Pankaj B Patil

EFFECT OF VRANA BASTI IN THE MANAGEMENT
OF DUSHTAVRANA
By
PANKAJ.B.PATIL
Dissertation Submitted to the
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

BANGALORE
In partial fulfilment of the requirements for the degree of
AYURVEDA VACHASPATI
(MASTER OF SURGERY)
In
SHALYA TANTRA
Under the guidance of
Dr. PRASANNA NARASIMHA RAO

M.S (Ayu) (IMS, BHU), PhD
Principal & Professor
DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA

SRI DHARMASTHALA MANJUNATHESHWARA
COLLEGE OF AYURVEDA & HOSPITAL,
HASSAN-573 201
2011
DEPARTMENT OF SHALYATANTRA
SHRI DHARMASTHALA MANJUNATHESHWARA
COLLEGE OF AYURVEDA & HOSPITAL, HASSAN – 573 201
(Affiliated to RGUHS, Karnataka, Bangalore)
Certificate
This is to certify that the dissertation entitled “Effect of Vrana Basti
in the management of Dushta Vrana” is the record of research work conducted by
Pankaj.B.Patil under our direct supervision and guidance as a partial fulfilment for
the award of the degree of Ayurveda Vachaspati (Master of Surgery) in Shalya
Tantra
The candidate has fulfilled all the requirement of ordinances laid down
in the prospectus of Rajiv Gandhi University of Health Sciences, Karnataka,
Bangalore, for the award of Degree of Ayurveda Vachaspati(Master of Surgery)in
Shalya Tantra
We are fully satisfied with his work and recommend this thesis to be
submitted for adjudication.
Co Guide: Guide:
Dr. Maheshkumar.E S Dr.Prasanna.N.Rao
Lecture Professor & Principal.
Dept.of Shalya Tantra Dept.of Shalya Tantra
S D M College of Ayurveda, S D M College of Ayurveda,
Hassan-573 201 Hassan-573 201
Date Date:
Place: Hassan Place: Hassan
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation / thesis entitled “Effect of Vrana Basti in the
Management of Dushtavrana” is a bonafide and genuine research work carried out
by me under the guidance of Dr. Prasanna Narasimha Rao, Principal, Professor,
Department of the P.G.Studies in Shalya Tantra, Shri Dharmasthala Manjunatheswara
College of Ayurveda and Hospital, Hassan – 573201.
Date: Signature of the candidate
Place: Hassan Pankaj.B.Patil

CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “Effect of Vrana Basti in the
Management of Dushtavrana” is a bonafide research work done by Pankaj.B.Patil
in partial fulfillment for the degree of Ayurveda Vachaspathi (Master of Surgery) in
Shalya Tantra.
Co-Guide: Guide:
Dr.Maheshkumar.E S Dr. Prasanna Narasimha. Rao

M.D (Ay) M.S (Ay)(IMS,BHU), Ph.D
Lecturer Professor, Department of
Dept. of P G Studies in Shalya Tantra P G Studies in Shalya Tantra
S D M College of Ayurveda, Shri Dharmasthala Manjunatheswara
Hassan. College of Ayurveda,
Hassan
Date:
Place: Hassan
ENDORSEMENT BY THE H.O.D, PRINCIPAL / HEAD OF THE
INSTITUTION
Management of Dushtavrana” is a bonafide research work done by
“Pankaj.B.Patil” under the guidance of Dr. Prasanna Narasimha Rao, Professor,
Department of Post – Graduate Studies in Shalya Tantra, S.D.M. College of
Ayurveda, Hassan – 573201.
Dr. P. Hemantha Kumar Dr. Prasanna N. Rao

MS (Ay) (IMS,BHU), PhD (NIA) MS(Ay) PhD (IMS,BHU)
Professor and Head, Professor and Principal,
P G Studies in Shalya Tantra, S D M College of Ayurveda & Hospital
S. D. M College of Ayurveda & Hospital Hassan.
Hassan.
COPYRIGHT
Declaration by the Candidate
I hereby declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this dissertation /
thesis in print or electronic format for academic / research purpose.
Date:
Signature of the Candidate
Place: Hassan
Pankaj.B.Patil
© Rajiv Gandhi University of Health Sciences, Karnataka

Acknowledgement
ACKNOWLEDGEMENT
I offer my prayers and bow my head to the fee of Lord Parshwanath and Lord Manjunath
Swamy for showering blessings and empowering me to do this work without any impediments and enabled
me to be what I am today.
I pay my respectful salutation to his holiness Pujya Padmabhushana Dr. Shri D.

Veerendra Heggadeji, founder of this institution for his blessings.
It has been the great opportunity and honour for me to work under the guidance of Dr. Prasanna
Narasimha Rao, MS(Ayu), Ph.D., IMS, BHU, Principal & Professor, Department of P.G.Studies in
Shalyatantra, whose expert supervision has enabled me to accomplish this work to my level best. I remain
indebted to him, who is the great source of inspiration for me, for his parentally concern and constant
encouragement.
I am very much indebted to my mentor, Dr. P. Hemantha Kumar Prof. and Head, Dept. of
Shalyatantra for providing an opportunity to carry out this work I will be ever grateful for his invaluable
guidance, support, Love & thought provoking ideas in every stage of this work.
It is a great pleasure for me to express deep gratitude, to my highly respected and revered preceptor
Prof. Gurdip Singh who gave me Constructive suggestions, confidence, guidance and cooperation in this
work.
I am also fortunate for having been associated with my co guide Dr.

Maheshkumar.E.S., Lecturer, Dept. of Shalyatantra for his progressive attitudes of mind in
accomplishing this project.
I extend heartfelt gratitude to my teachers Dr. Avnish Phatak , Dr. Gopikrishna.B.J, Dr.Pratibha
,for their care, affection and guidance.
It’s beyond the reach of any language to express the warm & bright flame of gratefulness to my
loving parents, Shri. Balasaheb.G.Patil & Smt. Vijaylaxmi B. Patil who are creditable for carrying me into
my present existence. Nothing can even absolve me of my indebtedness to the sacrifices of my parents. I bow
my head to my dearest granny Kushaldevi.G Patil for her love & blessing I take this opportunity to
remember my grandfather late Girigouda .Patil for his Vision and love and my uncle late Dadasaheb. Patil
Effect of Vrana Basti in the management of Dushta Vrana

Acknowledgement
Words fall short to express my gratitude to my beloved sisters Dr Mandakini & brother-in-law Dr
Vijay.Sangave & their entire family who continue to be my greatest force to move on..and my love to my
nephew Jay
At this moment, I remember the driving force behind my MS admission, Mr Kirankumar.T .Patil
my uncle and Mr Appasaheb.N.Rukade and family, Lande & Chougule famiy for their love & blessings,
without which it was very difficult for me to achieve the goal of MS course
I can never forget the love ,support bestowed by my fiancé, Dr Shree I have in deep corner of my
heart for her constant encouragement, love & moral support during study time which helped me work with
a new spirit I also thank my In-laws Mr Baburao Mudhol & Smt Pratibha
I think I am lucky enough to be gifted with friends like Dr Niranjan. Hegde, Dr Rahul. Hegana,
Dr Rahul Chougule who have made an ever lasting impressions in my life.
The idea to work on Vrana Basti was provoked to me by my friend Dr Advesh Holeache & my
teacher Dr Pradeep Shinde so I thank them.
I am very much thankful to all my colleagues Dr Brijesh Singh, Dr Keertiprakash, Dr

Sethukrishna, Dr Vishwabharati, Dr Sheetal Desai, Dr Amol, Dr Nikhil & seniors Dr Sudarshan, Dr
Varun, Dr Praveen, Dr Maheshwar, Dr Ramya, Dr Anita, Dr Janet, Dr Naveen, Dr Sachin, Dr
Shivkumar & juniors Dr Prem, Dr Abhayprakash, Dr Thameem, Dr Yashwant, Dr Vikas, Dr Suraj, Dr
Pratik, Dr Farook, Dr Sreerag for their love, affection, valuable suggestions & co-operation in completion.
I also thank interns Dr Ajit, Dr Basaveshwari, Dr Pratibha, Dr Saraswati, and Dr Sahana for their help.
I thank Patil family of Nandagaon, Ainapur, Kumbhoj and Tamdalge family of Arjunwad
I am thankful to all my teachers, peer research scholars, non-teaching staff and hospital staff for
their affection, timely help and co-operation throughout my research.
I am very much thankful to all my colleagues & junior friends for their love, affection & co-
operation in completion of my thesis work.
The co-operation shown by my patients, the foundation bricks of this work is not at all
forgettable as they followed up throughout the work.
The memories filled with gratefulness will always linger in my heart forever about all of
them that have helped me either directly / indirectly in my research.
Dr. Pankaj. B. Patil

Abbreviations
ABBREVIATION
A.C.T.S A concise text book of Surgery

A.S.S.D A system of surgical diagnosis
AT After treatment
A. H. Astanga Hrdaya
A. S. Astanga Samgraha
Ath. Atharvaveda
B. Pr. Bhava Prakash
BT Before treatment
Cha./Ca. Charaka/Caraka Samhita
Chi./Ci. Chikitsa/Cikitsa sthana
Ka Kashyapa
M Madhyama
Ma. Ni Madhavnidana
Ni. Nidanasthana
O.T. B.S Oxford text book of Surgery
Sha. Sharangadhara
S.T.B. S Sabiston Text book of surgery
Su. Sushruta Samhita
Su/Su. Sutrasthana
U Uttarasthana
UK. Uttara Khanda
ABSTRACT
Background: Wounds and there management are fundamental to the practice of
surgery. In surgery of trauma, wound is frequently a primary pathology. In elective
surgery, it is through the wound that access is obtained to deal with the underlying
pathology. In both situations surgeon’s task is to minimize the adverse effects of
wound, remove or repair damaged structures and harness the process of wound
healing to restore function.
Objectives:
1. To evaluate the role of Jatyadi Taila Vrana Basti in the Shodhana of Dushta
Vrana.
2. To evaluate the role of Jatyadi Taila Pichu in the Shodhana of Dushta Vrana.
3. To compare the effect of Jatyadi Taila Pichu with Jatyadi Taila Vrana Basti.
Methods: Clinically diagnosed 40 Patients of Dushta Vrana were randomly

divided into two groups, each consisting of 20 Patients. First (P group) as control
group was treated by Jatyadi Taila Pichu and second (VB group) as treated group
was treated with Jatyadi Taila Vrana Basti each for seven days.
Results: On the basis of assessment criteria and on the overall result of treatment
the patients of Jatyadi Taila Vrana Basti group showed better relief when
compared to Jatyadi Taila Pichu
Interpretation: Jatyadi Taila drugs are having Katu, Tikta Rasa predominance thus
had action of Kapha Vata Shamana, Krimighna, Rukshata, Kledashoshaka
Shothahara. Jantughna, Varnya, Raktashodhaka property etc. Thus this help for
Shodhana of Dushta Vrana.
Conclusion: Jatyadi Taila Vrana Basti has provided better relief in maximum signs
and symptoms of the patients of Dushta Vrana, in comparison to Jatyadi Taila Pichu.
Its overall effects were also better in comparison to Pichu with Jatyadi Taila. Vrana
Basti and dressing reduces the infection.
Keywords: VranaBasti, Dushta Vrana, Pichu, Jatyadi Taila
CONTENTS
Page no.
1. INTRODUCTION 1-2
2. CONCEPTUAL CONTRIVE
Review of Ayurvedic literature 3-26
Review of the wound / ulcer 27-54
3. DRUG REVIEW 55-59
4. MATERIALS AND METHODS 60-64
5. OBSERVATION AND RESULTS 65-86
6. DISCUSSION 87-97
7. CONCLUSION & SUMMARY 98-100
8. REFERENCES 101-105
9. BIBLIOGRAPHY 106-108
10. ANNEXURE 109-112

LIST OF TABLES
Table Table Contents Page

no no.
1. Nidaana of Vrana 7
2. Lakshanas of Vaataja Vrana 8
3. Lakshanas of Pittaja Vrana 8
4. Lakshanas of Kaphaja Vrana 9
5. Lakshanas of Raktaja Vrana 9
6. Lakshanas of Dvidoshaja Vrana 9 19
7. Lakshanas of Tridoshaja and Sannipaataja Vrana 10 20
8. Lakshanas of Dushta Vrana 11 21
9. Lakshanas of Shuddha Vrana 12 22
10. Vrana Sthaana and its Lakshanas Acc. to Maadhavakara 14 22
11. Vrana Varna 15 23
12. Vrana Vedana 15 24
13. Vrana Sraava Acc. to involvement of Dosha 15 24
14. Vrana Sraava Acc. to Sthaana 16
15. Vrana Upakramas 20 25
16. Incorporation of 60 Upakramas among 7 Upakramas 23
17. Aagantuja Vrana Lakshanas 24
18. Classification of ulcer 27
19. Five common types of ulcer edges in surgical practice 34
20. Classification of commonly used antiseptic in general practice 38
21. Gram positive cocci 41
22. Gram negative bacilli 42
23. Anaerobic organism 42
24. Description of ingredients of Jatyadi Taila 55
25. Distribution of 40 patients of Dushta Vrana based on Sex 66
26. Distribution of 40 Patients of Dushta Vrana based on Age 67
27. Distribution of 40 Patients of Dushta Vrana based on Habitat 67
28. Distribution of 40 Patients of Dushta Vrana based on Occupation 68
29. Distribution of 40 Patients of Dushta Vrana based on Religion 68
30. Distribution of 40 Patients of Dushta Vrana based on Socio - 69
economic status
31. Distribution of 40 Patients of Dushta Vrana based on Diet 69
32. Distribution of 40 Patients of Dushta Vrana based on Ahara Shakthi 70
33. Distribution of 40 Patients of Dushta Vrana based on Addiction 70
35. Distribution of 40 Patients of Dushta Vrana based on Aetiology of 71
wound
36. Distribution of 40 Patients of Dushta Vrana based on Chronicity of 71
wound
37. Distribution of 40 Patients of Dushta Vrana based on Diagnosis of 72
wound
38. Distribution of 40 Patients of Dushta Vrana based on Site of wound 72
39. Distribution of 40 Patients of Dushta Vrana based on Associated 73
disease
40. Distribution of 40 Patients of Dushta Vrana based on symptoms 73
41. Distribution of 40 Patients of Dushta Vrana based on body 74
temperature
42. Distribution of 40 Patients of Dushta Vrana based onVrana shape 74
43. Effect of Jatyadi Taila Pichu on Varna of 20 Patients of Dustha 79
Vrana
44. % of VranaShodhana in Jatyadi Taila Pichu 80
45. Effect of Jatyadi Taila Pichu on Shodhana percentage of 20 Patients 80
of Dustha Vrana
46. Showing Overall effect of Jatyadi Taila Pichu on Dustha Vrana 81
47. Showing Follow up of Jatyadi Taila Pichu Group 81
48. Effect of Jatyadi Taila Vrana Basti on Varna of 20 Patients of Dustha 83
Vrana
49. Effect of Jatyadi Taila Vrana Basti on Shodhana days of 20 Patients 83
of Dustha Vrana
50. Effect of Jatyadi Taila Vrana Basti on Shodhana percentage20 84
Patients of Dustha Vrana
51. Showing Overall effect of Jatyadi Taila Vrana Basti on Dustha Vrana 84
52. Showing Follow up of Jatyadi Taila Vrana Basti Group 85
LIST OF GRAPHS
Graph Graph Contents Page

no. no.
economic status
8. Distribution of 40 Patients of Dushta Vrana based on Ahara 73
Shakthi
wound
11. Distribution of 40 Patients of Dushta Vrana based on Chronicity 76
of wound
wound
13. Distribution of 40 Patients of Dushta Vrana based on Site of 77
wound
disease
temperature
18. Effect of Jatyadi Taila Pichu on Shodhana percentage of 20 86
20. Effect of Jatyadi Taila Vrana Bati on Shodhana percentage of 20 87
LIST OF CHARTS
Chart Chart Contents Page

no. no.
1. Pathological classification 28
2. Process of inflammation 45
3. Process of Wound Healing 52
LIST OF Figures
Figure Figure Contents Page

no. no.
1 Ingredients of JatyadiTaila 59
2. Case report no.1 96
3.. Case report no.2 98

Introduction
Introduction
Introduction
The life of every individual starts with the healing of the wound of the cut umbilical
cord. So, treatment for healing of this wound is of prime importance.
While explaining the scope of Shalya Tantra, Sushruta has mentioned Vrana
Vinishcayaartham as a major part of Shalya Tantra.1
Even though healing of Vrana is a natural process of the body, the Vrana should be
protected from Dosha Dushti and from various micro organisms, which may afflict the Vrana
and delay the normal healing process. So, for the early and uncomplicated healing of Vrana,
treatment is necessary.
The history of medical science starts with the art and skill of wound healing.
Treatment of the wound is probably the first medical problem faced by human beings. The
frequency of injuries is more common than any other disease.
Centuries ago, injury in the battle field due to hit by arrows was one of the common
problems, along with contamination of the wound. Falling from trees, fall from heights,
crushing against stone or hard materials, animal bites were the other causes for injury. The
contamination of the wound due to various micro organisms delayed the process of wound
healing. Bleeding and pain were and are the main complications of a wound which require
immediate treatment.
Usage of various types of leaves or soil was the treatment to arrest bleeding. Quest for
knowledge by Ancient peoples led to many investigations and assumptions. Gradually things
with better results were selected and tried with different forms.
Ayurveda, more a science of life than only a medical science, gives more importance
to preventive measures and complete curing of a disease with a minimum chance of
recurrence.
Sushruta – the Father of Indian surgery in his book Sushruta Samhita, has explained
Vrana, its complication and management in great detail. In the Vranitopaasaneeya Adhyaaya
he has explained that, “If the Rakshaa Karma of Vrana is proper then the Nis`aacara‟s leave
the patient, in the same way as the Mrugaas (deer) run away from the jungle terrified by a
lion.”2
For Sushruta health was not merely a freedom from disease, but a normal state of
mind, body and soul.3 He conceived of a total management of the disease from the earliest
Effect of Vrana Basti in the management of Dushta Vrana 1

Introduction
stage of vitiation of Dosha to total recovery in which he insisted on bringing back the site of
the lesion to normalcy in all respects. Thus it may well be said that Sushruta‟s management
was more thorough than even conceived today. Today wound is said to have healed when
epithelialisation is complete. But Sushruta would employ „Vaikrutaapaham‟4 measures which
will bring back the normal color and surface and even hairs.5
Sushruta‟s classification of traumatic wounds, their prognostic evaluation and
management, insistence on primary suturing in clean wounds, avoidance of sepsis etc.
correspond remarkably with the modern outlook of wounds and wound- management.6
In healing of Vrana, local treatment is also important along with oral medications.
Dushta Vrana is a long standing ulcer with profuse discharge and slough, where clearing
slough and enabling drug to reach the healthy tissue is more important. Slough can be cleared
by using surgical instruments or oxidizing agents where healthy granulation tissues are
damaged. In recent years various efforts were made in the field of wound healing, especially
as local treatments but healing remains the prime objective of the physicians.
Few previous works on Dushta Vrana are enlisted below;

 Study of Vajraka Tailam in Dushta Vrana by Dr. Sarangpani, S. in 1985. Ayurvedic
Collage, Hyderabad.
 Effect of Kshaara Taila in Dushta Vrana by Dr. Shetty, Narayana in 1987, Ayurvedic
Collage, Bangalore.
 Effect of “Kaaseesaadi Taila” in Dushta Vrana by Dr. Mashetti, N.B. in 1989,
Ayurvedic Collage, Bangalore.
 Effect of “Triphala Guggulu” in the management of Vrana by Dr. Sinha, R.K. in
1989. Ayurvedic Collage, Bangalore.
 Management of Dushta Vrana with “Karanjaadi Tailam” by Dr. Rao, P. in 1991.
Ayurvedic Collage, Hyderabad.
 Management of Dushta Vrana with Karkaraadi Ghrutam by Dr. Bindu, B. in 1993,
Government Ayurvedic Collage, Thiruvanthapuram.
For the clinical study, 40 patients of Dushta Vrana attending the OPD and IPD of
S.D.M. Ayurveda Hospital, Hassan, were selected randomly and subjected to clinical trial.
They were administered with Vrana Basti by Jatyadi Taila andJatyadi Taila Pichu.
The results are encouraging. This study has opened a new avenue for further
exploration in the field.

Review of Literature
Ayurvedic Review
AYURVEDIC REVIEW
Historical review:
History of Vrana is as old as mankind. Professionals faced the problem on healing of
wounds and ulcers. The review of literature makes it clear that constant research for new
techniques and solutions to problems was going on in the annals of history. Hence, the review
of literature regarding 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 era
2) Vedic era
3) Postvedic era
Prevedic era:
During this period no direct references regarding Vrana are available.
Vedic era:
During this period Rigveda and Atharvaveda are considered as chief sources of medical
information
Rigveda1:
Many references are seen in Rigveda. Sandhaan karma done by Ashwini Kumaaras in case
of severed head of Yajna (Daksha), joining the limb of Vishpala the daughter of Khela are
worth mentioning.
Atharvaveda2 :
Ayurveda is Upaveda of Atharvaveda . Many references are available like administration
of Rohini Aushadi in Kshata and Vrana, Sheetalajaladhaara for stoppage of bleeding in
Sadhyovrana are important.

Ayurvedic Review
Post vedic era:

Agnipurana3: Surgical wounds are enumerated in Agnipurana.
Mahavagga ( Buddhist tradition )4:Vrana with Pooya were drained and later they
were treated with bandaging, dusting, fumigation etc.
Kautilya Arthashaastra5:
When Kautilya defined legal offences he has mentioned these acts as punishable offences,
they are
1) 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.
3)
Jaatakamala6:
Dushta Vranas which are painful along with pocket full of pus, should be carefully
opened and drained. The wound becomes painful when it comes in contact with salt.
Harshacharita7:
References regarding the difficulty in management and arresting the bleeding in the
wounds located in Hruth Pradesha, complications like shock, collapse,and unconsciousness
in case of fresh wounds with pain and haemorrhage is mentioned.
Kaadambari8:
Wounds were produced by constant friction and injury. Sometimes injury produced
disabilities in the organs and after healing of the wound there remained scar.
Samhita Kaala9:
Detail description of Vrana with its management is mentioned in Brihatrayee and
Laghutrayee.36 therapeutic measures were explained in Charaka where as Sushruta has
mentioned 60 therapeutic measures for Vrana .Description about Vrana is also mentioned
in Bhela Samhita, Kaashyapa Samhita,Gadha Nigraha, Chakradatta, Yogaratnakara,
Bhaishajya Ratnavali.

Ayurvedic Review
Vrana:
Derivation10:
„ ‟ ,
The word Vrana is derived from the verb root, So the destruction or discontinuity of
body part or tissue is called as Vrana.

Dalhana gives the meaning of verb “Vrana” as causing discoloration of the body (or its parts).
Definition11:
As the scar of the wound never dissappears even after complete healing and as its
imprint persists life long it is called as Vrana by the wise.Vrana is that which makes person
to pray (to god) till his life exists, or that which exposes the interior of body.
Classification12:
Almost all the Acharyas have classified Vrana into two catagories i.e. Nija and
Aagantuja depending upon the causative factors.The Doshas get vitiated by their own
causative factors or by the external agents.
Nija or Shaareeraja vrana:

Sushruta has specially mentioned these Nija Vranas to be due to Vaataja , 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, Pitta and 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 their features They 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.

Ayurvedic Review
Description of Sadhyo Vrana in Maadhava Nidaana is similar to that mentioned by

Sushruta where as Shaarangadhara mentioned 8 types.Though Vaagbhata has also accepted
classification given by Sushruta, but has mentioned them along with specific clinical features.
Charaka has classified Vrana into 20 varieties depending upon their distinctive features, they
are13 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 Shuddha but not as a
type of classification.Charaka has also described 12 characteristic features indicating the
advanced stage of morbidity of Vrana. These morbid conditions are also classified into 24
categories depending upon 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 Ruhyamaana Vrana and
Roodha Vrana14.
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 discharge Vrana is classified as
Sukhasaadhya, Kruchrasaadhya, Yaapya and Asaadhya.
Nidaana of Vrana15 :
Shareeraja Vrana:
The causes for this are same as the causative factors reponsible for the vitiation of Doshas.
These are classified as Aaharaja and Vihaaraja Kaaranas.
Lakshanas16 :
Features of Vrana are of 2 types :
1)Saamanya : pain.
2)Vishesha : consists of signs and symptoms caused by Doshas

Ayurvedic Review
Table No. 1
DOSA KAARANAS
AAHARAJA VIHARAJA
VAATA Vaataprakopakaaharaas i.e. Katu, Lavana, Balavat Vigraha,Ativyaama, suppresion of
Laghuaahara, Sushkasaa Adhaarniya Vegas etc.
Valloora, Uddhalaka etc.
PITTA Pittaprakopakaahaaraas i.e.Katu, Amla, Krodha, Shoka, Bhaya, Maithuna, Aayasa
Lavana, Ushna, Vidaahi, Teekshna, Tila, Upavaasa etc.
Pinyaka, etc.
KAPHA Kaphaprakopakaaahaaraas, i.e. Divaswapna, Avyayaama, Aalasya .
Madhura, Amla, Lavana, Sheeta, Snigdha
Aahara, Maasha etc.
.
Vishesha Lakshanas:
Vaataja Vrana Lakshanas: Vrana caused due to Vaata is Stabdha, Katina has Shyaava or
Aruna Varna, Alpa Sraava and Vedana Baahulyata.
Pittaja Vrana Lakshanas : Vrana caused due to Pitta will be associated with Daaha, Paaka,
Raaga, Jwara, Trishna, Moha etc. has Kshipra Utpatti with Neela, Peeta Varna and
Pootisraava.
Kaphaja Vrana Lakshanas: Vrana caused due to Kapha will have Paandu or Shwetha
Varna associated with Ugra Kandu, Mandha Vedana, Shukla, Sheeta, Pichila and Ghana
Sraava.
Raktaja Vrana Lakshanas: In general this Vrana will have features similar to that of Pittaja
Vrana, has Pravaala (Rakta) Varna, Raktasraava covered with network of Krishna Sphota,
smells like Turanga or Vaajisthaana.

Ayurvedic Review
Table No. 2- Lakshanas according to various Acharyas17:
Lakshana Sushruta Charaka Kashyapa A.San. A.H. M.Ni.
Shyaava,
Shyaava or Shyaava, Krushna,
Aruna Aruna, Aruna,
Varna Shyaava - Krushna, Bhasma Shyaava
Bhasma of kapotha or
Asthi. Asthi
Varna
Stabdha, Stambha, Stabdha,
Vartma Rooksha - -
Kathina Kathina Kathina
Todha,
Teevra Sphuruna,To
Bheda, Todha,
Vedana Ruk, Maharuja dha, Bheda Maharuja
Chatachata Bheda etc.
Sphurana etc.
yana etc
Alpa sraava
resembling Alpasraava
Sheeta, Mastu, resembling
Mandha Mandha
Sraava Picchila, Alpasraava Kshaara, Mastu,
sraava sraava
Alpasraava Maamsa Maamsa,
Dhaavana, Pulakaamb
Pulakodaka
Lakshas Sushruta Charaka Ka.S. A.San. A.H. M.Ni

Peeta, Neela, Neela, Peeta,
Peeta,
Varna - - Haritha, Krushna, Kapila -
Neelabha
Pingala Pingala
Utpatti Kshipra - - Kshipra Kshipra -
Raaga,Paaka
Daaha, Trushna,
Trushna, Jwara, pain
Paaka, Daaha,Raaga, Moha,
Anya Moha, Daaha, resembling
Raaga, Paaka,Jwara, Jwara,
lakshanas Jwara, Moha, Vrana
studded with Dhoomayana, Kleda,
Sveda, Trushna caused by
Peeta Pidaka Daaha
Kshaara
Sraava is
Sraava large in
warm, large
Sraava qty. resembling
in qty
resembling Gomootra,
Pooti Pooti resembling Pooti
Sraava Kimshuka solution of
sraava sraava Kimshuka, sraava
flower, Bhasma,Kimshuk
Taila or
Ushna. or Mrudveeka or
solution of
Taila
Bhasma

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Lakshanas Sushruta Charaka Ka.sam. A.Sam. A.H. M.Ni.

Varna Paandu Paandu Paandu Paandu Paandu Paandu
Sthoola,
Sthoola, Katina,
covered with Snigdha, Snigdha, covered Bahu piccha,
Sthaimitha,
Vartma Stabdha Sira Guru,Bah Katina, with Guru,
Maardhava
Snaayu u piccha Sthoola Sira Snigdha
jaala, Katina Snaayu
Jaala
Mandha
Mandha
vedana,
Mandha, Mandha, vedana, Mandha
Anya severe Alparuk,
Vedana, Vedana Kandu, vedana,
lakshanas Kandu, Kandu
Chirakaari Chirakaari Swaapa, Sthaimithya
feeling of
Sthaimithya
heaviness
Sraava Large
Shukla, resembling qty. of Alpa
Alpa
Sraava Sheeta, Atisraava Navaneeta, Sveta Samkled
Samkleda
Saandra Tila pishta, Ghana Chirapaaki
Naarikelodaa sraava
Table No.5- Lakshanas according to various Acharyas20:

Lakshanas Sushruta A.Sam. A.H. M. Ni.
Varna Pravaala Dhala Nichaya Pravaala (Raktha) Pravaala (Raktha) Raktha
Covered with network Covered with
Vartma of Krushnasphota, Krushnasphota, - -
Pidaka Pidaka
Smells like Turanga
Smells like Vaaji Smells like Vaaji
sthaana, Vedanaayuktha,
Anyalakshanas Sthaana, has other Sthaana, has other -
Dhoomayana Sheela and
features of Pitta features of Pitta
having features of Pitta
Sarakthapooya Sarakthapooya Raktha
Sraava Raktha Sraava
Sraava Sraava Sraava
Table No.6- Dvidoshaja Vrana Lakshanas21:

Sushruta has explained the Lakshanas depending upon combination of Doshas while
Vaagbhata and Maadhavakara has also made the similar attempt.
Lakshanas VP VK PK VR PR KR
Ghrita
Aakruthi - - - - -
manda
Meena
Gandha - - - - dhaavana -
toya

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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 Snigdha
Table No. 7- Tridoshaja Vrana Lakshanas22:
Lakshanas VPR VKR PKR VPK VPKR

Has Varna
Varna - - - -
of 3 types
Nirdahana,
Sphurana, Has Nirmathana,
Kandu, Sphurana, Daaha,
Vedana Todha, Daaha, Vedana of Sphurana,
Chumachumayana Kandu
Dhoomayana 3 types Todha, Daaha,
Kandu
Paandu,
Peeta, Tanu, Paandu, Ghana, Has Sraava
Sraava Ghana, Naana Varna
Rakta Rakta of 3 types
Rakta
Anya Paaka,
- - - Paaka, Raaga
Lakshanas Raaga
Dushta Vrana23:
Dushta is one in which there is localization of Doshas or Dushta means getting
vitiated by Doshas. Vrana which smells badly (foul odour), has abnormal color with profuse
discharge, intense pain and takes long period to heal is said to be Dushta.The features of
Dushta Vrana will vary according to the predominant Dosha present in it.
Shuddha Vrana25:
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.

Ayurvedic Review
Lakshanas of Dushta Vrana24:

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 or Mentioned 12 Either Atisamvrutha or Either Samvrutha Discharges
Ativivrutha Ati- characteristic features Ativivrutha, Atimrudu or Vivrutha, Pooti
katina or indicating the advanced or Katina, Atiutsaadha Katina or Mrudu Sraava, or
Mrudu, Utsanna stage of morbidity of or Avasaadha, Atiutsanna or Dushta
or Avasanna. Vrana. Svetatva, Atisheeta or Usna Avasanna, Ashruk,has
Ati sheeta or Avasanna Vartmatva, Rakta, Krushna, or Atiushna or Utsangi
Usna, having Athisthoola- Paanduta, covered Atisheeta, (sinuses)
one of the Vartmatva,Atipinjaratv with Pooti Maamsa, Raktatwa or inside,
colours a, Neelatva, Syaavatva, Sira,Snaayu, etc. Paanduta,Dischar Chirastitha,
Krushna,Rakta, Atipidakatva, Rakta- Dishcarges Pooti ges Pooti Pooya emits Pooti
Peeta, Shukla Krushnatva Pooya, Daaha, Paaka, covered with Gandha &
etc,Bhairava,fill Atipootitva, Ropyatva Kandu,Svayathu,Veda Pooti Maamsa, doesn‟t
ed with Kumbhi- na Pitaka, etc. Sira, Snaayu, posses any
Pootipooya,Ma Mukhatva,.Vranas with appearing as associated with features of
amsa, Sira, Pootigandha, Vivarna, Upadravas, Dheerga Atiruk, Daaha, Shuddha
Snaayu etc. Bahusraava, Maharuja Kaalanubandha Swayathu, Kandu Vrana
Moving in & other
oblique track complications,
(Unmargi) Dheerga Kaalanu
having bandha
Amanoghna
Darshana,
Atigandha,
Vedanayukta,
associated with
Daaha, Paaka,
Raaga, Kandu,
Shopha Pidaka
Discharging
excessively
Dushta
Shonitha

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Table No. 9 - Lakshanas according to various Acharyas26:
Sushruta Charka A.San. A.H. M.Ni

Not invaded by Na Atirakta, Not vitiated by Resembles Jihva in ResemblesJihva
Tridoshas having Paandu, Doshas, color, Talaaba and is
Shyaava Oshta, Shyaava,(na resembles Jihva Mrudu,Slakshna Atimrudu,Slakshna,
resembles Jihva ati) Ruk, in color, and is with Shyaava Snigdha,
Talaabha & is Utsanna, Slakshna having Osta,Samapidika, Suvyavasthitha,
Mrudu, Snigdha Utsangi. Shyaava Oshta having Unnata Alpa Vedana ,
not having centre being Madhya,not Niraasraava.
Vedana, Sraava, elevated or even acommpanied with
good looking, has not having any Upadravas.
developed Sama Vedana, Sraava.
Pidika.
Ruhyamaana vrana27:
Vrana which has Kapotha Varna,devoid of Kledha and has Sthira Pitika is said to be
Ruhyamaana Vrana.Similar type of description is mentioned by Vaagbhata and in
Maadhavanidaana.
Samyak Roodha Vrana28:
Vrana which has healed in its seat (dwelling place) without eruptions (Granthi), pain
(Vedana) or swelling, has the colour as that of Twak and is even is said to be Samyak
Roodha.
Samprapti29:
Doshas being aggravated by their respective causative factors gets lodged in any 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 Vrana30:
Sushruta emphasizes that before treating the Vrana one should know the
Shanmoola 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,

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Marma),Pancha Lakshana Lakshitaha i.e. features of Vaataja, Pittaja, Kaphaja, Sannipaataja

and Agantuja Vranas as well as Varna, Sraava, Gandha, Vedana, Aakruti and also 60
Upakramas for the 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 with the Chikitsa
Chatushpaadha the treatment of ulcer becomes easier.
Examination of Vrana & patient suffering from this ailment is to be carried out 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)31:

Site of Vrana is to be taken into consideration while examination.Twak, Maamsa,
Sira, Snaayu, Asthi, Sandhi, Koshta, Marma - these eight are Vrana Vastu (dwelling seats of
Vrana).
In these all kinds of Vranas occur. Sushruta & Vaagbhata have mentioned Sandhi as
the site instead of Medas which was mentioned by Charaka.Maadhavakara
(Maadhavanidaana) explained Samaanya & Vishesha Lakshanas in case of injury to Maamsa,
Sira, Snaayu, Sandhi, Asthi,Marma

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Table No. 10- Vrana Sthaana and its Lakshanas according to

Maadhavakara
VRANASTHAANA LAKSHANAS
Injury to Maamsa, Sira, Snaayu, Saamanya Lakshanas:- Bhrama, Pralaapa, Pathana,
Sandhi, Asthi Srasthangatha,
Vichestana, Pramoha, Glani, Ushnata,
Moorcha, Teevraruja, dischrge of Rakta resembling
Mamsodaka, loss of functions of Indriyas etc.
Vishesha Lakshanas
Injury to Sira Profuse discharge like Indragopa.
Injury to Snaayu Decrease in height,drooping,loss of
Pain, Vrana takes long time to heal
Injury to Sandhi Increase in Shopha ,severe pain,loss of
strength, total loss of function etc
Injury 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)32:

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 resembling Sharaavanimna
madhyascha,others with elevation in the centre or Aagantuja Vranas have innumerable
shapes.
Vrana Gandha33:
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 been included in discharges by other Acharyas.

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Vrana Varna 34:

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 Vedana35:
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 Sraava36:
Sushruta and Vaagbhata have given list of discharges based on location (Vrana Vastu)
or involvement of Doshas.
Table No. 13- Vrana Sraava according to involvement of Dosha
Dosha Vrana Sraava

Vaata 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.

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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 Vrana37:
Vrana arising in Vayah (Vrana heals quickly because of Pratyagra Dhaatus),
Dhruda(Body having Sthira,Bahu Maamsa, Shastras even though used in treatment do not
cause damage to the Siras, Snaayus etc), 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 Vrana38:
Vranas arising in Vruddha, Krusha, Alpapraana, Bheeru etc. Vranas having Vikruta
Aakruth. 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.

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Yaapya Vrana39:
Vranas of Avapaatika, Niruddhaprakasha, Sanniruddha Gudha, Jatara, those suffering
from Twak Dosha, Prameha, Kantashaalooka, Dantasharkara etc.
Asaadhya Vrana40:
Vrana in spite of being situated in location not near Marma Sthaana, free from 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
Ashwa Apaana, indurated and protruded like Goshringa, those discharging Dushta
Rudhira,Tanu, Sheeta, Picchila Sraava, elevated in centre, some are Santoolavath contains
Snaayu, Jaalas, having Durdarshana, Vranas due to vititated Doshas discharging Vasa, Meda,
Majja, Mastulunga, Koshtastha.
Vrana having discharges of Peeta or Asita Varna, Mootra, Pureesha etc and also
those having discharges of Pooya and Rakta. Vranas situated in all ground materials
(Sarvotogatha) with Anumukha and Maamsa Budbudha. Vranas situated in Shira, kantha
from which air escapes making sound.Vranas in Heena Maamsa person discharging Pooya,
Rakta, associated with Arochaka, Avipaaka, Kaasa, Swaasa like Upadravas.
hinna 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 by Aagantuja Kaaranas, otherwise it is incurable (i.e. those
caused by Doshas).
Vranas with Pulakodaka like Sraava from Pakvaashaya, Kshaarodaka type of Sraava
from Raktaashaya, Kalaaya type of Sraava from Aamaashaya & Trikasandhi Pradesha.
If proper treatment is not done Saadhya Vrana becomes Yaapya, Yaapya becomes
Asaadhya and Asaadhya may kill the patient.
Vrana Chikitsa41:
Vranithaagaara:
Vrana Chikitsa should be done in Vranithaagaara to prevent the invasion of
Nishacharas in Vranithasya. It should be auspicious and in accordance with Vaastushaastra

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etc.Vranitha will not suffer from physical, mental & traumatic disorders by residing in such
Aagaara.Rakshakarma should be done along with Dhoopana.In Dushta Vrana Oordhava and
Adaha Shodhana should be done then Apatarpana, Raktamokshana should be employed.
Kashaaya of Aaragwadhadi & Surasadi Ghana Dravyas should be used for Dhaavana & Taila
prepared with Kashaaya of same Dravyas or with Kshaara Drava is used for Vrana
Shodhana.
Charaka has mentioned 36 Upakramas for the treatment of Vrana where as Sushruta
has mentioned 60 Upakramas among them Kashaaya,Kalka, Varthi, Sarpi, Taila, Rasakriya,
Avachoorna these 7 are both Shodhana as well as Ropana.Charaka has explained Samaanya
and Vishesha Chikitsa for Vrana42
Samaanya Chikitsa:
Vranitasya should be given Shodhana, therapies through Vamana or
Virechana.Venesection with help of Shastra and Basti. When body becomes Shuddha Vrana
gets healed up spontaneously.
Vishesha Chikitsa:
Vaataja Vrana Chikitsa: Person suffering from Vaataja Vrana should be treated with
Sampoorana, Snehapaana, Swedana,Upanaaha,Pradeha,Parisheka which are of unctuous
nature.Pittaja Vrana Chikitsa: Person suffering from Pittaja Vrana should be treated with
Pradeha, Parisheka, Sarpipaana, Virechana prepared by Sheetala, Madhura, Tikta Dravyas.
Kaphaja Vrana Chikitsa: Person suffering from Kaphaja Vrana should be treated with
Pradeha, Parishechana,prepared of drugs which are Kashaaya, Katu, Rooksha,Ushna and
Langhana, Paachana etc.
Saptaupakramas 43:
These are mentioned in treatment of Vrana Shopha they are Vimlaapana,
Avashechana, Upanaaha, Paatana, Shodhana, Ropana,Vaikritaapaham Sushruta has
mentioned Trividha Karmas for management of surgical disorders,they are44
1) Poorva Karma 2) Pradhaana Karma 3)Paschat Karma.

Ayurvedic Review
Poorva Karma:
Among 60 Upakramas from Apatarpana to Virechana(mentioned for Vranashopha)
these are considered as measures of Poorva Karma. By means of these measures either
pacification of Vrana Shopha occurs or it becomes ripened. Among 7 Upakramas of
Vranashopha Vimlaapana, Avashechana, Upanaaha these 3 should be employed during the
Aama Avastha of Vrana Shopha.
Pradhaana Karma:
Among 60 Upakramas starting form Chedana to Seevana (Shastrakarma) are
considered as Pradhaana Karma.In addition to Ashtavidha Shastra Karmas, Dharana Karma is
mentioned in case of Baala, Vruddha, Bheeru and Vrana Shopha present in Marma Pradesha
where Shastra Karma is contraindicated. This is performed by doing Peedana with local
application of Dravyas. Among 7 Upakramas of Vranashopha Paatana is considered as
Pradhaana Karma.
Paschat Karma:
Among 60 Upakramas starting from Sandhaana to Rakshavidhaana or among 7
Upakramas Shodhana, Ropana and Vaikrutaapaham are considered under Paschat Karma.
1)Vimlaapana: In case of Sthira, Mandha Ruja Vrana Shopha after doing Snehana and
Swedana to the part Peedana should be done with bamboo tube or palm and sole or thumb.
2)Avashechana: In case of Shopha of recent onset, Raktamokshana should be resorted in

order to mitigate the Vedana and Paaka. Even in Vranas associated with Shopha, which are
Katina, containing Rakta, Vedanayukta, deep seated Rakta Avashechana should be done. In
case of Shopha associated with Visha, Rakta Visraavana should be done by using leech or by
Shastra Padha in order to mitigate Vedana and prevent Paaka.
3)Upanaaha: It should be applied in Aamaavastha and Vidagdhaavastha of Vrana Shopha.It

pacifies the former and ripens the later.
4)Paatana: It should be done in case of Pakwa Shopha only.

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5)Shodhana: It is one of the important measures in case of Vrana Chikitsa.Among 60

Upakramas as mentioned earlier Kashaaya, Varti, Kalka, Sarpi, Taila, Rasakriya and
Avachoornana are the different methods for Shodhana.In case of Vrana associated with
Durgandha, Kledha and Picchila Shodhana should be done using Kashaaya of various
Dravyas.Shodhana Taila: In case of Vrana which has Utsanna Maamsa, Alpasraava
etc.Shodhana should be done with sesamum oil mixed with musterd oil.
6)Ropana: Ropana Kriya should be adopted in Vranas which are having

the features of Shuddha Vrana. Kashaaya, Varthi, Kalka, Sarpi, Taila, Rasakriya and
Avachoornana are the different methods for Ropana.Ropana Taila: In case of Vranas which
are predominent in Kapha and Vaata Ropana should be done by Taila processed with
Dravyas.
7)Vaikrutaapaham: Even after complete healing of Vrana restoration of normal colour, shape
are essential. So Vaikrutaapaham is such measure which helps in restoration. For this Krishna
Karma, Paandu Karma, Romasanjanana, Lomaapaharana etc are mentioned.
Table No.15- Upakramas of Vrana acc.to various Acharyas45:
Uapakrama Sushruta Charaka Kashyapa A.San/A.H

Apatarpana + - - -
Aalepa + - Pralepa Pradeha
Parisheka + - + +
Abhyanga + - - +
Swedana + + - +
Vimlaapana + - - +
Upanaaha + - + -
Paachana + - - +
Visraavana + - + +
Sneha + - + -
Vamana + - - +
Virechana + - - +
Chedana + + - -
Bhedana + Paatana - -

Ayurvedic Review
Dhaarana + - - +
Lekhana + + - -
Eshana + + - -
Aharana + - - -
Vyadhana + + - -
Sraavana + - - -
Seevana + + - -
Sandhaana + + - -
Peedana + + (Avapeedana) - +
Shonitasthaapana + - - -
Nirvaapana + + - +
Utkaarika + - - -
Kashaaya + Shodhana,Ropana - -
Kashaaya.
Varti + - - +
Kalka + - + -
Sarpi + Shodhana - Ropana
Ghrita,Ropana Ghrita.
Ghrita.
Taila + Shodhana - Ropana Taila.
Taila,Ropana
Taila
Rasakriya + - - +
Avachoornana + + - Choorna.
Vranadhoopana + + (Kaatinyakara, - +
Maardhavakara)
Utsaadana + + - +
Avasaadana + + - +
Mrudukarma + Maardhavakara - +
Aalepana.
Dhaarunakarma + Kaatinyakara - +
Aalepana
Kshaarakarma + + (Daaha) - +
Agnikarma + + (Daaha) - +
Krishnakarma + Varnya Savarneekaran Savarnakaran

Ayurvedic Review
a a
Paandukarma + Varnya Savarneekaran Savarnakaran
a a
Pratisaarana + - - -
Romasanjanana + + (Lomarohana) - +
Lomaapaharana + - - -
Bastikarma + - - -
Uttarabasti + - - -
Bandha + + + -
Patradhaana + Patrachaadana - -
(Baahya)
Patrachaadana
(Abhyantara)
Krimighna + - - -
Bhrimhana + - - -
Vishaghna + - - -
Shirovirechana + - - -
Nasya + - - -
Kavaladhaarana + - - -
Dhooma + - - -
Madhu-sarpi + - - -
Yantra + - - -
Aahaara + Bhojya - -
Rakshavidhaana + - - -
Shophaghna - + - -
Shamana - + + -
Chaadhana - + - -
Shodhanalepa - + - +
Ropanalepa - + - +
Ropana - + + -
Utklinnaprakshaalaa - - + Prakshaalana.
Shodhana - - + -
Pracchanna - + - -

Ayurvedic Review
In Sapta Upakramas also we can incorporate 60 therapeutic measures.
Table No. 16
7 Upakramas 60 Upakramas
Vimlaapana Aptarpana, Aalepa, Parisheka, Abhyanga, Swedana, Vimlaapana.
Avashechana Visraavana, Sneha, Vamana, Virechana.

Upanaaha Upanaaha, Paachana.
Paatana Chedana, Bhedana, Dhaarana, Lekhana, Eshana, Aharana, Vyadhana,
Visraavana, Seevana.
Shodhana, Sandhaana, Peedana, Shonitasthaapana, Nirvaapana, Utkaarika, Kashaaya,
Ropana Varti, Kalka, Sarpi, Taila, Rasakriya, Choorna, Dhoopana.
Vaikrutaapaham Utsaadhana – Rakshavidhi.
Among 36 Upakramas mentioned by Charaka, Shopaghna i.e. treatment of Vrana

Shopha which involves Rakta Avashechana, Langhana, Sneha, Pralepa, Pradeha, Upanaaha
etc can be incorporated under 11 Upakramas mentioned by Sushruta for Vrana Shopha.
Shastra Karmas mentioned by Sushruta can be incorporated under 6 measures mentioned by
Charaka even though he has told Eshana seperately and Aharana has been covered under 6
surgical measures only.Shodhana, Ropana, Vaikrutaapaham mentioned by Sushruta can also
be incorporated 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 by
Sushruta can be incorporated in 7 Upakramas of Vrana Shopha and most of them among 60
can be incorporated under 36 Upakramas mentioned by Charaka.
Pathyaapathya46:
Pathya:
Vrana patient should consume Jeerna Shaali,Odhana which is made warm unctuous&
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 house devoid of breeze etc.Vrana patient should remain devoid of undesirable
nails, hairs should be clean, resort to observance of propitiatory and auspicious rites.

Ayurvedic Review
Apathya:
Vrana patient should not consume Navadhaanya, Maasha, Tila, Kalaaya,
Kulattha, Nishpaava, Hareetaka Shaaka, Katu, Amla, Lavana Rasa substances, 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.
Upadravas47:
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 48:

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/straight,sepe five types i.e.Ghrishta, Avakritha, oblique/straight,
ration of body parts. Avagaada, Vilambita, Paatita. wide, causing
seperation of body
parts.
Bhinna Perforation/ Mentioned Anubhinna, Vrana Puncture of
puncture of Bhinnotthundita, Atibhinna, occuring in Aashayas,discharg
Aashayas, exuding Nirbhinna to those Vranas which Koshtha with ing contents to the
mild Sraava. occur in Koshtha. small orifice. exterior.

Ayurvedic Review
Viddha Injury to any part of Classified into further 8 types- Vrana with Injury to any part
body other than Anuviddha,Uttundita,Atividdha,Nirvi small orifice of body other than
Aashaya,Uttundita. ddha etc. occuring Aashayas and
anywhere Uttundita.
other than
Koshtha.
Kshata Vrana which is Considered Chinna,Viddha …………… Neither Atichinna
neither Ati Chinna &Picchita as Kshata because of loss ….. nor Ati Bhinna but
nor Ati Bhinna. but of skin continuity. having mild
having features of features of both &
both and irregular in irregular in shape
shape.
Picchita Flattening of any Body part with Asthi increasing in Mentioned Flattening of any
part of body along size by getting s oaked in Rakta and Vidalita in part of body along
with Asthi, filled Majja. it is of two types with Vrana which with Asthi, filled
with Rakta and and without Vrana. features are with Rakta and
Majja. similar to Majja.
features
mentioned in
Sushruta.
Ghrista Peeling of skin of Mentioned it as Twak Chedana. Exudes Peeling of skin of
any part of body Laseeka any part of body
accompanied with alone or accompanied with
watery exudation. mixed with watery exudation.
lttle of Rakta
associated
with burning
sensation.
Avagaada ……………… Broad and long(Vishaala and Severe than ………….
Aayama) mentioned it as a type of Ghrishta
Chinna Vrana. Vrana.
Vichinna ……………… ……………. Severe than …………….
Avagaada
Vrana.
Paatita ……………….. Body part getting detached or Injured body ……………….
seperated completely from body. part gets
seperated
from body.
Pravilam ……………… ………………… Vrana in ………………
bhi which Asthi
remains in
place.
Vilambita ……………… Vrana in which little of Asthi,Snaayu …………… ……………..
etc remains as residue. ……
Avakruta ……………… Abrasion of Twak and little of ……………. …………………
Maamsa.

Ayurvedic Review
Chikitsa49:
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 of drugs in the form of paste.
2)Vishesha Chikitsa:
Chinna, Bhinna, Viddha Vranas-Snehapaana, Seka, Upanaaha with Veshavaara,
Krushara, Swedana with cereals, Snigdha lepa, Sneha Basti with Vaataghna Oushadha,
Snigdha Sneha is prescribed
Ghrishta Vrana -In order to pacify Ushna, Sheetala Aalepa, Parisheka should be
done.These should be treated with Choornas (of Saala, Arjuna etc.) after relieving pain (by
applying Madhuka ,cold etc.)
Picchita Vrana - Sheetala Lepa, Pariskeka should be done.

Avakrita Vrana - Use of Kalka.Vicchinna and Pravilambita Vrana -Seevana, Bandhana,
Avapeedana should be done.
Viddha Vrana-Removal of Shalya.
The reference of Vrana Basti is found in SU SU 9th chapter where Acharya has
adviced a special Yantra for Vrana Basti .The idea behind this is to irrigate the wound with
Drava Dravya.

Modern Review
Modern Review
The word wound and ulcer are used synonymously though it has some similar &
dissimilar features. An ulcer is a discontinuity of an epithelial surface (skin or mucous
membrane).It may follow molecular death of surface epithelium or it‟s traumatic removal,
there is usually progressive destruction of surface tissue cell by cell, as distinct from death of
macroscopic portions (eg. Gangrene/necrosis)50.
Chronic ulcers are the wounds that fail to heal, in general they have a fibrotic margin
and a bed of granulation tissue which may include areas of slough (necrotic tissue).
Classification of Ulcers:
Two types of classification of ulcers are possible
1) Clinically
2) Pathologically.
Table No 18
Clinically51
Spreading ulcer Healing ulcer Callous ulcer
Surrounding skin of ulcer is Floor-gr.tissue is present, Floor- pale gr.tissue
inflammed, floor-covered Edge- bluish outline of induration- present at
with slough without any growing epithelium & slight base, edge, surrounding
granulation tissue. serous discharge. skin. Ulcer shows no
tendency towards
healing.
Pathologically52
Non-specific ulcers Specific ulcers Malignant ulcers

Modern Review
Non-specific ulcers:
These are due to infection of wounds or physical, chemical agents, local irritation, as
in the case of a dental ulcer or interference with the circulation e.g.: Varicose veins are
predisposing causes, so according to the cause these ulcers are classified as below
Mechanical e.g.: Dental ulcer of tongue from jagged tooth
Traumatic ulcer .
Physical e.g.: From electrical/ x ray burn.
Chemical e.g.: From application of caustics.
Arterial ulcer (occurs in atherosclerosis, burgers disease and raynauds disease)

Venous ulcer, Neurogenic ulcer, Infective ulcer, Tropical ulcer, Cryopathic ulcer, Martorells
ulcer, Bazins ulcer, Diabetic ulcer, Miscellaneous ulcers.
Specific ulcers:These are seen in T.B, syphilis, soft sore and actinomycosis.
Malignant ulcers: e.g.: Epithelioma, rodent ulcer and malignant melanoma.
Traumatic ulcer:
Occurs due to trauma in the areas where skin is closely applied to bony prominences
(shin, malleoli, and back of the heel). Characteristic features: It is circular, small in size and
painful.
E.g.: Foot ballers ulcer, plaster sores, dental ulcer of tongue.
Arterial ulcer/Ischaemic ulcer:

Occurs due to inadequate skin circulation(due to atherosclerosis, burgers and
Raynauds disease) in the limbs which are subjected to repeated pressure and trauma (antero
lateral aspect of the leg, toes, dorsum of the foot or heel). Characteristic features: Pain is the
main complaint with punched out edge and floor may expose the tendons.
Venous ulcers:
Occurs due to abnormal venous hypertension in the lower third of the leg, ankle and
dorsum of foot (this may be associated with demonstrable varicose veins and such ulceration
may follow thrombosis and phlebitis in deep and perforating veins).

Modern Review
Characteristic features:
Venous ulcers are most common on inner side just above medial malleolus of leg.
These ulcers are ovoid in shape, usually single in number with irregular, thin blue margin and
pale granulation tissue in the floor. Pigmentation is seen in the vicinity of ulcer. These ulcers
are usually shallow and never penetrate deep fascia and are slightly painful in the beginning
but gradually pain settles down. Base is fixed to deeper structures associated with
seropurulent discharge & occasional trace of blood.
Neurogenic ulcers /Neuropathic / Trophic / Penetrating ulcers:

Occurs due to impairment of the nutrition of tissues, inadequate blood supply and
neurological deficit or repeated trauma to the insensitive part of the body.
Features: These ulcers are commonly seen on the heel and ball of the foot when patient is
ambulatory and on buttocks, back of heel when patient is non-ambulatory.
Edge is punched out, base is slightly indurated and floor is covered with slough.
Surrounding skin has no sensation and these are painless.
Eg: Bed sore, perforating ulcers.
Infective ulcers:
Pyogenic ulcer: Causes: Commonly staphylococcus, and occasionally streptococcus.
Predisposing factors are anaemia, poor nutritional status. Features: These are multiple, small,
red, scabbed sores on leg or ankle.
Syphilitic ulcer: Ulcers due to syphilis are seen in all 3 stages.

Primary Hard chancre is seen (external genitalia) Features: Single, painless,
indurated base, oval/round in shape with raised hyperaemic margin.
Secondary Ulcer may develop in the form of mucous patches, snail track or in form
of condylomas.
Tertiary Typical lesion in this stage is localized gumma or

gummatous ulcer.

Modern Review
Gummatous ulcer:
Gumma is syphilitic hypersensitivity reaction consisting of granular tissue with
central necrosis.These ulcers are commonly seen over subcutaneous bones (tibia, sternum,
ulna and skull). Edges are punched out indolent, painless and floor is covered with wash-
leather slough (yellowish gray gummatous tissue).
Tropical ulcer:
Characteristic feature of this ulcer is callousness towards healing. Edge is slightly
raised and exudes copious serosanguineous discharge. Pain is an important symptom.
Martorells ulcer:
Occurs in patients who are usually hypertensive/ atherosclerotic.
Cryopathic ulcer:
These results from intense cold & chilly weather.
Diabetic ulcer:
In this slight injury to the glucose laden tissue may cause chronic infection and ulcer
formation. Ulceration in diabetes may be precipitated by ischaemia due to diabetic
atherosclerosis, infection or peripheral neuritis. When the ulcer is due to neuropathy a trophic
ulcer results (features are same as trophic ulcer but surrounding sensation of skin will be less.
When ulcer is due to ischaemia, ischaemic ulcer results but it is less painful than typical
arterial ulcer.Toes and feet are normally affected.
Tuberculous ulcer:
Such ulcer usually develops due to bursting of cold abscess, this cold abscess may
form from matted tuberculous lymph node or TB of bone or joint & from submucous lesions
eg intestinal TB.
It is oval in shape generally with irregular crescentic border, often multiple in number
with thin reddish blue, undermined edge and slightly indurated base. It is usually shallow,
accompanied with slight pain, variable amount of discharge and floor is covered with pale
granulation tissue.

Modern Review
Soft chancre/chancroid (ducrey‟s):

It is a contagious disease caused by gram –ve haemophillus ducreyi 3 to 5 days after
exposure multiple acute sores develop on external genetalia. These are often painful,
gradually becomes pustular and ulcerate to form soft sores. These are multiple, soft, rounded,
painful and readily bleed and edges are undermined.
Actinomycosis:
This condition causes multiple ulcers. At first area becomes indurated, nodules
appear, which soften and later ulcerates in various places. Surrounding skin often looks
bluish in color.
Rodent ulcer/Basal cell carcinoma:

It is locally invasive carcinoma of basal layer of epidermis. It is of low grade
malignancy. It is commonly seen on the face, above line from corner of mouth to ear, inner-
canthus of eye, nose on and around nasolabial fold, has raised and pearly white beaded edge,
irregular in shape and floor covered with coat of dried serum, epithelial cells.
Epithelioma (squamous cell carcinoma):

Occurs commonly in the dorsum of hands, in the face, limbs, lips, vulva, penis etc. It
has normal temperature and usually not tender, oval or circular in shape with raised and
everted edge, indurated base and floor is covered by necrotic tumour, serum & blood.
Marjolins ulcer:
It is the name given to a squamous carcinoma which arises in a chronic benign ulcer
or scar. It is slow growing malignant lesion, painless and edge is not always raised and
everted.
Miscellaneous ulcers:
Ulceration of leg may be associated with gross anaemia, leukaemia, polycythemia,
systemic sclerosis, RA, ulcerative colitis, poliomyelitis, arteriovenous fistula, acholuric
jaundice, various collagen disorders, chronic lymph edema, cortisone ulcers etc.
The life history of ulcer consists of 3 phases53
1) Stage of extension

Modern Review
2) Stage of transition
3) Stage of repair
Stage of extension: During this stage floor is covered with exudate and slough, while base is
indurated. The discharge is purulent and even blood stained.
Stage of transition: This prepares for healing. Floor becomes cleaner, slough seperates,
induration of base diminishes and discharge becomes more serous. Small reddish areas of
granulation tissue appear on the floor.
Stage of repair: It consists of transformation of granulation to fibrous tissue which gradually

contracts to form a scar. The epithelium gradually extends from the new shelving edge to
cover the floor. This healing edge consists of 3 zones. An outer layer of epithelium appears
white, middle one appears bluish in color (where granulation tissue is covered by a few layers
of epithelium) & inner reddish zone of granulation tissue covered by single layer of epithelial
cells. The red color of tissue is due to high density of new capillaries.
Clinical examination of an ulcer54: This should be conducted in systemic manner
Local examination: The following points should be noted i.e. Site, size, shape, number,
edge, floor, discharge, surrounding area etc.
Inspection:
Site: This is very important and often by itself gives a clue to diagnosis 95% of rodent ulcers
occur in the upper part of the face, carcinoma typically affects the lower lip, while a primary
chancre of syphilis is usually on upper lip.
Size: Size of an ulcer is important to know the time required for healing. A bigger ulcer will
take a longer time to heal particularly in relation to the length of history eg. A carcinoma
extends more rapidly than a rodent ulcer but more slowly than an inflammatory ulcer.
Shape: Tuberculous ulcers are generally oval in shape but their coalescence may give an

Modern Review
irregular crescentic border, rodent ulcer is usually circular, varicose ulcer is vertically oval in
shape, gummatous ulcer is circular or serpiginous due to fusion of multiple circles
& carcinomatous ulcer is irregular in shape.
Number: Tuberculous, gummatous, varicose ulcers, soft chancres may be more than one in
number.
Margin: It is the junction between normal epithelium and ulcer.
Edge: It is an area between the margin and floor of ulcer. Margin or edge takes a
characteristic shape in particular form of ulcer. Edge is an important finding of an ulcer
which by itself not only gives a clue to diagnosis of ulcer, but also the condition of ulcer eg.In
spreading ulcer edge is inflammed and edematous, in healing ulcer-If the edge is traced from
red granulation tissue in the centre towards periphery will show a blue zone (due to thin
growing epithelium) and a white zone due to fibrosis of the scar.
Floor: This is an exposed surface of the ulcer. When floor is covered with red granulation
tissue ulcer seems to be healthy and healing. In slowly healing ulcer floor is covered with
smooth and pale granulation tissue, in gummatous ulcer floor is covered with wash leather
slough, trophic ulcers penetrates down even to bone, so bone forms the floor & in malignant
melanoma black mass at floor will be seen
Discharge: The character of discharge, smell and amount should be noted. In healing ulcer
scanty serous discharge, in spreading and inflammed ulcer purulent discharge & in
tuberculous ulcer/ malignant ulcer serosanguinous discharge is seen. Purulent discharge
indicates active infection and blue green coloration suggests infection with Pseudomonas
pyocyaneus
Surrounding area: In acute inflammed ulcer surrounding area is glossy, red and edematous
and in varicose ulcer skin is eczematous and pigmented

Modern Review
Table No.19 Five common types of ulcer edges are seen in surgical practice
Undermined edge Punched out Sloping /shelving Raised and Rolled out or
pearly white everted
beaded
The disease The edge droops Every healing This type of edge Growing portion at
causing ulcer down at rt. angle ulcer has a sloping develops in the edge of ulcer
spreads in and to skin surface as edge, which is invasive cellular heaps up and spills
destroys the if it has been cut reddish purple in disease and over the normal
subcutaneous out with a punch color and consists becomes necrotic skin e.g.
tissue faster than it e.g.gummatous of new healthy at the centre e.g. Squamous cell
destroys the skin. ulcer, deep trophic epithelium e.g. rodent ulcer. carcinoma
The over hanging ulcer,syphilitic healing traumatic /epitheloma.
skin is thin, friable ulcer (vertically or venous ulcer.
and reddish blue, punched out).
unhealthy e.g.
tuberculosis
Vascular insufficiency: Examination of this should be done when the ulcer is situated on
lower part of the leg. One should always search for varicose veins in upper part of the leg or
thigh.
Palpation:
Edge: During palpation consistency of edge should be noted, marked induration of the edge
is characteristic feature of a carcinoma. A certain degree of induration is expected in any
chronic ulcer whether it is trophic/ gummatous/syphilitic ulcer.
Base: It is better felt than seen. It is that on which the ulcer rests. If an attempt is made to
pick up the ulcer between thumb and index finger the base will be felt.Slight induration of
base is seen in chronic ulcers, marked induration of base is seen in squamous cell carcinoma
and some times it is attached to deep structures eg: varicose ulcer to tibia.

Modern Review
Depth: It can be recorded in millimeters. Trophic ulcers are as deep as to reach even the
bone.
Bleeding: Bleeding to touch is common feature of a malignant ulcer.
Relation with deeper structures: Malignant ulcers will obviously be fixed to deeper
structure by infiltration. The gummatous ulcer over a subcutaneous bone is often fixed to it.
Lymph nodes: In acutely inflamed ulcers the regional lymph nodes becomes enlarged,
tender and shows the signs of acute lymphadenitis.
In tuberculous ulcer lymph nodes become enlarged, matted and slightly tender.In huntarian
chancre regional lymph nodes remain discrete, firm and shotty and in malignant ulcers lymph
nodes are stony hard and may be fixed to neighbouring structures in late stages.
Tenderness: An acutely inflammed ulcer is equisitely tender. Chronic ulcers such as

tuberculous and syphilitic ulcers are slightly tender. Varicose ulcers may or may not be
tender.
General examination: Evidence of debility, cardiac failure, all types of anaemia including
sickle cell anaemia or diabetes must be sought
Pathological Examination: E.g. Biopsy will confirm carcinoma, serological and mantoux
test may be of value for syphilis and TB respectively. Bacteriological examination of
discharge of ulcer is important in inflammed and spreading ulcers. This will not only give a
clue to type of organism present in ulcer but also its sensitivity to particular
antibiotic.Examination of urine: Urine sugar to exclude diabetes is important. Routine
examination of blood: TC, DC, HB%, RBC, ESR should always be done in a patient with an
ulcer.Blood sugar estimation may be performed to exclude diabetes. In tuberculous ulcers-
Lymphocyte count and ESR will be high.
General principles of ulcer management55a:

The main aim of ulcer management is to ensure the quickest & most durable form of
healing with a minimal scar.

Modern Review
Debridement: Removal of dead & devitalized tissues or foreign material is called as

debridement.It is essential to prevent the bacterial growth.
It is of following types
1. Surgical debridement.
2. Chemical debridement.
3. Mechanical debridement.
Surgical debridement: Excision of dead and devitalized tissue.
Chemical debridement: Debridement using chemicals like

Topical agents: A wide variety of topical wound cleaning agents being available and
bacteriostatic agents being promoted for local wound application. Some of them are:
Povidone iodine: Strong bactericidal for gram positive and negative organisms (it has a broad
spectrum of activity but its anti bacterial effect is reduced by contact with pus or exudate). It
should not be used in patients who are sensitive to iodine.
Eusol55b: It is one of the hypochlorite solutions widely used in the management of open
wounds left to heal by secondary intention. It consists of chlorinated lime and boric acid
solution containing 0.25% Wt./ volume of available chlorine with a pH between 7.5&8.5.In
dilute concentrations it kills fibroblasts, neutrophils and endothelial cells in tissue culture.
Eusol delays the appearance of hydroxyproline (the amino acid marker of wound collagen
content) and prolongs the acute inflammatory response. It has no role in the treatment of open
wounds that are clean and healing well with no signs of invasive infection.
Chlorhexidine: It is the topical antiseptic which is effective against a wide range of gram
positive and negative organisms and some fungi.
Hydrogen peroxide: It liberates nascent oxygen which bubbles up and opens up tissue spaces
for free oxygenation and helps in separating the slough. But it delays wound healing by
separating granulations and can cause haemolysis.
PDGF55c: Topical application of PDGF helps to rapidly heal chronic non-healing, non
malignant ulcers. It was a pilot study conducted in which PDGF derived from patients own
blood was used to treat chronic ulcers.

Modern Review
Sucralfate55d: It is basically a sugar that binds and activates fibroblast growth factor and
causes it to accumulate in wound areas and stimulate epithelial cell proliferation. It exhibits
antimicrobial activity against a range of micro organisms. Its antimicrobial activity is by its
macrophage activity. It prevents the release of cytokines from damaged skin cells there by
exerting anti-inflammatory and smoothening effect. It is absorbed and does not have any
toxic, allergic and systemic effects even after prolonged use.
Metronidazole as local adjunct55e: Topical preparation of metronidazole (1%) along with

sucralfate (7%) has been used to overcome the problem of inadequate drug delivery due to
poor blood supply. Both of them have shown to promote the accumulation of beta EGF and
thus enhance re-epithelialization, facilitates angiogenesis and granulation tissue formation.
Oxpentifylline55f: It has been found to have fibrinolytic effect and to influence the behaviour
of white cells. An experimental study says that healing rates of venous ulcers of the leg will
be increased appreciably by the addition of oxpentifylline to a standard regimen of dressing
and compression bandaging.
Collagen dressings: They significantly hasten the healing rates and reduction in wound
nuisance like discharge, soakage.
Mechanical debridement: Debridement by using flushing therapy or hydrotherapy etc.

Filling dead space: Dead space promotes anaerobic infection. So in order to achieve healing
from the base of a large cavity insert packing which prevents cavity collapse but does not add
to the wound tension.
Protecting adjacent skin: It is important as a moist environment promotes maceration.

Treatment of underlying disease.

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Table No.20-Classification of commonly used antiseptics in general surgicalpractice56

Name of presentation Uses comments
antiseptic
Chlorhexidine(H Alcohol-0.5% Skin preparation Has cumulative effect.
ibiscrub) Aqueous-4% Surgical scrub in Effective against gram positive
dilute solutions in organisms & relatively stable in
open wounds presence of pus, body fluids.
Povidone- iodine Alcohol-10% ,, Safe, fast acting broad spectrum.
Aqueous- Sporicidal activity, anti-fungal.
7.5% Iodine is not free but combined
with polyvinylpyrrolidone.
Cetrimide(savlon Aqueous Hand washing, Pseudomonas species may grow in
) Instrument and stored contaminated solutions.
surface cleaning.
Alcohols 70% ethyl, Skin preparation, Should be reserved for use as
Hypochlorites isopropyl instrument & disinfectant
aqueous surface cleaning
preparations(e (debriding agent
usol, Milton, in open wounds?)
chloramine T)
Hexachlorophae Aqueous Skin preparation, Has action against gram negative
bisphenol hand washing. organisms.
Treatment of different types of ulcers57:
It can be dealt under the following headings.
1) Treatment of spreading ulcers: After obtaining pus c/s report appropriate antibiotics
are given. Many solutions are available to treat the slough like hydrogen peroxide or
eusol.
2) Treatment of healing ulcers: Regular dressings are done for few days with antiseptic
creams like liquid iodine, Zinc oxide or silversulphadiazine preparation. A swab is
taken to rule out the presence of streptococcus haemolyticus which is contra

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indication for skin grafting. If the ulcer is small, it heals by itself with
epithelialisation from the cut edge of ulcer. If the ulcer is large, free split skin graft is
applied as early as possible.
3) Treatment of chronic ulcers: These do not respond to conventional methods of

treatment. Some special forms of treatment are available, their usefulness is doubtful.
They are as follows: infrared radiation, short-wave therapy, u.v-rays decrease the size
of ulcer, amnion helps in epithelialisation, chorion helps in granulation tissue.
4) Treatment of non-specific ulcers: Any underlying cause is treated eg: varicose veins,
diabetes arterial disease. Many lotions and nonadhesive applications are used to aid
the separation of sloughs, hasten granulation and stimulate
epithelialisation.Hypochlorite solution and 0.5% AgNo3 are popular in the earlier
stages and later 1% Zinc sulphate solution .Ointments and creams used include Zinc
oxide and 1% hydrocortisone.
Wound dressings58:
Hydrocolloid dressings such as granuflex or comfeel consist of a thin polyurethane
foam sheet bonded on to a semi permeable polyurethane film which is impermeable to
exudates and microorganisms, when the dressing comes into contact with wound exudates it
interacts to form a gel which expands into the wound.The moist conditions produced under
the dressing promote angiogenesis and wound healing without causing maceration.
A hydrocolloid dressing can be applied to small wounds containing dry slough or
necrosis, the dressing prevents the loss of water vapour from the skin surface and this
effectively rehydrates the dead tissue which is then removed by autolysis.
Hydrogel: Is a pale yellow/colorless transparent aqueous gel, when it comes into
contact with wound, the dressing absorbs excess exudates and produces a moist environment
at the surface of wound without causing tissue maceration.
Lyofoam: Is a low-adherent comfortable polyurethane foam sheet, the side of the

dressing that is to be placed in contact with skin has been heat treated to render it hydrophilic,
whilst the outer surface remains hydrophobic. The dressing is freely permeable to gases and
water vapour but resists the penetration of aqueous solutions and exudates. The dressing
maintains the moist warm environment at the surface of the wound, which is conducive to
granulation and epithelialisation.

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Wound59:
Definition: It is the discontinuity or break of the surface.
1) Simple: When only skin is involved.
2) Complex: When it involves underlying nerves, vessels, tendons etc.
From practical point of view wounds are classified into:
1) Tidy wounds- Contains no devitalized tissues, inflicted by sharp instruments.
2) Untidy wounds- These result from crushing, tearing, avulsion etc and contain
devitalized tissue.
Types of wounds:
1) Incised wounds- Caused by sharp objects, edges of the wound are sharp. Tends to
gape and bleed freely.
2) Lacerated wounds- Caused by blunt objects, edges of the wound are jagged. Causes
minimal bleeding because of crushing.
3) Penetrating wounds- (variation of punctured wound)- Stab injuries of abdomen are
notorious, depth is more.
4) Crushed or contused wounds- Caused by blunt trauma.
5) Abrasion- Caused by scraping away of superficial skin layer and is very painful.
Dangers and complications of wounds:

1) Haemorrhage- external or internal.
2) Damage to important deeper structures or vital organs.
3) Swelling- may cause local tissue hypoxia and pain.
4) Infection.
5) Scar-causing dysfunction, deformity or disfiguration.
Infection60:
It is a biological accident where in the pathogenic micro organism invades body by
contamination of tissues from with in or out side and sets the pathological manifestations.
Two factors govern the onset and development of infection- viz.,

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1. Virulence of micro organisms: It is markedly enhanced by toxigenicity (production of

toxin).These are of two types:
(i) Exotoxins- Toxin is liberated from the surface of living bacteria. These are
produced by gram positive bacteria. (ii) Endotoxins- These are produced by gram
negative bacilli only when they die out and liberating there contents.
2. Resistance of host: It is the result of integrated sequential function of its immune

apparatus consisting of polymorphs, lymphocytes etc.
Following are some of the important organisms of infection

Table No. 21-Gram positive cocci
Organism Site & Spread Principal infections Antibiotic sensitivity
Staphylococcus aureus Lives in naso Infections are
Most of the strains
pharynx, present in usually localized eg:are resistant to
infected discharges. Boils, Styes,
Penicillin because
Spread by contact, Carbuncle, Septic
they produce
air borne etc., hands, wound penicillinase. They
infections etc., are sensitive to
Flucloxacillin &
Methicillin.
Streptococcus Lives in pharynx. Infections tend to Highly sensitive to
Spread by air borne spread eg: Penicillin.
from respiratory, Erysipelas, cellulitis,
contact. puerperal sepsis,
tonsillitis etc.
Table No.22-Gram negative bacilli

Organism Site & Spread Infections Antibiotic sensitivity
E.Coli Normal inhabitant UTI, Peritonitis, Most of them are
of large bowel Contaminated sensitive to ampicillin,
wounds, Intra gentamycin.
abdominal sepsis.
Klebsiella ‟‟ ‟‟ Resistant to ampicillin
Pseudomonas Large bowel Attacks damaged and Sensitive to
aeruginosa moist tissues such as gentamycin and some
burns, urinary tract cephalosporins.
and tracheostomy
wounds with
production of
characteristic blue
geen pus.

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Table No.23-Anaerobic organisms

Organisms Site & Spread Infections Antibiotic sensitivity
Gram positive cocci Widely found in Abdominal sepsis, Sensitive to penicillin
eg: clostridium nature particularly wound infections and metronidazole.
species, peptococci, faeces, colon, with severe local
streptococci. rectum, oropharynx, pain
vagina etc,.
Gram negative Large bowel, vagina, Intra abdominal Sensitive to
bacilli. Eg; oro pharynx. sepsis, pelvic sepsis metronidazole and
bacteroides fragilis. some cephalosporins.
Types of infection61 :
1. Wound abscess.
2. Cellulitis and lymphangitis.
3. Bacteraemia.
4. Septicaemia.
Wound healing62 :
The word healing means replacement of destroyed tissue by living tissue i.e.
it is the body response to injury in an attempt to restore the normal structure and function. In
the context of wound healing two terms should be understood.
1. Regeneration – When healing takes place by proliferation of parenchymal cells and

usually results in complete restoration of the original tissues.
2. Repair – When healing takes place by proliferation of connective tissue elements

resulting in fibrosis and scarring. At times, both the processes take place
simultaneously. Healing of skin wounds provides a classical example of combination
of regeneration and repair. This can be accomplished in one of the following two
ways.
(i). Healing by first intention (primary union) - This is defined as healing of wound which
as following characteristics:
Clean and uninfected wounds,
Surgically incised wounds,
Wounds with out much loss of cells and tissues,
Edges of wounds or approximated by surgical sutures.i.e. Healing by first intention is
one in which healing occurs with minimum scarring.

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(ii). Healing by second intention (secondary union) - This is defined as healing of a wound
having the following characteristics:
Open wounds with a large tissue defect at times infected,
Wounds having extreme loss of cells and tissues,
Wound which is not approximated by surgical sutures but is left open.i.e. Healing by
second intention is one in which wound heals with more scar tissue and takes longer
time to heal.An ulcer heals in the same way.
Factors influencing wound healing63

1. General factors.
2. Local factors.
General factors:
1.Age: Healing is fast in the young.
2.Nutrition64: It is a vital component in optimizing the wound healing environment. It

provides the raw materials needed for the wound repair and the prevention of infection.
Wound healing depends upon the adequate intake and absorption of nutrients such as
vitamins, minerals, proteins and calories. Delayed wound healing occurs if nutritional
supplies are lacking due to intake (malnutrition), abnormal absorption (GIT disease or
Surgery), increased metabolic demands.Vitamins play significant role in promoting healing.
They are given usually to supplement the patient‟s diet. Vitamin C plays an important part in
wound healing process as it affects collagen synthesis, immune function and decreases
capillary fragility. Vitamin A enhances the process of collagen synthesis and epithelialisation.
In addition it counteracts the anti inflammatory effects of steroids and cell membranes.
3) Oxygen and its role in healing65:Oxygen has a significant role in wound healing being
essential to provide additional energy source for the repairing process. Oxygen may infact be
the rate limiting step in early wound repair. Many other components in addition to oxygen are
interrelated to provide the optimal environment for healing including nutritional state,
immune function, cardio pulmonary function etc.
4) Hormones: Corticosteroids inhibits granulation tissue formation.
5) Other conditions which delay or hamper healing are uraemia, jaundice, anaemia, diabetes,
cytotoxic drugs, and malignant diseases.

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Local factors:
Position of skin wounds- Skin wounds parallel to lines of Langer heal faster.
Blood supply- Wounds with poor blood supply heal slowly.
Tension – Healing is jeopardized if the wound is in tension.
Infection& Movement – Delays healing.
Necrosis- Obviously retards healing.
UV light- Exposure of wounds to UV light accelerates healing.
Exposure to ionizing radiation- Affects the vascularity and causes delay in
granulation tissue formation.
Lymph drainage- Impairment of lymph drainage causes edema of part, jeopardizes
the process of healing.
Wound healing is the summation of a number of processes which follow injury including
coagulation, inflammation, matrix synthesis and deposition, angiogenesis, fibroplasias,
epithelialisation, contraction, remodeling and scar maturation.
The four basic processes which take place in wound healing are
1. Inflammation.
2. Wound contraction.
3. Epithelialisation.
4. Granulation tissue formation.
Immediately after disruption of tissue integrity either by accidental trauma or by

surgeon‟s knife, inflammation starts.Sequence in inflammation: The inflammatory phase is
triggered by two classes of mediators (soluble signal factors) - those controlling vessel
permeability and those attracting or trapping cells. The clinical signs of inflammation are
caused by changes in blood vessels with dilatation leading to erythema and endothelial cell
separation allowing plasma extravasation, producing localized swelling

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Inflammation:
Schematic representation of phases of inflammation.
Injury
Initial haemorrhage
Inflammation starts
Haemostasis
Appearance of polymorphs
Diapedesis
Migration
Phagocytosis
. There are overlapping stages but, in general, the order of arrival at the wound site
from an intravascular space is thought to occur in the following sequence: plasma with
soluble components and cellular constituents, first platelets, then neutrophils, followed by
monocytes and lymphocytes. The migration of epithelial cells to resurface the injured tissue
begins during this phase, mediated by the above events.
Alterations in microvascular permeability after injury allow both fluid and plasma
components to pass to the tissue. Vasoactive amines and peptides (including histamine from
mast cells, serotonin from platelets, and bradykinin from neutrophils) cause the reversible
opening of junctions between endothelial cells and allow the passage of neutrophils and
monocytes.
Platelets:
The earliest circulating cell or cell fragment detected in the injury site is the platelet.
Platelets contain three types of organelles involved in haemostasis and initiation of the
inflammatory phase, they are

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1. Alpha-Granules
2. Dense body granules
3. Lysosomes
The above substances are released when the platelets are activated by various factors.
When injury occurs, contact is made between platelets and insoluble components of the
subendothelial matrix, particularly collagen, promoting the release of alpha-granule contents
which then trigger the coagulation process. The activation of platelets is enhanced by some of
the complement factors and by bacterial lipopolysaccharides. The latter produce a 50-fold
increase in the amount of serotonin released.
Activated platelets become sticky and aggregate to form a plug that temporarily
occludes small vessels. Both damaged platelets and tissues release thrombokinase, which
converts prothrombin to thrombin, and this in turn ensures the conversion of soluble
fibrinogen to insoluble fibrin. The release of serotonin and adenine nucleotides contained in
the dense bodies of the platelets induces the aggregation of platelets, which interact with the
fibrin network to form a clot which is stronger and more durable than the initial platelet plug.
If the clot is allowed to dehydrate, it transforms to a dry eschar (scab) covering the wound.
Other substances released by the alpha-granules, such as platelet derived growth
factor (PDGF), and by the dense body, such as cyclic adenosine monophosphate (cAMP) are
chemotactic for neutrophils.
Accumulation of neutrophils:
Adhesion: Interaction between damaged tissue and serum releases the complement factor C3,
and the C3e fragment of this provokes the release of neutrophils from the bone marrow. At
the same time, circulating leucocytes near the wound site, particularly neutrophils, cease to
flow and adhere to the endothelium. It has been shown in vitro that adherence is enhanced by
inflammatory mediators, such as C5a (the fifth component of complement), platelet-
activating factor, and leukotriene. There is a very fast initial response, with onset of
adherence as early as 30 seconds after injury and with a maximum response at 2 minutes.
The binding of leucocytes to endothelium results from the interaction of
complementary receptors in both cell types. Their expression is enhanced by cytokines and
bacterial lipopolysaccharides. Physical factors, such as haemodynamic shear stress, also
influence adherence. This first stage of adherence is critical. While there is some evidence
that some wounds can heal without the presence of neutrophils, patients with leucocyte

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adhesion deficiency, lacking an essential glycoprotein, are unable to mobilize neutrophils or

monocytes, and exhibit decreased pus formation and impaired wound healing.
Diapedesis: Vasopermeability factors act on actin microfilaments inside the endothelial cells
and effect the reversible opening of junctions so that neutrophils are able to pass between the
endothelial cells to the extravascular space. It is suggested that the secretion of elastase and
other enzymes by the neutrophils enables them to degrade elastin and components of the
endothelial basement membrane.
Migration: Molecules released by platelets following disruption of the blood vessels, e.g.
kallikrein (an enzyme that leads to the formation of vasodilating peptides) and
fibrinopeptides, diffuse to the site of the wound and set up a concentration gradient of
chemotactic factors which attract the neutrophils that have traversed the endothelium through
the extracellular space to the injury site.
Phagocytosis: At the site the neutrophils form the first line of defence against the invading
micro-organisms. The neutrophils phagocytose bacteria, then kill the ingested cells by the
production of microbiocidal substances, oxygen metabolites such as hydroxyl radicals,
hydrogen peroxide, and the superoxide ion. Release of some of these substances to the
outside of the cell may also lead to tissue damage and prolong the inflammatory phase. Some
bacteria may be killed by non-oxidative mechanisms, but these are not defined in vivo. If
bacterial contamination is low, the density of neutrophils declines, but if numbers of micro-
organisms persist, the bacterial lipopolysaccharides continue to promote the arrival of further
neutrophils. The neutrophils are unable to regenerate their enzymes and so themselves decay
after phagocytosis.
Accumulation of macrophages:
The macrophage is indispensable in the degradation of injured tissue debris and in the
reparative phase of wound. If the macrophages are inhibited, wound healing is radically
impaired.
Normal tissues contain very few macrophages, but, in response to chemotactic factors
released after injury, circulating monocytes are attracted to the site of injury several hours
after the first neutrophils arrive. Endothelial cells in wounded tissue also play a role in this
process, and have been shown to regulate the preferential adhesion of monocytes and
lymphocytes to endothelium.

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At the injury site, monocytes differentiate into macrophages. One of the signals
promoting this differentiation is the binding of fibronectin to surface receptors on monocytes,
which induces the activation of the receptors for phagocytosis. Macrophages develop
functional complement receptors and undertake similar operations to the neutrophils.
However, further interactions with the interferons, and subsequently with bacterial or viral
products, induce further differentiation into a fully activated phenotype. Interferons enhance
endocytosis and phagocytosis and modulate the surface receptor functions of newly migrated
macrophages. Ingestion of bacteria by endocytosis triggers the primary oxygenase which
converts molecular oxygen to the superoxide, which then reacts to produce hydrogen
peroxide and hydroxyl radicals required for microbiocidal activity. Oxygen is essential. If the
partial pressure of oxygen falls below 30 mmHg, macrophages is inactivated; their
phagocytosing potential is reduced. The relationship between oxygen pressure and healing
has been shown to be linear, explaining the beneficial role of oxygen pressure in repair.
The activated macrophage is the major effector cell for degrading and removing
damaged connective tissue components, collagen, elastin, and proteoglycans. Initial
degradation takes place extracellularly up to several millimetres from the macrophage.
Collagen and other fragments are then ingested and degraded by the cathepsin enzymes and
other peptides. In contrast to neutrophils, macrophages can continue to synthesize the
necessary enzymes, thus persisting for a longer time. They also phagocytose the decaying
neutrophils.
Apart from their role in debridement, macrophages secrete chemotactic factors which
bring additional inflammatory cells to the wound site. Macrophages also produce
prostaglandins, which are strongly vasodilatory and affect the permeability properties of
microvessels. The macrophages act after the amines and kinins, and are produced on demand,
prolonging the inflammatory phase. Prostaglandins also augment the adenyl cyclase activity
in T lymphocytes, which accelerates the mitosis of other cells.
The angiogenesis stimulated in the early phase of wound healing has been shown to
be related to the presence of macrophages. Increased levels of lactate production, up to 15-
fold, have been found in wounded tissue, and have caused macrophages to produce and
release angiogenic substances. The macrophages also produce growth factors, such as
platelet-derived growth factor (PDGF), transforming-growth factor (TGF) and fibroblast
growth factor (FGF), which are necessary for the initiation and propagation of granulation

Modern Review
tissue. In this way the macrophages mediate the transition from the initial inflammatory
response to the early repair phase of wound healing.
Lymphocytes:
B lymphocytes may be absent from the wound site. However, helper T cells are
activated following injury, when they recognize any foreign antigen on the surface of
antigen-presenting cells, e.g. Langerhans cell in skin, and certain types of macrophage.
The T lymphocytes migrate into the wound along with the macrophages. Monoclonal
antibody staining has permitted the identification of sets and subsets of lymphocytes, and cell
culture and biochemical studies have identified and characterized some of the lymphokines,
molecular messengers secreted by lymphocytes, which influence other cells, particularly
macrophages and fibroblasts. Thus, lymphocytes can produce macrophage chemotactic factor
(MCF), macrophage inhibiting factor (MIF) regulating movement, macrophage activating
factor (MAF), and interleukin-2 (IL-2) which enables the T cells to proliferate by an
autocrine mechanism.
The colony stimulating factors are very potent, being effective at very low
concentrations (pg/ml). They are involved in the stimulation of proliferation, and of the
commitment of the monocyte to differentiation and maturation. They stimulate the function
of phagocytosis, and the production by macrophages of substances such as prostaglandins,
tumor necrosis factor (TNF) and further colony stimulating factors. As quantities are very
small, it is not known whether all cells are able to produce colony stimulating factors. They
are induced in vivo by the presence of micro-organisms. Colony stimulating factors are
currently in clinical use for the treatment of neutropenia, both congenital and induced by
cancer therapy. It has been suggested that there could be a prophylactic role for them in
abdominal and genitourinary surgery, where infections are common.
Macrophages and lymphocytes have been shown to be present from day-1 in wounds,
although lymphocytes are fewer in number than macrophages. In a study on human wounds
by Martin and colleagues, macrophages peaked between 3 and 6 days and lymphocytes
between 8 and 14 days. Thus they persist into the early repair phase of wound healing. Both
macrophages and lymphocytes disappear from mature wounds by an unknown mechanism,
but in abnormal scars both persist long afterwards. In hypertrophic scars, macrophages and
lymphocyte levels have been found to be very high 4 to 5 months after wounding, and
lymphocytes were still present at 40% of the high level after 2 years. It has been suggested
that control of lymphocytes might be a useful approach to control of scarring. It is of interest

Modern Review
that minoxidil, a drug that has been shown in vitro to inhibit collagen lattice contraction, has
been shown to inhibit DNA synthesis and leucocyte migration inhibition factor (LIF)
production by T lymphocytes.
Clinically inflammation is presented by redness, tenderness, heat, swelling and loss of
function.
Wound contraction: It is an important feature of secondary healing, not seen in primary
healing. It has been noticed in open wounds with tissue loss for centuries. The wound
contraction does not begin immediately and that about 3-4 days elapse before movement of
the edges become measurable. This period, when no wound contraction is noticed, is called
the initial „lag period‟. After this period there is a period of rapid contraction, which is
completed by the 14th day. At this time the wound is reduced to approximately 80% of its
original size. (Wound contraction is controlled by both the fibroblasts and extra cellular
matrix, and is due to the fibroblasts applying tension to the surrounding tissue matrix).
The first step in studying the mechanism of wound contraction is to try to define
precisely where the fundamental process is located. It should be determined whether a
centripetal movement occurs because an energy or power source located out side the defect,
is pushing the skin edges inwards or whether a centrally located power source is pulling the
skin edges to the centre of the defect.
In order to explain the mechanism of wound contraction, a number of factors have been
proposed. These are as under;
i) Removal of fluid by drying has been suggested as a cause of diminution in
the size of wound. But this has not been substantiated, as water content of
central wound tissue at the beginning of wound contraction has not changed
significantly as at the end of contraction.
ii) Contraction of collagen has also been incriminated as the cause of wound
contraction, but wound contraction proceeds at a stage when the collagen
content of granulation tissue is very small.
iii) Discovery of myofibroblasts appearing in active granulation tissue has
resolved the controversy surrounding the mechanism of wound contraction.
These cells have features intermediate between those of fibroblasts and
smooth muscle cells. Their migration in to the wound area and their active
contraction decreases the size of defect.

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Factors inhibiting wound contraction:

i) Corticosteroid administration
ii) Contraction does not occur normally in burns
iii) Immediate skin grafting
iv) X-irradiation
v) Colchicine and vinblastin also inhibit wound contraction, as they are
inhibitors of microtubule formation in the myofibroblasts
vi) Cytotoxic agents particularly the cytochrome poisons in non-lethal
doses.
Epithelialisation: Epithelial cells are important in the inflammatory phase as well as in the
later repair aspect of wound healing. In skin wounds, the epidermis immediately adjacent to
the wound edge begins thickening on the first day. Marginal basal cells loose their firm
attachment to the underlying dermis, enlarge and begin to migrate into the wound. The fixed
basal cells in a zone near the wound edge undergo rapid mitotic divisions and the daughter
cells migrate. Within 48 hours, the entire wound surface is re-epithelialised. After bridging
the wound defect, the migrating epithelial cells loose their flattened appearance and become
more columnar in shape. Layering of the epithelium starts and surface cells keratinize. The
epithelial cells also migrate down the suture tracts. Subsequent epithelial thickening and
keratinisation may produce marked foreign body reaction and formation of sterile abscess. In
one sentence epithelialisation of wound mainly occurs by proliferation and migration of the
marginal basal cells lying close to the wound margin.
Granulation tissue formation: Schematic representation of granulation tissue formation:
Phase of inflammation. Phase of clearance. Phase of ingrowth

of granulation tissue.
Angiogenesis (neo vascularisation) Fibrous tissue formation.

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The haematoma within the wound is soon replaced by granulation tissue, which consists
of a loose matrix of fibrin, fibronectin, collagen, glycosaminoglycans, particularly hyaluronic
acid, containing macrophages, fibroblasts and ingrowing blood vessels. Granulation tissue
formation consists of 3 phases.
I. Phase of inflammation
II. Phase of demolition or clearance: Combination of proteolytic enzymes liberated from
neutrophils, autolytic enzymes from dead tissue cells and phagocytic activity of
macrophages clear off the necrotic tissue, debris etc
III. Phase of ingrowth of granulation tissue
This phase consists of two main processes
1) Angiogenesis or Neovascularisation.
2) Formation of fibrous tissue.
Angiogenesis: Formation of new blood vessels at the injury site takes place by the
proliferation of endothelial cells from the margins of the severed blood vessels. Initially the
proliferated endothelial cells are solid buds but develop a lumen within few hours and start
carrying blood. The newly formed blood vessels are more leaky, accounting for the
edematous appearance of new granulation tissue. Soon these blood vessels differentiate into
muscular arterioles, thin walled venules and true capillaries. The process of angiogenesis
takes place under the influence of endothelial cell growth factors, some components of matrix
like type IV collagen.
Fibrous tissue formation:

The newly formed blood vessels are present in an amorphous ground substance or
matrix. The new fibroblasts originate from fibrocytes as well as by mitotic division of
fibroblasts. Collagen fibrils began to appear by about 6th day. As maturation proceeds, more
and more of collagen is formed while the number of active fibroblasts and new blood vessels
decreases. This results in the formation of the scar known as cicatrisation.
Two processes are involved in fibrosis
i) Emigration and proliferation of fibroblasts at the injury site.
ii) Deposition of extra cellular matrix by these cells.

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Extra cellular matrix:

It is a stable complex of macro molecules that underlies epithelial cells and surrounds
connective tissue cells. It plays an important role in wound healing through its chemotactic,
opsonic and attachment properties.The strength of healed wound and properties of scar
depends upon the deposition of an adequate extra cellular matrix.The major components in it
are collagen, basement membrane, elastic fibres etc.
Collagen:
It is an extra cellular secretion from specialized fibroblasts and the basic molecules
which fibroblasts synthesize are frequently called as tropocollagen. Several types of collagen
are there which differ in the amino acid sequence of constituent chains.
Type 1 collagen is found in the tendon, ligament and skin.
Type 2 collagen is found mainly in the cartilage.
Type 3 collagen is found in foetal dermis and later on is replaced by type 1 at birth.
Tensile strength:
The strength of a healing wound is of great practical importance to the surgeon. It acts
as the main safeguard against wound dehiscence. Experimentally it may be estimated by
measuring the force necessary to disrupt the wound. In the first few days the strength of a
wound is only that of the clot which cements the cut surfaces together. Later on various
changes takes place in the wound healing process and at the end the tensile strength of the
wound corresponds to the increase in amount of collagen present.
Factors influencing the tensile strength of the wound are

Direction of the wound: Skin wounds parallel to the lines of langer heal faster. Skin incisions
made across langer‟s lines tend to gape and their healing is delayed. Tensile strength of the
wound becomes more when this is parallel to the lines of langer. That is why the transverse
abdominal incisions produce strong scar than the longitudinal ones.
Pull of underlying muscles: The wounds which are parallel to the pull of the underlying
muscles constitute strong scar.
Previous wound: Resutured wounds heal faster than those sutured primarily, as the
repairative process has already commenced.
Abdominal binders: Reduce the rate of gain in strength.

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Factors affecting granulation tissue formation:

Cortisone administration: Excess corticosteroid administration inhibits granulation
tissue formation. Fibroblasts remain small with little collagen formation. This effect is well
accepted in experimental animals, but corticosteroid in normal dosage may not influence
wound healing in human beings.
Scurvy: In this condition though vascular granulation tissue is formed, yet there is failure of
collagen formation. Instead there are thick reticulin fibres. Maturation to collagen does not
occur in the absence of vitamin-C
Protein starvation: Also causes delayed formation of collagen. There remains excessive
accumulation of poorly- sulphated ground substance.
Complications of wound healing:66
1. Implantation cysts
2. Painful scars
3. Cicatrisation – it often produces various deformities
4. Keloid formation
5. Neoplasia.

Drug Review
Drug Review
Jatyadi Taila
In the universe everything is a medicine depending on the user. Due to vividities in

the manifestation of Vrana, the various recipes of external application and internal
administration are available.In case of external application various formulations for
debridement are mentioned such as Kwaatha, Kalka, Choorna, Rasakriya, Varthi, Taila and
Ghrita depending on the Avastha of Vrana.
In the present study use of Jatyadi Taila for external application At this juncture the
study of the drugs with regards to its mode of action and combination is necessary.
Jatyadi Taila 1:
Ingredients: Jaati,Nimba,Patola,Naktamaala,Siktaka,Madhuka,Kusta,Haridra,
Dhaaruharidra,Katurohini,Manjistha, Padmaka, Lodhra, Abhaya, Nilotpala, Tutha, Saariva,
Taila (Tila).
Table No.24 - Description of ingredients of Jatyadi Taila:
Dravya Rasa Guna Veerya Vipaaka Prabhaa Karma

va
Jaati Tikta, Laghu, Ushna Katu - Kapha, Pitta, Vaata
Kashaaya Snigdha, Hara
Mrudu
Nimba Tikta, Laghu Sheeta Katu - Kapha, Pitta
Kashaaya Shaamaka,
Pootihara,
Kushtaghna,
Kandooghna,
Shodhana, Ropana,
Vedana sthaapana
Patola Tikta Laghu, Ushna Katu - Vaata
Rooksha, Pitta
Kapha Hara, Vrana
Shodhana, Ropana,
Vedanasthaapana
Naktama Tikta, Laghu, Ushna Katu - Kapha
ala Katu, Teekshna Vaatahara, Pitta
Kashaaya Vardhaka.
Siktaka Madhura Snigdha, - - - Sand-
Picchila hanakara,
Vrana Ropaka,
Bhootaghna

Drug Review
Madhuka Madhura. Guru, Sheeta Madhura - Vaata

Snigdha Pittahara,
Vedana sthaapana,
Daahashaamaka
Kushta Tikta, Laghu, Ushna Katu - Kapha Vaatahara,

Katu, Rooksha, Vedana
Madhura Teekshna -sthaapana,
Rakshoghna,
Durgandha
naashana,Varnya.
Haridra Tikta, Laghu, Ushna Katu - VPK Shaamaka
Katu Rooksha
Dhaaruha Tikta, Laghu, Ushna Katu - KP Shaamaka,
ridra Kashaaya Rooksha Vedana Sthaapana,
Shodhana, Ropana
Katurohi Tikta Laghu, Sheeta Katu - KP Hara
ni Rooksha
Manjistha Tikta, Guru, Ushna Katu - KP Hara, Vrana
Kashaaya, Rooksha Ropana
Madhura
Padmaka Kashaaya, Laghu Sheeta Katu Vedana KP Shamana,
Tikta Sthaapana Daahaprashamana
Lodhra Kashaaya Laghu, Sheeta Katu - KP Shamana,
Rooksha Ropana, Shothahara
Abhaya Kashaaya Laghu, Ushna Madhura Tridoshah VPK Shaamaka,
Pradhaana Rooksha ara Shodhana, Ropana,
, Vedana Sthaapana
Pancharas
a Alavana
Neelotpal Madhura, Laghu, Sheeta Madhura - Daahaprashamana,
a Kashaaya, Picchila, Tridoshahara
Tikta Snigdha
Tuttha Kashaaya, Laghu, Ushna Katu - Lekhana, Bedhana,
Madhura, Ushna Medhohara
Katu
Saariva Madhura, Guru, Sheeta Madhura - VPK Shaamaka,
Tikta Snigdha Shodhana,
Dourgandha Hara
Tila Madhura, Guru, Ushna Madhura - VPK Shamana,
Kashaaya Snigdha Vrana Shodhana,
(Anurasa) Ropana,
, Tikta

Drug Review
Dravya Paryaaya Latin Family Useful part Chemical

name composition
Jaati Sumana, Jasminum Oleaceae Patra, Puspha, Salicylic acid,
Chetika officinale Moola. Jasminine
Nimba Tiktaka, Azadiracht Meliaceae Panchangas. Bark-nimbine,
Pichu- a indica Margosine,
marda nimbidine
Patola Kulaka, Tricho Cucurbitaceae Patra. Fruit-protein,
Raaji- santhus fat, Calcium,
Phala dioca Mg
Naktamaala Karanja, Pongamia Legu- Patra, Twak, Kara-
Snigdha patra pinnata minosae. Beeja. njin, pongamol,
pongamin
Siktaka - - - - -
Madhuka Kleethaka, Glycyrrhiz Leguminosae Moola Glycyrrhizin.
Yashtimadhu. a glabra
Kushta Vaapya, Saussurea Compositae Moola Alkoloids
Utpala lappa inulin,saussurin
e
Haridra Gouri,Nisha Curcuma Zingiberaceae Kandha Curcumin
longa
Dhaaruharidr Dhaarvi, Berberis Berberidaceae Kaanda, Moola, Berberine
a Katankateri aristata Phala
Katurohini Katuka, Tikta Picrohiza Scrophulariacea Moola(Bhoumik Roots-
kurroa e a Kaanda) Picrorhizin
Manjistha Vikaasa, Rubia Rubiaceae Moola Manjistin,
Yojanavalli cordifolia Rubiadin
Padmaka Padmagandhi Prunus Rosaceae Twak, Prunetin,
cerasoides Beejamajja Padmakastin
Lodhra Sthoolavalkal Symplocos Symplocaceae Twak Loturine,
a racemosa Tannin
Abhaya Hareetaki, Terminalia Combretaceae Phala Chebulinic acid
Pathya chebula
Neelotpala Utpala Nymphoea Nymphoeaceae Moola, Protein, starch
stellata Pushpa, Beeja
Tuttha Mayooraka, - - - CuSo4. 7 H2O
Tamragarbha
Pathya chebula
Tamragarbha
Saariva Ananta, Hemidesmu Asclepiadaceae Moola Roots-oil-P-
Gopavalli s indicus Methoxy
salicylic
aldehyde
Tila Pavitra, Jatila Sesamum Pedaliaceae Beeja Seeds- Protein,
indicum Fat ,
Oil-Sesamin,
Oleic acid
Tamragarbha

Drug Review
Preperation:
Jaati Dhaaruharidra
Nimba Manjistha
Patola Katurohini
Naktamaala Padmaka
Siktaka all equal parts Lodhra all equal parts
Madhuka Abhaya
Kushta Neelotpala
Haridra Tuttha
Saariva
Kalka of above drugs: 1 part

Tila Taila: 4 parts
Dravadravya (water): 16 parts
Equal quantities of above drugs are taken and made into Kalka.Then Kwaatha is
added to the Taila and Paaka is done. Later the Kalka is mixed with the Sneha and Paaka is
done over Mridu Agni till the total water content is evaporated.
Jatyadi Taila is benificial in cases of Naadivrana, Spotaka, Kacchu, Visarpa, Dagdha Vrana,
Kshata by Nakha, Dhanta, Vranas due to Visha, Sadhyovrana, Kushta etc and other types of
Dushta Vrana. By applying Taila on Vrana it does Shodhana and Ropana.

Drug Review
Abhaya Daruharidra Jati
aaaaaa
Haridra Katuki Manjista
Lodhra Naktamla Padmaka
Sariva Yashtimadhu

Methodology
Material & Methods
MATERIALS AND METHODS
Source of Data:
Cases of Dushta Vrana were selected from Out Patient and In PatientDepartments of
P.G Studies in Shalyatantra, S.D.M.College of Ayurveda and Hospital, Hassan.
Methods of Collection of Data:

Patients were examined in detail with the help of Research Proforma as prepared for
the study.
Diagnostic Criteria:
Diagnosis was be made on the basis of Lakshanas of Dushta Vrana like.
Deergha Kaleena
Poothi Pooya
Ateeva Vedana
Daha
Kandu Shopha
Shonita Srava
Inclusion Criteria:
Patients suffering from Dushta Vrana of all types
Dushta Vrana within size of 5x5 cm(length x breadth)
Exclusion Criteria
 Patients with disorders like Leprosy
 Tuberculousis, Mallignancy
Groups of Treatment:
40 patients of Dushta Vrana were randomly categorized into 2 groups, of each
comprising 20 patients.
Jatyadi Taila Pichu Group (P Group): The patients of this group were applied by Jatyadi
Taila Pichu, once in a day and properly bandaged. Next day the Pichu was changed and in
this way it was continued for 7 days.

Material & Methods
Jatyadi Taila Vrana Basti Group (VB Group): The patients of this group were applied
Vrana Basti by Jatyadi Taila, once in a day and properly bandaged. Next day again Vrana
Basti was done and in this way it was continued for 7 days.
Procedure for Vrana Basti and Pichu:

Under all aseptic precautions the Vrana was cleaned with normal saline. Later the
slough was removed and area was dried by a cotton plug using an artery forceps. Then in
Group P, sterile gauze impregnated with Jatyadi Taila was kept over the Vrana and
over it a sterile pad was placed and dressing was done.
In Group VB, a wall was erected around the wound by Masha Pishti of having 2cm
height and thickness of about 0.5 cm. In a bowl Jatyadi Taila was taken and warmed on hot
water till it became lukewarm. Then lukewarm oil was poured into the well on the wound
surface by using spoon. When the oil got cooled it was taken out and warmed oil was poured
again. This procedure was done for 30 minutes. Lastly the Taila was taken out and Masha
Pishti was removed and a dry sterile pad was kept and bandaging was done. This procedure
was done once in a day for consecutive 7 days.
If the bandage got wet completely within 24 hours re-bandaging was carried out.
After 7 days or on attaining Shuddha Vrana Lakshana (before 7 days) further management for
Ropana was under taken.
Assessment Criteria:
The patients were assessed on the basis of subjective and objective parameters
before and after treatment.
Subjective parameters:
Vrana Vedana
Daha
Kandu
Objective parameters:
Vrana Gandha
Vrana Varna
Vrana Shrava
Vrana Akruti

Material & Methods
Duration of Treatment:
Duration of treatment was up to appearance of Shuddha Vrana Lakshanas or up to
7 days whichever was earlier.
Follow-up of Study:
On completion of the treatment the patients were asked to attend the OPD at
the interval of one week for a period of two months.
7.3. Laboratory Investigations:

Blood Urine
Haemoglobin percentage - Urine Sugar
Total Count - Albumin
Differential Count -Microscopy
Erythrocyte Sedimentation Rate
Blood Sugar Level
Other Investigations
 Culture and Sensitivity test of wound discharge
 Histopathological Examination. (If necessary)
ASSESSMENT
Subjective criteria:
A. Vedana(Pain):
0- no pain
1- localized feeling of pain during movement but tolerable
2- localized feeling of pain during movement which affects the movement
3- localized feeling of pain even during rest but not disturbing the sleep
4- localized continuous feeling of pain disturbing the sleep also.
5-
B. Daha( Burning sensation):
0- No burning
1- Little, localized & some time feeling of burning sensation
2- Moderate localized & some time feeling of burning sensation

Material & Methods
3- More localized & often burning sensation which does not disturbed sleep
4- Continuous burning sensation which disturbed sleep.
C.Kandu( Itching):
0- No itching
1- Slight, Localized itching sensation
2- Moderate Localized itching sensation
3- More, Localized & often itched but not disturbs sleep
4- Continuous itching which disturbed the sleep.
Objective criteria:
A. Srava( Discharge):
0- No discharge\dry dressing
1- The gauze is slight moist
2- After opening the bandage, the gauze is completely wet
3- The bandage moist completely within 24 hours, but no need to change the dressing
4- Bandage moist completely in 24 hours and bandage is changed.
B.Gandha(Smell):
0- No smell
1- Minimum bad smell
2- Moderate bad smell
3- Unpleasant but tolerable
4- Foul smell which is intolerable
C.Akruti:
0- Smooth, regular floor & with healthy granulation tissue
1- Smooth, regular floor, slight discharge, with absence of slough
2- Smooth, irregular, slight discharge, less granulation tissue and presence of slough

Material & Methods
3- Rough floor and presence of slough with moderate quantity of discharge
5- Rough, irregular floor with more slough and profuse discharge, needs frequent
dressing.
CRITERIA FOR ASSESSMENT OF OVERALL EFFECT:
Overall effect of the therapy was assessed in terms of complete Shodhana, marked
improvement, moderate improvement, and mild improvement and unchanged by adopting the
following criteria.
Complete Shodhana: 100% relief in Chief complaints and no recurrence during follow up
study were considered as complete Shodhana.
Marked improvement: 75 – 99 % improvement in chief complaints is considered as

marked improvement.
Moderate improvement: 50 - 74% improvement in chief complaints is considered as

moderate improvement.
Mild improvement: 25 - 49% improvement in chief complaints is considered as mild

improvement.
No Shodhana Less than 24% reduction in chief complaints or recurrence of the symptoms to
the similar extent of severity is noted as unchanged

Observations and Results
Observations
OBSERVATIONS
Clinically diagnosed 40 Patients of Dushta Vrana were selected and assigned in two
groups of 20 Patients each randomly for the study. P Group patients were treated with
JatyadiTaila Pichu for seven days as control group. The patients of second Group named as
VB group were treated with Jatyadi TailaVrana Basti for seven days. The age, sex, religion,
socio – economic status, occupation, Nidana etc. were noted in all the 40 patients of this
study, details of which are presented here in tabular form with brief description of each
finding:
Sex: Out of 40 patients of this series, maximum patients i.e. 75% were male and 25% were
female (Table – 25).
Table – 25
Distribution of 40 patients of Dushta Vrana based on Sex
Sex P Group VB Group Total
No. of patients % No. of patients % No. of patients %

Male 15 37.5 15 37.5 30 75.0
Female 05 12.5 05 12.5 10 25.0
Age: Out of 40 patients of this series, maximum patients i.e. 40% were from the age group of
51 – 60 years, 20% from the age group of 31-40 years, 15% from the age group of 41-50
years & 61-70years. Minimum number i.e. 10% of the patients was from 21-30 (Table-26).
Habitat: Out of 40 patients of this seriesv 50% were from rural area and 50% were from
urban area (Table-27).

Observations
Table-26
Distribution of 40 patients of Dushta Vrana based on Age
P Group VB Group Total
Age No. of % No. of patients % No. of patients %
patients
21-30 03 7.5 01 2.5 04 10
31-40 06 15 02 5 08 20
41-50 02 5 04 10 06 15
51-60 07 17.5 09 22.5 16 40
61-70 02 5 04 10 06 15
Table-27
Habitat Recorded in 40 Patients of Dushta Vrana
Habitat
Rural 12 30 08 20 20 50
Urban 08 20 12 30 20 50
Occupation: Out of 40 patients of this series, maximum patients i.e. 35% were farmer by
nature of work, 25% were housewife,15% were Businessmen, 10 % were each
employee,7.5% coolie, 5%teacher driver and2.5% Cook (Table-28).
Religion: Out of 40 patients of this series, maximum patients i.e. 90 % were Hindus and
minimum i.e. 5 % were Muslims & Christian each (Table-29).

Observations
Table-28
Distribution of 40 patients of Dushta Vrana based on Occupation
PGroup VB Group Total
Occupation No. of % No. of % No. of %

patients patients patients
Farmer 08 20 06 15 14 35
Cook 01 2.5 00 00 01 2.5
Teacher 02 5 00 00 02 5
Coolie 02 5 01 2.5 03 7.5
House Wife 05 12.5 05 12.5 10 25
Employee 02 5 02 5 04 10
Buisness 00 00 06 15 06 15
Table-29
Distribution of 40 patients of Dushta Vrana based on Religion
Religion No. of % No. of % No. of %

Hindus 17 42.5 19 47.5 26 90
Christians 01 2.5 01 2.5 02 5
Muslims 02 5 00 00 02 5
Socio-economic Status: Out of 40 patients of this series, maximum patients i.e. 50% were of
Poor group and 47.5% were from middle Class group and only 5% were Rich (Table-30).

Observations
Table -30
Distribution of 40 patients of Dushta Vrana based on Socio-economic status
S-E
Status No. of % No. of % No. of %
P 13 32.5 07 17.5 20 50
M 07 17.5 12 30 19 47.5
R 00 00 01 05 01 0.5
Diet: Out of 40 patients of this series, maximum patients i.e. 65% were having mixed type of
diet, minimum i.e. 45 % were having vegetarian diet (Table-31).
Table-31
Distribution of 40 patients of Dushta Vrana based on Diet
Diet
Mixed 16 40 10 25 26 65
Vegetarian 04 10 10 25 04 35
Ahara Shakti: Out of 40 patients of this series, 50% had good appetite,42.5% had moderate
appetite and 2,5% had poor apprtite (Table –32)

Observations
Table-32
Distribution of 40 patients of Dushta Vrana based on Ahara Shakti
Ahara
Shakti No.of % No.of % No. of %
Good 10 25 10 25 20 50
Moderate 09 22.5 10 25 19 42.5
Poor 01 2.5 00 00 01 2.5
Addiction: Out of 40 patients of this series, maximum patients i.e 67.5% were not indulged
in smoking or alcohol1,17.5% in only smoking,7.5% only in alcohol and minimum i.e. 7.5%
were indulged both in smoking and alcohol (Table-33).
Table-33
Distribution of 40 patients of Dushta Vrana based on Addiction
PI Group ST Group Total

Addiction
No. of % No. of % No. of %
Alcohol 02 5 01 2.5 03 7.5
Smoking 03 7.5 05 10 08 17.5
Alcohol and 01 2.5 02 5 03 7.5

Smoking
None 14 35 13 32.5 27 67.5
Aetiology of wound: Out of 40 patients of this series, the Aetiology for Nija Vrana was
42.5% and also 57.5% for Agantuja Vrana (Table-35).

Observations
Table-35
Distribution of 40 patients of Dushta Vrana based on Aetiology of wound
Aetiology of
wound No. of % No. of % No. of %
Nija 09 22.5 08 20 17 42.5
Agantuja 11 27.5 12 30 23 57.5
Chronicity of wound: Out of 40 patients of this series, maximum Patients i.e.62.5% had 1wk
to 4wk of chronicity of wound. 17.5% had 1mth to 3mth as wound period and 7.5% had
4mnth to 6mnth and 3.3% 7mnth to 1yr the period of chronicity of wound (Table-36).
Table-36
Distribution of 40 patients of Dushta Vrana based on Chronicity of wound
Chronicity of
patient patients patients
1 wk - 4 wk 15 37.5 10 25 25 62.5
1 mth - 3 mth 3 7.5 4 10 07 17.5
4mth – 6mth 1 2.5 2 5 03 7.5
7 mth – 1 yr 1 2.5 4 10 05 12.5
Diagnosis of Wound: Out of 40 patients of this series, maximum Patients i.e.42.5% were
Traumatic Ulcer, 27.5% were Venous Ulcer, 25% were Diabetic ulcer and 5% were Snake
bite ulcer (Table-37).

Observations
Table-37
Distribution of 40 patients of Dushta Vrana based on Diagnosis of wound
Diagnosis of
Traumatic 10 25 07 17.5 17 42.5
Venous Ulcer 02 5 09 22.5 11 27.5
Diabetic Ulcer 07 17.5 03 7.5 10 25
Snake Bite 01 2.5 01 2.5 02 5
Site of wound: Out of 40 patients of this series, maximum patients i.e. 50% were having
wound in Left lower limb and 48.5% in Right lower limb and minimum 2.5% were having
wound at other area (scapular region) (Table –38).
Table-38
Distribution of 40 patients of Dushta Vrana based on Site of wound
Site of wound No. of % No. of % No. of %

Right Lower 10 25 10 25 20 50
Limb
Left Lower 9 22.5 10 25 19 48.5
Limb
Other area 01 2.5 00 00 01 2.5
Past History: Out of 40 patients of this series, maximum patients were found with no past
history,then TypeII DMand HTN . They were 55% ,42.5% and 2.5% respectively (Table-39).

Observations
Table-39
Distribution of 40 Patients of Dushta Vrana based on Past history

Past Disease
History No. of % No. of % No. of %
HTN 1 2.5 00 00 01 2.5
Type II DM 9 22.5 8 20 17 42.5
None 10 25 12 30 22 55
Table-40
Distribution of 40 patients of Dushta Vrana based on Symotoms
Symptoms No. of % No. of % No. of %

Srava 08 20 16 40 24 60
Gandha 10 25 13 32.5 27 57.5
Kandu 11 27.5 17 42.5 03 70
Daha 15 37.5 19 47.5 00 75
Vedana 17 42.5 16 40 82.5
Body Temperature: Out of 40 patients of this series, 57.5% patients were having Grade 0
Body Temperature and 42.5% Patient were having Grade 1 (Table-41).

Observations
Table-41
Distribution of 40 patients of Dushta Vrana based on Body Temperature.

Grades of Body
Temperature No. of % No. of % No. of %
0 13 32.5 10 25 23 57.5
1 07 17.5 10 25 17 42.5
2 00 00 00 00 00 00
3 00 00 00 00 00 00
Vrana Shape: Out of 40 patients of this series, maximum patients 50% were found in Oval
shape, 20% were seen in both Elliptical & Irregular Shape and 10% seen in Circular Shape
that (Table-42)..
Table-42
Dirtribution of 40 patients of Dushta Vrana based on Vrana Shape

Shape 0f
Oval 08 20 12 30 20 50
Elliptical 03 7.5 05 12.5 08 20
Circular 03 7.5 01 2.5 04 10
Irregular 06 15 02 5 08 20

Observations
List of Graphs

Observations

Observations

Results
RESULTS
This study was carried out on 40 patients of Dushta Vrana by dividing them in two
groups each comprising of 20 patients. One group was treated with the local application of
Jatyadi Taila Pichu for a period of 07 days. The second group of 20 patients was treated with
Jatyadi Taila Vrana Basti for a period of 07 days. The effects obtained in each group are
being presented here under the separate headings.
Effect of Jatyadi Taila Pichu on Dustha Vrana:

Jatyadi Taila is a known drug for its Shodhana & Ropana qualities for the
management of Vrana. In this study using this drug in 2 different forms was studied. Jatyadi
Taila Pichu was kept as a known control to compare the effects of the trial Form- Jatyadi
Taila Vrana Basti. Effect of this control goup on the various signs and symptoms of Dushta
Vrana were as follow.
Effect on Pain: The mean score of the pain before the treatment was 3.00. It reduced to 1.15
showing 61.6% of improvement which was statistically significant at the level of P<0.001
(Table-43).
Effect on Itching: The mean score of the itching before the treatment was 1.25 . It reduced to
0.40 showing 68% of improvement which was statistically significant at the level of P<0.001
(Table-43)
Effect on Burning Sensation: The mean score of the burning sensation before the treatment
was 2.35 . It reduced to 1.00 showing 57.4% of improvement which was statistically
significant at the level of P<0.001 (Table-43).
Effect on Tenderness: The mean score of the tenderness before the treatment was 2.20 . It
reduced to 0.90 showing 59% of improvement which was statistically significant at the level
of P<0.001 (Table-43)
Effect on Discharge: The mean score of the discharge before the treatment was 1.25 . It
of P<0.01 (Table-43).

Results
Effect on Gandha: The mean score of the Gandha before the treatment was 1.15 . It reduced
to 0.65 showing 43.4% of improvement which was statistically significant at the level of
P<0.05 (Table-43).
Effect on Granulation: The mean score of the granulation before the treatment was 1.15 . It
reduced to 0.65 showing 43.6% of improvement which was statistically significant at the
level of P<0.01 (Table-43).
Table-43
Effect of Jatyadi Taila Pichu on 20 Patients of Dustha Vrana
No of Mean score % of S.D S.E „t‟ P

Patient reduction (±) (±) Value Value
B.T. A.T
Pain 3.00 1.15 61.6 0.67 0.153 12.33 <0.001

Itching 1.25 0.40 68 1.08 0.24 3.48 <0.001
Burning 2.35 1.00 0.98 0.22 6.110 <0.001
Sensation 57.4
Tenderness 2.20 0.90 59.0 0.80 0.17 7.255 <0.001
Discharge 1.25 0.40 68 1.08 0.24 3.48 <0.01
Smell 1.15 0.65 43.4 1.14 0.24 2.023 <0.05
Granulation 1.15 0.65 43.4 1.10 0.24 2.03 <0.001
Effect on Shodhana-The initial mean score of the Shodhana was 0 which remained the same
after two days of the treatment. Then it reduced to 1.93 showing 17.5% of improvement after
three days of the treatment. After the 4 days of the treatment, it reduced to 2.33 showing
21.2% of improvement and it reduced to 5.13 showing 46.6% after 5 days and it reduced to
6.93 showing 63.0 and then it reduced to 9.06 showing 82.4% after 7 daysoftreatment.

Results
Table-44
Vrana Shodhana found in Jatyadi Taila Pichu Group
Symptoms Mean Score of Shodhana % Shodhana

1 1.85 61.6
2 0.85 68
3 1.35 57.4
4 1.3 59.0
5 0.85 68
6 0.50 434
7 1.9 43.4
Jatyadi Taila Pichu showed 0% Complete Shodhana, it showed 40% Marked Shodhana and
40% Moderate Shodhana, 15%Mild Shodhana and 5% No Shodhana
Table-45
Effect of Jatyadi Taila Pichu on Shodhana of 20 Patients of Dustha Vrana
Shodhana No. of Patients %
Complete 0 0
Shodhana
Marked 8 40
Shodhana
Moderate 8 40
Shodhana
Mild shodhana 3 15
No Shodhana 1 5
Overall effect: Consideration of the overall effects of Jatyadi Taila Pichu showed that in
this group 40.0% patients had marked improvement, 40% patients had moderate
improvement (Table-46).

Results
Table-46
Overall Effects of Jatyadi Taila Pichu on the Patients of Dustha Vrana
Overall Effect P group %
Marked Improvement 8 40
Moderate Improvement 8 40
Mild Improvement 3 15
Anupashaya 1 5
Follow-Up Study - At the first week 20 patients reported for of follow-up, out of which 6.7%
showed the recurrence of the symptoms. On the second week of the follow up out of 20
patients 6.7% had the recurrence. On the third week 20 patients reported for follow up out of
which 13.3% patients were having the recurrence. On the fourth week of the follow up, out of
15 patients 13.3% patients were having recurrence. On the fifth week 20 patients reported for
follow up, out which 6.7% were having recurrence and on sixth week out of 20 patients 6.7%
having recurrence. On eighth week of the follow up none of the patient reported the
recurrence (Table-47).
Table-47
Results of Follow-up Study after stopping the Jatyadi Taila Pichu Treatment
Follow Up No. of Recurrence Percentage of

Pts attended Reported Recurrence
1st Week 20 01 6.7%
2nd Week 20 01 6.7%
rd
3 week 20 02 13.3%
4th week 20 02 13.3%
5th week 20 01 6.7%
th
6 week 20 01 6.7%
7th Week 20 00 0.0%
8th Week 20 00 0.0%

Results
Effect of Vrana Basti with Jatyadi Taila on Dustha Vrana

Study of Vrana Basti with Jatyadi Taila was selected for this study. It was applied
locally on the ulcers for 7 days. Its effect on the signs and symptoms of Dushta Vrana are
(Table-48).
Effect on Itching: The mean score of the itching before the treatment was 2.20. It reduced to
0.80 showing 63.6% of improvement which was statistically significant at the level of
P<0.001 (Table-48).
was 2.85. It reduced to 1.30 showing 54.3% of improvement which was statistically
Effect on Tenderness: The mean score of the tenderness before the treatment was 2.40. It
level of P<0.001 (Table-48)
P<0.001 (Table-48).

Results
Table no 48
Effect of Jatyadi Taila Vrana Basti on 20 Patients of Dustha Vrana
Symptoms Mean score % of S.D S.E „t‟ P

reduction (±) (±) Value Value
B.T. A.T
Pain 2.75 0.75 72.7 0.64 0.14 13.7 <0.001

Itching 2.20 0.80 63.6 0.82 0.18 7.62 <0.001
Burning 2.85 1.30 0.88 0.19 7.81 <0.001
Sensation 54.3
Tenderness 2.40 0.80 66.6 0.50 0.11 14.23 <0.001
Discharge 2.45 0.95 61.2 0.68 0.15 9.74 <0.001
Smell 1.65 0.35 78.8 0.92 0.20 6.29 <0.001
Granulation 2.85 0.80 71.9 0.68 0.15 13.35 <0.001
Effect on Shodhana-The initial mean score of the Shodhana was 2.00 which remained the
same after three days of the treatment. Then it reduced to 2.0 showing 18.2% of improvement
after 4 days of the treatment. then it reduced to 4.66 showing 42.4% of improvement after 5
days and it reduced to 6.0 showing 54.5% after 6 days and it reduced to 9.33 showing 84.8
after 7 days of treatment.(Table-49)
Table no 49
Vrana Shodhana found in Jatyadi Taila Vrana Basti Group
No.of days Mean score of shodhana % Shodhana

1 2.00 72.7
2 1.40 63.6
3 1.55 54.3
4 1.60 66.6
5 1.50 61.2
6 1.30 78.8
7 2.05 71.9

Results
Jatyadi Taila Vrana Basti showed 25.0% Marked shodhana, it showed 60% Moderate
Shodhana, 15% Mild Shodhana.
Table-50
Shodhana No. of %
Patients
Complete shodhana 00
Marked Shodhana 05 25
Moderate Shodhana 12 60
Mild Shodhana 03 15
No Shodhana 00 00
Oerall Effects of Vrana Basti with Jatyadi Taila:

The consideration of overall effect Jatyadi Taila Vrana Basti on the patients of Dushta
Vrana showed that in this group 25% patients had marked improvement and 60% patients had
moderate improvemen and 15% showed Mild improvement (Table-51)‟
Table-51
Showing Overall effect of Vrana Basti with Jatyadi Taila on Kaphaja Dustha Vrana
Overall Effect Vb group %
Marked 05 25
improvement
Moderate 12 60
Improvement
Mild 03 15
Improvement
Unchanged 00 0.0
Showing Overall Effect of Treatment on Kaphaja Dustha Vrana

Follow-up Study:
After 7 days of the treatment the patients were shifted on to dressing with Go-ghrita
for Vrana Ropana. Then patients were discharged by educating them the procedure of
dressing and advised to attend Shalya OPD for follow up at the interval of every 1 week up to
2 months.

Results
Follow-up Study in Jatyadi Taila Vrana Basti Group:

In Jatyadi Taila Vrana Basti group after the stopping the treatment at the first week of
follow up all the 20 patients reported out of which 6.7% showed the recurrence of the
symptoms. On the second week of the follow up 20 patients reported for follow up study and
out of which 6.7% had recurrence. On the third week 20 patients reported and out of which
13.3% patients were having recurrence. On the fourth week of the follow up 20 patients
reported and out of which 13.3% were having recurrence. On fifth week 20 patients reported
out of which 13.3% were having recurrence. On sixth week 20 patients reported out of which
6.7% were having recurrence and on the seventh week 20 patients reported out of which
6.7% were having recurrence. On eight week follow up 20 patients reported and none of them
had the recurrence (Table-52).
Table-52
Results of Follow-up Study after stopping the Jatyadi Taila Vrana Basti Treatment
1st Week 20 01 6.7%
2nd Week 20 01 6.7%
3rd Week 20 01 6.7%
4th week 20 02 13.3%
5th week 20 02 13.3%
6th week 20 01 6.7%
7th week 20 01 6.7%
8th Week 20 00 0%

Results
Shodhana Percentage in Vrana Pichu Group
Graph-37
Follow up
Graph-39
% of Reccurence
14.00%
12.00%
10.00%
Percentage
8.00%
6.00%
%
4.00%
2.00%
0.00%
1st 2nd 3rd 4th 5th 6th 7th 8th
week week week week week week week week

Results
Effect of Vrana Basti on Shodhana of Dushta Varna
Shodhana percentage
Graph-49
VB Group
14
12
10
8
6
VB Group
4
2
0
Complete Marked Moderate Mild Unchanged
Shodhana improvement improvement improvement
Follow up
Graph-51
% of Reccurence
14.00%
12.00%
10.00%
Percentage
8.00%
6.00% %
4.00%
2.00%
0.00%

Discussion
Discussion
DISCUSSION
Since antiquity the problem of wound management has been a great challenge to the
clinician and drawn the attention of the surgeon in the different parts of World. Without
treatment in proper time, curable (Sadhya) ulcer may convert to Yaapya, Yaapya to
Asaadhya, and Asaadhya may become fatal. According to Ayurveda if proper care is not
taken for the simple wound then it may turn to Dushta Vrana which is characterized by
profuse discharge, foul smell and having irregular floor and unhealthy granulation
tissue77Dushta Vrana means without signs of healing.
Even though healing is a natural process, it is inhibited by various factors. Alleviating
these inhibitory factors is the goal of Shodhana Chikitsa. At the end of Shodhana Chikitsa,
Vrana becomes Shuddha and Ropana Chikitsa has to be followed further for healing of the
ulcer.
Clinically diagnosed 40 Patients of Dushta Vrana were selected and randomly

assigned in two groups of 20 Patients each. First (P group) as control group was treated by
Jatyadi Taila Pichu for seven days and second (VB group) was treated with Jatyadi Taila
Vrana Basti for seven days. The significant findings, results and reasoning of these 40
Patients are as follows.
Sex: In the present study, out of 40 Patients maximum patients i.e 75% were male and 25 %
were female. It suggests that the occurrence of the wound in male is more when compared to
female. This is because with compare to females, males are working outside the home and
more prone to get wound by external trauma during their routine works.
Age: In the present study of 40 Patients, maximum i.e. 40 % patients were from the age
group of 51-60 and minimum i.e. 10 % were from 21-30 and . The Nijavrana may be caused
by certain systemic disorders occurring as a complication like the Madhumehaja Vrana. It
generally occurs at the later stage of life, where the Sanga and Vimarga Gamana type of
Srotodushti is the main factor.
According to contemporary view the diabetic ulcers, are the complications due to
diabeticneuropathy and microangiopathy.

Discussion
Habitat: In Present study of 40 Patients, 50.0% patients were from rural area and 50.0%
were from urban area. These shows Dushta Vrana are common in both rural & urban areas.
Occupation: In the present study maximum patients i.e. 35% were Farmer and minimum i.e.
2.5% were each cook. This is because of continuous work and abnormal intake of food
causes nutritional deficiency; these delays wound healing and even leads to Dhatu Kshaya
which in turn cause Vata Prakopa.
Religion: In Present study, out of 40 Patients, maximum i.e. 90% were Hindu,5% were
Muslims and Christian.
Socio-economic status: In Present study, out of 40 Patients, maximum i.e. 50% were of Low
socio economic group, 47.5% were from middle economic group and minimum i.e. 0.5%
were rich.
Diet: In Present study, out of 40 Patients maximum patients i.e. 65% were having mixed type
of diet and minimum i.e. 35% were having vegetarian diet. It is well known fact that
nitrogenous product will hamper wound healing and now more emphasis is made on
vegetarian food habits, which carries low calories and more nutritive value.
Ahara Shakti : In Present study, out of 40 Patients, maximum i.e. 50% were having good
Ahara Shakti, 42.5% were having moderate and minimum i.e. 2.5% were having poor Ahara
Shakti .
Addiction: In Present study, out of 40 Patients, maximum i.e. 67.5% did not have any
addiction,17.5% were having history of smoking ciggaret,7.5% alcohol intake.
Aetiology of Wound: In Present study, out of 40 Patients 42.5% had etiology as Nija Vrana
and 57.5% had Agantuja Vrana. This may be because of the increased prevalence of the
systemic diseases like diabetes etc, diseases and trauma.
Chronicity of Wound: In Present study, out of 40 Patients maximum patients i.e. 62.5% had
1 week to 4 weeks of chronicity of wound, 17.5% had 1 month to 3 months and 12.5% had 7
months to 1yr and minimum i.e. 7.5 % had 4 months to 6 months as the period of chronicity
of the wound.

Discussion
Diagnosis of wound: In Present study, out of 40 Patients maximum patients i.e. 42.5% were
traumatic ulcer,27.5% were Venous ulcer,25% were Diabetic ulcer and 5% wre due to Snake
bite.
Site of Wound: In the present study, out of 40 Patients maximum patients i.e. 50% were
having wound in Right lower limb,48.5% were in Left lower limb and minimum i.e. 2.5%
were having wound at other area (scapular region). The maximum patients were of Diabetic
pathology. In Diabetics because of weakness of the Rasa-carrying channels, the vitiated
Doshas fail to reach the upper regions of the body and get settled in the lower extremities and
produces the Pidakas which may later convert into Dushta Vrana (Su.Chi. 12/8). This is due
to microangiopathy.
Past History : In the present study, out of 40 Patients maximum patients i.e. 42.5% were
having TypeII DM, 55% not having any past history of diseases and minimum i.e. 2.5% were
having HTN
Body Temperature:. In the present study, out of 40 Patients maximum patients i.e. 57.5%
were having Body Temperature between98.1 to 98.9Degree Farenhiet, 42.5% having Body
Temperature between 99.0 to 99.9 degree Farenhiet.
Vrana Shape: In the present study, out of 40 Patients maximum patients i.e. 50% were having
Oval shape ulcer, 20% Elliptical & Irregular shape and minimum i.e. 10% were having
circular shape wound.
Effects of Therapies Dushta Varna

Effect on Vedana: The improvement in pain in Jatyadi Taila Vrana Basti group started after
4 days of the treatment (11.76%) and it becomes 72.7% (P<0.001) after 7 days of the
treatment.
On the other hand in Jatyadi Taila Pichu group improvement pain in ulcer was first
seen after the treatment of 3 days (6.25%), which become 61.6% (P<0.001) after the 7 days
of the treatment (Table-48).
It is evident from the foregoing that provided Jatyadi Taila Vrana Basti faster and better
relief in pain incomparison to Jatyadi Taila Pichu group.

Discussion
Effect on Srava: The reduction in discharge from the ulcer in Jatyadi Taila Vrana Basti
group started after 3 days of the treatment (10.5%) and it becomes 61.2% (P<0.001) after 7
days of the treatment.
On the other hand in Jatyadi Taila Pichu group reduction in discharge from the ulcer
was first seen after the treatment of 3 days (14.7%), which become 68% (P<0.001) after the 7
days of the treatment (Table-48 ).
Thus it may be said that the effect of Jatyadi Taila Pichu in improving the discharge from the
ulcer was bit better in comparison to Jatyadi Taila Vrana Basti.
Effect on Durgandha (Foul Smell): The improvement in foul smell from ulcer in Jatyadi
Taila Vrana Basti group started after 4 days of the treatment (43.7%) and it becomes 78.9%
(P<0.001) after 7 days of the treatment.
On the other hand in Jatyadi Taila Pichu group improvement in foul smell from ulcer was
first seen after the treatment of 3 days (3.33%), which become 43.4% (P<0.001) after the 7
It is evident from the foregoing that the effect of Jatyadi Taila Vrana Basti in
reducing smell was better than Jatyadi Taila Pichu.
Effect on Akruti (Size of Ulcer): The reduction in size of the ulcer in Jatyadi Taila Vrana
Basti group started after 6 days of the treatment (2.99%) and it becomes 3.21% (P<0.01) after
7 days of the treatment.
On the other hand in Povodine-iodine group reduction in size of the ulcer was first
seen after the treatment of 6 days (2.34%), which become 2.87% (P<0.01) after the 7 days of
the treatment(Table-48 )..
reduction the size of the ulcer was better in comparison to Povodine-iodine group.
Effect of Kandu: The improvement in itching in ulcer in Jatyadi Taila Vrana Basti group
started after 3 days of the treatment (4.76%) and it becomes 63.6% (P<0.001) after 7 days of
the treatment.
On the other hand in Jatyadi Taila Pichu group improvement in itching in ulcer was
first seen after the treatment of 4 days (15.7%), which become 68% (P<0.001) after the 7
days of the treatment. (Table-48 ).

Discussion
It is evident from the foregoing that the effect of Jatyadi Taila Pichu in reducing the
itching was better in comparison to Jatyadi Taila Vrana Basti group.
Effect of Tenderness: The improvement in tenderness in ulcer in Jatyadi Taila Vrana Basti
days of the treatment
On the other hand in Jatyadi Taila Pichu group improvement in tenderness in ulcer
days of the treatment(Table-48 ).
reducing the tenderness in the ulcer started bit late but then it become better in comparison to
Jatyadi Taila Pichu.
Effect on Granulation: The granulation in ulcer in Jatyadi Taila Vrana Basti group started
after 4 days of the treatment (26.6%) and it became 71.9% (P<0.001) after 7 days of the
treatment.
On the other hand in Jatyadi Taila Pichu group granulation in ulcer was first seen after
the treatment of 4 days (13.3%), which became 43.4% (P<9.991) after the 7 days of the
treatment (Table-48 ).
increasing the granulation in ulcer was better in comparison to Jatyadi Taila Pichu group.
Shodhana Effects: The Jatyadi Taila Pichu initiated Shodhana effect after 3 days of the
treatment (17.5%) and at the end of the treatment it was 82.2%. Further analysis showed that
7 days application of Jatyadi Taila Pichu on the Dushta Vrana provided marked Shodhana in
40% and moderate Shodhana in 40%, mild Shodhana in 15% and no Shodhanain 5%
On the other hand Jatyadi Taila Vrana Basti initiated Shodhana in the Dushta Vrana
after 4 days of the treatment (18.2%) and at the end of the treatment it became 84.8%. Further
analysis showed that 7 days application of Jatyadi Taila Vrana Basti on the Dushta Vrana
provided Marked Shodhanain 25%, Moderate improvement in 60.0% followed by mild
improvement in 15% (Table-49).
It is obivious from the foregoing results that though Jatyadi Taila Pichu initiated
Shodhana one day earlier than Jatyadi Taila Vrana Basti, but on the last day the effect of

Discussion
Jatyadi Taila Vrana Basti was better than Jatyadi Taila Pichu. The overall Shodhana effect of
Jatyadi Taila Vrana Basti was also better.
On the basis of the above results it can be said that Shodhana effect of Jatyadi Taila
Vrana Basti was better than Jatyadi Taila Pichu.
Over all Effects: In the Jatyadi Taila Pichu group, 40% patients had marked improvement
aswell as moderate improvement.
Whereas in Jatyadi Taila Vrana Basti Group 60% patients had marked improvement
and 25% patients had moderate improvement.(Table-50)
Hence it can be inferred that Jatyadi Taila Vrana Basti provided better overall effect to
the patients of Dushta Vrana in comparison to Jatyadi Taila Pichu.
Significant Effects of Jatyadi Taila Vrana Basti: Jatyadi Taila Vrana Basti provided
significant relief after the 7 days of its application in Pain (72.7%), Discharge (61.2%), Smell
(78.9%), Itching (63.6), Granulation (71.9), Tenderness (66.6%) and burning
sensation(54.3%).
Jatyadi Taila Vrana Basti initiated Shodhana in the Dushta Vrana after 4 days of the
treatment where it was 18.2% and on the last day it became 84.8%. Consideration of overall
Shodhana showed that it provided marked improvement in 25%, moderate Shodhanain 60%
and mild improvement15%.
Significant Effects of Jatyadi Taila Pichu: Jatyadi Taila Pichu provided significant relief
after the 7 days of its application in, Pain (61.6%), Discharge (68%), Smell (43.4%), Itching
(68%), Granulation (43.4%) , Tenderness (59%) and burning sensation(57.4%). Jatyadi Taila
Pichu initiated Shodhana in the Dushta Vrana after 3 days of the treatment where it was
17.5% and on the last day it became 82.4%. Consideration of overall Shodhana showed that
40% both marked & moderate improvement and 15% mild improvement.
Comparison of the Effects: Jatyadi Taila Vrana Basti provided comparatively better relief in
Smell (78.9%), Itching (90.7%), Tenderness (66.6%) and Granulation (71.9%). It also
provided better overall relief to the patients.
Jatyadi Taila Pichu provided comparatively better relief in Itching (68%), Discharge (68%),
Burningsensation.

Discussion
On the basis of the foregoing discussions it can be concluded that Jatyadi Taila Vrana Basti
was better in providing relief to the patients of Dushta Vrana in comparision to Jatyadi Taila
Pichu
Mode of Action of Drugs:

After a detailed study on the Vrana, Sushruta observed that deranged Doshas cannot
be treated with a single drug all the times. Therefore numbers of drugs of different properties
are described as Vrana Shodhaka and Vrana Ropaka in the management of Vrana. The delay
in healing of any wound is due to Contamination, infection, discharge, slough and reduced
local immunity.
After the overall analysis of the drug Jatyadi Taila Vrana Basti it is inferred that the
drug has: Because of Tikta Rasa all the drugs Jaati, Nimba, Patola, Naktamaala, Siktaka,
Madhuka, Kusta, Haridra, Dhaaruharidra, Katurohini, Manjistha, Padmaka, Lodhra, Abhaya,
Nilotpala, Tutha, Saariva, Taila (Tila) are having Vrana Shodhana , Ropana,
Pootihara,Vedana Sthapana,Tridoshagna action which are directly helping in Vrana.
Salicylic acid present in Jaati is antibacterial, antifungal, antiviral and anti-inflammatory etc.
Nimbine Margosin present in Nimb is antiinflammatory, antibacterial, analgesic
etc.Glycyrrhizi of Madhuk is having wound healing property. Curcumin is present in
Haridra and it is also antiinflammatory, antiseptic, antibacterial and antimicrobial etc.
CuSO4.7 H2O present in Tutha which helps in Lekhana. Sesamolinol.7- tocopherol is
antioxidant and present in sesame oil provides better results in tissue injury. Sesame oil acts
as good vehicle in bringing out pharmacological actions of other ingredients in the
formulation.
In this way all the drugs which were used forthe clinical trials are contributing for the
cleansing of wound. This may be the reason that Jatyadi Taila Vrana Basti has shown
significant cleansing effect on tthe patients of Dushta Vrana, which is a significant finding.

Discussion
CaseReport No 1
Name:Govinda Patel
Sex/Age: M/67yrs
Occupation: Buisnessman
Date: 08/04/2011
OPD/IPD No: 211031/55042
Residence: Banglore
Details of the Patient:

Patient presented with the complaints of non healing ulcer 5cm above left medial
malleolus since 1 yr. He has a history of Varicosity.
On the day of examination: There was a nonhealing ulcer, foul smelling discharge ulcer
with irregular margin with irregular shape above the left malleolus.
Treatment: Patient was admitted and treated with Vrana Basti by using Jatyadi Taila twice
daily for 7 days .After 7 days patient was adviced Go-Ghrita for Dressing.

Discussion
Before Treatment
During Treatment After Treatment

Discussion
CASE REPORT No.2
Name: Byarappa
Sex/Age: M/60 yrs
Occupation: Driver
Date: 3/09/2011
OPD/IPD No: 233682/58053
Residence: Hosahalli Allur

Patient presented with the complaints of non healing ulcer over the left foot dorsal apect
since 15days. He had a history of trauma. He is diabetic since 2yrs.
with irregular margin with irregular shape on the left foot.
Treatment: Patient was admitted and treated with Jatyadi Taila Pichu daily for 7 days .After
7 days patient was adviced Go-ghrita for Dressing.

Discussion
Before treatment
During Treatment After treatment

Summary &
Conclusion
Summary &Conclusion
SUMMARY & CONCLUSION
The dissertation entitled “Effect of Vrana Basti in the management of Dushta

Vrana” comprises of 5 parts viz. Conceptual Study, Drug Review, Clinical Study,
Discussion, Summary and Conclusion.
Conceptual study at the outset highlights the wound debridement i.e Shodhana
before its Ropana, along with Sushruta‟s views of Vrana and its management. It follows
the description of historical and Nidanatmaka aspects of Vrana. Modern aspects of ulcer
such as definition, classification, clinical features, management etc are also described in
this chapter.
The second part designated as Drug Review describes the drug under trial-Jatyadi
Taila along with its ingredients in detail.
Clinical study begins with the description of materials used and methods adopted for
this study. The criteria of diagnosis, inclusion, exclusion and assessment of the results as well
as groups of the treatments are also dealt with therein. It follows the explaining of the
observations made on the Nidanatmaka aspects of 40 patients of Dushta Vrana in tabular
form with brief description on each finding. The last portions of this part describe the various
effects noted in Vrana Basti group and Pichu group. The results are depicted in tables along
with statistical data with brief description of the each effect.
The results obtained in this clinical study were discussed in the fourth part of this dissertation
under the heading of Discussions. The logical conclusions thus obtained were as follow:
Out of 40 Patients of Dushta Vrana maximum were belonging to 51-60 years of age
group (40%,), male sex (75%), rural area (50.0%), agricultural occupation (35%), Hindu
religion (90%), low socio class (50%) and taking mixed diet (65%,).
Maximum patients of this series were having good Ahara Shakthi (50 %,) and (67.5%)
were nothavingany addiction.
In this series number of patients was of Agantuja Vrana (57.5%) with 62.5% patients
having the chronicity of wound for 1 to 4week and 42.5% patients were of Traumatic &
Diabetic Ulcer.
50% of patient in this series had wound on their right lower limb were as left lower limb
it was 48.5%

Summary &Conclusion
Effects of Vrana Basti: 20 patients of Dushta Vrana were treated with local application of
Vrana Basti with Jatyadi Taila for 7 days. It provided significant relief in Pain (72.7%),
Discharge (61.2%), Smell (78.8%), Itching (63.6.%), Granulation (71.9%) and Tenderness
(66.6%) Burning sensation (54.3%) Gandha(71.9%).
On the other hand Vrana Basti group initiated Shodhana in the Vrana after 4 days of the
treatment. Further analysis showed that 7 days application of Vrana Basti with Jatyadi Taila
on the Dushta Vrana provided marked improvement in 25%, 60%inmoderate and mild
improvement in 15%.
In this group Group 25% got marked improvement, 60% patients got moderate improvement
and 15% patients had mild improvement.
Effects of Pichu Group: 20 patients of Dushta Vrana were treated with local application of
Jatyadi Taila Pichu. Its 7 days application provided significant relief in Pain (61.6%),
Discharge (68%), Smell (43.4%), Itching (68%),Granulation (43.4%) and Tenderness
(59%)Burning Sensation(57.4%).
The Pichu group initiated Shodhana effect after 3 days of the treatment. Further
analysis showed that 7 days application of Jatyadi Taila Pichu on Dushta Vrana provided
40% in both marked and moderate improvement, followed by mild improvement in 15% and
Anupashaya in 5%.
The Jatyadi Taila Pichu initiated Shodhana effect after 3 days of the treatmen.
Further analysis showed that 7 days application of Jatyadi Taila Pichu on the Dushta Vrana
marked and moderate Shodhana was seen in 40% patient and 15%in mild
Smell (78.8%), Granulation (71.9%) Pain (72.7%), Tenderness (66.6%). Jatyadi Taila Vrana
Basti initiates Shodhana process comparatively bit late but becomes better at the end of 7
days of the treatment. It also provided comparatively better overall relief to the patients of
Dushta Vrana.
Jatyadi Taila Pichu provided comparatively better relief in itching (68%), discharge
(68%), and burning sensation (57.4%).

Summary &Conclusion
On the basis of the foregoing discussions it can be concluded that Jatyadi Taila Vrana
Basti was better in providing relief to the patients of Dushta Vrana in comparison to Jatyadi
Taila Pichu
Hoping that the results of this study will encourage Ayurvedic surgeons to use
Ayurvedic Shodhana drugs particularly Jatyadi Taila used in this study for cleansing the
infected wound (Dushta Vrana).
Jatyadi Taila by its Chedana, Amapachana, Kapha Vata Shamana, Rukshata,

Raktashodhaka, Sthambhana, Shoolahara, Jantughna, Varnya and Lekhana property
checks the Vrana Varna, Vedana, Gandha, Srava, Akruthi, Kandu, Tenderness and
removes the slough in the Vrana.These drugs also have Ushna Veerya .Thus helps in
healthy Granulation tissue Formation . On basis of different research analysis done over
the ingredients of the drug Jatyadi Taila it is proved to have antiseptic, antibacterial, anti
inflammatory, prostaglandin inhibitor, antihistaminic and antimicrobial Properties.Thus
helps for the Shodhana of Vrana.

References
References
References
Historical review:
1) Rigveda- 1.112.10; 116, 15; 17, 11, 118, 8; 10.39, 8.
2) Atharvaveda- 2.3.2 –6; 19.34.10; 8.9.1-10.
3) Agnipurana- 31.18-36.
4) Mahavagga- 14.4-5, 23.6.
5) Kautilyas Arthashastra- 3.67.11.14, 3.73.19.10, 2.43.27.11.
6) Jaatakamala- 8.24, 26.29,112.
7) Harshacharita- 324,454,432.
8) Kaadambari- 102,644, 329.
9) Charaka Samhita Sootra Sthana - 19/7,
Charaka Samhita Chikitsa Sthana 25;
Sushruta Samhita Chikitsa Sthana Chapt 1,2 ;
Sushruta Samhita Sootra Sthana Chapt 17, 21, 22, 23;
Kashayapa Samhita.Dvivraneeya -11/8, 10;
Ashtanga Sangraha Uttarasthana Chapt 29, 30, 31;
Ashtanga Hrudaya -Chapt 25, 26;
Madhava Nidana Chapt 42, 43;
G.N- Vranashopha Dvivraneeya Adhikaara;Chakra- Chapt 44, 45;
Sharangadhara Samhita Porva Khanda-Chapt 7;
Bhava Prakash madhyama Khanda-Chapt 47;
Bhyashjya Ratnavali-Chapt 47, 48.
Ayurvedic Review
10) Sushruta Samhita ChiktsaSthana Chapter 1/6.
11) Sushruta Samhita Sootra Sthana 21/40
Ashtanga Sangraha Uttarasthana 29/2.
12) Sushruta Samhita ChiktsaSthana 1/3;
Charaka Samhita Sootra Sthana 19/7,
Charaka Samhita Chikitsa Sthana. 25/5,6;
Ashtanga Sangraha Uttarasthana 29/3;
Ashtanga Hrudaya25/1,2a.
13) Charaka Samhita Chikitsa Sthana. 25/20,21.
14) Sushruta Samhita Sootra Sthana 23/19,20.

References
15) Sushruta Samhita Sootra Sthana 21/19-23

Charaka Samhita Chikitsa Sthana. 25/6,7.
16) Sushruta Samhita ChiktsaSthana 1/6.
17) Sushruta Samhita ChiktsaSthana 1/7
Charaka Samhita Chikitsa Sthana 25/11;
Ashtanga Hrudaya.25/5,6;
Kashayapa Samhita.Dvivraneeya.Chi.8th sloka; M.Ni.42/2.
Madhava Nidana42/3;
Kashayapa Samhita.Dvivraneeya.Chi.8th sloka.
Charaka Samhita Chikitsa Sthana.25/15
Ashtanga Hrudaya.25/9;
Madhava Nidana 42/4;
Kashayapa Samhita.Dvivraneeya Chi.8th sloka.
Madhava Nidana.42/4.
23) Ashtanga Sangraha Uttarasthana 29/4;
Ashtanga Hrudaya 25/2a.
24) Sushruta Samhita Sootra Sthana 22/7;
Charaka Samhita Chikitsa Sthana 25/24,25,83;
Ashtanga Hrudaya 25/2-4;
Madhava Nidana 42/7.

References
25) Sushruta Samhita Sootra Sthana 23/18,

Sushruta Samhita Chiktsa Sthana 1/7.
Sushruta Samhita ChiktsaSthana 1/7;
Ashtanga Sangraha Uttarasthana 29/12
Ashtanga Hrudaya.25/11b-12a;
Ashtanga Hrudaya 25/22;
29) Charaka Samhita Chikitsa Sthana 25/10.
Charaka Samhita Chikitsa Sthana 25/22, 23.
Madhava Nidana.43/18-24.
Sushruta Samhita ChiktsaSthana 2/5, 6,8a;
Ashtanga Hrudaya Soo.28/18.
34) Sushruta Samhita Sootra Sthana 22/12.
35) Sushruta Samhita SootraSthana 22/11.
Charaka Samhita Chikitsa Sthana 25/28,29a;
Ashtanga Sangraha Uttarasthana 29/13-21.
37) Sushruta Samhita Sootra Sthana 22/4,23/3,5;
Ashtanga Sangraha Uttarasthana 29/22,26;
Ashtanga Hrudaya 25/13,14.

References
38) Sushruta Samhita Sootra Sthana 22/5,6b,23/4,6,7;

Charaka Samhita Chikitsa Sthana 25/29-35,37;
Ashtanga Sangraha Uttarasthana 29/25-27;
Ashtanga Hrudaya 25/15-17.
40) Sushruta Samhita Sootra Sthana 23/12,14;
Charaka Samhita Chikitsa Sthana 25/37,
41) Sushruta Samhita Sootra Sthana 19/3-8,
Charaka Samhita Chikitsa Sthana 2/86-88.
42) Charaka Samhita Chikitsa Sthana 25/38,39a,
Charaka Samhita Chikitsa Sthana 25/12,14,16.
Charaka Samhita Chikitsa Sthana 25/39-43;
Ashtanga Sangraha Uttarasthana Chapt-30;
Ashtanga Hrudaya Chapt25;
Kashayapa Samhita.Dvivraneeya Chi-10th sloka.
46) Sushruta Samhita Sootra Sthana 19/16-20,23,32-36;
Charaka Samhita Chikitsa Sthana 25/97,98.
47) Sushruta Samhita ChiktsaSthana 1/138,139;
Charaka Samhita Chikitsa Sthana 25/29b-31a;
Madhava Nidana 43/25,26.
48) Sushruta Samhita ChiktsaSthana 2/8-11,19-22;
Madhava Nidana 43/2-4,11-14.
49)Sushruta Samhita ChiktsaSthana 1/4,

References
Sushruta Samhita ChiktsaSthana 2/2327,76b;

Charaka Samhita Chikitsa Sthana 25/8a;
Ashtanga Sangraha Uttarasthana 31/6,7,12;
Ashtanga Hrudaya 26/14b,15,28a,
Ashtanga Hrudaya 26/6,7,12.
Modern Review
50) Bailey.& Love.3/Pg-36,12/Pg-158;
S.Das. Surgery 11/Pg-125.
51) S.Das. Surgery-11/Pg-126;M.M.S.6/Pg-44.
52) S.Das.Surgery.11/Pg-126;B.&L.12/Pg-158;M.M.S.6/Pg-44,45.
53) Bailey.& Love.12/158,159.
54) S.Das.Surgery.3/Pg-31-34;B.&L.12/Pg-159.
55a) Hospital Today-vol 3 No.7-July 98.
55b) BMJ vol 8 No.5 July 92.
55c) The Antiseptic vol 99 July 02.
55d) Hospital Today vol 7 No.6 June 02.
55e) Hospital Today vol 7 No.12 Dec 02.
55f) BMJ vol 6 No.6 Aug 90.
56) Bailey.& Love.7/Pg-95.
57) M.M.S.6/Pg-48,49;B.&L.12/Pg-159.
58) Bailey.& Love 12/Pg-160; Hospital Today vol 5 No.11 Nov 2000.
59) Bailey.& Love 3/Pg-31,33,34; M.M.S.1/Pg-1;
Hand book of surgery-S.C.Atri-1/Pg-1.
60) Hand book of surgery-S.C.Atri-1/Pg- 4,5;B.&L.7/Pg.95-98.
61) B.&L.7/Pg.89-91.
62) S.Das.Surgery.1/Pg.1-5; Text book of pathology-Harshmohan.5/Pg.17 B & L.3
Pg-29; Oxford text book of surgery Chapt 1.1.
63) S.Das.Surgery.1/Pg-6,7.
64) Hospital Today vol 5 No.4-April 2000.
65) Internet reference-Brian A.Youn, M.D.Director, Dept of hyperbaric medicine.
66) S.Das.Surgery.1/Pg-6;Hand book of surgery- S.C.Atri-1/Pg.4.

Bibliography
Bibliography
BIBLIOGRAPHY
o Agnivesha, Charaka Samhita reducted by Charaka and Drudhabala, with Ayurveda

Deepika Commentary by Chakrapaanidatta, edited by Vaidya Yadavji Trikamji
Aachaarya, 5th edition, 2001, Published by Chaukhambha Sanskrit Sansthaan, Varanasi
o Agnivesha, Charaka Samhita redacted by Charaka and Drudhabala, with Ayurveda
Deepika Commentary by Chakrapaanidatta English translated edition, 2002, by Ram
Karan Sharma & Vaidya Bhagavan Dash, Published by Chaukhambha Sanskrit
Sansthaan, Varanasi.
o Ayurvedeeya Rasa Shaastra by Prof. Siddhinandan Mishra,9th edition 1999, Published by
Chaukhambha Orientalia, Varanasi.
o Bailey & Love‟s Short Practice of Surgery, edited by R.C.G Russell, N.S. Williams,
C.J.K. Bulstrode, 23rd edition.
o Bhaavamishra,Bhaava Prakaasha with Vidyotini Hindi Teeka by Bhishak Ratna Sri
Shankara Shaastri and Sri. Roopalal Vaishya; 8th edition, 1997, Published by
Chaukhambha Sanskrit Sansthaan, Varanasi.
o Bhela, Bhela Samhita, with English translation Dr. K. H. Krishnamurthy, edited by
Professor Priyavat Sharma, 1st edition, 2000, Published by Chaukhambha Sanskrit
o Chakrapaanidatta, Chakradatta with Vaidyaprabha Hindi Commentary by Dr. Indradeva
Tripathi,3rd edition 1997, Published by Chaukhambha Sanskrit sansthaan,Varanasi.
o Govinda Daasa, Bhaishajya Ratnaavali, redacted by Bhishak Ratna Sri Brahma Shankara
Mishra with Vidyotini Teeka by Kaviraj Sri. Ambikadatta Shaastri edited by Sri.
Rajeshwara Datta Shaastri, 16th edition 2002, Published by Chaukhambha Sanskrit
Samsthaan, Varanasi.
o Harsh Mohan,Text book of Pathology, 3rd edition, 1998, Jaypee publication.
o Konman E.W., Alles S.D., Janda W.M.; Color atlas and text book of diagnostic
microbiology, 4th edition, 1992, Schreckenberga pc, winn. JB Lippinocott, Philaelphia.
o K.Rajgopal Shenoy, Manipal Manual of Surgery, 1st edition, 2001, CBS Publishers, New
Delhi.
o Maadhavakara, Maadhava Nidaana with Madhukosha Vyaakhya by Vijayarakshita and
Srikantadatta and Vidyotini Teeka by Ayurvedaachaarya Sri Sudarshana Shaastri, 30 th
edition, 2001, Chaukhambha Sanskrit Sansthaan, Varanasi.

Bibliography
o Maadhava, Ayurveda Prakaasha with Artha Vidyotini and Arthaprakaashini Sanskrit

Hindi Vyaakhya, edited by Sri Gulraj Sharma Mishra, 1999, Published by Chaukhambha
Bharati Academy Varanasi.
o Mahajan B.K,Methods in Biostatistics, 6th Edition, Pub: Jaypee Brothers.
o Morris Peter j., Ronald A. Malt; Oxford Text-book of Surgery, Oxford CD-ROM, 1995,
Oxford University Press.
o P.V.Sharma, Dravya Guna Vignana, vol. 2, 17th edition, 1996, Chaukhambha Vishva
Bharathi Academy, Varanasi.
o P.V.Sharma, Indian Medicine in the classical age, 1st edition 1972, Published by
Chaukhambha Sanskrit Series, Varanasi.
o P.V.Sharma, History of Medicine in India, 2nd edition, 1992, Published by Indian
National Science Academy New Delhi.
o Rasa Shaastra by Dr. Damodhar Joshi, 1st edition 1986, Published by Publication
Division, Ayurveda College Trivandrum.
o Rasayoga Saagara with Sanskrit and English introduction, notes by Pandit Hariprapannaji
vol 1,Reprint edition 1998, Published by Krishna Das Academy, Varanasi.
o S.Das, A Concise Text book of Surgery, 3rd edition, 2001, Published by Dr. S. Das., 13,
Old Mayors‟ Court, Calcutta.
o S.Das, A Manual on Clinical Surgery by, 3rd edition, 1996, Published by Dr. S. Das. 13,
o Sodhala, Gadanigraha with Vidyotini Hindi commentary by Sri Indradeva Tripathi, 3rd
edition 1999, Published by Chaukhambha Sanskrit Sansthaan, Varanasi.
o S.C.Atri,Hand Book of Surgery,3rd edition, Published by Scientific Book Company Patna.
o Shaarangadhara, Shaarangadhara Samhita, edited by Pandit Parashuraama Shaastri,
Vidyasagar, 4th edition 2000, Published by Chaukhambha Sanskrit Sansthaan, Varanasi.
o Singal G.D and Singh L.M, Ancient Indian surgery 1st edition, Published by
Chaukhambha Sanskrit Sansthaan Varanasi.
o Sushruta, Sushruta Samhita with English translation by Prof. K.R. Srikantha Moorthy, 1 st
edition 2002, Published by Chaukhambha Orientalia Varanasi.
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edited and translated by P. V. Sharma, 1st edition, 1999, Published by Chaukhambha
Sanskrit Sansthaan Varanasi.

Bibliography
o Sushruta,Sushruta Samhita with Nibandhasangraha Commentary of Sri Dalhana

Aachaarya and Nyaaya Chandrika Panjikaa Vyaakhya of Sri Gayadaasaachaarya, edited
by Vaidya Yadavji, Trikamji Aachaarya, 7th edition 2002, Published by Chaukhambha
Orientalia Varanasi.
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Ayurveda Rasayana of Hemaadri, collated by Late Dr. Anna Moreshwara Kunte and
Krishna Raamachandra Shaastri,8th edition 1998, Published by Chaukhambha Orientalia,
Varanasi.
o Vruddha Jeevaka, Kaashyapa Samhita, with English Translation and commentary, edited
by P.V.Tewari, 1st edition 1996, Published by Chaukhambha Visvabharati, Varanasi.
o Vruddha Vaagbhata, Ashtaanga Sangraha, by Kaviraj Atrideva Gupta, edition 1993,
Published by Krishna Das Academy, Varanasi.
o Yogaratnaakara, with Vaidyaprabha Hindi Commentary by Dr. Indradev Tripathi and Dr.
Dayashankar Tripathi,1st edition 1998, Published by Krishna Das Academy, Varanasi.

Annexure
Annexure
DEPARTMENT OF POST-GRADUATE STUDIES IN SHALYA TANTRA S.D.M.

COLLEGE OF AYURVEDA HASSAN
Case Proforma for Clinical Study
EFFECT OF VRANA BASTI IN THE MANAGEMENT OF DUSHTA VRANA
CASE NO: GROUP:
Name : 0PD No:
Age : IPD No:
Sex : Date of admission:
Occupation : Date of Discharge:
Religion : Economic status:
Address : Ph no:
I.CHIEF COMPLAINTS:
1) VRANA: a) Kala ( Duration ):
b) Sthana:
c) Onset: (Sudden/ Recurrent/ gradual)
d) Number of ulcers/wound:
2) SRAVA: a) Present/Absent
b) Varna
c) Consistency
3) GANDHA: Present/Absent
4) KANDU: a) Present/Absent
5) DAAHA: Present/Absent
6) VEDANA: a) Present/Absent
If present duration:
7) JWARA: Present/Absent
If present
a) Duration c) Rigors
b) Character d) Chill
8) ANY OTHER ASSOCIATED COMPLAINTS

Annexure
II.HISTORY OF PRESENT ILLNESS:
III.HISTORY OF PAST ILLNESS:
IV.FAMILY HISTORY:
V.PERSONAL HISTORY:
1) Appetite: Good/Moderate/Poor 4)Micturation
2) Diet: Vegetarian/Mixed 5) Sleep
3) Bowel: R/IR/Constipated/Loose Stools 6) Addiction
VI.TREATMENT HISTORY:
Vll.OBS. HISTORY/GYNAEC HISTORY:
VIII.GENERAL EXAMINATION:
P R: R.R:
B P: Temp:
IX.SYSTEMIC EXAMINATION:
Respiratory System: Gastro Intestinal System:
Cardio Vascular System: Central Nervous System:
X.STHANIKA PAREEKSHA
A. DARSHANA PAREEKSHA
Vrana Akruti: Vrana Shrava:
Vrana Sankhya: Vrana Gandha:
Vrana Sthana: Vrana Varna
B. Palpation: (i) Size of the ulcer: Length
Breadth
(ii) Tenderness: Present/Absent
(iii) Bleeding on touch: Present/Absent
(iv)Local Temperature: Normal/Cold/Hot

Annexure
Xl. Examination of Vascularity:

A. Inspection: Visible colour changes:
B. Palpation (a) Arterial Pulsation
C. Varicosity: Present/Absent
D. Deep vein thrombosis: Present/Absent
Xll. Investigations:
Blood Urine
Hemoglobin percentage - Urine Sugar
Sr. Creatinine -Microscopy
Blood Sugar Level
HIV/HbsAg
Culture and Sensitivity test of wound discharge
Histopathological Examination (If necessary).
XIII. Diagnosis according to the cause:
XIV. Chikitsa:
XV. Complications during the treatment:
XVI. Conclusion: Complete Shodhana

Partial Shodhana
Incomplete Shodhana

Annexure
FOLLOW UP CHART
NAME O.P NO/I.P NO
Assessment BT 2nd 3rd 4th 5th 6th 7th AT End of End of

criteria D D D D D D
1 Month 2nd Month
Pain
Itching
Burning
sensation
Tenderness
Discharge
Smell
Surroundi
area ofulcer
Floor &
granulation
tissue

Summary &
Conclusion
Acknowledgement
ACKNOWLEDGEMENT

encouragement.
work.


Acknowledgement
nephew Jay


Abbreviations
ABBREVIATION

AT After treatment
Ath. Atharvaveda
BT Before treatment
Ka Kashyapa
M Madhyama
Ma. Ni Madhavnidana
Ni. Nidanasthana
Sha. Sharangadhara
Su/Su. Sutrasthana
U Uttarasthana
UK. Uttara Khanda
ABSTRACT
Objectives:
Vrana.

CONTENTS
Page no.
1. INTRODUCTION 1-2
6. DISCUSSION 87-97

LIST OF TABLES

no no.
economic status
wound
wound
wound
disease
temperature
Vrana
of Dustha Vrana
Vrana
of Dustha Vrana
LIST OF GRAPHS

no. no.
economic status
Shakthi
wound
of wound
wound
wound
disease
temperature
LIST OF CHARTS

no. no.
LIST OF Figures

no. no.

OF DUSHTAVRANA
By
PANKAJ.B.PATIL

BANGALORE
AYURVEDA VACHASPATI
(MASTER OF SURGERY)
In
SHALYA TANTRA


HASSAN-573 201
2011
Certificate
Tantra
Shalya Tantra
Co Guide: Guide:
Date Date:

Shalya Tantra.
Co-Guide: Guide:

Hassan
Date:
Place: Hassan
INSTITUTION

Hassan.
COPYRIGHT

Date:
Place: Hassan
Pankaj.B.Patil

Introduction
Introduction
recurrence.
lion.”2

Introduction

Collage, Hyderabad.
Collage, Bangalore.

Ayurvedic Review
AYURVEDIC REVIEW
Historical review:

1) Prevedic era
2) Vedic era
3) Postvedic era
Prevedic era:
Vedic era:
information
Rigveda1:
worth mentioning.
Atharvaveda2 :

Ayurvedic Review
Post vedic era:

they are
3)
Jaatakamala6:
Harshacharita7:
Kaadambari8:
Samhita Kaala9:

Ayurvedic Review
Vrana:
Derivation10:
„ ‟ ,

Definition11:
Classification12:

Aagantuja vrana:

Ayurvedic Review

Roodha Vrana14.
Shareeraja Vrana:
Lakshanas16 :
1)Saamanya : pain.

Ayurvedic Review
Table No. 1
DOSA KAARANAS
AAHARAJA VIHARAJA
Pinyaka, etc.
Aahara, Maasha etc.
.
Vishesha Lakshanas:
Pootisraava.
Sraava.

Ayurvedic Review
Shyaava,
Aruna Aruna, Aruna,
Asthi. Asthi
Varna
Vartma Rooksha - -
Todha,
Teevra Sphuruna,To
Bheda, Todha,
Sphurana etc.
yana etc
Alpa sraava
Mandha Mandha
sraava sraava
Dhaavana, Pulakaamb
Pulakodaka

Peeta,
Neelabha
Pingala Pingala
Raaga,Paaka
Daaha, Trushna,
Peeta Pidaka Daaha
Kshaara
Sraava is
Sraava large in
warm, large
in qty
Taila or
solution of
Taila
Bhasma

Ayurvedic Review

Sthoola,
Sthoola, Katina,
Sthaimitha,
Maardhava
Jaala
Mandha
Mandha
vedana,
feeling of
Sthaimithya
heaviness
Sraava Large
Alpa
Samkleda
Naarikelodaa sraava

Pidaka Pidaka
Smells like Turanga

Ghrita
Aakruthi - - - - -
manda
Meena
toya

Ayurvedic Review
Rakta,
Aruna
Vedana - Kandu
Sheeta,
Alpa
Rooksha, Guru,
Dhaaruna Snigdha

Has Varna
Varna - - - -
of 3 types
Nirdahana,
Kandu
Paandu,
Rakta
Anya Paaka,
- - - Paaka, Raaga
Lakshanas Raaga
Dushta Vrana23:
Shuddha Vrana25:
similar.

Ayurvedic Review

Moving in & other
having bandha
Amanoghna
Darshana,
Atigandha,
Vedanayukta,
associated with
Daaha, Paaka,
Raaga, Kandu,
Shopha Pidaka
Discharging
excessively
Dushta
Shonitha

Ayurvedic Review

Pidika.
Ruhyamaana vrana27:
Maadhavanidaana.
Roodha.
Samprapti29:

Ayurvedic Review

Darshana:
Sparshana:
temperature etc.
Prashna:

Vrana).

Ayurvedic Review

Maadhavakara
Vishesha Lakshanas

shapes.
Vrana Gandha33:

Ayurvedic Review
Vrana Varna 34:

Vrana Vedana35:
Dosha Vedana
Vrana Sraava36:
Dosha Vrana Sraava


Ayurvedic Review
Sthaana Sraava

Saadhyaasadhyatha:

Ayurvedic Review
Yaapya Vrana39:
Asaadhya Vrana40:
caused by Doshas).
Vrana Chikitsa41:
Vranithaagaara:

Ayurvedic Review
Shodhana.
Samaanya Chikitsa:
Vishesha Chikitsa:
Saptaupakramas 43:

Ayurvedic Review
Poorva Karma:
Pradhaana Karma:
Pradhaana Karma.
Paschat Karma:



Ayurvedic Review


Dravyas.

Apatarpana + - - -
Parisheka + - + +
Abhyanga + - - +
Swedana + + - +
Vimlaapana + - - +
Upanaaha + - + -
Paachana + - - +
Visraavana + - + +
Sneha + - + -
Vamana + - - +
Virechana + - - +
Chedana + + - -

Ayurvedic Review
Dhaarana + - - +
Lekhana + + - -
Eshana + + - -
Aharana + - - -
Vyadhana + + - -
Sraavana + - - -
Seevana + + - -
Sandhaana + + - -
Nirvaapana + + - +
Utkaarika + - - -
Kashaaya.
Varti + - - +
Kalka + - + -
Ghrita.
Taila,Ropana
Taila
Rasakriya + - - +
Maardhavakara)
Utsaadana + + - +
Avasaadana + + - +
Aalepana.
Aalepana

Ayurvedic Review
a a
a a
Bastikarma + - - -
Uttarabasti + - - -
Bandha + + + -
(Baahya)
Patrachaadana
(Abhyantara)
Krimighna + - - -
Bhrimhana + - - -
Vishaghna + - - -
Nasya + - - -
Dhooma + - - -
Madhu-sarpi + - - -
Yantra + - - -
Shophaghna - + - -
Shamana - + + -
Chaadhana - + - -
Ropanalepa - + - +
Ropana - + + -
Shodhana - - + -
Pracchanna - + - -

Ayurvedic Review
Table No. 16


Pathyaapathya46:
Pathya:

Ayurvedic Review
Apathya:
etc.
Upadravas47:
Avipaaka, Trushna.
Aagantuja Vrana 48:


seperation of body
parts.

Ayurvedic Review
anywhere Uttundita.
other than
Koshtha.
shape.
features
mentioned in
Sushruta.
lttle of Rakta
associated
with burning
sensation.
Avagaada
Vrana.
seperated
from body.
bhi which Asthi
remains in
place.
Maamsa.

Ayurvedic Review
Chikitsa49:

Drava Dravya.

Modern Review
Modern Review
1) Clinically
2) Pathologically.
Table No 18
Clinically51
tendency towards
healing.
Pathologically52

Modern Review
Traumatic ulcer .

Traumatic ulcer:
painful.

Venous ulcers:

Modern Review

Infective ulcers:

of condylomas.

gummatous ulcer.

Modern Review
Gummatous ulcer:
Tropical ulcer:
Martorells ulcer:
Cryopathic ulcer:
Diabetic ulcer:
Tuberculous ulcer:
eg intestinal TB.
granulation tissue.

Modern Review

Actinomycosis:
bluish in color.


Marjolins ulcer:
everted.

Modern Review
3) Stage of repair

Inspection:

Modern Review
number.
pyocyaneus

Modern Review
beaded
unhealthy e.g.
tuberculosis
thigh.
Palpation:

Modern Review
bone.

tender.


Modern Review



Modern Review




Modern Review

antiseptic
surface cleaning.
chloramine T)
eusol.

Modern Review

Wound dressings58:


Modern Review
Wound59:
devitalized tissue.
Types of wounds:

4) Infection.
Infection60:

Modern Review



Most of the strains
Penicillin because
they produce
Flucloxacillin &
Methicillin.
tonsillitis etc.

abdominal sepsis.
and tracheostomy
wounds with
production of
characteristic blue
geen pus.

Modern Review

vagina etc,.
1. Wound abscess.
3. Bacteraemia.
4. Septicaemia.
Wound healing62 :


ways.

Modern Review

1. General factors.
2. Local factors.
General factors:


Modern Review
Local factors:
1. Inflammation.


Modern Review
Inflammation:
Injury
Initial haemorrhage
Inflammation starts
Haemostasis
Diapedesis
Migration
Phagocytosis
monocytes.
Platelets:

Modern Review
1. Alpha-Granules
3. Lysosomes

Modern Review

after phagocytosis.
impaired.

Modern Review
neutrophils.

Modern Review
Lymphocytes:

Modern Review
function.

Modern Review

iv) X-irradiation
doses.


Modern Review


Modern Review

Collagen:
Tensile strength:


Modern Review

2. Painful scars
4. Keloid formation
5. Neoplasia.

Drug Review
Jatyadi Taila

Jatyadi Taila 1:
Taila (Tila).

va
Mrudu
Kashaaya Shaamaka,
Pootihara,
Kushtaghna,
Kandooghna,
Shodhana, Ropana,
Vedana sthaapana
Rooksha, Pitta
Kapha Hara, Vrana
Shodhana, Ropana,
Vedanasthaapana
Kashaaya Vardhaka.
Picchila hanakara,
Vrana Ropaka,
Bhootaghna

Drug Review

Snigdha Pittahara,
Vedana sthaapana,
Daahashaamaka

Rakshoghna,
Durgandha
naashana,Varnya.
Katu Rooksha
Shodhana, Ropana
ni Rooksha
Madhura
, Vedana Sthaapana
Pancharas
a Alavana
Tikta Snigdha
Katu
Dourgandha Hara
(Anurasa) Ropana,
, Tikta

Drug Review

name composition
marda nimbidine
Phala dioca Mg
pongamin
Siktaka - - - - -
e
longa
a racemosa Tannin
Pathya chebula
Tamragarbha
Pathya chebula
Tamragarbha
salicylic
aldehyde
indicum Fat ,
Oil-Sesamin,
Oleic acid
Tamragarbha

Drug Review
Preperation:
Jaati Dhaaruharidra
Nimba Manjistha
Patola Katurohini
Naktamaala Padmaka
Madhuka Abhaya
Kushta Neelotpala
Haridra Tuttha
Saariva

Tila Taila: 4 parts

Drug Review
aaaaaa
Sariva Yashtimadhu

Material & Methods
Source of Data:

the study.
Deergha Kaleena
Poothi Pooya
Ateeva Vedana
Daha
Kandu Shopha
Shonita Srava
Inclusion Criteria:
Exclusion Criteria

Material & Methods

Vrana Vedana
Daha
Kandu
Vrana Gandha
Vrana Varna
Vrana Shrava
Vrana Akruti

Material & Methods
Follow-up of Study:

Blood Urine
Blood Sugar Level
ASSESSMENT
A. Vedana(Pain):
0- no pain
5-
0- No burning

Material & Methods
C.Kandu( Itching):
0- No itching
Objective criteria:
B.Gandha(Smell):
0- No smell
C.Akruti:

Material & Methods
dressing.
following criteria.

marked improvement.


improvement.

Observations
OBSERVATIONS
finding:
Table – 25

Male 15 37.5 15 37.5 30 75.0
Female 05 12.5 05 12.5 10 25.0

Observations
Table-26
patients
21-30 03 7.5 01 2.5 04 10
31-40 06 15 02 5 08 20
41-50 02 5 04 10 06 15
51-60 07 17.5 09 22.5 16 40
61-70 02 5 04 10 06 15
Table-27
Habitat
Rural 12 30 08 20 20 50
Urban 08 20 12 30 20 50

Observations
Table-28

Farmer 08 20 06 15 14 35
Cook 01 2.5 00 00 01 2.5
Teacher 02 5 00 00 02 5
Coolie 02 5 01 2.5 03 7.5
House Wife 05 12.5 05 12.5 10 25
Employee 02 5 02 5 04 10
Buisness 00 00 06 15 06 15
Table-29

Hindus 17 42.5 19 47.5 26 90
Christians 01 2.5 01 2.5 02 5
Muslims 02 5 00 00 02 5

Observations
Table -30
S-E
P 13 32.5 07 17.5 20 50
M 07 17.5 12 30 19 47.5
R 00 00 01 05 01 0.5
Table-31
Diet
Mixed 16 40 10 25 26 65
Vegetarian 04 10 10 25 04 35

Observations
Table-32
Ahara
Good 10 25 10 25 20 50
Moderate 09 22.5 10 25 19 42.5
Poor 01 2.5 00 00 01 2.5
Table-33

Addiction
Alcohol 02 5 01 2.5 03 7.5
Smoking 03 7.5 05 10 08 17.5
Alcohol and 01 2.5 02 5 03 7.5

Smoking
None 14 35 13 32.5 27 67.5

Observations
Table-35
Aetiology of
Nija 09 22.5 08 20 17 42.5
Agantuja 11 27.5 12 30 23 57.5
Table-36
Chronicity of
1 wk - 4 wk 15 37.5 10 25 25 62.5
1 mth - 3 mth 3 7.5 4 10 07 17.5
4mth – 6mth 1 2.5 2 5 03 7.5
7 mth – 1 yr 1 2.5 4 10 05 12.5

Observations
Table-37
Diagnosis of
Traumatic 10 25 07 17.5 17 42.5
Venous Ulcer 02 5 09 22.5 11 27.5
Diabetic Ulcer 07 17.5 03 7.5 10 25
Snake Bite 01 2.5 01 2.5 02 5
Table-38

Right Lower 10 25 10 25 20 50
Limb
Left Lower 9 22.5 10 25 19 48.5
Limb
Other area 01 2.5 00 00 01 2.5

Observations
Table-39

Past Disease
HTN 1 2.5 00 00 01 2.5
Type II DM 9 22.5 8 20 17 42.5
None 10 25 12 30 22 55
Table-40

Srava 08 20 16 40 24 60
Gandha 10 25 13 32.5 27 57.5
Kandu 11 27.5 17 42.5 03 70
Daha 15 37.5 19 47.5 00 75
Vedana 17 42.5 16 40 82.5

Observations
Table-41

Grades of Body
0 13 32.5 10 25 23 57.5
1 07 17.5 10 25 17 42.5
2 00 00 00 00 00 00
3 00 00 00 00 00 00
that (Table-42)..
Table-42

Shape 0f
Oval 08 20 12 30 20 50
Elliptical 03 7.5 05 12.5 08 20
Circular 03 7.5 01 2.5 04 10
Irregular 06 15 02 5 08 20

Observations
List of Graphs

Observations

Observations

Results
RESULTS

(Table-43).
(Table-43)
of P<0.001 (Table-43)
of P<0.01 (Table-43).

Results
P<0.05 (Table-43).
Table-43

B.T. A.T
Pain 3.00 1.15 61.6 0.67 0.153 12.33 <0.001

Itching 1.25 0.40 68 1.08 0.24 3.48 <0.001
Burning 2.35 1.00 0.98 0.22 6.110 <0.001
Sensation 57.4
Tenderness 2.20 0.90 59.0 0.80 0.17 7.255 <0.001
Discharge 1.25 0.40 68 1.08 0.24 3.48 <0.01
Smell 1.15 0.65 43.4 1.14 0.24 2.023 <0.05
Granulation 1.15 0.65 43.4 1.10 0.24 2.03 <0.001

Results
Table-44

1 1.85 61.6
2 0.85 68
3 1.35 57.4
4 1.3 59.0
5 0.85 68
6 0.50 434
7 1.9 43.4
Table-45
Complete 0 0
Shodhana
Marked 8 40
Shodhana
Moderate 8 40
Shodhana
Mild shodhana 3 15
No Shodhana 1 5

Results
Table-46
Anupashaya 1 5
Table-47

1st Week 20 01 6.7%
2nd Week 20 01 6.7%
rd
3 week 20 02 13.3%
4th week 20 02 13.3%
5th week 20 01 6.7%
th
6 week 20 01 6.7%
7th Week 20 00 0.0%
8th Week 20 00 0.0%

Results

(Table-48).
P<0.001 (Table-48).
P<0.001 (Table-48).

Results
Table no 48

B.T. A.T
Pain 2.75 0.75 72.7 0.64 0.14 13.7 <0.001

Itching 2.20 0.80 63.6 0.82 0.18 7.62 <0.001
Burning 2.85 1.30 0.88 0.19 7.81 <0.001
Sensation 54.3
Tenderness 2.40 0.80 66.6 0.50 0.11 14.23 <0.001
Discharge 2.45 0.95 61.2 0.68 0.15 9.74 <0.001
Smell 1.65 0.35 78.8 0.92 0.20 6.29 <0.001
Granulation 2.85 0.80 71.9 0.68 0.15 13.35 <0.001
Table no 49

1 2.00 72.7
2 1.40 63.6
3 1.55 54.3
4 1.60 66.6
5 1.50 61.2
6 1.30 78.8
7 2.05 71.9

Results
Table-50
Shodhana No. of %
Patients
Mild Shodhana 03 15
No Shodhana 00 00

Table-51
Marked 05 25
improvement
Moderate 12 60
Improvement
Mild 03 15
Improvement
Unchanged 00 0.0

Follow-up Study:
2 months.

Results

Table-52
1st Week 20 01 6.7%
2nd Week 20 01 6.7%
3rd Week 20 01 6.7%
4th week 20 02 13.3%
5th week 20 02 13.3%
6th week 20 01 6.7%
7th week 20 01 6.7%
8th Week 20 00 0%

Results
Graph-37
Follow up
Graph-39
% of Reccurence
14.00%
12.00%
10.00%
Percentage
8.00%
6.00%
%
4.00%
2.00%
0.00%

Results
Shodhana percentage
Graph-49
VB Group
14
12
10
8
6
VB Group
4
2
0
Follow up
Graph-51
% of Reccurence
14.00%
12.00%
10.00%
Percentage
8.00%
6.00% %
4.00%
2.00%
0.00%

Discussion
DISCUSSION
ulcer.


Discussion
were rich.
Shakti .
of the wound.

Discussion
bite.
to microangiopathy.
having HTN

treatment.

Discussion
the treatment.

Discussion
treatment.

Discussion
sensation(54.3%).
Burningsensation.

Discussion
Pichu

local immunity.
formulation.

Discussion
CaseReport No 1
Name:Govinda Patel
Sex/Age: M/67yrs
Date: 08/04/2011
OPD/IPD No: 211031/55042
Residence: Banglore


Discussion
Before Treatment

Discussion
CASE REPORT No.2
Name: Byarappa
Sex/Age: M/60 yrs
Occupation: Driver
Date: 3/09/2011
OPD/IPD No: 233682/58053


Discussion
Before treatment

Summary &Conclusion

this chapter.
Diabetic Ulcer.
it was 48.5%

Summary &Conclusion
improvement in 15%.
Anupashaya in 5%.
Dushta Vrana.

Summary &Conclusion
Taila Pichu


References
References
Historical review:
1) Rigveda- 1.112.10; 116, 15; 17, 11, 118, 8; 10.39, 8.
2) Atharvaveda- 2.3.2 –6; 19.34.10; 8.9.1-10.
4) Mahavagga- 14.4-5, 23.6.
6) Jaatakamala- 8.24, 26.29,112.
8) Kaadambari- 102,644, 329.
Ayurvedic Review

References

Madhava Nidana42/3;

References


References


References

Modern Review
50) Bailey.& Love.3/Pg-36,12/Pg-158;
53) Bailey.& Love.12/158,159.
57) M.M.S.6/Pg-48,49;B.&L.12/Pg-159.
61) B.&L.7/Pg.89-91.

Bibliography
BIBLIOGRAPHY

Delhi.

Bibliography


Bibliography

Varanasi.

Annexure

CASE NO: GROUP:
Name : 0PD No:
Age : IPD No:
Address : Ph no:
I.CHIEF COMPLAINTS:
b) Sthana:
b) Varna
c) Consistency
If present

Annexure
IV.FAMILY HISTORY:
V.PERSONAL HISTORY:
P R: R.R:
B P: Temp:
Breadth

Annexure

Blood Urine
Blood Sugar Level
HIV/HbsAg
XIV. Chikitsa:

Partial Shodhana
Incomplete Shodhana

Annexure
FOLLOW UP CHART
NAME O.P NO/I.P NO

1 Month 2nd Month
Pain
Itching
Burning
sensation
Tenderness
Discharge
Smell
Surroundi
area ofulcer
Floor &
granulation
tissue

OF DUSHTAVRANA
By
PANKAJ.B.PATIL

BANGALORE
AYURVEDA VACHASPATI
(MASTER OF SURGERY)
In
SHALYA TANTRA


HASSAN-573 201
2011
Certificate
Tantra
Shalya Tantra
Co Guide: Guide:
Date Date:
Drug Review
aaaaaa
Sariva Yashtimadhu

Observations
List of Graphs

Observations

Observations

Results
Graph-37
Follow up
Graph-39
% of Reccurence
14.00%
12.00%
10.00%
Percentage
8.00%
6.00%
%
4.00%
2.00%
0.00%

Results
Shodhana percentage
Graph-49
VB Group
14
12
10
8
6
VB Group
4
2
0
Follow up
Graph-51
% of Reccurence
14.00%
12.00%
10.00%
Percentage
8.00%
6.00% %
4.00%
2.00%
0.00%

Discussion
Before Treatment

Discussion
Before treatment


Shalya Tantra.
Co-Guide: Guide:

Hassan
Date:
Place: Hassan
INSTITUTION

Hassan.
COPYRIGHT

Date:
Place: Hassan
Pankaj.B.Patil

Acknowledgement
ACKNOWLEDGEMENT

encouragement.
work.


Acknowledgement
nephew Jay


Abbreviations
ABBREVIATION

AT After treatment
Ath. Atharvaveda
BT Before treatment
Ka Kashyapa
M Madhyama
Ma. Ni Madhavnidana
Ni. Nidanasthana
Sha. Sharangadhara
Su/Su. Sutrasthana
U Uttarasthana
UK. Uttara Khanda
ABSTRACT
Objectives:
Vrana.

CONTENTS
Page no.
1. INTRODUCTION 1-2
6. DISCUSSION 87-97

LIST OF TABLES

no no.
economic status
wound
wound
wound
disease
temperature
Vrana
of Dustha Vrana
Vrana
of Dustha Vrana
LIST OF GRAPHS

no. no.
economic status
Shakthi
wound
of wound
wound
wound
disease
temperature
LIST OF CHARTS

no. no.
LIST OF Figures

no. no.

Introduction
Introduction
Introduction
recurrence.
lion.”2

Introduction

Collage, Hyderabad.
Collage, Bangalore.

Ayurvedic Review
AYURVEDIC REVIEW
Historical review:

1) Prevedic era
2) Vedic era
3) Postvedic era
Prevedic era:
Vedic era:
information
Rigveda1:
worth mentioning.
Atharvaveda2 :

Ayurvedic Review
Post vedic era:

they are
3)
Jaatakamala6:
Harshacharita7:
Kaadambari8:
Samhita Kaala9:

Ayurvedic Review
Vrana:
Derivation10:
„ ‟ ,

Definition11:
Classification12:

Aagantuja vrana:

Ayurvedic Review

Roodha Vrana14.
Shareeraja Vrana:
Lakshanas16 :
1)Saamanya : pain.

Ayurvedic Review
Table No. 1
DOSA KAARANAS
AAHARAJA VIHARAJA
Pinyaka, etc.
Aahara, Maasha etc.
.
Vishesha Lakshanas:
Pootisraava.
Sraava.

Ayurvedic Review
Shyaava,
Aruna Aruna, Aruna,
Asthi. Asthi
Varna
Vartma Rooksha - -
Todha,
Teevra Sphuruna,To
Bheda, Todha,
Sphurana etc.
yana etc
Alpa sraava
Mandha Mandha
sraava sraava
Dhaavana, Pulakaamb
Pulakodaka

Peeta,
Neelabha
Pingala Pingala
Raaga,Paaka
Daaha, Trushna,
Peeta Pidaka Daaha
Kshaara
Sraava is
Sraava large in
warm, large
in qty
Taila or
solution of
Taila
Bhasma

Ayurvedic Review

Sthoola,
Sthoola, Katina,
Sthaimitha,
Maardhava
Jaala
Mandha
Mandha
vedana,
feeling of
Sthaimithya
heaviness
Sraava Large
Alpa
Samkleda
Naarikelodaa sraava

Pidaka Pidaka
Smells like Turanga

Ghrita
Aakruthi - - - - -
manda
Meena
toya

Ayurvedic Review
Rakta,
Aruna
Vedana - Kandu
Sheeta,
Alpa
Rooksha, Guru,
Dhaaruna Snigdha

Has Varna
Varna - - - -
of 3 types
Nirdahana,
Kandu
Paandu,
Rakta
Anya Paaka,
- - - Paaka, Raaga
Lakshanas Raaga
Dushta Vrana23:
Shuddha Vrana25:
similar.

Ayurvedic Review

Moving in & other
having bandha
Amanoghna
Darshana,
Atigandha,
Vedanayukta,
associated with
Daaha, Paaka,
Raaga, Kandu,
Shopha Pidaka
Discharging
excessively
Dushta
Shonitha

Ayurvedic Review

Pidika.
Ruhyamaana vrana27:
Maadhavanidaana.
Roodha.
Samprapti29:

Ayurvedic Review

Darshana:
Sparshana:
temperature etc.
Prashna:

Vrana).

Ayurvedic Review

Maadhavakara
Vishesha Lakshanas

shapes.
Vrana Gandha33:

Ayurvedic Review
Vrana Varna 34:

Vrana Vedana35:
Dosha Vedana
Vrana Sraava36:
Dosha Vrana Sraava


Ayurvedic Review
Sthaana Sraava

Saadhyaasadhyatha:

Ayurvedic Review
Yaapya Vrana39:
Asaadhya Vrana40:
caused by Doshas).
Vrana Chikitsa41:
Vranithaagaara:

Ayurvedic Review
Shodhana.
Samaanya Chikitsa:
Vishesha Chikitsa:
Saptaupakramas 43:

Ayurvedic Review
Poorva Karma:
Pradhaana Karma:
Pradhaana Karma.
Paschat Karma:



Ayurvedic Review


Dravyas.

Apatarpana + - - -
Parisheka + - + +
Abhyanga + - - +
Swedana + + - +
Vimlaapana + - - +
Upanaaha + - + -
Paachana + - - +
Visraavana + - + +
Sneha + - + -
Vamana + - - +
Virechana + - - +
Chedana + + - -

Ayurvedic Review
Dhaarana + - - +
Lekhana + + - -
Eshana + + - -
Aharana + - - -
Vyadhana + + - -
Sraavana + - - -
Seevana + + - -
Sandhaana + + - -
Nirvaapana + + - +
Utkaarika + - - -
Kashaaya.
Varti + - - +
Kalka + - + -
Ghrita.
Taila,Ropana
Taila
Rasakriya + - - +
Maardhavakara)
Utsaadana + + - +
Avasaadana + + - +
Aalepana.
Aalepana

Ayurvedic Review
a a
a a
Bastikarma + - - -
Uttarabasti + - - -
Bandha + + + -
(Baahya)
Patrachaadana
(Abhyantara)
Krimighna + - - -
Bhrimhana + - - -
Vishaghna + - - -
Nasya + - - -
Dhooma + - - -
Madhu-sarpi + - - -
Yantra + - - -
Shophaghna - + - -
Shamana - + + -
Chaadhana - + - -
Ropanalepa - + - +
Ropana - + + -
Shodhana - - + -
Pracchanna - + - -

Ayurvedic Review
Table No. 16


Pathyaapathya46:
Pathya:

Ayurvedic Review
Apathya:
etc.
Upadravas47:
Avipaaka, Trushna.
Aagantuja Vrana 48:


seperation of body
parts.

Ayurvedic Review
anywhere Uttundita.
other than
Koshtha.
shape.
features
mentioned in
Sushruta.
lttle of Rakta
associated
with burning
sensation.
Avagaada
Vrana.
seperated
from body.
bhi which Asthi
remains in
place.
Maamsa.

Ayurvedic Review
Chikitsa49:

Drava Dravya.

Modern Review
Modern Review
1) Clinically
2) Pathologically.
Table No 18
Clinically51
tendency towards
healing.
Pathologically52

Modern Review
Traumatic ulcer .

Traumatic ulcer:
painful.

Venous ulcers:

Modern Review

Infective ulcers:

of condylomas.

gummatous ulcer.

Modern Review
Gummatous ulcer:
Tropical ulcer:
Martorells ulcer:
Cryopathic ulcer:
Diabetic ulcer:
Tuberculous ulcer:
eg intestinal TB.
granulation tissue.

Modern Review

Actinomycosis:
bluish in color.


Marjolins ulcer:
everted.

Modern Review
3) Stage of repair

Inspection:

Modern Review
number.
pyocyaneus

Modern Review
beaded
unhealthy e.g.
tuberculosis
thigh.
Palpation:

Modern Review
bone.

tender.


Modern Review



Modern Review




Modern Review

antiseptic
surface cleaning.
chloramine T)
eusol.

Modern Review

Wound dressings58:


Modern Review
Wound59:
devitalized tissue.
Types of wounds:

4) Infection.
Infection60:

Modern Review



Most of the strains
Penicillin because
they produce
Flucloxacillin &
Methicillin.
tonsillitis etc.

abdominal sepsis.
and tracheostomy
wounds with
production of
characteristic blue
geen pus.

Modern Review

vagina etc,.
1. Wound abscess.
3. Bacteraemia.
4. Septicaemia.
Wound healing62 :


ways.

Modern Review

1. General factors.
2. Local factors.
General factors:


Modern Review
Local factors:
1. Inflammation.


Modern Review
Inflammation:
Injury
Initial haemorrhage
Inflammation starts
Haemostasis
Diapedesis
Migration
Phagocytosis
monocytes.
Platelets:

Modern Review
1. Alpha-Granules
3. Lysosomes

Modern Review

after phagocytosis.
impaired.

Modern Review
neutrophils.

Modern Review
Lymphocytes:

Modern Review
function.

Modern Review

iv) X-irradiation
doses.


Modern Review


Modern Review

Collagen:
Tensile strength:


Modern Review

2. Painful scars
4. Keloid formation
5. Neoplasia.

Drug Review
Drug Review
Jatyadi Taila

Jatyadi Taila 1:
Taila (Tila).

va
Mrudu
Kashaaya Shaamaka,
Pootihara,
Kushtaghna,
Kandooghna,
Shodhana, Ropana,
Vedana sthaapana
Rooksha, Pitta
Kapha Hara, Vrana
Shodhana, Ropana,
Vedanasthaapana
Kashaaya Vardhaka.
Picchila hanakara,
Vrana Ropaka,
Bhootaghna

Drug Review

Snigdha Pittahara,
Vedana sthaapana,
Daahashaamaka

Rakshoghna,
Durgandha
naashana,Varnya.
Katu Rooksha
Shodhana, Ropana
ni Rooksha
Madhura
, Vedana Sthaapana
Pancharas
a Alavana
Tikta Snigdha
Katu
Dourgandha Hara
(Anurasa) Ropana,
, Tikta

Drug Review

name composition
marda nimbidine
Phala dioca Mg
pongamin
Siktaka - - - - -
e
longa
a racemosa Tannin
Pathya chebula
Tamragarbha
Pathya chebula
Tamragarbha
salicylic
aldehyde
indicum Fat ,
Oil-Sesamin,
Oleic acid
Tamragarbha

Drug Review
Preperation:
Jaati Dhaaruharidra
Nimba Manjistha
Patola Katurohini
Naktamaala Padmaka
Madhuka Abhaya
Kushta Neelotpala
Haridra Tuttha
Saariva

Tila Taila: 4 parts

Methodology
Material & Methods
Source of Data:

the study.
Deergha Kaleena
Poothi Pooya
Ateeva Vedana
Daha
Kandu Shopha
Shonita Srava
Inclusion Criteria:
Exclusion Criteria

Material & Methods

Vrana Vedana
Daha
Kandu
Vrana Gandha
Vrana Varna
Vrana Shrava
Vrana Akruti

Material & Methods
Follow-up of Study:

Blood Urine
Blood Sugar Level
ASSESSMENT
A. Vedana(Pain):
0- no pain
5-
0- No burning

Material & Methods
C.Kandu( Itching):
0- No itching
Objective criteria:
B.Gandha(Smell):
0- No smell
C.Akruti:

Material & Methods
dressing.
following criteria.

marked improvement.


improvement.

Observations
OBSERVATIONS
finding:
Table – 25

Male 15 37.5 15 37.5 30 75.0
Female 05 12.5 05 12.5 10 25.0

Observations
Table-26
patients
21-30 03 7.5 01 2.5 04 10
31-40 06 15 02 5 08 20
41-50 02 5 04 10 06 15
51-60 07 17.5 09 22.5 16 40
61-70 02 5 04 10 06 15
Table-27
Habitat
Rural 12 30 08 20 20 50
Urban 08 20 12 30 20 50

Observations
Table-28

Farmer 08 20 06 15 14 35
Cook 01 2.5 00 00 01 2.5
Teacher 02 5 00 00 02 5
Coolie 02 5 01 2.5 03 7.5
House Wife 05 12.5 05 12.5 10 25
Employee 02 5 02 5 04 10
Buisness 00 00 06 15 06 15
Table-29

Hindus 17 42.5 19 47.5 26 90
Christians 01 2.5 01 2.5 02 5
Muslims 02 5 00 00 02 5

Observations
Table -30
S-E
P 13 32.5 07 17.5 20 50
M 07 17.5 12 30 19 47.5
R 00 00 01 05 01 0.5
Table-31
Diet
Mixed 16 40 10 25 26 65
Vegetarian 04 10 10 25 04 35

Observations
Table-32
Ahara
Good 10 25 10 25 20 50
Moderate 09 22.5 10 25 19 42.5
Poor 01 2.5 00 00 01 2.5
Table-33

Addiction
Alcohol 02 5 01 2.5 03 7.5
Smoking 03 7.5 05 10 08 17.5
Alcohol and 01 2.5 02 5 03 7.5

Smoking
None 14 35 13 32.5 27 67.5

Observations
Table-35
Aetiology of
Nija 09 22.5 08 20 17 42.5
Agantuja 11 27.5 12 30 23 57.5
Table-36
Chronicity of
1 wk - 4 wk 15 37.5 10 25 25 62.5
1 mth - 3 mth 3 7.5 4 10 07 17.5
4mth – 6mth 1 2.5 2 5 03 7.5
7 mth – 1 yr 1 2.5 4 10 05 12.5

Observations
Table-37
Diagnosis of
Traumatic 10 25 07 17.5 17 42.5
Venous Ulcer 02 5 09 22.5 11 27.5
Diabetic Ulcer 07 17.5 03 7.5 10 25
Snake Bite 01 2.5 01 2.5 02 5
Table-38

Right Lower 10 25 10 25 20 50
Limb
Left Lower 9 22.5 10 25 19 48.5
Limb
Other area 01 2.5 00 00 01 2.5

Observations
Table-39

Past Disease
HTN 1 2.5 00 00 01 2.5
Type II DM 9 22.5 8 20 17 42.5
None 10 25 12 30 22 55
Table-40

Srava 08 20 16 40 24 60
Gandha 10 25 13 32.5 27 57.5
Kandu 11 27.5 17 42.5 03 70
Daha 15 37.5 19 47.5 00 75
Vedana 17 42.5 16 40 82.5

Observations
Table-41

Grades of Body
0 13 32.5 10 25 23 57.5
1 07 17.5 10 25 17 42.5
2 00 00 00 00 00 00
3 00 00 00 00 00 00
that (Table-42)..
Table-42

Shape 0f
Oval 08 20 12 30 20 50
Elliptical 03 7.5 05 12.5 08 20
Circular 03 7.5 01 2.5 04 10
Irregular 06 15 02 5 08 20

Results
RESULTS

(Table-43).
(Table-43)
of P<0.001 (Table-43)
of P<0.01 (Table-43).

Results
P<0.05 (Table-43).
Table-43

B.T. A.T
Pain 3.00 1.15 61.6 0.67 0.153 12.33 <0.001

Itching 1.25 0.40 68 1.08 0.24 3.48 <0.001
Burning 2.35 1.00 0.98 0.22 6.110 <0.001
Sensation 57.4
Tenderness 2.20 0.90 59.0 0.80 0.17 7.255 <0.001
Discharge 1.25 0.40 68 1.08 0.24 3.48 <0.01
Smell 1.15 0.65 43.4 1.14 0.24 2.023 <0.05
Granulation 1.15 0.65 43.4 1.10 0.24 2.03 <0.001

Results
Table-44

1 1.85 61.6
2 0.85 68
3 1.35 57.4
4 1.3 59.0
5 0.85 68
6 0.50 434
7 1.9 43.4
Table-45
Complete 0 0
Shodhana
Marked 8 40
Shodhana
Moderate 8 40
Shodhana
Mild shodhana 3 15
No Shodhana 1 5

Results
Table-46
Anupashaya 1 5
Table-47

1st Week 20 01 6.7%
2nd Week 20 01 6.7%
rd
3 week 20 02 13.3%
4th week 20 02 13.3%
5th week 20 01 6.7%
th
6 week 20 01 6.7%
7th Week 20 00 0.0%
8th Week 20 00 0.0%

Results

(Table-48).
P<0.001 (Table-48).
P<0.001 (Table-48).

Results
Table no 48

B.T. A.T
Pain 2.75 0.75 72.7 0.64 0.14 13.7 <0.001

Itching 2.20 0.80 63.6 0.82 0.18 7.62 <0.001
Burning 2.85 1.30 0.88 0.19 7.81 <0.001
Sensation 54.3
Tenderness 2.40 0.80 66.6 0.50 0.11 14.23 <0.001
Discharge 2.45 0.95 61.2 0.68 0.15 9.74 <0.001
Smell 1.65 0.35 78.8 0.92 0.20 6.29 <0.001
Granulation 2.85 0.80 71.9 0.68 0.15 13.35 <0.001
Table no 49

1 2.00 72.7
2 1.40 63.6
3 1.55 54.3
4 1.60 66.6
5 1.50 61.2
6 1.30 78.8
7 2.05 71.9

Results
Table-50
Shodhana No. of %
Patients
Mild Shodhana 03 15
No Shodhana 00 00

Table-51
Marked 05 25
improvement
Moderate 12 60
Improvement
Mild 03 15
Improvement
Unchanged 00 0.0

Follow-up Study:
2 months.

Results

Table-52
1st Week 20 01 6.7%
2nd Week 20 01 6.7%
3rd Week 20 01 6.7%
4th week 20 02 13.3%
5th week 20 02 13.3%
6th week 20 01 6.7%
7th week 20 01 6.7%
8th Week 20 00 0%

Discussion
Discussion
DISCUSSION
ulcer.


Discussion
were rich.
Shakti .
of the wound.

Discussion
bite.
to microangiopathy.
having HTN

treatment.

Discussion
the treatment.

Discussion
treatment.

Discussion
sensation(54.3%).
Burningsensation.

Discussion
Pichu

local immunity.
formulation.

Discussion
CaseReport No 1
Name:Govinda Patel
Sex/Age: M/67yrs
Date: 08/04/2011
OPD/IPD No: 211031/55042
Residence: Banglore


Discussion
CASE REPORT No.2
Name: Byarappa
Sex/Age: M/60 yrs
Occupation: Driver
Date: 3/09/2011
OPD/IPD No: 233682/58053


Summary &
Conclusion
Summary &Conclusion

this chapter.
Diabetic Ulcer.
it was 48.5%

Summary &Conclusion
improvement in 15%.
Anupashaya in 5%.
Dushta Vrana.

Summary &Conclusion
Taila Pichu


References
References
References
Historical review:
1) Rigveda- 1.112.10; 116, 15; 17, 11, 118, 8; 10.39, 8.
2) Atharvaveda- 2.3.2 –6; 19.34.10; 8.9.1-10.
4) Mahavagga- 14.4-5, 23.6.
6) Jaatakamala- 8.24, 26.29,112.
8) Kaadambari- 102,644, 329.
Ayurvedic Review

References

Madhava Nidana42/3;

References


References


References

Modern Review
50) Bailey.& Love.3/Pg-36,12/Pg-158;
53) Bailey.& Love.12/158,159.
57) M.M.S.6/Pg-48,49;B.&L.12/Pg-159.
61) B.&L.7/Pg.89-91.

Bibliography
Bibliography
BIBLIOGRAPHY

Delhi.

Bibliography


Bibliography

Varanasi.

Annexure
Annexure

CASE NO: GROUP:
Name : 0PD No:
Age : IPD No:
Address : Ph no:
I.CHIEF COMPLAINTS:
b) Sthana:
b) Varna
c) Consistency
If present

Annexure
IV.FAMILY HISTORY:
V.PERSONAL HISTORY:
P R: R.R:
B P: Temp:
Breadth

Annexure

Blood Urine
Blood Sugar Level
HIV/HbsAg
XIV. Chikitsa:

Partial Shodhana
Incomplete Shodhana

Annexure
FOLLOW UP CHART
NAME O.P NO/I.P NO

1 Month 2nd Month
Pain
Itching
Burning
sensation
Tenderness
Discharge
Smell
Surroundi
area ofulcer
Floor &
granulation
tissue

Introduction
Drug Review
Methodology
Discussion
Conclusion
Summary
References
Bibliography
Annexure

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EFFECT OF VRANA BASTI IN THE MANAGEMENT

Dissertation Submitted to the

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA

In partial fulfilment of the requirements for the degree of

Under the guidance of

Dr. PRASANNA NARASIMHA RAO

DEPARTMENT OF POST GRADUATE STUDIES IN SHALYA TANTRA

DECLARATION BY THE CANDIDATE

Date: Signature of the candidate

Place: Hassan Pankaj.B.Patil

Dr.Maheshkumar.E S Dr. Prasanna Narasimha. Rao

Dr. P. Hemantha Kumar Dr. Prasanna N. Rao

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of Health Sciences,

© Rajiv Gandhi University of Health Sciences, Karnataka

I pay my respectful salutation to his holiness Pujya Padmabhushana Dr. Shri D.

I am also fortunate for having been associated with my co guide Dr.

Effect of Vrana Basti in the management of Dushta Vrana

I am very much thankful to all my colleagues Dr Brijesh Singh, Dr Keertiprakash, Dr

Dr. Pankaj. B. Patil

Effect of Vrana Basti in the management of Dushta Vrana

A.C.T.S A concise text book of Surgery

Methods: Clinically diagnosed 40 Patients of Dushta Vrana were randomly

Review of Ayurvedic literature 3-26

Review of the wound / ulcer 27-54

3. DRUG REVIEW 55-59

4. MATERIALS AND METHODS 60-64

5. OBSERVATION AND RESULTS 65-86

7. CONCLUSION & SUMMARY 98-100

10. ANNEXURE 109-112

Table Table Contents Page

Graph Graph Contents Page

Chart Chart Contents Page

3. Process of Wound Healing 52

Figure Figure Contents Page

2. Case report no.1 96

3.. Case report no.2 98

Effect of Vrana Basti in the management of Dushta Vrana 1

Few previous works on Dushta Vrana are enlisted below;

Effect of Vrana Basti in the management of Dushta Vrana 2

Some of them are as follows:

Effect of Vrana Basti in the management of Dushta Vrana 3

Post vedic era:

Effect of Vrana Basti in the management of Dushta Vrana 4

body part or tissue is called as Vrana.

Nija or Shaareeraja vrana:

Effect of Vrana Basti in the management of Dushta Vrana 5

Description of Sadhyo Vrana in Maadhava Nidaana is similar to that mentioned by

Effect of Vrana Basti in the management of Dushta Vrana 6

Effect of Vrana Basti in the management of Dushta Vrana 7

Table No. 2- Lakshanas according to various Acharyas17:

Lakshana Sushruta Charaka Kashyapa A.San. A.H. M.Ni.

Table No. 3- Lakshanas according to various Acharyas18:

Lakshas Sushruta Charaka Ka.S. A.San. A.H. M.Ni

Effect of Vrana Basti in the management of Dushta Vrana 8

Table No. 4- Lakshanas according to various Acharyas19:

Lakshanas Sushruta Charaka Ka.sam. A.Sam. A.H. M.Ni.

Table No.5- Lakshanas according to various Acharyas20:

Table No.6- Dvidoshaja Vrana Lakshanas21: