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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 16  |  Issue : 3  |  Page : 252-256

Wound-healing effect of Thumari Taila in the management of diabetic foot ulcer


1 Department of Shalyatantra, JS Ayurved Mahavidyalaya, Nadiad, Gujarat, India
2 Department of Shalyatantra, ITRA, Jamnagar, Gujarat, India

Date of Submission10-Oct-2020
Date of Decision11-Jan-2022
Date of Acceptance12-Apr-2022
Date of Web Publication28-Sep-2022

Correspondence Address:
Foram P Joshi
Department of Shalyatantra, JS Ayurved Mahavidyalaya, Nadiad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_171_20

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  Abstract 


Introduction: With increasing diabetic poppulation, diabetic foot ulcers (DFUs) are also rising parallelly. Limb salvaging methods and lifesaving methods have been focused on getting rid of it till date. Main Clinical Findings: This case refers to a wonder drug Thumari and its role in enhancing wound healing in a case of DFU of a 68-year-old female. Outcome and Conclusion: Complete wound healing was achieved in 60 days with unit healing time of 12.79 days/cm3. Local cleaning by Triphala Kwatha has shown antimicrobial effects which augmented the healing process, while Thumari Taila application enhanced tissue debridement. Internal Ayurveda medications such as Pippali (Piper longum Linn.), Haritaki (Terminalia chebula Linn.), and Sanjivani Vati (polyherbomineral medication) with Pathya-Apathya (prescribed diet and regimen) pacified vitiated Kapha-Vata Pradhana Tridosha and enhanced tissue rejuvenation and repair by their pharmacological properties.

Keywords: Diabetic foot ulcer, healing, Thumari Taila


How to cite this article:
Joshi FP, Dudhamal TS. Wound-healing effect of Thumari Taila in the management of diabetic foot ulcer. J Ayurveda 2022;16:252-6

How to cite this URL:
Joshi FP, Dudhamal TS. Wound-healing effect of Thumari Taila in the management of diabetic foot ulcer. J Ayurveda [serial online] 2022 [cited 2022 Dec 4];16:252-6. Available from: http://www.journayu.in/text.asp?2022/16/3/252/357294




  Introduction Top


Diabetic population with foot ulcers are at increased risk of lower extremity amputation due to nonhealing ulcers.[1] Rate of amputations in diagnosed diabetics has been reported 10–20 times more than those of nondiabetics.[2] To treat such life-threatening condition by limb salvaging methods is a big challenge for Ayurvedic fraternity.


  Case Report Top


A 68-year-old female reported to the Shalyatantra outpatient department with a 4-month history of a nonhealing ulcer at her right great toe. Due to that, she had difficulties walking and mild seropurulent discharge from the nonhealing ulcer with the same duration of time. She was also a known case of diabetes mellitus (type 2 diabetes mellitus [T2DM]) and was on regular oral hypoglycemic medications (capsule glimepiride 1 mg and metformin 500 mg) along with regular antiseptic dressing from diabetic care clinic. When wound condition got worse with blackish discoloration, foul smell, and burning feet, she was advised for amputation of the right great toe. As she was not convinced for amputation, she switched on to Ayurvedic management.

Apart from her diabetic care, she was also taking cilostazol 50 mg 1 time a day for the last 1 year and enalapril 5 mg once a day for the last 2 years. She was taking oral analgesic medicines: sometimes, capsule diclofenac sodium 75 mg once a day and oral multivitamin supplement tablet 10 mg once a day on a regular basis after developing ulceration.

The patient revealed positive diabetic (T2DM) history in the first-degree relatives (father and mother both) and siblings.

On general examination, the patient was normal with her stable vitals. She was conscious and oriented. Clinical findings of nonhealing diabetic foot ulcer (DFU) with adopted diagnostic methods and prognostic values suggested the case as a diabetic toe of University of Texas (UT) Classification of Diabetic Wounds Grade II Stage D and Grade III ulcer of Wagner Maggit Classification of Diabetic Ulcer [Table 1] and [Figure 1]a.
Figure 1: Before Treatment (Day 0) (1a: visible osteomyelitis, 1b: ulcer)

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Table 1: Clinical evaluation of case before and after the treatment

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Case management

Along with all the Ayurvedic management for diabetic ulcer, the conventional treatment of oral hypoglycemic medicine, antihypertensive, blood-thinning agent, and analgesic was continued as advised by the consulting physician and diabetologist of the patient.

Local wound care was done with Triphala Kwatha (decoction preparation of course powder of Triphala with 16 times water) wound wash followed by wound dressing with Thumari Taila (medicated oil of Securinega leucopyrus Willd. and Meul.) packing.[3] Sterile bandaging was applied after each dressing for 60 days consequently [Table 2]. During wound dressing, instrumental debridement was done on a daily basis up to achieving clean and primary granulated wound, i.e., 30 days.
Table 2: Case timeline for management of nonhealing diabetic ulcer

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The patient was instructed to follow specialized diet plan (green gram soup and curry and boiled green grams) for initial 30 days of the treatment along with oral Ayurvedic medicines. After 30 days, all the oral Ayurvedic medications were discontinued, and local wound dressing was continued up to complete wound healing, i.e., up to 60 days as the same.

Outcome, measurements, and follow-up

Wound-healing progress was observed with periodic assessment of the case. On first consultation, the patient had nonhealing diabetic ulcer in the right great toe with UT Classification Grade II Stage D and Wagner Maggit Grade III [Figure 1]b. Primary granulation was achieved by day 30 [Figure 2], and by the 45th day of regular treatment, wound contraction was improved significantly [Figure 3]. Complete wound healing was achieved by 60th day [Figure 4].
Figure 2: During Treatment with primary granulation (Day 30)

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Figure 3: Significant Wound contraction (Day 45)

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Figure 4: Complete wound Healing (Day 60)

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Till date, the patient is living symptom-free and improved quality of life and has not developed any complications in the last 1 year and 8 months.

The unit healing time (UHT) was found 12.79/cm3 in this case.



On subsequent follow-ups of each fortnight post to the complete healing of wound, the patient has been reported symptom-free.


  Discussion Top


Dushta vrana of Madhumeh (nonhealing ulcers of diabetic patients) has been declared to have poor prognostic values.[5] Further, the endogenous ulcers are considered difficult to cure in Ayurveda.[6] In a case of DFU, it is a challenging job to achieve complete healing without disturbing vital organs. Wound-healing mechanism is having a barrier of reactive oxygen species in nonhealing ulcers. Antioxidant properties of Pippali (fruit of Piper longum Linn.) helped in tissue rejuvenation and promoted the physiological repair of cellular injury.[7] Anulomana effect of Haritaki (Terminalia chebula Linn.) releases wastes from Shakha and Koshtha. Antioxidant property of tannins reduces oxidative stress of tissues and may have augmented oxygenated blood flow toward the wound.[8] Green gram soup and plain rice helped tissue rejuvenation by providing necessary nutrients.

It is challenging to prevent the amputation in a diabetic case with micro- and macro-angiopathies. However, the patient's desire to save her limb leads to follow Ayurvedic regimen. Gairola et al. concluded that Sanjivani Vati is a diaphoretic formulation and supports detoxifying role.[9] These actions of Sanjivani Vati might have made the circulatory pathway patent by clearing the blockage of distal arterioles (microvascular channels), which ultimately resulted in better tissue perfusion.

Antibacterial and antimicrobial effects of Triphala help in providing autolytic debridement.[10] Thumari Taila promotes wound debridement and cellular proliferation by its own properties such as high antioxidant properties, tannins, flavonoids, and nitric oxides, which help in tissue debridement, angiogenesis, cellular proliferation, tissue contracture, and wound healing ultimately.[11]

This case also clarifies that careful case evaluation, precise necessary treatment, and obedience of the patient make one revives soon with this treatment protocol.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Moxey PW, Gogalniceanu P, Hinchliffe RJ, Loftus IM, Jones KJ, Thompson MM, et al. Lower extremity amputations – A review of global variability in incidence. Diabet Med 2011;28:1144-53.  Back to cited text no. 1
    
2.
World Health Organization. Part 1: Global burden of diabetes, burden and trends in the complications of diabetes. In: Global Report on Diabetes. Geneva: World Health Organization; 2016. p. 30. Available from: https://www.who.int/health-topics/diabetes#tab=tab_. [Last accessed on 2020 Mar 30].  Back to cited text no. 2
    
3.
Pn. Shastri P, Editor, Bhishagvara Adhamalla, Commentator; Dipika and Gudhartha Dipika Commentaries, Acharya Sharangadhara. In: Sharangadhara Samhita, Madhyama Khanda Snehapaka Vidhi Adhyaya 9/12. Varanasi: Chaukhamba Orientalia; 2007. p. 212.  Back to cited text no. 3
    
4.
Joshi F, Dudhamal TS. Tissue debridement effect of Apamarga kshara taila and adjuvant medications in the management of non-healing venous ulcer: A case series. Med J DY Patil Vidyapeeth 2021;14:549-53.  Back to cited text no. 4
  [Full text]  
5.
Sushruta Samhita, Sutra Sthana, Krityaakritiya Adhyaya 23/7. Available from: https://niimh.nic.in/ebooks/esushruta. [Last accessed on 2020 Sep 30].  Back to cited text no. 5
    
6.
Sushruta Samhita, Sutra Sthana, Vranaasravavigyaniya Adhyaya, 22/4. Available from: https://niimh.nic.in/ebooks/esushruta. [Last accessed on 2020 Sep 30].  Back to cited text no. 6
    
7.
Mittal R, Gupta RL. In vitro antioxidant activity of piperine. Methods Find Exp Clin Pharmacol 2000;22:271-4.  Back to cited text no. 7
    
8.
Afshari AR, Sadeghnia HR, Mollazadeh H. A review on potential mechanisms of Terminalia chebula in Alzheimer's disease. Adv Pharmacol Sci 2016;2016:8964849.  Back to cited text no. 8
    
9.
Gairola S, Gupta V, Bansal P, Maithani M, Murali Krishna C. Pharmacological activities of polyherbal formulation – Sanjivani Vati. Int J Ayurvedic Med 2010;2:1-19.  Back to cited text no. 9
    
10.
Tambekar DH, Dahikar SB. Antibacterial activity of some Indian Ayurvedic preparations against enteric bacterial pathogens. J Adv Pharm Technol Res 2011;2:24-9.  Back to cited text no. 10
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11.
Ambhaji D, Shahan A. A, Kumar V. In-vitro antimicrobial and antioxidant activity of Securinega leucopyrus (Willd) Muell. Biomed Pharmacol J 2020;13:1251-60.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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