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  Table of Contents  
CASE STUDY
Year : 2014  |  Volume : 35  |  Issue : 2  |  Page : 175-178  

Topical application of Katupila (Securinega leucopyrus) in Dushta Vrana (chronic wound) showing excellent healing effect: A case study


1 Maharshi Hospital, Mount Lavinia, Colombo, Sri Lanka
2 Department of Shalyatantra, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Web Publication5-Dec-2014

Correspondence Address:
Tukaram S Dudhamal
Assistant Professor, Department of Shalyatantra, I.P.G.T. and R.A., Gujarat Ayurved University, Jamnagar - 361 008, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-8520.146238

Clinical trial registration CTRI/2013/09/004020

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   Abstract 

Securinega leucopyrus (Willd.) Muell. is known as Humari in India, Katupila in Sri Lanka and Spinous fluggea in English. It is a desert climatic plant used topically in paste form for healing of chronic and non-healing wounds. Application of Katupila Kalka (paste) is used commonly in the management of acute as well as chronic wounds in Sri Lanka as a folklore medicine. The aim of this study is to evaluate the role of herbal paste of Katupila in the treatment of Dushta Vrana (chronic wound). It is a single observational innovative case study. A female aged 40 years presented with a non-healing infected wound on her right buttock with a history of 2 months. On examination, there was a rounded wound having black color necrosed tissue and slough with foul smelling, measuring about 3 inch Χ 3 inch Χ 1 inch in diameter caused by pyogenic local infection. The routine laboratory investigations were within normal limit except hemoglobin and the swab culture test of the wound bed was reported infection of Staphylococcus aureus. This case study showed effective wound healing by topical application of Katupila paste and sesame oil.

Keywords: Dushta Vrana, Humari, Katupila, Securinega leucopyrus, wounds


How to cite this article:
Ajmeer AS, Dudhamal TS, Gupta SK, Mahanta V. Topical application of Katupila (Securinega leucopyrus) in Dushta Vrana (chronic wound) showing excellent healing effect: A case study. AYU 2014;35:175-8

How to cite this URL:
Ajmeer AS, Dudhamal TS, Gupta SK, Mahanta V. Topical application of Katupila (Securinega leucopyrus) in Dushta Vrana (chronic wound) showing excellent healing effect: A case study. AYU [serial online] 2014 [cited 2020 Apr 4];35:175-8. Available from: http://www.ayujournal.org/text.asp?2014/35/2/175/146238


   Introduction Top


Sushruta has described 60 measures for the comprehensive management of Vrana (wound), which includes local as well as the systematic use of different drugs and treatment modalities under a dedicated chapter. In the treatment of Vrana, Sushruta mentioned the Dushta Vrana (chronic wounds), which is difficult to heal. [1] Dushta is one in which there is localization of three Dosha. Vrana, which had a bad odor, has abnormal color, with profuse discharge, intense pain and takes a long period to heal. Dushta Vrana is a long standing ulcer where removing debris enabling drug to reach healthy tissue is more important. In Ayurveda Dushta Vrana are treated effectively by Ghrita and Taila preparations. Among Ghrita - Karpuradi, Manjisthadi and Karanjadi; while in Taila - Jatyadi, Pilu, Durvadi, Asthishrinkala showed effective in wound healing. [2]

Securinega leucopyrus (Willd.) Muell is known as Humari in India, Katupila in Sri Lanka and spinous fluggea in English [Figure 1]. It is a desert climatic plant used topically in paste form for healing of chronic and non-healing wounds. The healing process becomes diminished in chronic wounds due to reduced tissue regeneration, angiogenesis and neurological problem. [3] There are so many research works have been carried out for the management of chronic and non-healing wounds, but still it is a big confront for the medical professionals to deal this problem comprehensively. [4],[5],[6] In search of an effective herbal preparation Katupila paste tried in this case and showed effective in healing of chronic wound. Pharmacognostical study of Katupila powder shows the presence of calcium oxalate crystals, large amount of tannin and oil helpful in the treatment of cuts and wounds. [7]
Figure 1: Shrub Katupila / Humari (Securinega leucopyrus)

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   Case Report Top


A female patient, aged about 40 years, presented with non-healing chronic wound on the right buttock since 2 months in the Outdoor Patient Department (OPD) of Shalya Tantra. Patient was thoroughly examined locally as well as systematically. The local findings revealed a foul smelling deep wound, having fixed and black slough area, around, that is, 3 inch × 3 inch × 1 inch. The culture swab report of the wound was done, and it reported the presence of Staphylococcus aureus infection. All the other laboratory findings were found to be within normal limits except hemoglobin level, which was 8 g %. Patient gave a history that she had taken treatment for wound since last 1 month with dressing by antiseptic solution, but there was no improvement in the wound. No any major systemic disease or surgery reported by the patient.

Diagnosis

This chronic wound was diagnosed as trophic ulcer because the ulcer was located at buttock region having less blood supply and pressure point during sitting posture. This type of ulcer can also be correlated with pressure ulcer.

Intervention

Local dressing of wound by Katupila powder mixed with sesame oil was carried out.

The wound was cleaned with decoction of Panchavalkala. The dried leaf powder of Katupila mixed with sesame oil was applied on wound once daily. The Katupila dressing was continued until complete healing achieved and the result was assessed at regular intervals. Along with local dressing; capsule of hematinic drug composed of vitamin B-12, Ferrous Fumarate, vitamin C and Folic acid was administered orally once a day for 30 days.

Observations

The characteristics of Dushta Vrana like Ativivrita (broad base), Bhairava (ugly look), Putipuyamansa (pus discharge), Durgandha (foul smell), Vedana (pain), Dirghakalanubandhi (chronic) were noted in the wound [Figure 2]. There was deep seated blackish slough at the base of the wound and which was hard to remove initially. The wound was cleaned daily with Panchawalkala Kwatha and then the paste made up of dried leaves powder of Katupila with sesame oil was applied in adequate quantity [Figure 3]. Wound was bandaged after covering with sterilized gauze and cotton pads.
Figure 2: Dushta vrana (infected non-healing wound) at left buttock on 1st day of treatment

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Figure 3: After application of Securinega leucopyrus paste

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It was noted that the deep seated slough, which was hard to remove, started to dissolve from the base and wound became clean and healthy on 4 th day [Figure 4]. The healing was started with the formation of healthy granulation tissue. The margin of wound became bluish showing growing epithelium. The wound started to contract by filling of tissue from the base of wound day by day. The Katupila dressing was continued, and on 21 st day, it was observed that wound size was markedly reduced with normal skin coloration at the healed area [Figure 5]. On the 35 th day, the wound was healed completely with minimum scar tissue formation [Figure 6]. After completion of a month, the hemoglobin was increased and became 10 g %.
Figure 4: Status of wound on the 4th day of treatment

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Figure 5: Wound status on the 21 day after treatment

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Figure 6: Complete healed wound with minimum scar on the 35th day

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   Discussion Top


According to Acharya Sushruta, among the 60 measures of comprehensive wound management, Kalka (paste) is indicated in cases of chronic wound, which is full of slough, deep seated in muscle and reluctant to heal. [8] The paste performs both the functions of Shodhana (cleansing) and Ropana (healing) in cases of Dushta Vrana. Extracts of the Katupila leaves exhibited a broad spectrum antimicrobial activity, which is an important requirement of wound healing by controlling and reducing the microbial load. [9],[10] In this case, the black slough removed on 4 th day without surgical debridement because Katupila has Kashaya Rasa (astringent taste), which exerted Lekhana (scraping) action that helped in removing slough and prepared the wound bed for healing. [11] Wound became clean with healthy granulation on 21 st day as Katupila is having the ability to disinfect and destroy the micro-organisms in cases of sores acted as a disinfectant and promoted excellent healing. [12]

Signs and symptoms such as pain, discharge, discoloration, bad odor, etc., are considered due to active involvement of Tridosha. The Tikta Rasa (bitter taste) of the Katupila and Snigdha Guna of sesame oil pacified the vitiated Doshas, rendered relief in pain, discharge which were proven helpful in the healing process of wound. [13] All those properties of drug assisted in cleaning the wound and helped to inhibit the growth of micro-organisms. Another property of Katupila is antioxidant activity due to the presence of some flavanoids and tannins in abundant quantity. Tanin is supposed to be having wound healing property, which helped in wound healing. [14] It acted as scavenger and probably helped to remove free radicals as well as inhibited further generation of free radicals. [15],[16] Patient was anemic at the first consultation; systemic use of hemainic capsule had also played an important role to increase hemoglobin level and general condition of the patient. Anemia is one of cause for non-healing of wound so improving hemoglobin level by hematanic ultimately promoted wound healing. The hemoglobin in the blood circulation nourishes the newly generated cell. [17] It is supposed to be the systemic effect of Hematinic drug and local effect of Katupila for wound healing.

After application of the Katupila paste the wound became clean and free from slough and foul smell within 3 days. There was a significant increase in granulation tissue showing good healing effect after 15 days. The wound became contacted markedly by 21 days, and complete wound healing was observed by 35 days (5 weeks). After wound healing, there was little formation of scar tissue with noticeable pigmentation. There were no any adverse events noted throughout the treatment and healing occurred uneventfully. The dressing of Katupila in chronic wound is found to be cost-effective, safe, and easy to implement.


   Conclusion Top


This single case study highlighted the topical application of Katupila (S. leucopyrus [Willd.]). Muell paste with sesame oil was found very effective and shown excellent healing effect in a case of chronic and nonhealing wounds.


   Acknowledgments Top


The authors acknowledge Prof. M. S. Baghel - Director, IPGT and RA, GAU, Jamnagar for motivation and kind support.

 
   References Top

1.
Sushruta. Susrutha Samhitha, Sutra Sthana, Krutyakrutavidhi Adhyaya, 23/7, edited by Shastri A, 12 th ed. Chaukhambha Sanskrita Sansthan, Varanasi, 2001; 98.  Back to cited text no. 1
    
2.
Sathish HS, Baghel MS, Bhuyan C, Gupta SK, Dudhamal TS. Review of clinical observational studies conducted on tissue healing at I.P.G.T. and R.A., Jamnagar. International Journal of Research in Ayurveda and Pharmacy 2011; 2 (1):13-17. Available on http://www.ijrap.net/admin/php/uploads/352_pdf.pdf [Last accessed on 2013 May 06].  Back to cited text no. 2
    
3.
P. Ronan O′Connell, Norman Williams, Christopher Bulstrode. Wound tissue repair and scars. Bailey and Love′s Short Practice of Surgery. 25 th ed. Landon: Adward Arnold Publishers Ltd.; 2008. pp. 24-31.  Back to cited text no. 3
    
4.
Datta HS, Mitra SK, Patwardhan B. Wound healing activity of topical application forms based on Ayurveda. Evid Based Complement Alternat Med 2011;2011:134378.  Back to cited text no. 4
    
5.
Dudhamal TS, Gupta SK, Bhuyan C. Role of honey (Madhu) in the management of wounds (Dushta Vrana). Int J Ayurveda Res 2010;1:271-3.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.
Vijaya KK, Nishteswar K. Wound healing activity of honey: A pilot study. Ayu 2012;33:374-7.  Back to cited text no. 6
    
7.
Ajmeer AS, Harisha CR, Dudhamal TS, Gupta SK. Micromorphological and micrometric evaluation of Securinega leucopyrus (Willd.) Muell. Leaf and stem-unexplored drug. Int J Sci Invent Today 2013;2:140-9.  Back to cited text no. 7
    
8.
Sushruta, Susrutha Samhitha, Chikitas Sthana, Dwivraniya Adhyaya, 1/55, edited by Yadavji Trikamji Acharya, 12 th ed. Chaukhambha Sanskrita Sansthan, Varanasi, 2001; 8.  Back to cited text no. 8
    
9.
Bakshu LM, Jeevan Ram A, Venkata Raju R. Antimicrobial activity of Securinega leucopyrus. Fitoterapia 2001;72:930-3.  Back to cited text no. 9
    
10.
Santhapu H. Plants of Saurashtra A Preliminary List. Humari (Securinega leucopyrus) Rajkot: S.J.F.N.I Saurashtra Research Society; 1953.  Back to cited text no. 10
    
11.
Bhavamishra, Bhavprakasha, Part-1, Mishraprakaranam, 6/192, edited by Pandit Mishra BS, Vaisya SR, 11 th ed. Chaukhambha Sanskrit Bhawan, Varanasi, 2007; 187.  Back to cited text no. 11
    
12.
Paanduraphali- Securinega leucopyrus. Available from: https://www.groups.google.com/group/bodhi-nighantu/browse_thread/thread/ce052aa26c217fb6. [Last accessed on 2013 May 08]  Back to cited text no. 12
    
13.
Sushruta, Susrutha Samhitha, Sutra Sthana, DravadravyaVidhi Adhyaya 45/112, edited by Yadavji Trikamji Acharya, 12 th ed. Chaukhambha Sanskrita Sansthan, Varanasi, 2001; 178.  Back to cited text no. 13
    
14.
Li K, Diao Y, Zhang H, Wang S, Zhang Z, Yu B, et al. Tannin extracts from immature fruits of Terminalia chebula Fructus Retz. promote cutaneous wound healing in rats. BMC Complement Altern Med 2011;11:86.  Back to cited text no. 14
    
15.
Vidyadhar S, Sheela T, Reddy LS, Gopal TK, Chamundeeswari D, Saidulu A, Reddy CU. In vitro antioxidant activity of chloroform extract of aerial parts of Securinega leucopyrus (Willd.) Muell. Der Pharmacia Lettre 2010;2(6):252-56. Available from: http://www.scholarsresearchlibrary.com. [Last accessed on 2013 May 08]  Back to cited text no. 15
    
16.
Megha G. In-vitro anti-arthritic activity of aerial parts of Securinega leucopyrus (Willd) Muell, Euphorbiaceae SRMC and RI, Porur PT-066. Available from: http://www.jsscpooty.org/assets/pdf/Selected-List-Category-C.pdf. [Last accessed on 2013 Mar 30].  Back to cited text no. 16
    
17.
Plock JA, Rafatmehr N, Sinovcic D, Schnider J, Sakai H, Tsuchida E, et al. Hemoglobin vesicles improve wound healing and tissue survival in critically ischemic skin in mice. Am J Physiol Heart Circ Physiol 2009;297:H905-10.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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