, Vedanayukta, associated with Daaha, Paaka, Raaga, Kandu,Shopha Pidaka etc. Discharging excessively Dushta Shonitha, Dheerga
e¡dæµd£d¬ddªddy «dmQgZ e±¦d›¥dZ ¯¬d´Pddy e®d›d£d®dyQ¦dZ ±dg®Sd®de±¤d£ddy e¦dTdàd®dÜdye£d ¯dg¥Qdy ®d‚Pd Be£d || ±dg.eŸd.1/7 Shuddha Vrana is one, which is free from the localization of Doshas. Vrana which is not invaded by Tridoshas, having Shyaava Oshta, which has developed Sama Pidaka, not having Vedana and Sraava is said to be Shuddha Vrana. Vrana which resembles Jihwa Talaaba, Mrudu, Snigdha, not having Vedana, Sraava and good looking is said to be Shuddha. Features mentioned by Sushruta and Vaagbhata are almost similar. Table No. 9 - Lakshanas according to various Acharyas17: Sushruta Charka A.San. A.H. M.NiNot invaded by Na Not vitiated by Resembles Jihva ResemblesJihva Tridoshas Atirakta, Doshas, in color, Talaaba and ishaving Shyaava Paandu, resembles Jihva Mrudu,Slakshna Atimrudu,Slakshna Oshta, Shyaava,(n in color, and is with Shyaava ,Snigdha,resembles Jihva a ati) Ruk, Slakshna having Osta,Samapidika, Suvyavasthitha, Talaabha & is Utsanna, Shyaava Oshta having Unnata Alpa Vedana ,Mrudu, Snigdha Utsangi. centre being Madhya,not Niraasraava. not having elevated or even acommpaniedVedana, Sraava, not having with any good looking, Vedana, Sraava. Upadravas. has developed Sama Pidika. Ruhyamaana vrana18:
Lakshanas: I¶§ddy£d®dPd‰§d‚e£d«dd Sd±Sdd¦£ddZ ™¬dyQ®de¡d‰£ddZ | e±¤dTdeÜde§deLµI¶d®d¦£ddy TdyUµ£dfe£d £d«ddeQ¯dy£dŠ || ±dg.±dj. 23/19Vrana which has Kapotha Varna,devoid of Kledha and has Sthira Pitika issaid to be Ruhyamaana Vrana.Similar type of description is mentioned by Vaagbhata and inMaadhavanidaana.Samyak Roodha Vrana19:Lakshanas:éOµ®d£«dd‰¦d«d›d‚e¦¤d«d¯dj¦d«dè¡da ®d‚Pd«dŠ | £®d™±d®dPd‰a ±d«d£d¬da ±d«Sd›d‚jOµa e®de¦deQ‰¯dy£dŠ || ±dg.±dj. 23/20Vrana which has healed in its seat (dwelling place) without eruptions(Granthi), pain (Vedana) or swelling, has the colour as that of Twak and iseven is said to be Samyak Roodha.Samprapti20:Doshas being aggravated by their respective causative factors gets lodged inany of Vrana Sthaanas to give rise to Vrana.Vaata, Pitta, Kapha being aggravated by their respective causative factors
gets lodged in the exterior of the body to give rise to Nija Vrana.Examination of Vrana21:°dP«dj¬ddyíÝ§deT›d‚dUµf §d¢Ÿd¬d´dPd¬de´d£dZ| °d°Æd e®d¥dd¦dze¦d‰eQ‰ÝzÜd£dgeªd‰Z ±ddØ£dy ®d‚PdZ || ±dg. eŸd. 1/134Sushruta emphasizes that before treating the Vrana one should know theShanmoola i.e. the causative factors (Vaata, Pitta, Kapha, Sannipata, Rakta,Aagantuja),Ashta Parigrahee i.e. 8 Vrana Adhistaanas (Twak, Maamsa, Sira,Snaayu, Asthi, Sandhi, Koshta, Marma),Pancha Lakshana Lakshitaha i.e.features of Vaataja, Pittaja, Kaphaja, Sannipaataja and Agantuja Vranas aswell as Varna, Sraava, Gandha, Vedana, Aakruti and also 60 Upakramas forthe proper management of Vrana. Further it is said that these four(i.e.Shanmoola, Astha Parigraahi, Pancha Lakshana and Shastya Vidhana)are to be thoroughly understood by the Vaidya before treatment,along withthe Chikitsa Chatushpaadha the treatment of ulcer becomes easier.Examination of Vrana & patient suffering from this ailment is to be carriedout in 3 different ways. They are Darshana, Sparshana and Prashna.Darshana:By Darshana Pareeksha age of patient, site of Vrana, Aakruthi, Varna,condition of Vrana, etc. can be elicited.
Sparshana:It helps in eliciting the hardness or softness of Vrana, increase or decrease oflocal temperature etc.Prashna:By Prashna Pareeksha the cause for Vrana, type of Vedana, Agni Bala,Saatmya etc. are to be examined.Sushruta mentioned Shadvidha Pareeksha for the diagnosis.Darshana and Sparshana should be done by Panchaindriya Pareeksha.Sthaana of Vrana (Vranavasthu)22:Site of Vrana is to be taken into consideration while examination.Twak, Maamsa, Sira, Snaayu, Asthi, Sandhi, Koshta, Marma - these eightare Vrana Vastu (dwelling seats of Vrana). In these all kinds of Vranasoccur.Sushruta & Vaagbhata have mentioned Sandhi as the site instead of Medaswhich was mentioned by Charaka.Maadhavakara (Maadhavanidaana) explained Samaanya & VisheshaLakshanas in case of injury to Maamsa, Sira, Snaayu, Sandhi, Asthi,Marma.
Table No. 10- Vrana Sthaana and its Lakshanas according toMaadhavakaraVRANASTHAANA LAKSHANASInjury to Maamsa, Sira, Snaayu, Saamanya Lakshanas:- Bhrama, Pralaapa,Sandhi, Asthi Pathana, Srasthangatha, Vichestana, Pramoha, Glani, Ushnata, Moorcha, Teevraruja, dischrge of Rakta resembling Mamsodaka, loss of functions of Indriyas etc. Vishesha LakshanasInjury to Sira Profuse discharge like Indragopa.Injury to Snaayu Decrease in height,drooping,loss of Pain, Vrana takes long time to healInjury to Sandhi Increase in Shopha ,severe pain,loss of strength, total loss of function etcInjury to Asthi Severe pain continuously throughout the day and night, no relief in any posture.Injury to Maamsa Marma Pallor,loss of tactile sensation.Shape of Vrana (Aakruthi)23:Aayatha, Chaturasra, Vrutha, Triputaka. These are the shapes of Vrana,others with abnormal shapes are treatable with difficulty.According to Vaagbhata shape of Vrana is considered according to the shape
of Shalya.Shapes of Aagantuja Vranas are Aayatha, Chaturasra,Trayastra, Mandalina,Ardhachandraakaara, Vishaala and Kutila etc.some resemblingSharaavanimna madhyascha,others with elevation in the centre or AagantujaVranas have innumerable shapes.Vrana Gandha24:Examination of Gandha of Vrana is also important.Eight types of Gandha are described by Charaka.i.e.Sarpi,Taila,Vasa,Pooya,Rakta,Shyaava,Amla,Pootika. These have beenincluded in discharges by other Acharyas.Vrana Varna 25:Table No. 11- Colour of Vrana according to the involvement of Doshas Dosha Colour of Vrana Vaata Bhasma, Kapota, Asthi, Parusha, Aruna, Krushna. Pitta & Rakta Neela, Peeta, Haritha, Shyaava, Krushna, Rakta, Kapila, Pingala. Kapha Sweta, Paandu, Snigdha. Sannipaataja Sarva Varna.Vrana Vedana26:Table No. 12- Vrana Vedana according to Dosha involvement Dosha Vedana Vaata Todha, Bhedana, Chedana, Taadana, Manthana, Chumachumaayana, Nirdahana, Sphotana, Kampana, Vidaarana etc. Pitta Osha, Chosa, Daaha, Dhoomaayana, Vedana as if Kshaara is put in Vrana. Kapha Kandu, Gurutwa, Suptata, Alpa Vedana. Rakta Similar to that of Pitta. Sannipaata All types of Vedana.
Vrana Sraava27:Sushruta and Vaagbhata have given list of discharges based on location(Vranavastu) or involvement of Doshas.Table No. 13- Vrana Sraava according to involvement of DoshaDosha Vrana SraavaVaata Parusha, Shyaava, Dadhimastu, Kshaarodaka, Maamsa- dhaavana,Pulakodaka.Pitta Gomeda, Gomootra, Shanka, Kashaayodaka, Maadhveeka Taila etc.Kapha Navaneeta, Kaseesa, Majja, Naarikelodaka,Varaahavasa.Raktha Like Pitta but more of Raktha Sraava.Sannipaataja Naarikelodaka, Priyanguphala, Kaanjeeka etc.Table No. 14 - Vrana Sraava according to Sthaana Sthaana Sraava Twak Salilaprakasha, Peetaavabaasa. Maamsa Sarpiprakasha ,Sheeta, Picchila. Sira Rakta Atipravruthi, Pooya comes out after Paaka. Snaayu Snigdha, Ghana, Singhanaka pratima, Sarakta. Asthi Discharge mixed with Rakta, Majja. Sandhi Picchila, Saphenarudhira. Kostha Discharges Asruk, Mootra, Pureesha, Pooya, Udaka.Features of Sraava mentioned Vaagbhata is similar to Sushruta.Charaka has explained 14 types of Sraava they are Laseeka, Jala,Pooya,Asruk, Haridra, Aruna, Pinjara, Kashaaya, Neela, Haritha, Snigdha,Rooksha, Sita, Asita.Saadhyaasadhyatha:Sukha saadhya Vrana28:
Characters:£dÎd ®dSdZ ±¤dd¦dda QmOµd¦dda §d‚dPd®d£dda ±d£®d®d£dda Ÿd ±dgeŸdeI¶£±Sdd ®d‚PddZ || ±dg. ±dj. 23/3Vrana arising in Vayah (Vrana heals quickly because of PratyagraDhaatus),Dhruda(Body having Sthira,Bahu Maamsa, Shastras even thoughused in treatment do not cause damage to the Siras, Snaayusetc),Praanavanta(Do not become exhausted by Vedana, Abhighaata etc) andSatwavanta(Do not suffer from Vedana caused by Dhaaruna Kriya). Vranas arising in Twak, Maamsa as Adhisthaana. Aayatha, Chaturasra, Vrutha, Triputa Aakruthi Vranas. Vranas treated by good Vaidyas & patient who is Aatmavantha. Vranas situated in Sphik, Paayu, Prajanana, Lalaata, Ganda, Oshta, Prusta,Karna,Phalakosha, Udara etc. Location of Vrana in easily approachable site. Vranas of recent origin & not associated with Upadravas.Kruchrasaadhya Vrana29:Characters: Vranas arising in Vruddha, Krusha,Alpapraana,Bheeru etc. Vranas having Vikruta Aakruthi. Vranas situated in Akshi, Dantha, Naasa, Apanga,
Srotra,Naabhi,Jatara,Sevani,Nitamba,Parshwa,Kukshi, Vaksha,Kaksha etc. Vranas of those suffering from Kushta, Visha, Shosha, Madhumeha. Vrana associated with complications. Vranas treated by quacks & patient who is Anaatmavantha. Vranas which exude Phena, Pooya, Anila, having Shalya,elevated, Bhagandara etc.Yaapya Vrana30:Characters:Vranas of Avapaatika, Niruddhaprakasha, Sanniruddha Gudha, Jatara, thosesuffering from Twak Dosha, Prameha, Kantashaalooka, Dantasharkara etc.Asaadhya Vrana31:Characters:Vrana in spite of being situated in location not near Marma Sthaana, freefrom Siras, Sandhis, Asthi, spreads all over the body.Vranas which are elevated like Maamsapinda with excessive discharge,containing Pooya inside associated with Vedana, having Oshta like AshwaApaana, indurated and protruded like Goshringa, those discharging DushtaRudhira,Tanu,Sheeta,Picchila Sraava, elevated in centre, some are
Santoolavath contains Snaayu, Jaalas, having Durdarshana, Vranas due tovititated Doshas discharging Vasa, Meda, Majja, Mastulunga, KoshtasthaVrana having discharges of Peeta or Asita Varna, Mootra, Pureesha etc. andalso those having discharges of Pooya and Rakta.Vranas situated in all ground materials (Sarvotogatha) with Anumukha andMaamsa Budbudha. Vranas situated in Shira, kantha from which air escapesmaking sound.Vranas in Heena Maamsa person discharging Pooya, Rakta, associated withArochaka, Avipaaka, Kaasa, Swaasa like Upadravas.Bhinna Vrana in Shira, Kapaala, followed by appearance of Mastulunga,features of all the 3 vitiated Doshas or Kaasa & Swaasa are incurable.Vranas discharging Vasa, Majja, Mastulunga are curable if caused byAagantuja Kaaranas, otherwise it is incurable (i.e. those caused by Doshas).Vranas with Pulakodaka like Sraava from Pakvaashaya, Kshaarodaka typeof Sraava from Raktaashaya, Kalaaya type of Sraava from Aamaashaya &Trikasandhi Pradesha. ±dd¥Sdd Sdd§Sd£®d«ddSdde¦£d Sdd§SddÜdd±dd¥Sd£dda £d¤dd | œ¦de¦£d §d‚dPdd¦d±dd¥Sdd±£dg ¦dTdPdd«de¸¶Sdd®d£dd«dŠ || ±dg.±dj. 23/9
If proper treatment is not done Saadhya Vrana becomes Yaapya, Yaapyabecomes Asaadhya and Asaadhya may kill the patient.Vrana Chikitsa32:Vranithaagaara:Vrana Chikitsa should be done in Vranithaagaara to prevent the invasion ofNishacharas in Vranithasya. It should be auspicious and in accordance withVaastushaastra etc.Vranitha will not suffer from physical, mental & traumatic disorders byresiding in such Aagaara.Rakshakarma should be done along withDhoopana. QgÝ®d‚Pdy°dg I¶£d‰®Sd«dj¥®d‰a Ÿdd¥dÜd ¯ddy¥d¦d«dŠ || e®d¯ddy°dPda £d¤ddííUµdTZ ¯ddyePd£d±Sd Ÿd «ddy´dPd«dŠ | I¶°ddSda Td¡d®dm´ddQdz ±dgT±ddQdz Ÿd ¥dd®d¦d«dŠ || £dSddyTy®d I¶°ddSdyPd £dz¬da ¯ddy¥d¦de«d°Sd£dy | ´ddTI¶¬§dy¦d ®dd £dz¬da ´ddTQ„®Sdy°dg ±dde¥d£d«dŠ || ±dg. eŸd. 2/86-88 £dy°dg I¶°ddSddy ®de£d‰Z I¶¬I¶Z ±de§d‰±£dz¬da T±de¸¶Sddí®dŸdjPd‰¦de«de£d ¯ddy¥d¦d Tdy§dPdde¦d........_|| ±dg. eŸd. 1/9
In Dushta Vrana Oordhava and Adaha Shodhana should be done thenApatarpana, Raktamokshana should be employed. Kashaaya ofAaragwadhadi & Surasadi Ghana Dravyas should be used for Dhaavana &Taila prepared with Kashaaya of same Dravyas or with Kshaara Drava isused for Vrana Shodhana.Charaka has mentioned 36 Upakramas for the treatment of Vrana where asSushruta has mentioned 60 Upakramas among them Kashaaya,Kalka,Varthi, Sarpi, Taila, Rasakriya, Avachoorna these 7 are both Shodhana aswell as Ropana.Charaka has explained Samaanya and Vishesha Chikitsa for Vrana33Samaanya Chikitsa:Vranitasya should be given Shodhana, therapies through Vamana orVirechana.Venesection with help of Shastra and Basti. When body becomesShuddha Vrana gets healed up spontaneously.Vishesha Chikitsa:Vaataja Vrana Chikitsa: Person suffering from Vaataja Vrana should betreated with Sampoorana, Snehapaana, Swedana,Upanaaha,Pradeha,Parisheka which are of unctuous nature.Pittaja Vrana Chikitsa: Person suffering from Pittaja Vrana should betreated with Pradeha, Parisheka, Sarpipaana, Virechana prepared by
Sheetala, Madhura, Tikta Dravyas.Kaphaja Vrana Chikitsa: Person suffering from Kaphaja Vrana should betreated with Pradeha, Parishechana,prepared of drugs which are Kashaaya,Katu, Rooksha,Ushna and Langhana, Paachana etc.Saptaupakramas 34:These are mentioned in treatment of Vrana Shopha they areVimlaapana,Avashechana,Upanaaha,Paatana,Shodhana,Ropana,VaikritaapahamSushruta has mentioned Trividha Karmas for management of surgicaldisorders,they are351) Poorva Karma 2) Pradhaana Karma 3)Paschat Karma.Poorva Karma:Among 60 Upakramas from Apatarpana to Virechana(mentioned forVranashopha) these are considered as measures of Poorva Karma. By meansof these measures either pacification of Vrana Shopha occurs or it becomesripened.Among 7 Upakramas of Vranashopha Vimlaapana, Avashechana, Upanaahathese 3 should be employed during the Aama Avastha of Vrana Shopha.Pradhaana Karma:Among 60 Upakramas starting form Chedana to Seevana (Shastrakarma) areconsidered as Pradhaana Karma.
In addition to Ashtavidha Shastra Karmas, Dharana Karma is mentioned incase of Baala, Vruddha, Bheeru and Vrana Shopha present in MarmaPradesha where Shastra Karma is contraindicated. This is performed bydoing Peedana with local application of Dravyas.Among 7 Upakramas of Vranashopha Paatana is considered as PradhaanaKarma.Paschat Karma:Among 60 Upakramas starting from Sandhaana to Rakshavidhaana oramong 7 Upakramas Shodhana, Ropana and Vaikrutaapaham areconsidered under Paschat Karma.1)Vimlaapana: In case of Sthira, Mandha Ruja Vrana Shopha after doingSnehana and Swedana to the part Peedana should be done with bamboo tubeor palm and sole or thumb.2)Avashechana: In case of Shopha of recent onset, Raktamokshana shouldbe resorted in order to mitigate the Vedana and Paaka. Even in Vranasassociated with Shopha, which are Katina, containing Rakta, Vedanayukta,deep seated Rakta Avashechana should be done. In case of Shophaassociated with Visha, Rakta Visraavana should be done by using leech orby Shastra Padha in order to mitigate Vedana and prevent Paaka.3)Upanaaha: It should be applied in Aamaavastha and Vidagdhaavastha ofVrana Shopha.It pacifies the former and ripens the later.4)Paatana: It should be done in case of Pakwa Shopha only.
5)Shodhana: It is one of the important measures in case of VranaChikitsa.Among 60 Upakramas as mentioned earlier Kashaaya, Varti, Kalka,Sarpi, Taila, Rasakriya and Avachoornana are the different methods forShodhana.In case of Vrana associated with Durgandha, Kledha and PicchilaShodhana should be done using Kashaaya of various Dravyas.Shodhana Taila: In case of Vrana which has Utsanna Maamsa, Alpasraavaetc.Shodhana should be done with sesamum oil mixed with musterd oil.6)Ropana: Ropana Kriya should be adopted in Vranas which are havingthe features of Shuddha Vrana .Kashaaya, Varthi, Kalka, Sarpi, Taila, Rasakriya and Avachoornana are thedifferent methods for Ropana.Ropana Taila: In case of Vranas which are predominent in Kapha andVaata Ropana should be done by Taila processed with Dravyas.7)Vaikrutaapaham: Even after complete healing of Vrana restoration ofnormal colour, shape are essential. So Vaikrutaapaham is such measurewhich helps in restoration. For this Krishna Karma, Paandu Karma,Romasanjanana, Lomaapaharana etc are mentioned.Table No.15- Upakramas of Vrana acc.to various Acharyas36: Uapakrama Sushruta Charaka Kashyapa A.San/A.H Apatarpana + - - - Aalepa + - Pralepa Pradeha Parisheka + - + + Abhyanga + - - + Swedana + + - + Vimlaapana + - - +
Upanaaha Upanaaha, Paachana.Paatana Chedana, Bhedana, Dhaarana, Lekhana, Eshana, Aharana, Vyadhana, Visraavana, Seevana.Shodhana, Sandhaana, Peedana, Shonitasthaapana, Nirvaapana, Utkaarika,Ropana Kashaaya, Varti, Kalka, Sarpi, Taila, Rasakriya, Choorna, Dhoopana.Vaikrutaapaham Utsaadhana – Rakshavidhi.Among 36 Upakramas mentioned by Charaka, Shopaghna i.e. treatment ofVrana Shopha which involves Rakta Avashechana, Langhana, Sneha,Pralepa, Pradeha, Upanaaha etc. can be incorporated under 11 Upakramasmentioned by Sushruta for Vrana Shopha.Shastra Karmas mentioned by Sushruta can be incorporated under 6measures mentioned by Charaka even though he has told Eshana seperatelyand Aharana has been covered under 6 surgical measures only.Shodhana, Ropana, Vaikrutaapaham mentioned by Sushruta can also beincorporated under those mentioned by Charaka i.e. like Shodhana-Kashaaya, Taila, Ghrita, Ropana-Kashaaya, Taila, Ghrita, Utsaadana,Avasaadana, Aalepana (Maardhavakara & Kaatinyakara) etc.So from the above it becomes evident that 60 Upakramas mentioned bySushruta can be incorporated in 7 Upakramas of Vrana Shopha and most ofthem among 60 can be incorporated under 36 Upakramas mentioned byCharaka.Pathyaapathya37:
Pathya:Vrana patient should consume Jeerna Shaali,Odhana which is made warmunctuous& taken with Jaangala Maamsa. Soup prepared from Tanduliyaka,Jeevanti, Vaartaaka, Patola, Kaaravellaka, Daadima,Aamalaka etc.Vrana person should not sleep during day, should remain inside housedevoid of breeze etc.Vrana patient should remain devoid of undesirable nails, hairs should beclean, resort to observance of propitiatory and auspicious rites.Apathya:Vrana patient should not consume Navadhaanya, Maasha, Tila, Kalaaya,Kulattha, Nishpaava, Hareetaka Shaaka, Katu, Amla, Lavana Rasasubstances, Guda,Sushka Shaaka,eatables made from Pishta, Ajaa, Avika,Anoopa, Maamsa, Sheeta Udaka, Krushara, Paayasa, Dadhi, Dugdha etc.Person who is habituated to drinking Madhya should avoid using Maireya,Arista, Aasava, Seedhu etc.Vrana person should avoid Vaata, Aatapa, Raja, Dhooma, Atibhojana,Bhaya,Shoka, Krodha,Raatri Jaagarana, Vishamaashana, Vyayaama,Upavaasa,Chankramana etc.Upadravas38:These are mainly classified as Vranasya Upadravas,Vranitasya Upadravas
Vranasya Upadravas :- are five relating to abnormality in Aakruthi, Vedana,Gandha,Sraava, Varna. Vranitasya Upadravas:-Jwara, Atisaara, Moorcha, Hikka, Chardi, Arochaka, Swaasa, Kaasa, Avipaaka, Trushna. Charaka mentioned 16 types of Upadravas they are: Visarpa,Pakshaaghaata, Sirasthamba, Apataanaka, Moha, Unmaada, Vrana Ruk, Jwara, Trushna, Hanugraha, Kaasa, Chardi, Atisaara, Hikka, Swaasa and Vepathu. Aagantuja Vrana 39: These are caused by exogenous factors like physical, chemical, mechanical, trauma etc and produces 6 varieties of Vrana. They are classified on the basis of type,depth of injury, amount of destruction of tissue and macroscopic features. Table No.17- Aagantuja Vrana Lakshanas according to various Acharyas:Type Sushruta A. San. A.H. M.Ni.Chinna Vrana is Chinna Vrana is further divided into ---- Vrana is oblique five types oblique/straight, /straight,sepera i.e.Ghrishta,Avakritha,Avagaada,Vila wide, causing tion of body mbita,Paatita. seperation of parts. body parts.Bhinna Perforation/ Mentioned Vrana Puncture of puncture of Anubhinna,Bhinnotthundita,Atibhinna occuring in Aashayas,dischar
Aashayas,exud ,Nirbhinna to those Vranas which Koshtha ging contents to ing mild occur in Koshtha. with small the exterior. Sraava. orifice.Viddha Injury to any Classified into further 8 types- Vrana with Injury to any part part of body Anuviddha,Uttundita,Atividdha,Nirvid small of body other other than dha etc. orifice than Aashayas Aashaya,Uttun occuring and Uttundita. dita. anywhere other than Koshtha.Kshata Vrana which is Considered Chinna,Viddha &Picchita ………… Neither neither Ati as Kshata because of loss of skin …….. Atichinna nor Chinna nor Ati continuity. Ati Bhinna but Bhinna. but having mild having features of both features of & irregular in both and shape irregular in shape.Type Sushruta A. San. A.H. M.Ni.Picchita Flattening of Body part with Asthi increasing in size Mentioned Flattening of any any part of by getting soaked in Rakta and Majja. Vidalita in part of body body along it is of two types with Vrana and which along with Asthi, with Asthi, without Vrana. features are filled with Rakta filled with similar to and Majja. Rakta and features Majja. mentioned in Sushruta.Ghrista Peeling of skin Mentioned it as Twak Chedana. Exudes Peeling of skin of any part of Laseeka of any part of body alone or body accompanied mixed with accompanied with watery lttle of with watery exudation. Rakta exudation. associated with burning sensation.Avagaad ……………… Broad and long(Vishaala and Severe than ………….a Aayama)mentioned it as a type of Ghrishta Chinna Vrana. Vrana.Vichinn ……………… ……………. Severe than …………….a Avagaada Vrana.
Paatita ……………… Body part getting detached or Injured ………………. .. seperated completely from body. body part gets seperated from body.Pravila ……………… ………………… Vrana in ………………mbhi which Asthi remains in place.Vilambit ……………… Vrana in which little of Asthi,Snaayu ………… ……………..a etc remains as residue. ………Avakrut ……………… Abrasion of Twak and little of ………… ………………ha Maamsa. …. … Chikitsa40: 1) Saamaanya Chikitsa: Immediate general treatment is to pacify the Ooshma released at the site of injury by Sheetala Kriya’s(cooling measures )[ i.e.like that of Pitta Chikitsa] along with use of Madhu, Ghrita for Shodhana. Sadhyo Vrana which has severe pain should be washed in warm Yashti Ghrita or Bala Taila often in order to mitigate the heat of Vrana. Drugs which posses Kashaaya,Sheeta,Madhura,Snigdha properties should be made use for Lepa. Snehapaana,Parisheka,Swedana,Lepa,Upanaaha,Snehabasti prepared from Vaatahara drugs should be adiministered.
Agatunja Vrana can be cured by Mantra,Agada and external application ofdrugs in the form of paste.2)Vishesha Chikitsa:Chinna,Bhinna,Viddha Vranas --- Snehapaana,Seka,Upanaaha withVeshavaara,Krushara,Swedana with cereals, Snigdha lepa,Sneha Basti withVaataghna Oushadha,Snigdha Sneha is prescribedGhrishta Vrana -----In order to pacify Ushna, Sheetala Aalepa, Parishekashould be done.These should be treated with Choornas (of Saala,Arjuna etc.) after relievingpain (by applying Madhuka ,cold etc.)Picchita Vrana ---- Sheetala Lepa,Pariskeka should be done.Avakrita Vrana ---– Use of Kalka.Vicchinna and Pravilambita Vrana --- Seevana,Bandhana,Avapeedanashould be done.Viddha Vrana---Removal of Shalya.
In the universe everything is a medicine depending on the user. Due tovividities in the manifestation of Vrana, the various recipes of externalapplication and internal administration are available.In case of external application various formulations for debridement arementioned such as Kwaatha, Kalka, Choorna, Rasakriya, Varthi, Taila andGhrita depending on the Avastha of Vrana.In the present study use of Jatyadi Taila for external application, TriphalaGuggulu and Gandhaka Rasayana for internal administration were taken up.At this juncture the study of the drugs with regards to its mode of action and]combination is necessary.Jatyadi Taila1:Ingredients:Jaati,Nimba,Patola,Naktamaala,Siktaka,Madhuka,Kusta,Haridra,Dhaaruharidra,Katurohini,Manjistha, Padmaka, Lodhra, Abhaya, Nilotpala,Tutha, Saariva, Taila (Tila).