68-year-old male artist patient came to our clinic with a chief complaint of swelling of the left leg with watery discharge from the small and medium-sized wounds over the calf muscles and tibial shin since 8 days. He had severe itching and pain at the site of the wound with general malaise as well since 8 days.On examination:P/R: 90/minBP: 110/70mm HgRR: 20/minEyes: No pallor/icterus/cyanosisUrine: Pale yellow colorBowel Movement: Satisfactory bowelsAppetite: ModerateTongue: Saam(coated)Built: ThinSparsha: AfebrileRS: Clear air entry on both sidesCVS: NADPA: SoftVrana ParikshanVrana tala: Yellowish colourStrava: Jalavat (watery)Gandha: Puti gandha (foul smell)Pitting oedema with peeling of peripheral skinSparsha: Ushna sparsha (local warmth)Investigations: Haemogram, KFT, LFT, Lipid profile within normal limits, Urine routine and microscopic- NADNidana: Kapha – Vataj Vrana
Treatment: Vrana karma for first 7 days; Shodhan with Panchavalkala Kashayam Parisheka: Lukewarm decoction
Vrana Dhupana: Vacha+Nimba+Haridra Churna Hartala (AS2S3)
Nimba Patra Kalka (paste of Neem leaves freshly prepared with cow’s urine) was applied on the wound for Shodhan (purificatory) purpose.
Internal medicine
Panchatikta Kashayam 20ml Vyanodana Kaal (after meals two times)
Punarnavasav 20ml apan kaal (before meals)
Gandhak rasayan 250mg tab- 2-2-2 after meals
Sukshma triphala 250mg tab 2-2-2
Swayambhu guggulu 250mg 2-2-2 apan kaal
Nimba+Vidanga+Sariva+Manjistha Churna 200mg each + Rasamanikya 200mg with Panchatikta Kashayam
Diet: Steamed rice (rice from the old stock around 6 months old), moong curry, mudga yusha, saariva+ arjun siddha dugdha in the morning.
For drinking water: Shadanga Paan (mentioned in jwara chikitsa Charak Samhita) instead of chandan churna, Rakta chandan was used (cost-effective).
After 7 days once it attained Shuddha vrana avastha, it was dressed with panchavalkal lepa with ghritakumari (ready-made ointment is available).
Post 2 weeks followup:
Swelling of the leg subsided
Secretion from the wound got dried
Color of skin changed from red to normal skin color
Foul smell disappeared
Ulcer floor color changed from yellow slough to red granulation; shuddha vrana lakshan mentioned by Acharya Sushruta- jivha talabho (color of the tongue), mrudu (soft), shlakshna (smooth), snigdha (unctuous), vigata vedna (pain subsided).
Conclusion: An infected wound can be effectively managed without antibiotics purely on Ayurvediya nidan and Chikitsa.
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