1. Welcome U All

2. JOURNAL PRESENTATION
PRESENTATION BY
Dr. S. KAMALAKAR
1ST YEAR PG
DEPARTMENT OF SAMHITA SIDDANTA

3. International Ayurvedic Medical Journal
AYURVEDIC PERSPECTIVE OF
DUSTAVRANA(NONHEALINGULCER)
Dr.Prem Chandra
Dr.Hemantha Kumar
Dr.P. Gopikrishna B. J.
Dr.Pathak Avnish
Dr.Pratibha K.
Dept. of Shalya Tantra,
SDM College of Ayurveda and Hospital,
Hassan, Karnataka

4. AIM OF THE ARTICLE
Management of Dusta Vrana

5. METHOD EMPLOYED BY AUTHOR
Vrana Shodhaka and Vrana Ropaka methods in the
management of Dushta Vrana.

6. AUTHOR LANGUAGESTYLE AND EXPRESSION
Very simple,
Easily understandable language
Gramatically correct,straight to point
Has systematically arranged the information under
proper headings

7.  Introduction
 Definition of dusta vrana
 Dusta vrana lakshanas
 Ayurveda management of dusta vrana
 Author’s conclusion
 Further understanding of dusta vrana
 My conclusion
CONTENTS

8.  A common and oftenly encountered problem in day to day
practice by a medical practitioner is Dushta Vrana.
 Wound healing is the major problem in today practice.
For these, the most fearful is infection. Due to infection,
Vrana becomes complicated.
 The presence of Dushta Vrana worsens the condition of the
patient with different complications and may become fatal.
INTRODUCTION

9.  As the scar of wound never disappears even after complete
healing and its imprint persisting life long, it is called as
Vrana. As it causes destruction of the tissue or damage of
body part, so it is termed as Vrana.
 Vrana which has foul smell, continuously flowing putrefied
pus along with blood, with cavity, since long time
andVrana lakshanas are high in intensity.
DEFINITION

10.  Foul smelling , purulent discharge ,Black coloured oozing
 Ulcer edges are elevated or deep
 Elevated surface floor
 Healing is delayed abnormally
 The ulcer is apparently closed but pus will be getting accumilated
day to day .so probing through the mouth of the ulcer, emits pus and
discharge
 Hardness of the surrounding skin
 Highly soft with a sponge consistency indicating gangrene and
sloughing of the tissue
 Too hot or too cold(heat indicates combustion of tissue and coldness
indicates gangrene formation)
 Maggots formation
LAKSHANAS

11. Ayurvedic management
 Shasti Vranopakarma’s
 Urdhwa Shodhana by Vamana, Shirovirechana,
 Adho Shodhana by Virechana, Basti followed by
Langhana, Katu-Tiktaka, kashaya Ahara then
Raktamokshna.

12. Dustavranatreatment broadly classified into twoheadings
Medical management:
Apatarpana, Aalepa, Parisheka, Abhyanga, Sweda,
Vimlapana, Upanaha, Pachana, Sneha, Vamana, Virecana
etc.
Surgical management:
Astavidha sastra karmas and Kshaarakarma, Agnikarma,

13. vranaShodhana
Abhyantara Shodhana
Bahirgata Shodhana

14.  Vamana: Vrana which are situated above Nabhi Pradesha with
Kapha Pradhana Lakshana are better treated with the Vamana
Karma.
 Virechana: The Vrana which are affected by Pitta Dosha and
situated middle portion of the body and non-healing wound with
long duration, in such cases Virechana plays a better role in
healing.
 Basti: Vrana which is having Vata Pradhana Dosha, and
Marga avarana janya Vrana and Vrana situated in lower
extremities are better treated with Basti Chikitsa.
 Shirovirechana: Vrana which are situated in Urdvajatrugata
area and Kapha pradhana conditions, this procedure is beneficial.

15.  Raktamokshana:The Vrana which is predominant of
Pitta and Rakta and in Margavarana conditions.
 Vrana Prakshalana :Aragwadhadi kashaya,
Sursadigana kashaya, Lakshadigana kashaya,
Panchavalkala kashaya
 Vrana Pichu :Jatyaditaila/ghrita, Kshara taila ,
Nimbadi taila, Sursadi taila, Doorvadi ghrita,
Hingulamrutadi malahara
 Vrana Lepa :Tilakalkadi
 Vrana basti : jatyadi taila

16.  Ropana means a factor, which promotes or quickens the healing
process. At present the modern system of medicine could not find
such karma which promotes the process of healing except
anti-infective and debriding agents.
 Ropana process in the form of Kalka, Kashaya,Varthi,
Ghrita, Taila, Choorna etc.
Eg: Jatyadi ghrita, Ropana ghrita, Ambasthadi ghrita.
vranaRopana

17. This is the case of Dustavrana in left leg and it was treated by
the prakshalana with Panchavalkala kashaya and of
Hingulamrutadi Malahara.
CASE
BT DT AT

18.  The Vrana should be protected from Dosha Dusthi and from various micro-organisms,
which may afflict the Vrana and delay the normal healing process.
 For the early and uncomplicated healing of Vrana, treatment is necessary.
 Number of patients were having Dushta Vranas on lower extremities than any other parts
of the body so adequate care is needed to lower limbs for any type of Vrana before it’s
converted into Dustavrana .
 Before starting the treatment we must to assess which type of Vrana, level of Dusthi,
predominance of Dosha, involvement of Dhatu, site and size of the Vrana,
Sadhyaasadhyata of Vrana. When wound will be completely free from discharge, slough,
foul smell, burning sensation, itching, then healing can be achieved very well.
CONCLUSION

20. Vrana is defined as the condition where in tissue undergo
destruction
Vrana causes not only tissue destruction but also causes
discolouration of the affected region
Vrana is a condition, which even after complete healing ,
leaves a scar over the area,which stays as long as the person
is alive
Definition

21. DIFFERENCE B/W WOUND&ULCER
Wound
Breach in the continuity of skin or mucous membrane
Ulcer
Persistent breach in the continuity of skin or mucous
membrane associated with cell death

22.  Vrana has 6 roots of vitiation:
Vata, Pitta, Kapha, Rakta, Sannipataja and Agantuja
 8 sites for localisation of dosa:
Skin,Muscles,Vessels,Ligaments,Joints,Bones,
Abdomen and Vital organs
 5 features of identification:
Shape,Pain,Color,Odour,Discharge
 Can be managed by 60 Measures
 Can be succesfully treated if the 4 necessities of the
theraupeutics
Points to remember

23. EXAMINATIONOF AN ULCER

24. Vrana pariksha
 Shape of the ulcer (aakrithi)
 Odour (gandha)
 Colour (varna)
 Discharge (srava)
 Pain (vedhana)

25. SURROUNDING
AREA
FLOOR
DISCHARGE
EDGE
SHAPE
SIZE
SITE
NUMBER
ASSOCIATED
DISEASES
DISCHARGE
PAIN
DURATION
ONSET
PRASNASPARSANADARSANA
TENDERNESS
BASE
DEPTH
SKIN
Methods of examination

26. History :
1.Mode of onset:
 A.Secondary to trauma - AAGANTUJA
 B.On its own(spontaneously)-NIJA
 Traumatic Ulcers heal on their own ,when the trauma
causing agent is removed. But if trauma continues, the ulcer
becomes chronic.
 Ulcer which occur spontaneously, generally occur secondary
to a swelling, which may be a infected lymphnode, tubercular
lymphnode, malignant growths.
 Varicose ulcer secondary to a Varicosed limb

27. 2.Duration:
 Acute,
 Chronic
3.Pain:
Ulcer with associated pain indicate inflamation
Ulcer with no pain occur when there is associated nerve diseases.
EX.Trophic ulcers
Ulcer with mild pain. EX.Tuberculosis ulcer
4.Discharge : Nature and quantity of discharge
5.Associated Disease: Diabetis, Tuberculosis etc

28. `
Inspection:
1.Number : Whether ulcer is single or multiple
2.Site : This provide a clue for the provisional diagnosis
 Ulcer on the medial malleolus: Varicose ulcer
 Ulcer on the upper part of the face: Rodent
 Ulcers in the neck axilla inguinal region: Tuberculous
 Ulcers on the heel: Trophic ulcers
3.Size : Exact size has to be recorded ,to foretell the time required for
healing. Bigger ulcers will obviously heal over longer periods of time

29. 4.Shape :
Tuberculous ulcers: Generally oval
Syphilitic ulcers: Circular
Varicose ulcers: Vertically oval
Malignant ulcers: Irregular
5.Floor :
 Floor denotes exposed surface of the ulcer.
 Floor covered by red granulation tissue –indicates healing;
 Pale granulation tissue- indicates slow healing

30. 6.Edge : Mode of union between the floor and margin of the ulcer
7.Discharge :The quantity and odour of discharge is to be noted
 Inflammed ulcer :Has purulent discharge
 Healing ulcer : Scanty serous discharge
 Tuberculous ulcer: Sero-sanguinious discharge
8.Surrounding area: Has to be checked for signs of inflamation
viz.redness,odema,glossiness.
The sorrounding area is hyper pigmented and eczematous in varicose ulcer
HEALING ULCERS
TROPHIC ULCERS
TB ULCERS
RODENT ULCERS
MALIG ULCERS

31. 2.Palpation:
1.Tenderness :
 An acutely inflammed ulcer will be very tender.
 Chronic ulcers are slightly tender.
 Neoplastic ulcers are never tender
2.Base :
 Base is the area on which ulcer rests.
 indurated base is a characteristic feature of chronic ulcers.
 very significant induration is a feature of squamous carcinoma

32. 3.Depth :
 Depth of the ulcer is recorded to asses the amount of tissue
involved/necrosed and to understand the prognosis of the disease.
 Neurogenic ulcers are very deep and may even reach the bone
4.Surrounding skin :
 Incresed temperature and tenderness around indicates accute
inflammation
 Fixity to deeper structures ….Malignant lesions
 Loss of sensation or motor functions… Nerve lesions…Trophic ulcers
 Pulsations of surrounding arteries..Absent/decreased pulsation
….Ischaemic ulcers
 Associated varicosity…Varicose ulcers

33. Special investigationS
 Blood –TC,DC,Hb,ESR,FBS-PLBS
 Urine – CUE,ALB
 Swab from the wound for culture and sensitivity
 Mx test
 Chest xray
 X ray of bone and joints
 Biopsy from the edge of the ulcer

34. Clean {Suddha vrana}
Healing {Ruhyamana vrana}
Healed {Ruda vrana}
Infected {Dusta vrana}

35. Suddha vrana:
 Edges should be greyish
 Granulation tissue in the ulcer should be of the same level as the
surrounding.
 Not associated with pain and any discharge
 Ulcer floor should be red like a clean tongue
 Is soft
 Smooth
 Regular
 Such a ulcer is considered clean or healthy and has a good
chance to heal

36. RUHYAMANA VRANA :
 Edges are Dark
 Ulcer area is free of moisture
 The tissues in the site and around are stable area is covered by
small out growth (granulation tissue)
 In a healing ulcer the edge if traced from the red granulation in
the centre towards periphary, will show a blue zone (due to thin
growing epithelium) and a white zone due to fibrosis of the scar
 Floor covered by red granulation tissue indicates that the ulcer is
healthy and healing

37. RUDA VRANA:
 No swelling
 No hard ness
 No scar tissue
 No pain
 Color of the site should be like that of the surrounding
skin

38. Dusta vrana:
Ulcers in people who don’t have control over senses
When a person with Vrana follows unwholesome diet and
regimen,
If Vrana in a person who follows proper diet etc but is
wrongly treated by a quack,
Then the vrana becomes severly vitiated and is called a Dusta
vrana. Such vrana are very difficult or impossible to treat.

39. FACTORS WHICH PRODUCE DEFECTIVE OR
DELAYEDHEALING

40. Increased untous applications,
Increased moistness Improper bandinging
When hairs are present between the
healing tissue
Increased use of strong or pungent
applications
Greater depth of ulcer Condition of indigestion in the patient
Infected by maggots Excessive diet
Fracture of underlying bones Virudhha bhojana, Asatmya ahara
Presence of poision, foreign body Excessive sorrow, Excessive exercise
Fast spreading, Excessive cohabitation Excess anger, Day sleep
When vrana breaks open due to contact
with nail
When opposite edges or surfaces of
wound constantly rub with each other
Increased fluid in bloodvessels

41. Reasons for a healed wound to break:
Aggravate dosha
Exercise
Trauma
Excessive laughter
Excessive anger
Fear

42. Clinical
1. Spreading
2. Healing
3. Chronic
Pathological
1. Specific -
2. Malignant
3. Non-Specific -
Tuberculosis
Syphilis
Arterial
Venous
Trophic
Infective
Tropical
Diabetic

43. s.n
o
Spreading ulcer Chronic ulcer Healing ulcer
1 No granulation tissue Pale granulation Red granulation
2 Plenty of discharge Serous discharge Minimal serous
discharge
3 Excessive and offensive
slough
Slough present Slough is absent
4 Surrounding area is
inflammed and odematous
Induration at the base
,edge and surrounding
area
Minimal signs of
inflammation
5 Purulent smell present Purulent smell can be
present
Purulent smell absent

44. WHAT ARE THE COMMONTYPE OF
PATHALOGICAL NON HEALING ULCERS
(DUSTA VRANAS)IN PRESENT
PRACTICE????

45. Varicose ulcers
 Occurs due to increased venous hydrostatic pressure.
 Generally manifests on medial side of lower 1/3rd of the leg {long saphanous
vericosity} & also ocassioanally lateral aspect of lower leg region {short
saphanous vericosity}.
 It is generally shallow & superficial edge is sloping.
 Never penetrates deep fascia , floor is covered by pale granulation.
 Occurs secondary to many years of venous disease.
 Discomfort, pigmentation, odema & tenderness of skin exists for months prior
to ulceration.

46. Arterial ulcer
• They are painful
• occur commonly in tips of finger & toes.
• Ulcer is dry , punched out & penetrates deep fascia.
• Diagnosis is based on presence of signs of ischaemia in the region around the
ulcer.
• Ulceration is secondary to peripheral arterial disease & poor peripheral
circulation.

47. Neurogenic ulcer
 Repeated trauma over an anesthetic limb results in such ulcers the causes of
nueropathy are
Diabetic neuropathy, Leprosy, Alcholic nueropathy, Nerve injuries.
 Ulcers manifest over various pressure points, heal, gluteal region
Eg;Bed sore.
 It penatrates deeper tissue , edges are punched out
 May involve the underline bone causing osteomilitis.

48. Bed sores
A chronic ulcer of the skin caused by prolonged pressure on it (as in bedridden patients)
They appear and sometimes spread rapidly within short notice in bed ridden patients

49. Diabetic gangrin
 Necrotic tissue;
 A mortified or gangrenous part or mass .
 The localized death of living cells (as from infection or the interruption of
blood supply)
It caused mainly due to
 Trophic changes secondary to peripheral neuritis.
 Ischaemia due to atheromo of arteries
 Reduced resistence due to sugar laden tissues
 Neuritis impairs sensation to a site, which makes the person neglect minor
injuries ,thus the damage occuring to the tissues.

50. Tropical ulcers
 Aggrevating factors are poor status of nutrition, humid climate,
ill health & poor immunity.
 Starts a pustule with extensive inflammation.
 The pustule bursts resulting in formation of ulcer.
 This ulcer spreads rapidly causing destruction of surrounding tissue.

51. Cellulitis
 An inflammation of body tissue (especially that below the skin)
characterized by fever and swelling and redness and pain
 It is a non-suppurative inflammation spreading along the sub cutaneous
tissue & connective tissue planes,& across intracellular spaces.
 Varying degree of pyrexia & toxaemia
 The site is swollen & tender
 Diabetic patients have greater tendency of getting it.
 Regional lymph nodes are enlarged & tender.
 There is a wide spread sweling & redness at the site.

52. Syphilitic
 Treponema Pallidum
 papule appears on the skin that devolop into a Hard Chancre(A
small hard painless nodule at the site of entry of a pathogen- Ext
Genitals
 Painless, indurated (hard)base(button Like)
 Nipple, lip, tongue, anal canal
 Secondary- Mucus patches
 Tertiary – Gummatous (A small rubbery granuloma)

53. MANAGEMENT OF DUSTA VRANA
1.SODHANA 2.ROPANA
 Sodhana means cleaning.This is done with instruments ,with douches
by application of sodhana dravyas
 Sodhana is indicated in durgandha,klinna,pichila vranas . this is done
after vrana is opened
 The ulcers which are deep seated, foul smelling and covered with thick
slough should be managed by sodhana dravyas
 Sodhana converts a dusta vrana into suddha vrana
 Healing will never take place when a vrana is in a stage of dustavrana
.By sodhana sloughs, pus etc will be completely washed away and the
floor of this ulcer appears just like a surface of tongue with bright,clean
and red margins.

54. Ropana
 Which promote healing process.
 Once procedures of sodhana are over and the ulcer has become
clean, then one should adopt ropana measures to ensures its healing
for this purpose
i. Decoction of various drugs like vata etc… which promote healing,
can be used for irrigation
ii. Wicks prepared of ropana drugs can be placed in deep ulcers
iii. A paste of tila and madhu can be applied
iv. A paste of tila and ropana drugs
v. A paste of tila madhu and gritha can also be applied
Barley can also be mixed with above pastes

55.  In ulcers caused by vitiated Pitta Rakta Visha and foreign objects and other extrinsic
causes- healing is promoted using gritha prepared with ksheera and Ropana drugs
 In ulcers, predominately vitiated by kapha and vata- healing is promoted using
taila prepared with Ropana drugs
 In ulcers, which are situated over joints or area where bandaging cannot be done-
Ropana drugs along with both the varieties of haridra is made in to Rasa kriya and
applied
 For vataja vrana – Drugs of laghu and brihath pancha mula are used
 In pithaja vrana – Nyagrodhadhi and kakolyadhi ghana drugs are used
 In kaphaja vrana- Aragvadhadhi ghana drugs used
 For promote healing lepa of sharapunkha with madhu

56. Important healing drugs
 Ashwagandha,
 Rohini,
 Lodhra ,
 Khatphala.,
 Madhu yashti,
 Samanga ,
 Dhathaki pushpa,
 Arjuna ,
 Udumbara,
 Jambhu,
 Ashwatha

57. Dr Pankaj.B.Patil
PG Scholar
Dept of Shalya Tantra

58. Name:Govinda Patel
Sex/Age: M/67yrs
Occupation: Buisnessman
Date: 08/04/2011
OPD/IPD No: 211031/55042
Residence: Banglore
Details of the Patient:
Patient presented with the complaints of non healing ulcer 5cm above left medial malleolus
since 1 yr. He has a history of Varicosity.
On the day of examination: There was a nonhealing ulcer, foul smelling discharge ulcer with
irregular margin with irregular shape above the left malleolus.
Treatment: Patient was admitted and treated with Vrana Basti by using Jatyadi Taila twice
daily for 7 days .After 7 days patient was adviced Go-Ghrita for Dressing.

60. trole

62.  Even though healing is a natural process, it is inhibited by various factors.
Derranged Doshas cannot be treated with a single drug all the times.
 Therefore number of drugs of different properties is described as Vrana
Shodhaka and Vrana Ropaka in the management of Dushta Vrana.
 At the end of Sodhana Chikitsa, Vrana becomes Shuddha Vrana and
Ropana Cikitsa has to be followed further.
 Various causes of Non Healing Ulcer needs to be evaluated like Arterial
Ulcer, Venous Ulcer, Neurogenic Ulcer, Tropic Ulcer etc and treatment
is to be done accordingly.
CONCLUSION

63. THANK
BISHAK DRAVYA
ROGIUPASTATHA