Abstract:
In the present scenario sedentary lifestyle, a lot of stress, and overnutrition are very important etiology of diabetes, as truly one of their most prevalent diseases in the environment. Foot complication leading to amputations represents one of the significant risk factors of diabetes.
Typically diabetic Foot ulcers are caused by underlying neuropathy, vasculopathy, etc., and responsible for more hospitalizations than any other complication of diabetes. It is the primary cause of non-traumatic lower extremity amputations in India, with approximately 5-6 percent of diabetics developing foot ulcers annually and approximately 1% requiring amputation.
Ayurvedic literature has provided detailed explanations on wound healing from its symptom to comprehensive healing, shown very good results in non-healing wounds.
Introduction:
Madhumeha or Diabetes mellitus is very well known from ancient times. Even in Vedas and Puranas the description of Madhumeh and its remedy is given. Diabetes mellitus represents a group of chronic diseases characterized by an increased level of glucose in the blood leading to defects in insulin production, insulin action, or both.
Worldwide, The amount of all cases of diabetes was estimated to be 171 million, and by 2025, this number is projected to reach 366 million. As obesity represents an important risk factor for type 2 (Non-insulin-dependent) diabetes. Patients who have diabetes are at risk for developing severe health issues that may affect the kidneys, eyes, feet, skin, and heart.
Refernce: https://www.who.int/diabetes/facts/en/diabcare0504.pdf
‘Diabetic foot’ this term is somewhat a misnomer since the state has been described as a group of syndromes that can involve, neuropathy, Ischemia, and Infection, and with all the neuropathic types being the most common. Diabetic ulcers often occur most often on the subcutaneous fat bearing surfaces of the foot under the pressure point.”
Vrana” is an entity of tissue destruction and tenderness, in which permanent scar tissue has been left on the body on its healing and remains on the body till the person survives.
The development of diabetic foot ulcers (DFUs) typically Results from large vessel disease and or peripheral neuropathy, but often DFUs are caused by peripheral Neuropathy.
It was estimated that approximately 1 percent of the world population is affected by Diabetes. An effect of hyperglycemia of Diabetes, every tissue, and organ of the human body undergoes structural and biochemical alterations cause’s severe complications.
Diabetic foot ulcer or Dusth Vrana:
A diabetic foot ulcer is one of the contagious complications, in which the glucose-laden tissue may cause ulcer formation and chronic infection. Ulceration in diabetes may be precipitated by ischemia as a result of diabetic atherosclerosis, infection, or peripheral neuritis. Diabetes is connected with gangrene, which complication of a pre-existing health state.
Gangrene happened when insufficiently oxygenated blood Causes tissue to perish in a few parts of the body, often the hand or feet. In such instances, patients, who have an accident may not observe the dead tissue illness diabetic neuropathy. It’s a serious illness that results in the amputation of the limb. Post management is a major problem in diabetics due to illness; the wound becomes complicated and sometimes needs skin grafting.
Ayurvedic Samhitas has given detailed management regarding wound management starting from pathogenesis, types, clinical symptoms, and management.
Acharya Susruta named Dushta Vrana revealed features of the non-healing wounds according to modern science. He explained 60 Upakramas(steps) for wound treatment from its manifestation to the complete healing, which shows very good results in chronic wounds Dusta Vrana.
The characteristics of Dushta Vrana: (Diabetic foot ulcer stages)
- Ativivrita (broad base)
- Bhairava (ugly look)
- Putipuyamansa (pus discharge)
- Durgandha (foul smell)
- Vedana (pain)
- Dirghakalanubandhi (chronic)
Diabetic Foot Ulcer Line of Treatment:
- Acharya Sushruta describes Shodana(cleansing), Ropana (healing) procedures for wounds healing with Ayurvedic formulations includes Jatyadi Taila and Panchavalkala Kashaya.
- While describing the types of Vrana, Dushta Vrana is mentioned which is having similar clinical features of chronic non-healing wounds based on current medical science. From the Vrana treatment along with Upakrama, a lot of medications in various formulations for wound management were described.
60 types of wound healing measures are mentioned in Sapt Vidha Upkarm.
- Vimlapana is performed with bamboo reeds or thumb, i.e. local use of pressure.
- Avasechana can be done with Sringa, Alabu, Jalouk (leeches), or Shastra, i.e. from the wound.
- Upanaha performed with a poultice to stimulate paka of a wound.
- Patana is a surgical or para surgical procedure used to remove slough from the wound.
- Shodhana is one of the major part in wound treatment. Wound cleaning is done with herbs decoctions, Kalka (paste).
- Ropana procedure performed for wound healing. Medicated herb oil or honey or ghee or medicated churna applied as dressing in ropana.
- Vaikrutapaha done after wound healing. It’s a cosmetic treatment performed for getting the normal skin texture with hair growth.
Based on symptoms shodhana with panchavalkala Kashaya and Ropana with jatyadi tails done till the end of healing. If symptoms like constipation, skin itching arises then to control infection Triphala Guggulu and Gandhaka Rasayana given orally, and healing of the wound achieved within a short period.
- Panchavalkala is one of the ideal combinations for a vast range of therapeutics focused in Ayurveda like Vrana ropana, Shothahar, Graahi, Visarpahara, etc.
- It is prepared with barks of five trees viz. Vata (Ficus bengalensis Linn), Udumbara (Ficus glomerate Roxb.), Ashwatha (Ficus religiosa Linn.), Parish (Thespesia populenea Soland ex corea.), and Plaksha (Ficus lacor Buch-Ham).
Add on factors in management:
- In Ayurveda dietary and lifestyle plays an important role in the management of a disease.
- The first step in the treatment is to control blood sugar levels and bring them to normal values.
Avoid food prepared out of:
- Haritaka Shaaka
- Amla
- Lavana
- Katu Dravyas
- Intake of Cold water
- Dahi (Curd)
- Dugdha(Milk)
Avoid:
- Vata, Aatapa,
- Ati Bhojana (over eating)
- Unpleasant Noises and Scene,
- Raatri Jaagarana (late night wake up)
- Irregular food habits,
- Sleeping on an uneven bed,
- Langhana,
- Heavy exercise,
- Standing for a long time,
- Adhyashana, Ajeerna
FAQ :diabetic foot ulcers
1) How can a diabetic wound heal faster?
Good nutrition provides what your body needs for faster healing of a wound, so eat a healthy diet and stay active. Exercise helps improve insulin sensitivity. This helps sugar in the bloodstream enter your cells more efficiently, which promotes healing and health.
2) What is the best dressing for diabetic foot ulcers?
Panchvalkal kshaya along with jatyadi tail is best for such types of ulcers.
3) Can diabetic leg ulcers be cured?
With proper diet and lifestyle along and with a course of treatment, diabetic leg ulcers can start healing.
4) How do you treat diabetic ulcers on toes?
The course of treatment will be the same just like the legs.
- Prevention of infection.
- Taking the pressure off the area, called “off-loading”
- Removing dead skin and tissue, called “debridement”
- Applying medication or dressings to the ulcer.
- Managing blood glucose and other health problems.
5) How can wounds heal faster?
Various factors are responsible for faster healing.
You have to keep the blood sugar levels under check and take good care of the wound. Maintain good hygiene.
6) What is the best medicine for healing wounds?
Healing of the wound is a complex process. This needs the management of wounds internally and externally. So a complete course of medicine can be started after consulting a Life Aveda physician.
7) What herbs are good for healing wounds?
Panchvalkal kshay is very good for cleansing the wound and jatyadi
Taila has wonderful effects on healing ulcers.
8) What is the Ayurvedic medicine for ulcers?
Depending on symptoms and for better healing of the wound following medications can be given locally and orally.
Locally:
The wound has to be washed with the decoction of Panchavalkala Kashaya daily, which is made from 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 ) after washing, let the wound dried, then by aseptic technique Jatyadi Taila can be applied daily up to complete healing of wounds.
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
Conclusion:
Even after following standard management, recurrence of Diabetic foot ulcers is common. Poor control of sugar level leads to vascular & neuropathic deformities and ulceration, several therapies have been studied so far to reduce Dusht Vrana ( Diabetic foot ulcer) healing time and amputation rates, but there is still space for improvement in Diabetic foot ulcer management. Hence by adopting traditional wound management, the risk of foot ulcers and its associated morbidities can be reduced.
