ayurvedic intervention in the management of post-operative diabetic foot gangrene - a case study

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Ayurvedic Intervention Diabetic Foot Gangrene

Basavaraj Chanda1, Vislavath Srikanth1,2Post Graduate Scholar

1,3,4Department oSri Dharmasthala Manjunatheshwara College

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 Nonwounds. 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 prescomplains 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 postwound management was carried under Ayurvedtreatment 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

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Ayurvedic Intervention in the Management of PostDiabetic Foot Gangrene – A Case Study

, Vislavath Srikanth2, Gopikrishna3, Prasanna N RaoPost Graduate Scholar, 3Professor & HOD, 4Professor & Principal

of Shalya Tantra, 2Department of Rachana SharirSri Dharmasthala Manjunatheshwara College of Ayurveda And Hospital, Hassan

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 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

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

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 15complications 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 due to diabetic atherosclerosis, infection or peripheral neuritis.

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 infectiondiabetic neuropathy. It is a serious condition ramputation of limb.[3] Postmanagement is serious problem in diabetic patients due to infection, wound becomes complicated and sometimes needs skin grafting

Ayurvedic literature has given detailed explanationregarding wound management startingpathogenesis, types, clinical featuresand management. Acharya Susterm Dushta Vrana which showed sfeatures of the non–healing wounds according to present medical science. He explained 60Upakramas(measures) for wound management from its manifestation to the complete healing, which shown good results in chronic wounds aka Dusta Vrana.[5]

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f Post-Operative A Case Study

, Prasanna N Rao4 Principal

Rachana Sharir Hassan, Karnataka, India

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 the glucose laden tissue may cause chronic infection

ormation. Ulceration in diabetes may be precipitated by ischemia due to diabetic atherosclerosis, infection or peripheral neuritis. [2]

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

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. He explained 60

for wound management from its manifestation to the complete healing, which

in chronic wounds aka Dusta

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The present case is diabetic foot gangrene which amputated in SDM Hospital and post operative wound management carried under Ayurvedic wound treatment protocol. CASE REPORT This is a case of 45years old male, diabetic patientcame 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, nin the hands and feet, Irregular constipation since 1month. History of present illness: The patient hadblackish discoloration, pain during pressurefoul 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 noticeddiscoloration 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 2foot, done 1year back in allopathic hospital due to chronic non-healing ulcer. Personal history

Name :XYZ Bala : Madhyama

B.P: 130/88 mm of Hg.

Age:45years Sleep: Disturbed due to pain

P.R: 68/min.

Gender : Male Appetite :Good Weight:54kgs

Marital status : Married

Bowel: Irregular Height:5.7ft

Occupation: Revenue officer

Addictions : No

International Journal of Trend in Scientific Research and Development (IJTSRD) ISSN: 2456


rene which was operative wound

management carried under Ayurvedic wound

This is a case of 45years old male, diabetic patient came to SDM Ayurvedic hospital with the chief

ration over the 5th

Swollen, reddish discoloration over the ulcer since

: General weakness, numbness constipation since

: 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

that, he went to allopathic hospital and diagnosed with diabetic foot

suggested amputation by 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

B.P: 130/88 mm of Hg.

P.R: 68/min.

Weight:54kgs

Height:5.7ft

Systemic Examination: Not significantLocal Examination: Site – over 5th right Size - Length: 2.5 cm, Width: 1.6cmNumber : 1 Edge and margin –Inflamed with irregular borderFloor : Covered with slough and

granulation tissueBase : Indurated Discharge : blood stained smelling - on and off Surroundings : Blackish in colourBleeding (-) Tenderness : Present Regional Lymph node : Not palpable.Rogaadhishtanam: Adhahkayam Asthi, Sira) Avastha : Pakwam. Provisional diagnosis: Dushta Vranam.Clinical diagnosis: Dushta Vranamgangrene) Prognosis : Krichra Sadhyam. Examination of Gangrene: Symptoms such as claudication and rest pain are present. Inspection: Change in colour : Blackish in colourExtension : Up to metatarsalSigns of ischemia : Thinning of skin noted Loss of subcutaneous fat Trophic changes in nails such astransverse 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 findingsdiagnosed 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

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Systemic Examination: Not significant

toe Length: 2.5 cm, Width: 1.6cm

Inflamed with irregular border : Covered with slough and unhealthy granulation tissue

pus discharge with foul

: Blackish in colour

: Not palpable. kayam (Twak, Mamsam,

ta Vranam. Clinical diagnosis: Dushta Vranam (diabetic foot

adhyam.

Symptoms such as claudication and rest pain are

: Blackish in colour p to metatarsal

: Thinning of skin noted Loss of subcutaneous fat

Trophic changes in nails such as-brittle nail with

negative, normal popliteal artery on felt with oscillatory movements of foot.

After careful examination and clinical findings, it is [gangrene wound] and

ical word of SDM hospital. A rough counselling was done to the patient

regarding severity of wound and future complications of gangrene. After consent of patient, Ray’s



amputation procedure was performed on 5Healing of amputated wound in diabetic patient is major challenge in practice. Patient has similar historof delayed wound healing during 2amputation, which took 4 months to heal. The postamputated wound was treated under Sushruta’s Dushta Vrana management protocol. Basedwe performed Chedana, Bhedana, Shodana and Ropana measures from Sushruta’s 60 Uthis case. The management of amputatedprotocol 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 ProtocolType of

treatment From—to Intervention

Local 2.1.2018 to 12.1.2018

Panchavalkala Qwatha to wash wound

Local 5.1.2018 to 15.2.2018

Applied JatyadiTaila over

Systemic treatment

2.1. 2018 to 16.1.2018 Then again on 2.2.2018 to 16.3.2018

Tab Gandhak RasayanaBD

2.1.2018 to 2.2.2018

Triphala G250 mg BD

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 Buchwashing 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



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

Table No.1: Chronology of Treatment Protocol

Intervention

Panchavalkala atha to wash

Applied Jatyadi aila over the wound

Gandhak a 500 mg 2

Triphala Guggulu 250 mg BD

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

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.

Apathyam: Masha, sour and salty food, curd, oily and spicy foods and day sleep are adviced to avoid. OBSERVATION AND RESULTHealthy granulation tissue was formed within one week. Washing of the wound waPanchavalkala 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.

Figure 1: Diabetic foot gangrene before treatment

Figure2: Diabetic foot gangrene


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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 was continued with

ll 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

Diabetic foot gangrene before treatment

iabetic foot gangrene after treatment



DISCUSSION Diabetic foot ulcers (DFU) are a fairly common complication of Diabetes mellitus. Theforms: 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 globally, increase in complications is also unquestionable. Overall individuals with Diabetes mellitus will have foot ulcer during their lifetime and the annual incidence is 2The 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 angiopathyhappened, 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, Muscle weakness, contractures and Autonomic dysfunction. frequent symptom is Oedema. Foot amputationDiabetes, have challenging problem ofsurgical practice.[9]

In Ayurvedic science, the cmanagement 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 Vmentioned the term Dushta Vrana which is hsimilar clinical features of chronic nonwounds according to present medical science. In the Vrana management along with Upakrama, lot of medications in different formulations for whealing were explained.[10] The sixty measures are for wound management are incorporated in Sapta Vidha Upakrama. These 7 main procedures areswelling of wound present. Vimlapana is done with thumb or bamboo reeds, i.e. local application of pressure. Avasechana done with Jalouka



Diabetic foot ulcers (DFU) are a fairly common . These are two schemic ulcers,

mixture of both. because of high

the nerves known as peripheral neuropathy. As the incidence of Diabetes mellitus is increasing globally, increase in

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

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, Muscle weakness, contractures and Autonomic dysfunction. The

oot amputation in , have challenging problem of healing in

In Ayurvedic science, the 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, rana which is having

nic non-healing science. In the

pakrama, lot of medications in different formulations for wound

measures are for management are incorporated in Sapta Vidha

main procedures are carried when swelling of wound present. Vimlapana is done with

local application of alouka (leeches),

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 withmedicated decoctions, paste, medicatedRopana procedure done for wound healing. Medicated oil or ghee or honey or medicated churna used as dressing in ropana, usuallyVaikrutapaha used after wound healing, known as cosmetic treatment do for the colour with hair growth.[11]

In the present study, we used Patana Kamputation of 5th right tPanchavalkala Kashaya and RTaila carried till the end of healingsymptoms like constipation, skin control infection Triphala Guggulu and Gandhaka Rasayana given orally and healing of wound achieved within a short period. ROLE OF PANCHAVALKALPanchavalkala 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 glomeratRoxb.), 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 and healing 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 TAIL AThe wound dressing was done with Jatyadi Tailaformulation, which has good Sand Ropana (healing) properties classics. This Traditional oil-basedantiseptic, fungicidal and a good healer used in boils, cuts, wounds, burns, piles & fistula. Jatyadi TSDM Pharmacy (udupi), Karnataka, India was used. Jatyadi Taila ingredients: Jati Nimba – Neem – Azardirachta indica; Patola Stereospermum suaveolens; Naktamala


Dec 2018 Page: 518

removing impure blood one with poultice to induce

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 the getting normal skin

used Patana Karma to do right toe. Shodana with

haya and Ropana with Jatyadi carried till the end of healing. Based on

symptoms like constipation, skin itching and to Guggulu and Gandhaka

healing of wound achieved

ROLE OF PANCHAVALKAL A 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 and healing operties due to the presence of Tannin, Silica and

xtraction of barks of these plants blood sugar in normal as well as in alloxan

[13] and hypoglycaemic

A e wound dressing was done with Jatyadi Taila

good Shodhana (cleansing) properties as per Ayurvedic

based formulation acts as antiseptic, fungicidal and a good healer used in boils,

rns, piles & fistula. Jatyadi Taila of SDM Pharmacy (udupi), Karnataka, India was used.

: Jati – Myristica fragrans; irachta indica; Patola –

Stereospermum suaveolens; Naktamala – leaves of



Pongamia pinnata; Sikta – Honey bee wax; Madhuka – Licorice – Glycyrrhiza glabra; Kushta lappa; Haridra – Turmeric – Curcuma longa; Daruharidra – Berberis aristata; Manjiscordifolia; Katurohini – Picrorhiza kurroa; PadmakaPrunus 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 antibacterial, antiproperties and the combined effect of all of them facilitated wound healing by improving granulation tissue. Nimba bark extract produced significant antiinflammatory activity, aqueous extract of leaves decreased blood sugar in dogs.[17]

antibacterial activity against gram-positive and gramnegative organism and anti-inflammatory activity.The leaf juice of Jati plant showed antibacterial activity against Staphylococcus Aureus. ROLE OF GANDHAKA RASAYANAGandhaka Rasayana is broad spectrum Aantibiotic, anti-microbial, anti-inflammatory and is blood purifier also. The ingredients used in this formulation are Gandhaka(sulphu(Cinnamomum zeylanicum), Ela (Elettaria cardmomum), Tejpatra (Cinnamomum tamala), 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 GandhakRasayana. Its in-vitro antifungal and antibacterial activity was found that Gandhaka Rasayanin 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 Vatadoshaindicated in Shota (inflammation), haemorrhoids and in fistula treatment. Contents of Triphala Guggulu are(Terminalia chebula) Bibhitaki, (Terminala belerica)



Honey bee wax; Madhuka Glycyrrhiza glabra; Kushta – Saussurea

Curcuma longa; Berberis aristata; Manjishta – Rubia

Picrorhiza kurroa; Padmaka– Symplocos racemosa;

Terminalia chebula; Nilotpala - Nymphaea Copper sulphate; Sariva –

Hemidesmus indicus; Naktamala beeja – Seeds of [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 [17] Haridra has

positive and gram-inflammatory activity.[18]

ti plant showed antibacterial ureus.[19]

ROLE OF GANDHAKA RASAYANA is broad spectrum Ayurvedic

inflammatory and is blood purifier also. The ingredients used in this

(sulphur), Twak Cinnamomum zeylanicum), Ela (Elettaria

jpatra (Cinnamomum tamala), keshar (Mesua farrea), Guduchi (Tinospora

aritaki (Terminalia chebula), Amalaki (Phyllanthus emblica), Bibhitaki (Terminlia bellirica),

draka (Zingiber officinale). A study was done for screening of antibacterial and antifungal activity of Gandhaka

vitro antifungal and antibacterial Rasayana solution

showed a significant zone of inhibition against three strains of bacteria and four

t acts on blood and skin. It removes toxicity from blood and promotes

controlling infection. Gandhaka hepatotoxicity, therefore it

It is a popular safe and effective formulation for atadosha. It was

), haemorrhoids and

uggulu are- Haritaki, (Terminala belerica)

Amalaki, (Emblica officinalis) Pippalilongum) Suddha Guggulu (Commiphora mukul).Components of Triphala Gantibacterial activity in invitro studies against gram positive and gram negative organisms. Haritaki, Amalaki found to possess hypoglycaemic activity on glucose-induced hyperglycaemia in rats. Amfound potent antibacterial activity along inflammatory activity and antiactivity.[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 postmanagement carried under Ayurveda treatment.Shodhana and Ropana KPanchavalkala Kashaya and Jsignificant improvement in wound REFERENCES 1. Mohan H, Text Book of Pathology, 4

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(Emblica officinalis) Pippali, (Piper (Commiphora mukul).[21]

omponents of Triphala Guggulu showed antibacterial activity in invitro studies against gram

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 anti-atherosclerotic

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 Karma carried with aya and Jatyadi Taila, showed

significant improvement in wound healing.

Mohan H, Text Book of Pathology, 4thed, New Delhi: Jaypee Brothers medical publishers (pvt)

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