A case study of dushta vrana treated with apamarga kshar with jatyadi taila pichu.

 The treatment and healing of Wounds are some of the oldest subjects discussed in the medical Literature. The same events, in the same order, occur in every healing process regardless of the tissue type or the inciting injury. Knowledge of Wound healing allows Surgeons to manipulate wounds to achieve optimal results in a short period. In Ayurveda non healing ulcer can be correlated with Dushta Vrana. Application of Kshar karma for shodhana and ropana of  Dushta Vrana is one among the Sixty upakramas of Vrana. Pratisaarniya Kshar is indicated for Dushta Vrana in Ksharpakavidhi Adhayaya (Sutrasthana chapter 11) of Sushruta Samhita. Kshar has chhedana (excision), Bhedana (incision), and Lekhana (scrapping) properties along with Tridoshhara (equilibrium of Vata, Pitta, Kapha) properties, thus considered as a good curative measure for local treatment of Dushta vrana. A case report of an open traumatic ulcer successfully treated by local application of Apamarga Kshar Pichu,Haridra,Jatyadi Taila has been presented here.

The treatment and healing of Wounds are some of the oldest subjects discussed in the medical Literature. The same events, in the same order, occur in every healing process regardless of the tissue type or the inciting injury. Knowledge of Wound healing allows Surgeons to manipulate wounds to achieve optimal results in a short period. In Ayurveda non healing ulcer can be correlated with Dushta Vrana.

INTRUDUCTION-
Vrana is seen as debilitating and scaring disorder usually seen affecting the human being at any age. Vrana is the condition associated with Dhatu nasha (destruction of tissue), and characterized by Vedana (pain), Srava (discharge), and Vikriti (deformity). Acharya Sushruta has described Shastiupakramas (60 procedures) for management of Wound 1 , to achieve good approximation, early healing, without complications, and acceptable scar. Among these Kshar karma has its own specific indication in the management of Vrana. Kshar karma, which is non-invasive procedure without major complications, does the shodhana of Dushta Vrana, remove all slough/dead tissue and vrana becomes Shuddha and thus enhances wound healing. Acharya Sushruta has given number of dressing materials eg. Pichu, Plota, Kawalika and Vikeshika. Among these Pichu is used to clean the vrana as well as to absorb the vranasrava. Thus, Apamarga Kshar Pichu, Haridra & Jatyadi Taila was selected for the management of Dushta Vrana.

Type of Study
Observational single case design.
A 67 Years old female patient presented with the complaints of Traumatic broad ulcer on left upper side of buttock region with severe pain , pus discharge , foul smelling ,inflamed and oedematous skin margins, which was not responding to treatment given elsewhere . Before 2 months, the patient was alright then while going on road, a bike man hit him from rear, he fell down and stuck with a sharp stone and got injured badly on left upper side of buttock, which produced swelling with pain and formation of a wound. After few days, swelling became infected and showed freely flowing pus. The wound was treated with antibiotics ointment by a local doctor but it failed to respond. The patient also went to some allopathic hospitals for treatment but it did not react positively to the treatment. At last, he came for Ayurvedic management at C.S.M.S.S., Ayurved Hospital, Kanchanwadi, Aurangabad. There was no history of HTN, DM, Tuberculosis or any other major systemic disorder.

Local Examination
Ulcer was seen on left upper side of buttock measuring about 10x8.5x0.5cm in dimension with profuse purulent discharge and irregular margins, edges were inflamed. The floor was unhealthy covered with slough, and unpleasant intolerable smell was present. Tenderness was also present with surrounding induration and local rise in temprature. Local lymph nodes were not involved.

MATERIALS AND METHODS
In this study Apamarga Kshar Pichu with Jatyadi Taila was used for local application.

Treatment Plan
Wound was cleaned with Triphala Kwath daily, after proper cleaning with sterile swabs, Apamarga Kshar Pichu with Jatyadi Taila was locally applied and dressing was done with sterile gauze and bandage once daily. Total duration of treatment was 08 weeks.

RESULTS
The clinical features of Dushta Vrana were improved by the end of 2nd week and the wound was healed completely at the end of 08th week leaving minimal scar. During a follow up for a period of 1 month, no signs of recurrence were noticed.