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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 61-65

Gojihva (Launaea nudicaulis [L.] Hook.f.), a potential herb for chronic wound healing: A case study


1 Department of Dravyaguna, All India Institute of Ayurveda, New Delhi, India
2 Department of Shalya Tantra, All India Institute of Ayurveda, New Delhi, India

Date of Submission29-Feb-2020
Date of Acceptance04-Jul-2020
Date of Web Publication16-Oct-2020

Correspondence Address:
Dr. Shivani Ghildiyal
Department of Dravyaguna, All India Institute of Ayurveda, New Delhi - 110 076
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JACR.JACR_14_20

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  Abstract 


Chronic wounds are becoming challenge for scientific community due to their economical and psychological burden. Contemporary science tried hard to cop up with this difficult situation by the use of tissue engineering, cell-based therapy, plasma therapy along with various dressings, and surgical procedures, but the results are not very promising. Wounds are described under the heading of Vrana in Ayurveda along with various herbs and herbomineral preparations for their management. Gojihva (Launaea nudicaulis [L.] Hook.f.) is an herb mentioned to be useful in various diseases as well as for wounds. It is also practiced ethnomedicinally for wound management in various countries. A 60-year-old male having non-healing wound on his dorsal surface of the forearm for the past 45 days was treated with dressing of Gojihva kwatha (~ decoction) for 28 days. Bates–Jensen Wound Assessment Tool (BWAT), wound tracing and digital photography was used to asses wound healing on every week. BWAT score was 52 before treatment and 13 after the treatment. The surface area was 42.9 cm2 before treatment and nil after treatment. The wound was completely healed in 28 days without any complications.

Keywords: Chronic wound, Ethnomedicine, Gojihva, Vrana


How to cite this article:
Kumar V, Ghildiyal S, Sherkhane R, Nesari TM. Gojihva (Launaea nudicaulis [L.] Hook.f.), a potential herb for chronic wound healing: A case study. J Ayurveda Case Rep 2020;3:61-5

How to cite this URL:
Kumar V, Ghildiyal S, Sherkhane R, Nesari TM. Gojihva (Launaea nudicaulis [L.] Hook.f.), a potential herb for chronic wound healing: A case study. J Ayurveda Case Rep [serial online] 2020 [cited 2020 Dec 3];3:61-5. Available from: http://www.ayucare.org/text.asp?2020/3/2/61/298290




  Introduction Top


Wound healing is a complex and dynamic process of various biological events; however, when wounds fail to achieve sufficient healing after four weeks of standard treatment and care, they are known as chronic non-healing wounds.[1] Chronic wounds are becoming more prevalent, difficult to treat, and burden for patient as well as for medical system.[2] Many factors are responsible for delayed healing such as advanced age, steroids like-glucocorticosteroid and chemotherapeutic agents in large dosages, metabolic disorders such as Diabetes Mellitus (DM), nutritional deficiencies such as vitamin A, zinc, infections, trauma, smoking, edema, and low oxygen.[3] In the conventional medical system, the management of wound depends on its site, cause, type of wound and time duration, but few common procedures are used such as wound dressing (non-resorbable occlusive dressings, hydrophilic, and hydrogels), topical application of antimicrobials (antibiotics, antiseptics, and superoxidized solutions, for example – mupirocin, neomycin, bacitracin, and silver agents), growth factors (recombinant human platelet derived factor, epidermal growth factors), matrix-forming agents (pure collagen, hybrid collagen, and collagen-containing dressings), enzymes (collagenase, papain–urea combination), and surgical procedures such as suturing, skin grafting, and flaps.[4] Tissue engineering, cell-based therapy, and plasma therapy are advances in the treatment of wound, but the gold standard for wound management is not available till date.[5] Thus, there is a need to adopt potential references to wound management from well-established systems such as Ayurveda. In Sushruta Samhita, vivid description of wounds and their management is described under the heading of Vrana.[6] Acharya Sushruta had explained Vrana as the damage of tissues.[7] In Ayurveda, the herb Gojihva [Figure 1] is mentioned for various diseases, i.e., in Raktapitta (~hemorrhagic disorders), Kushtha (~skin diseases), Prameha (~diabetes mellitus), Shwaasa (~breathing problems), Kasa (~cough) and Aruchi (~anorexia),[8] Vrana (~wounds) and Visarpa (~erysipelas) in the form of Lepa (~external application of pack) as well as other preparations such as Churna (~powder) and Ghrita.[9] In the current study, the herb Gojihva is taken as (Launaea nudicaulis [L.] Hook.f.) on the basis of Bihar ki Vanaspatiyan of Thakur Balwant Singh.[10] The herb was authenticated from the Botanical Survey of India, Dehradun (Voucher Specimen No. 290). A case of chronic non-healing wound which healed in 28 days after application of Gojihva kwatha without internal medicine is reported here.
Figure 1: Herb Gojihva (Launaea nudicaulis [L.] Hook.f.) with flowering

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  Case Report Top


A 60-year-old male came to Shalya Tantra OPD with complaint of wound on the right forearm for the past 45 days with huge amount of watery discharge, pain, and swelling. No history of DM, hypertension, tuberculosis, thyroid, asthma etc., was found. The patient was taking mixed diet and had addiction to alcohol and tobacco chewing. Bowel, micturition, and sleep habits were normal. Before 45 days, the patient was apparently healthy; however, he got injured in an accident. The wound was sutured and was prescribed with conventional medicine. However, the wound does not heal after 45 days in spite of conventional treatment. Thus, he visited the Shalya Tantra OPD for Ayurvedic treatment.

Clinical findings

The patient was examined and detailed history was taken. On local examination, a large (11 cm × 3.5 cm × 0.5 cm) single wound of irregular shape with punched out edges and edematous margins was noted on the right forearm between wrist joint and elbow. Foul smell, watery discharge, pain, and swelling were present. The floor of wound had white slough, and the surrounding area was wrinkled with hyper-pigmentation. The skin and muscles of affected area were involved. All the symptoms were persistent from day one of registration. The patient has four sutures and hypergranulation over the stitches was seen. The patient was advised for daily dressing with Gojihva kwatha (~decoction of Gojihva) for 28 days. No internal medicines was given during this period.

Diagnosis

The patient has Ativivrita (~large wound), Puya (~pus), Puti (~putrid smell), Amanogaya (~unpleasant to eyes), Vedana (~pain), Sopha (~swelling), Deergha kalanubandhi (~long duration), and irregular wound which was non-healing for the past 45 days. On the basis of sign and symptoms, it was diagnosed as Dushta vrana (~chronic wound).


  Timeline Top


The written consent from patient was taken for the treatment. Sutures were removed with the help of surgical blade and other surgical equipment at first day of treatment. The Gojihva kwatha from dried whole herb was prepared as per the classical method,[11] which was used for wound cleaning and dressing. The wound was cleaned every day 2–3 times in a single sitting with Gojihva kwatha soaked gauze with gentle hands following aseptic precautions. After that, Kwatha soaked gauze was applied over the wound and dry sterilized gauze was placed over it and then dressing was done. Similar dressing was done daily for 28 days. No other oral medication was given during the treatment. Wound assessment was done by Bates–Jensen Wound Assessment Tool (BWAT),[12] pain was assessed by Visual Analog Scale (VAS),[13] and wound tracing was done with the help of butter paper and pencil at weekly interval. The digital photography was also done for overall assessment and comparison.


  Follow-up and Outcome Top


The patient Responded well to the treatment and assessment was done at weekly interval. Changes in BWAT grading is shown in [Table 1]. The total score was 52 before treatment and 13 after treatment, which suggests good improvement in the wound. The surface area was measured by tracing method as shown in [Table 2]. The surface area was 42.9 cm 2 before the treatment and nil after treatment, which indicates complete healing of wound. Pain score recorded on VAS scale [Table 3]. The pain score was six before treatment and nil after the treatment, which indicates the pain reliving property of the herb. All the clinical changes observed during weekly examination are shown in [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6] which are comparable. In the 1st week, the slough was reduced day by day and disappeared by 7th day. The wound become more clean, and by 7th day, healthy granulation tissues were seen. In the 2nd week, the wound become dry, having only scanty clean discharge; swelling and pain also reduced. Epithelial tissues were seen on 14th day. In 3rd week, the discharge was minimum. Pain was completely resolved, hyper-pigmentation was reduced, and the wound was completely covered by the epithelial tissues. Wound contraction was also seen on each week and wound margins came closer. In the last week, the wound margins attached with each other and the wound was completely healed with 0.65 unit healing time (unit healing time = numbers of days taken in healing/initial surface area in square centimeters), and all associated symptoms (pain, swelling, discharge, and hyper-pigmentation) disappeared. The patient did not developed any complications during the treatment and after two months of follow-up.
Table 1: Wound assessment by Bates-Jensen Wound Assessment Tool (BWAT)

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Table 2: Surface area by tracing

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Table 3: Pain assessment by Visual Analog Scale (VAS)

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Figure 2: Day 1 (wound with slough)

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Figure 3: Day 7 (wound without slough and with granulation tissue)

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Figure 4: Day 14 (wound with epithelial tissue)

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Figure 5: Day 21 (wound fully covered with epithelial tissues)

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Figure 6: Day 28 (completely healed wound)

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  Discussion Top


The pharmacodynamic attributes of Gojihva is Kashaya (~astringent), Tikta (~bitter), Rasa (~taste), and Sheetaveerya (~cold potency). As per the Ayurvedic fundamental principles, Kashaya and Tikta rasa are having moisture reducing action and property of drying,[14],[15],[16] which may be helpful in reduction of excessive exudates in wound. Further, Tikta rasa has the Krimighana (~antimicrobial) property and it provides Sthirikarana (~stability) to Tvak (~skin) and Mamsa (~muscular tissue).[14] The Kashaya rasa has Sandhana (~tissue binding) and Ropana (~healing) action.[17] These potentials of Gojihva may help to prevent secondary infections and enhance healing. In addition to these, herbs of Tikta and Kashaya rasa are of Sheeta veerya[18] that has Stambhana (~styptic therapy) property. Thus, pharmacodynamics of Gojihva indicates towards its wound-healing potential. Further, Gojihva is also reported to have pharmacological activities, i.e., antibacterial,[19] antifungal,[19] and antioxidant,[20] which supports the wound healing. The pain reduction was noted in the patient which may be due to the analgesic effect of herb as it is reported having analgesic compounds, i.e., thymol, trans-totrol, eugenol, etc., by which it showed analgesic effect.[21]

The wound-healing property observed with this herb may be ascribed to its ability to keep the wound free from infection possibly through its antimicrobial effects and to enhance wound healing through its pharmacodynamic attributes as per Ayurveda. However, further studies are needed to ascertain its mechanism of action on scientific parameters.


  Conclusion Top


The present case report reveals complete healing of chronic non-healing wound by topical application of Gojihva kwatha within 28 days without any adverse effect. This unexplored novel herb may be developed as a cost-effective and potential wound-healing drug through further vigorous preclinical and clinical researches. The herb has potential in wound healing and may be useful in other types of chronic nonhealing wounds as well as acute wounds. The plant is easily available as a weed, and it may be the answer of safe, cost-effective, and potential wound-healing drug for rational use.

Declaration of patient consent

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

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Sorg H, Tilkorn DJ, Hager S, Hauser J, Mirastschijski U. Skin wound healing: An Update on the current knowledge and concepts. Eur Surg Res 2017;58:81-94.  Back to cited text no. 5
    
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Singh TB, editor. Bihar Ki Vanaspatiyan. Bihar: Baidyanath Ayurved Bhawan; 1955.  Back to cited text no. 10
    
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Bates-Jensen BM, McCreath HE, Harputlu D, Patlan A. Reliability of the Bates-Jensen wound assessment tool for pressure injury assessment: The pressure ulcer detection study. Wound Repair Regen 2019;27:386-95.  Back to cited text no. 12
    
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Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011;63 Suppl 11:S240-52.  Back to cited text no. 13
    
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Rashid S, Ashraf M, Bibi S, Anjum R. Antibacterial and antifungal activities of Launaea nudicaulis (Roxb.) and Launaea resedifolia (Linn.). Pak J Bio Sci 2000;3:630-2.  Back to cited text no. 19
    
20.
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21.
Seddiki LS, Belboukhari N, Yakoubi M, Sekkoum K, Cheriti A, Sulaiman MR. Investigation of The Analgesic and Anti-Inflammatory Activities of Launaea Nudicaulis From Southwest of Algeria. Biomed J Sci Tech Res 2019;23:17173-8.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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