Ayurvedic Intervention in the Management of Post Operative Diabetic Foot Gangrene - A Case Study

1. International Journal of Trend in International Open International Open Access Journal | www.ijtsrd.com International Journal of Trend in Scientific Research and Development (IJTSRD) Research and Development (IJTSRD) www.ijtsrd.com ISSN No: 2456 ISSN No: 2456 - 6470 | Volume - 3 | Issue – 1 | Nov Nov – Dec 2018 Ayurvedic Intervention Diabetic Foot Gangrene Diabetic Foot Gangrene – A Case Study Ayurvedic Intervention in the Management of Post f Post-Operative A Case Study Basavaraj Chanda1, Vislavath Srikanth 1,2Post Graduate Scholar 1,3,4Department o Sri Dharmasthala Manjunatheshwara College Sri Dharmasthala Manjunatheshwara College of Ayurveda And Hospital, Hassan , Vislavath Srikanth2, Gopikrishna3, Prasanna N Rao Post Graduate Scholar, 3Professor & HOD, 4Professor & Principal of Shalya Tantra, 2Department of Rachana Sharir , Prasanna N Rao4 Principal Rachana Sharir Hassan, Karnataka, India ABSTRACT Surgical procedures normally carry a risk of wound infection, excessive bleeding or tissue damage. Diabetes has higher risk of wound healing complications following surgery. Wound tends to require more time to heal due to poor blood circulation, nerve damage, or a compromised immune system. In such conditions, non-healing wounds can lead to osteomyelitis, sepsis and even death also. Ayurvedic literature has given detailed explanations on wound management from its manifestation to the complete healing, shown good results in Non wounds. Acharya Sushruta, explained Shodana (purification), Ropana (healing) procedures for wounds with Ayurvedic formulations includes Panchavalkala Kashaya and Jatyadi Taila. This is a case of 45-years old male, diabetic pres complains of non-healing wound on 5th right toe with swelling, discharge, foul smell and blackish discoloration of skin, diagnosed as diabetic foot gangrene. Ray’s amputation done and post wound management was carried under Ayurved treatment procedures. Significant improvement seen in wound healing within a short period. In this case Panchavalaka Kashaya and Jatyadi Taila show its Shodhana and Ropana properties. KEY WORDS: Diabetes, Foot gangrene, Ayurvedic treatment, Panchavalkala Kashaya, Jatyadi Taila. INTRODUCTION Diabetic Mellitus is a chronic clinical syndrome characterised by hyperglycaemia, due to deficiency or defective response of insulin. It was estimated that approximately 1% of world population suffers from Diabetes. A consequence of hyperglycaemia of Diabetes, every tissue and organ of body undergoes biochemical and structural alterations causes severe complications. A number of systemic complications may develop after a period of 15 complications are largely responsible for morbidity and premature mortality. Diabetic foot ulcer is one the infectious complication.[1] the glucose laden tissue may cause chronic infection and ulcer formation. Ulceration in diabetes may be precipitated by ischemia atherosclerosis, infection or peripheral neuritis. Surgical procedures normally carry a risk of wound infection, excessive bleeding or tissue damage. Diabetes has higher risk of wound healing complications following surgery. Wound tends to require more time to heal due to poor blood ge, or a compromised immune Diabetes, every tissue and organ of body undergoes biochemical and structural alterations causes severe complications. A number of systemic complications od of 15-20yrs. These late complications are largely responsible for morbidity and premature mortality. Diabetic foot ulcer is one of [1] In this slight injury to healing wounds can lead to osteomyelitis, sepsis and even death also. Ayurvedic literature has given detailed explanations on wound management from its manifestation to the good results in Non-healing wounds. Acharya Sushruta, explained Shodana (purification), Ropana (healing) procedures for wounds with Ayurvedic formulations includes Panchavalkala Kashaya and Jatyadi Taila. This is a years old male, diabetic presented with the healing wound on 5th right toe with swelling, discharge, foul smell and blackish discoloration of skin, diagnosed as diabetic foot gangrene. Ray’s amputation done and post-operative wound management was carried under Ayurvedic treatment procedures. Significant improvement seen in wound healing within a short period. In this case Panchavalaka Kashaya and Jatyadi Taila show its the glucose laden tissue may cause chronic infection ormation. Ulceration in diabetes may be precipitated by ischemia atherosclerosis, infection or peripheral neuritis. [2] due due to to diabetic diabetic Diabetes is linked to gangrene, which occurs as a existing health condition. Gangrene happened, when lack of oxygenated blood causes tissue to die in some parts of body, often the hand or feet. In these cases, patient, who have an injury may not notice the dead tissue infection due to diabetic neuropathy. It is a serious condition results in Diabetes is linked to gangrene, which complication of a pre-existing health condition. Gangrene happened, when lack of oxygenated blood causes tissue to die in some parts of body, often the hand or feet. In these cases, patient, who have an injury may not notice the dead tissue infection diabetic neuropathy. It is a serious condition r amputation of limb.[3] management is serious problem in diabetic patients due to infection, wound becomes complicated and sometimes needs skin grafting Post Post-amputated wound management is serious problem in diabetic patients due to infection, wound becomes complicated and needs skin grafting.[4] erature has given detailed explanation regarding wound management starting from its pathogenesis, types, clinical features, complications Acharya Sushruta mentioned the rana which showed similar clinical ling wounds according to present medical science. for wound management from its manifestation to the complete healing, which in chronic wounds aka Dusta Ayurvedic literature has given detailed explanation regarding wound management starting pathogenesis, types, clinical features and management. Acharya Sus term Dushta Vrana which showed s features of the non–healing wounds according to present medical science. Upakramas(measures) for wound management from its manifestation to the complete healing, which shown good results in chronic wounds aka Dusta Vrana.[5] Diabetes, Foot gangrene, Ayurvedic atyadi Taila. Diabetic Mellitus is a chronic clinical syndrome characterised by hyperglycaemia, due to deficiency or defective response of insulin. It was estimated that of world population suffers from Diabetes. A consequence of hyperglycaemia of He He explained explained 60 60 @ IJTSRD | Available Online @ www.ijtsrd.com www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec Dec 2018 Page: 515

2. International Journal of Trend in Scientific Research an International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 d Development (IJTSRD) ISSN: 2456-6470 Systemic Examination: Not significant Systemic Examination: Not significant Local Examination: Site – over 5th right Size - Length: 2.5 cm, Width: 1.6cm Number : 1 Edge and margin –Inflamed with irregular border Floor : Covered with slough and granulation tissue Base : Indurated Discharge : blood stained smelling - on and off Surroundings : Blackish in colour Bleeding (-) Tenderness : Present Regional Lymph node : Not palpable. Rogaadhishtanam: Adhahkayam Asthi, Sira) Avastha : Pakwam. Provisional diagnosis: Dushta Vranam. Clinical diagnosis: Dushta Vranam gangrene) Prognosis : Krichra Sadhyam. Examination of Gangrene: Symptoms such as claudication and rest pain are present. Inspection: Change in colour : Blackish in colour Extension : Up to metatarsal Signs of ischemia : Thinning of skin noted Loss of subcutaneous fat Trophic changes in nails such as transverse ridges noted. Burger’s Angle was >600. Palpation: Skin temperature-cold Capillary filling test-slow Venous refilling time-12sec Fuching test-negative, normal popliteal artery pulsation felt with oscillatory movements of foot. TREATMENT After careful examination and clinical findings diagnosed as Dushta Vrana patient admitted in surgical word of SDM hospital. A thorough counselling was done to regarding severity of wound and future complications of gangrene. After consent of patient, Ray’s The present case is diabetic foot gangrene which amputated in SDM Hospital and post operative wound management carried under treatment protocol. CASE REPORT This is a case of 45years old male, diabetic patient came to SDM Ayurvedic hospital with the complaints of – Blackish discoloration right little toe for 4 days. Pain during pressure on toe, Foul smell with watery discharge, Swollen, reddish discoloration over the ulcer since 5days Associated symptoms: General weakness, n in the hands and feet, Irregular constipation since 1month. History of present illness: The patient had blackish discoloration, pain during pressure foul smelling with watery discharge at since 4-5days. The onset of symptoms was developed rapidly. Patient was not aware of changing in skin colour until pressure pain felt and noticed discoloration on 5thright toe. After that, he allopathic hospital and diagnosed with diabetic foot gangrene of 5thright toe and suggested Diabetalogist. Patient refused and came to Ayurvedic hospital to seek conservative management. Past history He was known diabetic and on oral hypoglycaemic medications since 10 years, continued till today. He had previous history of amputation of 2 foot, done 1year back in allopathic hospital due to chronic non-healing ulcer. Personal history Bala : Madhyama Sleep: Disturbed due to pain Gender : Male Appetite :Good Marital status : Married Occupation: Revenue officer rene which was operative wound management carried under Ayurvedic Ayurvedic wound wound toe Length: 2.5 cm, Width: 1.6cm Inflamed with irregular border : Covered with slough and unhealthy granulation tissue This is a case of 45years old male, diabetic patient came to SDM Ayurvedic hospital with the chief ration over the 5th pus discharge with foul : Blackish in colour Swollen, reddish discoloration over the ulcer since : Not palpable. kayam (Twak, Mamsam, : General weakness, numbness constipation since ta Vranam. Clinical diagnosis: Dushta Vranam (diabetic foot : The patient had noticed , pain during pressure at toe and discharge at 5th right toe ptoms was developed changing in skin until pressure pain felt and noticed blackish adhyam. Symptoms such as claudication and rest pain are that, he went to allopathic hospital and diagnosed with diabetic foot amputation by : Blackish in colour p to metatarsal : Thinning of skin noted Loss of subcutaneous fat and came to Ayurvedic hospital to seek conservative management. He was known diabetic and on oral hypoglycaemic years, continued till today. He ory of amputation of 2nd toe of right , done 1year back in allopathic hospital due to Trophic changes in nails such as-brittle nail with B.P: 130/88 mm of Hg. mm of Hg. B.P: 130/88 Name :XYZ negative, normal popliteal artery on felt with oscillatory movements of foot. Age:45years P.R: 68/min. P.R: 68/min. Weight:54kgs Weight:54kgs After careful examination and clinical findings, it is [gangrene wound] and ical word of SDM hospital. A Bowel: Irregular Height:5.7ft Height:5.7ft rough counselling was done to the patient regarding severity of wound and future complications of gangrene. After consent of patient, Ray’s Addictions : No @ IJTSRD | Available Online @ www.ijtsrd.com www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec Dec 2018 Page: 516

3. International Journal of Trend in Scientific Research an International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 amputation procedure was performed on 5th right toe. Healing of amputated wound in diabetic patient is major challenge in practice. Patient has similar history of delayed wound healing during 2nd right toe months to heal. The post- amputated wound was treated under Sushruta’s Based on need we performed Chedana, Bhedana, Shodana and Upakramas for amputated wound At the end of 2nd month wound healed completely without need of skin grafting with minimal scar formation. The details of d Development (IJTSRD) ISSN: 2456-6470 amputation procedure was performed on 5 Healing of amputated wound in diabetic patient is major challenge in practice. Patient has similar histor of delayed wound healing during 2 amputation, which took 4 months to heal. The post amputated wound was treated under Sushruta’s Dushta Vrana management protocol. Based we performed Chedana, Bhedana, Shodana and Ropana measures from Sushruta’s 60 U this case. The management of amputated protocol summarized in table no.1. At the end of 2nd month wound healed completely without need of skin grafting with minimal scar formation. The details of treatment are explained in discussion. Table No.1: Chronology of Treatment Protocol Type of treatment Apathyam: Masha, sour and salty food, curd, oily and spicy foods and day sleep are adviced to avoid. Apathyam: Masha, sour and salty food, curd, oily and spicy foods and day sleep are adviced to avoid. OBSERVATION AND RESULT Healthy granulation tissue was formed within one week. Washing of the wound wa Panchavalkala Kashaya till above. Healthy granulation tissue was observed after 10 days. The wound started to contract by filling of tissue from the base of wound day by day. The Jatyadi Taila dressing was continued till complete healing. on 31st day, it was observed that wound size was markedly reduced with normal skin coloration at the healed area. On the 50th day, the wound was healed completely with minimum scar tissue formation. observed that patient’s associated symptoms also reduced markedly. OBSERVATION AND RESULT Healthy granulation tissue was formed within one week. Washing of the wound was continued with the end as mentioned ealthy granulation tissue was observed after The wound started to contract by filling of base of wound day by day. The Jatyadi aila dressing was continued till complete healing. on erved that wound size was markedly reduced with normal skin coloration at the healed area. On the 50th day, the wound was healed completely with minimum scar tissue formation. It is observed that patient’s associated symptoms also Table No.1: Chronology of Treatment Protocol From—to Intervention Intervention Panchavalkala Qwatha to wash wound Applied Jatyadi Taila over aila over the wound Panchavalkala atha to wash 2.1.2018 to 12.1.2018 Local 5.1.2018 to 15.2.2018 2.1. 2018 to 16.1.2018 Then again on 2.2.2018 to 16.3.2018 2.1.2018 to 2.2.2018 Applied Jatyadi Local Tab Gandhak Rasayana BD Gandhak a 500 mg 2 Systemic treatment Triphala G 250 mg BD 250 mg BD Triphala Guggulu Local treatment The wound was washed with the decoction of Panchavalkala Kashaya daily, which was made up of barks of Vata (Ficus bengalensis Linn), Udumbara (Ficus glomerata Roxb.), Ashwatha (Ficus religiosa Linn.), Parisha (Thespesia populenea Soland ex corea.) and Plaksha (Ficus lacor Buch washing the wound dried, then by aseptic technique Jatyadi Taila was applied daily up to complete heal. Systemic treatment Depending on symptoms and for better healing of wound following medications were given orally. ?Tab Gandhak Rasayana 500 mg 2 BD for 15 days with 15 days gap, repeated twice. ?Triphala Guggulu 250 mg BD for 1 month Follow up advices Advice to review every 7 days Pathya: Shali, Patolam, Karavellaka, Amalak s washed with the decoction of anchavalkala Kashaya daily, which was made up of barks of Vata (Ficus bengalensis Linn), Udumbara (Ficus glomerata Roxb.), Ashwatha (Ficus religiosa (Thespesia populenea Soland ex corea.) and Plaksha (Ficus lacor Buch-Ham). After Figure 1: Diabetic foot gangrene before treatment Diabetic foot gangrene before treatment by aseptic technique was applied daily up to complete heal. Depending on symptoms and for better healing of ound following medications were given orally. 500 mg 2 BD for 15 repeated twice. 250 mg BD for 1 month malaki. Figure2: Diabetic foot gangrene iabetic foot gangrene after treatment @ IJTSRD | Available Online @ www.ijtsrd.com www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec Dec 2018 Page: 517

4. International Journal of Trend in Scientific Research an International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 d Development (IJTSRD) ISSN: 2456-6470 DISCUSSION Diabetic foot ulcers (DFU) are a fairly common complication of Diabetes mellitus. The forms: Neuropathic ulcers and Ischemic ulcers, although most DFUs are a mixture of both. Neuropathic Diabetic Foot Ulcer is because of high blood sugar levels damaging the nerves known as peripheral neuropathy. As the incidence of mellitus is increasing complications is also unquestionable. Overall individuals with Diabetes mellitus will have foot ulcer during their lifetime and the annual incidence is 2 The general line of treatment includes antibiotics to treat infections, revascularisation if associated with ischemia, to improve the condition of the wound or ulcer by wound-bed preparation, topical applications, and removal of callus. Amputation is the last option for complicated wounds.[6] Foot gangrene is a frequent complication in diabetes mellitus. from various factors such as atherosclerosis, neuropathy, infection and angiopathy happened, when lack of oxygenated blood tissue in some parts of body, often the hand or feet. In these cases, patients who have an injury may not notice the dead tissue infection due to Diabetic neuropathy. It is a serious condition results in amputation of limb.[8] As with any surgery, an amputation carries a risk of complications. Wounds infection, Pain, contractures and Autonomic dysfunction. frequent symptom is Oedema. Foot amputation Diabetes, have challenging problem of surgical practice.[9] In Ayurvedic science, management of all Vrana(wounds/ulcer) were exclusively described by Acharya Sushruta under Shashti Upakrama (sixty procedures). He has explained wound from its different aspects right from the definition, causes, types and their management in detail. While describing the types of V mentioned the term Dushta Vrana which is h similar clinical features of chronic non wounds according to present medical science. In the Vrana management along with Upakrama, lot of medications in different formulations for w healing were explained.[10] The sixty measures are for wound management are incorporated in Sapta Vidha Upakrama. These 7 main procedures are swelling of wound present. Vimlapana is done with thumb or bamboo reeds, i.e. local application of pressure. Avasechana done with Jalouka Sringa, Alabu or Shastra, i.e. from wound. Upanaha done with poultice to paka of wound. Patana is a surgical or para surgical procedure used to remove slough from wound. Shodhana is one of the important wound management. Wound cleaning is done with medicated decoctions, paste, medicated Ropana procedure done for wound healing. Medicated oil or ghee or honey or medicated churna used as dressing in ropana, usually Vaikrutapaha used after wound healing, known as cosmetic treatment do for the colour with hair growth.[11] removing impure blood one with poultice to induce Diabetic foot ulcers (DFU) are a fairly common . These are two schemic ulcers, mixture of both. because of high the nerves known as of wound. Patana is a surgical or para surgical procedure used to remove slough from wound. Shodhana is one of the important procedures in wound management. Wound cleaning is done with medicated decoctions, paste, medicated ghee, oil etc. Ropana procedure done for wound healing. Medicated oil or ghee or honey or medicated churna used as dressing in ropana, usually done after shodana. a used after wound healing, known as peripheral neuropathy. As the incidence of Diabetes mellitus is increasing also unquestionable. Overall 15% of iabetes mellitus will have foot ulcer and the annual incidence is 2-3%. The general line of treatment includes antibiotics to treat infections, revascularisation if associated with ischemia, to improve the condition of the wound or bed preparation, topical applications, val of callus. Amputation is the last option globally, globally, increase increase in in the getting normal skin In the present study, we used Patana K amputation of 5th Panchavalkala Kashaya and R Taila carried till the end of healing symptoms like constipation, skin control infection Triphala Guggulu and Gandhaka Rasayana given orally and healing of wound achieved within a short period. ROLE OF PANCHAVALKAL Panchavalkala is one of the ideal combinations for a vast range of therapeutics focused in Ayurveda like Vranaropana, Shothahara, Graahi, Visarpahara etc. It was prepared with barks of five trees viz. Vata (Ficus bengalensis Linn), Udumbara (Ficus glomerat Roxb.), Ashwatha (Ficus religiosa Linn.), Parish (Thespesia populenea Soland ex corea.) and Plaksha (Ficus lacor Buch-Ham.). Researchers in recent and past evaluated that The barks of these plants contain anti-inflammatory, anti-bacterial properties due to the presence of phosphorus.[12] Extraction of barks of these plants reduced blood sugar in normal as well as induced diabetic rabbits[13] activity seen in albino rats.[14] ROLE OF JATYADI TAILA The wound dressing was done with Jatyadi Taila formulation, which has good S and Ropana (healing) properties classics. This Traditional oil-based antiseptic, fungicidal and a good healer used in boils, cuts, wounds, burns, piles & fistula. Jatyadi T SDM Pharmacy (udupi), Karnataka, India was used. Jatyadi Taila ingredients: Jati Nimba – Neem – Azardirachta indica; Patola Stereospermum suaveolens; Naktamala Stereospermum suaveolens; Naktamala – leaves of used Patana Karma to do Shodana haya and Ropana with Jatyadi carried till the end of healing. Based on symptoms like constipation, skin itching and to right right t toe. with Foot gangrene is a frequent complication in diabetes mellitus. It results from various factors such as atherosclerosis, neuropathy, infection and angiopathy.[7] Gangrene , when lack of oxygenated blood to the tissue in some parts of body, often the hand or feet. In these cases, patients who have an injury may not notice the dead tissue infection due to Diabetic neuropathy. It is a serious condition results in As with any surgery, an amputation carries a risk of complications. Such as Wounds infection, Pain, contractures and Autonomic dysfunction. The Guggulu and Gandhaka healing of wound achieved ROLE OF PANCHAVALKALA KASHAYA Panchavalkala is one of the ideal combinations for a vast range of therapeutics focused in Ayurveda like Vranaropana, Shothahara, Graahi, Visarpahara etc. It was prepared with barks of five trees viz. Vata (Ficus bengalensis Linn), Udumbara (Ficus glomerata Roxb.), Ashwatha (Ficus religiosa Linn.), Parisha (Thespesia populenea Soland ex corea.) and Plaksha Ham.). Researchers in recent and past evaluated that The barks of these plants contain bacterial operties due to the presence of Tannin, Silica and xtraction of barks of these plants blood sugar in normal as well as in alloxan Muscle Muscle weakness, weakness, oot amputation in , have challenging problem of healing in and and healing healing In Ayurvedic science, the the c comprehensive rana(wounds/ulcer) were ibed by Acharya Sushruta under ma (sixty procedures). He has wound from its different aspects right from the definition, causes, types and their management in While describing the types of Vrana, [13] and hypoglycaemic A rana which is having nic non-healing science. In the pakrama, lot of e wound dressing was done with Jatyadi Taila good Shodhana (cleansing) properties as per Ayurvedic based formulation acts as medications in different formulations for wound antiseptic, fungicidal and a good healer used in boils, rns, piles & fistula. Jatyadi Taila of SDM Pharmacy (udupi), Karnataka, India was used. measures are for management are incorporated in Sapta Vidha main procedures are carried when swelling of wound present. Vimlapana is done with : Jati – Myristica fragrans; irachta indica; Patola – local application of alouka (leeches), @ IJTSRD | Available Online @ www.ijtsrd.com www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec Dec 2018 Page: 518

5. International Journal of Trend in Scientific Research an International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 d Development (IJTSRD) ISSN: 2456-6470 Pongamia pinnata; Sikta – Honey bee wax; Madhuka – Licorice – Glycyrrhiza glabra; Kushta lappa; Haridra – Turmeric – Curcuma longa; Daruharidra – Berberis aristata; Manjis cordifolia; Katurohini – Picrorhiza kurroa; Padmaka Prunus puddum; Lodhra – Symplocos racemosa; Abhaya – Terminalia chebula; Nilotpala stellata; Tutthaka – Copper sulphate; Sariva Hemidesmus indicus; Naktamala beeja Pongamia pinnata; Taila & Water.[15,16] dravyas(drugs) have anti- bacterial, anti properties and the combined effect of all of them facilitated wound healing by improving granulation tissue. Nimba bark extract produced significant anti inflammatory activity, aqueous extract of leaves decreased blood sugar in dogs.[17] antibacterial activity against gram-positive and gram negative organism and anti-inflammatory activity. The leaf juice of Jati plant showed antibacterial activity against Staphylococcus Aureus. ROLE OF GANDHAKA RASAYANA Gandhaka Rasayana is broad spectrum A antibiotic, anti-microbial, anti-inflammatory and is blood purifier also. The ingredients used in this formulation are Gandhaka(sulphu (Cinnamomum zeylanicum), cardmomum), Tejpatra Nagakeshar (Mesua farrea), Guduchi (Tinospora cordifolia), Haritaki (Terminalia chebula), A (Phyllanthus emblica), Bibhitaki (Terminlia bellirica), Bhringaraja (Eclipta alba) and Ardraka (Zingiber officinale). A study was done for screening of antibacterial and antifungal activity of Gandhak Rasayana. Its in-vitro antifungal and antibacterial activity was found that Gandhaka Rasayan in different concentrations showed a significant zone of inhibition against three strains of bacteria and four strains of fungi. As per classics, it acts on blood and skin. It removes toxicity from blood and promotes wound healing by controlling infection. Gandhaka Rasayana has known hepatotoxicity, therefore it cannot be given for longer period.[20] ROLE OF TRIPHALA GUGGULU It is a popular safe and effective formulation for mitigation of Tridosha, mainly Vatadosha indicated in Shota (inflammation), haemorrhoids and in fistula treatment. Contents of Triphala Guggulu are (Terminalia chebula) Bibhitaki, (Terminala belerica) Honey bee wax; Madhuka (Emblica officinalis) Pippali, (Piper (Commiphora mukul).[21] omponents of Triphala antibacterial activity in invitro studies against gram Amalaki, (Emblica officinalis) Pippali longum) Suddha Guggulu (Commiphora mukul). Components of Triphala antibacterial activity in invitro studies against gram positive and gram negative organisms. Haritaki, Amalaki found to possess hypoglycaemic activity on glucose-induced hyperglycaemia in rats. Am found potent antibacterial activity along inflammatory activity activity.[22] CONCLUSION Foot gangrene is a frequent complication in mellitus. It results from various factors such as atherosclerosis, neuropathy, infection and angiopathy. The present case diagnosed as diabetic foot gangrene and after amputation of toe post management carried under Ayurveda treatment. Shodhana and Ropana Panchavalkala Kashaya and J significant improvement in wound REFERENCES 1.Mohan H, Text Book of Pathology, 4 Delhi: Jaypee Brothers medical publishers (pvt) Limited; 2010, p802-808 2.Ajith A, “Role of Aragwada A management of Dushta dissertation, Rajiv Gandhi sciences, Bengaluru, 2015, 3.https://www.medicalnewstoday.com/articles/1587 70.php 4.Soni1 S, Avinash Markam A, Singh B et al review literature on Dushta V Journal of Biomedical and Pharmaceutical Sciences;2017, 4(7):p252- 5.Kumar A, Kumar RG, Dutt VS perspective of Dusta Vrana (non International Ayurvedic 2016Januar, Volume 4(02) 6.Saha A, Halder S, Giri KN identification, diagnosis and Journal of Ayurveda and Pharma Research December, Vol 3(12):p33- 7.Oriani G, Meazza D, Favales F, et al oxygen in diabetic gangrene 1990,Vol 5:p171–5 8.https://www.medicalnewstoday.com/articles/1587 70.php Glycyrrhiza glabra; Kushta – Saussurea Curcuma longa; G Guggulu showed Berberis aristata; Manjishta – Rubia Picrorhiza kurroa; Padmaka– Symplocos racemosa; Terminalia chebula; Nilotpala - Nymphaea Copper sulphate; Sariva – Hemidesmus indicus; Naktamala beeja – Seeds of ive organisms. Haritaki, found to possess hypoglycaemic activity on induced hyperglycaemia in rats. Amalaki has found potent antibacterial activity along with anti- inflammatory activity and and anti anti-atherosclerotic [15,16] All of these bacterial, anti-slough properties and the combined effect of all of them facilitated wound healing by improving granulation tissue. Nimba bark extract produced significant anti- lammatory activity, aqueous extract of leaves Foot gangrene is a frequent complication in Diabetes t results from various factors such as atherosclerosis, neuropathy, infection and angiopathy. case diagnosed as diabetic foot gangrene and after amputation of toe post-operative wound management carried under Ayurveda treatment. opana aya and Jatyadi Taila, showed significant improvement in wound healing. Haridra has positive and gram- inflammatory activity.[18] ti plant showed antibacterial ureus.[19] K Karma carried with ROLE OF GANDHAKA RASAYANA is broad spectrum Ayurvedic inflammatory and is Mohan H, Text Book of Pathology, 4thed, New Delhi: Jaypee Brothers medical publishers (pvt) blood purifier also. The ingredients used in this (sulphur), Twak Cinnamomum zeylanicum), jpatra Ela Ela (Elettaria tamala), tamala), (Elettaria Role of Aragwada Avachoornana in the management of Dushta ajiv Gandhi University of health 2015, p34 (Cinnamomum (Cinnamomum V Vrana” Master’s keshar (Mesua farrea), Guduchi (Tinospora aritaki (Terminalia chebula), Amalaki (Phyllanthus emblica), Bibhitaki (Terminlia bellirica), https://www.medicalnewstoday.com/articles/1587 draka (Zingiber officinale). A study was done for screening of antibacterial and antifungal activity of Gandhaka vitro antifungal and antibacterial Soni1 S, Avinash Markam A, Singh B et al, A review literature on Dushta Vrana, European Journal of Biomedical and Pharmaceutical -254 Rasayana solution showed a significant zone of inhibition against three strains of bacteria and four Kumar A, Kumar RG, Dutt VS, Ayurvedic rana (non-healing ulcer), International Ayurvedic Januar, Volume 4(02):p51-55 t acts on blood and skin. It removes toxicity from blood and promotes controlling infection. Gandhaka hepatotoxicity, therefore it Medical Medical Journal Journal; Saha A, Halder S, Giri KN, Diabetic foot ulcers: identification, diagnosis and cure, International Journal of Ayurveda and Pharma Research; 2015 It is a popular safe and effective formulation for -38 atadosha. It was ), haemorrhoids and Oriani G, Meazza D, Favales F, et al,Hyperbaric oxygen in diabetic gangrene, J Hyperb Med; uggulu are- Haritaki, (Terminala belerica) https://www.medicalnewstoday.com/articles/1587 @ IJTSRD | Available Online @ www.ijtsrd.com www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec Dec 2018 Page: 519

6. International Journal of Trend in Scientific Research an International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456 d Development (IJTSRD) ISSN: 2456-6470 9.Mcintosh J, Earnshaw J J, Antibiotic Prophylaxis for the Prevention of Infection after Major Limb Amputation, European Journal of Vascular and Endovascular Surgery; 2009, Vol 37(6 10.Kumar A, Kumar RG, Dutt VS perspective of Dusta Vrana (non-healing ulcer), International Ayurvedic 2016January, Volume 4(02):p51-55 11.Acharya YT, Sushruta Samhita of Sushruta, Sthana, Ch.17, Ver.17. 8th ed. Chaukamaba publications; 2006.p84. 12.12.Khadkutkar D, Kanthi GV, Tukaram D Antimicrobial Activity of Panchavalkal Powder and Ointment, International Journal of Medicinal Plants and Natural Products; 2016, Vol 15 13.Sastry JLN, Dravyaguna Vijnana,2nd Chaukhambha orientalia; 2005, p501 14.Sastry JLN, Dravyaguna Vijnana,2nd Chaukhambha orientalia; 2005, p945 15.Anantramram Sharma, Sushruta Samhita of Sushruta, Chikitsastan Sthana, Vol Ver.06, varanasi: Chaukamaba publica 2001.p407 16.Priti DP, Simpy R, Nargis KI, et al Healing Potential of Jatyadi Formulations in Rats Research Journal of Pharmaceutical, Biological and Chemical Sciences;2012, Vol 17.Sastry JLN, Dravyaguna Vijnana, Varanasi: Chaukhambha orientalia; 18.Sastry JLN, Dravyaguna Vijnana, Varanasi: Chaukhambha orientalia; 19.Sastry JLN, Dravyaguna Vijnana, Varanasi: Chaukhambha Orientalia; 2005 20.Asore GR, Sheth SS, Shinde of Gandhak Rasayana with special reference to Tvachavikara, International Research Journal of Integrated Medicine & Surgery p37-39. 21.Gandhi TN, Gupta SN, Pharmacuetico-analytical guggulu, Journal of Ayurveda and integrated medical scienes; 2017, Vol 22.Sastry JLN, Dravyaguna Vijnana, Varanasi: Chaukhambha orientalia; 2005 224. Antibiotic Prophylaxis Priti DP, Simpy R, Nargis KI, et al, Burn Wound Healing Potential of Jatyadi Formulations in Rats, Research Journal of Pharmaceutical, Biological ;2012, Vol 3(4): p747-754. Sastry JLN, Dravyaguna Vijnana, 2nd ed, Varanasi: Chaukhambha orientalia; 2005, p126 Sastry JLN, Dravyaguna Vijnana, 2nd ed, Varanasi: Chaukhambha orientalia; 2005, p515 Sastry JLN, Dravyaguna Vijnana, 2nd ed, Orientalia; 2005, p834 for the Prevention of Infection after Major Limb European Journal of Vascular and 37(6): p696-703 A, Kumar RG, Dutt VS,Ayurvedic healing ulcer), International Ayurvedic Medical Medical Journal Journal; Acharya YT, Sushruta Samhita of Sushruta, Sutra 8th ed. varanasi: ublications; 2006.p84. Asore GR, Sheth SS, Shinde SB, Critical review with special reference to , International Research Journal of Integrated Medicine & Surgery; 2017, Vol 4(1): 12.Khadkutkar D, Kanthi GV, Tukaram D, Antimicrobial Activity of Panchavalkal Powder and Ointment, International Journal of Medicinal 2016, Vol2 (1): p9- upta SN, Patel MV et al, analytical ournal of Ayurveda and integrated 2017, Vol 2(5): p67-71 Sastry JLN, Dravyaguna Vijnana, 2nd ed, Varanasi: Chaukhambha orientalia; 2005, p210- nd ed, Varanasi: 501 study study of of Triphala Triphala nd ed, Varanasi: p945 Anantramram Sharma, Sushruta Samhita of Vol-2, Ch.31, haukamaba publications; @ IJTSRD | Available Online @ www.ijtsrd.com www.ijtsrd.com | Volume – 3 | Issue – 1 | Nov-Dec Dec 2018 Page: 520