CASE REPORT
Year : 2019 | Volume
: 2 | Issue : 1 | Page : 28--31
Applicability of Thumari (Securinega leucopyrus [Willd.] Muell.) Gel and Oral Adjuvant Drugs in the Management of Infected Diabetic Wound
Naresh K Ghodela1, Tukaram S Dudhamal1, Sanjay K Gupta2, Vyasadeva Mahanta2,
1 Department of Shalya Tantra, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 All India Institute of Ayurveda, New Delhi, India
Correspondence Address:
Naresh K Ghodela
Department of Shalya Tantra, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat
India
Abstract
Generally, infected wounds are associated with presence of slough, pus, swelling, increased local temperature, foul smell, and fever. Wound-care is difficult to manage when it becomes systematic. In Ayurveda, wound-care is based on involvement of Dosha and Dushya, which can further be managed with topical applications and oral administration of suitable medicines. A 45 years old, diabetic male patient presented with an infected wound on lateral aspect of left forearm, associated with pain, pus discharge, slough, and raised local temperature since two weeks. He is advised for skin grafting by surgeon, but was unable to follow grafting considering financial constraints. Thus, the patient approached OPD, Shalya Tantra for possibilities of better management. This case was managed on Ayurveda wound-care principles along with topical application of Thumari (Securinega leucopyrus) gel and oral Ayurveda medications. Wound healed completely within two months of regular wound-care along with internal Ayurveda medicines. This case report revealed usefulness of Thumari gel and Ayurveda medicines in the management of infected diabetic wound.
How to cite this article:
Ghodela NK, Dudhamal TS, Gupta SK, Mahanta V. Applicability of Thumari (Securinega leucopyrus [Willd.] Muell.) Gel and Oral Adjuvant Drugs in the Management of Infected Diabetic Wound.J Ayurveda Case Rep 2019;2:28-31
|
How to cite this URL:
Ghodela NK, Dudhamal TS, Gupta SK, Mahanta V. Applicability of Thumari (Securinega leucopyrus [Willd.] Muell.) Gel and Oral Adjuvant Drugs in the Management of Infected Diabetic Wound. J Ayurveda Case Rep [serial online] 2019 [cited 2023 May 30 ];2:28-31
Available from: http://www.ayucare.org/text.asp?2019/2/1/28/351381 |
Full Text
Introduction
Healing of Vrana (~wound) is a natural phenomenon but it should be protected from various micro-organism which may vitiate the Dosha. This may affect the normal healing process of Vrana. Surgical interventions are usually followed in infected wound management that helps in eliminating debris and purulent material. Acharya Sushruta described vitiation of Dosha in Dushta vrana (~ infected wound) with specific symptoms like Daha (~burning sensation), Paka (~inflammation), Vedana (~pain), Srava (~discharge), Kandu (~itching), Puti puya srava (~foul smelling pus discharge), Atyartha gandhi (~intense foul smell).[1] Most of these symptoms appear in Dushta vrana. Among these symptoms, secretions that are Peeta (~yellowish), Neela (~bluish), Ghana (~thick), Rakta (~sanguinous), Pooya (~purulent) and resembling Dadhi mastu (~curd water) infers involvement of Tridosha in Dushta vrana.[2] Judicious administration of formulations that help in Vrana shodhana (~cleansing of wounds) and Vrana ropana (~wound healing) is necessary in the treatment.
Thumari (Securinega leucopyrus [Wild.] Muell) is an extra- pharmacopoeial drug, traditionally used in Sri Lanka for healing of diabetic wounds. Its efficacy in diabetic and non-healing wounds is reported.[3],[4] Pharmacologically it possess anti-inflammatory, antioxidant[5], anti-bacterial[6] and immune-modulatory properties[5]. Considering this, the drug is being used to manage wounds.
Case Report
A 45 years old male, diabetic patient approached for the treatment of wound on lateral aspect of left forearm. The patient had an injury some time back that was not managed systematically. A week back, an abscess was developed in the vicinity of the wound that was drained by a surgeon, who further suggested skin grafting after controlling infection. Considering financial constraints, patient didn’t follow the advice and discontinued the suggested treatment protocol. Wound dressing was being continued, but wound was not healed. Thus, a week later, he approached OPD, Shalya Tantra for possibility of better management.
On local examination a wound, exposing extensor fascia, measured about 15 cm x 6 cm in size associated with necrotized tissue, swelling, slough, and purulent discharge was observed. [Figure 1] On palpation, raised local temperature with tenderness observed.{Figure 1}
The case was managed at OPD by implementing principles of wound management as explained in Ayurveda. Freshly prepared decoction of Triphala (Fruits of Emblica officinalis, Terminalia chebula, and Terminalia belerica) was used to clean the wound, followed by dressing with application of Thumari gel over the wound. Improvement in symptoms was noted on weekly intervals. Triphala guggulu (1 gm thrice a day) and Manjisthadi kashaya (50 ml once daily) were given after meal for six weeks. During the course of treatment, the patient was using Glipizide (5 mg) and Metformin (500 mg) for the management of diabetes and was under the consultation of general physician.
Preparation of Thumari gel: Primarily Thumari oil was prepared by following classical guidelines of Sneha paka kalpana (~oil preparation methods) using sesame oil, paste of Thumari leaves and Thumari decoction. 15% w/w, Aerosil was added to this medicated oil and triturated until the formation of a uniform gel and packed in airtight containers.{Table 1}{Table 2}
Observations: On 3rd day, surgical debridement of necrotized tissue was done. During initial days, patient was advised to elevate his limb using arm sling. Discharge, tenderness and swelling were reduced and healthy granulation tissue were noticed in the affected area within a week of management. Initial wound contraction was progressed over incised area (made for abscess drainage by the surgeon). Regular aseptic dressings and oral medications (Triphala guggulu and Manjisthadi kashaya) along with oral hypoglycemic drugs and diet regimen prescribed by general physician were followed to control sugar levels. Wound approximated within two months with normal skin pigmentation. [Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6],[Figure 7],[Figure 8]{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}{Figure 7}{Figure 8}
Discussion
In diabetic patient, wound healing process delays because of several factors including poor glycemic control, presence of slough, necrotized tissue, poor circulation etc. that hampers healing of tissues.[7] In this case report, healing sequels of infected diabetic wound were observed satisfactorily. Triphala kashaya is useful in Vrana shodhana because of its Kapha pitta shamana properties. Cleaning of wound with Triphala kashaya resulted in reduction of discharge and inflammation. Triphala also possess antimicrobial, anti-inflammatory and antioxidant properties.[8],[9] Manjisthadi kashaya has Pitta shamana, Rakta shodhana properties that helps in normal pigmentation of skin.[10] It also proved to possess antioxidant activity.[11] Triphla guggulu reduces Kleda, Paaka, Putigandha, Shotha and Ruja in wound.[12] Intervention with all these drugs along with topical application of Thumari gel resulted in reducing inflammation and wound healing significantly.
Conclusion
Application of Thumari gel is safe and efficacious in management of infected diabetic wound. The gel found to be convenient to apply over such infected wounds. No irritation was reported and patient was comfortable with its application. Clinical trials involving larger sample size are needed to evaluate actual efficacy of the trial drug for the management of diabetic wound.
References
| 1 | Shastri AD, editor. Sushruta samhita of sushruta, sutra sthana; vranasrava vigyaniya; chapter 22, verse 7. Varanasi: Chaukhamba Sanskrit Sansthana; 2007. p. 95. |
| 2 | Gupta AD, editor, Ashtanga hridaya of vagbhata, uttara sthana; vranavigyan pratisedha; chapter 25, verse 6-10. Varanasi: Chaukhambha Sanskrit series office; 1970. p. 540. |
| 3 | Ajmeer AS, Dudhamal TS, Gupta SK, Mahanta VD. Katupila (Securinega leucopyrus) as a potential option for diabetic wound management. J Ayurveda Integr Med 2014;5(1):60-3. |
| 4 | Ghodela NK, Dudhamal TS. Clinical efficacy of thumari gel (Securinega leucopyrus [Willd.] Muell) in the management of superficial non-healing leg ulcers- A rare case report. Int J AYUSH CaRe 2017;1(1):1-5. |
| 5 | Gopal TK. Investigation of in-vitro anti-oxidant, anti-inflammatory and anti-arthritic activity of aerial parts of Securinega leucopyrus (Willd.) Muell. Indian Journal of Research in Pharmacy and Biotechnology 2013;1(3);371-8. |
| 6 | Ajmeer AS, Dudhamal TS, Gupta SK. A clinical study on madhumehajanya vrana (diabetic ulcer) and its management with katupila / humari (Securinega leucopyrus) [Willd.] Muell. Dept of Shalya Tantra, IPGT & RA, Gujarat Ayurved University, Jamnagar, 2014:121-50. |
| 7 | Spanos K, Saleptsis V, Athanasoulas A, Karathanos C, Bargiota A, Chan P, et al. Factors associated with ulcer healing and quality of life in patients with diabetic foot ulcer. Angiology 2017;68(3):242-50. |
| 8 | Kamali SH, Khalaj AR, Shirin HR, Esfehani MM, Kamalinejad M, Larijani B. A systematic review of the antioxidant, anti-diabetic, and anti-obesity effects and safety of triphala herbal formulation. J Med Plants Res 2013;7(14):831-44. |
| 9 | Guerrini A, Mancini I, Maietti S, Rossi D, Poli F, Sacchetti G, et al. Expression of pro-inflammatory interleukin-8 reduced by Ayurvedic decoctions. Phytother Res 2014;28(8):1173-81. |
| 10 | Srivastava S. Sharngadhara samhita, madhyam khanda 2, jivanprada hindi commentary, Varanasi: Chaukhambha orientalia; 2011. p. 137-42. |
| 11 | Sruthi CV, Sindhu A. A comparison of the antioxidant property of five Ayurvedic formulations commonly used in the management of Vata Vyadhis. J Ayurveda Integr Med 2012;3(1):29-32. |
| 12 | Shastri BB, editor. Yogaratnakara vidyotini hindi tika samhita (uttaradha), 7th edition, verse 15. New Delhi: Chaukhamba Publications, Daryaganj; 1999. p. 177. |
|
