|Year : 2020 | Volume
| Issue : 3 | Page : 95-98
Efficacy of Ashwagandha [Withania somnifera (Linn.) dunal] leaf paste in the management of chronic non-healing wound: A case report
Sombir Sheoran1, Bushra Khanam2, Vyasadeva Mahanta1, Sanjay Kumar Gupta1
1 Department of Shalya Tantra, All India Institute of Ayurveda, New Delhi, India
2 Department of AYUSH, Uttar Pradesh, India
|Date of Submission||05-Jul-2019|
|Date of Acceptance||23-Jul-2020|
|Date of Web Publication||18-Jan-2021|
Dr. Sombir Sheoran
V.P.O Fartia Bhima Teh, Loharu, Bhiwani - 127 201, Haryana
Source of Support: None, Conflict of Interest: None
Since time immemorial, healing of wounds has been the central problem of surgical practices. If any wound does not heal in six weeks, it is considered chronic wound (~Dushta vrana) which presents with discharge, slough, pain, etc. Kalka (~paste) has been reported to be an effective form in the management of such Dushta vrana. It is used for Shodhana (~cleansing) as well as Ropana (~healing). A huge number of herbal interventions have been emphasized in classical literature for the management of chronic wound. In this case study, Panchavalkala kwatha and Ashwagandha patra kalka [~leaf paste of Withania somnifera (Linn.) Dunal] were used for the management of Dushta vrana. A 60-year-old male patient, having Vatapitta prakriti, presented with the complaints of a non-healing ulcer with severe pain at the right big toe associated with purulent discharge since about 45 days. On local examination, an ulcer was seen over the dorsum of the right big toe measuring about 2.5 cm × 2.0 cm × 1.0 cm in dimension with irregular margins. The floor was covered with slough and the edges were inflamed with surrounding indurations and raised local temperature. Tenderness was present. The surgeons advised for amputation, but the patient visited Shalya tantra outpatient department for possibility of management. The wound was managed with Ashwagandha patra kalka, where significant wound-healing activity was found.
Keywords: Ashwagandha, chronic wounds, Dushta vrana, Kalka, Panchavalkala
|How to cite this article:|
Sheoran S, Khanam B, Mahanta V, Gupta SK. Efficacy of Ashwagandha [Withania somnifera (Linn.) dunal] leaf paste in the management of chronic non-healing wound: A case report. J Ayurveda Case Rep 2020;3:95-8
|How to cite this URL:|
Sheoran S, Khanam B, Mahanta V, Gupta SK. Efficacy of Ashwagandha [Withania somnifera (Linn.) dunal] leaf paste in the management of chronic non-healing wound: A case report. J Ayurveda Case Rep [serial online] 2020 [cited 2021 Feb 28];3:95-8. Available from: http://www.ayucare.org/text.asp?2020/3/3/95/307220
| Introduction|| |
Wounds are probably one of the first medical problems faced by the society. Due to many causes, simple wounds in some persons may not heal properly. A wound which does not show healing in six weeks is called chronic wound. Dirghakala anubandhativam (~chronic in nature) term is used to denote chronic wounds (~Dushta vrana) in Ayurvedic classics. It is a type of Vrana with vitiated Tridoshas that is reluctant to heal due to the presence of Srava (~discharge), Putipuyamansa (~slough), Vedana (~pain), etc., The signs and symptoms of Dushta vrana mentioned in the classics are Ativivrita (~broad base); Bhairava (~ugly look); Gandha (~bad odour); and Putipuyamansa, Vedana, and Dirghakala anubandhi that are Krichchhrasadhya (~difficult to treat).
Acharya sushruta has mentioned Sapta upakarma to manage Dushta vrana and to achieve complete healing without further complications. These Upakarmas are purposefully described for debridement of necrotic tissue, maintenance of a favorable moist wound environment that can facilitate healing, and addressing to host tissues to retain nutritional, metabolic, and circulatory status. Kalka is one among Sasthi upakarma, and Ashwagandha is advocated to be used in Kalka form for the management of Dushta vrana.
In the present case study, Panchavalkala kwatha and Ashwagandha patra kalka were used in the management of Dushta vrana. Till date, no evidences have reported about the utility of Ashwagandha patra kalka for its wound-healing activity. Ashwagandha is an easily available, cost-effective drug, and used in folklore medicine in South Haryana (India), for managing wound.
| Case Report|| |
A 60-year-old male patient, residing at Aligarh, Uttar Pradesh, visited the outpatient department of Shalya tantra with the complaints of severe pain at the right big toe associated with purulent discharge. The patient was asymptomatic about 45 days back. He suddenly developed severe pain at the right big toe during night hours followed by swelling over the right big toe. The pain was intolerable, so he visited the nearest allopathic hospital, where he had diagnosed to be suffering from gangrene. Incision was made to drain the collection of pus and necrotic tissue at the planter surface of the big toe followed by regular dressing with povidone-iodine for nearly one month, but he did not get relief from pain and other symptoms. The patient also visited other allopathic hospitals at New Delhi, where amputation was advised. The patient expressed unwillingness for this and visited an Ayurvedic hospital.
The patient was fully conscious and had normal body built and normal gait. There was no history of diabetes mellitus, hypertension, thyroid, asthma, or any other major disorders. Pallor and cyanosis were also absent in general. A wound over the planter surface of the big toe measuring about 2.5 cm × 2 cm × 1 cm in dimension with purulent discharge and irregular margins and scaling of the surrounding skin was seen; on palpation, dorsalis pedis pulse was noticed, and the movement of the big toe and the whole foot was normal. The floor of the wound was covered with slough, the edges were punched out, and the margins were inflamed. Tenderness was present with surrounding indurations with raised local temperature but lymph nodes were not involved. Ultrasonography and color doppler imaging were suggestive of right dorsalis pedis artery with low-resistance flow pattern and loss of triphasic flow likely due to the infection/inflammation.
| Timeline|| |
After taking written informed consent from the patient, the treatment was initiated. Panchavalkala kwatha was prepared following the classical principles and the wound was cleaned with it. A fine paste was obtained by grinding 5–6 fresh leaves of Ashwagandha to make as Kalka. It was used as a local application for cleaning, and the application was continued for 28 days (May 12, 2018, to June 08, 2018). Tablet tramadol (100 mg) twice daily after food was continued from the earlier prescription for the initial three days (May 12, 2018, to May 14, 2018) (after three days, pain subsided to moderate intensity). Vatagajankusha rasa (250 mg) twice daily after food was advised for the initial seven days (May 12, 2018, to May 18, 2018) to manage Vata dosha vedana [Table 1]. The patient was advised to avoid water contact and further injury to the affected site. Consumption of Puyavardhaka aahara (~pus-forming diet), including buttermilk, milk, yogurt, barley, and beans, was restricted.
| Follow-up and outcome|| |
The wound was observed regularly. On the 1st day, the patient reported severe pain [Visual Analog Scale (VAS)-8)] and after seven days of management, the patient got relief from pain (VAS-6) and required no analgesic. All necrosed tissues were sloughed out, the wound became clean, and the floor of the wound was covered by a healthy granulation tissue indicating Shodhana and Ropana properties of Ashwagandha and Panchavalkala kwatha. At the end of the 3rd week, wound contraction was fully achieved and there was mild pain (VAS-2). On the 4th week, the wound completely healed and there was no pain (VAS-0) [Figure 1][Figure 2][Figure 3][Figure 4].
| Discussion|| |
Ashwagandha patra kalka has both Shodhana and Ropana properties. Ashwagandha has Madhura, Tikta, and Kashaya rasa. In this case, slough was removed on the 2nd day without any surgical debridement because of Kashaya rasa (~astringent taste) of Ashwagandha which was helpful in Lekhana (~scraping) action that helped in removing slough and prepared the wound bed for healing. Signs and symptoms such as pain, discharge, edema, and bad odor are due to the involvement of Tridosha. Ashwagandha has Shodhana (~cleansing agent), Shothahara (~anti-inflammatory), Vedanahara (~analgesic), and Ropana (~healing) properties along with antioxidant property. All these properties of the drug assisted in cleaning the wound and helped to inhibit the growth of microorganisms, which yielded the ability to take care of Dosha. The unsaturated lactose isolated from the leaves of Ashwagandha inhibits the bacterial growth of Staphylococcus aureus, Bacillus subtilis, and Staphylococcus pyogenes. Panchavalkala kwatha has the dominance of Kashaya (~astringent) rasa which is also useful in the management of Shotha (~inflammation) as well as Vrana.
Complete wound healing was observed by the 4th week. After wound healing, there was minimum scar formation. Madhura rasa of Ashwagandha is known for its Twachya and Vranya properties which are essential to maintain the normal color of the skin and may play role in minimum scaring. In the present study, no adverse effect was noticed during the treatment. Healing occurred uneventfully. During the follow-up period of 15 days, no medicine was prescribed and no symptoms were reported by the patient. No conventional medicines were required after the 1st follow-up of management.
| Conclusion|| |
This case study concludes that Ashwagandha patra kalka possesses significant wound-healing activity, possibly due to Lekhana, Shodhana, Ropana, and Savarnikaran properties, and has the potential to heal Dushta vrana. It infers that such wounds also can be managed with topical application alone. Taking leads from the observations, well-designed clinical trials involving larger sample size can be initiated.
Declaration of patient consent
The 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
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]