Man is the superior most creature of God, having a sufficient intellectual mind to discover new things andconcurrently overcome the existing problems. So from very ancient time different methods of wound carehave been described. Wound is a separation or break in continuity of skin, mucous membrane or tissuecaused by physical, chemical or biological insult. Wound infections continue to represent a major medicalproblem, both in terms of how they affect the outcome of surgical procedures and for their impact on thelength of hospital stay and medical costs. In Ayurveda, an infected wound may be co-related with dushtavrana. Sushruta has explained that “vrana” (wound) is so called as it covers the site and the scar and evenafter healing, does not disappear till the person lives. Proper wound care is necessary to prevent infectionand to promote healing of the wound. In this paper, emphasis has been given to dushta vrana and itsmanagement description according to Samhita and an attempt has been made to explain the infectedwound according to modern concept

Gond, Pushpa

Singh, Lakshman

English

Advanced Research Publications: Medical Journals

© ADR Journals 2017. All Rights Reserved.Research ArticleConcept of Infected Wound (Dushta                           Vrana) in AyurvedaPushpa Gond1, Lakshman Singh2AbstractMan is the superior most creature of God, having a sufficient intellectual mind to discover new things and concurrently overcome the existing problems. So from very ancient time different methods of wound care have been described. Wound is a separation or break in continuity of skin, mucous membrane or tissue caused by physical, chemical or biological insult. Wound infections continue to represent a major medical problem, both in terms of how they affect the outcome of surgical procedures and for their impact on the length of hospital stay and medical costs. In Ayurveda, an infected wound may be co-related with dushta vrana. Sushruta has explained that “vrana” (wound) is so called as it covers the site and the scar and even after healing, does not disappear till the person lives. Proper wound care is necessary to prevent infection and to promote healing of the wound. In this paper, emphasis has been given to dushta vrana and its management description according to Samhita and an attempt has been made to explain the infected wound according to modern concept.Keywords: Vrana, Infected wound, Dushta vranaIntroduction A wound is a break in the integrity of the skin or tissue often, which may be associated with disruption of the structure and function.1 Wound healing is the body response to injury in an attempt to restore normal structure and function. The wound healing process can be divided into three phases: 1. Inflammatory (reactive) phase. 2. Proliferative (reparative phase). 3. Maturation (remodeling) phase. Wound healing is a dynamic process and all the three phases may occur simultaneously.2 It may be divided as: according to length of time 1. Acute – <6 weeks and 2. Chronic wound >6 weeks.3 Majority of skin lesions are called wounds and primarily are divided into acute and chronic, the difference being the time period during which they have been in existence and/or their tendency to heal properly or not.4 Vrana “Vrana Gatravichurne, Vranayateti Vranah” (Su.S. Chi.1/6)“Gatra” means body (body tissue or part of body). “Vichurnane” means destruction, break, rupture and discontinuity (of the body or tissue). “The destruction/break/rupture/discontinuity of body/tissue/part of body, is called “vrana.”5Sushruta has explained that “the scars of a wound never disappear even after complete healing and its imprint persists lifelong and it is called vrana by the wise.”6 Vagbhat gave a beautiful definition of vrana, i.e., vrana makes the person pray (to God ) till his life exists” or “that which exposes the interior of the body.”7 It is of two types: 1. Nija (Organic) – is 1Ph.D. Scholar, 2Professor and Head, Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi.Correspondence: Dr. Pushpa Gond, Department of Shalya Tantra, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi.E-mail Id: drpushpagond@gmail.comOrcid Id: http://orcid.org/0000-0002-1311-3675How to cite this article: Gond P, Singh L. Concept of Infected Wound (Dushta Vrana) in Ayurveda. J Adv Res Ayur Yoga Unani Sidd Homeo 2017; 4(3): 11-15.Digital Object Identifier (DOI): https://doi.org/10.24321/2394.6547.201713ISSN: 2394-6547J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2017; 4(3)ISSN: 2394-6547Gond P et al.born from the doshas and agantu (Traumatic) – caused by sharp weapons, implements, stone, baton, nails, teeth, horns, poisons, aruskara, etc. Even this (agantu vrana) when gets vitiated by vata and other dosha becomes a nija vrana. Again, he described types of vrana are of two kinds: duhsta (vitiated) and suddha (non-vitiated); dushta means getting vitiated by the doshas.Infected Chronic Wound These chronic wounds may also be considered infectious. Chronic wounds are those which do not respond to treatment and/or demands of treatment are beyond the patient’s health, tolerance or stamina or alternatively any wound lasting for more than 6 weeks.8 A biofilm is an aggregate of multiple microorganisms (polymicrobial), adherent to each other on a surface and embedded within a self-produced carbohydrate and protein matrix of extracellular polymeric substance or exopolysaccharide. Biofilms account for more than 80% of all microbial infections of the human body. In context of human infection, biofilms are an integral part of chronic wounds, but are uncommon in acute wounds. They have been identified as one of the main variables responsible for resistant infection or recurrence of a seemingly cured infection. The site of attachment and formation of the biofilm includes wound surface, dressings, sutures, etc. Some of the important surgical site infections and chronic soft tissue infections, etc. The protective nature of the biofilm structure makes the bacteria embedded within them remarkably difficult to treat with antimicrobials.9 The effect of bacteria in a wound is often described as a continuum, which extends from contamination (the presence of bacteria without problems), to colonization (the presence of multiplying bacteria), to infection with tissue invasion. Infection may be localized to the wound, spread into nearby tissues, or cause systemic illness such as systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction (MODS). The classical signs of local infection are pain, heat, swelling, redness and loss of function, and may be accompanied by purulent discharge, pyrexia and malodor. However in chronic wounds, the patient often has comorbidities that suppress the signs of inflammation. As a result, identifying infection in chronic wounds may be difficult and clinicians need to rely on other signs and symptoms (Table 1).10 Localized Infection Spreading infectionAcute Wounds, e.g., surgical or traumatic wounds, burnsClassical signs and symptoms:New or increasing pain ErythemaLocal warmthSwellingPurulent dischargePyrexiaDelayed or stalled healing Abscess Malodor As for localized infection, plusFurther extension of erythemaLymphangitisCrepitus in soft tissuesWound dehiscenceChronic wounds, e.g., diabetic foot ulcers, venous leg ulcers, arterial leg/foot ulcers, pressure ulcersNew, increased or altered painDelayed (or stalled) healingPeriwound edemaBleeding or friable granulation tissueDistinctive malodor or change in odorWound bed discoloration Increased, altered or purulent exudates IndurationPocketing or bridging As for localized chronic infection, plus:Wound dehiscence Erythema extending from the wound edgeCrepitus, warmth, induration or discoloration spreading into periwound areaLymphangitisMalaise or non-specific deterioration in the patient’s general conditionSystemic InfectionSepsis: Documented infection with pyrexia or hypothermia, tachycardia, tachypnea, raised or depressed white blood cell countSevere Sepsis: sepsis and multiple organ dysfunctions.Table 1.Signs and Symptoms of Localized, Spreading and Systemic Infection in WoundsDushta Vrana The word dushta literally means a putrified ulcer – the wound that has got vitiated.11 The muscular tissues are afflicted with sensitization (praharsha) and scatteredness/disintegration of the blood (rudhiramvikira) basically cause severe kind of dushta vrana.1212J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2017; 4(3)ISSN: 2394-6547Gond P et al.According to Charaka, vrana which produces foul smell, has lost its normal color, produces excessive discharge with excessive pain is dushta vrana. According to Acharya Madhava, dushta vrana is chronic in nature, elevated from the surface, discharges pus and impure blood with foul smell and has opposite characters of suddha vrana.13 Causes of Dushta Vrana • Improper dressing• Infected ward or dressing material• Intake of contraindicated diet such as new paddy, pea, green leafy vegetables, yoghurt, milk, butter milk• Intake of alcohol• Flies• Contact of vrana with draughts, hot sun, dust, smoke, dew, etc• Improper nutrition• Contact with ‘harmful organisms’ due to unhygienic conditions.14 Types of Dushta Vrana Sushruta classified dushta vrana on the basis of involvement of doshas. He mentioned that on the basis of severity of doshas, dushta vrana is divided into six types15 – vataja, pittaja, kaphaja, raktaja, sannipataja, and agantuja. According to Bhela Samhita, there are twelve blemishes of the wounds; their examination is of six kinds and the procedures for treatment thirty-six as far as they are determined for the purposes of surgical treatment.16 Apart from this, Charaka classified dushta vrana on the basis of clinical features into 12 categories mentioned in Table 2.17 S. No. Type Clinical Feature1 Shweta Paleness of ulcer2 Avasanna vartma Depressed margin of ulcer3 Ati sthula vartma Thick margins of ulcer 4 Ati pinjara Very reddish yellow mixed coloration of ulcer5 Nila Blue coloration of ulcer6 Shyava Blackish brown color floor7 Ati pidika Excessive blisters on and around vrana8 Rakta Red colored floor9 Krishna Black colored floor10 Ati putika Excessive putrification11 Ropya Recurrence due to deep seated vitiated doshas12 Kumbhimukha Vrana with narrow external opening and wide base like a jarTable 2.Types of Dushta VranaClinical Features of Dushta Vrana Sushruta described about dushta vrana in detail. According to him, excessively narrow or wide mouth, too hard or too soft vrana, elevation of floor or depressed floor, too cold or too hot, having one of the colors – black, red, yellow, white – frightful, full of fetid pus, muscles, vessels, ligaments, etc., discharging fetid pus, moving in oblique track, having deep base, with ugly sight and foul smell, severely painful; associates with heat, suppuration, redness, itching, swelling and boils, excessively discharging vitiated blood and long lasting – these are features of a vitiated ulcer.18 Factors Responsible for Healing of Wounds according to Ayurveda Sushruta described about factors, i.e., wounds are easily curable in patients who are youthful, strong, full of vitality and with tolerant psyche or in a single person who has all these four qualities, the wounds are curable in the easiest way. There, in youthful persons due to fresh (developing) tissues, wounds heal up rapidly; in strong persons, because of firm and profuse musculature, applied sharp instruments do not touch vessels, ligaments etc.; in those having high vitality pin, injury, dietetic restrictions, etc., do not produce malaise and in those having high vitality pain, injury, dietetic restrictions, etc., do not produce malaise and in those having tolerant psyche no pain is felt even by harsh operations. Hence in such persons, wounds are easily curable.19 Wounds of those suffering from leprosy, poison, consumption and diabetes are cured with difficulty and also of those who have wounds over wounds.20 Management Although much progress has been made in management of wounds in the past few years, management of vrana has been remaining significant health-related issue ever since the period of Sushruta. He described even about wounded person that should live in a house architecturally commendable, clean, and free from the sun and wind.21 Again, Sushruta described about precautions which should be taken like – one should avoid disturbing agents like excessive exposure to wind, the sun, dust, smoke, dew, excessive eating, undesirable food, sound and sight; envy, wrath, fear, grief, anxiety, awaking in night, irregular eating and sleeping, fasting, speaking, exercise, standing, walking, 13J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2017; 4(3)ISSN: 2394-6547Gond P et al.cold wind, incompatible food, eating when previous meal is not digested, indigestion, flies, etc.22 There are a number of procedures performed for various steps of healing of vrana. Among these, shuddha vrana has been treated by ropana remedies, whereas dushta vrana is managed on the basis of involvement of vitiated doshas, site of vrana, excessive putrification, and inflammatory changes. Sushruta described sixty different types of management of vrana in general. Of them, decoction, wick, paste, ghee, oil, semisolid extract and dusting powder are both for cleansing and healing procedures described by Sushruta. [23] Conclusion In this way, vrana is an important issue of shalya tantra due to its involvement in many surgical conditions and Ayurveda gives message how to check disease causative factors and what should be done when a person becomes diseased too. Sushruta, the father of Indian surgery, has scientifically classified in a systemic manner a wealth of clinical material and the principles of management which are valid even today. Description of vrana is one of the very important area covered by him, for which only he has dedicated eight chapters in his Samhita Grantha. A broad classification of vrana, shuddha vrana, nadi vrana, sadhya vrana, dagdha vrana, etc., and their management in the form of sixty upakramas which are from apatarpana to rakshavidhana are given in the text. There are many factors which are responsible for resulting in delayed wound healing like diabetes, anemia and the infection is one of these. So, infection in wound delays the healing of wound stages and produces a chronic wound. Infected wound may be correlated to dushta vrana. In ancient time Sushruta, Charak, Vagbhat, etc., provided a lot of knowledge related to dushta vrana. They also described detailed knowledge about management of dushta vrana. They described preventive measures for wounds and described dos and don’ts for a wounded patient too. So, there is huge description in Ayurveda to describe dushta vrana (infected wound). Now it is our skill to learn from our Samhita and utilize it to manage dushta vrana accordingly.Conflict of Interest: NoneReferences1. 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Concept of Infected Wound (Dushta Vrana) in Ayurveda

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Concept of Infected Wound (Dushta Vrana) in Ayurveda

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