Changes

#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>

#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. <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>

#''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.)<ref>Deshmukh PT, Fernandes J, Atul A, Toppo E. Wound healing activity of Calotropis gigantea root bark in rats, Journal of Ethnopharmacology 2009; 125(1):178-81</ref> 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<ref>Dwivedi Ap, Rahtod AS, Dhariya SA. A clinical study to evaluate the antiseptic and bactericidal effect of yashtimadhu ghrita in non infected surgical wounds. International Journal of Applied Ayurved Research. 2015;2(3):248-252</ref>- 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.)<ref>Biswas TK, Maity LN, Mukherjee B. Wound healing potential of Pterocarpus santalinus linn: a pharmacological evaluation, The international Journal of Lower Extremity Wounds 2004 Sep ; 3 (3) :143-50</ref> is an excellent ulcer healing agent. Oil cooked with durva juice or kampillaka or paste of daruharidra bark is an important ulcer healer.<ref>Pankhaniya LJ, Sharma PP, Manjusha R. A comparative study of Durvadi taila and povidone iodine in the management of vrana. AYU. 2009;30(4): 459-462</ref>,<ref>Jadhav NM, Auti SS, Sreeja S, Mourya OPS. Management of corneal erosions due to chemical burn by Durvadi ghritam: a case study. Ayurpharm - International Journal of Ayurveda and Allied Sciences. 2012; 1 (4) : 73-76</ref>,<ref>Dhiman K, Parmar M, Dhiman KS. Kampillakadi Ghrita In Garbhashaya Greeva Gata Vrana (Cervical Erosion). International Journal of Research in Ayurveda and Pharmacy. 2012; 3 (2):203-209</ref> 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.<ref>Wani P, Pathak A, Hemanthakumar P. Effect of Apamarga pratisaraeeya kshara in the management of nadivrana (pilonidal sinus) – a case report. International Ayurvedic Medical Journal. 2013; 1 (4) : 1-2.</ref>,<ref>Shekokar AV, Borkar KM. Innovation of Ksharaplota (medicated gauze) in the management of vrana (ulcer). International Journal of Ayurveda and Pharma Research. 2013; 1 (2):10-16.</ref>,<ref>Gupta S, Gupta SJ, Singh SK. Role of Palashkshara (butea monosperma) in the management of dusta vrana (chronic ulcers) with special reference to infected wound. International Journal of Ayurveda and Pharma Research. 2014; 2 (3): 86-93</ref>,<ref>Apaturkar N, Pimpalkar P, Pal R, Raut S, Lakhapati AM. Role of Apamarga Kshara with apamarga kshara tailam on dushtavrana with reference to infected wound – a case report. e-Journal Rasamruta. 2013; 5 (26): 1- 8.</ref>

#By dusting the wound with the powders of barks of kakubha (Termalia arjuna),[ ] udumbara,[ ] ashvattha, lodhra (Symplocos racemosa Roxb), jambu (Eugenia jambolana Lam) and katphala (Myrica esculenta Buch-Ham) they heals the skin quickly. Manashila (Realgar), manjistha, [ , ] lac, haridra and daruharidra used as paste with ghee and honey is an excellent cleanser of skin.

#By dusting the wound with the powders of barks of kakubha (Termalia arjuna),<ref>Narayana A, Swamy RK . A medico-historical review of Arjuna (Terminalia arjuna, w. & a.). Bulletin of the Indian Institute of History of Medicine. 1998; 26(1-2): 1-10</ref> udumbara,<ref>Vinaya Kumar, P.V. Tiwari. Post-Cautery Effect of Udumbar Ointment on Cervical Erosion, Ancient Science of Life 1993 July ; 13 (1-2) :97-101</ref> ashvattha, lodhra (Symplocos racemosa Roxb), jambu (Eugenia jambolana Lam) and katphala (Myrica esculenta Buch-Ham) they heals the skin quickly. Manashila (Realgar), manjistha,<ref>Baria J, Gupta SK, Bhuyan C. Clinical Study of Manjishthadi Ghrita in Vrana Ropana. AYU. 2011; 32 (1): 95-99.</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> lac, haridra and daruharidra used as paste with ghee and honey is an excellent cleanser of skin.

==== Potential areas /Scope for research ====

==== Potential areas /Scope for research ====