From,

DR. VISHESH SHARMA

Preliminary M.S. (Ayu.) Scholar.

Department of Post Graduate Studies in Shalya-Tantra.

N.K.J Ayurvedic Medical College & Research Centre, Gumpa,

Bidar-585403

To,

The Registrar,

Rajiv Gandhi University of Health Sciences

Bangalore, Karnataka

Through,

The Principal and H.O.D,

N.K.J Ayurvedic Medical College & Research Centre Gumpa,

Bidar-585403

Subject: Submission of Completed Performa for registration of Synopsis for Dissertation

Respected Sir,

I request you to kindly register the below mentioned subject against my name for the submission of dissertation to Rajiv Gandhi University of Health Sciences Bangalore, for the partial fulfillment of M.S. (Ayu.) in Shalya-Tantra.

TITLE OF DISSERTATION:

“ROLE OF DHOOPANA KARMA IN THE MANAGEMENT OF DUSHTA VRANA”

I am hereby enclosing, completed Performa for registration of subject for dissertation.

Thanking You Yours Sincerely;

Date:-

Place:- Bidar (DR.VISHESH SHARMA)

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA-BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1.  Name of the Candidate : DR. VISHESH SHARMA
S/O DR.VISHNU SHARMA

H.NO.1 NIRMAL NIWAS,

KANGRA COLONY,

B/S CELEBRATION MALL,

DIST:- AMRITSAR. (PB.)

2.  Name of Institution : N.K.J. AYURVEDIC MEDICAL

COLLEGE AND POST GRADUATE

CENTRE BIDAR-585 403.

KARNATAKA (INDIA).

3.  Course of study and Subject : M.S. (SHALYA-TANTRA)

4. Date of Admission to Centre: 30/AUG/2012.

5. Title of Topic :

“ROLE OF DHOOPANA KARMA IN THE MANAGEMENT OF DUSHTA VRANA”

6. BRIEF RESUME OF THE INTENDED WORK.

INTRODUCTION

Wound healing is the major problem in the surgical practice. For these, the most fearful is infection. Due to infection, wound becomes complicated. The importance of wound healing has long being recognized as fundamentally essential for the practice of surgery. In the past, number of pioneer surgeons have shown their keen interest in the study of wound healing and have significantly contributed to the proper understanding of this subject. The problem of wound healing has attracted attention of large number of scientists all over the world.

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Acharya Sushruta, the father of surgery, explained Vrana as;

“व्रण गात्रविचूर्णने, व्रणयतीति व्रणः|”(1)

Means the destruction or damage of tissues, to open due to break in skin and muscle, classified wounds as Sadhyo Vrana and Dushta Vrana. According to modern science wound and ulcer both are synonymously used. Wound is defined as the disruption of cellular and anatomic continuity of skin, any damage leading to a break in the continuity of the skin is called as a wound, an ulcer is discontinuity of epithelium, as a result of molecular death of tissues.(2).

Sadhyo Vrana is an excessively damaged condition characterized by vitiation of doshas, after seven days of injury it may converted into Dushta Vrana. The Dushta Vrana have Lakshanas of Kathina (hard), Vedanavan (severe pain), Daha (burning sensation at site), Paka (suppuration), Putimamsasirasnayu pratipurna (full of foited pus), Puyasravya (discharging pus), Kandu (itching), Shopha (swelling), Pidaka (with boils), Bhairava (frightful) with no intension to heal. So the wound becomes complicated which needs a specific management as it is vitiated by tridoshas.(3)

Even though various studies are done over the healing of Dushta Vrana still it is one of the areas which is open for various researches.

Hence, its need of time to search for the preparation which fulfills wound healing principles described by Acharya Sushrutha. In Sutra Sthana, Vranitopasaneeya adhyaya Acharya Sushruta has mentioned the Dhoopana karma in the management of Dushta Vrana i.e Dhoopana karma is to be done twice for ten days with Sarshapa, Nimba Patra, Ghee, Lavana on the Vrana.

सर्षपारिष्टपत्राभ्यां सर्पिषा लवणेन च |

द्विरह्नः कारयेद्धूपं दशरात्रमतन्द्रितः ||(4)

Thus, present study has been undertaken to evaluate the effect of Dhoopana karma in the management of Dushta Vrana.

6.1 NEED FOR STUDY:

·  Most procedures in surgical practice are invasive and also expensive due to prolonged hospitalization, surgical debridement and repeated course of antibiotics to cure completely.

·  The procedure of Dhoopana karma on Dushta Vrana assumes to be effective because the drugs like Nimba patra, Sarshapa, Ghrita, Lavana having krimighana, vrana-shodhaka, vrana-ropaka properties, they kills the micro organisms when used in the form of fumes and keeps the wound clean and hastens healing process.

·  So, Dhoopana karma, and drugs to be used being cost-effective, self-applicable, non-invasive and easy to implement, is a new therapeutic aspect and doesn’t need any hospitalization, thus taken for the study.

6.2 REVIEW OF LITERATURE :

(1)  Acharya Charaka mentioned the importance of Vrana Dhoopana as ruja, srava, gandha, krimi nashaka.(5).

(2)  In Sushruta Samhita, chikitsa sthana chapter 1st, importance of Dhoopana karma in Vrana as ugraruja and srava-nashaka,vranamukta are described by Acharya Sushruta.(6)

(3)  In Sushruta Samhita, chikitsa sthana chapter 40th, Dhoopana yantra and the procedure of Vrana Dhoopana is mentioned.(7)

(4)  In Sushruta Samhita Sutra Sthana, drugs used in vrana Dhoopana are given.

(5)  Acharya Vagbhata also mentioned importance of Dhoopana karma in dushta vrana as ugravedna-nashka and srava-nashka(8).

(6)  In Bhaisajya Ratnavali, importance of Vrana Dhoopana is also given.(9)

(7)  Gunas of Nimbapatra are given in Bhavamishra Purvakhanda Nighantu bhaga in guduchyadi varga(10)

(8)  Gunas of Sarshapa are given in Bhavamishra Purvakhanda Nighantu bhaga in Dhanya varga(11)

(9)  The detailed study of Jatyadi ghrita, its composition, action etc are to be discussed as mentioned in Yogaratnakara.(12)

The list of previous work done

1.  Sanjeev kumar LB – Clinical study in the management of Dushta Vrana with Rasa-Sindoora internally and Rasa-Karpooradi Dhoopana externally (1990) Govt. Ayurvedic college, Kerala Univ. Thiruvananthapuram.

2.  Soni Laxmi R – Role of Dhoopana on dushtavrana (1999) RK Toshaniwal Ayurveda Mahavidyalaya Amaravati University.Akola.

6.3 Objectives of the STUDY:

The objectives of the selected research work is:-

1.  To study and compare the efficacy of Dhoopana karma and Jatyadi Ghrita in the management of Dushta Vrana.

7.0 MATERIALS AND METHODS:

7.1 SOURCES OF DATA

  1. 30 patients will be randomly selected from the O.P.D. & I.P.D. of Shri Siddharudha Charitable teaching Hospital of N.K.J. Ayurvedic Medical College and P.G. Research centre, Bidar.
  2. Raw drugs will be collected from the Herbal garden & market.
  3. Patients will be screened on routine clinical examination.
  4. Samhitas and modern books of surgery.
  5. National, international journals, magazines, seminar, conference, internet material, presented papers etc.

MATERIALS:

Dhoopana yantra, Sarshapa, Nimba patra, Ghrita, Lavana, Measuring scale, Normal

Saline for cleaning of wound, Wood Charcoal.

7.2 METHODS OF COLLECTION OF DATA

·  Selection of patients will be done on the basis of chief complaints and physical, systemic and local examination of Dushta Vrana’s.

A)  SAMPLE SIZE

30 patients of Dushta Vrana fulfilling the inclusion criteria will be selected for the study and assigned in two group:-

G1-Trial group - 15 Patients will be treated with Dhoopana karma twice a day for 10 days.

G2-Control group - 15 Patients will be treated with Jatyadi Ghrita twice a day externally

daily for 10 days.

STUDY DESIGN

BT1 Vs AT1 / Will be assessed / AT1 Vs AT2 / will be assessed & evaluated by “t” test
BT2 Vs AT2

Diagnostic criteria:

Diagnosis will be made on the basis of lakshanas of Dushta Vrana.

B) PROCEDURE

Group A : Dhoopana karma is to be done with Dhoopana yantra. Twice a day for ten days after cleansing the wound with NS and sterile bandage is to be done.

Group B : External application of Jatyadi Ghrita is to be done twice a day for 10 days after cleansing the wound with NS and sterile bandage is to be done.

SELECTION CRITERIA:

INCLUSION CRITERIA:-

1)  Selection of Dushta Vrana patients will be done irrespective of Age & Sex.

2)  Patients having the lakshanas of Dushta Vrana will be selected.

EXCLUSION CRITERIA:-

1.  Diabetic wound, Syphilitic ulcer, Trophic ulcer, and Vascular ulcers.

2.  Patients with disorders like Malignancy, Tuberculosis, Leprosy, HIV positive, HBsAg positive, Burns, Osteomyelitis will be excluded.

ASSESSMENT PARAMETERS:

Assessment will be made with the following parameters:

In both the groups after the procedure, the patients will be regularly observed. The assessment will be done on 2nd, 4th , 6th, 8th , 10th day. The progress will be noted in specially prepared research case sheet as per the assessment parameters (subjective & objective). Finally, the results will be statistically evaluated.

ASSESSMENT CRITERIA:

1. Days taken to get the Shuddha Vrana Lakshanas will be explained in the literary review.

2. Self-gradation will be given to the Lakshanas of Dushta Vrana depending upon Pancha lakshanas of Vrana.

SUBJECTIVE PARAMETERS:

  1. Pain

OBJECTIVE PARAMETERS:-

1. Colour

  1. Size of wound
  2. Discharge
  3. Granulation of tissue

DURATION OF TREATMENT:

Treatment will be carried out for ten minutes, twice a day for ten days.

GRADING OF OBJECTIVE & SUBJECTIVE PARAMETERS

Parameter of assessment:-

The patients will be assessed on the basis of Subjective and Objective parameters before and

after treatment.

Pain - As the sufferer himself expresses the pain in his own terms, so this is graded,

starting from mild to severe.

·  Grade 0 – Absence of pain/no pain.

·  Grade 1 – Mild – Pain that can easily be ignored.

·  Grade 2 – Moderate – Pain that cannot be ignored, interferes with function, and needs

treatment from time to time.

·  Grade 3 – Severe – Pain not relieved even after using analgesics.

Varna:-

·  Grade – 0 - Twak savarna. – healed wound/equivalent to skin colour.

·  Grade – 1 - Kapota varna (gray) - healing wound/equivalent to brownish-white.

·  Grade – 2 - Shwetarakta - Cleaned wound/equivalent to reddish-white.

·  Grade – 3 -Krishna Varna - Contaminated with dust or soiled wound/equivalent to

congested reddish-black.

Sraava:-

·  Grade – 0 - No discharge

·  Grade – 1 – Mild - If vrana wets 1 pad of 4x4 cm gauze piece.

·  Grade – 2 - Moderate - If vrana wets 2 pads of 4x4 cm gauze piece.

·  Grade – 3 – Profuse - If vrana wets more than 2 pads of 4x 4 cm gauze piece.

Granulation tissue:-

·  Grade – 0 - Healthy granulation without slough.

·  Grade – 1 - Moderate granulation with slough.

·  Grade – 2 - Unhealthy granulation with slough or hyper granulation.

·  Grade - 3 - Granulation tissue absent

Parimana (size of wound):- The size was directly recorded. The sterile blotting paper was placed over the wound and pressed with uniform pressure. The impression was directly measured. The depth was directly measured with the help of a sterile probe.

·  Grade - 0 - Healed

·  Grade – 1 - Within 1 - 4 cm

·  Grade – 2 - Within 5 - 8 cm

·  Grade – 3 - Within 9 -12 cm

Unit healing time (cm2 / day) = Total no. of days of wound healing =....Days/ Square cm

Initial length × Breadth × Height

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE

CONDUCTED ON THE PATIENTS/ OTHER ANIMALS ? IF SO,

PLEASE DESCRIBE BRIEFLY:-

Investigations to be done on patients (if necessary)

·  RBS, V.D.R.L, HIV, HBsAg.

·  Wound Biopsy (if necessary)

7.4 HAS ETHICAL CLEARNCE BEEN OBTAINED FROM YOUR INSTITUTION –

YES OBTAINED

8. LIST OF REFERENCES:-

1.  Dr.Ambikadatt Shastri, Edited Sushruta Samhita Chikitsa Sthana 1/6, Reprint 2007, Varanasi Chaukhamba Sanskrit Samsthan, P-3

2.  Basu S.C, Handbook of Surgery, chapter 1, current distributors, Calcutta, 1995, 2nd edition, P-3.

3.  Dr.Ambikadatt Shastri, Edited Sushruta Samhita Sutra Sthana 22/7, Reprint 2007, Varanasi Chaukhamba Sanskrit Samsthan, P-95.

4.  Dr.Ambikadatt Shastri, Edited Sushruta Samhita Sutra Sthana 19/28, Reprint 2007, Varanasi Chaukhamba Sanskrit Samsthan, P-81.

5.  Pandit kashi nath shastri and Dr. Gorkha natha chaturvedi, edited charaka samhita chikitsa sthana 25/108, reprint 2004, Varanasi chaukhamba bharti academy, P-714

6.  Dr.Ambikadatt Shastri, Edited Sushruta Samhita Chikitsa Sthana, Reprint 2007, Varanasi Chaukhamba Sanskrit Samsthan, Sushruta chikitsa 1/80, P-10

7.  Dr.Ambikadatt Shastri, Edited Sushruta Samhita Chikitsa Sthana, Reprint 2007, Varanasi Chaukhamba Sanskrit Sansthana, Sushruta chikitsa 40/19, P-182

8.  Dr. Shivprasad Sharma, Edited Ashtanga Sangraha Uttara tantra 30/32, 1st edition 2006 Varanasi Chaukhamba Sanskrit Series, P-781.

9.  Brahmashankar Mishra, Edited Bhaisajya Ratnavali, Vol.2, 47/48, 1st edition 2006, Varanasi Chaukhamba Sanskrit Bhawan, P-756.

10.  Brahmashankar Mishra, Edited Bhavaprakasha Purvakhanda, Guduchyadi Varga Shloka- 95, 9th Edition 2005, Varanasi Chaukhamba Sanskrit Samsthan, P-328

11.  Brahmashankar mishra, Edited Bhavaprakasha Purvakhanda (nighantu bhaga), Dhanyadi Varga Shloka -71 , 9th Edition 2005, Varanasi Chaukhamba Sanskrit Samsthan, P-654

12.  Brahmashankar Shastri Edited Yogaratnakara Utrardha, 8th Edition 2004, P-177

09 / SIGNATURE OF THE
CANDIDATE
10 / REMARKS OF THE GUIDE
11 / NAME AND DESIGNATION
OF THE GUIDE / DR.CHANDRAKANT HALLI
M.D (AYU)
11.1 / SIGNATURE
11.2 / CO – GUIDE / DR. ASHOK NAIKAR
M.S (AYU)
11.3 / SIGNATURE
11.4 / HEAD OF THE DEPARTMENT / DR. B. N. MURTHY
M.D. (SHALYA)
PROFESSOR. & H.O.D.
11.5 / SIGNATURE
12 / REMARKS OF THE CHAIRMAN
AND PRINCIPAL
12.1 / SIGNATURE

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