Dr. Prabudh Kumar Praveen.pdf

A CLINICAL COMPARATIVE STUDY ON THE EFFICACY OF GHONTAPHALADI VARTI AND ARAGVADHADI VARTI IN THE MANAGEMENT OF

NADI VRANA W.S.R. SINUS.

BY

DR. PRABUDH KUMAR PRAVEEN

Dissertation submitted to Rajiv Gandhi University of Health Science,

Bangalore, Karnataka.

In the Partial fulfillment of the requirement for the degree of

AYURVEDA DHANWANTARI (M.S. Ayu.)

In

Shalya Tantra

Under the guidance of

Dr. B.S.SAVADI M.D. (Ayu)

DEPARTMENT OF SHALYA TANTRA

S.J.G.AYURVEDIC MEDICAL COLLEGE, POSTGRADUATE STUDIES AND RESEARCH CENTRE

KOPPAL-583231

2011-2014

SHREE JAGADGURU GAVISIDDHESHWAR AYURVEDIC MEDICALCOLLEGE, POST GRADUATE STUDIES & RESEARCH CENTRE.

KOPPAL– 583231. KARNATAKA

CERTIFICATE

This is to certify that the dissertation “A CLINICAL COMPARATIVE STUDY ON

EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADI VARTI IN THE

MANAGEMENT OF NADI VRANA W.S.R. SINUS” is a bonafide research work done by

DR. PRABUDH KUMAR PRAVEEN in partial fulfillment of the requirement for the post

graduate degree of “Ayurveda Dhanwantari (M.S. Ayu.)” under Rajiv Gandhi

University of Health Science, Bangalore, Karnataka.

Guide

DR. B. S. SAVADI

Principal & HOD

Dept. of Shalya Tantra

S.J.G. Ayurvedic Medical College, Post

Graduate Studies & Research Centre

Koppal- 583231

Date:-

Place:- Koppal

SHREE JAGADGURU GAVISIDDHESHWAR AYURVEDIC MEDICALCOLLEGE & H0SPITAL POST GRADUATE STUDIES & RESEARCH

CENTRE.KOPPAL– 583231. KARNATAKA

CERTIFICATE

This is to certify that the dissertation “A CLINICAL COMPARATIVE STUDY ON

EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADI VARTI IN THE

MANAGEMENT OF NADI VRANA W.S.R. SINUS” is a bonafide research work done by

DR. PRABUDH KUMAR PRAVEEN in partial fulfillment of the requirement for the post

graduate degree of “Ayurveda Dhanwantari (M.S. Ayu.)” under Rajiv Gandhi

University of Health Science, Bangalore, Karnataka.

Co-Guide:-

DR. SRIKANTH P. L.

Dept. of Shalya Tantra,



Koppal- 583231

Date:-

Place:- Koppal

SHREE JAGADGURU GAVISIDDHESHWAR AYURVEDIC MEDICALCOLLEGE, POST GRADUATE STUDIES & RESEARCH CENTRE.

KOPPAL – 583231. KARNATAKA

ENDORSEMENT

This is to certify that the dissertation entitled “A CLINICAL COMPARATIVE

STUDY ON EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADI VARTI IN

THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” is a bonafide research work

done by DR. PRABUDH KUMAR PRAVEEN under the guidance of Prof. Dr. B. S. Savadi,

M.D. (Ayu), in Shalya Tantra in partial requirement for the post graduation degree

of Ayurveda Dhanwantari (M.S. Ayu.) under Rajiv Gandhi University of Health

Science, Bangalore, Karnataka.

PROF. DR. B. S. SAVADIPrincipal & HOD

Dept. of Shalya Tantra,



Koppal- 583231

Date:-

Place:- Koppal

SHREE JAGADGURU GAVISIDDHESHWAR AYURVEDIC MEDICALCOLLEGE ,POST GRADUATE STUDIES & RESEARCH CENTRE.

KOPPAL – 583231. KARNATAKA

DECLARATION BY THE CANDIDATE

I hereby declare that the dissertation entitled “A CLINICAL COMPARATIVE

STUDY ON EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADI VARTI IN

THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” is a bonafide and genuine

research work carried out by me under the guidance of Prof. Dr. B. S. Savadi, M.D

(Ayu), in Shalya Tantra. S.J.G. Ayurvedic Medical College, Post Graduate Studies

& Research Centre, Koppal.

DR. PRABUDH KUMAR PRAVEEN

Date:-

Place:- Koppal

COPY RIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall

have the rights to preserve, use and disseminate this dissertation / thesis in print or

electronic format for academic / research purpose.

© Rajiv Gandhi University of Health Sciences, Karnataka.

Date:-

Place:- Koppal

Signature of the CandidateDR. PRABUDH KUMAR PRAVEEN

ACKNOWLEDGEMENT

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page i

ACKNOWLEDGEMENT

First of all I wish and koti koti naman to my grandfather Lt. Vaidya Sudisht

Narayan Jha

I would like to take this opportunity to express my thanks to those who helped

me in the completion of this dissertation work. It is very difficult to find a vocabulary

to appraise my sincere and heartily gratitude to my guide Prof. Dr. B. S. Savadi,

H.O.D. of Shalya Tantra and Principal of S. J. G. Ayu. Medical College, Koppal for

this kindly suggestions and timely guidance benefited me in completing this thesis

work.

I express my sincere thanks to Dr. M. M. Salimath, P.G. co-ordinater and Prof.

of Dept. of Shalya Tantra for provided me scientific knowledge and dynamic idea.

I express my sincere thanks to my co-guide Dr. Srikanth P. L. Dept. of Shalya

Tantra.

I express my sincere thanks to Dr. K. B. Hiremath, Dean of S.J.G. Ayu.

Medical College, Koppal.

I would like to thanks management members for supporting and providing me

an opportunity to conduct my study.

I am thankful to my father Sri Arun Kumar Jha and mother Smt. Sunaina Devi

for providing my all requirement as well as possible and my uncle Dr. Binod Kumar

Jha and my all Vaidya family, Champapur, Patahi, East Champaran, Bihar for their

timely support and help.

ACKNOWLEDGEMENT

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page ii

I am thankful to all person of Dept. of Ras Sashtra and Dravyaguna for

suggest and help in preparation of drug.

I am thankful to Dr. Jitender Kaushik, Dr. Deepak Chaudhary, Dr. Vikram

Patil and Dr. Charu Gupta for their co-operation and advice.

I am thankful to Dr. Amiya Bhonsle for help in collection of raw drug

materials.

I am also thankful to all my U.G. and P.G. colleagues who have helped me in

many ways.

I express my sincere thanks to all colleagues, office staff, hospital staff,

laboratory staff, pharmacy staff for their help and support.

Also I thanks to Mr. Vinod, librarian for providing books and collection of

literature by various sources.

I also thanks to Mr. Prabhu statistician for his valuable guidelines for my

study.

I am thankful to Xerox, Printing and Binding center for their efficient and

meticulous typing for this dissertation.

I express my thanks to all the patients who have co-operated and taken

treatment in this study.

Again I am thankful to all the person who have helped me directly and

indirectly for completion of my study.

Dr. Prabudh Kumar Praveen

ABSTRACT

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page iii

ABSTRACT

Background:-

Nadi Vrana is a common disorder in tropics due to unhygienic conditions.

Clinically Nadi Vrana forms if abscess is avoid or treated improperly and

ineffectively with post-operative complications and complaints of recurrences in most

of the cases by the line of treatment adopted by modern surgeons. In spite of

tremendous progress in the field of modern surgery, still there or greatly analyzed

chances of recurrence are noticed.

Nadi Vrana occurs in different sites of body due to different pathogens. So a

medicine which acts systemically is also required for the management of Nadi Vrana.

Hence para-surgical procedure planned which ultimately fulfills all the lacunas or

pitfalls encountered in the present day management.

Hence the proper, effective, simple, safe, non-emulative and non-invasive

procedure i.e. Varti application is advised because it is not only on innovative

technique but also devoid of any complication or recurrence.

Objective:-

To study critically Nadi Vrana and Sinus.

To know the comparative efficacy of Ghonta Phaladi Varti and Aragvadhadi

Varti in the management of Nadi Vrana.

ABSTRACT

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page iv

Methods:-

Total 30 patients diagnosed to be suffering from Nadi Vrana (Sinus) were

selected randomly. These were divided into two groups A and B containing 15

patients in each. Group A patients were treated with Ghonta Phaladi Varti application

and group B patients were treated with Aragvadhadi Varti application. The data was

collected and observation were made before treatment, during treatment on 3rd, 6

th, 9th,

12ve, 15th, 18th, 21st, 24th, 27th, 30th day and during follow up on 37th, 45th, 53rd, 60th

day. The data obtained from the results was subjected analysis and conclusions were

drown.

In groups A the drugs showed highly significant results in parameters such as

Pain, Tenderness, Surrounding Skin, Discharge, Length of tract and significant results

in parameters such as Local Temperature, Burning sensation, Itching. In group B the

drugs showed highly significant results in parameters such as Pain, Surrounding Skin,

Length of tract and significant results in parameters such as Discharge, Tenderness,

Burning sensation, Itching. and mild significant results in parameters such as Local

Temperature.

Conclusion:-

The drugs of both groups were quiet effective in all the parameters but group

A medicine is more effective than group B in reducing the length of the tract and

other.

Key word:-

Vrana, Nadi Vrana, Sinus, Ghonta Phaladi Varti, Aragvadhadi Varti

CONTENTS

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page v

CONTENTS

Chapter No. Index Pg. No.

1. Introduction 1 - 5

2. Objective of the study 6

3. Previous work done 7

4. Literary review 8 - 71

A) Diseases review 8 - 49

a) Ayurvedic review 8 - 32

b) Modern review 33 - 49

B) Drug review 50 - 71

5. Materials and Methods 72 - 85

6. Observations & Results 86 - 155

7. Discussion 156 - 164

8. Conclusion 165 - 166

9. Summary 167 - 168

10. Bibliography 169-171

11. Reference 172-178

`12. Annexure І - XIV

a) Case sheet I - VIII

b) Master (Demography) chart IX - XI

c) Master (Parameter) chart XІI- XІII

CONTENTS

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page vi

LIST OF TABLE

Sl. No. Title of table Pg. No.

1 Incidence of Group 86

2 Incidence of Sex 87

3 Incidence of Age 88

4 Incidence of Religion 89

5 Incidence of Diet Pattern 90

6 Incidence of Marital Status 91

7 Incidence of Occupation 92

8 Incidence of Socio-Economic Status 93

9 Incidence of Family History 94

10 Incidence of Agni 95

11 Incidence of Kostha 96

12 Incidence of Prakriti 97

13 Incidence of Vyasana 98

14 Incidence of Chronicity 0f Disease 100

15 No. of Opening 101

16 Incidence of Position or Site 102

17 Incidence of Direction of Sinus 103

18 Incidence of Length of Sinus 105

19 Incidence of Discharge 106

20 Incidence of Surrounding Skin 107

21 Incidence of Tenderness 108

CONTENTS

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page vii

22 Incidence of Local Temperature 109

23 Incidence of Pain 110

24 Incidence of Burning Sensation 111

25 Incidence of Itching 112

26 Observation of Length in Group 'A' 113

27 Observation of Length in Group 'B' 114

28 Observation of Discharge in Group 'A' 115

29 Observation of Discharge in Group 'B' 116

30 Observation of Surrounding Skin in Group 'A' 117

31 Observation of Surrounding Skin in Group 'B' 118

32 Observation of Tenderness in Group 'A' 119

33 Observation of Tenderness in Group 'B' 120

34 Observation of Local Temperature in Group 'A' 121

35 Observation of Local Temperature in Group 'B' 122

36 Observation of Pain in Group 'A' 123

37 Observation of Pain in Group 'B' 124

38 Observation of Burning Sensation in Group 'A' 125

39 Observation of Burning Sensation in Group 'B' 126

40 Observation of Itching in Group 'A' 127

41 Observation of Itching in Group 'B' 128

42 Evaluation of Rate of healing per seating and Unit healing time

of length

129

43 Evaluation of Average rate of healing and Average healing time

of Length

131

CONTENTS

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page viii

44 Evaluation of Discharge 132

45 Evaluation of Surrounding Skin 134

46 Evaluation of Tenderness 136

47 Evaluation of Local Temperature 138

48 Evaluation of Pain 140

49 Evaluation of Burning Sensation 142

50 Evaluation of Itching 144

51 Statistical analysis of all parameter B.T.-A.T. in Group 'A' 146

52 Statistical analysis of all parameter B.T.-A.F. in Group 'A' 146

53 Statistical analysis of all parameter B.T.-A.T. in Group 'B' 147

54 Statistical analysis of all parameter B.T.-A.F. in Group 'B' 147

55 Comparing Statistical analysis of all parameter B.T.-A.T. in

Group 'A' and 'B'

148

56 Master chart (Demography) in Group 'A' X

57 Master chart (Demography) in Group 'B' XI

58 Master chart (Parameter) in Group 'A' XIII

59 Master chart (Parameter) in Group 'B' XIV

CONTENTS

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page ix

LIST OF GRAPH

Sl. No. Title of graph Pg. No.

1 Incidence of Group 86

2 Incidence of Sex 87

3 Incidence of Age 88

4 Incidence of Religion 89

5 Incidence of Diet Pattern 90

6 Incidence of Marital Status 91

7 Incidence of Occupation 92

8 Incidence of Socio-Economic Status 93

9 Incidence of Family History 94

10 Incidence of Agni 95

11 Incidence of Kostha 96

12 Incidence of Prakriti 97

13 Incidence of Vyasana 99

14 Incidence of Chronicity 0f Disease 100

15 No. of Opening 101

16 Incidence of Position or Site 102

17 Incidence of Direction of Sinus 104

18 Incidence of Length of Sinus 105

19 Incidence of Discharge 106

20 Incidence of Surrounding Skin 107

21 Incidence of Tenderness 108

22 Incidence of Local Temperature 109

CONTENTS

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page x

23 Incidence of Pain 110

24 Incidence of Burning Sensation 111

25 Incidence of Itching 112

26 Evaluation of Rate of healing per seating and Unit healing time of

length in Group 'A'

130

27 Evaluation of Rate of healing per seating and Unit healing time of

length in Group 'B'

130

28 Evaluation of Average rate of healing and Average healing time of

Length in both Groups

131

29 Evaluation of Discharge in Group 'A' 133

30 Evaluation of Discharge in Group 'B' 133

31 Evaluation of Surrounding Skin in Group 'A' 135

32 Evaluation of Surrounding Skin in Group 'B' 135

33 Evaluation of Tenderness in Group 'A' 137

34 Evaluation of Tenderness in Group 'B' 137

35 Evaluation of Local Temperature in Group 'A' 139

36 Evaluation of Local Temperature in Group 'B' 139

37 Evaluation of Pain in Group 'A' 141

38 Evaluation of Pain in Group 'B' 141

39 Evaluation of Burning Sensation in Group 'A' 143

40 Evaluation of Burning Sensation in Group 'B' 143

41 Evaluation of Itching in Group 'A' 145

42 Evaluation of Itching in Group 'B' 145

ABBREVATION

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page xi

ABBREVATION

A.H. Astanga Hridaya

A.S. Astanga Sangraha

Su. Sushruta Samhita

Ch. Charaka Samhita

B.P. Bhava Prakash

D.V. Dravyaguna Vigyana

Y.R. Yog Ratnakara

Ch.D. Chakradatta

Sh.S. Sharangadhara Samhita

Bh.R. Bhaishajya Ratnavali

Bh.K.V. Bhaishajya Kalpana Vigyana

B.S.S. Bang Sen Samhita

A.V. Atherva Veda

A.P. Ayurvedic Pharmacology & Therapeutic use of

Medicinal Plants (Dravyagunavigyana)

su. Sutra Sthana

nd. Nidana Sthana

ABBREVATION

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page xii

sh. Sharira Sthana

ch. Chikitsa Sthana

ut. Uter Tantra

us Uttara Sthana

PAS Perianal Sinus

PNS Pilonidal Sinus

w.s.r. With special reference

B.T. Before Treatment

A.T. After Treatment

A.F. After Follow up

SD Stander Deviation

SE Stander Error

INTRODUCTION

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page 1

INTRODUCTION

The term Ayurveda means the science of life. It is traditionally considered as

Upveda of Atharva Veda1 & has been categorized into Astangas2. Among the eight

categories of Ayurveda Shalya Tantra one of the predominant branches lays emphasis

on:-

,

,

3 । Su.

Diagnosis of wounds, extraction of foreign bodies and description of

instruments are dealt in depth in Shalya Tantra4 only.

The word Vrana means to break or tearing of the body. The word is derived

from the verbal root of 'Vran' It means anything that causing discontinuity of the skin

and flesh of the effected part5.

Broadly Vrana is classified into two groups:-

1) Suddha Vrana

2) Dusta Vrana

Grossly, Suddha Vrana is comparable with healing ulcer and Dusta Vrana is

comparable with non-healing ulcer.

INTRODUCTION


According to modern science an ulcer can be defined as break down in the

continuity of the covering epithelium skin or mucous membrane. It is molecular death

of the surface epithelium leading to ulcer formation6.

Clinically it is of 3 types7:-

1) Spreading Ulcer,

2) Healing Ulcer &

3) Callous Ulcer.

Pathologically it is again 3 types8:-

1) Non Specific Ulcer,

2) Specific Ulcer &

3) Malignant Ulcer.

Sushruta explain the Nadi Vrana comes under Dusta Vrana

,

,

, नाडीव तेन मता तु नाडी ॥ Su.

When a surgeon opens an Apakwa swelling (Vrana Shopha), and ignores a

Pakwa Vrana Shopha out o negligence or ignorance and if the patient continues

unhealthy food and activities, then the pus break down the unimpaired intact tissues,

passes deeper and deeper destroying the Vrana Sthana, because of its moving inside

greatly it is known as Gati and since the spread is through a tube, it is called as Nadi9.

INTRODUCTION


The term Nadi implies tube like structure. Nadi Vrana is an ulcer having a

tract extending into in the deeper tissues. Nadi Vrana is associated with presence of

the large number of recesses or cavity in an ulcer. When excessive infiltration of pus

burrows deeply then it can be called as Gati. Thus Gati is synonym of Nadi Vrana10.

There are 8 types of Nadi Vrana; Vataja, Pittaja, Kaphaja, Vata-pittaja, Vata-

kaphaja, Pitta-kaphaja, Tridoshaja and Shalyaja according to Sushruta and According to

Vagbhata and Madhavakara it is of five kinds; one from each of the three Doshas (Vataja,

Pittaja, Kaphaja), and from the combination of all the three Doshas together (Tridoshaja)

and another from the presence of a foreign body (Shalyaja)11.

Nadi Vrana and Sinus comes a non-healing ulcer so to understand the nature

and clinical presentation of Nadi Vrana, the knowledge of an ulcer is needed

Ayurvedic classics state.

Nadi Vrana is comprised and treated as a Sinus by Monior and Monior

Williams. Sinus is a Latin word which means 'a hollow' or 'cavity' or 'recess' or cavity

with a bone or any supporting channel or tract12.

A Sinus is defined as a blind tract leading from surface down into the tissue

and lines either by granulation tissue or by epithelium tissue. It persists due to the

presence of in depth foreign body (sequestrum, suturing material etc.) non dependent

drainage and infection13.

Being the tract is line with epithelium and dense fibrosis collapse of the tract is

prevented. A Nadi Vrana if not timely treated may lead to be formation of fistula by

burrowing deeper and deeper into the tissue .

INTRODUCTION


Sinus first reported in 1883. Mostly of the sinuses are known to occur in the

perianal region. In all of sinus pilonidal sinus most commonly observed in age group

15-30 years after age of puberty by James De Caestecker14. It is rare in more than 40

year. Recurrence rate of sinus is 9-27%, 19% observed after 18 months follow up by

Doll D. Krueger15. Incidence of pilonidal sinus 26/100000 people. It is pre sensitive

in age of 21 in male and 19 in female. Males are more frequently effected by pilonidal

sinus than females with the ratio of 2.2:116.

Nadi Vrana is a common disorder in tropics, due to unhygienic conditions.

Inspire of the tremendous progress in the field of modern surgery, it still exist as a

challenging and troublesome disease. Clinically Nadi Vrana has been treated

improperly, ineffectively with post-operative complications and complaints of

recurrences in most of the cases by the line of treatment adopted by modern surgeons.

The lacunas or short falls of the present day management can be summed up

as follows:-

Whereas modern surgical intervention with excision of sinus tract requires

lengthy hospital stay and regular post-operative dressing and it cause lot of problems

to the patient.

Wide excision of sinus tract becomes the major surgery because it cannot be

done without general anesthesia.

Inability to maintain compete sterility is due to constant source of infection

from anus.

In case of multiple sinuses total excision of various tracts are practically

impossible due to infective identification of minute sinus tracts.

INTRODUCTION


In case of Pilonidal sinus, ramifications force the surgeon to excise a wide area

of tissue causing delay in healing of ulcer.

So as the operative treatment has its own limitations and adverse effects, there

is a dearth of treatment which, should be convenient, effective and economic for a

sinus patients.

In our Ayurveda, Acharyas have explained in detail about the management of

Nadi Vrana with different treatment modalities. Varti application is one among them

which does not require anesthesia and having good curative properties with wrathful

results.

The Varti is considered to possess an anti inflammatory and good broad

spectrum activity. It must be remembered that Nadi Vrana is a chronic non-healing

ulcer (Dusta Vrana) and may occurs due to specific organism also.

त ्फलचंालवणंच

॥ Ch.D.

Ch.D

Here Acharya Chakradatta explained Ghonta Phaladi Varti and Aragvadhadi

Varti which have Shodhana and Ropana properties, thus selected for the study and

help in treating the Nadi Vrana effectively17.

OBJECTIVE OF STUDY

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADIVARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page 6

OBJECTIVE OF STUDY

1) To study critically Nadi Vrana and Sinus.

2) To know the comparative efficacy of Ghonta Phaladi Varti and Aragvadhadi Varti in

the management of Nadi Vrana.

PREVIOUS WORK DONE


PREVIOUS WORK DONE

1) Kishore T.S.A.- Effect of Pugadi Varti in the management of Nadi Vrana

(1989), Bangalore.

2) Dr. Vasudha A.- Management of Shalyaja Nadi Vrana (Pilonidal Sinus) with

Jatyadi Varti And Saindhav Varti- A comparative study (2003).

3) Ishwar S. Kattewadi- A comparative study of Aragvadhadi Sutra Varti and

Chhedana Karma in the management of Nadi Vrana w.s.r. to Pilonidal Sinus

(2006), Bangalore.

4) Yadav. Amit Singh- A clinical study on study on role of Aragvadhadi Varti

and Sandhav Varti in the management of Nadi Vrana (2006), Bangalore.

5) Vikram S.- A clinical comparative study on the efficacy of Ghonta Phaladi

Varti and Sandhav Varti in the management of Nadi Vrana (2007), Davangere.

6) Pavani M.- A clinical study in the management of Nadi Vrana with

Saindhavadi Varti and Saptanga Guggulu (2007), Hospet.

7) Baslingappa K.- Comparative study of Jatyadi and Aragvadhadi Varti in the

management of Nadi Vrana w.s.r. Pilonidal Sinus (2008), Bidar.

AYURVEDIC REVIEW


HISTORICAL REVIEW

VEDIC PERIOD:-

As there is no much details are available in the pre-Vedic period, the recorded

evidence from the beginning of Ayurveda is seen in Rig-Veda and then in the Atharva

Veda.

Atharva Veda:-

1. 18 ॥Atharva Veda.6/138.4

This verse describes the ducts above the testicles, through which semen flows.

This word Nadi is related etymologically with NADA (reed), means hollow within,

which grows in rainy season.

2. The diminutive of Nada is Nadika

It is used in Atharva Veda to denote speech organ Vak (wind pipe).

In Atharva Veda different ailments are explained and its effects on

different organs were mentioned, along with them there are the

references about the disease Asrava (formation of pus) along with

other diseases19. (Atharva Veda 7/78.1)

These two references give an idea that the people of Vedic period also

suffered from collection of pus and formation of Nadi Vrana, but we do not get direct

reference of the term Nadivrana as such.

AYURVEDIC REVIEW


SAMHITHA PERIOD:-

The term Nadi Vrana was coined during this period and described extensively

by Acharya Sushruta20 and also by Vagbhata21. In this treatise several methods are

explained for the treatment of Nadi Vrana one among them is application of Vartis.

MEDIEVAL PERIOD:-

Acharya Chakrapani, has explained in his book ‘Chakradatta’ about Nadi

Vrana and its different treatment principles like Patana, application of Varti and

Kshara Sutra application in Nadi Vrana Chikitsa 45th chapter22.

In Bhaisajya Ratnavali23, Bang Sen Samhita24 and Yogratnakara25 like classics

also a separate chapter is dedicated for treatment modalities of Nadi Vrana.

Hence the Acharyas have added the improved versions of treatment modalities

for Nadi Vrana in addition to the procedures which were mentioned in Brihatrayees.

MODERN PERIOD:-

Post independence period saw the revival of Ayurveda and the Shalya Tantra

in many aspects like in the preparation of Pratisarneeya Kshara, Kshara Sutra, Varti

etc., which are considered as prime procedures in the management of Nadi Vrana.

AYURVEDIC REVIEW


CONCEPT OF VRANA

NIRUKTI (Etymology)26:-

The word Vrana is derived from वृ - means to consume, to conceal, a

sore, a bruise or an injury.

' ' । Su.

A Vrana is so named from its etymology (the term being derived from the

root Vrana to break) and signifies a cracked or broken condition of the skin and flesh

of the afflicted part of the body.

PARIBHASHA (Definition)27:-

वृ ढेक

Su.

An inflammatory swelling which results in an abscess and ulcer and which

never leaves the body till the patient's death. This means the ulcer heals but its scar

will never leaves the body.

BHEDA (Types)28:-

- ,

। Su.

AYURVEDIC REVIEW


The Vrana was broadly classified into 2 varieties in all the Ayurvedic texts:-

Nija Vrana (Due to vitiated of Doshas) &

Agantuja Vrana (Due to external causes or trauma).

Nija group includes within its boundary all ulcers that are caused through the

vitiated condition of Doshas.

Agantuja Vrana is a fresh wound caused by various external agents such as

trauma from blunt or sharp objects, Agni, Kshara and animal bites. Agantuja Vranas

consequently gets converted into Nija Vranas due to vitiated of Doshas after a

stipulated period i.e., 7 days.

SHUDDHA VRANA29:-

अवेदनो ॥ Su.

Suddha Vrana, which is unaffected by any of the three Doshas, and assumes a

dark brown hue along its edges, and is characterized by the absence of any pain,

pustular eruptions or secretions, wound floor should be red, like a clean tongue,

regular (suvyavasthita) and which is of an even or of an equal elevation throughout its

length, should be regarded as Suddha Vrana. It is cleansed and deprived of all morbid

matter or principals.

Suddha Vrana is also caused generally by a surgeon's knife and these Vranas

do not require any specific treatment, except its protection from various

contamination.

AYURVEDIC REVIEW


DUSHTA VRANA30:-

तोऽ तोऽ ऽमृ ऽ ऽ ऽ ....

............................. । Su.

Dushta Vrana is an excessively damaged wound with discoloration of its

Adhisthana (seat), whether it may be caused by vitiated Doshas (Nija Vrana) or

caused by external injuries (Agantuja Vrana).

Dusta Vranas are either too narrow or too wide mouthed. They feel either

extremely hard or soft to touch and present either a raised or depressed. They are of a

black, red, yellow or white in colour and are characterized by extremes of

temperature. Exhibiting strange and unusual features, they are filled with putrid and

sloughing flesh. Indefinite and irregular in shape. They are found to exude a short of

dirty, foetid pus, which runs into fissures and cavities, following an oblique and

upward course. They have a cadaverous odour (look and smell) and are characterized

by extreme pain and burning sensation, attended with redness, swelling, itching and

suppuration. Pustules crop up round these ulcers, which largely secrete vitiated blood,

and linger unhealed for an inordinate length of time.

VRANA LAKSHANAS31 :-

णं -

’ ' , । Su.

Symptoms of an ulcer may be divided into two kinds, General & Specific.

AYURVEDIC REVIEW


General:-

Ruk or Vedana (Pain)

Gatra Vichoornane (Crushing of the body)

Specific:-

Exhibited in each patients due to vitiated Doshas Lakshnas appearing

according to the dominant Doshas.

VISHESHA LAKSHANAS32:-

.................................. Ch.

Both Nija and Agantuja Vranas have the following characteristic features:-

Classified into twenty varieties,

Examined in three different ways,

Exhibit twelve characteristic features in their advanced stages,

Located in eight places,

Associated with eight types of foul odors,

Fourteen types of discharges,

Sixteen types of complications,

Twenty four factors which cause impediments and

Thirty six effective therapeutic measures.

AYURVEDIC REVIEW


VRANA ADHISTHANA33:-

Su.

Base of Vrana is known as Vrana Adhisthana. These are eight ground

materials for Vrana. All Vrana are situated in them, those are Twak (skin), Mamsa

(flesh), Sira (veins), Snayu (ligaments), Asthi (bones), Sandhi (joints), Kostha

(viscera), and Marma (vital spots).

A little variation is found in the concepts of Acharya Sushruta and Acharya

Charaka. Acharya Charaka has mentioned Medas as one of the Adhisthana in the

place of Snayu mentioned by Acharya Sushruta, maintaining the number to be the

same34.

MANAGEMENT:-

.............................. Su.

Acharya Sushruta approach towards the management of Vrana is very

comprehensive. He has described sixty different factors i.e., "Shashtiupakramas"

towards the medical and surgical treatment of Vrana35.

............................... तापहम ्॥ Su.

Acharya Sushruta has also mentioned seven remedial measures for Vrana-

shotha (inflammatory lesion) i.e., Saptopakarmas36:-

AYURVEDIC REVIEW


1) Vimalapana,

2) Avasechana,

3) Upanaha,

4) Patana,

5) Shodhana,

6) Ropana and

7) Vikritapaharanam.

These Saptopakarmas comprehensively includes all the Shashtiupakramas.

AYURVEDIC REVIEW


SHARIRAM (Anatomy and Physiology)

Acharya Sushruta has mentioned eight sites of ulcerative lesions in the

body37:-

Twaka, Mamsa, Sira, Snayu, Asthi, Sandhi, Kostha and Marma.

All types of ulcers can occurs at those places. According to Nadi Vrana also

occurs in the above said eight sites and it is justifiable to know the Sharira of all the

eight sites.

Twak (Skin)38:-

The human skin have seven layers. These layers of skin are formed and

deposited on the rapidly transforming product of the combination of Sukra and Sonita

which have been thus charged with the individual soul or self in the same manner as

layers are formed and deposited on the surface of milk.

The first layer is called Avabhasini, as it serves to reflect all colours and is

capable of being tinged with the hues of all the five material principals of the body.

The thickness of the layer measures 18 of a Vrihi (Rice grain) and it the seat of skin

diseases such as Sidhma, Padma-Kantaka etc. The second layer is Lohita It's thickness

is 16 of a Vrihi and it is seat of Tilakalaka, Nyachchha and Vyanga. The third layer is

called as Shweta, which measures in thickness is 12 of a Vrihi and forms the seat of

such disease as Ajagalli, Charmadala and Masaka. The fourth layer is called as

Tamra, measuring an 8 of a Vrihi and is the seat of varieties of Kilasa and Kustha.

The fifth layer is Vedini, measuring in thickness of a 5 of a Vrihi and forms the seat

of Kustha, Visarpa etc. The sixth layer is called as Rohini, which is a equal thickness

AYURVEDIC REVIEW


as a Vrihi and is the seat of Granthi, Apachi, Arbuda, Slipada and Galgand. The

seventh layer is called as Mansdhara, twice a Vrihi in thickness and is the seat of

Bhagandara, Vidradhi and Arsha.

Mamsa (Muscles):-

Five hundred muscles are present in males39 and five hundred twenty in

female40.Vayu enters the fleshy Mass and separates the Pesi (Muscles). Pesi is the

growing of fleshy organs. When separated Pesis enclose all Siras, Snayu, Asthi and

Sandhi41.

According to their position in the system, these muscles are found to be thick,

slender, small, expanded, circular, short, long, hard, soft, smooth or rough. The

muscles cover the veins, ligaments, bones and joints, hence their shape and size are

determined by the exigencies (organic structures) of their positions42.

Sira (Vessels):-

The Siras are 700 in number. Siras are tubular structures, which carry the vital

fluid 'Sarana' means passing from one organ to another. Siras are like the fine fibers in

the leaf of the tree, thick at their roots becoming finer towards the end. The main Siras

are attached to the heart. They carry the vital fluid consisting of Rasa, to all parts of

the body and in the directions43.

Siras are divided as44:-

According to the Doshas ( Vatavaha, Pittavaha, Shleshmavaha &

Sarvavaha).

According to the colour (Aruna, Neela, Gouri, Rohini)

AYURVEDIC REVIEW


The body is nourished by the Siras, like the same manner as streamlets and

canals serve to keep a field or a garden moist and fruitful. All the Siras originate from

the umbilical region (Nabhi) and then they spread all over the body upwards,

downwards and obliquely. The life of an organic animal is seated in the vessels

surrounding its navel, which forms their starting point. The navel in its tern rests on or

is attached to the Pranas45.

Snayu (Ligament):-

The numbers of Snayus in the body are 90046, which are divided into four

types47:-

1) Pratanavatya, 2) Vritta, 3) Prithula and 4) Susira.

The Snayus are mainly supported by bones. Fleshy organs are tied to the bones

by Snayu and Sira. Snayus are formed from Medas48.

Asthi (Bones):-

As trees are supported by the hard core inside their trunks, so is the body

supported (and kept erect) by the firm bones and since this bones from the Sara of the

human organisms, they are not destroy even after the destruction and falling off the

attached flesh, skin etc49. The Medas nourishes the Asthi and the Asthi also sustain

the Majja50. Number of bones according to Charaka 36051, according to Sushruta

30052 and according to modern 206 in number.

The Asthi Dhatu is produced by the transformation of Medas (Fat tissue) into

a compact form. This compactness is brought about by the action of the Ushman

(Enzymes) present in the Medas itself upon the Mahabhutas (Akash, Vayu, Agni, Jala

AYURVEDIC REVIEW


& Prithvi) of this tissue element. This enzymatic action gives rise to Kharatwa

(Hardness & Roughness), with the result Asthi is manifested in human being53.

Asthi may be divided into five classes according to their character, such as

the Kapalasthi, Ruchikasthi, Tarunasthi, Valayasthi and Nalakasthi54.

Sandhi (Joints):-

There are two types of Sandhi; Chesta and Isthira55. Two hundred ten joints

are present in the body56. These Sandhi may be divided into eight classes according to

its shape namely Kora, Ulukhala, Samudaga, Pratara, Tanu Sevani, Vayasa Tunda,

Mandala and Sankhavarta57. The joints are a structure where the epiphyseal ends

(Asthi Parva) are kept together by means of ligaments58. Slesma Dhara Kala is present

in the Sandhi59.

Kostha (Viscera):-

The interior of the trunk or Kostha includes thorax, abdomen and pelvic

region. It consists60:-

Amasaya (stomach),

Pakwasaya (Intestines),

Agnyasaya (Gall bladder),

Mutrasaya ( Urinary bladder, Kidney)

Raktasaya (Receptacle of blood),

Hridaya (Heart),

Unduka and

Phuphusa (Lungs).

AYURVEDIC REVIEW


Marma (Vulnerable or Vital parts):-

There are 107 Marmas in the human body, which may be divided into five

classes according to their structure such as the61:-

Mansa,

Sira,

Snayu,

Asthi and

Sandhi.

Again Marmas are classified into 5 types according to Parinama, such as62:-

Sadyah Pranhar,

Kalantar Pranhar,

Vishlyaghna,

Vaikalyakara and

Rujakara.

Marmas are the vital parts of the body. A Marma contains the elements of

Somya, Vayu, Tejas, the primary Gunas Satvas, Rajas and Tamas and the individual

soul. That is why persons do not live when their Marmas are hurt63. All Marmas are a

more or less the seats of Prana. Owing to this close association with Chetna, injury to

a Marma produces sever suffering64. Knowledge of Marma means half the knowledge

of surgery because Marma is such a vulnerable part where a wound proves fatal and

those who survive, surely from some defect.

AYURVEDIC REVIEW


NADI - VRANA

DERIVATION OF NADI VRANA:-

1) (Shabdakalpdrum)65

That which is having a tract inside the ulcer is called Nadi Vrana.

A Vrana Vishesha which discharges pus at all time is called “Nadi

Vrana”.

2)

(Amarkosha)66

'NADA' - means a reed.

That which is having a tract like a reed.

A Vrana Vishesha, the nature of which remains unhealed with the

characteristic of oozing or discharge of pus is called as Nadi Vrana.

3) 'NADI': A tract, “VRANA” – an ulcer.

4) (Amarkosha Manushyavarga)67

The one, which is having " " property letting or expelling

out material, is known as Nadi Vrana.

The word "Nadi" refers to a deformity where the formation of tract or a

passage takes place.

AYURVEDIC REVIEW


5)

i.e. reed or flute. This is described as Pranali or a condition causing

Nali or Pranali or Nadi and this occurs in the case of Nadi Vrana.

6)

7)

that which resembles tubular (hallow) structure is called Nadi.

Nadi implies a tube like structure and Nadi Vrana is a tube shaped ulcer i.e.,

either a Sinus or a Fistula as held by Sir Monier Williaams in his Sanskrit to English

dictionary and by Vaman Shiv Ram Apte in his 'The Practical Sanskrit-English

dictionary'.

DEFINITION68:-

यो,

,

, नाडीव तने मता तु नाडी ॥ Su.

पूयोऽ

कानृ Ah.

AYURVEDIC REVIEW


Improper managements or negligence of management will lead the Vrana into

chronic stages; that condition is known as Nadi Vrana

When a surgeon opens an Apakwa swelling (Vrana Shopha), and ignores a

Pakwa Vrana Shopha out o negligence or ignorance and if the patient continues

unhealthy food and activities, then the pus break down the unimpaired intact tissues,

passes deeper and deeper destroying the Vrana Sthana, because of its moving inside

greatly it is known as Gati and since the spread is through a tube it is called as Nadi.

In case of a Vrana Sopha too early or too later surgery will lead to Nadi Vrana.

PARYAYA (Synonyms)69:-

As the word Nadi implies the direction of Pooya (Atimatragamana) embedded

inside "Gati" is also a synonym of Nadivrana, Nadishatam, Gati, Avaram:

Because of its copious flow; it is also known as Gati.

As if flows like a drain, it is called as Nadi.

According to some ancient authors if Pooya (pus), Rakta (blood) etc. passes

through a single curved tract it is called Nadi Vrana and that passing through, more

than one curved tract attains the name Gati70.

NIDANA (Etiological factors of Nadi Vrana):-

As Shopha is the primordial condition of Nadi Vrana, the etiological factors of

Sopha can be considered for Nadi Vrana too. Sopha means inflammatory swelling, is

defined as an elevation caused by Doshas localized and situated between skin and

muscles, widespread, knotty, even or uneven71.

AYURVEDIC REVIEW


The Doshas become aggravated to give rise to Shopha in the body, by such

causes, as by undertaking a journey immediately after meal, or by, the use of Harita-

sakas, or by the excessive use of acids by weak and emaciated persons, or by the use

of clay, baked or unbaked, of lime stones, or of the flesh of aquatic animals, or of

those frequenting swampy places, excessive sexual intercourse, use of fares

containing of incompatible articles and lastly by the jotting when riding on elephants,

horses, camels, in vehicles etc. or on persons on the part of dyspeptic patients72.

SAMPRAPTI (Pathogenesis ):-

If Vrana Shopha is not timely treated in Pakvavastha or inadequately drained

the pus, invades deeper and deeper into the tissues in the form of a tube resulting in

Nadi Vrana. The direction of invasion might be straight or depending upon it is Gati

or Nadi Vrana.

The pus of an abscess or swelling burrows into the affected part if a person's

neglects it in its fully suppurated stage, and then the pus has been entered into deeper

tissues and penetrates inside and results into Nadi Vrana73.

If immature inflammation is incised there may damage muscles, vessels,

ligaments, joints, bones, excessive hemorrhage, appearance of pain, tearing,

manifestation of many complications or traumatic abscess. When the surgeon takes

the mature as the immature and neglects the disease for a long time due to fear and

confusion the pus deep seated not finding exit tears its location, produces cavity by

creating big lap-like space ultimately resulting in Nadi Vrana, and thus becomes

curable with difficulty or incurable74.

AYURVEDIC REVIEW


Non-bursting of suppurated swellings and observing Apathyas by an ulcer

patient causes the pus in the ulcer to spread into deeper tissues for long distances.

Thus resulting in the formation of Nadi Vrana.

Analogy to the formation of Nadi Vrana75:-

As fire caused by wind reaches grassy region and burns it forcibly, the

undrained pus, likewise, eats of muscles, vessels and ligaments.

CLASSIFICATION OF NADI VRANA76:-

तोऽ Su.

सा दोषःॆ पृ प मी ॥ Ah.

Acharya Sushruta has classified Nadi Vrana into eight types - Vataja, Pittaja,

Kaphaja, Vata-pittaja, Vata-kaphaja, Pitta-kaphaja, Tridoshaja and Shalyaja.

According to Vagbhata and Madhavakara it is of five kinds. one from each of

the three Doshas (Vataja, Pittaja, Kaphaja), and from the combination of all the three

Doshas together (Tridoshaja) and another from the presence of a foreign body

(Shalyaja)77.

LAKSHANAS ( Symptoms ):-

।

AYURVEDIC REVIEW


Su.

- -पयूाऽऽ

कृ

डीं,

Ah.

1) Vataja Nadi Vrana78,79:-

Nadi Vrana caused by vitiated Vata has rough, have a small and narrow

opening, discolored, associated with Shoola and excessive foam mixed discharge

which occurs more at night.

AYURVEDIC REVIEW


2) Pittaja Nadi Vrana80, 81:-

Nadi Vrana caused by vitiated Pitta Dosha has thirst, fever, burning sensation,

exudes yellow, warm, foul smelling pus, occurs more during the day.

3) Kaphaja Nadi Vrana82, 83:-

Nadi Vrana caused by vitiated Kapha Dosha has very thick, slimy exudation,

severe itching, hardness, exudation occurs more at night.

4) Dwandaja Nadi Vrana84:-

Three types of Nadi Vrana (Vata-pittaja, Vata-kaphaja & Pitta-kaphaja) due

to combination of two Doshas exhibit the characteristic features of two Dushita.

5) Tridoshaja Nadi Vrana85, 86:-

Exhibit symptoms of all three Doshas and attend with fever, burning

sensation, breathlessness, dryness of the mouth and syncope. An attack of this type

should be regarded as dreadful and fatal, casting around the gloom of death.

6) Shalyaja Nadi Vrana87, 88:-

The foreign body remaining inside the body and invisible to the eyes, tend to

burst open the skin etc., of the locality along it's channel of insertion and gives rise to

a Nadi Vrana. It is characterized by a constant pain, exudes thin, warm, frothy blood

and pus every day.

AYURVEDIC REVIEW


COMPLICATION OF NADI VRANA:-

As previously narrated Nadi Vrana of Bhaga Pradesh is termed as

Bhagandara, which means the tubular ulcer piercing Bhaga Pradesh including Bhaga,

Guda and Vasti.

SADHYASADHYATA (PROGNOSIS)89:-A

॥ Su.

Nadivrana caused by all the Doshas (Tridoshaja) presence of all the symptoms

should be rejected, while the four remaining types amenable to careful medical

treatment.

MANAGEMENT:-

Broadly the whole methodology of management classified into 4 types.

1. Bhaisajya Chikitsa (Medical treatment),.

2. Kshara karma (Para surgical procedure),

3. Agni karma (Cauterization) &

4. Shastra karma (Surgical treatment).

Among these Bhaishajya Chikitsa, Kshara Karma, Shastra Karma are

applicable to the management of Nadi Vrana90.

Generally the treatment advised for all Nadi Vranas is as opening up of the

course of the pus channels with a surgical knife and followed by the Sodhana and

Ropana measures91.

AYURVEDIC REVIEW


For all Nadi Vranas the treatment mentioned is Chhedana and application of

Lepa according to Doshas (Vagbhata)92.

Acharya Sushruta while mentioning sixty types of treatments93 has highlighted

the importance of Shodhana and Ropana by using the Kashaya, Varti, Kalka, Ghrita,

Tail, Raskriya and Avachurnan in all types of Vranas94. The healing and purifying

measures described should be deemed equally applicable to, and efficacious in cases

of ulcers in general with regard to their Doshas (Both idiopathic and traumatic).

VARTI (Wicks) KALPANA:-

व

Sh.S.

Vartis are basically come under ‘Vati’ Kalpana, it's a synonym of Vati95. They

differ only in shape and use. Vartis are elongated with tapering ends while Vatis are

round. Vartis are used externally. Vartis help in expelling the collected Mala, Mootra,

Pooya, Rakta, Kapha, etc. thus help in therapeutic field96.

Depending upon the organ & action Vartis are classified and named as97:-

1) Guda Varti

2) Yoni Varti

3) Shishna Varti

4) Vrana Varti

5) Netra Varti

6) Dhooma Varti

7) Nasa Varti and

AYURVEDIC REVIEW


8) Phala Varti

General method of preparation:-

Sh.S.

A thick syrup of (3-4 thread consistency) Jaggery is taken in equal proportion

to the weight of all the ingredients. To this syrup, fine powder of the ingredients is

added, mixed well and Vartis are prepared98.

Other wise Bhavana with specific liquid is given to the fine powder of the

ingredients and Vartis are made99.

The size of Vartis should be 2” – 6” long and ¼ “ – ½ “ thick or mainly on the

base of length and diameter of Nadi Vrana.

Vrana Varti Actions:-

1) Vrana Shodhana & Ropana

2) Pooya Nisaraka

Vrana Varti Indications:-

1) Nadi Vrana

2) Dusta Vrana

AYURVEDIC REVIEW


Method of Administration:-

The site of application as well as the end of the Vartis to be applied should be

lubricated with Taila or Ghrita before introducing it.

Different types of Vartis are described in “Dwivraneeya Adhyaya” Varti is

also one among Shashtiupakramas explained by Sushruta in the management of

Vranas. Further among Shastiupakramas it comes under “Sapta Shodhana–

Ropaneeyas”

Varti is mainly indicated in Vranas with embedded foreign body, which has

small external opening which involved deeper tissues. Varti prepared using Shodhana

Dravyas destroys unhealthy tissues100.

Varti Prayoga is given much importance in the management of Nadi Vrana in

texts like Chakradatta101 and Yogarathnakar102.

Sushrutha103 and Vagbhata104 both have explained regarding Varti properties

action and also explained about its adverse effects. If not prepared properly or if it is

not properly placed. Varti should not be very Snigdha (Unctuous) Ruksha nor it

should be very thick or thin and it should not cause any problem to the patient. If it is

very unctuous it causes excess exudation; if it is dry it causes abrasion, bleeding and

pain, if thick or thin or not inserted properly causes friction to the edges of the sinus.

If correctly prepared and placed it drains the pus and removes the unhealthy tissues

and purifies the tract.

AYURVEDIC REVIEW


Generally the treatment advocated for all Nadi Vranas is as opening up of the

course of the pus channels with a surgical knife and followed by the Shodhana and

Ropana measures.

Prior to this Shastra Karma Poorva Karma in the form of Snehan, Swedan and

after the Shastra Karma i.e. Samsarjanakarma must be done.

Pathya and Apathya in Nadivrana105:-

Pathya (Indication):-

Yava, Shashtika Shali, Godhuma Purana Shali, Sita, Masura, Dhanya, Tuvari,

Mudga, Yusha, Madhu, Sharkara Vilepi, Laajamanda, Jaangala Mamsa Rasa, Ghrita,

Taila, Patola, Vetragra, Balamoola Vaartaka, Kaaravella, Karkotha, Tandulodaka.

Apathya (Contra-indication):-

Ruksha, Sheeta, Amla, Lavana Ahara Sevana.

Vyayama, Vyavaya, Paribhashana, Nidra Prajagaram, Chankraman, Shoka,

Virudhashana, Ambupana, Tambula, Patrashaka, Ajangala Mamsa, Asatmya Anna.

These should be avoided for a period of one year.

MODERN REVIEW


MODERN REVIEW

HISTORICAL ASPECTS:-

A clear and successful data is not available in the management of sinuses in

general, because of versatility of anatomical locations, specific infections etc.

However the nature of the disease (e.g. congenital nature in bronchial sinuses and

fistulae) infectious pathology (e.g. Tuberculoses sinuses following tuberculosis,

lymphadenitis), affinity of certain areas of the body (e.g. pre-auricular sinus at the

root of helix in pinna), obstructive pathology (e.g. pilonidal sinus) etc, reveals that

majority of the sinuses occurs in anorectal region possible because of the extensive

chances of infection from this unhygienic locality. Studies and literature of

management procedures are vast.

John Ardene described the steps of operation for anal sinus in 1339 and

following that Charles Felix performed the operation for anal sinus in 1339 and

following that Charles Felix performed the operation successfully in 14th century.

Exposure of the tract and it's important for adequate drainage was emphasized by

Fercival Pott (18th century). But later studies with ligaturing the tract with strong silk

or India rubber ligaturing, injections of modification of the classical incision by

Fredrick Salman followed by Norgan, Milligan and Gabriel etc. satisfies the

contention that none of the procedures were better than that the others.

MODERN REVIEW


DEFINATION OF WOUND106:-

A wound is a break in the integrity of the skin or tissue often, which may be

associated with disruption of the structure and function.

Wound is simply a distribution of any tissues- soft tissue or bone or internal

organs. Ulcer is disruption or break in the continuity of any lining- may be skin,

mucous membrane or others. Ulcer is one of the types of wounds.

CLASSIFICATION OF WOUNDS107:-

1) Classification based on Rank and Wakefield:-

Tidy wounds:- Tidy wounds are inflicted by sharp instruments and

contain no devitalized tissue.

Untidy wounds:- Untidy wounds result from gushing, tearing,

avulsion, vascular injury or burns and contain devitalized tissue.

2) Classification based on Type of Wound:-

Clean incised wound

Lacerated wounds

Bruising and contusion

Hematoma

Closed blunt injury

Puncture wounds and bites

Abrasion

Traction and avulsion injury

Crush injury

Injuries to nerves, either clean cut or crush

MODERN REVIEW


Injuries to arteries and veins

Injury to internal organs, may be of penetrating or nonpenetrating

types

Penetrating wounds.

3) Classification based on Thickness of the Wound:-

Superficial wound

Partial thickness

Full thickness

Deep wounds

Complicated wounds

Penetrating wound

4) Classification based on Involvement of Structure:-

Simple wounds

Combined wounds

5) Classification based on the Time Elapsed:-

Acute wound

Chronic wounds

6) Classification of Surgical wounds:-

Clean wound

Clean contaminated wound

Contaminated wound

Dirty infected wound

WOUNDS HEALING:-

Wound healing is complex method to achieve anatomical and functional

integrity of disrupted tissue by various components like neutrophils, macrophages,

MODERN REVIEW


lymphocytes, fibroblasts, collagen; in an organized staged pathways —› haemostasis

—› inflammation —› prolifaration —› matrix synthesis (collagen and proteoglycan

ground substance) —› maturation —› remodeling —› epithelialisation —› wound

contraction (by myofibroblast)108.

When tissue is damaged, platelets adhere to exposed matrix via integrins that

bind to collagen and laminin. Blood coagulation produces thrombin, which promotes

platelet aggregation and granule release. The platelet granules generate an

inflammatory response. White blood cells are attached by selections and bind to

integrins on endothelial cells, leading to their extravasations through the blood vessel

walls. Cytokines released by the white blood cells and platelets up regulate integrins

on macro phases, which mediate wound to the area of injury, and on fibroblasts and

epithelial cells, which mediate wound healing and scar formation. Plasmin aids

healing by removing excess fibrin. This aids the migration of keratinocytes into the

wound to restore the epithelium under the scab. Collagen proliferates producing the

scar. Wounds gain 20% of their ultimate strength in three weeks and later gain more

strength, but they never reach more than about 70% of the strength of normal skin.

Types of wound healing109:-

Wound healing is a special kind of repair. It may take place by

1) Primary intension and

2) Secondary intension.

1) Primary intension:-

This occurs in clean, incised when the edges of the wound are re-

approximated with sutures. The healing process is fast and leaves a thin and neat scar.

MODERN REVIEW


2) Secondary intension:-

This occurs in open wounds, particularly when there has been significant loss

of tissue, necrosis or infection.

The healing process is slow by the phenomenon of wound contraction and

leaves a wide and irregular scar.

In open wound healing if the infection supervened, the wound turns into non-

healing type or delayed in healing, infection of specific or non -specific and some of

the systemic disease will find the healing process from its normal stages in their

specified time.

Wound healing can be accomplished in two ways110.

1) Regeneration:- In this lost specialized tissue is replaced by proliferation of

surrounding undamaged specialized cells.

2) Repair:- Repair is the replacement of lost tissue by granulation tissue,

which mature to form scar tissue. This is inevitable when the surrounding specialized

cell do not possess the capacity to proliferate and replace the lost tissue. e.g.- Muscle

and Neurons.

Phases of healing111, 112:-

There are three phases of wound healing. However, the process itself is a

continuous one, which one phase proceeds into the next until healing achieved.

Part-1 Inflammatory phase, Substrate phase, Lag phase,

Exudative phase,

Duration 1-4 days.

Part-2 Proliferative phase, Fibroblastic phase,

connective tissue phase.

Duration 5-20 days.

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Part-3 Resorptive phase, Remodeling phase,

Maturation phase, Phase of differentiation (scar

tissue).

Duration 20th day onwards.

Phase (1) Inflammatory phase:-

Clinically, this is manifest by the classified features of inflammation namely,

heat, redness, tenderness, swelling and loss of function.

Immediately there is a change in tissue tension, which causes a change in the

charge on the collagen molecule. The constituents of the blood flowing into the

wound come into contact with collagen and clotting is induced, with activation of

kinin and complement cascades. Platelets undergo brief constitution followed by

vasodilatation under the influence of histamine from platelets and mast cells.

Capillary permeability increases serotonin, the kinins and prostaglandins (the

chemical mediators of the inflammatory response) maintain capillary engorgement.

Red and white blood cells escape through the vessel walls and a net work of fibrin

forms over the wound, which within 3 hours is surrounded by a few lymphocytes and

an increasing number of polymorph neutrophills. These neutrophills have a

predominantly lytic function because of their lysosome content.

Monocytes being into appear in increasing numbers and become the dominant

cell type by the 5th day. They are phagocytes and ingest cellular debris. Depression of

this macrophage function will delay wound healing.

By the end of first phase new capillaries bud from endothelial cells in

capillaries near the wound edge, while in the connective tissue surrounding the

vessels, mesenchymal cells differentiate to become fibroblasts.

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Phase (2) Proliferative phase:-

It beings as the fibroblasts appear in the wound. There is a proliferation in the

fibroblasts, epithelial and endothelial cells. These cells multiply and migrate in a

random fusion in wound area. The random migration of the cells takes place at the

rate of 0.2mm per day and is guided by the fibrin strands, anatomical tissue planes

physical tension planes. The fibroblasts are active protein producing cells synthesize

mucopolysaccharide, glycoprotein and collagen which is formed into fibers.

In the early proliferative phase, synthesis of new and lysis of old collagen

takes place simultaneously and the bridging of the tissue discontinuity becomes a

struggle between the lysis and synthesis of collagen. A circulating collagens inhibitor,

influence tensile strength, tissue synthesis and remodeling.

Phase (3) Resorptive phase:-

During this phase reorganization and maturation of the

connective tissue in the wound beings. There is a decrease in the in the number of

cells and obliteration of capillaries. The excessive collagen is removed and the needed

collagen forms sheets or strands parallel to the physiological tension lines with

increasingly firm chemical cross-linking. Collagen is still synthesized more rapidly in

the wound than in the normal tissues, but resorption of collagen leads to a net collagen

loss. The collagen fibers become more insoluble and remodeled by interweaving and

closer packing of the fibers and the tensile strength of the wound increases, though the

total amount of collagen in the area decreases.

MODERN REVIEW


DEFINITION OF SINUS:-

A sinus is a blind tract leading from the surface down to the tissues. There

may be a cavity in the tissue, which is connected to the surface through a sinus. The

sinus is lined by unhealthy granulation tissue, which may be epithelialised113.

In Latin "sinus' means - ;A hollow', a bay' or 'gulf114

AETIOLOGICAL FACTORS (CAUSES FOR PERSISTANCE OF

SINUS)115, 116:-

1) Presence of foreign body or necrotic tissue in the depth (e.g. Sequestrum or a

suturing material) a faecolith, even a worm.

2) Trauma,

3) Non-dependent drainage or inadequate drainage of an abscess.

4) Inadequate rest during healing time.

5) Presence of infection.

6) Congenital anomalies.

7) Occupational factors.

8) When the tract becomes epithelialized.

9) Sometimes there may be a dense fibrosis around the wall of the tract and the

cavity preventing their collapse.

10) Irritant discharges with obstruction distal to the tract.

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11) Presence of malignant disease.

12) Ischaemia.

13) Malnutrition.

14) Crohn's disease.

15) Drugs e.g. steroids, cytotoxics.

16) Type of infection e.g. Tuberculosis, Actinomycosis etc.

CLASSIFICATION117:-

A) Congenital B) Acquired

1) Pre-auricular, 1) Pilonidal,

2) Umbilical, 2) Suture,

3) Urachal, 3) Perineal or Post

surgical

abdominal,

4) Coccygeal and 4) Hydradenitis

suppurative,

5) Sacral. 5) Actinomycosis,

6) Tuberculosis and

7) Osteomyelitis.

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ANATOMICAL LOCATION OF SINUSES118:-

1) Perianal region:-

A majority of sinuses occur in the anal region and reason might be.

a) Increased chances of infection of the anal glands due to constant contact with

faecal matter.

b) Constant exposure of the region to trauma as from horse riding, cycle riding etc.

c) The anatomical peculiarities of anorectal region.

2) Sinuses are known to occur at the end of long bones following osteomyelitis.

3) Root of the helix or tragus on the pinna in the case of preauricular sinus

(congenital origin or due to failure of fusion of the ear tubercles). Direction of sinus is

upwards and backwards.

4) A Pilonidal sinus is a subcutaneous sinus contains hair lined by granulation tissue

rather than epithelium, usually occurs in the natal cleft. Also seen in inter digital

clefts, face and axilla.

5) Sinuses present at the umbilical region are met with the following aspects,

a. The entry of hairs,

b. Foreign body after operation,

c. Gall stones,

d. Diverticulitis.

e. Carcinoma of the colon.

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6) Multiple indurated sinuses situated in the upper part of the neck in the case of

actinomycosis.

7) In the neck it is presented at the anterior lower third of the sternomastoid

muscle in the case of bronchial sinus (congenital origin).

8) In the thyroid region due to bursting of inflamed thyroglossal cyst.

9) Sinuses may occurs anywhere in the subcutaneous plane as in the case of

subcutaneous and inter sphicteric abscess.

PATHOPHYGIOLOGY119:-

In chronic inflammation, necrosis with liquification of tissue is not unusual

(e.g. - in actinomycosis). As the liquefied debris slowly accumulates, a gradual

increase in local pressure occurs. The contents of such an area may finally escape

by forming long complex channels called sinuses through adjacent tissues.

(Boyd's pathology for the surgeon).

1) Almost in all instances with the exception of congenital cases, sinus is the

result of an internal pathology, which the body finds it necessary to exclude, the sinus

crystallizes as a tract to the external in draining the resultant materials of the

pathology whatever it may be. The pathological factors can be infective as in the case

of tuberculous lymphadenitis or osteomyelitis, a foreign body such as hair etc., in the

case of pilonidal sinus or even suturing material following operations. Following this

the defense mechanism of the body always tries to let out these factors. In the

pathological process first forms an abscess to collect all the unnecessary elements. At

this stage if adequate removal of the material is done with operations followed by

proper drainage, sinus might not result. But the most of the pathogenesis is lying in

MODERN REVIEW


inaccessible deeper tissues the drainage is seldom adequate. The result is the

manifestation of sinus is internally lined with granulation tissue or epithelial tissue

and might be associated with dense fibrosis along the wall of its tract preventing it's

collapse. The infective pathology is relevant in case of actinomycosis, bilharziasis,

tuberculosis, dracontiasis, ulcerative proctocolitis, lymphogranuloma inguinal with

fibrous rectal stricture, chron's disease of colon or ileum, osteomyelitis etc.

2) Sinuses resulting from constant exposure to tract might have an entirely

different pathology. Following trauma hematoma is liable to occur resulting in the

formation of abscess, the pus inside finding no way out to manifest sinus. This is seen

especially in the cases of Ano- rectal sinuses.

3) In case of congenital deformity, the pathology of the case is different. It is

due to imperfect structural fusion as in the case of brachial and pre-auricular sinuses.

4) Still different in the pathology of the sinuses due to carcinomatous origin

and relates specifically to the carcinogenesis or the type of growth and location

involved.

5) After the onset of puberty, sex hormones affect the pilosebaceous glands,

and subsequently, the hair follicle becomes distended with keratin. As a result, a

folliculitis is created, which produces edema and follicle occlusion. The infected

follicle extends and ruptures into the subcutaneous tissue, forming a pilonidal abscess.

This results in a sinus tract is cephalad in 90% of cases, which coincides with the

directional growth of the follicle. This usually places the tracking follicle

approximately 5-8cm from the anus. In the more rare instance that the sinus is located

caudally, it is usually found 4-5cm from the anus. The laterally communicating sinus

MODERN REVIEW


overlying the sacrum is created as the pilonidal abscess spontaneously drains to the

skin surface. The original sinus tract from the natal cleft becomes an epithelialized

tube. The laterally draining tract becomes a granulating sinus tract opening.

Loose hairs are drilled, propelled, and sucked into the pilonidal sinus by

friction and movement of the buttocks whenever a patient stands or sits. Hair enters

tip first, and the barbs on the hair prevent it from being expelled so that the hair

becomes entrapped. Physical examination occasionally may reveal a tuft of hair

emerging from the midline opening in the natal cleft. This trapped hair stimulates a

foreign body reaction and infection. Rarely, foreign bodies other than human hair can

cause this disease process. Rare case reports exist in which the hair did not come from

the patient but instead from a bird's feather , the type used to stuff feather bedding.

6) As abscess if not properly drained is known to result in a sinus.

SYMPTOMATOLOGY120:-

The clinical presentation in most instances will be done one or more external

openings with a history of discharge and presenting sprouting granulation tissue

around the orifice.

a. Orifice:-

Slightly elevated with granulation tissue.

b. Pain:-

Pain might not be a constant features and it will not be there when the tract is

open. If the tract is closed either by foreign body or by the growth of granulation

MODERN REVIEW


tissue, pressure shoots up in the area of suppuration and pain results. However, in the

cases of neoplastic origin, pain is a constant feature in later stages.

c. Irritation:-

This complaint is caused by the purulent discharge.

d. Discharge:-

It should be examined macroscopically, physically, chemically; and

microscopically.

Staphylococcal pus is yellow and of creamy consistency whereas

Streptococcal pus is watery slightly opalescent and sometimes it will be stained with

blood. Pseudomonas aeruginosa discharges the typical or bluish green pus. Sometimes

the sinus might discharge pus containing sulphur granules as in actinomycosis or

sequestrum in osteomyelitis or faecal matter, and bile in fistula etc. Association with

pus can be understood according to the site of the sinus.

e. Odour:-

E.coli pus is absolutely colourless where as B.coli pus is of an objectionable

odour. The odour is thought to be due to the proteolytic properties of the causative

organism.

f. Surrounding skin:-

There may be a scar in surrounding tissue, which may indicate chronic

osteomyelitis or previously healed tuberculosis sinus. There may be surrounding

MODERN REVIEW


dermatitis and pigmentation, which are characteristic features of crohn's disease and

actinomycosis.

g. Wall of the sinus:-

Chronic of sinuses will have thick wall due to presence of fibrosis surrounding

the wall of the sinus.

h. Tenderness:-

It can be elicited in the sinus tract closed due to obstruction.

COMPLICATION OF SINUS:-

1. Abscess formation.

2. Recurrent inflammation.

3. Recurrence of Sinus formation.

The main complication of sinuses is fistula. This is true especially when the

sinus is in contact with a hollow viscous internally. Fistula in ano is a striking

example, result in the formation of fistula in ano as majority of the sinuses occurs in

the perianal region. In case of osteomyelitis damaging of the tissue results in the

formation of a big cavity.

DIFFERENTIAL DIAGNOSIS:-

1. Post-anal dermoid.

2. Fistula-in-ano.

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MANAGEMENT121:-

As sinuses are tubular ulcers penetrating deeper into the tissues the problem

confronted by the surgeons in the management aspect are many.

The principles of management:-

1) Removal of obstructive factors.

2) Laying open the sinus tracts.

3) Enabling healing to start from the bottom.

4) Prevention of excess formation of scar tissue to avoid contracture of the

part.

5) Treatment of specific infection.

6) Prevention of formation of granulation and epithelial tissue as well as

removal.

MANAGEMENT TECHNIQUES:-

1) Excision with primary closure.

2) Laying open the sinus tract to allow healing by secondary intention.

3) Excision of excessive fibrous tissue.

4) Curetting the wound by removing the hair, granulation tissue and skin

debris to promote adequate wound healing.

MODERN REVIEW


Creation of an internal opening to form a fistula by Probing. For example, the

surgical options for management of a uncomplicated chronic pilonidal sinus include

excision with primary closure, excision and laying open the tract, wide and deep

excision to the sacrum, incision and marsupialization, and phenol injection.

NON-OPERATIVE AND PARA SURGICAL PROCEDURE:-

The Para surgical procedure available at present in indigenous system is

Sposetry, Alkaline, oil infiltration therapy etc.

Injection of irritant chemical such as 3-4 silver nitrate, urethane etc., which

was prevalent earlier was later discarded owing to its complications and failure.

LACUNA IN THE PRESENT DAY MANAGEMENT:-

1) Higher incidence of recurrence rate.

2) Excess of scar tissue formation causing severe contracture of the part.

3) Excessive excision leads to prolapsed of supportive tissue and in the

case of anorectal sinuses; faecal incontinence is a drawback.

4) Prolonged hospital stay.

5) In case of multiple sinuses, total excisions of various tracts are

practically impossible due to ineffective identification of minute sinus

tracts.

6) In specific infection, the treatment should be specific.

PHOTOS OF DIFFERENT TYPES OF SINUSES

DRUG REVIEW


DRUG REVIEW

In the Chikitsa of Nadi Vrana, we find references of different preparations of

Vartis mentioned in Ayurveda. As Nadi Vranas are manifested with different

etiology they are Krichrasadhya. Drug to cure all such Nadi Vranas should have

Shodhak, Ropaka, Shothaghna, Shoolaghna properties. According to modern

medicine, there is no such applicant which will have wide range of activity and

effective in healing all types of non-healing Nadi Vranas and they are having their

own limitations and drawbacks. But there are many drugs in Ayurveda, which are said

to be effective in healing of Nadi Vrana. Kshara Sutra Varti therapy is considered as

an excellent para surgical procedure for Nadi Vrana. But the application of Kshara

Sutra is a long process and once the sinus tissue is cut it has to be again managed like

wound management. literature related to Ghonta Phaladi Varti and Aragvadhadi

Varti, reveals that cutting and healing process of the sinus tract occurs simultaneously

in a short duration. So, in this present clinical study to assess the efficacy of Ghonta

Phaladi Varti and Aragvadhadi Varti are taken for the management of Nadi Vrana.

GROUP ‘A’ MEDICINE

Ghonta Phaladi Varti:-

Ghonta Phaladi Varti was said to be effective in Nadi Vrana. It is described

in Chakradatta, Nadi Vrana Chikitsa Adhyaya.

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Ingredients of Ghonta Phaladi Varti:-

1. Ghonta Phala Twaka,

2. Saindhava Lavanam,

3. Laksha,

4. Puga Phala,

5. Jyotishmati,

6. Snuhi Ksheera and

7. Arka Ksheera.

GHONTA PHALA122,123

Botanical Name : Zizyphus xylopyra Willd.

Family : Rhamnaceae

Kula : Badarakula

Classical Categorization : Shramahara, Virechanopaga, Swedopaga,

Hridya, Hikkanigrahan

Udardaprashaman (Charak)

Aragvadhadi

Vatashamanadi (Sushruta)

Synonyms : Karkandu, Kola , Badari, Ajapriya, Koli,

Sauveer, Abhay Kantak, Rajabadara

Vernacular Names : Kannada : Bare, Borehannu,

Hindi : Baer, Tamil : Koli, Elandai

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Telugu : Badaram , Regu,

Malayalam : Lanta

English : Jujaba Fruit, Indian Cherry

Botanical Description : It is a medium sized tree with spikes, bark

– grey and torn , drupe 1.5 to 2.5 cm

diameter globose first yellow then orange

and finally reddish brown ,containing a

single seed surrounded by fleshy pulp,

Rajabadar variety is used in medicine.

Distribution : Punjab, Himachal Pradesh, West Bengal,

Afghanistan, Iran, Kashmir, China & all

over India

Chemical Composition : Alkaloids, Jejubosides a & b

Properties : Rasa – Amla, Madhura, Kashayam. Guna-

Guru, Snigdha, Pischila. Veerya – Seta

Vipaka – Madhura

Karma : Vrana Ropaka, Vrana Shodhaka,

Sonitasthapana, Hridya, Grahi, Vata-

Pittahara, Sukrala

Indications : Vranashodhaka, Vrana Ropaka Kasa,

Swarabheda, Udara, Chardi Krimi, Pradara

Parts Used : Fruit Seed

Dosage : Power of dried fruit 20 gms , Juice ½ Oz to

1 Oz

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SAINDHAV LAVANAM124

Latin Name : Sodium Chloride

Hindi : Sendha namak, Sendhanana Lahuri namak

Bengali Saindhava Lovana, Saindhava nun

Marathi : Sende lona

Guajarati : Sindha Luna

English : Rock Salt

Description : Saindhava Lavanam is mineral which is

obtained from Punjab, mines. Two varieties

of Saindhava are available i.e. white and Red.

According to Charaka Saindhava is

considered best amongst all the salts for

internal use.

Properties :

Rasa : Lavan

Guna : Laghu

Veerya : Seta

Karma : Dipana, Hridya, Vrishya, Avidahi & Sukhada

Tridoshagna

Indication : Aruchi, Netraroga, Vrana & Vibandha

DRUG REVIEW


LAKSHA125

Botanical Name : Laccifer lacca (Kerr)

Family : Laccififeridae

Kula : Haritkyadi Varga

Synonyms : Laksha, Palamkashha, Vrukshamaya, Jatu,

Bramhani, Hajjika, Kharshakha etc

Vernacular Names : Kannada - Argu, Hindi- Lakh, Lahi, Tamil-

Kadudum, Pungarai, Telugu- Lakka,

Lavaka, Laka Marathi, Panjabi, Guajarati-

Lakh, Bengali- Gala, Laha Eng- Lac, Shell

Lac

Botanical Description : It is latex material dark brown in coloured.

Distribution : It is found in Bihar, Jharkhand, Madhya

Pradesh, Bangal, Chhattisgarh etc.

Major Chemical Composition :

Seeds Contains : Volatile oil.

Properties :

Rasa : Kashaya

Guna : Laghu, Snigdha, Anushna

Veerya : Sheet

Vipaka : Katu

Karma : Vrana Prasadana, Balkaraka, Rakt – Pitta

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Samaka

Indications : Vrana, Rakt-Pitta, Jwara, Daha,

Raktpradara, Urha-kshata, Krimidant

Parts Used : Latex

Dosage : Powder 1-3 germs, Decoction of fruits rind

15-30 Taila.

Preparations : Madanadi Lepa, Charaka Kalpa Sthana

contains 133 Kalpanas derived through this

drug.

POOGA126,127

Botanical Name : Areca catechu Linn

Family : Palmae

Kula

Classical categorization

:

:

Narikela Kula

Krimighna

Vernacular Names : Kan-Adike, Adaki, Hindi-Supari, Tamil-

Kamugu, Pakku, Telugu-Oppulu, Poka,

Malayalam-Atekka, Pakka, Marathi-Supari,

Gujarathi-Sopari, Bengali-Gua, English,

Arecanut, Beetle Nutpalm

Synonyms : Akota, Chikkana, Guvaka, Kramuka Puga,

Deerghapadapa, Valkataru, Dridavalka,

Poogi, Tamboola, Suranjana.

Botanical Description : A tree 10-15 mts, high having no branches,

DRUG REVIEW


usually 50 cm in circumference, uniformly

thick. Leaves-1.5 to 2mts, leaflets-30 to

50cms long & slender, Flower stalk-hard &

branched, Fruits-appear in bunches 3-6 cm

round, smooth & hard orange or scarlet

colour.

Distribution : East & Western Ghats of India & Indo-

Malaya.

Chemical composition : Catechu -15%, Gallic acid-14%, it contains

arecoline 0.07%, arecaine-1%, arecaidine,

Guvacine, & chloride Guvacoline in traces.

Properties :

Rasa : Kashaya, Madhura

Guna : Guru, Ruksha

Veerya : Sheeta

Vipaka : Katu

Karma : Kapha, Pittanashaka, Tridoshaghna if

Roasted with sand Mohaka, Deepaka,

Ruchya, Aasyavairasya Nashaka.

Indications : Haemostatic, Wound-Healing

(Raktastambaka) (Vrana Ropaka),

Katishoola, Krimi, Swetapradhara, Aruchi,

Mukharogas, Nadidourbalya

Parts Used : Seed, fruit

DRUG REVIEW


Dosage : Nut 1 to 3 gms, it is intoxicant because of

its Vikasi Guna, in such conditions water,

milk and milk products should be used.

Preparations : Poogakhanda

JYOTISHMATI128,129

Botanical Name : Celastrus paniculatus Willd.

Family : Celastraceae

Kula : Haritkyadi Varga

Classical categorization : Vamaka (Charaka)

Synonyms : Jyotishmati, katabhi, Jyotiska, Lata,

Kukundani, Paravatpadi, Kanguni etc.

Vernacular Names : Kannada : Kariganne,

Hindi : Malkangani, Malkauni,

Tamil : Koli,Elandai

Telugu : Bavangi,

Malayalam : Malkangoni,

English : Staff Tree

Botanical Description : Vertically growing large netted creeper

attaining a large height. Leaves - egg

shaped, tapering with serrated edges.

Flowers - greenish, sweet in taste,

inflorance in summer. Fruits - round like

pea, yellow and tripartite.

DRUG REVIEW


Distribution : Ushna and Sadharana Pradesh of

Himalayas region, Bihar, Panjab, East

Bangal, South India etc.

Major Chemical Composition : Seeds contain 62% oil which is thick,

reddish yellow coloured, bitter and having

smell. It also contains bitter resin, 5% salt.

Properties :

Rasa : Katu, Tikta

Guna : Ushna, Tikchhna

Veerya : Ushna

Vipaka

Prabhava

:

:

Katu

Medhya

Karma : Saraka, Vamaka, Agni Pradipaka, Smarana

and Buddhi Vardhaka, Kapha-Vata Samaka

Indications : Jalodara, Aam Vata, Vata Rakta, Kustha,

Vrana, Beri Beri etc.

Parts Used : Leaves, Seeds and Oil

Dosage : Seed- 5-15 , 1-10 Drops

Preparations : Jyotishmatyadi Taila

SNUHI130, 131

Botanical Name : Euphorbia nerifolia Linn,

Classical Categorization : Virechana (Charak), Adhobhaghara

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(Sushruta)

Family : Euphorbiaceae

Kula : Erand Kula

Synonyms : Snuk, Snuhi, Mahavruksha, Guda

Nistrinshapatrak, Samantdugdha Gandir,

Vajrakantak, Suddha, English Name-

Common milk hage.

Botanical description : Shrub is small with trunk and branches

bearing thorns leaves 30-60 cm thick and

fleshy. Flowers-Yellowish, seeds-flat

leaves shred during winter. Flowering and

fruiting occurs in summer Charakacharya

has divided it into

a) Alpakantaka b) Bahukantak

The latter variety is considered to be

superior. Latex is usually collected at the

end of winter from a plant which is 2 to 3

years old.

Distribution : All over India, Sikkim, and Bhutan

Chemical Composition : Euphorban, resin, gum rubber, calcium

maleate etc.

Properties : Rasa-Katu, Guna-Laghu, Snigdha, Tikshna,

Veerya-Ushna, Vipaka-Katu, Karma-

Kapha-Vata hara, Pittashodana Sodhana of

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Rasa, Rakta, Mamsa, Meda Majja.

Parts used : Latex, Leaves, Root powder

Dosage : Root powder - 250 to 500 mg

Juice of stem - 12 to 24 ml

Leaf Juice - 2 to 5 drops

Latex - 20 to 125 mg

Indications : Inflammatory conditions, skin diseases,

toothache, piles, as a strong purgative,

Anemia Ascitis, Leucoderma, DM, RA,

Gout, Swasa, In preparation of Kshara

Sutra, Root is used as antidote to poisons of

plant origin.

Preparations : Vajrakshar, Snuhyadi Taila

ARKA132, 133

Botanical Name : Calatropis Procera

Family : Asclepiadacea

Kula : Arka Kula

Classical categorization : Bhedaneeya, Swedopaga, Vamanopaga

(Charak), Arkadi, Adhobhagahara

(Sushruta)

Synonyms : Toolaphala, Ksheeraparna, Arka,

Arkanama, Arka parna, Vasuka Supushpa,

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Shuklarka, Viksheer.

Vernacular Name : Kannada-Ekke, Hindi-Aak, Tamil-

Aerakham, Telugu-Jilledu, Malayalam-

Erukku, Marathi-Rooee, Gujarati-Aakado,

Bengali-Aakanda, Panjab-Aak, English-

Madar.

Botanical Description : This is a much Branched Large, Erect,

Pale, Greyish, Profusely milky shrub grows

about 2-3mts. High, leaves are 10 to 15 cm

long and 2.5 to 7.5 cm wide big and ovoid

in shape, Flowers are white externally,

Internally reddish, Fruits are long, curved

and break open on drying, Seeds are small

4-6 mm and black in colour flowering

occurs in spring and fruiting in summer.

Distribution : All over India in dry and pungent soil,

Srilanka, Afghanistan, Iran & Africa.

Chemical Composition : Its root bark has a Bitter Principle. It has

yeast in small amount because of which hot

milk curdles immediately (gets solidified).

Besides that, it contains Madar alban,

Madar Fluabil black acid resin. Yellow

bitter resin, calatropin.

Properties :

DRUG REVIEW


Rasa : Tikta, Katu

Guna : Laghu, Rooksha, Teekshna

Veerya : Ushna

Vipaka : Katu

Karma : Kapha, Vata, Samaka, Sara, Krimighna,

Vamaka, Deepaka, Vishaghna.

Parts used : Root bark, Latex, Flowers

Dosage : Root powder 2-3 grains, Arka Ksheera ¼ -

½ gms. Flower Kalka-5 gms.

Indications : Kustha, Kandu, Gulma, Arsha,

Pleehavriddhi, Sleshmodara.

Preparations : Arka Lavana, Arkataila, Sootika bharana,

Ekangaveer Rasa

Varieties : A/C to colour of flowers

i) White & ii) Blue

A/C to Raja Nighantu

i) Arka, Alarka ii) Rajarka,, iii) Shuklarka,

iv) Shwetamandara.

Method of preparation of Ghonta Phaladi Varti134:-

The powder of Ghonta Phala Twaka, Saindhav Lavanam, Laksha , Pooga

Phala and Jyotishmati are taken in equal quantity. This powder is mixed with

quantity sufficient Snuhi Ksheera and Arka Ksheera and made in to paste. This paste

was applied on plain thread and preserved after dryness is attained and kept inside the

sterilized test tube and closed by tight air cork.

DRUG REVIEW


GROUP ‘B’ MEDICINE

ARAGVADHADI VARTI:-

Aragvadhadi Varti was said to be effective in Nadi Vrana. It is described in

Chakradatta, Nadi Vrana Chikitsa Adhyaya.

Ingredients of Aragvadhadi Varti:-

1) Aragvadha,

2) Haridra,

3) Manjistha,

4) Ghrita,

5) Madhu &

6) Go Mutra.

ARAGVADHA135, 136

Botanical Name : Cassia fistula Linn.

Family : Caesalpinacea

Kula : Simbi Kula

Classical categorization : Charaka- Kusthaghna, Kandughna,

Virechana, Tiktaskandha. Sushruta-

DRUG REVIEW


Aragvadhadi, Syamadi, Sleshmasamsaman.

Synonyms : Suvarnaka, Shampaka, Rajvriksha,

Arogyashimbi, Karna etc.

Vernacular Names : Kannada -Phallus, Hindi-Amaltas, Telugu-

Rela, Tamil-Kondrum, Malayalam-

Kanikanna, Marathi-Bahva, Guajarati-

Garmalo, Eng-Surging cassia

Botanical Description : Medium size tree, 8-10 mtrs. Stem-

straight, Bark is smooth and greenish grey

or light red. Leaves- compound, 0.33 mtrs.

in length having 8-10 pairs of leaflets on it.

Flower- yellow, grow in branches having

fragrance. There are 5 petals and 10

androceum, 3 big and 3 small. Flower

stalk- oblong. Fruits- 0.33 to 1 mtr. in

length, 2.5 cms. in width, hard with narrow

ends. Unripe pod is green and ripe is black.

Pulp is black. There are septa inside the

pod. Seeds- many, smooth, flat and grey

seeds are present between two septa. Dry

pod gives a sound on shaking.

Distribution : All over India

Major Chemical Composition : Pulp- glucose 60%, glutin, pectin, dyes,

calcium, oxalate, minerals, gum and water.

DRUG REVIEW


Properties :

Rasa : Madhura, Tikta.

Guna : Guru, Snigdha.

Veerya : Sheet

Vipaka : Madhura

Karma : Vata–Pitta Samaka, Kapha-Pitta

Sansodhana.

Indications : Vrana, Kustha, Prameha, Aam Vata,

Kamala, Udar Rog, Sula, Udavarta, Vata-

Rakta.

Parts Used : Pulp, Root, Bark, Flowers and Leaves.

Dosage : Pulp- 10-20grms, decoction of root bark- 2-

4mls, flowers- 5-10grms.

Preparations : Aragvadhadi Tail, Aragvadhadi Leha,

Aragvadharista etc.

HARIDRA137, 138

Botanical Name : Curcuma longa Linn.

Family : Zinzererceae

Kula : Haridra Kula

Classical categorization : Charaka- Kusthaghna, Kandughna,

Krimighna, Lekhaniya, Sirovirechana.

Sushruta- Haridradi, Mustadi,

Sleshmasamsaman.

DRUG REVIEW


Synonyms : Nisha, Yositpriya, Hattavilasni Gauri etc.

Vernacular Names : Kannada - Aabhinin, Hindi- Haldi, Telugu-

Mamal, Eng- Turmeric.

Botanical Description : Annual shrub, rhizome grows underground.

Leaves are 30-40cms. in length and they

smell like ginger. The petiole is long and

broad like leaves and it smells like mango.

The stalk of the flower is 12-16 cms. long

and yellow flower grows at tip. Fruit-oval

with deep yellow pulp. The flowering of

the plant occurs in the beginning of rainy

season.

Distribution : All over India

Major Chemical Composition : 1% volatile oil, resin, curcumin is

responsible for its colour. Turmeric oil has

a peculiar odour and taste.

Properties :

Rasa : Katu, Tikta.

Guna : Laghu, Ruksha.

Veerya : Ushna

Vipaka : Katu

Karma : Tridoshaghna, Lekhana, Vishaghna,

Varnya.

DRUG REVIEW


Indications : Vrana, Kandu, Kustha, Prameha, Kamala.

Parts Used : Rhizome.

Dosage : 10-15ml or 1-3grms powder.

Preparations : Haridrakhanda etc.

MANJISTHA139, 140

Botanical Name : Rubia cordifolia Linn.

Family : Rubiaceae.

Kula : Manjistha Kula

Classical categorization : Charaka- Jwarhara, Varnya, Vishaghna.

Sushruta- Priyangvadi, Pittasamsamana.

Synonyms : Jingi, Vastra Ranjani, Vikasa,

Mandukaparni, Yojanavalli, Samanga, Lata

Bhandi, Raktanga etc.

Vernacular Names : Kannada - Aabhinin, Hindi- Manjetha,

Telugu- Manjistha, Eng- Indian Maddar.

Botanical Description : It is climber, whose branches spread for a

long distance. Trunk- square shaped and

reddish. Leaves- heart shaped, pointed, 6-

12cms. long, rough on upper surface and

has superfluous hair on lower side. Stalk-

its length double the length of leaves and

has thorn like structures on it. Flower-

small, yellowish white, with superfluous

DRUG REVIEW


hair. Fruit- 1.5cms long, round, fleshy,

violet, or black in colour. Root- reddish,

long and thick.

Distribution : All over India mainly in hilly areas, Nepal,

Iran, Afghan etc.

Major Chemical Composition : Antitumour

Properties

Rasa : Katu, Tikta.

Guna : Laghu, Ruksha.

Veerya : Ushna

Vipaka : Katu

Karma : Tridoshaghna, Lekhana, Vishaghna,

Varnya.

Indications : Vrana, Kandu, Pandu, Kustha, Prameha,

Kamala.

Parts Used : Rhizome.

Dosage : 10-15ml or 1-3grms powder.

Preparations : Haridrakhanda etc.

GHRITA (GO-GHRITA)141

Ghrita (Ghee / butter-fat) is best suited for those desirous of intelligence,

memory, digestive power, long life, sexual vigor and good eye sight, for children and

old people, for those desiring off spring good complexion, softness of the body and

good voice, for those suffering from injury to the chest, emaciation, Visarpa,

DRUG REVIEW


tuberculosis, inauspiciousness. It is the best among fatty materials, coolant, retards

senility, possesses a thousand good qualities and dose a thousand actions, when used

with proper process.

Purana Ghrita (old ghee) cures disease such as intoxication, epilepsy,

fainting, diseases of the head, ears, eyes and vaginal tract. a0It cleanses and heal ulcer.

It possesses all the qualities and does the functions ascribed to fresh ghee in greater

measure and so similar to nectar26a.

MADHU142

Botanical name : Mel.

Synonyms : Madhu, Makshika, Madhvika,

Kshoudra, Saragha,

Makshikavanta, Varatavaanta,

Bhringavaanta and

Pushparasodbhava.

Vernaculars Name : Hindi- Madhu, Sahada; Kannada-

Jenutuppa; English- Honey

Types : 1) Makshika, 2) Bharamara,

3) Kshaudra,4) Pautika, 5) Chhatra,

6) Audalaka, 7) Argha and 8) Dala.

Properties

Rasa : Madhura.

Anu-Rasa : Kashaya.

DRUG REVIEW


Guna : Sheeta, Laghu, Ruksha.

Karma : Grahi, Srotoshodhaka, Chakshusya,

Deepana, Lekhana, Kapha-Pitta-Rakta

Samaka etc.

Indications : Kustha, Prameha, Krimi Rog, Atisara,

Trishna, Daha, Kaasa, Shwasa,

Malsanga etc.

Chemical constituents:-

1) Moisture- 14-20%

2) Ash- 0.05-0.18%

3) Sucrose- 2-5%

4) Reducing sugar- 65-79%

5) Formic Acid- 0.0825%

6) Certain Enzymes i.e. Diastase and Invertase.

7) Various other compounds of Calcium, Sodium, Potassium, Sulphur, Iron, Silica,

Phosphorus, Copper, Manganese, Chlorides, Magnesium and Aluminum in the

proportion in which they are available in fruits.

8) Some experts say that in honey some non-detectable amounts of Vitamin A,B,C

and D are present.

GO-MUTRA143

Properties of Go-Mutra:-

Rasa:- Katu, Tikta and Kashaya.

Guna:- Tikshna, Kshara, Laghu, Lekhana,

Ushna.

DRUG REVIEW


Veerya:- Ushna (Su. Y.R)

Vipaka:- Katu

Karma:- Kapha-Vata Samaka, Pittakaraka,

Agni Pradeepaka, Medhya.

Indication:- Shula, Gulma, Udara Rog, Kandu,

Arsha, Anaha, Kaasa, Kilasa, Yakrita-

Pliha Rog etc.

Chemical Constituents:- Urea, Uric acid, Vitamins, Hormones,

Enzymes, Sodium, Calcium, Iron,

Phosphate, Lead, Copper, Arsenic,

Magnesium, Chlorine, Iodine, Amylase,

Hippuric acid, Oxalatic acid and Protein.

METHOD OF PREPARATION OF ARAGVADHADI VARTI144

Aragvadha Pulp : 1Part

Haridra : 1Part

Manjistha : 1Part

Go-Mutra : 2Pal

Go-Ghrita + Madhu : 1Part

Aragvadha Pulp, Haridra and Manjistha has taken in equal quantity then made

in the form of Churna and rubbed with Go-Mutra till paste form then mixed Go-

Ghrita and Madhu. This paste was applied on thread and preserved after dryness is

attained and kept inside the sterilized test tube and closed by tight air cork.

PHOTOS OF PREPARATION OF DRUG

MATERIALS AND METHODS



The clinical trial will be carried out on the patients attending the OPD & IPD

which is undertaken by the Department of Shalya Tantra of S.J.G. Ayurvedic Medical

College and Hospital, Post Graduate Studies and Research Centre, Koppal, Karnataka.

Source of the data:-

1) Patients attending the OPD and IPD of S.J.G. Ayurvedic Medical College and

Hospital, Post Graduate Studies and Research Centre, Koppal, Karnataka with

classical symptoms of sinus (Nadi Vrana) are selected for the study.

2) Pharmacy attached to the college for the preparation of drug.

3) OPD, IPD, Laboratory and other provisions of the hospital are availed to do

this intended work.

Selection of Patients:-

30 Patients were selected in two groups excluding dropouts with 15 patients in

each group on the basis of inclusion and exclusion criteria.

Inclusion Criteria:-

Patients having signs and Symptoms of Nadi Vrana (Sinus).

Patients between the age group of 20 to 60 years.

Patients of either sex.



Exclusion Criteria:-

Patient having Diabetes mellitus.

Patients having Neoplastic Sinus.

Patients having Tuberculosis.

The age group below 20 years and above 60 years.

Congenital sinuses.

Patient having Actinomycosis.

Osteomyelitis followed by sinus.

Patients having H.I.V. & C. A.

Sinus with multiple opening.

Patient with any other systemic illness.

Subjective Parameter:-

Pain,

Tenderness,

Local Temperature,

Burning Sensation &

Itching

Objective Parameter:-

Number,

Length,

Position,

Direction,

Color of Discharge &

Surrounding Skin.



Study Design:-

A comparative clinical Trial and was designed in the following manner.

1) The patients were selected by simple randomized sampling procedures.

2) 15 patients were selected in group ‘A’ and 15 patients were in group ‘B’.

3) Group ‘A’ patients were treated with ‘Ghonta Phaladi Varti’ and group ‘B’

patients were treated with Aragvadhadi Varti.

4) Finally the results were assessed.

Study duration:-

60 days.

Observation:-

3 days once for 10 seating.

Follow up:-

Weekly once, up to one months.

Posology:-

The Varti should be changed on every third day up to 30 days.

Method of Collection of Data :

Drugs were collected from the market under the guidance of Dravyaguna

specialist from our college. The patients attending to the O.P.D. & I.P.D. attached to

the hospital will be selected based on the clinical examination and documented in the

specially prepared case Performa. In this research work 30 patients will be taken, part

into two groups of patients each. The total duration of the treatment with follow up

taken is 60 days. Observation will be observed scientifically and the result will be

statically analyzed and progress was assessed on regular follow up.



1. Group ‘A’ – Ghonta Phaladi Varti

2. Group ‘B’ – Aragvadhadi Varti.

Required Equipment for Varti application:-

i) Lithotomy table examination table,

ii) Shadowless light,

iii) Instruments,

Various sizes of probes,

Artery forceps,

Scissors,

Surgical blade,

Scalpel,

Plain forceps,

Cotton,

Gauze piece etc.

iv) Surgical Gloves,

v) Kidney tray,

vi) Sterilizer,

vii) Anesthetic drugs,

viii) Antiseptic lotion,

ix) Syringes,

x) Nadi Sweda Mantra etc.



Examination of the patient:-

History taking

The religion, sex, age, occupation and residence are noted.

Complaints and their duration (clinical status) are noted.

The signs and symptoms of Nadi Vrana are estimated as follows:-

Presence of opening and number,

Site of openings,

Discharge,

Duration,

Pigmentation of the skin around the opening,

Pain,

Tenderness,

Burning sensation,

Itching,

Local Temperature,

Induration,

Lump.

Chief complaints:-

Discharge through an opening with or without pain, itching, burning sensation

and indurations etc. are considered as chief complaints.



Present History:-

The present history of illness from the onset of the disease

eg. - History of abscess before formation of sinus.

Past History:-

It should include all important illness from infancy onwards. The following

points should be noted.

History of abscess formation

History of disease causing formation of sinus like Actinomycosis,

Osteomyelitis, Tuberculosis, Ulcerative Colitis, Crohn’s disease.

History of previous medical and surgical treatment. etc.

Personal history:-

The following are noted under this

1. Nature of work,

2. Diet regime,

3. Address,

4. Addiction/s,

5. Agni,

6. Kostha,

7. Age etc.



Family History:-

It includes the state of health of the family members, and the illness suffered

with the same or any other disease. The cause of death of immediate relatives is also

to be noted A few diseases often involve more than one member of the same family,

which may predispose sinus formation.

e.g. - Actinomycosis, Osteomyelitis, Tuberculosis, Ulcerative Colitis, Crohn’s

disease.

Physical Examination:-

a) General Examination:-

Pulse - Rate,

Temperature,

Conjunctiva,

Blood Pressure,

Respiratory Rate,

Pallor,

Edema,

Weight,

Height etc.

b) Systemic examination:-

Respiratory System,

Cardio Vascular System,



Gastro Intestinal System,

Central Nervous System

c) Local examination:-

1) Inspection:-

The following points should be observed.

Number:-

Nadi Vrana having single opening are selected for the study.

Position:-

It is to make the diagnosis only by looking at the position of these

sinuses. Congenital and acquired can be known by its position.

Sprouting Granulation Tissue:-

Sprouting Granulation Tissue at the opening of the sinus suggests

presence of foreign body at the depth.

Eg. Sequestrum, Draining tube etc and to diagnose the presence of systemic

diseases like TB.

Discharge, Blood and Pus:-

Look for the characteristic features of the discharge. Pus in

osteomyelitis, serosanguineous in tuberculosis Ulcer and presence of sulphar

granules in actinomycosis.

Surrounding Skin, Pigmentation and Scar-:

Scar indicates chronic osteomyelitis (or) previously healed Tubercular

sinus. Dermatitis and Pigmentation are characteristic features of Crohn’s

disease and actinomycosis.



2) Palpation:-

Tenderness,

Temperature,

Induration &

Lump.

Probing:-

Acharya Sushruta has mentioned regarding this in 1st chapter of Chikitsa

Sthana. this Eshana Karma is important but should be performed with due to

precaution. The examination will signify the following:-

Direction of the Sinus,

Depth in Sinus in mm,

Foreign bodies,

Bone chips,

End of the Probe enters the bone cavity &

Discharge comes out on withdrawal of the Probe.

Provisional Diagnosis:-

Sinus (Nadi Vrana) is provisionally diagnosed on the basis of the chief

complaints and clinical examination.

Specific Investigations:-

Sinogram X-ray Examination (Whenever required)

Injection of Canray 420 into the sinus tract is done to determine the tract of the

sinus and to exclude the fistula-in-Ano in case of Perianal region of doubtful cases.



Laboratory Examination:-

Hb%,

TC,

DC,

ESR &

RBS.

Other Investigation:-

a) Per Rectal Examination:-

This is done to know the condition of mucous membrane and Rectal wall.

b) Bimanual Examination:-

This is done to elicit the presence or absence of abscesses, indurations and

condition of the associated structure etc.

Diagnosis:-

The cases are diagnosed and selected based on the above mentioned

symptomatology and investigation.

Management:-

The present clinical study is taken up to assess the combined effect of Ghonta

Phaladi Varti and Aragvadhadi Varti in Nadi Vrana. Nadi Vrana having a single

external openings only considered for the present study.

Preparation of the patient for Varti application:-

The site of the application of the Varti is shaved and made aseptic. The

wound is cleaned with Triphala Kashaya and the dead tissue is removed with the help



of plain toothed forceps. Systemic and general examination of the patient is

thoroughly performed and details were noted.

Method of application of Varti (Ghonta Phaladi Varti &

Aragvadhadi Varti):-

After detecting the tract with probe Varti is introduced in the Sinus with the

help of a probe. Which goes up to the end. Varti is changed on 3th day, 6th day, 9th

day etc., up to 30th day of duration giving two days gap between two applications

changing of Varti was continued145, 146.

After taking all aseptic precautions the patient is made to lie down on the table

according to the site of the sinus. A simple probe is introduced into the sinus tract

from skin surface slowly & depth of the tract is estimated. If the depth of the tract is

more, local anesthesia may be use. The Varti is introduced into the sinus by probe and

then the probe is pulled out from the sinus tract.

Clinical Status:-

Symptamaology is recorded in detail under the healing of Vrana, Srava,

Gandha, Vedana and Kandu etc. At the commencement of treatment detailed

symptamaology as mentioned above

is recorded and improvement is noted in further weekly follow up of the patient.

Follow up and Termination:-

Weekly follow up is done up to 30 days after treatment duration(30 days),

using the above said parameters for assessing the result of the treatment.



Pathya and Apathya in Nadivrana147:-

Pathya (Indication):-

Yava, Shashtika Shali, Godhuma Purana Shali, Sita, Masura, Dhanya, Tuvari,

Mudga, Yusha, Madhu, Sharkara Vilepi, Laajamanda, Jaangala Mamsa Rasa, Grita,

Taila, Patola, Vetragra, Balamoola Vaartaka, Kaaravella, Karkotha, Tandulodaka etc.

Apathya (Contra-indication):-

Ruksha, Sheeta, Amla, Lavana Ahara Sevana. Vyayama, Vyavaya,

Paribhashana, Nidra Prajagaram, Chankraman, Shoka, Virudhashana, Ambupana,

Tambula, Patrashaka, Ajangala Mamsa, Asatmya Anna, Dadhi, Urada etc.

These should be avoided for a period of one year.

Parameters for assessment:-

Patients are assessed every 3rd days and improvement was recorded using the

following parameters:-

1) The initial length of the tract was noted with help of a probe in the specially

prepared Performa. Progress was recorded at 3 days once for 10 seating. The

assessment is done as mentioned here under:-

A) Rate of healing per seating (3 days) = Initial length of the tract

No. of seating taken for heal

B) Average rate of healing in a group= Total average rate of healing

15

C) Unit healing time= No. of seating taken for heal

Initial length of the tract

D) Average healing time in a group= Total average time of selected group

15



GRADING:-

1) Pain:-

No Pain 0

Mild Pain 1

Moderate Pain 2

Sever Pain 3

2) Tenderness:-

Absent 0

Present 1

3) Local Temperature:-

Normal 0

Raised 1

4) Burning Sensation:-

Absent 0

Present 1

5) Itching:-

Absent 0



Present 1

6) Number:-

Always taken single number of sinus.

7) Length:-

Length of the tract will be measured and mentioned in mm with the

help of Probe.

8) Discharge:-

Absent 0

Gauze is wet slightly 1

Gauze is wet after opening the bandage 2

Bandage is completely wet 3

9) Surrounding Skin:-

No Pigmentation of Skin 0

Pinkish 1

Radish Black 2

Pale / Yellow / Bluish / Black 3

PROCEDURE PHOTO

OBSERVATIONS AND RESULTS



The following observations were made during the course of the present clinical

research study.

Table No. (1) Incidence of Group:-

Sl. No. Group No. of Patients Percentage

1 Group 'A' 15 50.00

2 Group 'B' 15 50.00

3 Total 30 100.00

Graph No. (1) Incidence of Group:-

All the selected patients were divided into two groups. Group 'A' has 15(50.00%)

patients and Group 'B' has 15(50.00%) patients.

0

20

40

60

80

100

120

Group 'A' Group 'B' Total

1 2 3

No. of Patients

Percentage



Table No. (2) Incidence of Sex:-

Sl. No. Sex No. of Patients Percentage

Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Male 13 13 26 86.67 86.67 86.67

2 Female 2 2 4 13.33 13.33 13.33

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (2) Incidence of Sex:-

Out of 30 patients 13 male and 2 female in group 'A' and 13 male and 2 female in

group 'B'.

0

20

40

60

80

100

120

Group 'A' Group 'B' Total Group 'A' Group 'B' Total

No. of Patients Percentage

1 Male

2 Female

3 Total



Table No. (3) Incidence of Age:-

Sl. No. Age

Group

in Years


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 21-25 4 5 9 26.67 33.33 30.00

2 26-30 4 4 8 26.67 26.64 26.67

3 31-35 3 3 6 20.00 20.00 20.00

4 36-40 2 0 2 13.33 00.00 06.67

5 41-45 1 1 2 06.67 06.67 06.67

6 46-50 0 1 1 00.00 06.67 03.33

7 51-55 1 1 2 06.67 06.67 06.67

8 56-60 0 0 0 00.00 00.00 00.00

9 Total 15 15 30 100.00 100.00 100.00

Graph No. (3) Incidence of Age:-

Out of 30 patients 4 & 5 patients in the age group of 21-25 in group A and group

B respectively, 4 & 4 patients in the age group of 26-30 in group A and group B

respectively, 3 & 3 patients in the age group of 31-35 in group A and group B

0

20

40

60

80

100

120

21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 Total

1 2 3 4 5 6 7 8 9

No. of Patients Group'A'

No. of Patients Group'B'

No. of Patients Total

Percentage Group 'A'

Percentage Group 'B'

Percentage Total







respectively and no any patients in the age group of 56-60 and above.

Table No. (4) Incidence of Religion:-

Sl. No. Religion No. of Patients Percentage

Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Hindu 10 11 21 66.67 73.33 70.00

2 Muslim 5 4 9 33.33 26.67 30.00

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (4) Incidence of Religion:-

Out of 30 patients 10 Hindus & 5 Muslims in group A and 11 Hindus & 4

Muslims in group B.

0

50

100

150

200

250



3 Total

2 Muslim

1 Hindu



Table No. (5) Incidence of Diet Pattern:-

Sl. No. Diet

Pattern


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Veg 4 5 9 26.67 33.33 30.00

2 Mixed 11 10 21 73.33 66.67 70.00

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (5) Incidence of Diet Pattern:-

Out of 30 patients 4 veg & 11 mixed type in group A and 5 veg & 10 mixed were

in group B.

0

20

40

60

80

100

120



1 Veg

2 Mixed

3 Total



Table No. (6) Incidence of Marital Status:-

Sl. No. Marital

Status


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Married 9 9 18 60.00 60.00 60.00

2 Unmarried 6 6 12 40.00 40.00 40.00

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (6) Incidence of Marital Status:-

Out of 30 patients 9 married and 6 unmarried in each group A & B.

0

20

40

60

80

100

120



1 Married

2 Unmarried

3 Total



Table No. (7) Incidence of Occupation:-

Sl. No. Occupation No. of Patients Percentage

Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Labor 2 3 5 13.33 20.00 16.67

2 Student 5 5 10 33.33 33.33 33.33

3 Driver 2 2 4 13.33 13.33 13.33

4 Employee 1 2 3 06.67 13.33 10.00

5 Clerk 1 1 2 06.67 06.67 06.67

6 Business 3 2 5 20.00 13.33 16.67

7 House

Maker

1 0 1 06.67 00.00 03.33

8 Total 15 15 30 100.00 100.00 100.00

Graph No. (7) Incidence of Occupation:-

Out of 30 patients 2 & 3 patients were labor in group A & B respectively, 5 & 5

patients were student in group A & B respectively, 2 & 2 patients were driver in group A

& B respectively, 1 & 2 patients were employee in group A & B respectively, 1 & 1

020406080

100120

Labo

r

Stud

ent

Driv

er

Empl

oyee

Cler

k

Busin

ess

Hous

e M

aker

Tota

l

1 2 3 4 5 6 7 8






Percentage Total



patients were clerk in group A & B respectively, 3 & 2 patients were business in group A

& B respectively, 1 & 0 patients were house maker in group A & B respectively.

Table No. (8) Incidence of Socio-Economic Status:-

Sl. No. Socio-

Economic

Status


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Poor 7 7 14 46.67 46.67 46.67

2 Lower

Middle

Class

4 5 9 26.67 33.33 30.00

3 Upper

Middle

Class

4 2 6 26.67 13.33 20.00

4 Rich 0 1 1 00.00 06.67 03.33

5 Total 15 15 30 100.00 100.00 100.00

Graph No. (8) Incidence of Socio-Economic Status:-

0

20

40

60

80

100

120



1 Poor

2 Lower Middle Class

3 Upper Middle Class

4 Rich

5 Total



Out of 30 patients 7 patients were poor in each group A& B, 4 & 5 patients were

lower middle class in group A & B respectively, 4 & 2 patients were upper middle class

in group A & B respectively and 0 & 1 patients were rich in group A & B respectively.

Table No. (9) Incidence of Family History:-

Sl. No. Family

History


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Yes 2 2 4 13.33 13.33 13.33

2 No 13 13 26 86.67 86.67 86.67

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (9) Incidence of Family History:-

Out of 30 patients 2 patients having family history in group A & B respectively

and 13 patients having no any one family history in each group A & B.

0

20

40

60

80

100

120



1 Yes

2 No

3 Total



Table No. (10) Incidence of Agni:-

Sl. No. Agni No. of Patients Percentage

Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Mandagni 2 3 5 13.33 20.00 16.67

2 Samagni 8 9 17 53.33 60.00 56.67

3 Tikshnagni 3 2 5 20.00 13.33 16.67

4 Vismagni 2 1 3 13.33 06.67 10.00

5 Total 15 15 30 100.00 100.00 100.00

Graph No. (10) Incidence of Agni:-

Out of 30 patients Mandagni occurs in 2 & 3 patients in each group A & B, Samagni

occurs in 8 & 9 patients in each group A & B,Ttikshagni occurs in 3 & 2 patients in each

group A & B and Vismagni occurs in 2 & 1 patients in each group A & B.

0

20

40

60

80

100

120



1 Mandagni

2 Samagni

3 Tikshnagni

4 Vismagni

5 Total



Table No. (11) Incidence of Kostha:-

Sl. No. Kostha No. of Patients Percentage

Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Mridu 4 2 6 26.67 13.33 20.00

2 Madhyama 9 11 20 60.00 73.33 66.67

3 Krura 2 2 4 13.33 13.33 13.33

4 Total 15 15 30 100.00 100.00 100.00

Graph No. (11) Incidence of Kostha:-

Out of 30 patients Mridu kostha occurs in 4 & 2 patients in group A & B

respectively, Madhyama kostha occurs in 9 & 11 patients in group A & B respectively

and Krura kostha occurs in 2 & 2 patients in group A & B respectively.

0

20

40

60

80

100

120



1 Mridu

2 Madhyama

3 Krura

4 Total



Table No. (12) Incidence of Prakriti:-

Sl. No. Prakriti No. of Patients Percentage

Group'A'

Group'B'

Total Group'A'

Group'B'

Total

1 Vataja 1 1 2 06.67 06.67 06.67

2 Pittaja 0 0 0 00.00 00.00 00.00

3 Kaphaja 0 0 0 00.00 00.00 00.00

4 Vata-Pittaja

3 3 6 20.00 20.00 20.00

5 Vata-Kaphaja

3 5 8 20.00 33.33 26.67

6 Pitta-Kaphaja

7 5 12 46.67 33.33 40.00

7 Sanipataja 1 1 2 06.67 06.67 06.678 Total 15 15 30 100.00 100.00 100.00

Graph No. (12) Incidence of Prakriti:-

020406080

100120

Vata

ja

Pitt

aja

Kaph

aja

Vata

-Pitt

aja

Vata

-Kap

haja

Pitt

a-Ka

phaj

a

Sani

pata

ja

Tota

l

1 2 3 4 5 6 7 8








Out of 30 patients 1 patient having Vataja Prakriti in each groups A & B, no any

patient having Pittaja and Kaphaja Prakriti in group A & B, 3 patients having Vata-

Pittaja Prakriti in each group A & B, 3 & 5 patients having Vata-Kaphaja Prakriti in

group A & B respectively, 7 & 5 patients having Pitta-Kaphaja Prakriti in group A & B

respectively and 1 patient having Sanipataja Prakriti in group A & B.

Table No. (13) Incidence of Vyasana:-

Sl. No. Vyasana No. of Patients Percentage

Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 No Any 8 8 16 53.33 53.33 53.33

2 Tobacco

chewing

2 1 3 13.33 06.67 10.00

3 Smoking 1 0 1 06.67 00.00 03.33

4 Alcoholic 1 1 2 06.67 06.67 06.67

5 Tobacco

chewing,

Smoking

1 1 2 06.67 06.67 06.67

6 Tobacco

chewing,

Alcoholic

0 0 0 00.00 00.00 00.00

7 Smoking,

Alcoholic

1 2 3 06.67 13.33 10.00

8 Tobacco

chewing,

Smoking,

Alcoholic

1 2 3 06.67 13.33 10.00

9 Total 15 15 30 100.00 100.00 100.00



Graph No. (13) Incidence of Vyasana:-

Out of 30 patients 8 patients in each group A & B having no anyone addiction, 2

& 1 patients having only addiction of Tobacco chewing in group A & B respectively, 1 &

0 patient having only addiction of Smoking in group A & B respectively, 1 patient having

only addiction of Alcohol in each group, 1 patient having addiction of Tobacco chewing

& Smoking in each group A & B, 1 & 2 patients having addiction of Smoke & Alcohol

in group A & B respectively and 1 & 2 patients having addiction of Tobacco chewing,

Smoke & Alcohol in group A & B respectively.

020406080

100120

No A

ny

Toba

cco

chew

ing

Smok

ing

Alco

holic

Toba

cco

chew

ing,

Sm

okin

g

Toba

cco

chew

ing,

Alco

holic

Smok

ing,

Alco

holic

Toba

cco

chew

ing,

Sm

okin

g, A

lcoho

lic

Tota

l1 2 3 4 5 6 7 8 9






Percentage Total



Table No. (14) Incidence of Chronicity 0f Disease:-

Sl. No. Chronicity

of Disease

in months


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 1 to 6 3 2 5 20.00 13.33 16.67

2 7 to 12 4 3 7 26.67 20.00 23.33

3 13 to 18 1 2 3 06.67 13.33 10.00

4 19 to 24 2 3 5 13.33 20.00 16.67

5 25 to 30 3 2 5 20.00 13.33 16.67

6 31 to 36 2 1 3 13.33 06.67 10.00

7 36& above 0 2 2 00.00 13.33 06.67

8 Total 15 15 30 100.00 100.00 100.00

Graph No. (14) Incidence of Chronicity 0f Disease:-

Out of 30 patients 3 & 2 patients having chronicity of group of below 6 months

in group A & B respectively, patients 4 & 3 patients having chronicity of group of 7-12

months in group A & B respectively, patients 1 & 2 patients having chronicity of group

0

20

40

60

80

100

120

1 to 6 7 to 12 13 to18

19 to24

25 to30

31 to36

36&above

Total

1 2 3 4 5 6 7 8






Percentage Total



of 13-18 months in group A & B respectively, patients 2 & 3 patients having chronicity

of group of 19-24 months in group A & B respectively, patients 3 & 2 patients having

chronicity of group of 25-30 months in group A & B respectively, patients 2 & 1 patients

having chronicity of group of 31-36 months in group A & B respectively and patients 0

& 2 patients having chronicity of group of more than 37 months in group A & B

respectively.

Table No. (15) No. of Opening:-

Sl. No. No. ofOpening

No. of Patients PercentageGroup'A'

Group'B'

Total Group'A'

Group'B'

Total

1 1 15 15 30 100.00 100.00 100.002 2 0 0 0 00.00 00.00 00.003 3 0 0 0 00.00 00.00 00.004 Total 15 15 30 100.00 100.00 100.00

Graph No. (15) No. of Opening:-

0

20

40

60

80

100

120



1

2

3

Total



Out of 30 patients 15 in each group A & B having only one opening due to I

excludes more than one opening.

Table No. (16) Incidence of Position or Site:-

Sl. No. Positionor Site

No. of Patients PercentageGroup'A'

Group'B'

Total Group'A'

Group'B'

Total

1 PilonidalSinus

6 6 12 40.00 40.00 40.00

2 PerianalSinus

7 7 14 46.67 46.67 46.67

3 InguinalSinus

0 1 1 00.00 06.67 03.33

4 Sinus ofChronicAbscessin thighRegion

2 1 3 13.33 06.67 10.00

5 Total 15 15 30 100.00 100.00 100.00

Graph No. (16) Incidence of Position or Site:-

0

20

40

60

80

100

120

Group'A'

Group'B'

Total Group'A'

Group'B'

Total


1 Pilonidal Sinus

2 Perianal Sinus

3 Inguinal Sinus

4 Sinus of Chronic Abscess inthigh Region

5 Total



Out of 30 patients 6 patients in each group A & B, of Pilonidal Sinus, 7 patients

in each group A & B of Perianal Sinus, 0 & 1 patient in group A & B respectively of

Inguinal Sinus, 2 & 1 patients in group A & B respectively of Sinus of chronic abscess in

thigh region.

Table No. (17) Incidence of Direction of Sinus:-

Sl. No. Position

or Site


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 LL. 1 0 1 06.67

2 RL. 1 1 2 06.67 06.67 06.67

3 U 0 2 2 00.00 13.33 06.67

4 D 1 2 3 06.67 13.33 10.00

5 M 2 0 2 13.33 00.00 06.67

6 F 1 2 3 06.67 13.33 10.00

7 LL, D 1 1 2 06.67 06.67 06.67

8 RL, D 1 2 3 06.67 13.33 10.00

9 F, M 1 1 2 06.67 06.67 06.67

10 U, M 3 3 6 20.00 20.00 20.00

11 D, M 1 1 2 06.67 06.67 06.67

12 RL, U 1 0 1 06.67 00.00 3.33

13 U, F, M 1 0 1 06.67 00.00 3.33

14 Total 15 15 30 100.00 100.00 100.00

LL.- Left Lateral, RL.- Right Lateral, M.- Medial, U.- Upward, D.- Downward, F.-Forward.



Graph No. (17) Incidence of Direction of Sinus:-

Out of 30 patients direction of 1 & 0 patient in group A & B respectively is Left

Lateral, 1 patient in each group A & B is Right Lateral, 0 & 2 patients in group A & B

respectively is Upward, 1 & 2 patients in group A & B respectively is Downward, 2 & 0

patients in group A & B respectively is Medial, 1 & 2 patients in group A & B

respectively is Forward, 1 patient in each group A & B is Left Lateral-Downward, 1 & 2

patients in group A & B respectively is Right Lateral-Downward, 1 patient in each group

A & B is Forward-Medial, 3 patients in each group A & B is Upward-Medial, 1 patient in

each group A & B is Downward-Medial, 1 & 0 patient in group A & B respectively is

Right Lateral-Upward, 1 & 0 patient in group A & B respectively is Upward-Forward-

Medial.

0

20

40

60

80

100

120

LL.

RL. U D M F

LL, D

RL, D

F, M

U, M

D, M

RL, U

U, F

, M

Tota

l

1 2 3 4 5 6 7 8 9 10 11 12 13 14






Percentage Total



Table No. (18) Incidence of Length of Sinus:-

Sl. No. Length

0f Sinus

in mms.


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 1 to 10 1 0 1 06.67 00.00 03.33

2 11 to 20 1 2 3 06.67 13.33 10.00

3 21 to 30 3 4 7 20.00 26.67 23.33

4 31 to 40 5 4 9 33.33 26.67 30.00

5 41 to 50 3 3 6 20.00 20.00 20.00

6 51 to 60 2 1 3 13.33 06.67 10.00

7 61 to 70 0 1 1 00.00 06.67 03.33

8 71 to 80 0 0 0 00.00 00.00 00.00

9 81 to 90 0 0 0 00.00 00.00 00.00

10 91 to 100 0 0 0 00.00 00.00 00.00

11 Total 15 15 30 100.00 100.00 100.00

Graph No. (18) Incidence of Length of Sinus:-

Out of 30 patients group of 1-10mms occurs in 1 & 0 patient in group A & B

respectively, group of 11-20mms occurs in 1 & 2 patients in group A & B respectively,

0

20

40

60

80

100

120

1 to10

11 to20

21 to30

31 to40

41 to50

51 to60

61 to70

71 to80

81 to90

91 to100

Total

1 2 3 4 5 6 7 8 9 10 11






Percentage Total



group of 21-30mms occurs in 3 & 4 patients in group A & B respectively, group of 31-

40mms occurs in 5 & 4 patients in group A & B respectively, group of 41-50mms occurs

in 3 patient in each group A & B, group of 51-60mms occurs in 2 & 1 patients in group A

& B respectively, group of 61-70mms occurs in 0 & 1 patient in group A & B

respectively and no anyone patients occurs after this group of length.

Table No. (19) Incidence of Discharge:-

Sl. No. Discharge

in Grade


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Grade-0 1 1 2 06.67 06.67 06.67

2 Grade-1 7 10 17 46.67 66.67 56.67

3 Grade-2 5 3 8 33.33 20.00 26.67

4 Grade-3 2 1 3 13.33 06.67 10.00

5 Total 15 15 30 100.00 100.00 100.00

Graph No. (19) Incidence of Discharge:-

0

20

40

60

80

100

120



1 Grade-0

2 Grade-1

3 Grade-2

4 Grade-3

5 Total



Out of 30 patients 1 patients in each group A & B under grade-0 means no

discharge, 7 & 10 patients in group A & B respectively under grade-1 discharge, means

gauss is slightly wet, 5 & 3 patients in group A & B respectively under grade-2 discharge,

means gauss is wet after opening the bandage, 2 & 1 patients in group A & B respectively

under grade-3 discharge, means bandage is completely wet.

Table No. (20) Incidence of Surrounding Skin:-

Sl. No. Surrounding

Skin in

Grade


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Grade-0 1 2 3 06.67 13.33 10.00

2 Grade-1 6 5 11 40.00 33.33 36.67

3 Grade-2 4 6 10 26.67 40.00 33.33

4 Grade-3 4 2 6 26.67 13.33 20.00

5 Total 15 15 30 100.00 100.00 100.00

Graph No. (20) Incidence of Surrounding Skin:-

0

20

40

60

80

100

120



1 Grade-0

2 Grade-1

3 Grade-2

4 Grade-3

5 Total



Out of 30 patients 1 & 2 patients in group A & B respectively under grade-0

means no pigmentation, 6 & 5 patients in group A & B respectively under grade-1 means

colour of surrounding skin is pinkish, 4 & 6 patients in group A & B respectively under

grade-2 means colour of surrounding skin is radish black, 4 & 2 patients in group A & B

respectively under grade-3 means colour of surrounding skin is pale, yellow, bluish or

black.

Table No. (21) Incidence of Tenderness:-

Sl. No. Tenderness

in Grade


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Grade-0 0 0 0 00.00 00.00 00.00

2 Grade-1 15 15 30 100.00 100.00 100.00

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (21) Incidence of Tenderness:-

0

20

40

60

80

100

120



1 Grade-0

2 Grade-1

3 Total



Out of 30 patients no anyone patients having grade-0 means absent of tenderness

in each group A & B and 15 patients in each group having grade one means presence of

tenderness.

Table No. (22) Incidence of Local Temperature:-

Sl. No. Local

Temperature

in Grade


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Grade-0 8 9 17 53.33 60.00 56.67

2 Grade-1 7 6 13 46.67 40.00 43.33

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (22) Incidence of Local Temperature:-

0

20

40

60

80

100

120



1 Grade-0

2 Grade-1

3 Total



Out of 30 patients 8 & 9 patients in group A & B respectively under grade-0,

means normal temperature and 7 & 6 patients in group A & B respectively under grade-1,

means raised temperature.

Table No. (23) Incidence of Pain:-

Sl. No. Pain in

Grade


Group'A'

Group'B'

Total Group'A'

Group'B'

Total

1 Grade-0 0 0 0 00.00 00.00 00.002 Grade-1 7 8 15 46.67 53.33 50.003 Grade-2 5 5 10 33.33 33.33 33.334 Grade-3 3 2 5 20.00 13.33 16.675 Total 15 15 30 100.00 100.00 100.00Graph No. (23) Incidence of Pain:-

Out of 30 patients no anyone patient in group A & B under grade-0 means no

pain, 7 & 8 patients in group A & B respectively under grade-1 means pain, 5 patients in

each group A & B under grade-2 means moderate pain, 3 & 2 patients in group A & B

respectively under grade-3 means severe pain.

0

20

40

60

80

100

120



1 Grade-0

2 Grade-1

3 Grade-2

4 Grade-3

5 Total



Table No. (24) Incidence of Burning Sensation:-

Sl. No. Burning

Sensation

in Grade


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Grade-0 5 6 11 33.33 40 36.67

2 Grade-1 10 9 19 66.67 60 63.33

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (24) Incidence of Burning Sensation:-


means absence of burning sensation and 10 & 9 patients in group A & B respectively

under grade-1 means presence of burning sensation.

0

20

40

60

80

100

120



1 Grade-0

2 Grade-1

3 Total



Table No. (25) Incidence of Itching:-

Sl. No. Itching

in Grade


Group

'A'

Group

'B'

Total Group

'A'

Group

'B'

Total

1 Grade-0 6 5 11 40.00 33.33 36.67

2 Grade-1 9 10 19 60.00 66.67 63.33

3 Total 15 15 30 100.00 100.00 100.00

Graph No. (25)


means absence of itching sensation and 9 & 10 patients in group A & B respectively

under grade-1 means presence of itching sensation.

0

20

40

60

80

100

120



1 Grade-0

2 Grade-1

3 Total



Table No. (26) Observation of Length in Group 'A':-

Sl.No. B.T. During Treatment During Follow Up

3rd 6th 9th 12ve 15th 18th 21st 24th 27th 30th 37th 45th 52nd 60th

1) 31 28 25 24 17 14 10 6 2 0 0 0 0 0 0

2) 35 32 27 22 17 11 6 3 0 0 0 0 0 0 0

3) 38 35 31 27 23 20 16 11 7 4 0 0 0 0 0

4) 47 44 41 38 34 29 26 22 17 12 8 6 6 6 6

5) 9 7 4 2 0 0 0 0 0 0 0 0 0 0 0

6) 16 14 11 8 4 1 0 0 0 0 0 0 0 0 0

7) 23 19 14 11 7 3 0 0 0 0 0 0 0 0 0

8) 59 56 52 48 45 41 36 32 29 25 21 20 20 20 20

9) 42 39 36 32 27 24 19 15 11 6 2 0 0 0 0

10) 56 53 50 46 43 38 34 30 27 23 18 16 16 16 16

11) 26 24 21 17 14 10 6 2 0 0 0 0 0 0 0

12) 36 34 31 27 23 20 16 11 7 3 0 0 0 0 0

13) 36 34 31 28 24 21 17 13 9 5 2 0 0 0 0

14) 48 46 43 39 36 32 28 23 19 15 12 10 10 10 10

15) 27 25 22 18 15 12 8 5 2 0 0 0 0 0 0



Table No. (27) Observation of Length in Group 'B':-



1) 63 61 59 56 52 49 46 43 39 35 31 30 30 30 30

2) 27 25 23 20 17 14 11 8 5 2 0 0 0 0 0

3) 33 31 28 25 22 18 14 10 7 4 0 0 0 0 0

4) 37 35 33 30 27 23 20 18 15 12 9 8 8 8 8

5) 24 22 20 17 14 12 9 6 2 0 0 0 0 0 0

6) 42 40 38 35 32 29 26 22 19 16 12 10 10 10 10

7) 38 36 34 31 28 25 21 18 15 12 9 8 8 8 8

8) 36 34 31 29 26 23 20 17 14 10 7 6 6 6 6

9) 47 45 43 40 37 33 30 27 25 22 19 18 18 18 18

10) 29 27 24 21 17 14 11 8 6 3 0 0 0 0 0

11) 54 52 50 47 44 42 39 36 32 28 25 25 25 25 25

12) 11 9 7 4 2 0 0 0 0 0 0 0 0 0 0

13) 43 41 38 35 32 30 27 24 21 18 15 15 15 15 15

14) 21 19 17 14 11 8 5 2 0 0 0 0 0 0 0

15) 18 16 14 12 10 8 6 4 2 0 0 0 0 0 0



Table No. (28) Observation of Discharge in Group 'A':-



1) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0

2) 3 3 3 3 2 2 1 1 0 0 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0

4) 2 2 2 2 2 2 2 1 1 1 1 0 0 1 1

5) 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

6) 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0

7) 3 3 2 2 1 1 0 0 0 0 0 0 0 0 0

8) 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

9) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0

10) 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1

11) 2 2 2 2 1 1 1 0 0 0 0 0 0 0 0

12) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0

13) 2 2 2 2 2 1 1 1 1 1 0 0 0 0 0

14) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

15) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0



Table No. (29) Observation of Discharge in Group 'B':-



1) 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

2) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0

4) 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0

5) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0

6) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

7) 1 1 1 1 1 1 1 1 1 1 1 1 0 1 1

8) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 1

9) 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1

10) 3 3 3 2 2 1 1 1 0 0 0 0 0 0 0

11) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

12) 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0

13) 2 2 2 2 2 2 2 2 2 1 1 1 1 1 2

14) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

15) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0



Table No. (30) Observation of Surrounding Skin in Group 'A':-



1) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

2) 3 3 3 3 2 2 1 1 0 0 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0

4) 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1

5) 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0

6) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7) 3 3 2 2 2 1 1 0 0 0 0 0 0 0 0

8) 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

9) 2 2 2 2 2 2 1 1 1 1 1 0 0 0 0

10) 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2

11) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

12) 2 2 2 2 2 2 1 1 1 0 0 0 0 0 0

13) 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0

14) 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1

15) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0



Table No. (31) Observation of Surrounding Skin in Group 'B':-



1) 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1

2) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4) 2 2 2 2 2 2 2 2 1 1 1 1 1 0 0

5) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0

6) 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

7) 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1

8) 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0

9) 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1

10) 3 3 3 2 2 2 2 1 1 1 1 0 0 0 0

11) 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

12) 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0

13) 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1

14) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

15) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



Table No. (32) Observation of Tenderness in Group 'A':-



1) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0

2) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0

4) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

5) 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0

6) 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0

7) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

8) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

9) 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0

10) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

11) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

12) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

13) 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0

14) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

15) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0



Table No. (33) Observation of Tenderness in Group 'B':-



1) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0

4) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

5) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0

6) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

7) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

8) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

9) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

10) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0

11) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

12) 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0

13) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

14) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0

15) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0



Table No. (34) Observation of Local Temperature in Group 'A':-



1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2) 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0

3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6) 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0

7) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

8) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

9) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

11) 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0

12) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13) 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0

14) 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0

15) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



Table No. (35) Observation of Local Temperature in Group 'B':-



1) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

6) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9) 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0

10) 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0

11) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

12) 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0

13) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



Table No. (36) Observation of Pain in Group 'A':-



1) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0

2) 3 3 3 2 2 1 1 0 0 0 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0

4) 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1

5) 2 2 1 1 0 0 0 0 0 0 0 0 0 0 0

6) 2 2 2 1 1 0 0 0 0 0 0 0 0 0 0

7) 3 3 3 2 2 1 0 0 0 0 0 0 0 0 0

8) 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

9) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

10) 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1

11) 2 2 2 2 2 1 1 1 0 0 0 0 0 0 0

12) 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0

13) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0

14) 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2

15) 2 2 2 1 1 1 0 0 0 0 0 0 0 0 0



Table No. (37) Observation of Pain in Group 'B':-



1) 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

2) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0

4) 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1

5) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

6) 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2

7) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

8) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

9) 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

10) 2 2 2 2 1 1 1 0 0 0 0 0 0 0 0

11) 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

12) 2 2 1 1 0 0 0 0 0 0 0 0 0 0 0

13) 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1

14) 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0

15) 2 2 2 2 2 1 1 1 1 0 0 0 0 0 0



Table No. (38) Observation of Burning Sensation in Group 'A':-



1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5) 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0

6) 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0

7) 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0

8) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

9) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

10) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

11) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

14) 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0

15) 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0



Table No. (39) Observation of Burning Sensation in Group 'B':-



1) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

4) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

5) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

6) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

7) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8) 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0

9) 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0

10) 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0

11) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

14) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0



Table No. (40) Observation of Itching in Group 'A':-



1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4) 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0

5) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

7) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

9) 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0

10) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

11) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

12) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

15) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0



Table No. (41) Observation of Itching in Group 'B':-

Sr.No. B.T. During Treatment During Follow Up


1) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3) 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0

4) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5) 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0

6) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

8) 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0

9) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

10) 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0

11) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

12) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13) 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

14) 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0

15) 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0



Table No. (42) Evaluation of Rate of healing per seating and Unithealing time of length:-

Sl. No. Group A Group B

Initial

length in

mm

Rate of

healing per

seating(3days)

Unit

healing

time

Initial

length in

mm

Rate of

healing per

seating(3days)

Unit

healing

time

1 31 3.44 0.29 63 3.00 0.33

2 35 4.38 0.23 27 2.70 0.37

3 38 3.80 0.26 33 3.30 0.30

4 47 3.73 0.27 37 2.64 0.38

5 9 2.25 0.44 24 2.67 0.38

6 16 2.67 0.38 42 2.91 0.34

7 23 3.83 0.26 38 2.73 0.37

8 59 3.55 0.28 36 2.73 0.37

9 42 3.82 0.26 47 2.64 0.38

10 56 3.64 0.28 29 2.90 0.34

11 26 3.25 0.31 54 2.90 0.34

12 36 3.60 0.28 11 2.20 0.45

13 36 3.27 0.31 43 2.80 0.36

14 48 3.45 0.29 21 2.62 0.38

15 27 3.00 0.33 18 2.00 0.50



Graph No. (26) Evaluation of Rate of healing per seating and Unithealing time of length in Group 'A':-

Graph No. (27) Evaluation of Rate of healing per seating and Unithealing time of length in Group 'B':-

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Group A Unit healing time

Group A Rate of healing perseating(3days)

Group A Initial length in mm

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Group B Unit healing time

Group B Rate of healing perseating(3days)

Group B Initial length in mm



Table No. (43) Evaluation of Average rate of healing and Averagehealing time of Length:-

Sl. No. Group Average rate ofhealing

Average healingtime

1 Group A 3.45 0.302 Group B 2.72 0.37

Graph No. (28) Table No. (43) Evaluation of Average rate of healingand Average healing time of Length in both Groups:-

0

0.5

1

1.5

2

2.5

3

3.5

4

Average rate of healing Average healing time

Sl. No. Group A

Sl. No. Group B



Table No. (44) Evaluation of Discharge:-

Group A BDischarge

Grade-3

Grade-2

Grade-1

Grade-0

Grade-3

Grade-2

Grade-1

Grade-0

No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

%

BT 2 13.3

5 33.3

7 46.7

1 06.7

1 06.7

3 20 10 66.7

1 06.7

3rd day 2 13.3

5 33.3

8 53.3

0 00 1 06.7

3 20 11 73.3

0 00

6th day 1 06.7

6 40 7 46.7

1 06.7

1 06.7

3 20 10 66.7

1 06.7

9th day 1 06.7

6 40 7 46.7

1 06.7

0 00 4 26.7

10 66.7

1 06.7

12th

day0 00 5 33.

38 53.

32 13.

30 00 4 26.

710 66.

71 06.

715th

day0 00 4 26.

79 60 2 13.

30 00 3 20 11 73.

31 06.

718th

day0 00 3 20 9 60 3 20 0 00 3 20 10 66.

72 13.

321st

day0 00 2 13.

37 46.

76 40 0 00 3 20 8 53.

34 26.

724th

day0 00 2 13.

36 40 7 46.

70 00 3 20 6 40 6 40

27th

day0 00 1 06.

76 40 8 53.

30 00 1 06.

77 46.

77 46.

730th

day0 00 1 06.

73 20 11 73.

30 00 1 06.

76 40 8 53.

3

AT 73.30 53.3037th

day0 00 1 06.

72 13.

312 80 0 00 1 06.

75 33.

39 60

45th

day0 00 1 06.

72 13.

312 80 0 00 1 06.

74 26.

710 66.

752ndday

0 00 1 06.7

3 20 11 73.3

0 00 1 06.7

5 33.3

9 60

60th

day0 00 1 06.

73 20 11 73.

30 00 2 13.

35 33.

38 53.

3AF 73.30 53.30



Graph No. (29) Evaluation of Discharge in Group 'A':-

Graph No. (30) Evaluation of Discharge in Group 'B':-

0

20

40

60

80

100

120

140BT

3rd

day

6th

day

9th

day

12th

day

15th

day

18th

day

21st

day

24th

day

27th

day

30th

day AT

37th

day

45th

day

52nd

day

60th

day AF

A Grade-0 %

A Grade-0 No. of Pt.

A Grade-1 %


A Grade-2 %


A Grade-3 %


0

20

40

60

80

100

120

140

BT3r

d da

y6t

h da

y9t

h da

y12

th d

ay15

th d

ay18

th d

ay21

st d

ay24

th d

ay27

th d

ay30

th d

ay AT37

th d

ay45

th d

ay52

ndda

y60

th d

ay AF

B Grade-0 %

B Grade-0 No. of Pt.

B Grade- 1 %

B Grade- 1 No. of Pt.

B Grade- 2 %


B Grade- 3 %




Table No. (45) Evaluation of Surrounding Skin:-

Group A BSurroundingSkin

Grade-3

Grade-2

Grade-1

Grade-0

Grade-3

Grade-2

Grade-1

Grade-0

No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

%

BT 4 26.7

4 26.7

6 40 1 06.7

2 13.3

6 40 5 33.3

2 13.3

3rd day 4 26.7

4 26.7

6 40 1 13.3

2 13.3

6 40 5 33.3

2 13.3

6th day 3 20 5 33.3

6 40 1 13.3

2 13.3

6 40 5 33.3

2 13.3

9th day 3 20 5 33.3

5 33.3

2 13.3

1 06.7

7 46.7

4 26.7

3 20

12th day 2 13.3

6 40 5 33.3

2 13.3

1 06.7

7 46.7

4 26.7

3 20

15th day 2 13.3

5 33.3

6 40 2 13.3

1 06.7

7 46.7

4 26.7

3 20

18th day 2 13.3

2 13.3

9 60 2 13.3

1 06.7

7 46.7

3 20 4 26.7

21st day 2 13.3

2 13.3

8 53.3

3 20 1 06.7

6 40 4 26.7

4 26.7

24th day 2 13.3

2 13.3

5 33.3

6 40 1 06.7

5 33.3

4 26.7

5 33.3

27th day 2 13.3

1 06.7

4 26.7

8 53.3

1 06.7

3 20 5 33.3

6 40

30th day 1 06.7

2 06.7

3 20 9 60 1 06.7

2 13.3

6 40 6 40

AT 60 4037th day 1 06

.71 06

.73 20 10 66

.71 06

.71 06

.75 33

.38 53

.345th day 1 06

.71 06

.72 13

.311 73

.31 06

.71 06

.75 33

.38 53

.352nd day 1 06

.71 06

.72 13

.311 73

.31 06

.71 06

.74 26

.79 60

60th day 1 06.7

1 06.7

2 13.3

11 73.3

1 06.7

1 06.7

4 26.7

9 60

AF 73.30 60



Graph No. (31) Evaluation of Surrounding Skin in Group 'A':-

Graph No. (32) Evaluation of Surrounding Skin in Group 'B':-

0

20

40

60

80

100

120

140BT

3rd

day

6th

day

9th

day

12th

day

15th

day

0

20

40

60

80

100

120

140

BT3r

d da

y6t

h da

y9t

h da

y12

th d

ay15

th d

ay





15th

day

18th

day

21st

day

24th

day

27th

day

30th

day AT

37th

day

45th

day

52nd

day

60th

day AF

A Grade-0 %


A Grade-1 %


A Grade-2 %


A Grade-3 %


15th

day

18th

day

21st

day

24th

day

27th

day

30th

day AT

37th

day

45th

day

52nd

day

60th

day AF

B Grade-0 %


B Grade- 1 %


B Grade- 2 %


B Grade- 3 %






A Grade-0 %


A Grade-1 %


A Grade-2 %


A Grade-3 %


B Grade-0 %


B Grade- 1 %


B Grade- 2 %


B Grade- 3 %




Table No. (46) Evaluation of Tenderness:-

Group A B

Tenderness Present Absent Present Absent

No.

of

Pt.

Percentage No.

of

Pt.

Percentage No.

of

Pt.

Percentage No.

of

Pt.

Percentage

BT 15 100 0 00 15 100 0 00

3rd day 15 100 0 00 15 100 0 00

6th day 15 100 0 00 15 100 0 00

9th day 15 100 0 00 15 100 0 00

12th day 14 93.3 1 06.7 14 93.3 1 06.7

15th day 13 86.7 2 13.3 14 93.3 1 06.7

18th day 12 80 3 20 14 93.3 1 06.7

21st day 11 73.3 4 26.7 13 86.7 2 13.3

24th day 8 53.3 7 46.7 13 86.7 2 13.3

27th day 8 53.3 7 46.7 11 73.3 4 26.7

30th day 6 40 9 60 9 60 6 40

AT 60 40

37th day 5 33.3 10 66.7 9 60 6 40

45th day 4 26.7 11 73.3 8 53.3 7 46.7

52nd day 4 26.7 11 73.3 8 53.3 7 46.7

60th day 4 26.7 11 73.3 8 53.3 7 46.7

AF 73.30 46.70



Graph No. (33) Evaluation of Tenderness in Group 'A':-

Graph No. (34) Evaluation of Tenderness in Group 'B':-

0

20

40

60

80

100

120

140BT

3rd

day

6th

day

9th

day

12th

day

15th

day

18th

day

21st

day

24th

day

27th

day

30th

day AT

37th

day

45th

day

52nd

day

60th

day AF

A Absent Percentage

A Absent No. of Pt.

A Present Percentage

A Present No. of Pt.

0

20

40

60

80

100

120

140

BT3r

d d

ay6t

h da

y9t

h da

y12

th d

ay15

th d

ay18

th d

ay21

st d

ay24

th d

ay27

th d

ay30

th d

ay AT37

th d

ay45

th d

ay52

nd d

ay60

th d

ay AF

B Absent Percentage

B Absent No. of Pt.

B Present Percentage

B Present No. of Pt.



Table No. (47) Evaluation of Local Temperature:-

Group A B

Local

Temperature

Present Absent Present Absent

No.

of

Pt.

Percentage No.

of

Pt.

Percentage No.

of

Pt.

Percentage No.

of

Pt.

Percentage

BT 7 46.7 8 53.3 6 40 9 60

3rd day 7 46.7 8 53.3 6 40 9 60

6th day 7 46.7 8 53.3 6 40 9 60

9th day 7 46.7 8 53.3 5 33.3 10 66.7

12th day 5 33.3 10 66.7 5 33.3 10 66.7

15th day 4 26.7 11 73.3 4 26.7 11 73.3

18th day 3 20 12 80 3 20 12 80

21st day 3 20 12 80 3 20 12 80

24th day 3 20 12 80 3 20 12 80

27th day 3 20 12 80 3 20 12 80

30th day 3 20 12 80 3 20 12 80

AT 80 80

37th day 2 13.3 13 86.7 2 13.3 13 86.7

45th day 2 13.3 13 86.7 2 13.3 13 86.7

52nd day 1 06.7 14 93.3 2 13.3% 13 86.7

60th day 1 06.7 14 93.3 2 13.3% 13 86.7

AF 93.3 86.7



Graph No. (35) Evaluation of Local Temperature in Group 'A':-

Graph No. (36) Evaluation of Local Temperature in Group 'B':-

0

20

40

60

80

100

120

140BT

3rd

day

6th

day

9th

day

12th

day

15th

day

18th

day

21st

day

24th

day

27th

day

30th

day AT

37th

day

45th

day

52nd

day

60th

day AF

A Absent Percentage

A Absent No. of Pt.

A Present Percentage

A Present No. of Pt.

0

20

40

60

80

100

120

140

BT3r

d da

y6t

h da

y9t

h da

y12

th d

ay15

th d

ay18

th d

ay21

st d

ay24

th d

ay27

th d

ay30

th d

ay AT37

th d

ay45

th d

ay52

nd d

ay60

th d

ay AF

B Absent Percentage

B Absent No. of Pt.

B Present Percentage

B Present No. of Pt.



Table No. (48) Evaluation of Pain:-

Group

A B

Pain Grade-3 Grade-2 Grade-1 Grade-0 Grade-3

Grade-2

Grade-1

Grade-0

No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

% No.ofPt.

%

BT 4 26.7

6 40 5 33.3

0 00 3 20 6 40 6 40 0 00

3rd

day4 26.

76 40 5 33.

30 00 3 20 6 40 6 40 0 00

6th

day4 26.

75 33.

36 40 0 00 3 20 5 33.

37 46.

70 00

9th

day2 13.

35 33.

38 53.

30 00 3 20 5 33.

36 40 1 06.

712th

day2 13.

35 33.

36 40 2 13.

33 20 4 26.

76 40 2 13.

315th

day2 13.

32 13.

38 53.

33 20 3 20 3 20 7 46.

72 13.

318th

day2 13.

31 06.

77 46.

75 33.

33 20 3 20 7 46.

72 13.

321st

day1 06.

72 13.

34 26.

78 53.

33 20 3 20 5 33.

34 26.

724th

day1 06.

72 13.

32 13.

310 66.

73 20 2 13.

35 33.

35 33.

327th

day1 06.

71 06.

72 13.

311 73.

33 20 1 06.

74 26.

77 46.

730th

day1 06.

71 06.

72 13.

311 73.

32 13.

32 13.

34 26.

77 46.

7AT 73.30 46.7037th

day1 06.

71 06.

72 13.

311 73.

32 13.

32 13.

34 26.

77 46.

745th

day1 06.

71 06.

72 13.

310 73.

32 13.

32 13.

34 26.

77 46.

752nd

day1 06.

71 06.

72 13.

311 73.

32 13.

32 13.

34 26.

77 46.

760th

day1 06.

71 06.

72 13.

311 73.

32 13.

32 33.

34 26.

77 46.

7AF 73.30 46.70



Graph No. (37) Evaluation of Pain in Group 'A':-

Graph No. (38) Evaluation of Pain in Group 'B':-

0

20

40

60

80

100

120

140BT

3rd

day

6th

day

9th

day

12th

day

15th

day

18th

day

21st

day

24th

day

27th

day

30th

day AT

37th

day

45th

day

52nd

day

60th

day AF

A Grade-0 %


A Grade-1 %


A Grade-2 %


A Grade-3 %


0

20

40

60

80

100

120

140

160

BT3r

d da

y6t

h da

y9t

h da

y12

th d

ay15

th d

ay18

th d

ay21

st d

ay24

th d

ay27

th d

ay30

th d

ay AT37

th d

ay45

th d

ay52

nd d

ay60

th d

ay AF

B Grade-0 %


B Grade- 1 %


B Grade- 2 %


B Grade- 3 %




Table No. (49) Evaluation of Burning Sensation:-

Burning

Sensation

Group- A Group- B


No.

of

Pt.

Percentage No.

of

Pt.

Percentage No.

of

Pt.

Percentage No.

of

Pt.

Percentage

BT 10 66.7 5 33.3 9 60 6 40

3rd day 10 66.7 5 33.3 9 60 6 40

6th day 9 60 6 40 9 60 6 40

9th day 9 60 6 40 9 60 6 40

12th day 8 53.3 7 46.7 9 60 6 40

15th day 7 46.7 8 53.3 8 53.3 7 46.7

18th day 6 40 9 60 8 53.3 7 46.7

21st day 5 33.3 10 66.7 8 53.3 7 46.7

24th day 3 20 12 80 5 33.3 10 66.7

27th day 3 13.3 12 80 5 33.3 10 66.7

30th day 3 06.7 12 80 5 33.3 10 66.7

AT 80 66.7

37th day 3 06.7 12 80 5 33.3 10 66.7

45th day 2 13.3 13 86.7 4 26.7 11 73.3

52nd day 2 13.3 13 86.7 3 20 12 80

60th day 2 13.3 13 86.7 2 13.3 13 86.7

AF 86.7 86.7



Graph No. (39) Evaluation of Burning Sensation in Group 'A':-

Graph No. (40) Evaluation of Burning Sensation in Group 'B':-

0

20

40

60

80

100

120

140BT

3rd

day

6th

day

9th

day

12th

day

15th

day

18th

day

21st

day

24th

day

27th

day

30th

day AT

37th

day

45th

day

52nd

day

60th

day AF

Group- A Absent Percentage

Group- A Absent No. of Pt.

Group- A Present Percentage

Group- A Present No. of Pt.

0

20

40

60

80

100

120

140

BT3r

d da

y6t

h da

y9t

h da

y12

th d

ay15

th d

ay18

th d

ay21

st d

ay24

th d

ay27

th d

ay30

th d

ay AT37

th d

ay45

th d

ay52

nd d

ay60

th d

ay AF

Group- B Absent Percentage

Group- B Absent No. of Pt.

Group- B Present Percentage

Group- B Present No. of Pt.



Table No. (50) Evaluation of Itching:-

Itching Group- A Group- B


No.

of

Pt.

Percentage No.

of

Pt.

Percentage No.

of

Pt.

Percentage No.

of

Pt.

Percentage

BT 9 60 6 40 10 66.7 5 33.3

3rd day 9 60 6 40 10 66.7 5 33.3

6th day 9 60 6 40 10 66.7 5 33.3

9th day 9 60 6 40 10 66.7 5 33.3

12th day 9 60 6 40 10 66.7 5 33.3

15th day 9 60 6 40 10 66.7 5 33.3

18th day 7 46.7 8 53.3 9 60 6 40

21st day 7 46.7 8 53.3 9 60 6 40

24th day 6 40 9 60 8 53.3 7 46.7

27th day 6 40 9 60 7 46.7 8 53.3

30th day 5 33.3 10 66.7 6 40 9 60

AT 66.7 60

37th day 3 20 12 80 5 33.3 10 66.7

45th day 3 20 12 80 4 26.7 11 73.3

52ndday 3 20 12 80 4 26.7 11 73.3

60thday 3 20 12 80 4 26.7 11 73.3

AF 80 73.3



Graph No. (41) Evaluation of Itching in Group 'A':-

Graph No. (42) Evaluation of Itching in Group 'B':-

0

20

40

60

80

100

120

140BT

3rd

day

6th

day

9th

day

12th

day

15th

day

18th

day

21st

day

24th

day

27th

day

30th

day AT

37th

day

45th

day

52nd

day

60th

day AF

Group- A Absent Percentage

Group- A Absent No. of Pt.

Group- A Present Percentage

Group- A Present No. of Pt.

0

20

40

60

80

100

120

140

BT3r

d da

y6t

h da

y9t

h da

y12

th d

ay15

th d

ay18

th d

ay21

st d

ay24

th d

ay27

th d

ay30

th d

ay AT37

th d

ay45

th d

ay52

ndda

y60

thda

y AF

Group- B Absent Percentage

Group- B Absent No. of Pt.

Group- B Present Percentage

Group- B Present No. of Pt.



STASTICAL ANALYSIS

Table No. (51) Statistical analysis of all parameter B.T.-A.T. in Group'A'

Group "A" Mean Reduction

%

±SD ±SE T P Remark

B.T. A.T.

Length 35.27 4.20 88.09 9.18 2.37 13.10 <0.001 H.S.

Discharge 1.53 0.33 78.26 0.94 0.24 4.94 <0.001 H.S.

Surrounding

Skin

1.73 0.67 61.54 0.96 0.25 4.30 <0.001 H.S.

Tenderness 1.00 0.40 60.00 0.51 0.13 4.58 <0.001 H.S.

Temperature 0.47 0.20 57.14 0.46 0.12 2.26 <0.05 M.S.

Pain 1.93 0.47 75.86 0.83 0.22 6.81 <0.001 H.S.

Burning

Sensation

0.67 0.20 70.00 0.52 0.13 3.50 <0.01 S.

Itching 0.60 0.33 44.44 0.46 0.12 2.26 <0.05 M.S.

Table No. (52) Statistical analysis of all parameter B.T.-A.F. in Group'A'

Group "A" Mean Reduction%


B.T. A.F.Length 35.27 3.47 90.17 9.76 2.52 12.62 <0.001 H.S.

Discharge 1.53 0.33 78.26 0.94 0.24 4.94 <O.001 H.S.

SurroundingSkin

1.73 0.47 73.08 0.88 0.23 5.55 <0.001 H.S.

Tenderness 1.00 0.27 73.33 0.46 0.12 6.20 <0.001 H.S.

Temperature 0.47 0.07 85.71 0.51 0.13 3.06 <0.01 S.

Pain 1.93 0.47 75.86 0.83 0.22 6.81 <0.001 H.S.

BurningSensation

0.67 0.13 80.00 0.52 0.13 4.00 <0.01 S.

Itching 0.60 0.20 66.67 0.51 0.13 3.06 <0.01 S.



Table No. (53) Statistical analysis of all parameter B.T.-A.T. in Group'B'

Group "B" Mean Reduction

%


B.T. A.T.

Length 34.87 8.47 75.72 5.77 1.49 17.73 <0.001 H.S.

Discharge 1.27 0.53 57.89 0.80 0.21 3.56 <0.01 S.

Surrounding

Skin

1.53 0.87 43.48 0.62 0.16 4.18 <0.001 H.S.

Tenderness 1.00 0.60 40.00 0.51 0.13 3.06 <0.01 S.

Temperature 0.40 0.20 50.00 0.41 0.11 1.87 >0.05 I.S.

Pain 1.80 0.93 48.15 0.74 0.19 4.52 <0.001 H.S.

Burning

Sensation

0.60 0.33 44.44 0.46 0.12 2.26 <0.05 M.S.

Itching 0.67 0.40 40.00 0.46 0.12 2.26 <0.05 M.S.

Table No. (54) Statistical analysis of all parameter B.T.-A.F. in Group'B'

Group "B" Mean Reduction

%


B.T. A.F.

Length 34.87 8.00 77.06 6.06 1.56 17.18 <0.001 H.S.

Discharge 1.27 0.60 52.63 0.82 0.21 3.16 <0.01 S.

Surrounding

Skin

1.53 0.60 60.87 0.80 0.21 4.53 <0.001 H.S.

Tenderness 1.00 0.53 46.67 0.52 0.13 3.50 <0.01 S.

Temperature 0.40 0.13 66.67 0.46 0.12 2.26 <0.05 M.S.

Pain 1.80 0.93 48.15 0.74 0.19 4.52 <0.001 H.S.

Burning

Sensation

0.60 0.20 60.67 0.51 0.13 3.06 <0.01 S.

Itching 0.67 0.27 60.00 0.51 0.13 3.06 <0.01 S.



Table No. (55) Comparing Statistical analysis of all parameter B.T.-A.T.in Group 'A' and 'B'

Group B Group A % 0f

Difference

±SE T P Remark

N Mean±S.D. n Mean±S.D.

Length 15 8.47±10.19 15 4.20±7.15 50.39 3.21 1.33 >0.05 I.S.

Discharge 15 0.53±0.64 15 0.33±0.62 37.50 0.23 0.87 >0.05 I.S.

Surrounding

Skin

15 0.87±0.92 15 0.67±0.97 23.08 0.35 0.58 >0.05 I.S.

Tenderness 15 0.60±0.51 15 0.40±0.51 33.33 0.19 1.08 >0.05 I.S.

Temperature 15 0.20±0.41 15 0.20±0.41 0.00 0.15 0.00 0 -

Pain 15 0.93±1.09 15 0.47±0.92 50.00 0.37 1.26 >0.05 I.S.

Burning

Sensation

15 0.33±0.49 15 0.20±0.41 40.00 0.17 0.81 >0.05 I.S.

Itching 15 0.40±0.51 15 0.33±0.49 16.67 0.18 0.37 >0.05 I.S.

On the parameter of length of tract among 15 patients in each group, average rate

of healing per seating (3 days) in group A 3.45mm & in group B 2.72mm and average

healing time per1mm in group A o.30 seating & in group Bo.37 seating. Where before

treatment mean value is 35.27 & 34.87 in group A & B respectively.

After treatment in group A recovery of patients is 60.00%. Mean value is 4.20,

SD value ± 9.18, SE value ± 2.37, reduction 88.09%, t value 13.10, P value <0.001. So

highly significant result. In group B recovery of patients is 46.67%. Mean value is 8.47,


highly significant result.

After follow up in group A recovery of patients is 73.33%. Mean value is 3.47,




highly significant result. In group B recovery of patients is 46.67%. Mean value is 8.00,


highly significant result.

On the parameter of discharge among 15 patients in each group. Where before

treatment in group A 2 patients were in Grade-3, 5 patients in Grade-2, 7 patients in

Grade-1 & 1 patient in Grade-0. Mean value is 1.53. In group B 1 patient were in Grade-

3, 3 patients in Grade-2, 10 patients in Grade-1 & 1 patient in Grade-0 pain, Mean value

is 1.27.

After treatment in group A 0 patient were in Grade-3, 1 patient in Grade-2, 3

patients in Grade-1 & 11 patients in Grade-0 . So recovery of patients is 73.33%. Mean

value is 0.33, SD value ± 0.94, SE value ± 0.24, reduction 78.26%, t value 4.94 , P value

<0.001. So highly significant result. In group B 0 patient were in Grade-3, 1 patient in

Grade-2, 6 patients in Grade-1 & 8 patients in Grade-0 pain. So recovery of patients is

53.33%. Mean value is 0.53, SD value ± 0.80, SE value ± 0.21, reduction 57.89%, t value

3.56, P value <0.01. So significant result.

After follow up in group A 0 patient were in Grade-3, 1 patient in Grade-2, 3

patients in Grade-1 & 11 patients in Grade-0. So recovery of patients is 73.33%. Mean

value is 0.33, SD value ± 0.94, reduction 78.26%, t value 4.94, P value <0.001. So highly

significant result. In group B 0 patients were in Grade-3, 2 patients in Grade-2, 5 patients

in Grade-1 & 8 patients in Grade-0 pain. So recovery of patients is 53.33%. Mean value

is 0.60, SD value ± 0.82, SE value ± 0.21 reduction 52.63%, t value 3.16, P value <0.01.

So significant result.



On the parameter of colour of surrounding skin among 15 patients in each group.

Where before treatment in group A 4 patients were in Grade-3, 4 patients in Grade-2, 6

patients in Grade-1 & 1 patient in Grade-0. Mean value is 1.73. In group B 2 patients

were in Grade-3, 6 patients in Grade-2, 5 patients in Grade-1 & 2 patients in Grade-0

pain, Mean value is 1.53.

After treatment in group A 1 patient were in Grade-3, 2 patients in Grade-2, 3


value is 0.67, SD value ± 0.96, SE value ± 0.25, reduction 61.54%, t value 4.30, P value

<0.001. So highly significant result. In group B 1 patient were in Grade-3, 2 patients in



4.18, P value <0.001. So highly significant result.


patients in Grade-1 & 11 patients in Grade-0. So recovery of patients is 73.33%. Mean

value is 0.47, SD value ± 0.88,SE ± 0.23, reduction 73.08%, t value 5.95, P value <0.001.

So highly significant result. In group B 1 patients were in Grade-3, 1 patients in Grade-2,

4 patients in Grade-1 & 9 patients in Grade-0. So recovery of patients is 60.00%. Mean

value is 0.60, SD value ± 0.80, SE value ± 0.21 reduction 60.87%, t value 4.53, P value

<0.001. So highly significant result.

On the parameter of tenderness among 15 patients in each group. Where before

treatment in group A 15 patients were present & 0 patient absent. . Mean value is 1. In

group B 15 patients were present & 0 patient absent. . Mean value is 1.



After treatment in group A 6 patients were present & 9 patients absent. So

recovery of patients is 60.00%. Mean value is 0.40, SD value ± 0.51, SE value ± 0.13

reduction 60.0%8, t value 4.38, P value <0.001. So highly significant result. In group B 9

patients were present & 6 patients absent. So recovery of patients is 40.00%. Mean value



After follow up in group A 4 patients were present & 11 patients absent. So


reduction 73.33%, t value 6.20, P value <0.001. So highly significant result. In group B 8




On the parameter of temperature among 15 patients in each group. Where before

treatment in group A 7 patients were present & 8 patient absent. Mean value is 0.47. In

group B 6 patients were present & 9 patients absent. Mean value is 0.40.



reduction 57.14%, t value 2.26, P value <0.05. So mild significant result. In group B 3

patients were present & 12 patients absent. So recovery of patients is 80.00%. Mean

value is 0.40, SD value ± 0.41, SE value ± 0.11 reduction 50.00%, t value 1.87, P value

>0.05. So insignificant result.



After follow up in group A 1 patient were present & 14 patients absent. So


reduction 85.71%, t value 3.06, P value <0.01. So significant result. In group B 2 patients

were present & 13 patients absent. So recovery of patients is 86.67%. Mean value is 0.13,

SD value ± 0.46, SE value ± 0.12 reduction 66.67%, t value 2.26, P value <0.05. So mild

significant result.

On the parameter of pain among 15 patients in each group. Where before

treatment in group A 4 patients were in Grade-3, 6 patients in Grade-2, 5 patients in

Grade-1 & 0 patient in Grade-0. Mean value is1.93. In group B 3 patients were in Grade-

3, 6 patients in Grade-2, 6 patients in Grade-1 & 0 patient in Grade-0 pain, Mean value is

1.80.

After treatment in group A 1 patient were in Grade-3, 1 patient in Grade-2, 2


value is 0.47, SD value ± 0.83, SE value ± 0.22, reduction 75.86%, t value 6.81 , P value

<0.001. So highly significant result. In group B 2 patients were in Grade-3, 2 patients in



4.52, P value <0.001. So highly significant result.


patients in Grade-1 & 11 patients in Grade-0 pain. So recovery of patients is 73.33%.

Mean value is 0.47, SD value ± 0.83, reduction 75.86%, t value 6,81, P value <0.001. So

highly significant result. In group B 2 patients were in Grade-3, 2 patients in Grade-2, 4



patients in Grade-1 & 7 patients in Grade-0 pain. So recovery of patients is 46.67%.

Mean value is 0.93, SD value ± 0.74, SE value ± 0.19 reduction 48.15%, t value 4.52, P

value <0.001. So highly significant result.

On the parameter of burning sensation among 15 patients in each group. Where

before treatment in group A 10 patients were present & 5 patients absent. Mean value is

0.67. In group B 9 patients were present & 6 patients absent. Mean value is 0.60.





SD value ± 0.46, SE value ± 0.12 reduction 40.00%, t value 2.26, P value <0.05. So mild

significant result.





SD value ± 0.51, SE value ± 0.13 reduction 60.67%, t value 3.06, P value <0.01. So

significant result.

On the parameter of itching among 15 patients in each group. Where before

treatment in group A 9 patients were present & 6 patient absent. Mean value is 0.60. In

group B 10 patients were present & 5 patients absent. Mean value is 0.67.





reduction 44.44%, t value 2.26, P value <0.05. So mild significant result. In group B 6



So mild significant result.





SD value ± 0.51, SE value ± 0.13 reduction 60.00%, t value 3.06, P value <0.01. So

significant result.

Comparative statistical analysis of both groups "A" Ghonta Phaladi Varti and "B"

Aragvadhadi Varti denotes insignificant difference with respect to parameters such as

length of the tract, discharge, surrounding skin, tenderness, temperature, pain, burning

sensation and itching. But group A is more effective than group B.

Effect of Ghonta Phaladi Varti application in group ‘A’ shown more efficacy with

respect to length of the tract after follow up with a reduction of 90.17% where as the

Aragvadhadi Varti application in group ‘B’ shown low efficacy with 77.06% reduction.


respect to discharge after follow up with a reduction of 78.26% where as the Aragvadhadi

Varti application in group ‘B’ shown low efficacy with 52.63% reduction.




respect to surrounding skin after follow up with a reduction of 73.08% where as the



respect to tenderness after follow up with a reduction of 73.33% where as the



respect to temperature after follow up with a reduction of 85.71% where as the



respect to pain after follow up with a reduction of 75,86% where as the Aragvadhadi



respect to burning sensation after follow up with a reduction of 80.00% where as the



respect to itching after follow up with a reduction of 66.67% where as the Aragvadhadi


DISCUSSION


DISCUSSION

Nadi Vrana is a common problem in clinical practice. According to Sushruta

Nidana Sthana Adhyaya 10, Nadi Vrana is one of the troublesome disease which can

occur anywhere in the body and is encountered in surgical practice which do not

respond to the medical treatment. The management of sinus still remains a riddle to

the attending surgeons. Even surgical management is also not completely effective if

the rate of recurrence is considered. Patients with sinuses of different pathology often

look for the treatment which is effective and affordable. very important factor is the

recurrence which should not be there.

The current methodology of treating sinus is expensive and extensive surgery,

or heavy use of antibiotics which are not effective all the times & also accompanies

various adverse effects. So definitely there is a need of searching for a very good and

acceptable treatment for the same.

In the present clinical study, Ayurvedic preparations such as Ghonta Phaladi

Varti and Aragvadhadi Varti were selected. Both the Vartis are well known for its

Vrana Shodhana and Vrana Ropaka (wound healing) properties.

The basic principles of Vrana management include aetiopathogenesis of Vrana

as well as Dusta Vrana in which involvement of Tridoshas are there. Nadi Vrana also

considered as Dusta Vrana due to its non healing in nature

This trial is planned for the evaluation of Vartis (Ghonta Phaladi Varti and

Aragvadhadi Varti) on random cases of Nadi Vrana in the line of the understanding of

aetiopathogenesis and pharmacotherapeutics of Nadi Vrana, explained by our

DISCUSSION


Acharyas in Ayurveda with concurrent use of the parameters available for the present

day.

Discussion on the disease:-

Nadi Vrana is identified as a tubular Vrana and qualifies in every sense with

Dusta Vrana. Just a deep into the modern parlance will enable us to directly correlate

this condition as sinus because it is also a blind tubular tract leading from surface

down into the tissues. Innate foreign bodies according to the classics also cause sinus.

One of the main causes of non healing nature of Nadi Vrana (shalyaja) is the presence

of hair.

The occurrence of sinus in anal region is also well understood to be proceeded

by local abscesses as per the modern and Ayurvedic concepts. These abscesses also

may be followers of infected anal crypts. More than 85% of the sinuses occurring in

the anorectal region are of infection to the anal glands. It is well known fact that these

sinuses are given rise to problem to the patients.

The obstructive pathology playing behind the screen in the genesis of sinuses

are well studied as in the case of pilonidal sinuses of the anal canal as explained by

modern authors. Walsh T.H. and Manna. V.C. 1983 Br. J. Sury.

Thus it can be understood that a decent amount of correlation exists between

the modern and ancient in understanding of Nadi Vrana with relevance to its Nidana

and Samprapti.

DISCUSSION


Discussion on the Management:-

The Management comprised of administration of Ghonta Phaladi Varti and

Aragvadhadi Varti into Nadi Vrana (sinus). Varti is mainly indicated in Vrana with

minute external opening and in Antaha Shalyaja Vrana. These Vartis prepared with

Shodhana and Ropana Dravyas does debridement of the slough (or) unhealthy tissue,

alleviates all the vitiated Doshas and facilitates for the healing process. Every third

day probing sessions are conducted for removing any obstructive pathology in the

sinus tract by which adequate drainage could be done and the tract become more

suitable for healing in proper way.

Ghonta Phaladi Varti consists of Ghonta Phala Twaka, Saindhav Lavanam,

Laksha, Puga Phala, Jyotishmati, Snuhi Ksheera & Arka Ksheera and Aragvadhadi

Varti consists of Aragvadha, Haridra, Manjistha, Ghrita, Madhu, Go-Mutra. These are

all known to possess Tridosha Shamaka and anti-inflammatory activities irrespective

of the organisms due to its Teekshna, Sookshma, Sara, Krimighna and Vishagna

properties. It acts as local degrading agent and keeps the tract clean and devoid of

purulent substances. Its Laghu, Rooksha and Sara properties enable it to penetrate

deeper into the tissues and acts against the tendency of body towards formation of

fibrous tissues there by resulting in non-healing nature of Nadi Vrana besides, after

healing scar tissue formation is less.

Discussion on drug:-

Thus the manifestation of sinus is more common at perianal region (perianal

sinus) and post anal region (pilonidal sinus).

DISCUSSION


Group A Drug:-

Ghonta Phala helps in reducing the inflammation and promotes wound healing

by its Vrana Shodaka, Vrana Ropaka, Krimigna and Vatapittahara properties.

Saindhav Lavanam reduces discharge and pain by its Tridoshaghna properties,

Shoolagna and Sophagna properties, Lekhana and Ropana properties, helps in

healing of ulcers.

Laksha reduces burning sensation & local temperature from its Sheet Veerya,

reduces colour of surrounding skin from its Varna Prasadana properties.

Pooga Phala from its Kaphapittanashaka, Krimigna and Vrana Ropaka actions

it is useful in treatment of Nadi Vrana.

Jyotishmati having Kusthaghna and Vranaghna properties.

Snuhi Ksheera from its Kaphavatahara, Pitta Shodhana and unique properties

like Shodhana of Rasa, Rakta, Mamsa, Meda, Majja is very useful in

inflammatory conditions like Nadi Vrana.

Arkaksheera is Kaphavatashamaka, having Sara, Krimigna and Vishagna

properties useful in treating non healing ulcers like Nadi Vrana.

Group B drug:-

Aragvadha having Vranaghna, Kusthaghna, Sulahar properties so reduces

pain, length of tract, colour of surrounding skin and discharge due to Vata-

Pitta Samaka, Kapha-Pitta Sansodhana properties.

Haridra pacifies the features like the the pain, local temperature by inhibiting

the activated proteases resemble for acute inflammatory process and the

DISCUSSION


volatile oil presence in Haridra is a highly effective against inflammation than

each by hydrocortisone (Kataru, 1979).

Manjistha help in reducing the inflammation process being it acts against

Sotha and it is able to reduce the discharge.

Grita is useful in healing ulcers of chronic types.

Madhu reduces burning sensation, local temperature due to Sheet Veerya and

Dahaghna properties, length of tract due to Lekhana and Kusthaghna

properties.

Go-Mutra the granulation tissue in the Varti is cleaned off.

Discussion on Observations:-

Total 30 patients diagnosed to be suffering from Nadi Vrana (Sinus) were selected

randomly. These were divided into two groups A and B containing 15 patients in

each. Group A patients were treated with Ghonta Phaladi Varti application and group

B patients were treated with Aragvadhadi Varti application. The data was collected

and observation were made before treatment, during treatment on 3rd, 6th, 9th, 12ve,

15th, 18th, 21st, 24th, 27th, 30th day and during follow up on 37th, 45th, 53rd, 60th day.

The data obtained from the results was subjected analysis and conclusions were

drown.

Both the groups were observed thoroughly in respect of Sex, Age, Religion,

Diet pattern, Marital status, Occupation, Socio-economic status, Family history, Agni,

Kostha, Prakriti, Vyasana, Chronicity of disease, Position or site of sinuses.

DISCUSSION


Sex:-

In the present study 26 patients (86.67%) out of 30 patients were males and

only 4 patients (13.33%) were females this shows that the disease is predominant in

males.

Age:-

Maximum number of patients that is 17 (56.67%) out of 30 patients were

found in the age groups between 21-25 and 26-30 years in both groups it was

observed that patients between the age groups 21-25 and 26-30 years are more prone

to sinus disease.

Religion:-

Distribution of the patients based on their religion shows that 21 (70%) out of

30 patients were Hindus, followed by 9 patients (30%) were Muslims, the ratio tells

us well with the ratio of Hindus and Muslims in the general population. Hence

therefore cannot be assumed that Hindus are susceptible to Sinus.

Diet pattern:-

Among the 30 patients in the present study, 21 patients (70%) reported to be

having mixed diet and rest 9 patients (30%) were vegetarians. But it seems that

dietary habits play no role in causing sinus.

Marital Status:-

On observation about this out of 30 patients 18 patients (60%) were found to

be married and 12 patients (40%) were unmarried. This can be assured that the

DISCUSSION


disease is affecting the age group of 25-35 and this is the age group which a person

will be married.

Occupation:-

In this study out of 30 patients 10 patients were student, 4 patients were

drivers, 10 patients were doing sedentary work and 5 were doing manual labor works.

Thus it was seen that (pilonidal) sinus is more common in patients who were

drivers due to friction and long time sitting and also sinus is common in who were

doing sedentary work. Normally students comes under age group of 21-26 so effected.

Socio-Economic Status:-

In the present study the classification of patients based on their economic

status shows that people belonging to poor and lower middle class were more i.e., out

of 30 patients, 14 patients (62.67%) were of poor and 9 patients were of lower middle

socio-economic status.

Family History:-

Among the 30 patients in the present study, only 4 patients (13.33%) reported

to family history left 26 patients (86.67%) having no any family history. In which 2

patients cured and 2 patients till follow up not cured. So normally no effect of family

history in cure the disease.

Vyasana:-

3 patients (10%) having only addiction of Tobacco chewing, 1 patient

(03.33%) having only addiction of Smoking, 2 patients (06.67%) having only

DISCUSSION


addiction of Alcohol, 2 patient (06.67%) having addiction of Tobacco chewing &

Smoking, 3 patients (10%) having addiction of Smoke & Alcohol and 3 patients

(10%) having addiction of Tobacco chewing, Smoke & Alcohol in group A & B

respectively. Difficulty in reduction of length of tract and other parameter in addicted

person.

Chronicity of Disease:-

Out of 30 patients 5 patients (16.67%) having chronicity of group of below 6

months, 7 patients (23.33%) having chronicity of group of 7-12 months, 3 patients

(10%) having chronicity of group of 13-18 months, 5 patients (16.67%) having

chronicity of group of 19-24 months, 5 patients (16.67%) having chronicity of group

of 25-30 months, 3 patients (10%) having chronicity of group of 31-36 months and 2

patients (06.67%) having chronicity of group of more than 37 months. . It shows that

if chronicity of disease is less than length of tract is small ad possibilities of curing the

disease will be more.

Site of Sinuses:-

Distribution of patients based on site of sinus in the body indicates that

46.67% of the patients i.e., 14 out of 30 were perianal sinus, and 40% of patients i.e.,

12 out of 30 were pilonidal sinus, 1 (3.33%) patients were inguinal sinus and 3

patients (10%) were sinus of a chronic abscess in thigh region.

Discussion on results obtained:-

In both the groups the results obtained (within the group) using paired ‘t’ test

for all the parameters. In groups A the drugs showed highly significant results in

DISCUSSION


parameters such as Pain, Tenderness, Surrounding Skin, Discharge, Length of tract

and significant results in parameters such as Local Temperature, Burning sensation,

Itching. In group B the drugs showed highly significant results in parameters such as

Pain, Surrounding Skin, Length of tract and significant results in parameters such as

Discharge, Tenderness, Burning sensation, Itching. and mild significant results in

parameters such as Local Temperature.

On comparing for the observed differences in values obtained for the

respective parameters between both the groups A and B (using unpaired ‘t’ test) the

result showed insignificance for all the parameters.

From the above results it is proved that both the drugs are quiet effective in

relieving all the parameters. But Group A medicine i.e. Ghonta Phaladi Varti is more

effective than Group B medicine i.e. Aragvadhadi Varti.

Further it is recommended to conduct clinical trial on large sample size may be with

some acceptable modifications in drug, dose and durations which may give more

beneficial result.

CONCLUION


CONCLUSION

From this present clinical comparative study for evaluation of efficacy of

Ghonta Phaladi Varti and Aragvadhadi Varti in the management of Nadi Vrana. The

following conclusions were drawn after thorough review of the literature, materials &

methods, observations & results and scientific discussion.

The description of Nadi Vrana available in ancient Ayurvedic Literature is

implies to sinus described in modern literature.

The Healing of Nadi Vrana still remains a major problem.

The present study proved that Varti application procedure is very easy cheap

and effective than any surgical procedure.

The results of average rate of healing per seating (3 days) were seen as 3.45

mm in group ‘A’ and 2.72 mm in group ‘B’.

The average healing time for 1 mm in group ‘A’ is 0.30 seating and in group

‘B’ is 0.37 seating.

As per the unit healing time, Ghonta Phaladi Varti was found more effective

compared to Aragvadhadi Varti.

After the statistical analysis of Group ‘A’ Ghonta Phaladi Varti shown highly

significant effect on pain, colour of surrounding skin, tenderness, Discharge

and length of the tract, but it was significant effect on burning sensation, local

temperature & itching.

CONCLUION


After the statistical analysis of group ‘B’ Aragvadhadi varti shown highly

significant effect on pain, colour of surrounding skin and length of the tract, it

was significant effect on discharge, tenderness, burning sensation and itching

and it was mild significant effect on temperature.

Between the Group A and Group B the difference observed in all parameters

except temperature parameter is statistically insignificant and in temperature

non significant, but over all group A being more significant than group B.

This clinical study came out with the following interesting features.

No need for Hospitalization

It is an alternative to surgery

Post operative hypertrophic tarnish looking scar is avoided.

The clinical status of patients was significantly improved.

Maintenance of general hygiene control in diet, avoidance of obesity

and driving for long hours, weekly shaving to the post anal region

avoids recurrence of pilonidal sinus in future.

Scope for further study

The present study was carried out on 15 patients each for both the groups

which is a small sample. So further study may be done to conduct on a large

sample after which a precise conclusion can be drawn.

SUMMARY


SUMMARY

The study entitled ‘A clinical comparative study an efficacy of Ghonta Phaladi

Varti and Aragvadhadi Varti in the management of Nadi Vrana (Sinus)’ is

mainly based on clinical observation.

Review of both Ayurvedic and modern literature has been done and the

clinical symptoms of Nadi Vrana as described in classical Ayurvedic text

seems to correlate with sinus.

The concept of Vrana and formation of Nadi Vrana and its complications have

been described.

Management of Nadi Vrana and Pathyapathya has also been delt.

Varti Kalpana, Ghonta Phaladi Varti and Aragvadhadi Varti administration in

Nadivrana have been discussed.

Thorough review of drugs used in Ghonta Phaladi Varti and Aragvadhadi

Varti preparation has also been delt.

30 patients of Nadi Vrana were selected randomly irrespective of sex, age,

religion, diet pattern, marital status, occupation, socio economic status, family

history, Agni, Kostha, Prakriti, Vyasana, chronicity and were divided into two

groups ‘A’ and ‘B’ of 15 patients each group.

Patients in group A were treated with Ghonta Phaladi Varti and Patients in

Group B were treated with Aragvadhadi Varti for the duration of 10 seating

(30 days). Per seating is gap of 2 days or every third days.

SUMMARY


26 out of 30 patients were males and 4 were females with maximum age group

of 21-25 and 26-30 years.

In occupation students, labor, driver and sedentary working people like-

business were found to be maximum suffers, most of patients had chronicity

of less than 12 months and between 19-30 months duration.

When two groups were compared more improvement was seen in patients

treated with Ghonta Phaladi Varti than Aragvadhadi Varti.

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2) Su. su. 1/7.

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6) S. Das Pg. No. 125.

7) S. Das Pg. No. 126.

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9) Su. nd. 10/9.

10) Su. nd. 10/10.

11) Su. nd. 10/10.

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19) A.V. 7/78.1.

20) Su. nd. 10/9-17, Su. ch. 18/17-41.

21) Ah. us. 29/26-31, 30/33-40.

REFERENCES


22) Ch.D. 45th chapter.

23) Bh.R. 50th chapter.

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478-482.

25) Y.R. utrardhgata Nadi Vrana Nidan Adhaya Pg. No. 192-194.

& Nadi Vrana Chikitsa Adhyaya Pg. No. 194-195.

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27) Su. su. 21/40.

28) Su. ch. 1/3.

29) Su. su. 23/18.

30) Su. su. 22/7.

31) Su. ch. 1/6.

32) Ch. ch. 25/17-19.

33) Su. su. 22/3.

34) Ch. ch. 25/26.

35) Su. ch. 1/8.

36) Su. su. 17/18-19.

37) Su. su. 22/3.

38) Su. sh.4/4.

39) Su. sh. 5/37.

40) Su. sh. 5/39.

41) Su. sh. 4/8.

42) Su. sh. 5/40.

43) Su. sh. 6/3.

44) Su. sh. 7/ 16-18.

REFERENCES


45) Su. sh. 7/4-5.

46) Su. sh. 5/29.

47) Su. sh. 5/30.

48) Su. sh. 5/29.

49) Su. sh. 5/21-23.

50) Su.su.15/7.

51) Ch. sh. 7/6.

52) Su. sh. 5/18.

53) Ch. ch. 15/30-31.

54) Su. sh. 5/20.

55) Su. sh. 5/24.

56) Su. sh. 5/26.

57) Su. sh. 5/27.

58) Su. sh. 5/28.

59) Su. sh. 4/14.

60) Su. ch. 2/12.

61) Su. sh. 6/3.

62) Su. sh. 6/9.

63) Su. sh. 6/36.

64) Su. sh. 6/16.

65) Sabda Kalpdrum Dvitiya Kanda Pg. No. 854-855.

66) Amarkosh.

67) Amarkosh Manushya Varga

68) Su. nd. 10/9.

69) Su. nd. 10/10.

REFERENCES


70) Ah. us. 29/26-28.

71) Su. su. 17/3.

72) Su. ch. 23/3.

73) Su. nd. 10/9.

74) Su. su. 17/10.

75) Su. su. 17/17.

76) Su. nd. 10/10.

77) Ah. us. 29/28.

78) Su. nd. 10/11.

79) Ah. us.29/29.

80) Su. nd. 10/11.

81) Ah. us. 29/29-30.

82) Su. nd. 10/12.

83) Ah. us 29/30.

84) Su. nd. 10/12.

85) Su. nd. 10/13.

86) Ah. us. 29/30.

87) Su. nd. 10/14.

88) Ah. us. 29/31.

89) Su. ch. 17/17.

90) Su. ch. 17/18-42.

91) V.C.N.P. 13.

92) Ah. us. 30/33-40.

93) Su. ch. 1/8.

94) Su. ch. 1/9.

REFERENCES


95) Sh.S. Madhya Khanda 7/1.

96) Bh.K.V. Pg. No.437-438.

97) Bh.K.V. Pg. No. 438.



100) Su. ch. 1/53.

101) Ch.D. 45th chapter.

102) Y.R. Nadi Vrana Chikitsa Adhyaya Pg. No. 194-195.

103) Su. su. 18/ 37-40.

104) Ah. su. 29/45-48.

105) Y.R. Sarva Roganam Pathyapathyam Pg. No. 195.

106) SRB's Manual of Surgery Pg. No. 1.

107) SRB's Manual of Surgery Pg. No. 1-5.


109) Manipal Manual of Surgery Pg. No. 2.

110) A Concise Textbook of Surgery Pg. No. 1.

111) Manipal Manual of Surgery Pg. No. 2-3.

112) SRB's Manual of Surgery Pg. No. 6-7

113) A Concise Textbook of Surgery Pg. No. 132.


115) A concise Textbook of Surgery Pg. No. 132.

116) Manipal Manual of Surgery Pg. No. 21.

117) Bailey & Love's Short Practice of Surgery Pg. No. 209, Table

No. 15.3.

118) Human Anatomy Pg. No. 396. 397, 855.

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119) Robbins Basic Pathology Pg. No. 33-59.

120) A Textbook on Surgical Short Cases Pg. No. 41-42.

121) A Textbook on Surgical Short Cases Pg. No. 42-44.

122) B.P. Pg. No. 571-573.

123) D.V. Pg. No. 669-670.

124) A.P. Pg. No. 773-775.

125) B.P. Pg. No. 113-114.

126) B.P. Pg. No. 562-563.

127) D.V. Pg. No. 1010-1011.

128) B.P. Pg. No. 90-91.

129) D.V. Pg. No. 128-131.

130) B.P. Pg. No. 306-312.

131) D.V. Pg. No. 924-925.

132) B.P. Pg. No. 302-306.

133) D.V. Pg. No. 343-347.

134) Ch.D. 45/6.

135) B.P. Pg. No. 68-69.

136) D.V. Pg. No. 200-204.

137) B.P. Pg. No. 114-116.

138) D.V. Pg. No. 513-18.

139) B.P. Pg. No. 110-112.

140) D.V. Pg. No. 277-281.

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144) Ch.D. 45/5.

145) Ah. su. 29/43-44.

146) Su. su. 5/40.

147) Y.R. Sarva Roganam Pathyapathyam Pg. No. 195.

ANNEXURES

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page I

SPECIAL CASE SHEET FOR

“NADI VRANA “

DEPT OF POST GRADUATE STUDIES IN SHALYATANTRA

S.J.G. AYURVEDIC MEDICAL COLLEGE & HOSPITAL, KOPPAL

“A CLINICAL COMPARATIVE STUDY ON THE EFFICACY OF GHONTA PHALADIVARTI AND ARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA”

P.G Scholar: Dr. Prabudh Kumar Praveen Guide / HOD: Dr. B.S. SAVADISr. No: OPD: IPD:

Bed No: DOA: DOD:

Name:

Sex: Age:

Religion: H / M / S/ Ch/Others Commencement Date:Socio- economic: LM/M/UM/R Completion Date:

Occupation: Marrital Status:

Address & Contact No. :

Result:

INFORMED CONSENT

I ……....................……………… Son / Daughter/ Wife of ……………………………… amexercising my free will, to participate in above study as a subject. I have been informed to mysatisfaction , by the attending physician the purpose of the clinical evaluation and nature ofthe drug treatment. I am also aware of my right to opt out of the treatment schedule, at any timeduring the course of the treatment.

z£Á£ÀÄ ²æÃ/²æÃªÀÄw ........................................................... ಮಗ/ / ೦ ………………………………………………£À£Àß ¸ÀéEZÀÑ ¬ÄAzÀ PÉÆqÀÄªÀ aQvÁì ¸ÀªÀÄäw. £aQvÁì ¥ÀzÀÞw0iÀÄ §UÉÎ £À£ÀUÉ aQvÀìPÀjAzÀ ¸ÀA¥ÀÇtðªÀiÁ»w zÉÆgÉwzÀÄÝ ªÀÄvÀÄÛ 0iÀiÁªÁUÁzÀÄgÀÄ aQvÀì¬ÄAzÀ »AwgÀÄUÀ®Ä ¸ÁévÀAvÀæ÷å «zÉ JAzÀÄ w½¢gÀÄvÀÛ£É.

Witness's Signature gÉÆV0iÀÄ gÀÄdÄ/ Patient's Signature

ANNEXURES

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page II

Pradhana Vedana ( Chief Complaints)i. Vedana: a) Present / Absent :

b) Duration :

ii. Srava: a) Present/Absent :b) Consistency:

c) Duration :

iii. Burning Sensation: a) Present / Absent:b) Duration:

iv. Kandu: a) Present / Absent:b) Duration:

Anubandha Vedana (Associated Complaints)

Fever: Present/ Absent:

Constipation: Present/ Absent:

History of Present Illness:

Poorva Vyadhi Vrittant (Past History):

Koutumbika Vrittanta (Family History):

ANNEXURES

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page III

Vaiyaktika Vruttanta (Personal History)

1

Ahara Vegetarian Mixed Tastepreferred

2 Vihara Nature of work Sedentary Active Laborious

Standing Sitting Walking

3 Agni Samagni Mandagni Teekshnagni Vishamagni

4 Kostha Mrdu Madhyama Krura

5 Nidra Prakruta Alpa Ati Diwaswapna

6 Vyasana None Tabacco Smoking Alcohol

7 Aartava Regular Irregular Menopause

Sarvadaihika Pareeksha (General Examination)a) Pulse (nadi):

b) Temp:

c) Conjunctiva:

d) B.P.:

e) R. R:

f) Pallor:

g) Edema:

h) Weight:

i) Height:

Systemic Examination

Respiratory System: Gastro Intestinal System:

Cardio Vascular System: Central Nervous System

ANNEXURES

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page IV

Sthanika Pareeksha :(Local Examination Especially of the Sinus)

Inspection:-

1. Number :

2. Position :

3. Sprouting granulation tissue : Present / Absent

4. Discharge : Present / Absent

5. Blood : Present / Absent

6. Pus : Present / Absent

7. Surrounding skin: Healthy/Unhealthy/Induration/Others …….. . .

8. Scar : Present /Absent

9. Pigmentation: Present / Absent

Palpation:-

1. Tenderness : Present / Absent

2. Temperature : Normal / Raised

3. Induration : Present / Absent

4. Lump :

Examination: With a probe:-

1. Direction of the sinus– Upward/ Downward/ Forward/ Lateral/ Medial

2. Depth: …………….. mm.

3. Foreign bodies: Present/ Absent

4. Bone chips : Present (+) / Absent (-)

5. End of the probe enters the bone cavity: Present/ Absent

ANNEXURES

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page V

6. Discharge comes out on withdrawal of the probe : Present/Absent

Special Investigation:-

1. Sinogram X-ray Examination: (Whenever required)

2. Laboratory Examination

Hb%

TLC, DLC

ESR

RBS

DIAGNOSIS:-

TREATMENT:-

Group Treatment Duration Follow up

A Ghontaphaladi

Varti

Taking aseptic precautions Varti is

inserted into Nadi Vrana giving two

days gap between two applications for

30 days

Once in week for

one month

B Aragvadhadi

Varti

Taking aseptic precautions Varti is

inserted into Nadi Vrana giving two

days gap between two applications for

30 days.

Once in week for

one month

ANNEXURES

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page VI

PATHYA:-

APATHYA:-

ASSESSMENT OF THE PARAMETERS

A) Subjective Parameters:-

Sr. No Observation During Treatment

B.T 3rd 6th 9th 12th 15th 18th 21st 24th 27th 30th

1. Pain

2. Burning

Sensation

3. Itching

4. Tenderness

5. Local

Temperature

ANNEXURES

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page VII

B) Objective Parameters:-

Sr. No Observation During Treatment

B.T 3rd 6th 9th 12th 15th 18th 21st 24th 27th 30th

1. Length in mm.

2. Discharge

3. Colour of

Surrounding Skin

4. Number:

5. Position:

6. Direction:

Grading: 0- nil, 1- mild, 2- moderate, 3- severe

ANNEXURES

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI ANDARAGVADHADI VARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page VIII

FOLLOW UP TABLE

Sl No. Criteria 37th day 45nd day 53h day 60th day

1 Pain

2 Burning sensation

3 Itching

4 Length

5 Discharge

6 Surrounding skin

7 Tenderness

8 Temperature

RESULT: Very Good Response

Good Response

Fair Response

Poor Response

Signature of the Scholar Signature of the HOD/Guide

ANNEXURE

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADIVARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page IX

MASTER CHART (DEMOGRAPHY) IN GROUP 'A'

Sl.No.

NameofPatients

0PDNo.

Sex

Age

Religion

DietPattern

MaritalStatus

Occupation

Socio-economicStatus

FamilyHistory

Agni Kostha

Prakriti

Vyasana

No.ofopening

PositionorSite

InitialLengthinmm

Chronicity inmonth

Direction

1 RaviTiwari

24735

M 26

H Mixed

Unmarried

Student LowerMiddleclass

No Samagni

Madhyama

Pitta-Kaphaja

No 1 PNS

31 18 LeftLateral &Downward

2 Veeranna H.

24954

M 52

H Mixed

Married

Business Upp

erMiddleClass

No Mandagni

Madhyama

Pitta-Kaphaja

Smoking

1 A 35 2 Upward &Medial

3 AravindBalaji

25263

M 27

H Veg

Married

Labour Poor No Tikshnagni

Mridu

Vata-Kaphaja

Tobacocheuing

1 PNS

38 22 LeftLateral

4 Veeresh. S.Shetter

25266

M 45

H Mixed

Married

Driver Poor No Samagni

Krura Pitta-Kaphaja

Tobacocheuing,Smoking&Alcohalic

1 PNS

47 36 RightLateral &Downward

5 Sanjana

25268

F 21

H Veg

Unmarried

Student Poor No Samagni

Mridu

Vataja

No 1 PNS

9 7 RightLateral &Upward

6 Faizal 25343

M 21

M Mixed

Unmarried

Student UpperMiddleclass

No Vismagni

Madhyama

Vata-Pittaja

No 1 PAS

16 6 Upward &Medial

7 VishwanathH.

25370

M 40

H Veg

Married

Driver Poor No Tikshnagni

Madhyama

Pitta-Kaphaja

Smoking&Alcohalic

1 A 23 1 Medial

8 KritiVardhanRoy

26630

M 26

H Mixed

Unmarried


No Samagni

Madhyama

Vata-Pittaja

Tobacocheuing

1 PAS

59 30 Foreward

9 NoorBegaum

26690

F 32

M Mixed

Married

HouseMaker

Poor No Samagni

Madhyama

Pitta-Kaphaja

No 1 PAS

42 24 Medial

1 Maula 26 M 4 M Mi Ma Busine Low Sin Sama Madh Vata Toba 1 PA 56 32 Fore

ANNEXURE

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADIVARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page X

0 HusainS.

897

0 xed rried

ss erMiddleclass

us gni yama -Kaphaja

cocheuing,Smoking&Alcohalic

S ward&Medial

11

Mardan SabTalkal

26940

M 32

H Mixed

Married

Business

UpperMiddleclass

No Vismagni

Madhyama

Pitta-Kaphaja

No 1 PNS

26 11 RightLateral

12

SahebAkhter

27078

M 24

M Mixed

Unmarried

Employee

LowerMiddleclass

No Samagni

Mridu

Vata-Kaphaja

No 1 PAS

36 12 Upward &Medial

13

Md.Hamid

27105

M 26

M Mixed

Married

Labour Poor Leprocy

Tikshnagni

Krura Pitta-Kaphaja

Tobacocheuing,Smoking

1 PNS

36 26 Downward

14

Satyaprakash

27138

M 24

H Veg

Unmarried

Student Poor No Mandagni

Mridu

Sanipataja

No 1 PAS

48 28 upward,Medial &Foreward

15

BasilMahajan

27140

M 31

H Mixed

Married

Clerk LowerMiddleclass

No Samagni

Madhyama

Vata-Pittaja

No 1 PAS

27 12 Downward &Medial

MASTER CHART (DEMOGRAPHY) IN GROUP 'B'

Sl.No.

NameofPatients

0PDNo.

Sex

Age

Religion

DietPattern

MaritalStatus

Occupation

Socio-economicStatus

FamilyHistory

Agni Kostha

Prakriti

Vyasana

No.ofopening

PositionorSite

InitialLengthinmm

Chronicity inmonth

Direction

1 ShivappaBasappa

2526

2

M 26

H Mixed

Married

Labour Poor No Smagni

Madhyama

Pitta-Kaphaja

Tobaccochewing

1 PNS

63 38 Downward

2 Rameshwer

2526

4

M 23

H Mixed

Unmarried


No Mandagni

Mridu

Vata-Kaphaja

No 1 PNS

27 22 LeftLateral &Downward

3 VenkateshKr.Swamy

2530

3

M 26

H Veg

Married

Employee

LowerMiddleclass

No Smagni

Madhyama

Pitta-Kaphaja

Alcoholic

1 PAS

33 16 RightLateral

4 SaanappaJ.Hugar

2533

7

M 46

H Mixed

Married

Business

LowerMiddle

No Smagni

Madhyama

Vata-Kaphaja

Smoking&Alco

1 PAS

37 18 Forward

ANNEXURE

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADIVARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page XI

class halic5 Sivare

ddyMulmani

2533

8

M 35

H Veg

Married

Driver Poor T.B.

Smagni

Krura Pitta-Kaphaja

Tobaccochewing,Smoking&Alcoholic

1 PAS

24 10 Upward

6 MaulaHusainS.

2533

9

M 55

M Mixed

Married

Business

UpperMiddleclass

No Mandagni

Madhyama

Vata-Pittaja

No 1 PAS

42 24 Forward &Medial

7 HanumanthappaN.

2536

9

M 30

H Veg

Married

Employee

LowerMiddleclass

No Tikshnagni

Madhyama

Vata-Kaphaja

No 1 PAS


8 AbdulRashid

2537

9

M 22

M Mixed

Unmarried

Student Poor Fistula

Vismagni

Madhyama

Vata-Pittaja

No 1 PNS

36 26 rightLateral &Downward

9 Hamanth D.

2662

8

M 33

H Veg

Married


Madhyama

Sanipataja

Tobacochewing,Smoking

1 PAS


10

GagappaBelbanki

2689

6

M 45

H Mixed

Married


Madhyama

Vata-Kaphaja

Tobacocheuing,Smoking&Alcohalic

1 A 29 2 Upward &Medial

11

PratikBadiger

2707

7

M 26

H Mixed

Unmarried

Student Poor No Smagni

Madhyama

Vata-Pittaja

No 1 PAS

54 30 Forward

12

MansiKulkarni

2708

5

F 22

H Veg

Unmarried

Clerk Rich No Tikshnagni

Mridu

Vataja

No 1 PNS

11 5 Upward

13

MaheshSalgar

2708

6

M 31

H Mixed

Married

Driver Poor No Mandagni

Madhyama

Vata-Kaphaja

Smoking&Alcohalic

1 PNS

43 32 RightLateral &Downward

14

NasrinTavargeri

2710

6

F 21

M Mixed

Unmarried


No Smagni

Madhyama

Pitta-Kaphaja

No 1 PNS

21 11 Downward

15

Md.AbirRashid

2713

9

M 21

M Mixed

Unmarried


No Smagni

Krura Pitta-Kaphaja

No 1 I 18 10 Downward &Medial

ANNEXURE

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADIVARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page XII

MASTER CHART (PARAMETER) IN GROUP 'A'

SLNO..

LENGTH DISCHARGE SURROUNDINGSKIN

TENDERNESS TEMPERATURE PAIN BURNINGSENSATION

IITCHING

BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF1 31 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0

2 35 0 0 3 0 0 3 0 0 1 0 0 1 0 0 3 0 0 1 0 0 1 0 0

3 38 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0

4 47 8 6 2 1 1 2 1 1 1 1 1 0 0 0 2 1 1 0 0 0 1 1 0

5 9 0 0 0 0 0 1 0 0 1 0 0 0 0 0 2 0 0 1 0 0 0 0 0

6 16 0 0 1 0 0 0 0 0 1 0 0 1 0 0 2 0 0 1 0 0 1 0 0

7 23 0 0 3 0 0 3 0 0 1 0 0 1 0 0 3 0 0 1 0 0 0 0 0

8 59 21 20 2 2 2 3 3 3 1 1 1 1 1 1 3 3 3 1 1 1 1 1 1

9 42 2 0 1 0 0 2 1 0 1 1 0 0 0 0 1 0 0 1 0 0 1 1 0

10 56 18 16 2 1 1 3 2 2 1 1 1 0 0 0 2 1 1 1 1 1 1 1 1

11 26 0 0 2 0 0 1 0 0 1 0 0 1 0 0 2 0 0 0 0 0 1 0 0

12 36 0 0 1 0 0 2 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0

13 36 2 0 2 0 0 1 1 0 1 1 0 1 1 0 1 0 0 1 0 0 0 0 0

14 48 12 10 1 1 1 2 2 1 1 1 1 1 1 0 3 2 2 1 1 0 1 1 1

15 27 0 0 1 0 0 1 0 0 1 0 0 0 0 0 2 0 0 1 0 0 1 0 0

ANNEXURE

“A CLINICAL COMPARATIVE STUDY ON EFFICACY OF GHONTA PHALADI VARTI AND ARAGVADHADIVARTI IN THE MANAGEMENT OF NADI VRANA W.S.R. SINUS” Page XIII

MASTER CHART (PARAMETER) IN GROUP 'B'

SLNO.

LENGTH DISCHARGE SURROUNDINGSKIN

TENDERNESS TEMPERATURE PAIN BURNINGSENSATION

IITCHING

BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF BT AT AF1 63 31 30 2 2 2 2 1 1 1 1 1 1 1 1 2 2 2 1 1 1 0 0 0

2 27 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0

3 33 0 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 0 1 0 0 1 1 0

4 37 9 8 1 1 0 2 1 0 1 1 1 0 0 0 2 1 1 1 0 0 0 0 0

5 24 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0 1 0 0

6 42 12 10 1 1 1 2 2 2 1 1 1 0 0 0 3 2 2 1 1 1 0 0 0

7 38 9 8 1 1 1 2 1 1 1 1 1 0 0 0 1 1 1 0 0 0 1 1 1

8 36 7 6 1 0 1 1 1 0 1 1 1 0 0 0 1 1 1 1 1 0 1 1 0

9 47 19 18 2 1 1 2 2 1 1 1 1 1 1 0 3 3 3 1 1 0 1 1 1

10 29 0 0 3 0 0 3 1 0 1 0 0 1 0 0 2 0 0 1 0 0 1 0 0

11 54 25 25 1 1 1 3 3 3 1 1 1 1 1 1 3 3 3 0 0 0 1 1 1

12 11 0 0 0 0 0 1 0 0 1 0 0 1 0 0 2 0 0 0 0 0 0 0 0

13 43 15 15 2 1 2 2 1 1 1 1 1 0 0 0 2 1 1 1 1 1 1 1 1

14 21 0 0 1 0 0 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0

15 18 0 0 1 0 0 0 0 0 1 0 0 0 0 0 2 0 0 0 0 0 1 0 0

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