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==== Importance of ''dhupana karma'' (fumigation therapy) in wound sterilization healing process ====

==== Importance of ''dhupana karma'' (fumigation therapy) in wound sterilization healing process ====

Fumigation of ulcer is done with ''dhupana dravyas'' (fumigating materials). [ , ] Purpose of fumigation is to make suitable conditions for better ulcer healing such as local sterilization, vasodilation, decreased discharge and removal of foul smell.  

Fumigation of ulcer is done with ''dhupana dravyas'' (fumigating materials).<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Sutra sthana Chap 5, shlok no.17 ,Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 24</ref>, <ref>Kaviraj Atrideva Gupta, Astanga Hridaya, Vidyotini Tika, Uttara tantra Chap 25, shlok no.45, Reprint 2005, Chaukhambha Sanskrit Sansthan,Varanasi, pp 542.</ref>. Purpose of fumigation is to make suitable conditions for better ulcer healing such as local sterilization, vasodilation, decreased discharge and removal of foul smell.  

Fumigation also relieves pain, discharge and kills microorganisms due to ''vata, kapha'' alleviating property along with antiseptic property. [ ] Various types of preparations are  used to harden or soften the wounds as per condition of wound.

Fumigation also relieves pain, discharge and kills microorganisms due to ''vata, kapha'' alleviating property along with antiseptic property.<ref>Kaviraja Ambikadutta Shastri, Sushruta Samhita, Ist part, Chikitsa sthana Chap 1, shlok no.80, Reprint 2013, Chaukhambha Sanskrit Sansthan, Varanasi, pp 12</ref> Various types of preparations are  used to harden or soften the wounds as per condition of wound.

#Research studies on management of ulcers:  The physician observing inflammation as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. Sushruta also indicated blood letting in initial stage of abscess or inflammatory conditions and in ischemic condition of the wound. (SU. Su. ---) [  ]

#Research studies on management of ulcers:  The physician observing inflammation as prodromal sign in the beginning should apply blood-letting to prevent the manifestation of wound. Sushruta also indicated blood letting in initial stage of abscess or inflammatory conditions and in ischemic condition of the wound. (SU. Su. ---)<ref>Dwivedi SP, Shukla DV. Role of Jalaukavacharana (leech therapy) in the management of ankle sprain: a pilot study. International journal of Ayurveda & Alternative Medicine. 2014; 2 (4): 92-95.</ref>,<ref>Pandey BB, Kumar A, Singh N, Bhatia. Efficacy of Jalaukavcharana (Leech Application) in Ischemic Ulcer with Pre-Gangrenous Changes - A Case Report, Journal of Ayurveda 2012 Jul-Sep ; 4 (3) :103-107.</ref>

#The ''nagrodhyadi'' group is indicated in wound as cooling for wounds which is found healing potential in one research. [ ]

#The ''nagrodhyadi'' group is indicated in wound as cooling for wounds which is found healing potential in one research.<ref>Lad M, Bandgar S. Management of non healing wound with nyagrodhadi kwatha and jatyadi ghruta (classical ayurvedic preparations). Global Journal of Research on Medicinal Plants & Indigenous Medicine (GJRMI). 2012; 1 (7): 301-308.</ref>

#The ''panchavakkal'' (Vata (Ficus bengalensis Linn), ''Udumbara'' (Ficus glomerata Roxb.), ''Ashvattha'' (Ficus religiosa Linn.), ''Parisha/Pāriśa'' (Thespesia populenoides L.) and ''Plaksha'' (Ficus lacor Buch Ham.),) is indicated for the healing of chronic wound. In resent studies ''panchavalkal'' has  anti-inflammatory,  cleaning and healing potential in some research studies carried out and published in reputed journals of Ayurveda.[ ,  , , , , ]

#The ''panchavakkal'' (Vata (Ficus bengalensis Linn), ''Udumbara'' (Ficus glomerata Roxb.), ''Ashvattha'' (Ficus religiosa Linn.), ''Parisha/Pāriśa'' (Thespesia populenoides L.) and ''Plaksha'' (Ficus lacor Buch Ham.),) is indicated for the healing of chronic wound. In resent studies ''panchavalkal'' has  anti-inflammatory,  cleaning and healing potential in some research studies carried out and published in reputed journals of Ayurveda.<ref>Meena RK, Dudhamal T, Gupta SK, Mahanta V. Wound healing potential of Pañcavalkala formulations in a postfistulectomy wound. Ancient Sci Life (ASL) 2015;35 (2):118-21</ref>,<ref>Bhat KS, Vishwesh BN, Sahu M, Shukla VK. A clinical study on the efficacy of panchavalkala cream in vrana shodhana w.s.r to its action on microbial load and wound infection. AYU. 2014;35(2):135-140</ref>,<ref>K. Shobha Bhat, M. Sahu, V.K. Shukla. Efficacy of pancavalkala cream in the management of chronic non-healing wounds, Aryavaidyan 2013 May-July ; (26) :224-228</ref>, <ref>Khadkutkar DK, Prof. Kanthi Veena. Therapeutic uses of Panchvalkala in different forms-a review. Ayurlog; National Journal of Research in Ayurveda Science. 2014; 2(1): 1-5</ref>, <ref>Khadkutkar DK, Prof. Kanthi Veena G. A Brief Review of Research Studies Conducted on Panchavalkal. Indian Journal of Ancient Medicine and Yoga. 2015;8(2): 87-94</ref>,<ref>Khadkutkar DK, Kanthi VG, Dudhamal TS. Antimicrobial activity of Panchavalkal powder and ointment. International Journal of Medicinal Plants and Natural Products (IJMPNP). 2015; 1(3): 9-15</ref>

#''Bala'' (Sida cordifolia Linn.), ''guduchi'' (Tinospora cordifolia), ''madhuka'' (Glycyrrhiza glabra Linn.), ''prshnaparni'' (Uraria picta Desv), ''satavari'' (Asparagus racemosus Willd), ''jivanti'' (Leptadenia reticulate W. & A.), sugar, milk, oil, fish fat, ghee cooked with beeswax is known as ''sneha sarkara,'' it relieves pain. Some studies have highlighted the wound healing potential of honey mixed with above drugs. [ , ]Various preparations containing following herbal drugs have wound cleaning effect in single and combination of drugs. The recent studies showed their efficacy as evidence based. Leaves of nimb (Azadirachta indica A. Juss) [ , , , ] and haridra (Curcuma longa Linn.) are mentioned as the shodhan and ropan(healing) of wound. [ , , ] The daruharidra (Berberis aristata DC) also showed antimicrobial effect. [ ]Wounds with foul odour, abnormal colour, profuse discharge and intense pain should be known as dusta vrana (unclean) and as such wounds should be treated with cleansing agents. Decoctions of triphala, khadira (Acasia catechu Willd), daruharidra (Berberis aristata DC), nyagrodhadi group, bala (Sida cordifolia Linn.), kusa (Desmostachya bipinnata Stapf.), leaves of nimb (Azadirachta indica A. Juss) and badara (Zizyphus jujube Lam.) are regarded as cleansing drugs. Tila paste, salt, haridra (Curcuma longa Linn.), daruharidra (Berberis aristata DC), trivrit (Operculina turpethum Linn.) ghrita, madhuka, nimba leaves- this formulation is said as wound cleanser.  Most of the ingredients like triphala,[ ] khadira, daruharidra, nyagrodhadi group nimb, haridra, daruharidra, madhuka are the ingredients of jatyadi taila /ghrita which is well known formulation in managment of chronic wound for shodhan and ropan of wounds. [ , , , , , , ]

#''Bala'' (Sida cordifolia Linn.), ''guduchi'' (Tinospora cordifolia), ''madhuka'' (Glycyrrhiza glabra Linn.), ''prshnaparni'' (Uraria picta Desv), ''satavari'' (Asparagus racemosus Willd), ''jivanti'' (Leptadenia reticulate W. & A.), sugar, milk, oil, fish fat, ghee cooked with beeswax is known as ''sneha sarkara,'' it relieves pain. Some studies have highlighted the wound healing potential of honey mixed with above drugs. <ref>Dudhamal TS, Gupta SK, Bhuyan C. Role of honey (madhu) in the management of wounds (dushta vrana). International Journal of Ayurveda Research. 2010; 1 (4): 271-273</ref>,<ref>Vijayakumari K, Nishteswar K. Wound Healing Activity of Honey: A Pilot Study. AYU. 2013; 33 (3): 374-377.</ref>Various preparations containing following herbal drugs have wound cleaning effect in single and combination of drugs. The recent studies showed their efficacy as evidence based. Leaves of nimb (Azadirachta indica A. Juss)<ref>Gupta S, Bhat SS, Jaykrishna N. A clinical study to evaluate efficacy of nimbaadya taila in the management of dusta vrana (chronic ulcer). International Journal of Research in Ayurveda and Pharmacy.2012; 3(6):862-865</ref>,<ref>Jayasingh BK, Tewari PV. Clinical management of vicharchika with nimbadi yoga. Journal of Research in Ayurveda and Siddha. 2003; 24(1-2): 33-41</ref>,<ref>Singh A, Singh AK, Narayan G, Singh TB, Shukla VK. Effect of Neem Oil and Haridra on Non-Healing Wounds. AYU. 2014;35 (4) : 398-403</ref>,<ref>Singh AK, Srivastava PK, Shukla VK. Evaluation of nimba taila and manjistha churna in non healing ulcer. International Research Journal of Pharmacy. 2011; 2(5):201-210.</ref> and ''haridra'' (Curcuma longa Linn.) are mentioned as the shodhan and ropan(healing) of wound. <ref>Ballal V, Mamatha, Jain CM. A clinical study on efficacy of kumarimajja and haridra on episiotomy wound. Journal of Ayurveda. 2010; 4(2): 18-26</ref>,<ref>Kundu S, Biswas TK, Das P, Kumar S, De DK. Turmeric (Curcuma longa) rhizome paste and honey show similar Wound healing potential: a preclinical study in rabbits, The international Journal of Lower Extremity Wounds 2005 Dec ; 4(4):205-13</ref>,<ref>Mehra KS, Mikuni I, Gupta U, Gode KD. Curcuma longa (Linn) drops in corneal wound healing, The Tokai Journal of Experimental and Clinical Medicine 1984 Mar ; 9 (1) :27-31</ref> The daruharidra (Berberis aristata DC) also showed antimicrobial effect. <ref>Saravanakumar T, Venkatasubramanian P, Vasanthi NS, Manonmani E. Antimicrobial potential of Daruharidra (Berberis aristata DC) against the pathogens causing eye infection. Int J Green Pharm 2014;8:153-7</ref>Wounds with foul odor, abnormal colour, profuse discharge and intense pain should be known as dusta vrana (unclean) and as such wounds should be treated with cleansing agents. Decoctions of triphala, khadira (Acasia catechu Willd), daruharidra (Berberis aristata DC), nyagrodhadi group, bala (Sida cordifolia Linn.), kusa (Desmostachya bipinnata Stapf.), leaves of nimb (Azadirachta indica A. Juss) and badara (Zizyphus jujube Lam.) are regarded as cleansing drugs. Tila paste, salt, haridra (Curcuma longa Linn.), daruharidra (Berberis aristata DC), trivrit (Operculina turpethum Linn.) ghrita, madhuka, nimba leaves- this formulation is said as wound cleanser.  Most of the ingredients like triphala,<ref>Senthil KM, Kirubanandan S, Sripriya R, Sehgal PK. Triphala incorporated collagen sponge--a smart biomaterial for infected dermal wound healing, The Journal of Surgical Research 2010 158(1):162-70</ref> khadira, daruharidra, nyagrodhadi group nimb, haridra, daruharidra, madhuka are the ingredients of jatyadi taila /ghrita which is well known formulation in managment of chronic wound for shodhan and ropan of wounds. <ref>Kulkarni YS, Emmi SV, Dongargaon TN, Wali AA. Wound healing effect of Vimlapanakarma with Jatyadi tailam in diabetic foot, Ancient Science of Life 2015;34(3):171-174</ref>,<ref>Dudhamal TS, Bhuyan C, Baghel MS. Wound healing effect of Jatyadi Taila in the cases of chronic fissure-in-ano treated with Ksharasutra. AYU International Research Journal of Ayurved 2013; 34/5 (Suppl1) OA01:30.p-22.</ref>,<ref>Vijakumar B, Prasanna N. Rao PN, Hemantkumar P. A comparative study of kaseesadi avachurnana and jatyadi ghrita application in the management of dushta vrana. International Journal of Research in Ayurveda and Pharmacy. 2012; 3(6):852-858</ref>,<ref>Baslingappa Rajeshwari KPN, Aravattii S, Murthy BN, Shringi MK.Comparative clinical study of Jatyadi varti and Aragwadadi varti in the management of nadi vrana (pilonidal sinus). International Research Journal of Pharmacy. 2012;3(3):135-138</ref>,<ref>Lad M, Bandgar S. Management of non healing wound with Nyagrodhadi kwatha and Jatyadi ghruta (classical ayurvedic preparations). Global Journal of Research on Medicinal Plants & Indigenous Medicine (GJRMI). 2012; 1 (7): 301-308</ref>,<ref>Pal R, Apaturkar N, Pimpalkar P, Raut S, Lakhapati AM. Role of Jatyadi tailam vrana basti in the management of post operated haemorrhoidectomy. e-Journal Rasamruta. 2013; 5 (38): 1-5</ref>,<ref>Shailajan S, Menon S, Pednekar S, Singh A. Wound healing efficacy of Jatyadi Taila: in vivo evaluation in rat using excision Wound model, Journal of Ethnopharmacology 2011 Oct 31; 138 (1) :99-104</ref>

#The drugs which are helpful for healing of fresh and infected or chronic wounds are mentioned in the text. Among these drugs following drugs are having some research studies carried out for their healing effect.Decoction of Panchavalkal (nyagrodha, udumbara, asvattha, parish plaksha), karavira (Nerium indicum Mill.), arka (Calotropis procera R. Br.) [ ] and kutaja (Holarrhena antidysentrica Linn.) are wound healing. Candana (Santalum album Linn.),  daruharidra bark,  meda (Polygonatum airrhifolium Royle), mahameda (Polygonatum airrhifolium Royle), murva (Marsdenia tenacissima W. & A.), lajjalu (Mimosa pudica Linn.) and madhuyasti-[ ] this formulation is wound healer. Prapaundarika, jivanti, gojihva (Onosma bracteatum Wall.), dhataki, bala and sesamum should be applied as paste with ghee for wound healing. Kampillaka (Mallotus philippinensis Muell Arg), vidanga (Embelia ribes Burm), kutaja, triphala, bala, patola (Trichosanthes dioica Roxb.), nimba, musta (Cyperus rotundus Linn.), priyangu, khadira, dhataki, sarja, ela (Elleteria cardamomum Maton.), aguru (Aquilaria agallocha Roxb.) and candana are pounded together and used for cooking oil. This oil is used as ulcer healing agent. Similarly, oil prepared with equal quantity of prapaundarika, mahuka, kakoli (Roscoca procera Wall.), ksirakakoli (Roscoca procera Wall.), chandana and rakta chandana (Pterocarpus santalinus Linn.) [ ] is an excellent ulcer healing agent. Oil cooked with durva juice or kampillaka or paste of daruharidra bark is an important ulcer healer. [ ,  ,  ]  By the above method ghrita should be prepared and used for healing, ulcers predominant in rakta and pitta.

#The drugs which are helpful for healing of fresh and infected or chronic wounds are mentioned in the text. Among these drugs following drugs are having some research studies carried out for their healing effect.Decoction of Panchavalkal (nyagrodha, udumbara, asvattha, parish plaksha), karavira (Nerium indicum Mill.), arka (Calotropis procera R. Br.) [ ] and kutaja (Holarrhena antidysentrica Linn.) are wound healing. Candana (Santalum album Linn.),  daruharidra bark,  meda (Polygonatum airrhifolium Royle), mahameda (Polygonatum airrhifolium Royle), murva (Marsdenia tenacissima W. & A.), lajjalu (Mimosa pudica Linn.) and madhuyasti-[ ] this formulation is wound healer. Prapaundarika, jivanti, gojihva (Onosma bracteatum Wall.), dhataki, bala and sesamum should be applied as paste with ghee for wound healing. Kampillaka (Mallotus philippinensis Muell Arg), vidanga (Embelia ribes Burm), kutaja, triphala, bala, patola (Trichosanthes dioica Roxb.), nimba, musta (Cyperus rotundus Linn.), priyangu, khadira, dhataki, sarja, ela (Elleteria cardamomum Maton.), aguru (Aquilaria agallocha Roxb.) and candana are pounded together and used for cooking oil. This oil is used as ulcer healing agent. Similarly, oil prepared with equal quantity of prapaundarika, mahuka, kakoli (Roscoca procera Wall.), ksirakakoli (Roscoca procera Wall.), chandana and rakta chandana (Pterocarpus santalinus Linn.) [ ] is an excellent ulcer healing agent. Oil cooked with durva juice or kampillaka or paste of daruharidra bark is an important ulcer healer. [ ,  ,  ]  By the above method ghrita should be prepared and used for healing, ulcers predominant in rakta and pitta.

#The physician conversant with dose, time and agni (heat) may apply alkali in cases amenable to surgical operations.[ ,  ,  ,  ]

#The physician conversant with dose, time and agni (heat) may apply alkali in cases amenable to surgical operations.[ ,  ,  ,  ]