A Comparative Clinical Study To Evaluate The Efficacy Of Kasisa Churna And...

[Full title: A Comparative Clinical Study To Evaluate The Efficacy Of Kasisa Churna And Puga Churna Avachurnana In Vrana]

P a g e | 11 Research 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 10 1 PG Scholar Dept of Shalya tantra KVGAMCH 2 Professor & HOD, Dept of Shalya tantra, KVGAMCH Corresponding Author :- Babitha Rao A, PG Scholar Dept of -Shalya tantra (KVGAMCH), Email, Idbabitharao.a@gmail.com Article received on 15 th September 2021 Article Accepted 22 nd Oct 2021 Article published 31 st Oct 2021 ABSTRACT: - Healthy healing of Vrana is most important part of surgery it can be Nija (endogenous) and Agantu – (exogenous) or Shastrakrit ; it’s not merely deals with good closure of wound but also maintain its anatomical and functional integrity with minimal scar formation without complications . Avachurnana used in superficial/ Deep and foul-smelling ulcers covered with layers of deranged fat Shodhana (purification) and Ropana (healing) being safer, easy, potent and economic procedure useful to establish even Vaikrutapaham (to restore normalcy to scar). Kasisa is Shothahara (anti inflammatory), Rujahara, (analgesic) Krumihara (wormicidal) , Sankochakaraka etc, ingredient in Vrana Chikitsa kalpa’s - vrana Ropana churna, Vrana Shodhana Sutra/Varti, Roma Sanjana yoga etc. P atient belongs to whichever geographical area, the medicine grown in same region is hita; Puga , locally cultivated, available worldwide, economic, ingredient in various vrana yoga’s - Ghontaphaladi Varti; Pugadi yoga, Pugadi lepa, mocha-Pugadi ksheera etc; it possesses Kashaya rasa which aids vrana Ropana; Kledahara, Malahara , Rusha – Sankochakaraka, Shotahara, raktasthambana etc. Brinraja Bhavita Kasisa Churna and Puga Churna avachurnana (Topical Medicated Dusting) in Randomized comparative clinical study with Group A overall result is 94.21% and Group B overall result is 91.10% which shows statically significant results in both groups. Comparative analysis of the overall effect of the treatments in both the groups with unpaired t-test shows that the treatment is not significant in Group A. No Incidences of complications like infection, aggravation of Lakshana, recurrence or any other adverse effects were found during the study Keywords : Vrana; Wound; Avachurnana; Kasisa; Puga; Brinraja; Churna; Shodhana; Ropana; Upakrama; A Comparative Clinical Study To Evaluate The Efficacy Of Kasisa Churna And Puga Churna Avachurnana In Vrana Babitha Rao A 1 , Harsha vardhana 2

P a g e | 12 Research 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: Rao B.A, Vardhana H “A Comparative Clinical Study To Evaluate The Efficacy Of Kasisa Churna And Puga Churna Avachurnana In Vrana” IRJAY. [Online] 2021;4(10):11-23. Available from : http://irjay.com ; DOI:-https://doi.org/10.47223/IRJAY.2021.41002 INTRODUCTION Life starts with healing of Umbilical cord cut wound. Vrana (wound) is discontinuity of body surface, causes damage and discoloration of tissue with pain [1] . Ayurveda - Science of Life, being a Upaveda helps human to achieve Chaturvidha Purusharthas [2] ; obstacle is Ruja/ Vyadhi (Pain/ Disease). Ayurveda aims to prevent and cure the disease & maintain healthy state [3] ; understanding of this is made simpler under Ashtangas of Ayurveda and Shalyatantra (Medical Branch dealing with Surgery) is one among them [4] - Vrana Vinishcayaartham being one major subject [5] , its etiopathology - treatment is elaborately described [ 6] . All types of Shalya and Shastra - Anushastra Karma (Major Surgical and Para-surgical Procedures) ultimately result into Vrana formation; thus, its thorough knowledge is essential for the Shalya Kovida (Surgeon). Wound Healing is natural process, but many times requires support. Sandhana karma by Deva Vaidyas Ashwini Kumaras in head of Yajna (Daksha) [7] is reference from veda ; Puranas mention about Surgical wounds; Great Indian Epics Ramayana and Mahabharata also mention about wound healing and saving of life. Brihat trio, Laghu trio , Bhela Samhita, Kashyapa Samhita, Yogaratnakar, Bhaishajya Ratnaavali etc treaties describe different aspects of Vrana . Also, the references about wound can be found in the history of different civilizations across the world [8] . Shasthi Upakrama [9] (aids/ medications/ procedures) aids good approximation without complication with early healing and acceptable scar. Topical applications like Vrana Prakshalana (irrigation), Pichu, Lepa, Ghrita, Taila, Rasakriya, Avachurnana are adopted depending on Vrana Avastha (condition), Dosha , for Shodhana (cleansing/ debridement) and Ropana (accelerate early healing) [10 ]to avoid dead tissue, infection and foreign body etc affecting normal healing process and promote tissue healing. Going further, Acharya Sushruta has given much emphasis on Vaikruthapaham (to restore normalcy to scar). [11] - bringing back the normal color, surface and even hair [12] ; but presently wound is healed when epithelialization is complete/replacement of dead tissue with living tissue [13] . Need and significance for the study: In India, a recent study estimated a prevalence rate of chronic wounds at 4.5 per 1000 population, the incidence of acute wounds was more than double at 10.5 per 1000 population [14] . A search for more effective and safe method of Vrana Shodhana (purification) and Vrana Ropana (wound healing)is a demand for management of Vrana . For full application of principles told by our Acharyas there is need of extensive applied and evidence-based study. This Clinical Comparative study aims at the evaluation of the efficacy of Dusting of Medicated Powder ( Avachurnana ) using selected drugs ( Bringaraja bhavita Kasisa Churna and Puga Churna) in the

P a g e | 13 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION management of Wound ( Vrana ) . Avachuranana means sprinkling of Medicated Powder over the wound as Bahya Chikitsa (Topical application/ External local therapy); finest modalities in superficial/deep foulsmelling ulcers covered with deranged fat [15] for Shodhana and Ropana ; it’s safer, easy, potent and economic; also, helpful to establish Vaikrutapaham [16] . Kasisa, Kimshuka, Triphala, Lodhra etc are Avachurnana Dravya by Teeka Kaaras [17] . Kasisa is used in Vrana [18] for its properties like Shothahara, Rujahara, Krumihara, Sankochakaraka , Lekhana, Rakta Vardhaka, Ropaka, Shodhaka and so on [19]-[20] ; ingredient in Vrana Chikitsa kalpa’s - vrana Ropana churna, Vrana Shodhana Sutra/Varti, Roma Sanjana yoga etc . Patient belongs to whichever geographical area, the medicine grown in same region is Hita; Puga is locally cultivated, available worldwide, economic, possess Kashaya Rasa [21] which aids Vrana Ropana; it is Kleda – Malahara [22] , Rusha – Sankochakaraka [23] , Shodhaka, [24] Ropaka [25] and so on Rakta sthambaka; ingredient of Ghontaphaladi Varti [26] , Pugadi Yoga, Pugadi Lepa, Mocha-Pugadi Ksheera [27] etc formulations in Vrana Chikitsa. MATERIAL AND METHODS: A Randomized Comparative Clinical Study with Sample size of 40 Patients divided into two equal groups (Group A & Group B). Group A with Kasisa churna Avachurnana and Group B Puga churna Avachurnana. After Written Consent; positioning of patient comfortably (siting / lying down) in MOT with Asvasana and explanation of the procedure, Vrana was exposed properly. If necessary Normal saline/Distilled water wash and dried with sterile swab, then debridement followed by Avachurnana of quantity sufficient medicine - Kasisa / Puga Churna was applied on affected part with sterile gloved hand and covered with sterile gauge Sprinkled with Kasisa/Puga Churna with banding. Same procedure was repeated daily 7 days or till the wound heals up and 1 follow up on 14 th day. Subjective parameters and objective parameters like Vrana Vedana (Pain), Daha (Burning Sensation), Kandu (Itching), Vrana Srava (Discharge), Vrana Ayama Visthara (Size), Sparsha Asahatva (Tenderness), Gandha (Smell), Varna (Colour) and Sotha (Inflammation) were assessed with grading before and after treatment. And the Results were derived statistically Preparation of medicine: i Kasisa churna : Kasisa shodhana was done with Bringaraja Swarasa as it is Uttama . Two methods were followed as mentioned in Samhitas . Method 1: The Kasisa lumps were tied in Pottali and Swedhana was done in Dola Yantra with Bringaraja Swarasa for 1 Yama . But Kasisa was totally dissolved in Swarasa leaving the Pottali empty. The obtained Swarasa was boiled in earthen pot to evaporate the liquid content and obtain Kasisa . However very little quantity of Kasisa was procured which was not in the form of Avachurnana Dravya . Thus Method 2 was followed. Method 2: The Kasisa lumps were pounded in Khalva Yantra to form powder. The required quantity of Bringharaja Swarasa was added so that the powder is totally soaked in the Swarasa . Continuous Bhavana was given in the Khalva Yantra in unidirectional circular movement for 1 Day. It was dried in a shade to remove moisture totally and ground in Khalva to obtain powder, which was sieved to obtained Fine Powder. To remove moisture, it was kept in hot air oven/

P a g e | 14 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION dryer for 1 day. It was stored in a clean and dry air tight container. ii Puga churna : Locally grown Ripe Puga (Orangish) was collected, cleaned and dried in sun till it hardens. The external husk was removed and the brownish hard nut was extracted. In few geographical parts to reduce the strong nature of Areca it is boiled with Gomutra or Kashaya . But for this study no such procedure was adopted as this region Areca nuts are used as it is. The Areca nut was pound in Khalva Yantra to cut into small pieces/ coarse powder and fine powdered using Electrical Pulverizer. After sieving a super fine powder was obtained. To remove moisture, it was kept in hot air oven/ dryer for 1 day. It was stored in a clean and dry air tight container. Statistical test: Data was collected using Case Report Form (CRF); Collected data was tabulated and analyzed using SPSS (Statistical Package for Social Science) and MS - Excel by using appropriate statistical test. Demographic Data and other relevant information were analyzed with descriptive statistics. Continuous data was expressed in Mean +/- Standard Deviation. Nominal and Ordinal Data was expressed in Percentage and analyzed using non- Parametric tests like Repeated measures of ANOVA and Parametric Test like t-test. The changes with p-value < 0.05 was considered as Statistically Significant Investigations: The study was conducted clinically; No animal experimentation was carried out. Laboratory Investigation prescribed only upon necessity - Blood Routine (Hemoglobin %, Total Leucocyte Count, Differential Count, Erythrocyte Sedimentation Rate); FBS-PPBS/ FUS-RUS; Culture and Sensitivity Test of Wound Discharge; Histopathological Examination Materials and Instruments:

P a g e | 15 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Prepared Medicine – Kasisa and Puga Churna Preparation of medicine: 1. Kasisa churna: Raw drug Shodhana: Obtaining Bringaraja Swarasa

P a g e | 16 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION i. Dola yantra swedhana with bringaraja Swarasa: ii Bhavana with bringaraja swarasa: Puga churna: Raw drug:

P a g e | 17 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Preparation of Puga Churna : Treatment with kasisa churna – Procedure Treatment with puga churna – Procedure

P a g e | 18 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION Overall Effect of Treatment Before and After Treatment – Kasisa Churna Avachurnana : Overall Effect of Treatment Before and After Treatment – Puga Churna Avachurnana

P a g e | 19 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION RESULTS : 0 0.5 1 1.5 2 2.5 BT AT FU VRANA VEDANA(PAIN) Group A Group B 0 0.5 1 1.5 2 2.5 BT AT FU DAHA (BURNING SENSATION) Group A Group B 0 0.5 1 1.5 2 BT AT FU KANDU (ITCHING) Group A Group B 0 0.5 1 1.5 2 2.5 BT AT FU VRANA SRAVA (DISCHARGE) Group A Group B 0 0.5 1 1.5 2 2.5 3 3.5 4 BT AT FU VRANA AYAMA VISTARA (SIZE) Group A Group B 0 0.5 1 1.5 2 2.5 3 BT AT FU SPARSHA ASAHATVA (TENDERNESS) Group A Group B 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 BT AT FU GANDHA (SMELL) Group A Group B 0 0.5 1 1.5 2 2.5 BT AT FU VARNA (COLOR) Group A Group B 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 BT AT FU SOTHA (INFLAMATION) Group A Group B 0 10 20 30 40 50 60 70 80 90 100 Comparative Result Group A Group B

P a g e | 20 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION DISCUSSION As mentioned in classics, the ‘ Vimarsha’ i.e, discussion before coming to ‘ Nigamana ’ (Conclusion) is part of approving the knowledge as authentic (Con). Discussion being the important part of any research work provides a platform for re-examining the whole work, which is a key part of any scientific and methodical research work. Acharya Sushruta has made it clear that without the proper knowledge of wound and its management the success of surgery cannot be anticipated. When the wounds are not treated in proper time even the curable (Sadhya) ulcer may turn into Yaapya, Yaapya to Asadhya and Asadhya in to fatal. The Vrana Ropaka Kriya is still challenging aspect even till today since ancient times. Though a variety of medications have been evaluated and patented as wound healing agents, their inability to become successful drugs is due to the fact that these are able to act only at a particular step of the healing cascade. It is therefore, necessary that these agents of optimum biological activity have to be based on a border mechanism of the healing process. It is likely that more effective wound debridement and wound healing agent would be developed from natural products. Different regions employed different modalities and interventions for wound healing. Present work is also a further step in this path. The aim of wound cleansing should be complete removal of all nonviable tissues, enhancing wound hygiene and resolve the local pathology, as it is vital for proper wound bed preparation allowing the wound to heal faster. The above said form of treatment and pharmacodynamic properties of the drug might have corrected the local pathology and stimulated the healing process leading to Vrana shodhana and Ropana with glimpse of Vaikrutapaha. Kasisa Churna and Puga Churna Avachoornana ; which are having Vrana Shodhana, Ropana(healer) , Vedana-Sthapana (analgesic) properties are selected for the study. Puga: Geographically grown locally and easily available; Helps remove slough and dead tissues; If used for long term, observed to corrode normal tissue; Was not soluble and extra quantity remained on wound as it is. As per locals no shodhana is required for puga though in some place they use Gomutra or the rind Kashaya etc to boil. Kaseesa: Kaseesa for external use, shodhana not required as per Samhitas; in the later treaties Bhasma is used for internal purpose. Bringaraja Shodhita Kasisa churna was used. Helps Rakta Uttpatti, soluble and absorbed, Bandhana is an important as a Paschat Karma which provides a needy environment with rest to the part, keeping he medicament in situ and protecting the part for microbes as well as external climatic effect. Avachurnana also can cause Gharshana by the 0% 0% 5% 95% Overall Effect of Group A No change Mild Moderate Marked 0% 0% 10% 90% Overall Effect of Group B No change Mild Moderate Marked

P a g e | 21 Research Article. ISSN NO. 2581-785 X IRJAY IS OFFICIAL JOURNAL OF BALA G PUBLICATION minutest movements occurred which also helps debridement, healing and can facilitate blood flow. The presence of this medicated powder on the wound creates unsuitable condition for the microbes, also due to the thin filmy layers avoids the broken tissue direct exposure which in turn protects the wound from infection. Twak Savarnikarana, Roma Sanjanana etc properties of the selected drugs also helps Vaikruthapaham. Observation and Probability of Incidence: Equally male and female – Anyone can get injured, most from age group 40-50(age factortissue capability of rapid healing might be curbed delaying wound healing), maximum occupation was labournature of work prone to wound; mostly number were single and in lower limb - region being more prone to different forms of wounds; most were chronic and Dusta Vrana - negligence to avail treatment until aggravation; site movement altered - local destruction and alteration of functionality Discussion on Results and Probable Mode of Action: Overall Efficacy of the Drugs : Amongst 20 patients in Group-A, 95 % patients showed marked results ( Uttama Upashaya) and 5 % patients showed moderate results ( Madhyama Upashaya) . There were 0% patients with mild ( Alpa Upashaya) and no changed results- Anupashaya (no relief). Amongst 20 patients in Group-B, 90 % patients showed marked results and 10 % patients showed moderate results. There were 0% patients with mild and no changed results. Healing of any tissue can’t occur without remission of the cardinal clinical features of Vrana; Rasa, Guna & Karma of the trial drugs helped to check out the clinical features of the Vrana. After respective drug treatment, Group- A showed 94.21 % overall results and Group-B showed 91.10% overall results which are statistically significant. Comparative analysis of the overall effect of the treatments in both the groups was done by statistically with unpaired t test which showed treatment is not significant in Group A when compared to Group B CONCLUSION Sthanika Avachurnana Karma was the procedure adopted to administer the research drugs over Vrana which served both Shodhana (purification) and Ropana (healing) purpose as mentioned in the classics. It was also a safe, simple and cost-effective procedure. No Incidences of complications like infection, aggravation of Lakshanas (symptoms), recurrence or any other adverse effects were found during the study. Noticeable quality of healing with minimum scar formation and discoloration giving reasonably appreciable cosmetic results was observed. By the virtue of easy absorption medicines, Shodhana, Sthambhana, Sravahara, Soshana, Krimihara, Lekhana and Chedhana properties of Kasisa helped Varana Shodhana and Ropana. Puga showed considerable goodness in treatment which is Attributable to antiseptic, antiinflammatory, analgesic properties; Kledahara, Ropana, Krimihara. Acknowledgment: I feel warm hearted and thankful to my family for constant support and love, I dedicate this work to Mr Anantha Rao Jadav, Mrs Pushpavathi Bai, Mr Naveen Kosti and Family, Mr Hari Prasad, Mrs Leela Ranjitha, Dr Kushal Sonu, Lekha Rao And Adithya Dongre Financial Support: Nil. Conflict of Interest: Nil

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Shodhana, Ayurveda, Puga, Ropana, Dushtavrana, Shalyatantra, Kasisa, Vrana, Dolayantra, Upakrama, Khalvayantra, Shothahara, Churna, Avachurnana, Vranashodhana, Vranavedana, Vranachikitsa, Sparshasahatva, Vranaropana, Malahara, Burning sensation, Wound, Adverse effect, Wound cleansing, Kashaya Rasa, Wound healing, Group A, Clinical study, Air tight container, Wound debridement, Raw drug, Shasthi upakrama, Bahya Chikitsa, Overall result, Vrana Srava, Group B, Kledahara, Rakta Sthambaka, Krumihara.