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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 84-88

A report of a non-healing burn wound managed through Ayurveda


Department of Kayachikitsa, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh, India

Date of Submission19-Oct-2021
Date of Acceptance01-Jun-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Dr. Shikha Chaudhary
Department of Kayachikitsa, Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_93_21

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  Abstract 


Since ancient times, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Burn wounds are common during household chores. Normally, the partial-thickness burn does not take more than two to three weeks to re-epithelialize. If it does not, then the cause may be that the wounds have become deeper over time. A 62-year-old female, having Kapha vata prakriti, with complaints of non-healing burn wound with severe pain and visible purulent discharge visited to Ayurvedic hospital. On local examination, an unhealed wound was noticed on the posterolateral side of the right leg above the ankle joint. The wound was covered with debris associated with discharge, foul smell, and raised local temperature, which confirmed the presence of secondary infection. Before visiting the Ayurvedic hospital, the patient had twice completed the course of antibiotics and had been taking analgesics regularly. Although some relief was found, some part of the wound was not healed completely and was associated with severe pain. The patient's caregiver brought her to the outpatient department of Ayurvedic medicine for further management in hope. The patient was treated with internal and external medicines where significant wound healing was achieved in a span of 28 days. This case report sets an example of the benefits of Ayurvedic medication in chronic case of wounds when there are no other options available or fail to respond.

Keywords: Burn wound, Dushta vrana, Jatyadi gohrita, Panchavalkala kwatha


How to cite this article:
Chaudhary S, Minhas P. A report of a non-healing burn wound managed through Ayurveda. J Ayurveda Case Rep 2022;5:84-8

How to cite this URL:
Chaudhary S, Minhas P. A report of a non-healing burn wound managed through Ayurveda. J Ayurveda Case Rep [serial online] 2022 [cited 2022 Aug 13];5:84-8. Available from: http://www.ayucare.org/text.asp?2022/5/2/84/348704




  Introduction Top


Wounds are classified mainly on the basis of mode of infliction and causative agent. Open wound is any traumatic breach in the continuity of skin and deep tissue. Burn wounds are open type of wounds, and they are different from other types of wounds. In chronic stage of burns, wounds tend to get infected. In the healing of a burn wound, there is a large interplay of systemic factors also. The healing period may vary from vrana weeks if remain uninfected. Unhealed infected wounds are denoted as Dushta vrana (~infected wound) in Ayurvedic classics.[1] The signs and symptoms mentioned in classics are Ativivrita (~large in size); Bhairava (~dirty look), Gandha (~smell); Puti puya mansa (~purulent discharge); Vedana (~pain); and Dirgha kala anubandhi (~chronic in nature). Also, the detailed description of four types of burn wounds is available in the classical text under the name of Dagdha Vrana (~burn wound).[2]

The present case is of unhealed infected burn wound. The patient was treated by keeping the principles of Dagdha vrana and Dushta vrana in mind as Dagdha vrana usually catches secondary infection, and later, it becomes Dushta. In the present case, Ayurvedic treatment has been given and the promising results were observed. This case study substantiates the fact that Ayurvedic treatment could also manage infected unhealed burn wound effectively.


  Patient Information Top


A 62-year-old female, homemaker, visited to outpatient department with the complaints of non-healing burn wound associated with severe pain, discharge, and foul smell over posterolateral side of the right leg above the ankle joint for the last 20 days. The primary wound was at the right lower part of the leg and foot. The burn wound had healed except for the area shown in [Figure 1]. The patient was told by a treating physician that the wound is infected and was advised to take antibiotics and analgesics along with conventional topical treatment, but no lasting improvement was achieved even after 15 days of conventional medications. The patient did not get any satisfactory relief. Then, she came to Ayurvedic hospital. The patient was of Kapha vata prakriti with Madhyama bala (~medium physical endurance) and Satva (~medium psychological strength).
Figure 1: Unhealed burn wound (Day 0)

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The patient had a history of burn over her right leg and foot with boiling water on November 20, 2020, at her home. The patient took emergency care at a local village hospital till November 23, 2020. She visited the Government Medical College and Hospital for further treatment for about a month (until December 23, 2020). The patient got significant improvement, but some part of the wound got infected and was not healing even after all conventional treatment. The patient came to the Ayurvedic hospital and started administering prescribed Ayurvedic medicines on December 29, 2020, with the hope of remission. No previous history of diabetes mellitus, varicosity, or any other disease was significantly present.


  Clinical Findings Top


Local examination revealed an open unhealed wound over lateroposterior aspect of the right leg (approximately 12 cm × 8 cm × 3 cm burn wound of second degree) associated with pain Visual Analog Scale (VAS: 10), purulent discharge, slough, foul smell, and brown-blackish discoloration of skin. There was tenderness with raised local temperature. Other burnt area was healed. There was no sign of varicosity in the affected limb.


  Therapeutic Interventions Top


After taking written consent from the patient, the internal and topical interventions were prescribed [Table 1] and [Table 2]. The patient was advised to take proper care and suggested to avoid water contact and further injury to the affected site.
Table 1: Internal Ayurvedic formulations prescribed

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Table 2: Topical Ayurvedic formulations prescribed

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  Follow-Up and Outcome Top


On the first day, the patient reported severe pain (VAS – 10), and after seven days of management, pain was reduced (VAS – 6) and required no analgesics [Graph 1]. The other complaints were reduced from severe to no symptoms [Table 3]. Marked improvement in healing of the wound was noticed after administration of Ayurvedic formulations [Figure 1],[Figure 2],[Figure 3],[Figure 4]. The wound was completely healed in 28 days of treatment, and there were no associated complaints. There was normal pigmentation appreciated over the healed skin afterward.
Figure 2: Wound in reparative phase (Day 8)

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Figure 3: Re-epithelization of wound (Day 20)

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Figure 4: Complete wound healing (Day 28)

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Table 3: Effect of interventions on presenting symptoms

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  Discussion Top


The features of burns and associated consequences have been comprehensively described in ancient classics. Durdagdha (~blister formation) are those in which blisters appear associated with severe sucking pain, burning, redness, inflammation, and pain and take long time to subside.[2] In Ayurvedic purview of pathological events of burn, blood agitated by fire is exasperated leading to aggravation of Pitta. Both blood and Pitta are alike in Virya (~potency), Rasa (~taste), and Dravativa (~fluidity), that is why there is the presence of the severe pain, burning, the quick appearance of blisters, fever, and thirst.

Acharya Sushruta told that Vrana (~wound) gets vitiated, if proper treatment or care is not given. This leads to further vitiation of Doshas and denoted as Dushta Vrana (~infected wound). Dushta Vrana comprise pus, deep base, ugly sight, foul smell, severely painful, redness, swelling, discharging vitiated blood, and long-standing in nature.[1]

Sixty remedies for wound management, including local and systemic measures, have been described for comprehensive management.[3] Out of 60, Sarpi (~topical use of medicated ghee) is meant to be Shodhana (~major purification therapy) as well as Ropana (~healing); Virechana (~therapeutic purgation) is beneficial to pacify the vitiated Doshas. Shodhana has equal importance as Ropana of any type of Vrana. Shodhana will help in arresting the pathology and will also prevent the secondary infections. In the present case, the internal medicaments were directed toward the amelioration of vitiated Doshas mainly Pitta and Rakta. The balanced Pitta and Rakta will further help the wound to heal faster.

Kaishora guggulu balances Pitta and Kapha and creates Samsodhana (~detoxifying) and Rasayana (~rejuvenation) combination aiming primarily at removing deep seated Pitta from the tissues and checking the vitiated blood.[4] An active compound, 5 (1-methyl, 1-aminoethyl)-5-methyl-2-octanone present in Guggulu gum also showed significant antibacterial activity against Gram-positive bacteria and moderate activity against Gram-negative bacteria.[5]

Anti-inflammatory and antibacterial activities of Khadirarishta are established.[6] It alleviates Kapha and Pitta doshas and useful in skin-related disorders by its Prabhav (~exceptional activity).[7] Aarogyavardhini vati is one among the best poly herbo-mineral medicine to ameliorate the vitiated Pitta and Rakta. It helps in maintaining hepatic functions. Its antimicrobial activity has been established, and it is said to be an alternative to synthetic antibiotics against human bacterial infections.[8] Dashamoola ghana vati contains Dashamoola (~ten herbs) that is best known for its analgesic and anti-inflammatory activity.[9] An Ayurvedic decoction Aragwadhadi kashayam is used in cases of Kushtaghna (~antidermatoses), Vishaghna (~antitoxic), and having Shamanam (~pacifying) properties and acts as Dushta vrana vishodhaka.[10] Thus, it helps in accelerating the wound healing.

External measures were focused on attaining the desired effects such as cleansing of wound, reduce inflammation, prevention of any secondary infection, promotion of healthy granulation tissue, and epithelialization of skin. Tankana bhasma is Kaphahara and Vatahara. Tikshna guna helps the drug to penetrate the deeper parts of wound, which helps remove the debris and check the discharge.[11] Panchavalkala kwatha has both Shodhana and Ropana properties and is being used in the management of wound wash. It enhances wound healing.[12],[13] Jatyadi Ghrita has both Vrana shodhana and Ropana properties.[14] It heals the wounds that are presented with exudation, deep associated with pain. It is capable of increasing granulation tissue and thus enhancing wound healing. Shatadhauta ghrita helps in the regeneration of new cells in skin. It is an Ayurvedic lotion to soothe the chapped skin by rebuilding the skin tissues.[15]

By using the internal and external Ayurvedic measures, significant wound healing was attained. No adverse effect was noticed during the period of management and afterward. No conventional medicines were required after the first follow-up.

In burn wound, slow healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in the management.[16] Ayurvedic management could be mainstay for managing burn wound while checking all these challenges depending on presentations. To validate that further well-designed studies are needed to optimize the current treatment paradigms and to eventually augment the outcome for burn wound through Ayurveda.


  Conclusion Top


This case study upholds the efficacy of Ayurvedic interventions in the management of nonhealing chronic infected burn wound, which is safe and implementable. It infers that the infected wound can also be treated with Ayurveda within the expected time period of wound healing.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Acharya YT, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta, Sutra Sthana. Ch. 22, Ver. 7. Varanasi: Chaukhamba Surbharati Prakshan; 2014. p. 108.  Back to cited text no. 1
    
2.
Sharma PV, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta, Sutra Sthana. Ch. 12, Ver. 16. Varanasi: Chaukhamba Visvabharati; 1999. p. 128.  Back to cited text no. 2
    
3.
Acharya YT, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta, Chikitsa Sthana. Ch. 1, Ver. 9. Varanasi: Chaukhamba Surbharati Prakshan; 2014. p. 398.  Back to cited text no. 3
    
4.
Bharati PL, Agrawal P, Prakash O. A case study on the management of dry gangrene by Kaishore Guggulu, Sanjivani Vati and Dashanga Lepa. Ayu 2019;40:48-52.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Goyal P, Chauhan A, Kaushik P. Assessment of Commiphora wightii (Arn.) Bhandari (Guggul) as potential source for antibacterial agent. J Med Med Sci 2010;193:71-5.  Back to cited text no. 5
    
6.
Balkrishna A, Gupta AK, Gupta A, Singh P, Singh K, Tomar M, et al. Antibacterial activity and mechanism of action of an Ayurvedic formulation Khadirarishta. J Herb Med 2022;32:100509.  Back to cited text no. 6
    
7.
Narayana A. Khadira (Acasia catechu Linn.) – A medico-historical review. Bull Indian Inst Hist Med Hyderabad 1996;26:39-48.  Back to cited text no. 7
    
8.
Wijenayake AU, Abayasekara CL, Pitawala HM, Bandara BM. Antimicrobial potential of two traditional herbometallic drugs against certain pathogenic microbial species. BMC Complement Altern Med 2016;16:365.  Back to cited text no. 8
    
9.
Parekar RR, Bolegave SS, Marathe PA, Rege NN. Experimental evaluation of analgesic, anti-inflammatory and anti-platelet potential of Dashamoola. J Ayurveda Integr Med 2015;6:11-8.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Ratha KK, Barik L, Panda AK, Hazra J. A single case study of treating hypertrophic lichen planus with Ayurvedic medicine. Ayu 2016;37:56-61.  Back to cited text no. 10
[PUBMED]  [Full text]  
11.
Shastri K, editor. Rasatarangini of Shadananda Sharma. Ch. 13, Ver. 72-74. Delhi: Motilal Banarasidas; 2014. p. 318.  Back to cited text no. 11
    
12.
Murthy SK, editor. Sharangadhara Samhita of Sharangadhara, Madhyam Khanda. 3rd ed., Ch. 2, Ver. 149. Varanasi: Chaukhambha Orientalia; 2014. p. 73.  Back to cited text no. 12
    
13.
Meena RK, Dudhamal T, Gupta SK, Mahanta V. Wound healing potential of Pañcavalkala formulations in a postfistulectomy wound. Anc Sci Life 2015;35:118-21.  Back to cited text no. 13
    
14.
Tripathi B, editor. Sharangadhara Samhita of Sharangadhara, Madhyam Khanda. Ch. 9, Ver. 58-59. Varanasi: Chaukhamba Surbharati Prakshan; 2016. p. 149.  Back to cited text no. 14
    
15.
Vyas KY, Barve MV, Galib R, Ravishankar B, Prajapati PK. Wound healing activity of Shatadhauta Ghrita: An experimental evaluation. Inventi Rapid 2015;3:1-5.  Back to cited text no. 15
    
16.
Wang Y, Beekman J, Hew J, Jackson S, Issler-Fisher AC, Parungao R, et al. Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev 2018;123:3-17.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Patient Information
Clinical Findings
Therapeutic Inte...
Follow-Up and Ou...
Discussion
Conclusion
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