Ayurbindu Details

1. MMAANNAAGGEEMMEENNTT OOFF DDIIAABBEETTIICC FFOOOOTT
AANN EEXXPPEERRIIEENNCCEE
Dr. Aruna Katoch

2. INTRODUCTION
Diabetic population of the world is 5 crore seventy
lacs out of 17 crore i.e. 1/3 of the total population of
the diabetics belongs to India. The diabetic foot is
still a problem of first not only for the quality of life
of affected patient but also to society due to its high
cost. And only preventive measures are know to
lower down the risk for amputation of 60-80%. This
falls under the heading of PRAMEHA PIDIKA – the
major complication of Prameha.

3. PIDIKA SAMPRAPTI
“r=
olkesnksH;kefHkiUu’kjhjL;
f=fHknksZÔS’pkuqxr/kkrks%
çesfg.kks n’k fiMdk tk;UrsA”
In the patient of prameha when the body is
permeated by vasa and medas and dhatus
are affected by three dosas, ten boils
appears.

4. STHANA (SITE)
jlk;uhuka p
nkScZY;kUuks/oZeqfUr"BfUr
çesfg.kka nks"kk%] rrks
e/kqesfgUkke/k% dk;s fiMdk
% çknqHkZofUr
Susruta has mentioned in twelveth chapter of
Chikistasthana that due to atony of
Lymphatics (jlk;uhuka) in patient of
prameha, dosas do not move upwards and as
such boils appear in the lower parts of the

5. AETIOLOGY
• Peripheral sensory neuropathy
• Trauma
• High Planter Pressures
FEATURE
• Most characteristic lesion of Diabetic Foot is a
mal perforans ulceration

6. CLASSIFICATION
Modern : Wagner Ulcer Classification System:
Grd Lesion
0 No open lesions; may have deformity or cellulitis
1. Superficial diabetic ulcer (partial or full thickness)
2. Ulcer extension to ligament, tendon, joint capsule or
deep fascia without abcess or osteomyelitis
3. Deep ulcer with abcess, osteomyelitis or joint sepsis
4. Gangrene localized to portion of forefoot or heal.
5. Extensive gangrenous involvement of the entire foot.
American Family Physician
AYURVEDIC : Saravika, Sarsapika, Kacchapika, Jalini, Vinata,
Putrini, Masurika, Alaji, Vidarika, Vidradhika
Su.Ni-6/15-19

7. TREATMENT
For this Multidisciplinary management is advised Rest, elevation of the affected foot
& relief of pressure
¯
TCC is advised (Total contact casting)
¯
Debridement of all necrotic, callus & fibrous tissue
¯
If wound is
Healthy Unhealthy
¯
This leads towards gangrene
or osteomyelitis
¯
Hospitalization for surgical
drainage
¯
Skin grafting is done for deep If healthy
Ulcer as its repair ¯
Amputation

8. TREATMENT IN AYURVED
According to Susruta Samphita First Nine out of
Ten boils are Sadhya i.e. Saravika to Vidarika.
But treatment for all of them is described in seven
step as follows:
• Stage Treatment
• Apakva Pidika Shophvat Chikitsa
• Pakva Pidika Vranvat Chikitsa
• Ropanarth Use of medicated oil
• Utsadanarth Aargwadadi Kshayam
• Parishecanarth Salsaradi Kshayam
• Paan-Bhojanadi Pippaladi Kshayam
• Prasanarth Patadi Churan
Su.Chk.12/9

9. CASE PRESENTATION &
CLINICAL EVALUATION
• 70 yrs male suffering from diabetic foot ulcer from
April, 2004, came to us on 8th July, 2004 with
diagnosed D.M with large sized abscess on the sole of
the right foot with cellulitis of the dorsum. He was on
inj. Insulin from last 3 months
INVESTIGATIONS
• FBS = 80mg/dl.,
• Glycosylated Haemoglobin was under fair control.
• X-rays showing extensive bony destruction with
osteolytic area involving phalanges of great toe and
head of first metatarsal.

10. EXAMINATION
(i) Number of Wound = 3
(ii) Location with size:
(1) Great toe along with top of plantar
surface of sole of the foot.
3 cm x 2 cm (toe)
8 cm x 5 cm (over sole)
(2) Middle of foot = 5 cm x 1 cm
(3) Heel (Diameter) = 3 cm x 0.5 cm.
1
2
3

11. MATERIAL AND METHOD
Drug selected for study:
1. Paradadi churan(churan of impure parad,
ghandhak,
• kapur, sangjarahath, and pure neelatotha from
Rastantarsaar)
2. Jatayadi tail (Bh.R.)and Nirgundi tail(Sh.S)

12. TREATMENT SCHEDULE
Treatment was planned under two phases as per
treatment principle of Susruta Samhita for
Prameha Ppidika .
(i) Vranvat Chikitsa with Paradai Churan till
granulation appeared.
(ii) Ropan Chikitsa with Nirgundi Tail and Jatayadi tail
when granulation tissue had formed.
(iii) For controlling diabetes insulin was remained as
advised earlier.
(iv) Immunity enhances was also given in form of oral
medication

13. PROCEDURE FOR DRESSING
(i) For ten days, antiseptic dressing was done twice a day
with a paste of Paradadi Churan + Jatayadi Tail after
washing with saline water. Every time slough and
debris was removed. There was abcess underneath the
nail. So the nail was removed and osteoporotic pieces
of bone were also removed.
(ii) After ten days, dressing with Jatayadi Tail and
Nirgundi Tail was started which is continued till now.
(iii)After wound was healed for 3 cms. beneath the second
and third toes upto great toe it was observed that due to
formation of fibrous tissue the edge of the wound were
a part so both the edges were approximated by making
the area raw with lekhen karma and then suturing was
done.

14. CHRONOLOGY OF CLINICAL
OBSERVATION
(i) Patient was brought to OPD on 08.07.2004 with minor
gangrene of great toe and other three wounds discussed
above.
(ii) Patient was subjected to above scheduled treatment and
kept under regular observation.
(iii)After ten days, the gangrened area and the foul smell of
the wound disappeared, slough formation was reduced,
nocturnal pain disappeared, odema was reduced. But
size of the great toe shortens due to removal of
osteportic bone pieces and nail. Temp. was 99.4 F.
There was formation of granulation issue on the wound
no.1 and 2 whereas wound no.3 was completely healed.
The FBS was 110 mg/dl.

15. (iv) After one and half month, there was no slough
formation, no pain, Temp. was normal, slight
odema of feet was present. The value of F.B.S.
is 101 mg/dl. and the size of wound 1 was
reduced to 5 cm x 4 cm (8 cm x 5 cm earlier).
Size of wound 2 was reduced 2 cm x 1 cm (5 cm
x 1 cm earlier).
(v) After 18 days, size of the wound 1 was reduced
to 4cm x 2cm. But the edges of the wound were
apart because of formation of callus tissue over
remained 3 cms. So, both edges of the wound
were approximated by making them raw and
then sutured with Mercisilk 3-0.

16. (iv) After next 12 days stitches of the wound were
removed and observed that area was healed
completely and the wound remained 3 cm x 1
cm only whereas wound 2 was healed
completely as in photograph 2.
1
2
3
1
2
Photograph 2A Photograph 2B

17. vi) Now dressing of wound no.1 is still continued.
Photograph 3A Photograph 3B

18. DISCUSSION AND COMMENTS
• Diabetic foot ulcer associated with gangrene of localized are of
great toe is a challenging problem in day to day clinical practice
as it comes under the category of Grade 4 according to Wagner
Ulcer Classification System. The current medical management is
unsatisfactory as drugs which limit inflammation, such as non-steroidal
anti-inflammatory or steroids will slow the healing of a
wound as it hinders the first phase of healing i.e. inflammation.
Secondly, the preparatory solutions used for cleaning the wound,
such as iodide, peroxide or strong detergents will cause harm
than good as not only they kill bacteria but they also kill
fibroblasts and epithial cells (second phase of healing). Deeply
pigmented solutions can alter a wound’s appearance, making it
more difficult to determine tissue viability. So, only balanced salt
solution is entirely appropriate and then surgical intervention is
only the option i.e. amputation.
www.plasticsurgery.com

19. • On the other hand, Paradadi Churan which is a Herbomineral
component increases the blood supply as well as Bio-chemical
ingredients needed for healing of the affected area. So there is
increase in leukocyte and monocytes for bacterial phagocytosis
and lysis fibrogen for adherence of wound; histamine,
prostaglandins and vesoactive substances for haemostasis. So with
Paradadi Churan first phase of healing becomes faster. Jatayadi
Tail looks after for bacterial contamination and odema and
Nirgundi tail increases the epitheliazation. Both together reduces
the callus formation and enhance wound contraction by migration
of epithelium from wound margins to centre. Neither epithelial
migration nor contraction will proceed in the presence of
heavy bacterial contamination. Both oils is of special
significance of course maintaining asepsis is of immense
importance. With this I would like conclude that Susruta has
mentioned wonderful treatment for Prameha Pidika which is
followed by Ayurvedic Practitioners for Management of Foot
Ulcers whereas in Allopathic Treatment amputation is done.

20. At last
“We cared for the wound; but God healed it”.