Management of Diabetic Foot Ulcer - A Case Report

CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 253 Management of Diabetic Foot Ulcer - A Case Report Syeda Safina Naz 1 , L. Manonmani 2 , Sikandar Basha 3 1 Post Graduate Scholar, Department of Shalya Tantra, TMAES Ayurvedic Medical College, Hospete, Karnataka, India. 2 HOD, Department of Shalya Tantra, TMAES Ayurvedic Medical College, Hospete, Karnataka, India. 3 RMO, TMAES Ayurvedic Medical College, Hospete, Karnataka, India. I NTRODUCTION In India, the prevalence of diabetes is 8.7% among those aged 20 to 70, making it a rising concern [1] The majority of persons with diabetes mellitus are unaware that they have the condition and as a result, they are more likely to experience diabetic complications such diabetic neuropathy, diabetic retinopathy, kidney failure, coronary heart disease, and diabetic foot ulcers. When Type-2 diabetes is first discovered, the most frequent consequence is diabetic foot ulcers [2] It is estimated that diabetic foot ulcers affect 4.54% of people with diabetes [3] One significant side effect of Address for correspondence: Dr. Syeda Safina Naz Post Graduate Scholar, Department of Shalya Tantra, TMAES Ayurvedic Medical College, Hospete, Karnataka, India. E-mail: syedsafina 061@gmail.com Submission Date: 13/07/2024 Accepted Date: 22/08/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.8.38 diabetes is diabetic foot. Diabetic foot is characterized by tissue loss, ulceration, and infection. This wound needs to be debrided. Diabetes mellitus is correlated with Madhumeh and that of the diabetic foot ulcer is correlated with Madhumehjanya Pidika which comes under the category of Dushta Vrana . The sign and symptoms of this resembles with Dushta Vrana . Madhumehjanya Vrana are Kruchra Sadhya i.e., difficult to heal [4] Madhumeh is the last stage of Prameha which is Vapya type of disease [5] A IM AND O BJECTIVE To assess the effectiveness of Ayurvedic therapy in addition to the debridement for diabetic foot ulcers. C ASE P RESENTATION A 45 years old male patient came to Shalya Tantra OPD with complaint of ulcer. Patient had got injured by small stone during walking as he was walking bare footed which resulted in non-healing ulcer since one and half year. Patient has previously been diagnosed with diabetic mellitus. Family history: All other family members are said to be healthy. A B S T R A C T Due to sedentary lifestyle of today, diabetes mellitus is becoming a common illness. One of the complications of diabetes mellitus, the primary cause of lower limb amputations, is diabetic foot ulcers. It affects 15% of all diabetes mellitus patients and occurs before lower limb amputation in 84% of people with diabetic foot ulcers. Controlling blood sugar levels, debridement, improved dressings, and offloading techniques are all necessary for the treatment of diabetic foot ulcers. Acharya Sushruta has listed sixty different forms of treatment in the Ayurvedic literature. He has placed particular emphasis on Vranashodhana and Ropana . Blood sugar management with Arogyavardhini Vati , wound debridement and appropriate wound care are all part of the treatment of diabetic foot ulcers. It took a month for the ulcer to fully heal, and throughout that time, the patient's ability to carry out daily tasks improved. The Ayurvedic treatment that was implemented has shown encouraging outcomes in the management of diabetic foot ulcer. It is imperative to conduct more randomised controlled trials in this area of study. Key words: Diabetic foot ulcer, Dusta Vrana, Non healing ulcer, Vrana Ropana.

Syeda Safina Naz et al. Management of Diabetic Foot Ulcer ISSN: 2456-3110 CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 254 Personal history: ▪ Diet - Mixed ▪ Appetite - Moderate ▪ Sleep - Disturbed, 7-8 hours/night, 2-3 hours in the afternoon ▪ Micturition - 6-7 times/ day; 3-4 times/night ▪ Bowel - Regular, once/day, constipated sometimes. ▪ Habits - Tea/coffee - 3 cups/day General Examination ▪ Tongue - Uncoated ▪ Pulse - 74 beats/ min ▪ BP - 120/80 mm of Hg ▪ Temperature - 97.6°F ▪ Respiratory rate - 18/min ▪ Height - 154 cm ▪ Weight - 63 kgs ▪ BMI - 25 Examination of Ulcer History 1 Mode of onset - Spontaneous 2 Duration - 1 and half years 3 Pain - Present 4 Associated disease - Diabetes 5 Site - right foot 6 Size - 3 cm × 2 cm ×1 cm deep and circular in shape. 7 Number - 1 8 Edge and margins - Inflamed 9 Floor - Pale red and yellowish 10 Discharge - purulent and foul smelling 11 Tenderness - ++ Investigation ▪ Blood urea - 30 mg/dl ▪ Serum creatinine - 1.0 mg/dl ▪ Glycosylated Hemoglobin - 8.2 % ▪ FBS - 173 mg/dl ▪ PPBS - 336 mg/dl Methodology and Treatment given Arogyavardini Vati 250 mg BD orally was given along with debridement of the wound followed by dressing with antiseptic solution on daily basis. The above treatment was given for 1 month. The patient was treated on OPD bases and regular dressing done for the first 15 days and then on alternate days dressing was done. O BSERVATIONS AND R ESULTS After 2 nd week pus discharge reduced. After the 3 weeks of treatment the swelling, tenderness, and edema present at edges of the wound get reduced. The floor of the wound is clear i.e., without slough and healthy granulation developed. The wound completely cured.

Syeda Safina Naz et al. Management of Diabetic Foot Ulcer ISSN: 2456-3110 CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 255 DISCUSSION Diabetic foot ulcer linked to ischemia and neuropathy requires specific attention and the right medication. This patient's major objectives were to keep his blood sugar stable and cure his wound completely. The second goal was to stop the worsening of wound as people with diabetes are more prone to infections. Sushruta said that diabetic foot ulcers are related to Madhumehjanya Vrana and that this is Kasht Sadhya Vrana in his description of the condition. Acharya Sushruta states that Vasa , Meda , and other Dosha and Dushya combine to generate Pramehjanya Pidika , which subsequently transforms into a wound that does not heal and furthermore, wounds involving the lower limb are difficult to heal. The present case was carried out giving importance to Vranashodhana and Ropana. Arogyavardhini Vati has properties like Deepana, Pachana, Medovinasini (Medohara). Acharya said Arogyavardhini Vati is Sarvaroga Prasamani (capable to control all diseases). Rasa is Tikta so it acts anti - inflammatory and Agnivardhak properties. It is also hepato-protective. Arogyavardhini Vati as suggested by its name Arogya -Good health, Vardhini- improves is an Ayurvedic preparation that helps to improve overall health. It is also known as Sarvarog Prashmani which signifies a remedy for all kinds of illnesses. Arogyavardhini Vati helps to manage the digestive problem due to its Deepan a and Pachana properties. It also helps to maintain body weight and other complications of the digestive system by improving metabolism and expelling waste products from the body because of its Shodhana (detoxification) nature. CONCLUSION This case report shows a significant effect of systemic as well as localized Ayurveda treatment and debridement in the management of diabetic foot ulcers. REFERENCES 1 World Diabetes day: Prevalence rate of diabetes mellitus in India. Information available on who website on 14 November 2019 https://www.who.int/india/ Campaigns/and/events/world-diabetes-day 2 Das A, Pendsey S, Abhyankar M, Malabade R. Management of Diabetic Foot in an Indian Clinical Setup: An Opinion Survey. Cureus. 2020;12(6): e 8636. Published 2020 Jun 15. DOI:10.7759/cureus.8636 3 Sinharay K, Paul UK, Bhattacharyya AK, Pal SK. Prevalence of diabetic foot ulcers in newly diagnosed diabetes mellitus patients. J Indian Med Assoc. 2012;110(9):608-611. 4 Maharshi Sushruta Kaviraj Dr Ambika Datta Shastri, Sushruta Samhita with Ayurveda Deepika commentary Forwarded by Dr. Pranjeevan Manikchand Mehta, Chowkhamba Sanskrit sansthan. Edition-Reprint Varanasi; Sushrut sutrasthana 23/ 7; c 2019.

Syeda Safina Naz et al. Management of Diabetic Foot Ulcer ISSN: 2456-3110 CASE REPORT August 2024 Journal of Ayurveda and Integrated Medical Sciences | August 2024 | Vol. 9 | Issue 8 256 5 Maharshi Sushruta Kaviraj, Dr Ambika Datta Shastri, Sushruta Samhita with Ayurveda Deepika commentary Forwarded by Dr. Pranjeevan Manikchand Mehta, Chowkhamba Sanskrit sansthan. Edition-Reprint 2019 Varanasi. Nidana Sthana, Prameha Nidan Adhyaya, 6/30, edited by Shastri A, 12 th ed. Chaukhambha Sanskrit Sansthan, Varanasi; c 2013, 331.6. 6 Sriram Bhat M; SRB’s manual of surgery, Jaypee Brothers’ Medical Publishers (P) LTD,4 th edition,1 st chapter, pg-25, pp-1335.7. 7 Singh D, Singh D, Choi SM, Zo SM, Painuli RM, Kwon SW, et al. Effect of extracts of Terminalia Chebula on proliferation of keratinocytes and fibroblasts cells: An alternative approach for wound healing. Evidence- Based Complementary and Alternative Medicine. 2014;2014:1 – 13. Available from: https://doi.org/10.1155/2014/701656.8. 8 Babasaheb N Gadve and Priyanka S Tiwari-an Ayurvedic management of diabetic foot ulcera case studyinternation journal of herbal medicine. 9 Arogyavardhini Vati : Benefits, Precautions and Dosage | 1 mg ******************************* How to cite this article: Syeda Safina Naz, L. Manonmani, Sikandar Basha. Management of Diabetic Foot Ulcer - A Case Report. J Ayurveda Integr Med Sci 2024;8:253-256. http://dx.doi.org/10.21760/jaims.9.8.38 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Dushtavrana, Shalyatantra, Prameha, Vrana, Vranashodhana, Vranaropana, Family history, Diabetes mellitus, Ayurvedic treatment, Personal history, Wound healing, Overall health, Sedentary lifestyle, Ayurvedic literature, Case report, Acharya Sushruta, Arogyavardhini Vati, Ayurvedic Therapy, Type 2 diabetes, Diabetic Retinopathy, Diabetic Foot Ulcer, Non-healing ulcer, Blood sugar, Wound debridement, Wound care, Diabetic mellitus, Coronary heart disease, Ayurvedic preparation, Diabetic neuropathy, Blood sugar level, Debridement, Lower Limb Amputation, Diabetic Complication, Kidney Failure, Tissue loss, Digestive problem, Ulceration, Infection, Prameha Nidan.