Ambikadatta Shastri, Bahishajya Ratnavali, vranashotha Chikitsa chap-47 sloka 64-66 ... Bhatta, Sidhabhaishaja Manimala, Chturtha guchha, Udavarta Chikitsa.
Wound healing effect of Jatyadi Taila in the cases of chronic fissure-in-ano treated with Ksharasutra Tukaram Dudhamal1, Chaturbhuja Bhuyan2, Madhavsingh Baghel3 1. Assistant Professor, Dept. of Shalya Tantra, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat. 2. Ex. Professor & Head, Dept. of Shalya Tantra, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat. 3. Director, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat.
Purpose: The primary aim of the study was to evaluate wound healing effect of Jatyadi Taila and other adjuvant drugs in post Ksharasutra wounds. Total 100 patients of operated cases for chronic fissure-in-ano with Ksharasutra suturing were taken for study. Among them in group-A Ksharasutra suturing was done at fissure bed and in group-B Ksharasutra suturing after anal dilatation was carried out. The adjuvant drugs were prescribed till symptoms persist and Jatyadi Taila was used up to complete wound healing in both groups. Method: The wound created by Ksharasutra was cleaned with Sphatikadi decoction; Matra Basti (per anal installation) of 10 ml Jatyadi Taila with the help of rubber catheter no. 8 and plastic syringe of 20 cc. Gauze piece (Picchu) of Jatyadi Taila was kept on wound and T bandage applied. The same procedure was adopted after second postoperative day up to complete wound healing in both groups. Medications used during treatment: 1) Sphatikadi Yoga: for sitz bath, 2) Panchasarkara Churna: 5 g at bed time, 3) Vatagajankush Vati: 250 mg TDS. Result: In group-A 46 patients and group-B 48 patients got complete healing within 21 days. Four patients in group-A and 2 patients in group-B were taken more than 28 days. Jatyadi Taila is a good Shodhana and Ropana drug; it is in oil form and when used as Matra Basti, it acts as a soothing agent for smooth evacuation of feces and protects anal wound of fissure bed. Most of the ingredients used in Jatyadi Taila are Shothahara, Vedanasthapana and Ropaka, which are important requirements of healing a wound. The ingredients like Neem (Azadirachta indica) and Daruharidra (Beriberi aristata DC) are antibacterial and promote wound healing. Conclusion: The study concluded that Jatyadi Taila exhibits wound healing property in post Ksharasutra wound. Key-words: Fissure-in-ano, Jatyadi taila, Ksharasutra, Matra basti.
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Introduction: The management of Vrana (wound) is the first medico-surgical problem faced by physicians and surgeons. Comprehensive management of all Vranas (wounds) is exclusively described in the treatise Sushruta Samhita under Shashthi Upakrma (sixty measures). There are different formulations described for Vrana ropan according to its site, types and chronicity. Many types of Vrana like Suddhavrana (healing wound), Dushtavrana (nonhealing wound), Dagdhavrana (post burn wound) Nadivrana (sinus) etc. have been described with their appropriate management. A lot of drugs in different forms were prescribed for Vrana ropan but the management of Vrana, particularly Dushtavrana is still a challenge for physicians and surgeons. Ample works in this regard at different Ayurveda institutes of India have been carried out to make the standard management for Vrana; but still there is big scope to search out a suitable drug or drug formulation for better management of wound. On Vrana more than 230 works at PG/PhD level have been reported from various institutions across India. 1 Among these studies two studies were carried out on Jatyadi taila and found very good properties in debridement of chronic wound and wound healing. 2,3 The wounds after any surgical procedure of ano-rectum particularly fistula and fissure are more prone to infected with feces. The dressing in such cases was also difficult so in this study the taila kalpana among seven measures of Shodhan and Ropan of vrana was selected for vrana ropan and Jatyadi taila was installed per anal in the form of Matra basti. In this study, 100 patients of Parikartika were treated with Ksharasutra suturing and after cut through of Ksharasutra the wound was treated with Jatyadi taila matra basti daily up to complete wound healing. Assessment of relief in sign and symptoms was done weekly and recorded in the proforma. Finally obtained results were analyzed statistically and it was found that Jatyadi tail was very effective in early wound healing of post Ksharasutra wound. Subjects and Methods: Aim & Objective: To evaluate wound healing effect of Jatyadi taila and other adjuvant drugs in post Ksharasutra wounds. Material & Methods: Selection of Patients: The patients of post Ksharasutra suturing in Parikartika (chronic fissure-in-ano) were registered from IPD of the department of Shalya Tantra, irrespective of age, sex, occupation, and religion. Inclusion Criteria: Patients between age group of 16 years to 60 years and post operative wounds of Ksharasutra suturing in Parikartika (Chronic fissure-in-ano). Exclusion Criteria: Patients of acute fissure-in-ano, carcinoma of ano-rectum, congenital anal stricture and anal stenosis patients were excluded. Positive cases of HIV, VDRL and Hepatitis-B were also excluded.
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Laboratory Investigations: The investigations were carried out for fitness of the patients for Ksharasutra suturing like Hb%, TLC, DLC, BT, CT, ESR, FBS, PPBS, Blood urea, Serum creatinine. HIV,VDRL, HBsAg (Australia antigen), urine and stool examination. Materials: 1) 100 operated cases of Parikartika were registered. 2) Jatyadi taila for per anal installation 3) Sphatikadi Yoga for cleaning and sitz bath 4) Vatagajankush Vati 250 mg tds orally 5) Panchasakara Churna 5gm at bed time Posology: The following all the drugs were prepared in the Pharmacy of institute as per standard guidelines by API. Jatyadi Taila: The Ingredients of Jatyadi Taila are as follow: 4 Jati leaf (Jasminum officinalis L.) Neem leaf (Azadirachta indica A.Juss.) Patol Leaf (Tricosanthus diaoca L.) Karanja Leaf (Pongamia pinnata L. Pierre.) Mulethi (Glycyrrhiza glabra Linn.) Kushtha (Sanssurea lapp C.B. Clarke.) Haridra (Curcuma longa Linn.) Daruharidra (Berberis aristata DC.) Kutaki (Picrorrhiza kurroa Royle ex Benth.) Manjishtha (Rubia cardifolia L.) Kamal (Nelumbo nucifera Gaertn.) Lodhra (Symplocos racemosa Bedd.) Abhaya (Terminelia chebula Retz.) Sariva (Hemidesmus indicus R. Br.) Karanja beeja (Pongamia pinnata L. Pierre.) Siktha (Bee wax) Sphatikadi Yoga: The ingredients of Sphatikadi Yoga are as follow: 5 1. Sphatika (Potash Alum) 2. Khadira (Acacia catechu Wild) 3. Karanja beeja (Pongamia pinnata (L) Pierre) 4. Dry neem beeja (Azadirechta indica A. Juss)-
one part one part one part half part
Vatagajankush Vati : The Ingredients of Vatagajankush Vati are as follow: 6 Parada bhasma (Rasasindur) Lauhabhasma (Iron) Suvarnamakshik bhasma Copper) Shudha Gandhaka (Sulphur) Shudha Hartala (Arsenic Trisulphide) Tankan (Borax) Haritaki (Terminalia chebula Retz.) Kakadashringi (Pistacia integerimma L.) Shunthi (Zingiber officinalis Linn.) Shudha Vastanabha (Aconitum ferox) Pippali (Piper longum Linn.) Maricha (Piper nigram L.) Nirgundi (Vitex negundo L.) Agnimantha (Premna mucronata L.)
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Panchasakara Churna: The Ingredients of Panchasakara Churna are as follow:7 1. Sena /Swarnapatra (Cassia angustifolia Vahl.) 2. Small Haritaki (Terminalia chebula Retz.) 3. Saindhava (Sodium chloridum) 4. Sunthi (Zingiber officinalis Linn.) 5. Shatapushpa /Saunpha (Feniculum vulgare) Methodology: In patients of group-A Ksharasutra Suturing (KSS) at fissure bed followed by trans-fixation of sentinel tag and in cases of group-B Lord’s anal dilatation followed by Ksharasutra suture (KSS) at fissure bed with trans-fixation of sentinel tag was done under low spinal anesthesia. After cut through of the Ksharasutra fresh wounds of entire patients were treated with Jatyadi taila in following method. Required Materials: Jatyadi taila, Rubber catheter no.8, 20 ml plastic syringe, dressing materials. Procedure of Matra Basti: Before procedure patients were advised for Avagaha Swedan (sitz bath) with Sphatikadi yoga. Patient was laid in liyhotomy position; clean the wound and perianal area with Sphatikadi decoction. The Matra Basti (per anal installation) of 10 ml Jatyadi Taila was given in anal canal with the help of rubber catheter no. 8 and plastic syringe of 20 cc. Jatyadi taila picchu (gauze piece) was kept on wound and applied ‘T’ bandage. The similar procedure was adopted after 2nd post operative day up to complete wound healing in both groups. Other Medications: 1) Sphatikadi yoga: This formulation was used in the form of powder for sitz bath after Ksharasutra procedure. The 20 g powder was mixed with warm water in the plastic tub and allowed the patient to sit for 5-10 minutes daily for two times up to complete wound healing. 2) Panchasakar churna: 5g powder was given orally at bed time for initial 15 days after 2nd post operative night with luke warm water. 3) Vatagajankush vati: 250 mg three times a day for 15 days. 4) Patients were advised to take fiber rich diet and excess fluids from next day of operation. Duration of Treatment: 4 weeks Follow-up period: One month after completion of the treatment. Ethical Clearance: IEC No.PGT/Ethic-2008/09/2520; ag.no.2 sr.no.3, dated 24.11.2008. ASSESSMENT CRITERIA: Assessment was made by adopting gradation method on the features of per-rectal pain, oozing of serous discharge and wound healing as shown in table no.1, 2, 3.
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Table 1; Gradation for Pain: Grade Description 0 Patients free from pain 1 Pain during defecation & bearable which does not requires any analgesic drug 2 Pain during defecation & continuous which relieves after giving oral analgesic drug 3 Unbearable and continuous pain which relieves after giving injectable analgesic Table 2; Gradation for Oozing: Grade Description 0 Observe dry gauze piece after 24 hours of dressing 1 Observe spot of blood on gauze piece after 24 hours of dressing 2 Observe partially wet gauze piece with blood after 24 hours of dressing 3 Observe complete wet gauze piece with blood after 24 hours of dressing Table 3; Gradation for Wound Healing: Grade Description 0 Complete healed wound with healthy scar 1 Partially healed wound with healthy granulation tissue 2 Cleaned wound without slough / discharge 3 Fresh wound with discharge Results: Results in Group-A: Table 4; Pain Relief: Days 1st Day 7th Day 14th Day 21st day 28th day
n 50 29 9 2 0
n=50 Mean 2.120 1.040 0.260 0.0400 0.000
SEM ± 0.0887 ± 0.131 ±0.0746 ±0.0280 ±0.000
Std dev 0.627 0.925 0.527 0.198 0.000
M Diff ↓1.080 ↓1.860 ↓2.080 ↓2.120
Table 5; Relief in Oozing: Days 1st Day 7th Day 14th Day 21st day 28th day
n 50 19 3 0 0
Mean 2.500 0.920 0.1000 0.000 0.000
t
p
8.088
