World Journal of Pharmaceutical Research

Patel et al. World Journal of Pharmaceutical

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Volume 7, Issue 07, 1485-1491. Case Report ISSN 2277–7105

CLINICAL EFFICACY OF MADHUKADI YOGA IN THE

MANAGEMENT OF AGANTUJA VRANA (POST INSECT BITE
WOUND) - CASE STUDY

Dr. Kalpesh Dattani1 and Dr. Joyal Patel2*

1
Assistant Professor, Department of Kaumarbhritya, Shree Gulabkunverba Ayurveda
Mahavidyalaya, Gujarat Ayurved University, Jamnagar, Gujarat. Pin -361008. India.
2
Associate Professor, Department of Shalya Tantra, Shree Gulabkunverba Ayurveda
Mahavidyalaya, Gujarat Ayurved University, Jamnagar, Gujarat. Pin -361008. India.

ABSTRACT
Article Received on
13 Feb. 2018, Surgeons in ancient India defined wound as the solution of continuity
Revised on 06 March 2018, of the skin. The healing of wound is the natural mechanism of the
Accepted on 27 March 2018
DOI: 10.20959/wjpr20187-11774 body. There are mainly 2 types of wound i.e. Nija and Agantuja. Here I
have reported a new case of post wound of insect bite on medial aspect
of right ankle joint, presented with painful, severe itching, oedema, and
*Corresponding Author
irregular shaped wound since 2 months. A male patient of 68 years old
Dr. Joyal Patel
Assistant Professor, consulted to OPD, Shree Gulabkunverba Ayurveda Hospital,
Department of Jamnagar, with above complaint. Aims and objectives: To evaluate
Kaumarbhritya, Shree the clinical efficacy of Madhukadi Yoga in the management of
Gulabkunverba Ayurveda
Agantuja Vrana. Materials and Method: This case was managed with
Mahavidyalaya, Gujarat
External application of Madhukadi Yoga for 12 weeks. Result and
Ayurved University,
Jamnagar, Gujarat. Pin - Conclusion: This single case concluded that regular cleaning with
361008. India. Phalatrikadi Kwatha and local application of Madhukadi Yoga have
healing activity in non-healing chronic wounds(Agantuja Vrana). This
formulation is safe, easy to apply and tolerable to the patient without any side effect. This
formulation need to be tried in more number of cases.

INTRODUCTION
Surgeons in ancient India defined wound as the solution of continuity of the skin. Sushruta,
father of Indian surgery has been documented different types of Vrana (wound) like Nija
vrana and Agantuja Vrana. In Nija variety they have included all those causes where the

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Patel et al. World Journal of Pharmaceutical Research

systemic involvement of the body found, where as in Agantuja variety, they have explained
about vrana caused by the external factors mainly by Trauma, Insect Bite, Chemical
Exposure etc.[1] Wound healing is a complex phenomenon that results in restoration of
anatomic continuity and function, accomplished by several processes which involve different
phases including inflammation, granulation, fibrogenesis neovascularization, wound
contraction and epithelization.[2] Ayurveda, gives more importance to preventive measures
and complete curing of a disease with a minimum chance of recurrence. Acharya Sushruta
had advocated 60 procedures for wound care to meet the challenge of wound management.[3]
Acharya Sushruta has mentioned many effective yogas for wound management among them
for Ropana purpose Madhukadi Yoga[4] is selected. Madhukadi Yoga (Madhu, Ghrita, Til
Kalka, Nimba Patra Swarasa) is a known Vrana Ropana formulation. As per Ayurveda
Shodhana is equally important, so for shodhana purpose Phalatrikadi kwatha[5] was selected.
Hence considering the wound healing activity the drug it has been tried in this case and found
effective in Agantuja Vrana.

CASE REPORT
A male patient of 68 years old consulted to OPD of Shree Gulabkunverba Ayurved
Chikitsalaya, Jamnagar, presented with the post wound of insect bite on medial aspect of
right ankle joint along with painful, severe itching, oedema, and irregular shaped wound since
2 months. Patient is not a K/C/O DM & HTN and not taking any medicine. Routine
investigations were within normal limits. Before 2 months while sleeping at night patient
experienced an Insect bite with moderate pain and Itching. Next day morning patient had
visited civil hospital, Jamnagar with Inflammation, severe Itching and moderate pain at the
site of Insect bite and took allopathic medicine for 1 month. After 1 month the inflammation
converted into wound and they had started dressing of wound with Normal saline and
Betadine Ointment but patient did not get any relief. So after 2 months he consulted to OPD
of Shree Gulabkunverba Ayurved Chikitsalaya, Jamnagar

Vrana Pariksha (Local examination)

During the local examinations following findings were noted.
Site: medial aspect of right ankle joint.
Number: Single wound.
Edge and margin: Irregular.
Floor: hyper granulation tissue.

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Patel et al. World Journal of Pharmaceutical Research

Base: Indurated, Present with Slough.

Discharge: Purulent.
Surrounding skin: reddish discoloration.
Tenderness: Present.
Regional Lymph node: Not enlarged and palpable.

AIMS AND OBJECTIVES

To evaluate the clinical efficacy of Madhukadi Yoga in the management of Agantuja Vrana.

MATERIALS AND METHODS

Preparation of Madhukadi Yoga:
1. Goghrita - 1 part
2. Madhu - 1 part
3. Krishna tila - seed powder 1 part
4. Nimba Patra swaras – 1 part

Madhukadi Yoga is a combination of Madhu, Ghrita, Nimbapatra Swaras and Tila kalka.
Take all the above mentioned drugs in equal quantities (1 Part) and mix well before applying
and make it paste form. Fresh paste was prepared every day before using in wound.

Application of drug
Daily, once in the morning, dressing was done with Madhukadi Yoga after cleaning it with
Phalatrikadi Kwath and bandaged the wound. The assessment of the wound was done on the
basis of relief in symptoms i.e. pain, itching, size of wound and discharge.

Observation of wound

At the time of Insect Bite 1st Consultation at OPD, After 1 week

SGAC, Jamnagar

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Patel et al. World Journal of Pharmaceutical Research

3rd week 7th week

5th week

8th week 10th week 12th week

RESULTS AND DISCUSSION

As per Ayurveda, in case of Agantuja Vrana, the tri-doshas were not vitiated in initial stage,
later it will vitiate and the symptoms are manifested.[6] In this case after Insect bite, vrana was
formed after 1 month and further it converted into Dusta Vrana at the time of 1st consultation
i.e. after 2 month. Even though wound healing is a natural process, it is inhibited by various
factors. Deranged Doshas cannot be treated with a single drug all the times. Therefore
number of drugs of different properties is described as Vrana Shodhaka and Vrana Ropaka in
the management of wound. Drugs which contain Katu, Tikta, Madhura and Kashaya Rasa are
more useful. Ropana is always associated with shodhana because a wound cannot be healed
if it is not shuddha.

In this case consent has been taken and the prognosis of the disease was explained to the
patient and his relatives. The assessment was made on the basis of changes observed in the
signs and symptoms of wound. The parameters of pain, swelling, discharge along with
condition of floor, margin, granulation tissue and size of wound were recorded. To assess the
healing photographs of wound were taken on weekly intervals. Patient visited to Civil
Hospital, Jamnagar after insect bite (Fig-1). On 1st consultation patient came with unhealthy
wound (Fig-2). On 1st week unhealthy tissue was removed by debridement and regular

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Patel et al. World Journal of Pharmaceutical Research

dressing (Fig-3). On 3rd week, wounds were observed into smaller sized with good
epithelialisation (Fig-4). On 5th week, granulation tissue formation was observed (Fig-5).
During this treatment wound healing was progressively favorable in 7th and 8th week (Fig. 6
& 7). After 10th week wound sized was remarkably reduced with healthy contraction of
wound margins (Fig. 8 & 9). On 12th week complete healed wound was observed (Fig. 9).

Madhu is considered as good shodhaka dravya, due to its sukshmat it enters very small pores
around the wound site and does not allow any infections to enter the site. Goghrtia has a
soothing property. It forms a thin film over them and that allows early epithelization of
wound. It also protects wound from invasion of any micro organisms. Tila Kalka is soothing
and instant pain relieving since it pacifies vata. Seasemol a chemical present in tila has a
phenol ring and acts as an anti inflammatory drug. Neem contains many active ingredients
such as nimbidin, nimbin, and nimbidol with anti-inflammatory, anti-bacterial, anti-fungal
and anti-viral[7] properties that may help it accelerating the wound healing process. In
addition, neem contains an excellent amount of amino acids, vitamin and mineral that is very
important in wound healing processes in proliferation phase.[8] So in nut shell Madhukadi
yoga enhance the speed of process of healing by promoting epithelialization, reducing
inflammation by eliminating tikshna guna of pitta and relieving pain, reducing wound
contracture, by keeping the edges soft by reducing rukshata of vayu, it reduces the risk of
secondary infection and Kapha is counteracted by Madhu.[9] Madhu is pacifying the three
vitiated Doshas, i.e, Vata, Pitta, and Kapha by multiple actions attributable to its Madhura
(sweet) Rasa, Kashaya (astringent) Uparasa, Ruksha (dry) Guna, Sheeta (cold) Virya,
Madhura Vipaka, and Sukshma Marga Anusari (ability to permeate in microchannels)
Prabhava. Madhura Rasa gives nutrition to the tissue, which helps in granulation tissue
formation, while Kashaya Rasa provides Lekhana (scraping) that helps in deslough,
preparing the wound for healing. Thus Madhu has excellent properties to heal the wound by
virtue of its Sodhan (purification), Ropana (healing) and Sandhana (union) actions.[10] Honey
is a hyperosmolar medium, preventing bacterial growth. Because of its high viscosity it forms
a physical barrier, and the presence of the enzyme catalase gives honey antioxidant
properties.[11] Honey has been shown to be useful in the prevention of hypertrophic scarring
and post-burn contractures.[12] Honey is a very effective agent for dressing of split-thickness
skin graft.[13] Due to faster rate of healing and reduced or absence of wound contracture
phenomenon the ulcer remains open and the secretions which otherwise get collected in and

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Patel et al. World Journal of Pharmaceutical Research

hamper the healing process, get cleaned rapidly. This process adds to the regeneration of
tissue and minimum scaring, fibrosis of the wound edges.

Phalatrikadi kwath acts as a tridosha shamaka (pacifying the Vitiated dosha), Shotha-hara
(anti inflammatory), rasayana[14] (antioxidant, Initiate healing), Due to its tikta-kashaya
rasa[15] properties, it must have reduced the Srava (discharge). Pharmacological action of
Phalatrikadi kwath proves that all eight drugs of Phalatrikadi kwath are found to have anti-
inflammatory, analgesic, antimicrobial properties.[16]

CONCLUSION
This single case concluded that regular cleaning with Phalatrikadi Kwatha and local
application of Madhukadi Yoga have healing activity in non-healing chronic wounds
(Agantuja Vrana). This formulation is safe, easy to apply and tolerable to the patient without
any side effect.

ACKNOWLEDGEMENT
This research was supported by Dr. Joyal Patel, Associate Professor, Dept of Shalya Tantra,
Shree Gulabkunverba Ayurved Mahavidyalaya, Jamnagar. I thank my Colleague for provided
insight and expertise that greatly assisted the research.

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Sanskrit Sansthana, 12th ed, 2001; 95.
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PM, editors. Molecular and Cellular Biology of Wound Repair. New York: Plenum Press,
1996; 473-88.
3. Shastri A.D, Sushruta Samhita, Poorvardha Chikitsa sthana 1/8, Varanasi: Chaukhamba
Sanskrit Sansthan, 2010; P.5.
4. Acharya YT. Sushruta Samhita, Chikitsa Sthana, Chapter-1/69, Nibandhasangraha
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