Efficacy of topical application of paste mentioned in thalpthe pillium for Avasadana Karama: A case study

Abstract

Non-healing ulcers are defined as ulcers that persist despite appropriate treatment and do not proceed towards healing in a defined time period. Wound healing is a very dynamic and complex process. It is divided into 5 stages in which granulation tissue formation, angiogenesis and synthesis of collagen occurs in the proliferative phase. On the basis of clinical features, chronic non-healing ulcers can be considered as Dushtavrana in Ayurveda. Different types of Vrana and sixty types of treatment modalities are well explained in Susrutha Samhitha. Avasadana Karma is indicated in non-healing ulcers with hypergranulation tissues/wounds raised beyond the skin level. It is the procedure for reducing the overgrowth of tissue located at the wound base using drugs that promote necrotization or scraping of hypergranulated tissues. Thalpathe piliyam which is a collection of Ola leaf book drug remedies mentions some drug recipes for Avasadana karma. This study was designed to assess the effectiveness of Avasadana Karma on a chronic wound. In the present study, a 60-year old male patient visiting the IPD with a chronic non healing ulcer was selected for Avasadana karma. An elavated fleshy mass (5 cm x 2 cm x 1 cm) was present in the middle of the wound which hampered approximation of wound edges beyond the mass. Patient was not fit for instrumental excision due to his age and low haemoglobin levels. Daily dressing was done with paste mentioned in thalapathe pillium which contain goraka fruit (10 g) paste, tamarind leaf paste (10 g) and purified copper sulphate powder. It was observed that the tissue contacted with paste was necrotized by the next day. Necrrotized tissue was removed manuálly using surgical insruments. The study was done for a period of 30 days. The dimensions and attributes of the ulcer were systematically measured weekly and the result was assessed. Elavated mass like fleshy growth was completely removed and wound bed was clean after 2-3 days indicating that the above mentioned drugs have tissue necrotizing property.The result shows that topical application of paste is effective in Avasadana karama – stimulation of necrotize hypergranulation tissue formation of Dushta vrana.