E-ISSN:2456-3110

Case Report

Diabetic Ulcer

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 5 MAY
Publisherwww.maharshicharaka.in

Ayurvedic management of Dushta Vrana w.s.r. to Diabetic Ulcer - A Case Study

Kumar CSS1*, SV Shailaja2
DOI:10.21760/jaims.10.5.54

1* Chimakurthi Sesha Sai Kumar, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Centre, Bengaluru, Karnataka, India.

2 SV Shailaja, Professor and HOD, Department of PG Studies in Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Centre, Bengaluru, Karnataka, India.

Dushta Vrana is commonly encountered problem faced in surgical practise. Lower limb ulcers are of greater concern since vedic period. Present population is highly prone to non-healing ulcer due to trauma, life style changes, diabetes, infections and improper nutrition. Local factors like poor blood supply,[1] slough, pus discharge and foreign body delays the healing of wound. Therefore all efforts should be made to make Dushta Vrana to Shudda Vrana. A patient aged 50 years, male presented as wound with pain in left foot since 15 days. On examination there is a dense necrotic tissue present over the ulcer. The ulcer was treated with debridement followed by Prakshalana with Panchavalkala Kashaya followed by dressing with Jatyadi Taila along with oral medications like Chirabilwadi Kashayam and capsule Grab. The wound got healed in 56 days with healed scar and no reoccurrence has been observed with 1 year follow up. Vrana Prakshalana with Panchavalkala Kashaya showed antimicrobial process which helped in healing process, while Jatyadi Taila enhanced in healing of the wound.

Keywords: Dushta Vrana, Diabetic ulcer, Panchavalkala Kashayam, Jatyadi Taila

Corresponding Author How to Cite this Article To Browse
Chimakurthi Sesha Sai Kumar, Post Graduate Scholar, Department of PG Studies in Shalya Tantra, Sri Kalabyraveshwara Swamy Ayurvedic Medical College, Hospital and Research Centre, Bengaluru, Karnataka, India.
Email: 		Kumar CSS, SV Shailaja, Ayurvedic management of Dushta Vrana w.s.r. to Diabetic Ulcer - A Case Study. J Ayu Int Med Sci. 2025;10(5):342-347.
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https://jaims.in/jaims/article/view/4384/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-04-13 2025-04-26 2025-05-06 2025-05-16 2025-05-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Not required 11.36

© 2025 by Kumar CSS, SV Shailaja and Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2025;10(5)342
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Chimakurthi SSK et al. Ayurvedic management of Dushta Vrana w.s.r. to Diabetic Ulcer

Introduction

Shalya Tantra is one among the 8 branches of Ayurveda in which surgical and parasurgical techniques have been explained for the management of ulcers. Vrana is described in detail in Susrutha Samhitha.[2] Vrana is generally of two types[3] i.e., Sharira which is caused due to Sharirika Doshas and Aagantuja which is caused due to trauma. The scar which is formed after healing of Vrana stays for longer time. Wound healing is complex process to achieve anatomical and functional integrity of disrupted tissue by various components like neutrophils, macrophages, lymphocytes, fibroblasts, collagen in an organised staged pathway.[4] The wound will get infected and doesn’t heal for long time and turn to Dushta Vrana.[5] Presence of Dushta Vrana can damage the condition of the patient and may turn fatal.

Ulcer in the lower limb is quite common among middle aged population where symptoms include pain, swelling, odema, and bleeding. If not treated properly it can become infected and progresses into septicaemia and multiorgan failure. Acharya Susrutha has mentioned Shasti Upakrama[6] for the treatment for Vrana. Among them Kashaya, Varti, Sarpi, Taila and Rasakriya are explained for Vrana Shodana and Ropana. One among them includes Panchavalkala Kashaya of Nyagrodadhi Gana. Kashaya prepared with Panchavalkala Dravyas are found to be effective in treating the ulcers. For the healing of Vrana both Shodhana and Ropana plays an important role. Jatyadi Taila[7] is indicated in Dushta Vrana.

Case Report

A patient aged 50 years male, came to SKAMCH & RC for the complains of wound with pain in left foot since 15 days. Patient is a known case of Diabetes mellitus - type 2 since 2 years and is on regular medications. Patient was apparently healthy 15 days ago. The patient first developed swelling in left heel, patient neglected the condition which after 2 days opened spontaneously with pus discharge and pain. Pain was continuous which persisted throughout the day with throbbing in nature. Pus discharge was yellowish in colour with foul smell.

He consulted local physician for the treatment of the same and undergone local dressing along with oral medications (unknown) for 10 days.

The patient did not go for dressing regularly and had improper wound care. Gradually patient noticed blackish discolouration of ulcer during treatment.

The pain and pus discharge also increased, and the treating doctor has advised for amputation for which the patient did not agree. Discolouration gradually increased and pus discharge reduced but pain persisted. Patient came to SKAMCH&RC for further management as advised by his relatives.

Personal history

Diet - Vegetarian, 3 times a day
Appetite - Good
Sleep - Sound (8 to 10 hrs per day)
Micturition - 3-4 times per day and 0-1 time at night
Bowel - Regular, Formed stools, once in a day
Habits - Tea - Thrice a day, Milk - Twice a day

Familial history - Patients father is a known case of Diabetes mellitus.

General examination

  • Built - Well built
  • Nourishment - Well nourished
  • Pallor - Absent
  • Icterus - Absent
  • Cyanosis - Absent
  • Clubbing - Absent
  • Lymphadenopathy - Absent
  • Odema - Absent
  • Tongue - Coated
  • Temperature - 97.4°F
  • Pulse - 76 bpm
  • BP - 126/82mmhg
  • Respiratory - 14 cycles/min
  • Height - 162cms
  • Weight - 81 kgs
  • BMI - 30.9 kg/m2
  • Gait - Normal

Systemic examination

CNS - Higher mental functions intact. Patient is oriented to time, place and person

CVS - S1, S2 heard and no murmurs heard


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Chimakurthi SSK et al. Ayurvedic management of Dushta Vrana w.s.r. to Diabetic Ulcer

RS - Normal vesicular bronchial sounds, no added sounds

Per Abdomen - Soft, Non tender in all the quadrants

Vrana Pareeksha

  • Vrana Sthana - Vama Pada
  • Vrana Varna - Krishna Varna
  • Vrana Vedana - Toda
  • Vrana Akriti - Vrutta
  • Vrana Srava - Nirasrava

Local examination of wound

On Inspection

  • Site - Left Heel
  • Swelling - Absent
  • Redness - Absent
  • Pus - Absent
  • Slough - Absent
  • Necrotic Tissue - Present
  • Blackish Discoloration - Present
  • Size - 8 x 6 cms
  • Number - 1
  • Shape - Irregular
  • Edge - Odematous
  • Floor - Covered with Necrotic tissue
  • Margin - Regular
  • Discharge - Absent
  • Surrounding area – Normal

On palpation

  • Tenderness - Present
  • Warmth around the Wound - Absent
  • Base - slight indurated
  • Relation with deeper structure - Absent

Peripheral pulse examination

ArteryRight Lower limbLeft Lower limb
Dorsalis pedisNormalNormal
Anterior tibialNormalNormal
Posterior tibialNormalNormal
PoplitealNormalNormal
FemoralNormalNormal

Investigations

Hematology

Hb - 11.3 g/dl
TC - 13120 cells/cumm
FBS - 234 mg/dl
PPBS - 366 mg/dl
Blood urea - 29 mg/dl
Serum creatinine - 0.8 mg/dl

Chikitsa

Local wound care

On day 1 - local debridement of wound done followed by wash given with betadine and hydrogen peroxide and dressing done with betadine.

From day 2 to day 26 - Gradual debridement of slough done followed by Prakshalana of wound done with Panchavalkala Kashaya followed by dressing done with Jatyadi Taila.

From day 27 to 56 - Prakshalana of wound done with Panchavalkala Kashaya followed by dressing done with Jatyadi Taila.

Orally

1. Chirabilwadi Kashayam 15ml - 0 - 15ml with warm water - Before food and
2. Capsule Grab 1 - 0 - 1 After food for a period of 26 days
3. Kaishora Guggulu 2 - 0 - 2 After food and
4. Tablet Gandhaka Rasayana 1 - 1 - 1 After food for a period of one month

Pathya[8] and Apathya[9]

Pathya Aahara and Vihara

Aahara

  • Shali
  • Godhuma
  • Mudga
  • Saindhava Lavana
  • Ghrita

Vihara

  • To wear MCR slippers
  • Foot Hygiene
  • Non weight bearing on affected leg

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Chimakurthi SSK et al. Ayurvedic management of Dushta Vrana w.s.r. to Diabetic Ulcer

Apathya Aahara and Vihara

Aahara

  • Katu, Ushna, Teekshna
  • Masha
  • Dadhi
  • Mamsa

Vihara

  • Standing for long hours
  • Walking bare foot
  • Diva Swapna
  • Ratri Jagarana

Results

The wound got healed completely in 56 days.

jaims_4384_01.JPG
Day 1

jaims_4384_02.JPG
Day 7

jaims_4384_03.JPG
Day 14

jaims_4384_04.JPG
Day 23

jaims_4384_05.JPG
Day 38


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Chimakurthi SSK et al. Ayurvedic management of Dushta Vrana w.s.r. to Diabetic Ulcer

jaims_4384_06.JPG
Day 50

jaims_4384_07.JPG
Day 56

Discussion

Acharya Susrutha had explained about treatment of Vrana according to the stage of wound. Among Shasti Upakrama, Vrana Prakshalana with Kashaya[10] and Taila[11] Prayoga had employed in the current wound. Prakshalana with Panchavalkala Kashaya[12] helped in mechanical debridement as it washes away exudates and unhealthy tissue from the base of ulcer and helped in relief from pain.

It helps in increasing circulation and permeability by tactile stimulation and histamine release, resulting in absorption of drug and local nourishment of affected part.[13] The majority of Jatyadi Taila's constituents contain Tikta, Kashaya Rasas and Laghu, Ruksha Gunas. Jatyadi Taila is Tikta and Kashaya Rasa Pradhana, both of which are Pitta Kaphahara and have the properties of Vrana Shodhana, Ropana, Pootihara, and Vedanasthapana.[14] Internal medications which were administered helped in wound healing with improvement of general condition of the patient.

Conclusion

This case study shows that Dushta Vrana can be managed with holistic approach through Ayurveda. Management of Dushta Vrana by Prakshalana with Panchavalkala Kashaya and dressing with Jatyadi Taila along with oral medications helps in complete healing of the wound.

References

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