Changes

|keywords=Vrana (ulcer), trividha pariksha, bloodletting, dahakarma (cauterization), shodhanakarma (cleansing of ulcer), ropankarma (healing of ulcer), wound management, non healing ulcers,Ayurveda, Indian system of medicine, charak samhita.  

|keywords=Vrana (ulcer), trividha pariksha, bloodletting, dahakarma (cauterization), shodhanakarma (cleansing of ulcer), ropankarma (healing of ulcer), wound management, non healing ulcers,Ayurveda, Indian system of medicine, charak samhita.  

|description=Chikitsa Sthana Chapter 25. Management of two types of Vrana (ulcers)

|description=Chikitsa Sthana Chapter 25. Management of two types of Vrana (ulcers)

|image=http://www.carakasamhitaonline.com/mediawiki-1.32.1/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image_alt=charak samhita

|image_alt=charak samhita

|type=article

|type=article

|label7 = Reviewer  

|label7 = Reviewer  

|data7  = Dudhamal T.S.

|data7  = Dudhamal T.S.

|label8 = Editor

|label8 = Editors

|data8  = Dudhamal T.S.

|data8  = Dudhamal T.S.,Deole Y.S., Basisht G.

|label9 = Date of publication  

|label9 = Year of publication  

|data9 = December 17, 2018

|data9 = 2020

|label10 = DOI

|label10 = Publisher

|data10 =  

|data10 = [[Charak Samhita Research, Training and Skill Development Centre]]

|header3 =  

|label11 = DOI

 

}}

}}

<big>''' Abstract </big>'''

<big>''' Abstract </big>'''

<div style="text-align:justify;">

<div style="text-align:justify;">

''Vrana'' (ulcers) are of two types, ''nija vrana'' (endogenous ulcers) and ''agantuka vrana'' (exogenous ulcers). This classification is based on etiology and mode of treatments. Endogenous ulcers are caused by vitiation of ''vata etc. dosha'' from initial stage while exogenous ulcers are caused initially by various types of trauma and later ''dosha'' vitiation occurs. Complications of ulcers like ''visarpa'' (erysipelas), ''sirastambha'' (constricted vessels), ''jwara'' (fever) etc. have been described. Importance of bloodletting is described during the stage of ''vrana shopha'' (i.e.inflammatory phase), alleviation of impure blood from body reduces toxic chemicals and pacifies dosha. Description of fracture, its complications and management is elaborated. ''Dahakarma'' (cauterization) causes constriction of blood vessels to prevent bleeding from ulcer. Application of alkaline substances (''kshara'') on ulcer can be done along with surgical intervention and cauterization. Prognosis of ulcer can be described on the basis of type of ulcer and its various locations.  

''Vrana'' (ulcers) are of two types, ''nija vrana'' (endogenous ulcers) and ''agantuka vrana'' (exogenous ulcers). This classification is based on etiology and mode of treatments. Endogenous ulcers are caused by vitiation of [[vata]] etc. [[dosha]] from initial stage while exogenous ulcers are caused initially by various types of trauma and later [[dosha]] vitiation occurs. Complications of ulcers like ''visarpa'' (erysipelas), ''sirastambha'' (constricted vessels), ''jwara'' (fever) etc. have been described. Importance of bloodletting is described during the stage of ''vrana shopha'' (i.e.inflammatory phase), alleviation of impure blood from body reduces toxic chemicals and pacifies dosha. Description of fracture, its complications and management is elaborated. ''Dahakarma'' (cauterization) causes constriction of blood vessels to prevent bleeding from ulcer. Application of alkaline substances (''kshara'') on ulcer can be done along with surgical intervention and cauterization. Prognosis of ulcer can be described on the basis of type of ulcer and its various locations.  

'''Keywords''': ''Vrana'' (ulcer), ''trividha pariksha,'' bloodletting, ''dahakarma'' (cauterization), ''shodhanakarma'' (cleansing of ulcer), ''ropankarma'' (healing of ulcer), wound management, non healing ulcers.

'''Keywords''': ''Vrana'' (ulcer), ''trividha pariksha,'' bloodletting, ''dahakarma'' (cauterization), ''shodhanakarma'' (cleansing of ulcer), ''ropankarma'' (healing of ulcer), wound management, non healing ulcers.

== Introduction ==

== Introduction ==

<div style="text-align:justify;">

<div style="text-align:justify;">

The term ''vrana'' literally means destruction or rupture or discontinuation of body tissues. This chapter gives comprehensive information about endogenous and exogenous ulcers. ''Trividha pariksha'' or three different ways of examination of ulcer is done by ''darshana'' (inspection), ''prashna'' (interrogation) and ''sparshana'' (palpation). Inspection i.e. visual examination deals with general examination (whole body) and local examination (specific part or organ) to make proper diagnosis. The etiological factors, nature of pain, ability to get used to food (''satmya/asatmya''), drugs, status of digestive power etc are examined by interrogation. Palpation is the mode of direct examination  done by palpating the margin, size, depth, temperature, stiffness or hardness etc. Prognosis of ulcer is determined by its location eg. skin (''tvaka''), blood vessels (''shira''), muscle tissue (''mamsa''), fatty tissue (''meda''), bone (''asthi''), ligament (''snayu''), vital organs (''marma'')<ref>Sushruta. Chikitsa Sthana, Cha.1 Dwivraneeya Chikitsitam Adhyaya verse 134. In: Kaviraja Ambikadutta Shastri Editors. Sushruta Samhita. reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013.  pp 16.</ref>,visceras of chest and abdomen (''antarashraya'')<ref>Sushruta. Chikitsa Sthana, Cha.2 Sadyovrana Chikitsitam Adhyaya verse 12. In: Kaviraja Ambikadutta Shastri Editors. Sushruta Samhita. reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013.  pp 16.</ref> [ Cha. Sa. [[Sharira Sthana]] 7/10 ]  

The term ''vrana'' literally means destruction or rupture or discontinuation of body tissues. This chapter gives comprehensive information about endogenous and exogenous ulcers. ''Trividha pariksha'' or three different ways of examination of ulcer is done by ''darshana'' (inspection), ''prashna'' (interrogation) and ''sparshana'' (palpation). Inspection i.e. visual examination deals with general examination (whole body) and local examination (specific part or organ) to make proper diagnosis. The etiological factors, nature of pain, ability to get used to food (''satmya/asatmya''), drugs, status of digestive power etc are examined by interrogation. Palpation is the mode of direct examination  done by palpating the margin, size, depth, temperature, stiffness or hardness etc. Prognosis of ulcer is determined by its location eg. skin (''tvaka''), blood vessels (''shira''), muscle tissue ([[mamsa dhatu]]), fatty tissue ([[meda dhatu]]), bone ([[asthi dhatu]]), ligament (''snayu''), vital organs (''marma'')<ref>Sushruta. Chikitsa Sthana, Cha.1 Dwivraneeya Chikitsitam Adhyaya verse 134. In: Kaviraja Ambikadutta Shastri Editors. Sushruta Samhita. reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013.  pp 16.</ref>,visceras of chest and abdomen (''antarashraya'')<ref>Sushruta. Chikitsa Sthana, Cha.2 Sadyovrana Chikitsitam Adhyaya verse 12. In: Kaviraja Ambikadutta Shastri Editors. Sushruta Samhita. reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013.  pp 16.</ref> [ Cha. Sa. [[Sharira Sthana]] 7/10 ]  

Various complications of ulcers like ''visarpa'' (erysipelas), ''pakshaghata'' (hemiplegia), ''shirastambha'' (constricted vessels), ''jwara'' (fever) etc. are described. Sloughing of ligaments and vessels, deep seated appearance of maggots, fracture of bone near the ulcer, presence of foreign body in the ulcer etc hamper the healing process. Treatment of ''nija vrana'' (endogenous ulcer)<ref>Vagbhata. Uttara Sthana, Cha.26 Sadyovranapratishedha Adhyaya verse 13. In: Kaviraj Atrideva Gupta, Editors. Ashtanga Hridayam. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2005.pp 26</ref> is different from ''agantuja vrana'' (exogenous ulcer) because endogenous ulcers are caused by vitiation of ''vatadi doshaja'', and exogenous ulcers are initially caused by various type of trauma such as ''vadha'' (stab injury etc.), ''bandha'' (excessive tying), ''prapatana'' (injury due to fall), injury due to teeth and nail etc. But later on in exogenous ulcers also involvement of ''dosha'' takes place and then treatment should be adopted as ''nija vrana'' (endogenous ulcer). In endogenous ulcers, ''shodhana'' therapy should be adopted by ''vamana'' (emesis), ''virechana'' (purgation) and ''basti'' (medicated enema) and blood letting for removal of ''doshaja'' (toxic materials) from body. [ Cha. Sa. [[Sutra Sthana]] 16/17 ] and ''agnikarma''. ''Agnikarma'' has ''ushna guna'' (hot property) which is opposite to ''vata'' and ''kapha''. Due to heat, vasodilation leads to alleviation of ''srotorodha'' resulting in proper vascularity to organ or part. In exogenous ulcers, local treatment with use of ''kshara'' (alkaline substances), surgical intervention and cauterization is recommended.

Various complications of ulcers like ''visarpa'' (erysipelas), ''pakshaghata'' (hemiplegia), ''shirastambha'' (constricted vessels), ''jwara'' (fever) etc. are described. Sloughing of ligaments and vessels, deep seated appearance of maggots, fracture of bone near the ulcer, presence of foreign body in the ulcer etc hamper the healing process. Treatment of ''nija vrana'' (endogenous ulcer)<ref>Vagbhata. Uttara Sthana, Cha.26 Sadyovranapratishedha Adhyaya verse 13. In: Kaviraj Atrideva Gupta, Editors. Ashtanga Hridayam. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2005.pp 26</ref> is different from ''agantuja vrana'' (exogenous ulcer) because endogenous ulcers are caused by vitiation of [[vata]]di [[dosha]]ja, and exogenous ulcers are initially caused by various type of trauma such as ''vadha'' (stab injury etc.), ''bandha'' (excessive tying), ''prapatana'' (injury due to fall), injury due to teeth and nail etc. But later on in exogenous ulcers also involvement of [[dosha]] takes place and then treatment should be adopted as ''nija vrana'' (endogenous ulcer). In endogenous ulcers, ''shodhana'' therapy should be adopted by [[vamana]] (emesis), [[virechana]] (purgation) and [[basti]] (medicated enema) and blood letting for removal of [[dosha]]ja (toxic materials) from body. [ Cha. Sa. [[Sutra Sthana]] 16/17 ] and ''agnikarma''. ''Agnikarma'' has ushna [[guna]] (hot property) which is opposite to [[vata]] and [[kapha]]. Due to heat, vasodilation leads to alleviation of ''srotorodha'' resulting in proper vascularity to organ or part. In exogenous ulcers, local treatment with use of ''kshara'' (alkaline substances), surgical intervention and cauterization is recommended.

== Sanskrit Text, Transliteration and English Translation ==

== Sanskrit Text, Transliteration and English Translation ==

After listening the request of Agnivesa the teacher said – ‘O gentle! Listen about the symptoms and treatment of the two types of ''vrana'' (ulcers) , endogenous ulcer and exogenous ulcer, as mentioned earlier.The endogenous ulcers occur from the bodily ''dosha'', whereas the exogenous ulcers  are caused by external causative factors. Exogenous ulcer are caused by blowing, binding, falling down, injury with fangs, teeth or nails as well as due to poisonous contact, fire and weapons etc. Exogenous ulcers are different from the endogenous ones in respect of treatment with ''mantra'' (incantations), anti-poisonous pastes for external application etc. While endogenous ulcer bears opposite characteristic features in respect of etiology, sign symptoms and treatment. [5-8]

After listening the request of Agnivesa the teacher said – ‘O gentle! Listen about the symptoms and treatment of the two types of ''vrana'' (ulcers) , endogenous ulcer and exogenous ulcer, as mentioned earlier.The endogenous ulcers occur from the bodily ''dosha'', whereas the exogenous ulcers  are caused by external causative factors. Exogenous ulcer are caused by blowing, binding, falling down, injury with fangs, teeth or nails as well as due to poisonous contact, fire and weapons etc. Exogenous ulcers are different from the endogenous ones in respect of treatment with ''mantra'' (incantations), anti-poisonous pastes for external application etc. While endogenous ulcer bears opposite characteristic features in respect of etiology, sign symptoms and treatment. [5-8]

=== Importance of ''dosha'' dominance in treatment ===

=== Importance of [[dosha]] dominance in treatment ===

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</div></div>

Exogenous ulcers not being pacified and having endogenous causative factors should be treated as endogenous ulcers according to predominance of ''doshas''.[9]

Exogenous ulcers not being pacified and having endogenous causative factors should be treated as endogenous ulcers according to predominance of [[dosha]].[9]

=== Endogenous ulcers ===

=== Endogenous ulcers ===

</div></div>

</div></div>

''Vata, pitta'' and ''kapha'' are vitiated by their respective causes get lodged in external passage and thus produce endogenous ulcers. [10]

[[Vata]], [[pitta]] and [[kapha]] are vitiated by their respective causes get lodged in external passage and thus produce endogenous ulcers. [10]

=== ''Dosha'' dominant ''vrana'' and their treatment ===

=== [[Dosha]] dominant ''vrana'' and their treatment ===

==== ''Vata'' dominant ''vrana'' and treatment ====

==== [[Vata]] dominant ''vrana'' and treatment ====

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</div></div>

The ulcer caused by ''vata'' is stiff, hard to touch, with scanty exudation, excruciating and pricking pain with throbbing and blackish discoloration. ''Vatika'' ulcer should be treated with ''sampurana'' (filling of ulcer cavity), intake of unctuous substances (oleation therapy), unctuous fomentation and poultices, ointments and sprinklings.[11-12]

The ulcer caused by [[vata]] is stiff, hard to touch, with scanty exudation, excruciating and pricking pain with throbbing and blackish discoloration. ''Vatika'' ulcer should be treated with ''sampurana'' (filling of ulcer cavity), intake of unctuous substances (oleation therapy), unctuous fomentation and poultices, ointments and sprinklings.[11-12]

==== ''Pitta'' dominant ''vrana'' and treatment ====

==== [[Pitta]] dominant ''vrana'' and treatment ====

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

   

   

</div></div>

</div></div>

''Pittaja'' ulcer is known from thirst, unconsciousness, fever, sweating, burning sensation, impurity, tearing and foul smell with discharge of pus from ulcer. One should pacify the ''pittaja'' ulcer by anointing and sprinkling with cold, intake of sweet and bitter drugs, intake of ghee and purgation. [13-14]

[[Pitta]]ja ulcer is known from thirst, unconsciousness, fever, sweating, burning sensation, impurity, tearing and foul smell with discharge of pus from ulcer. One should pacify the [[pitta]]ja ulcer by anointing and sprinkling with cold, intake of sweet and bitter drugs, intake of ghee and purgation. [13-14]

==== ''Kapha'' dominant ''vrana'' and treatment ====

==== [[Kapha]] dominant ''vrana'' and treatment ====

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</div></div>

''Kaphaja'' ulcer has much sliminess, heavyness, unctuousness, numbness, with mild pain, paleness in color, little slough and prolonged healing. ''Kaphaja'' ulcer is treated with anointing and sprinkling with astringent, pungent, dry and hot drugs as well as fasting and digestive measures.[15-16]

[[Kapha]]ja ulcer has much sliminess, heavyness, unctuousness, numbness, with mild pain, paleness in color, little slough and prolonged healing. [[Kapha]]ja ulcer is treated with anointing and sprinkling with astringent, pungent, dry and hot drugs as well as fasting and digestive measures.[15-16]

<div class="mw-collapsible mw-collapsed">

<div class="mw-collapsible mw-collapsed">

</div></div>

</div></div>

In cases of wound, first of all, purification with therapeutic emesis, purgation, ''shastra karma'' (surgical intervention) and ''basti'' (medicated enema) should be done after assessment of condition because the wounds get healed quickly in those with cleansed body.[38-39]

In cases of wound, first of all, purification with therapeutic emesis, purgation, ''shastra karma'' (surgical intervention) and [[basti]] (medicated enema) should be done after assessment of condition because the wounds get healed quickly in those with cleansed body.[38-39]

=== Procedures for management of ulcers ===

=== Procedures for management of ulcers ===

</div></div>

</div></div>

The physician observing ''shopha'' (swelling) as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. One should evacuate the persons with plenty of impurity and lighten those with little impurity. He should overcome the wound predominant in ''vata'' first with decoctions and ghritas. Paste of ''nyogrodha'' bark (Ficus bengalensis Linn.), ''udumbara'' (Ficus glomerata Roxb.), ''ashwattha'' (Ficus religiosa Linn.), ''plaksha'' (Ficus lacor Buch.Ham.) and ''vetasa'' (Salix caprea Linn.) are  mixed with ghee is an excellent cooling for inflammation, other local applications prescribed are (1) ''vijaya'' (Terminalia chebula Retz.), ''madhuka'' (Glycyrrhiza glabra Linn.), ''vira , bisagranthi, shatavari'' (Asparagus racemosus Willd.), ''nilotpala'' (Nymphea stellata Willd.), ''nagapuspa'' (Mesua ferrea Linn.) and ''sandal'' (Santalum album Linn.). (2) Parched grain flour, ''madhuka, sarkara'' and ghee. ''Avidahi'' (non-burning) food is the best remedy for inflammation.[44-48]

The physician observing ''shopha'' (swelling) as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. One should evacuate the persons with plenty of impurity and lighten those with little impurity. He should overcome the wound predominant in [[vata]] first with decoctions and ghritas. Paste of ''nyogrodha'' bark (Ficus bengalensis Linn.), ''udumbara'' (Ficus glomerata Roxb.), ''ashwattha'' (Ficus religiosa Linn.), ''plaksha'' (Ficus lacor Buch.Ham.) and ''vetasa'' (Salix caprea Linn.) are  mixed with ghee is an excellent cooling for inflammation, other local applications prescribed are (1) ''vijaya'' (Terminalia chebula Retz.), ''madhuka'' (Glycyrrhiza glabra Linn.), ''vira , bisagranthi, shatavari'' (Asparagus racemosus Willd.), ''nilotpala'' (Nymphea stellata Willd.), ''nagapuspa'' (Mesua ferrea Linn.) and ''sandal'' (Santalum album Linn.). (2) Parched grain flour, ''madhuka, sarkara'' and ghee. ''Avidahi'' (non-burning) food is the best remedy for inflammation.[44-48]

=== ''Patana'' (incision) and ''upanaha'' (poultice) ===

=== ''Patana'' (incision) and ''upanaha'' (poultice) ===

</div></div>

</div></div>

Sinuses, ripened inflammations (i.e.suppurated ulcer or abscess), intestinal perforation, intestinal obstruction, having foreign body within and other similar conditions are incisable. Ascites, suppurated tumor and ''raktaja gulma'' (uterine tumor), blood disorders such as erysipelas, boils etc, are treated by puncturing. Wounds protruded with thick margins, elevated, hard, piles etc and other growths should be excised.The wise physician should scrape leucoderma, skin diseases and other such disorders which need scraping. The physician should perform scarification over ''vatarakta'' (nodular swelling), ''granthi'' (cysts) pimples, urticarial rashes, red patches, skin diseases, injured parts and swellings. Suturing should be done in pelvic, abdominal surgeries (i.e., laparotomy) etc.Thus the scholars have mentioned six types of surgical treatments.[56-61]

Sinuses, ripened inflammations (i.e.suppurated ulcer or abscess), intestinal perforation, intestinal obstruction, having foreign body within and other similar conditions are incisable. Ascites, suppurated tumor and [[rakta]]ja gulma (uterine tumor), blood disorders such as erysipelas, boils etc, are treated by puncturing. Wounds protruded with thick margins, elevated, hard, piles etc and other growths should be excised.The wise physician should scrape leucoderma, skin diseases and other such disorders which need scraping. The physician should perform scarification over vatarakta(nodular swelling), ''granthi'' (cysts) pimples, urticarial rashes, red patches, skin diseases, injured parts and swellings. Suturing should be done in pelvic, abdominal surgeries (i.e., laparotomy) etc.Thus the scholars have mentioned six types of surgical treatments.[56-61]

=== ''Vrana pidana''(pressing of wound) ===

=== ''Vrana pidana''(pressing of wound) ===

</div></div>

</div></div>

Wounds which are dry, intensely painful, stiffened and predominant in ''vata'' should be fomented by bolus fomentation with ''krishara'' and ''payasa'' (a type of dietary preparation). Similarly, they should be fomented with seasoned ''vesavara'' made of the meat of domestic, burrow-dwellers, aquatic or marshy animals or hot ''utkarika''. Thus the patient gets relief. If the wounds predominant in ''vata'' have burning sensation and pain, they should be pasted upon with linseed and sesamum seeds roasted, then dipped in milk and again pounded with the same milk. ''Bala'' (Sida cordifolia Linn.), ''guduchi'' (Tinospora cordifolia), ''madhuka'' (Glycyrrhiza glabra Linn.), ''prishnaparni'' (Uraria picta Desv), ''shatavari'' (Asparagus racemosus Willd), ''jivanti'' (Leptadenia reticulate W. & A.), sugar, milk, oil, fish fat, ghee cooked with beeswax is known as ''sneha sarkara'', it relieves pain.The wound should be sprinkled with warm decoction of two ''panchamula'' (ie.''dashamula''), milk and ghee with oil.

Wounds which are dry, intensely painful, stiffened and predominant in [[vata]] should be fomented by bolus fomentation with ''krishara'' and ''payasa'' (a type of dietary preparation). Similarly, they should be fomented with seasoned ''vesavara'' made of the meat of domestic, burrow-dwellers, aquatic or marshy animals or hot ''utkarika''. Thus the patient gets relief. If the wounds predominant in [[vata]] have burning sensation and pain, they should be pasted upon with linseed and sesamum seeds roasted, then dipped in milk and again pounded with the same milk. ''Bala'' (Sida cordifolia Linn.), ''guduchi'' (Tinospora cordifolia), ''madhuka'' (Glycyrrhiza glabra Linn.), ''prishnaparni'' (Uraria picta Desv), ''shatavari'' (Asparagus racemosus Willd), ''jivanti'' (Leptadenia reticulate W. & A.), sugar, milk, oil, fish fat, ghee cooked with beeswax is known as ''sneha sarkara'', it relieves pain.The wound should be sprinkled with warm decoction of two ''panchamula'' (ie.''dashamula''), milk and ghee with oil.

Barley powder (Hordeum vulgare Linn.), ''madhuka'' (Glycyrrhiza glabra Linn.) and ''tila'' mixed with ghee should be applied as warm paste for alleviating burning sensation and pain. ''Payasa'' prepared of ''mudga'' (Phaseolus radiates Linn.) mixed with ''tila'' should be applied as poultice to pacify pain and burning sensation. These management principles are beneficial in wounds.[72-79]

Barley powder (Hordeum vulgare Linn.), ''madhuka'' (Glycyrrhiza glabra Linn.) and ''tila'' mixed with ghee should be applied as warm paste for alleviating burning sensation and pain. ''Payasa'' prepared of ''mudga'' (Phaseolus radiates Linn.) mixed with ''tila'' should be applied as poultice to pacify pain and burning sensation. These management principles are beneficial in wounds.[72-79]

Those ulcers, are not very red, pale, blackish, painful, elevated and protruded should be known as clean and appeals healing process. Decoction of ''nyagrodha, udumbara, asvattha, kadamba, plaksha, vetasa, karavira'' (Nerium indicum Mill.), ''arka'' (Calotropis procera R. Br.) and ''kutaja'' (Holarrhena antidysentrica Linn.) are wound healing. ''Chandana'' (Santalum album Linn.), lotus stamens, ''daruharidra'' bark, blue water lily, ''meda'' (Polygonatum airrhifolium Royle), ''mahameda'' (Polygonatum airrhifolium Royle), ''murva'' (Marsdenia tenacissima W. & A.), ''lajjalu'' (Mimosa pudica Linn.) and ''madhuyasti''- this formulation is wound healer. ''Prapaundarika, jivanti, gojihva'' (Onosma bracteatum Wall.), ''dhataki, bala'' and sesamum should be applied as paste with ghee for wound healing. ''Kampillaka'' (Mallotus philippinensis Muell Arg), ''vidanga'' (Embelia ribes Burm), ''kutaja, triphala, bala, patola'' (Trichosanthes dioica Roxb.), ''nimba, musta'' (Cyperus rotundus Linn.), ''priyangu, khadira, dhataki, sarja, ela'' (Elleteria cardamomum Maton.), ''aguru'' (Aquilaria agallocha Roxb.) and ''chandana'' are pounded together and oil is extracted. This oil is used as ulcer healing agent.

Those ulcers, are not very red, pale, blackish, painful, elevated and protruded should be known as clean and appeals healing process. Decoction of ''nyagrodha, udumbara, asvattha, kadamba, plaksha, vetasa, karavira'' (Nerium indicum Mill.), ''arka'' (Calotropis procera R. Br.) and ''kutaja'' (Holarrhena antidysentrica Linn.) are wound healing. ''Chandana'' (Santalum album Linn.), lotus stamens, ''daruharidra'' bark, blue water lily, ''meda'' (Polygonatum airrhifolium Royle), ''mahameda'' (Polygonatum airrhifolium Royle), ''murva'' (Marsdenia tenacissima W. & A.), ''lajjalu'' (Mimosa pudica Linn.) and ''madhuyasti''- this formulation is wound healer. ''Prapaundarika, jivanti, gojihva'' (Onosma bracteatum Wall.), ''dhataki, bala'' and sesamum should be applied as paste with ghee for wound healing. ''Kampillaka'' (Mallotus philippinensis Muell Arg), ''vidanga'' (Embelia ribes Burm), ''kutaja, triphala, bala, patola'' (Trichosanthes dioica Roxb.), ''nimba, musta'' (Cyperus rotundus Linn.), ''priyangu, khadira, dhataki, sarja, ela'' (Elleteria cardamomum Maton.), ''aguru'' (Aquilaria agallocha Roxb.) and ''chandana'' are pounded together and oil is extracted. This oil is used as ulcer healing agent.

Similarly, oil prepared with equal quantity of ''prapaundarika, mahuka, kakoli'' (Roscoca procera Wall.), ''kshirakakoli'' (Roscoca procera Wall.), ''chandana'' and ''rakta chandana'' (Pterocarpus santalinus Linn.) is an excellent ulcer healing agent. Oil cooked with ''durva'' juice or ''kampillaka'' or paste of ''daruharidra'' bark is an important ulcer healer. By the above method ''ghrita'' should be prepared and used for healing, ulcers predominant in ''rakta'' and ''pitta''.[86-94]

Similarly, oil prepared with equal quantity of ''prapaundarika, mahuka, kakoli'' (Roscoca procera Wall.), ''kshirakakoli'' (Roscoca procera Wall.), ''chandana'' and ''rakta chandana'' (Pterocarpus santalinus Linn.) is an excellent ulcer healing agent. Oil cooked with ''durva'' juice or ''kampillaka'' or paste of ''daruharidra'' bark is an important ulcer healer. By the above method ''ghrita'' should be prepared and used for healing, ulcers predominant in [[rakta]] and [[pitta]].[86-94]

=== ''Patta bandhana'' (bandage) ===

=== ''Patta bandhana'' (bandage) ===

</div></div>

</div></div>

Excessive hemorrhage after excision, excisable growths, ''kaphaja'' nodules, glands, stiffness and disorders due to ''vata'', wounds with hidden pus and lymph, deep and firm; and after amputation of body part, cauterization is prescribed. The expert in cauterization should cauterize the spot with beeswax, oil, marrow, honey, muscle-fat, ''ghrita'' or various heated metallic sticks. Wounds deep and predominant in ''vata'' and in patients rough and delicate should be cauterized with fat or beeswax otherwise with iron stick or honey. Cauterization should not be applied in children, debilitated, old persons, pregnant women, those suffering from internal hemorrhage, thirst, fever, weak and poisoned persons and in wounds situated at ligaments and vital parts, poisoned, foreign body, ophthalmic and leprotic wounds.[101-106]

Excessive hemorrhage after excision, excisable growths, [[kapha]]ja nodules, glands, stiffness and disorders due to [[vata]], wounds with hidden pus and lymph, deep and firm; and after amputation of body part, cauterization is prescribed. The expert in cauterization should cauterize the spot with beeswax, oil, marrow, honey, muscle-fat, ''ghrita'' or various heated metallic sticks. Wounds deep and predominant in [[vata]] and in patients rough and delicate should be cauterized with fat or beeswax otherwise with iron stick or honey. Cauterization should not be applied in children, debilitated, old persons, pregnant women, those suffering from internal hemorrhage, thirst, fever, weak and poisoned persons and in wounds situated at ligaments and vital parts, poisoned, foreign body, ophthalmic and leprotic wounds.[101-106]

=== ''Kshara karma'' (application of alkali) and ''dhupana''(fumigation) ===

=== ''Kshara karma'' (application of alkali) and ''dhupana''(fumigation) ===

</div></div>

</div></div>

The physician conversant with dose, time and ''agni'' (heat) may apply alkali in cases amenable to surgical treatment and cauterization according to severity of disease and morbidity. Wounds attain hardness by being fumigated with aromatic substances and heartwood. The wounds get softened if fumigated with ''ghrita'', marrow or muscle-fat. Through fumigation pain, discharges, odors, maggots, hardness and softness of wounds are removed. ''Lodhra,'' leaf-buds of ''nyagrodha, khadira, triphala'' and ''ghrita'' - this combination used as paste provides looseness and softness in wounds. The wounds which are painful, hard, stiff and without discharge should be pasted frequently with barley powder mixed with ''ghrita''. Wounds may be saturated by applying frequently the paste of ''payasa'' (cereals cooked with milk) made of ''mudga, shashtika'' and ''shali'' rice or ''jivaniya'' drugs mixed with ''ghrita''.[110-112]

The physician conversant with dose, time and [[agni]] (heat) may apply alkali in cases amenable to surgical treatment and cauterization according to severity of disease and morbidity. Wounds attain hardness by being fumigated with aromatic substances and heartwood. The wounds get softened if fumigated with ''ghrita'', marrow or muscle-fat. Through fumigation pain, discharges, odors, maggots, hardness and softness of wounds are removed. ''Lodhra,'' leaf-buds of ''nyagrodha, khadira, triphala'' and ''ghrita'' - this combination used as paste provides looseness and softness in wounds. The wounds which are painful, hard, stiff and without discharge should be pasted frequently with barley powder mixed with ''ghrita''. Wounds may be saturated by applying frequently the paste of ''payasa'' (cereals cooked with milk) made of ''mudga, shashtika'' and ''shali'' rice or ''jivaniya'' drugs mixed with ''ghrita''.[110-112]

=== External applications ===

=== External applications ===

*''Vrana'' (ulcers) are broadly classified into two types viz. ''nija'' (endogenous) and ''agantu'' (exogenous).  

*''Vrana'' (ulcers) are broadly classified into two types viz. ''nija'' (endogenous) and ''agantu'' (exogenous).  

*The treatment of both types of ulcers is based upon the ''dosha'' dominance.  

*The treatment of both types of ulcers is based upon the [[dosha]] dominance.  

*Endogenous ulcers are caused due to vitiation of ''dosha'' located in external pathways.

*Endogenous ulcers are caused due to vitiation of [[dosha]] located in external pathways.

*The clinical features of ''vata'' dominance in ulcer are stiffness, hardness  on touch, scanty exudation, excruciating and pricking pain with throbbing and blackish discoloration. It should be treated with ''sampurana'' (filling of ulcer cavity), intake of unctuous substances (oleation therapy), unctuous fomentation and poultices, ointments and sprinklings.

*The clinical features of [[vata]] dominance in ulcer are stiffness, hardness  on touch, scanty exudation, excruciating and pricking pain with throbbing and blackish discoloration. It should be treated with ''sampurana'' (filling of ulcer cavity), intake of unctuous substances (oleation therapy), unctuous fomentation and poultices, ointments and sprinklings.

*The clinical features of ''pitta'' dominant ulcer are excessive thirst, unconsciousness, fever, sweating, burning sensation, impurities at the site of ulcer, tearing and foul smell with discharge pus from ulcer. The treatment includes anointing and sprinkling with cold drugs, intake of sweet and bitter drugs, intake of ghee and purgation.

*The clinical features of [[pitta]] dominant ulcer are excessive thirst, unconsciousness, fever, sweating, burning sensation, impurities at the site of ulcer, tearing and foul smell with discharge pus from ulcer. The treatment includes anointing and sprinkling with cold drugs, intake of sweet and bitter drugs, intake of ghee and purgation.

*The clinical features of ''kapha'' dominance in ulcer are sliminess, heaviness, unctuousness, numbness, with mild pain, paleness in color, little slough and prolonged healing. It is treated with anointing and sprinkling with astringent, pungent, dry and hot drugs as well as fasting and digestive measures.

*The clinical features of [[kapha]] dominance in ulcer are sliminess, heaviness, unctuousness, numbness, with mild pain, paleness in color, little slough and prolonged healing. It is treated with anointing and sprinkling with astringent, pungent, dry and hot drugs as well as fasting and digestive measures.

*The two types of ulcers are further divided into twenty types on the basis of distinctive features. Their examination can be done by three ways, signs of excess vitiation at site of ulcer are of twelve types, eight locations, fourteen types of discharges, sixteen complications, twenty four defects and thirty six therapeutic measures.

*The two types of ulcers are further divided into twenty types on the basis of distinctive features. Their examination can be done by three ways, signs of excess vitiation at site of ulcer are of twelve types, eight locations, fourteen types of discharges, sixteen complications, twenty four defects and thirty six therapeutic measures.

*Skin, blood vessels, flesh, fat, bone, ligament, vital parts and viscera are involved in the pathogenesis of ulcer.

*Skin, blood vessels, flesh, fat, bone, ligament, vital parts and viscera are involved in the pathogenesis of ulcer.

*The treatment of ulcer is done in two ways viz.1. systemic treatment (internal administration of medicine)  and 2. Local treatment of ulcer. The treatment is done with drugs that promote healing, purify body and local site of ulcer.   

*The treatment of ulcer is done in two ways viz.1. systemic treatment (internal administration of medicine)  and 2. Local treatment of ulcer. The treatment is done with drugs that promote healing, purify body and local site of ulcer.   

*The first principle of management of ulcer is body purification through therapeutic emesis, purgation, ''shastra karma'' (surgical intervention) or ''basti'' (medicated enema) after assessment of condition because the ulcers get healed quickly in those with cleansed body.

*The first principle of management of ulcer is body purification through therapeutic emesis, purgation, ''shastra karma'' (surgical intervention) or [[basti]] (medicated enema) after assessment of condition because the ulcers get healed quickly in those with cleansed body.

*The thirty six measures for treatments of ulcers are those for pacification of swelling, six types of surgical operations, pressing, refrigerating, uniting, fomentation, pacification, probing, cleansing, healing, cleaning paste, healing paste, cleaning oil, healing oil, two types of covering with leaf, two types of bandaging, diet, elevation, two types of cauterization, depression, hardening fumigation, softening fumigation, hardening paste, softening paste, powdering, colorization, healing, repillatory.  

*The thirty six measures for treatments of ulcers are those for pacification of swelling, six types of surgical operations, pressing, refrigerating, uniting, fomentation, pacification, probing, cleansing, healing, cleaning paste, healing paste, cleaning oil, healing oil, two types of covering with leaf, two types of bandaging, diet, elevation, two types of cauterization, depression, hardening fumigation, softening fumigation, hardening paste, softening paste, powdering, colorization, healing, repillatory.  

*At first, bloodletting therapy is done first to reduce swelling in ulcer. ''Upanaha'' (hot poultice) and ''patana'' (incision) are done according to stage of ulcer.

*At first, bloodletting therapy is done first to reduce swelling in ulcer. ''Upanaha'' (hot poultice) and ''patana'' (incision) are done according to stage of ulcer.

=== Classification of ulcers and causes ===

=== Classification of ulcers and causes ===

As said earlier, ulcers are of two types i.e. ''nija'' and ''agantuja'', another classification is clean and infected wound. ''Nija vrana'' (endogenous ulcer) are caused by vitiation of ''doshas'' in the body or due to disease process. The term ''sharira desotha'' (ie.endogenous in origin) is used for morbid factors occurring in the body that cause ''nija vrana'' (i.e. endogenous ulcer). While ''agantuja vrana'' (exogenous ulcer) are caused by external factors (trauma or surgical intervention) like wound caused by stab injury, poisons, fire and sharp weapons or excessive tying of that organ (''bandha'') etc. In exogenous ulcers, vitiation of ''dosha'' occurs later. ''Nija vrana'' i.e. ''vataja, pittaja, kaphaja, raktaja'' and ''sannipataja'', are caused due to faulty habit, mode of living and seasonal variation. These vitiated ''dosha'', after a series of pathological processes (''shada-kriyakala'') get lodged at particular site resulting in the formation of ''vrana''.

As said earlier, ulcers are of two types i.e. ''nija'' and ''agantuja'', another classification is clean and infected wound. ''Nija vrana'' (endogenous ulcer) are caused by vitiation of [[dosha]] in the body or due to disease process. The term ''sharira desotha'' (ie.endogenous in origin) is used for morbid factors occurring in the body that cause ''nija vrana'' (i.e. endogenous ulcer). While ''agantuja vrana'' (exogenous ulcer) are caused by external factors (trauma or surgical intervention) like wound caused by stab injury, poisons, fire and sharp weapons or excessive tying of that organ (''bandha'') etc. In exogenous ulcers, vitiation of [[dosha]] occurs later. ''Nija vrana'' i.e. [[vata]]ja, [[pitta]]ja, [[kapha]]ja, [[rakta]]ja and ''sannipataja'', are caused due to faulty habit, mode of living and seasonal variation. These vitiated [[dosha]], after a series of pathological processes (''shada-kriyakala'') get lodged at particular site resulting in the formation of ''vrana''.

=== ''Samprapti'' (pathogenesis of ''vrana''): based on ''shadakriya kala'' ===

=== ''Samprapti'' (pathogenesis of ''vrana''): based on ''shadakriya kala'' ===

The following ulcer is the case of diabetic ulcer. Clinical features include throbbing pain, swelling, redness, necrosis of involved tissue and non healing ulcer since 6 months.

The following ulcer is the case of diabetic ulcer. Clinical features include throbbing pain, swelling, redness, necrosis of involved tissue and non healing ulcer since 6 months.

[[File:DwivImage1.jpg|400px|Image 1: ''Vata'' dominant ulcer]]

[[File:DwivImage1.jpg|400px|Image 1: [[Vata]] dominant ulcer]]

   

   

'''Image 1: ''Vata'' dominant ulcer'''

'''Image 1: [[Vata]] dominant ulcer'''

The following ulcer is the case of non healing ulcer due to boils. Clinical features include burning pain,  redness, pus discharge, slough, with redness of involved tissue and non healing ulcer since 1month.

The following ulcer is the case of non healing ulcer due to boils. Clinical features include burning pain,  redness, pus discharge, slough, with redness of involved tissue and non healing ulcer since 1month.

[[File:DwivImage2.jpg|400px|Image 2: ''Pitta'' dominant ulcer]]

[[File:DwivImage2.jpg|400px|Image 2: [[Pitta]] dominant ulcer]]

   

   

'''Image 2: Pitta dominant ulcer'''

'''Image 2: [[Pitta]] dominant ulcer'''

The following ulcer is the case of non healing ulcer due to DCT (Deep vein thrombosis). Clinical features include pain, irregular superficial ulcer, redness, mild pus discharge, slough, with redness of involved tissue and non healing ulcer since 8 months.

The following ulcer is the case of non healing ulcer due to DCT (Deep vein thrombosis). Clinical features include pain, irregular superficial ulcer, redness, mild pus discharge, slough, with redness of involved tissue and non healing ulcer since 8 months.

   

   

[[File:DwivImage3.jpg|400px|Image 3: ''Kapha'' dominant ulcer ]]

[[File:DwivImage3.jpg|400px|Image 3: [[Kapha]] dominant ulcer ]]

'''Image 3: Kapha dominant ulcer'''  

'''Image 3: Kapha dominant ulcer'''  

==== Purification measures ====

==== Purification measures ====

Purificatory measures eliminate toxic material from body and improve healing process of ulcer. In case of endogenous ulcer removal of morbid matters (i.e. ''doshaja'') emesis through upward route, purgation through downward route are advised. Other purificatory measures like oleation therapy, sudation therapy should be done prior to emesis, purgation etc. For local purification of ulcer, venesection and ''vrana basti'' should be done.''Raktamokshana'' is an important modality<ref>Sushruta. Chikitsa Sthana, Cha.1 Dwivraniya Chikitsitam Adhyaya verse 27-18. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1. </ref> indicated predominantly in local vitiation of ''rakta'' as in ''dushta vrana''. So along with emesis and purgation blood letting is also important treatment modalities with the help of ''jalauka'' (leech application), veinpuncture etc.

Purificatory measures eliminate toxic material from body and improve healing process of ulcer. In case of endogenous ulcer removal of morbid matters (i.e. [[dosha]]ja) emesis through upward route, purgation through downward route are advised. Other purificatory measures like oleation therapy, sudation therapy should be done prior to emesis, purgation etc. For local purification of ulcer, venesection and vrana [[basti]] should be done.[[Raktamokshana]] is an important modality<ref>Sushruta. Chikitsa Sthana, Cha.1 Dwivraniya Chikitsitam Adhyaya verse 27-18. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1. </ref> indicated predominantly in local vitiation of [[rakta]] as in ''dushta vrana''. So along with emesis and purgation blood letting is also important treatment modalities with the help of ''jalauka'' (leech application), veinpuncture etc.

Selection of therapeutic measures is done as per condition of ''vrana'' and patient.

Selection of therapeutic measures is done as per condition of ''vrana'' and patient.

Thirty six types of therapeutic measures are described for the treatment of ulcer. Sixty types of treatment measures are described under the head of ''shashtiupakrama'' regarding ulcer treatment.<ref name =su>Sushruta. Chikitsa Sthana, Cha.1 Dwivraneeya Chikitsitam Adhyaya verse 8. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref> It is not necessary that all the thirty six or sixty therapeutic measures have to be applied in treating an ulcer. I A patient at a time 1 or 4 type of procedures are essential in single case of ''vrana'' according to condition of the wound.<ref name=su/>

Thirty six types of therapeutic measures are described for the treatment of ulcer. Sixty types of treatment measures are described under the head of ''shashtiupakrama'' regarding ulcer treatment.<ref name =su>Sushruta. Chikitsa Sthana, Cha.1 Dwivraneeya Chikitsitam Adhyaya verse 8. In: Jadavaji Trikamji Aacharya, Editors. Sushruta Samhita. 8th ed. Varanasi: Chaukhambha Orientalia;2005. p.1.</ref> It is not necessary that all the thirty six or sixty therapeutic measures have to be applied in treating an ulcer. I A patient at a time 1 or 4 type of procedures are essential in single case of ''vrana'' according to condition of the wound.<ref name=su/>

In early stage of ulcer only inflammation appears. At this stage bloodletting should be done to break the further manifestation of ulcer. Purificatory measures should be performed in excessively aggravated doshas while lightning measures should be adopted if ''doshas'' are less aggravated. In the beginning of edema, therapeutic measures aimed to alleviate aggravated ''vata'' followed by other ''dosha'' viz. ''pitta'' and ''kapha'' are advised. Application of various pastes made of ''vijaya, madhuka, vira, bisagranthi'' etc. also reduce edema. Edema reducing dietary regimen like light food and food that does not cause burning sensation (''avidahi'') should be followed.

In early stage of ulcer only inflammation appears. At this stage bloodletting should be done to break the further manifestation of ulcer. Purificatory measures should be performed in excessively aggravated doshas while lightning measures should be adopted if [[dosha]] are less aggravated. In the beginning of edema, therapeutic measures aimed to alleviate aggravated [[vata]] followed by other [[dosha]]viz. [[pitta]] and [[kapha]] are advised. Application of various pastes made of ''vijaya, madhuka, vira, bisagranthi'' etc. also reduce edema. Edema reducing dietary regimen like light food and food that does not cause burning sensation (''avidahi'') should be followed.

=== Indications and process of six fold surgical procedures ===

=== Indications and process of six fold surgical procedures ===

=== Bandaging material, methods and its applicability in ''vrana'' (wound) ===

=== Bandaging material, methods and its applicability in ''vrana'' (wound) ===

Bandaging of wound is very important as it stabilizes wounded part, prevents external injury, prevents contamination from external sources and enhances healing process. Bandaging should not be too tight, nor too loose. Act of bandaging may be from right or left side while others have mentioned fourteen types<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 18, shlok no.17 , Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 98</ref> and fifteen types. <ref>Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika, Sutra sthana Chap 29, shlok no.59-60, Reprint 2005, Chaukhambha Sanskrit Sansthan,Varanasi, pp 161</ref>

Bandaging of wound is very important as it stabilizes wounded part, prevents external injury, prevents contamination from external sources and enhances healing process. Bandaging should not be too tight, nor too loose. Act of bandaging may be from right or left side while others have mentioned fourteen types<ref>Sushruta. Sutra Sthana, Cha.18 Vranalepanabandhavidhi Adhyaya verse 17. In: Kaviraja Ambikadutta Shastri, Editors. Sushruta Samhita. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013. pp 98</ref>and fifteen types. <ref>Vagbhata. Sutra Sthana, Cha.29 Shastrakarmavidhi Adhyaya verse 59-60. In: Kaviraj Atrideva Gupta, Editors. Ashtanga Hridayam. reprint ed. Varanasi:Chaukhambha Sanskrit Sansthan,2005.p.4.pp 161</ref>

=== Diet: Wholesome and unwholesome aahar-vihar and ulcer healing promoters ===

=== Diet: Wholesome and unwholesome aahar-vihar and ulcer healing promoters ===

''Lavana'' is ''vishyandi'' i. e. producing more secretions from tissues; it aggravates ''kapha'' and ''pitta'' and mitigates ''vata''.<ref>Vagbhata. Sutra Sthana, Cha.6 Annaswarupavijnaneeyam Adhyaya verse 143. In: Kaviraj Atrideva Gupta, Editors. Ashtanga Hridayam. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2005 pp 64.</ref>  

''Lavana'' is ''vishyandi'' i. e. producing more secretions from tissues; it aggravates [[kapha]] and [[pitta]] and mitigates [[vata]]<ref>Vagbhata. Sutra Sthana, Cha.6 Annaswarupavijnaneeyam Adhyaya verse 143. In: Kaviraj Atrideva Gupta, Editors. Ashtanga Hridayam. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2005 pp 64.</ref>  

Due to ''kapha'' and ''pitta'' vitiating properties it causes sliminess (''kledana'') and burning pain. Excessive ''lavana, amla'' and ''katu rasa'' will provoke ''vata dosha'' and may produce various types of pain. ''Vidahi'' food also leads to burning sensation due to ''srotorodha'' while sexual intercourse leads to ''dhatukshaya'' and aggravates ''vata''. [ Cha. Sa. [[Chikitsa Sthana]] 28/59 ], [ Cha. Sa. [[Vimana Sthana]] 5/24].

Due to [[kapha]] and [[pitta]] vitiating properties it causes sliminess (''kledana'') and burning pain. Excessive ''lavana, amla'' and ''katu rasa'' will provoke [[vata]] [[dosha]] and may produce various types of pain. ''Vidahi'' food also leads to burning sensation due to ''srotorodha'' while sexual intercourse leads to [[dhatu]]kshaya and aggravates [[vata].] [ Cha. Sa. [[Chikitsa Sthana]] 28/59 ], [ Cha. Sa. [[Vimana Sthana]] 5/24].

Day time sleep causes ''srotorodha'' and gives rise to vitiation of ''kapha'' that leads to swelling. Elevation of depressed ulcer is very important aspect of healing process. In Ayurvedic classics ''stanya janana'' (galactogogue),[Cha. Sa. [[Sutra Sthana]] 4/17 ] ''jeevaniya'' (life promoters e.g. vitamins) [ Cha. Sa. [[Sutra Sthana]] 4/1 ] and ''brimhaniya gana'' (nourishing drugs) [ Cha. Sa. [[Sutra Sthana]] 4/2] are described. All these drugs have nutritional value (''dhatu poshana'') that helps in ulcer healing.

Day time sleep causes ''srotorodha'' and gives rise to vitiation of [[kapha]] that leads to swelling. Elevation of depressed ulcer is very important aspect of healing process. In Ayurvedic classics ''stanya janana'' (galactogogue),[Cha. Sa. [[Sutra Sthana]] 4/17 ] ''jeevaniya'' (life promoters e.g. vitamins) [ Cha. Sa. [[Sutra Sthana]] 4/1 ] and ''brimhaniya gana'' (nourishing drugs) [ Cha. Sa. [[Sutra Sthana]] 4/2] are described. All these drugs have nutritional value ([[dhatu]] poshana) that helps in ulcer healing.

=== Indications and contraindications of agnikarma (cauterization) in various disorders ===

=== Indications and contraindications of agnikarma (cauterization) in various disorders ===

''Agni karma'' (cauterization by application of heat) is used as precaution for excessive bleeding ulcers, excision of hanging flesh, ''kaphaja granthi'' (enlarged gland due to ''kapha''), goitre and in stiffness (associated with ''vata'') etc. ''Agnikarma'' has ''ushna guna'' (hot property) which is opposite to ''vata'' and ''kapha''. Due to heat, vasodilation leads to alleviation of ''srotorodha'' resulting in proper vascularity to organ or part. ''Dahakarma'' (cauterization) causes constriction of blood vessels so prevents bleeding from ulcer.<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 14, shlok no.40 ,Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 72</ref> Cauterization is performed with the help of many substances like unctuous or ununctous substances etc by many ways e.g. Small spot (''bindu''), shape of ring (''valaya'') etc depending on nature of disease, strength of patient and time of application.

''Agni karma'' (cauterization by application of heat) is used as precaution for excessive bleeding ulcers, excision of hanging flesh, [[kapha]]ja granthi (enlarged gland due to [[kapha]]), goitre and in stiffness (associated with [[vata]]) etc. ''Agnikarma'' has ''ushna [[guna]] (hot property) which is opposite to [[vata]] and [[kapha]]. Due to heat, vasodilation leads to alleviation of ''srotorodha'' resulting in proper vascularity to organ or part. ''Dahakarma'' (cauterization) causes constriction of blood vessels so prevents bleeding from ulcer.<ref>Sushruta. Sutra Sthana, Cha.14 Shonitavarnaneeya Adhyaya verse 40. In: Kaviraja Ambikadutta Shastri, Editors. Sushruta Samhita. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2013. pp 72</ref>Cauterization is performed with the help of many substances like unctuous or ununctous substances etc by many ways e.g. Small spot (''bindu''), shape of ring (''valaya'') etc depending on nature of disease, strength of patient and time of application.

=== Importance of ''dhupana karma'' (fumigation therapy) in wound sterilization healing process ===

=== Importance of ''dhupana karma'' (fumigation therapy) in wound sterilization healing process ===

Fumigation of ulcer is done with ''dhupana dravyas'' (fumigating materials).<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 5, shlok no.17 ,Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 24</ref>, <ref>Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika, Uttara tantra Chap 25, shlok no.45, Reprint 2005, Chaukhambha Sanskrit Sansthan,Varanasi, pp 542.</ref>. Purpose of fumigation is to make suitable conditions for better ulcer healing such as local sterilization, vasodilation, decreased discharge and removal of foul smell.  

Fumigation of ulcer is done with ''dhupana dravyas'' (fumigating materials).<ref>Sushruta. Sutra Sthana, Cha.5 Agropaharaneeya Adhyaya verse 17. In: Kaviraja Ambikadutta Shastri, Editors. Sushruta Samhita. Reprint ed. Varanasi:Chaukhambha Sanskrit Sansthan ;2013. pp 24.</ref>,  

 

<ref>Vagbhata. Uttara Sthana, Cha.25 Vranapratishedha Adhyaya verse 45. In: Kaviraj Atrideva Gupta,Editors. Ashtanga Hridayam. Reprint ed. Varanasi: Chaukhambha Sanskrit Sansthan;2005.pp 542.</ref>. Purpose of fumigation is to make suitable conditions for better ulcer healing such as local sterilization, vasodilation, decreased discharge and removal of foul smell.  

Fumigation also relieves pain, discharge and kills microorganisms due to ''vata, kapha'' alleviating property along with antiseptic property.<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Chikitsa sthana Chap 1, shlok no.80, Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 12</ref> Various types of preparations are  used to harden or soften the wounds as per condition of wound.

Fumigation also relieves pain, discharge and kills microorganisms due to [[vata]], [[kapha] ]alleviating property along with antiseptic property.Various types of preparations are  used to harden or soften the wounds as per condition of wound.

#Research studies on management of ulcers:  The physician observing inflammation as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. Sushruta also indicated blood letting in initial stage of abscess or inflammatory conditions and in ischemic condition of the wound. (SU. Su. ---)<ref>Dwivedi SP, Shukla DV. Role of Jalaukavacharana (leech therapy) in the management of ankle sprain: a pilot study. International journal of [[Ayurveda]] & Alternative Medicine. 2014; 2 (4): 92-95.</ref>,<ref>Pandey BB, Kumar A, Singh N, Bhatia. Efficacy of Jalaukavcharana (Leech Application) in Ischemic Ulcer with Pre-Gangrenous Changes - A Case Report, Journal of [[Ayurveda]] 2012 Jul-Sep ; 4 (3) :103-107.</ref>

#Research studies on management of ulcers:  The physician observing inflammation as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. Sushruta also indicated blood letting in initial stage of abscess or inflammatory conditions and in ischemic condition of the wound.<ref>Dwivedi SP, Shukla DV. Role of Jalaukavacharana (leech therapy) in the management of ankle sprain: a pilot study. International journal of [[Ayurveda]] & Alternative Medicine. 2014; 2 (4): 92-95.</ref>,<ref>Pandey BB, Kumar A, Singh N, Bhatia. Efficacy of Jalaukavcharana (Leech Application) in Ischemic Ulcer with Pre-Gangrenous Changes - A Case Report, Journal of [[Ayurveda]] 2012 Jul-Sep ; 4 (3) :103-107.</ref>

#The ''nagrodhyadi'' group is indicated in wound as cooling for wounds which is found healing potential in one research.<ref>Lad M, Bandgar S. Management of non healing wound with nyagrodhadi kwatha and jatyadi ghruta (classical ayurvedic preparations). Global Journal of Research on Medicinal Plants & Indigenous Medicine (GJRMI). 2012; 1 (7): 301-308.</ref>

#The ''nagrodhyadi'' group is indicated in wound as cooling for wounds which is found healing potential in one research.<ref>Lad M, Bandgar S. Management of non healing wound with nyagrodhadi kwatha and jatyadi ghruta (classical ayurvedic preparations). Global Journal of Research on Medicinal Plants & Indigenous Medicine (GJRMI). 2012; 1 (7): 301-308.</ref>

#The ''panchavakkal'' (Vata (Ficus bengalensis Linn), ''Udumbara'' (Ficus glomerata Roxb.), ''Ashvattha'' (Ficus religiosa Linn.), ''Parisha/Pāriśa'' (Thespesia populenoides L.) and ''Plaksha'' (Ficus lacor Buch Ham.),) is indicated for the healing of chronic wound. In resent studies ''panchavalkal'' has  anti-inflammatory,  cleaning and healing potential in some research studies carried out and published in reputed journals of [[Ayurveda]].<ref>Meena RK, Dudhamal T, Gupta SK, Mahanta V. Wound healing potential of Pañcavalkala formulations in a postfistulectomy wound. Ancient Sci Life (ASL) 2015;35 (2):118-21</ref>,<ref>Bhat KS, Vishwesh BN, Sahu M, Shukla VK. A clinical study on the efficacy of panchavalkala cream in vrana shodhana w.s.r to its action on microbial load and wound infection. AYU. 2014;35(2):135-140</ref>,<ref>K. Shobha Bhat, M. Sahu, V.K. Shukla. Efficacy of pancavalkala cream in the management of chronic non-healing wounds, Aryavaidyan 2013 May-July ; (26) :224-228</ref>, <ref>Khadkutkar DK, Prof. Kanthi Veena. Therapeutic uses of Panchvalkala in different forms-a review. Ayurlog; National Journal of Research in [[Ayurveda]] Science.  2014; 2(1): 1-5</ref>, <ref>Khadkutkar DK, Prof. Kanthi Veena G. A Brief Review of Research Studies Conducted on Panchavalkal. Indian Journal of Ancient Medicine and Yoga. 2015;8(2): 87-94</ref>,<ref>Khadkutkar DK, Kanthi VG, Dudhamal TS. Antimicrobial activity of Panchavalkal powder and ointment. International Journal of Medicinal Plants and Natural Products (IJMPNP). 2015; 1(3): 9-15</ref>

#The ''panchavakkal'' (Vata (Ficus bengalensis Linn), ''Udumbara'' (Ficus glomerata Roxb.), ''Ashvattha'' (Ficus religiosa Linn.), ''Parisha/Pāriśa'' (Thespesia populenoides L.) and ''Plaksha'' (Ficus lacor Buch Ham.),) is indicated for the healing of chronic wound. In resent studies ''panchavalkal'' has  anti-inflammatory,  cleaning and healing potential in some research studies carried out and published in reputed journals of [[Ayurveda]].<ref>Meena RK, Dudhamal T, Gupta SK, Mahanta V. Wound healing potential of Pañcavalkala formulations in a postfistulectomy wound. Ancient Sci Life (ASL) 2015;35 (2):118-21</ref>,<ref>Bhat KS, Vishwesh BN, Sahu M, Shukla VK. A clinical study on the efficacy of panchavalkala cream in vrana shodhana w.s.r to its action on microbial load and wound infection. AYU. 2014;35(2):135-140</ref>,<ref>K. Shobha Bhat, M. Sahu, V.K. Shukla. Efficacy of pancavalkala cream in the management of chronic non-healing wounds, Aryavaidyan 2013 May-July ; (26) :224-228</ref>, <ref>Khadkutkar DK, Prof. Kanthi Veena. Therapeutic uses of Panchvalkala in different forms-a review. Ayurlog; National Journal of Research in [[Ayurveda]] Science.  2014; 2(1): 1-5</ref>, <ref>Khadkutkar DK, Prof. Kanthi Veena G. A Brief Review of Research Studies Conducted on Panchavalkal. Indian Journal of Ancient Medicine and Yoga. 2015;8(2): 87-94</ref>,<ref>Khadkutkar DK, Kanthi VG, Dudhamal TS. Antimicrobial activity of Panchavalkal powder and ointment. International Journal of Medicinal Plants and Natural Products (IJMPNP). 2015; 1(3): 9-15</ref>

The role of diet is very important in wounded patients which can be considered for further research as Charak mentioned that wounded patients should abstain from salt, sour, pungent, hot, burning and heavy food and drinks and also sexual intercourse.

The role of diet is very important in wounded patients which can be considered for further research as Charak mentioned that wounded patients should abstain from salt, sour, pungent, hot, burning and heavy food and drinks and also sexual intercourse.

</div>

</div>

== References ==

== References ==