Role Of Lekhana Karma In Dushta Vrana (Wound) Management- A Review

P a g e | 238 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION International Research Journal of Ayurveda & Yoga An International Peer Reviewed Journal for Ayurveda & Yoga VOLUME 4 ISSUE 9 1.P.G. Scholar, PG Department Of Shalya Tantra, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University Jodhpur. 2.Professor & H.O.D. PG Department of Shalya Tantra, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University Jodhpur. 3.Associate professor, PG Department Of Shalya Tantra, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University Jodhpur. Corresponding Author :- Dr. Pankaj Potalia, P.G. Scholar, PG Department Of Shalya Tantra, Dr. Sarvepalli Radhakrishnan Rajasthan Ayurveda University Jodhpur . Email, Id - pankaj 25 potalia@gmail.com Article received on 28 th August 2021 Article Accepted 25 th Sept. 2021 Article published 30 th Sept. 2021 ABSTRACT: - Ayurveda is an ancient Eternal method of medicine. Ayurveda is concerned with all aspects of life, both healthy and unhealthy. It provides a lot of information aimed at healing wounds. For the treatment of different disorders, a variety of surgical and para surgical procedures have been described. Vrana is one among them, which is affecting the humans from the ancient period of civilization. Vrana stated in Ayurveda simulates Ulcers or wound; which may get converted into Dushta Vrana . The word Dushta means bad, wicked, offensive, and culpable or necrotic. In Ayurveda , the Vrana is referred to as Wound and healing process of Vrana is a natural phenomenon that begins almost immediately just after an injury. Shalya Tantra is a significant branch of Ayurveda . In this branch of Ayurveda i.e , Shalya Tantra Lekhana karma is one among the Shashthi Upakrama and Ashtavidh Shastrakarma . In the procedure of Lekhan Karma (Debridement), necrotic tissue & slough are removed till the fresh blood comes out. Lekhan Karma of vrana is removing of debris from the wound. wounds having thick and irregular edges which burst often with hard and elevated muscles, that means the floor is full of slough or with necrosed tissues. Coarse linen clothes, thick cotton clothes, alkali and surgical equipment’s are all the means we use for the purpose of Lekhana karma . Thus, the Infection is prevented by the removal of necrosed tissues. Keywords : Lekhana karma, vrana, wound management, Ashtavidh Shastrakarma Role Of Lekhana Karma In Dushta Vrana (Wound) Management- A Review Pankaj Potalia, 1 Rajesh Kumar Gupta, 2 Vishnu Dutt sharma 3

P a g e | 239 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION This work is licensed under a creative attribution -Non-commercial-No derivatives 4.0 International License commons How to cite this article: Potalia P, Gupta R.K. Sharma V.D “Role Of Lekhana Karma In Dushta Vrana (Wound) Management- A Review ” IRJAY. [Online] 2021;4(9): 238-243. Available from : http://irjay.com ; DOI: https://doi.org/10.47223/IRJAY.2021.4931 INTRODUCTION: Definition of Vran̩a It is based on both the immediate effect and the scar that it leaves behind. The word "Gatra" means "body" (body tissue or part of body) .“Vichurnane ” refers to devastation, rupture, and discontinuity (of the body or tissue) “ Vrana” refers to the destruction, break, rupture, or discontinuity of a body, tissue, or component of the body. “The scars of a wound never erase even after complete healing, and their imprint endures for life, and it is called Vranavastu,” says Acharya Susruta [1] Classification of Vrana :- [2][3] 1. According to Etiology (Nidana)- 1. Nija vrana 2. Agantuja vrana 2. According to Site -1. Skin, 2. Bone, 3. Muscle 4. Joints, 5. Vessels 6. Internal Organ, 7. Ligaments, 8. Vital Parts. 3. According to Clinical features - 1. Dushta 2. Shuddha 3. Ruhyamana 4. Rudha 4.According to Prognosis - 1. Sukha Sadhya 2. Kashta Sadhya 3. Yapya 4. Asadhya 4. Dushta Vrana: [4][5] The word “Dushta” literally means bad, wicked, offensive, and culpable or necrotic. Dushta Vrana : The word “ Dushta” literally means bad, wicked, offensive, and culpable or necrotic. Dushta Vrana is described as The Vrana in which all four doshas are vitiated, resulting in the chronicity of Vrana with symptoms viz; with profuse exudates, foul odours, indicators of inflammation and so on. In other terms, Dushta Vrana is a Vrana that lacks the qualities of Shuddha Vrana (clean wound) Dushta Vrana Lakshana: Durgandhita, Pooyayukta, Atipooya srava, Utsangi, Chiarkalin, Dushita, Atigandha Varna Srava, Vedanayukta, Suddha lakshana viparita e.g,the infectious wound in due course of time [6][7] MATERIALS AND METHODS All the Ayurveda and contemporary texts were explored and the relevant information was presented in the prescribed format AIM AND OBJECTIVE: 1 To evaluate, clarify, and analyse many surgical ideas which are described in Sushruta Samhita under Lekhana Karma . 2 To understand the basic principles of wound management. 3 Critical analysis of the application of Lekhana Karma corelated with modern medical science. RESULTS AND DISCUSSION Management of wound Haemostasis, inflammation, proliferation, and remodeling are the four stages of wound healing respectively. Infection, age, and sex hormones,

P a g e | 240 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION stress, diabetes, obesity, drugs, alcoholism, smoking, and diet are among the many elements that impact the healing process, with infection being our primary worry.

P a g e | 241 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION In wound treatment, the concept of treating the wound bed to encourage reepithelialization of chronic wounds has been managed. The four general steps to follow for preparation are compassed in the acronym DIME. * D: Debridement of necrotic tissue within the Wound. * I: Management of Inflammation and Infection * M: Moisture control * E: Environmental and Epithelialization assessment The DIME method to chronic wound treatment is a broad notion from which a more specific pathway to wound resolution may be developed. [8][9] Debridement: Debridement of nonviable tissue within the Wound It is described as the removal of non-viable tissue and the promotion of the growth of viable, well-vascularized tissue. Debridement is used to accomplish this. Surgical, mechanical, and chemical debridement are the three types of debridement used in Ayurveda . Surgical debridement is the quickest approach to remove debris and necrotic material from the wound bed while causing little injury to surrounding tissue. Surgical options are determined by the amount of slough on the wound bed. Chemical debridement agents such as Kshara (caustics) are utilized [10] The word “Lekhana” is derived from the root word “likh” which means to write, to remove, to scrap, to scratch ,to tear up, the furrow of. The suffix “Nyat” is added to it to get Lekhana , which means hurting scraping, and so on. Indication of Lekhana karma [11] in the wound in surgery Lekhana means scraping with instrument or alkalies

P a g e | 242 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION In Sushruta Samhita Lekhnan Karma is a type of Sastrakarma . and it is done by Vridhhipatra and Mandalagra Shastra and Kshar also possess the qualities of Lekhana Karma , honey, Tila Taila, Sarsapa Taila, Sandhav Lavana . In Sharangdhar Samhita it is described that Lekhana is the “the drug which will reduce or scrapes away the unwanted Dhatus (tissues) and Malas ( metabolic wastes ) is known as Lekhana” [12] DEBRIDEMENT (according to modern science):- Debridement's main purpose is to remove all devitalized tissue from the wound bed in order to enhance wound healing. Debridement is an important part of wound care that prepares the wound bed for reepithelialization. Bacteria gets their nourishment from devitalized tissue in general and necrotic tissue in particular. Devitalized tissue also functions as a physical barrier to reepithelialize, preventing topical medications from making direct touch with the wound bed and delivering their therapeutic benefits. Angiogenesis, granulation tissue creation, epidermal resurfacing, and normal extracellular matrix (ECM) development are all inhibited by necrotic tissue. Finally, the presence of necrotic tissue may make it difficult for the doctor to accurately determine the wound's size and severity. Technique Devitalized tissue can be removed using a variety of debridement. Surgical debridement, biological debridement, enzymatic debridement, and autolytic debridement are some of the options. Surgical Debridement with Sharp Instruments Surgical debridement is the most efficient way to remove debris and necrotic material from the wound bed while inflicting little tissue damage. The quantity of slough on the wound bed determines surgical choice. This is a sort of debridement in which devitalized tissue (slough, necrotic tissues) is removed with sharp instruments such as a scalpel in the presence of an underlying infection. Metzenbaum scissors, vridhhipatra and mandalagra shastra , curettes, etc [13] Chemical Debridement - This is a sort of debridement in which devitalized tissue (slough, necrotic, or eschar) is removed with a chemical like Kshara in the presence of an underlying infection. Mechanical Debridement Mechanical debridement is a nonselective debridement method that removes both devitalized and viable tissue. It is usually carried out using mechanical force like wet-to-dry ( Bandhan ), pulsatile lavage, or wound irrigation. Autolytic Debridement This is the gentlest method of debridement. This sort of debridement is a natural process in which necrotic tissue is broken down by endogenous phagocytic cells and proteolytic enzymes. Only necrotic tissue is damaged by the debridement, which is a very selective procedure. It is suggested for the wounds that aren't infected. It can also be used to treat infected wounds as an additional treatment. In the case of infected wounds, it can be used with any other debridement treatments. Biological Debridement Biological debridement, commonly known as a larval treatment, employs sterile Lucilia sericata

P a g e | 243 Review Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION green bottle fly larvae. It is an efficient form of debridement, especially in big wounds where painless necrotic tissue removal is required. CONCLUSION: In this review study, it can be concluded that Acharya Sushruta described Vrana (wound) and Vrana Upakrama (management of wound) in detail. This description clearly suggests that they have understood this disease clearly and therefore were, able to treat this condition properly. That can be employed according to the different types of wounds. It is easy to learn and apply the principle of Lekhana Krama in the management of Dushta Vrana i.e; wounds. Acknowledgment: Nil. Financial Support: Nil. Conflict of Interest: Nil REFERENCES 1 Singh L, Concept Of Vrana In Ayurveda, Chaukhambha Orientalia Publication, Varanasi, 2013.Pp. 1-2. 2 Concept Of Wound ( Vrana ) In Ayurveda, By DR. G. S.Rathore Et Al., ANVIKSHIKI Indian Journal Of Research(2012)6,108-115 3 Shastri A, Sushruta Samhita, Ayurved tatva Sandipika, Chikitsa Sthana. Published By Varanasi, Choukambha Surbharati Prakashan 2007. Pp.(57- 58):10. 4 Shastri A, Sushruta Samhita, Ayurvedtatva Sandipika, Sutra Sthana Chapeter 22/3 Published By Varanasi, Choukambha Surbharati Prakashan 2007. Pp.95 5 Shastri A, Sushruta Samhita, Ayurvedtatva Sandipika, Chikitsasthanam Chapter 1/8, Published By Varanasi, Choukambha Surbharati Prakashan ;2009.Pp.4 6 Rathore G.S Concept Of Wound (Vrana) In Ayurveda, ANVIKSHIKI Indian Journal Of Research(2012)6,Pp.-108 7 Tripathi B, Charaksamhita, Charak Chandrika, Hindi Commentry Vol I And II, Chikitsa Sthana, 25/6 Chaukhamba Subharti Prakashan, Varanasi, Reprinted,; 2003. 8 Shastri A, Sushruta Samhita, Ayurvedtatva Sandipika, Sutra Sthanam Chapter 36/10-11 Published By Varanasi, Choukambha Surbharati Prakashan 2007. 9 Shastri A, Sushruta Samhita, Ayurvedtatva Sandipika, S.Su 28/13-17, Published By Varanasi, Choukambha Surbharati Prakashan 2007. 10 Rathore G.S Concept Of Wound (Vrana) In Ayurveda, ANVIKSHIKI Indian Journal Of Research(2012)6,Pp.112 11 Shastri A, Sushruta Samhita, Ayurvedtatva Sandipika, Sutra Sthanam Chapter 17 /22,23, Published By Varanasi, Choukambha Surbharati Prakashan 2007.Pp 74. 12 Shastri A, Sushruta Samhita, Ayurvedtatva Sandipika, Chikitsasthanam Chapter 1 /8 Published By Varanasi, Choukambha Surbharati Prakashan;2007.pp.4 13 Verma A ‘A Brief Review On Shasti upakrama’, IJAAR Volume 1 Issue 5 May-Jun 2014

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