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Line 1,591: − + − + − + + + + + + + − Treatment of vrana (ulcers): − 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.Raktamokshan is an important modality (Sushruta samhita. Chi. 1/27-28) 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. − Thirty six treatment measures: − 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.[ ] 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. (Su. Chi. 1/8). − 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. − Indications and process of six fold surgical procedures: Six types of surgical procedures are described for treatment of ulcer such as patana (incision), vyadhana (puncturing), chhedana (excision), lekhana (scrapping), pracchana (scarification) and seevana (suturing). Patana procedure described by Charaka is same as for bhedana by Sushruta. Any similar or new procedure can be applied in wound management as per the surgeon’s freedom. [ ] − Pidana (Compression): − Widening of external opening (mouth) of ulcer or abscess along with breaking of multiple loculi to make uniform cavity, to avoid the collection of pus in multiple pockets and facilitate free drainage of pus. Pidana (compression) is also helpful to squeeze out the collected pus. For compression various pastes are applied over the ulcer of abscess except on mouth openings. − + + + + + + + + + + + + + + + + + + + + + + + +
→Investigations and their clinical interpretation in brief
==== Investigations and their clinical interpretation in brief ====
==== Investigations and their clinical interpretation in brief ====
The clinical features of ulcers are ulceration /disccontineous of skin, discharge (pus/blood/ serum), bad odor, differenct size, painful/painless ulcers. The above symptoms are described by Acharya Sushruta (Gandha, varna, sava, vedana, Akruti). On the basis of which kind of ulcer (varicose ulcer, diabetic ulcer, aterial ulcer, bedsores, leprotic ulcer, rodent ulcer, etc ) the symptoms may vary. In all types of ulcers on the basis of history and clinical examinations the following investigations play important role in diagnosis and prognosis of the Ulcer. TLC (Total leucocyte count), Hb% , Serum crestnine, BSL (Blood sugar level) swab culture, X-ray of affected part if chronic ulcer. if TLC are increase than normal range suggest the acute infection. if Hb% is low then the ulcer will heal delay due hyposia to the tissue. If serum creatnie is increased that might be due to kidney problem which hampered healing of ulcer. In diabetic patients BSL assessment is important for healing as glucose liden tissue are reluctant to heal. Swab culture of wound discharge is necessary to know the organism. Lastly s-xay is essential to know extension of wound upto bone/osteomylituis.
The clinical features of ulcers are ulceration /disccontineous of skin, discharge (pus/blood/ serum), bad odor, differenct size, painful/painless ulcers. The above symptoms are described by Acharya Sushruta (''gandha, varna, sava, vedana, akruti''). On the basis of which kind of ulcer (varicose ulcer, diabetic ulcer, arterial ulcer, bedsores, leprotic ulcer, rodent ulcer, etc) the symptoms may vary. In all types of ulcers on the basis of history and clinical examinations the following investigations play important role in diagnosis and prognosis of the Ulcer. TLC (Total leucocyte count), Hb% , Serum crestnine, BSL (Blood sugar level) swab culture, X-ray of affected part if chronic ulcer. If TLC are increase than normal range suggest the acute infection. if Hb% is low then the ulcer will heal delay due hyposia to the tissue. If serum creatinine is increased that might be due to kidney problem which hampered healing of ulcer. In diabetic patients BSL assessment is important for healing as glucose liden tissue are reluctant to heal. Swab culture of wound discharge is necessary to know the organism. Lastly s-xay is essential to know extension of wound upto bone/osteomylituis.
Complications of ulcer: If ulcer is not treated properly it may lead to local and systemic infection leading to septesemia. The tissue necrosis leads to gangrene which further need to amputation.
Causes of non-healing:
===== Complications of ulcer =====
If ulcer is not treated properly it may lead to local and systemic infection leading to septicemia. The tissue necrosis leads to gangrene which further need to amputation.
===== Causes of non-healing =====
Two factors mainly affect the process of wound healing viz. local factors and systemic factors.
Two factors mainly affect the process of wound healing viz. local factors and systemic factors.
Local factors are infection, necrosis, foreign body, vascular insufficiency, lymphatic obstruction, continuous movement of part. Systemic causes include old age, protein deficiency, vit-c and zinc deficiency, diabetes mellitus.
Local factors are infection, necrosis, foreign body, vascular insufficiency, lymphatic obstruction, continuous movement of part. Systemic causes include old age, protein deficiency, vit-c and zinc deficiency, diabetes mellitus.
Management of fracture and dislocation:
==== Treatment of ''vrana'' (ulcers) ====
===== 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 (Sushruta Samhita. Chi. 1/27-28) 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.
===== Thirty six treatment measures =====
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.[ ] 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. (Su. Chi. 1/8).
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.
==== Indications and process of six fold surgical procedures ====
Six types of surgical procedures are described for treatment of ulcer such as ''patana'' (incision), ''vyadhana'' (puncturing), ''chhedana'' (excision), ''lekhana'' (scrapping), ''pracchana'' (scarification) and ''seevana'' (suturing). ''Patana'' procedure described by Charaka is same as for ''bhedana'' by Sushruta. Any similar or new procedure can be applied in wound management as per the surgeon’s freedom. [ ]
===== ''Pidana'' (Compression) =====
Widening of external opening (mouth) of ulcer or abscess along with breaking of multiple loculi to make uniform cavity, to avoid the collection of pus in multiple pockets and facilitate free drainage of pus. ''Pidana'' (compression) is also helpful to squeeze out the collected pus. For compression various pastes are applied over the ulcer of abscess except on mouth openings.
===== Management of fracture and dislocation =====
The basic guidelines for management of fracture and dislocation are to stablise the fractured bone or dislocated joint by application of splints. Proper alignment of bone is mandatory for healing of fractured bone.[ ] Suitable dietary regimen should be followed with avoidance of vidahi (food which causes burning sensation) food. [ ] Strenous exercise is not allowed during healing period due to risk of re-fracture and dislocation. Complications due to fracture of bone or dislocation of joint are managed as per condition. For e.g. If ulcer is due to fracture of bone then treatment of ulcer along with fracture management should be adopted.
The basic guidelines for management of fracture and dislocation are to stablise the fractured bone or dislocated joint by application of splints. Proper alignment of bone is mandatory for healing of fractured bone.[ ] Suitable dietary regimen should be followed with avoidance of vidahi (food which causes burning sensation) food. [ ] Strenous exercise is not allowed during healing period due to risk of re-fracture and dislocation. Complications due to fracture of bone or dislocation of joint are managed as per condition. For e.g. If ulcer is due to fracture of bone then treatment of ulcer along with fracture management should be adopted.
Eshanakarma (probing):
Eshanakarma (probing):