Management of Burn Wound in Diabetic Old Patient with Panchagavya Formulations – A Case Report

ABSTRACT

Burn injuries are often prevalent and among the most catastrophic injuries encountered in casualty or surgery departments, involving skin and other tissues. These injuries typically result from heat sources such as solids, liquids, or fire, while scalds arise from hot liquids, electricity, chemicals, cold, friction, or radiation. Despite varying causes, the male-female ratio of burn cases remains consistent. In India, the annual incidence of burns is estimated at six to seven million. Topical antimicrobial agents are crucial for treatment. This case study focuses on an 83-year-old woman with acute burn wounds on her right leg and abdomen, accompanied by pain, discharge, foul odor, edema, and skin discoloration. Treatment involved Panchagavya Chikitsa, utilizing local applications of Gomutra twice daily for wound cleaning and Jatyadi Ghrita twice daily for wound healing over 60 days. Additionally, 15 ml of Gomutra Arka was administered internally twice daily for 15 days. Significant improvements were observed, including complete wound healing and associated symptom resolution. The positive outcomes may be attributed to the local and systemic effects of Gomutra, Jatyadi Ghrita, and Gomutra Arka, which possess antimicrobial, antiseptic, scrapping, and wound-healing properties. The findings suggest that Panchagavya formulations effectively and safely manage burn wounds, even in geriatric patients. Jatyadi Ghrita and Gomutra demonstrated promising results without causing adverse effects in this case.

INTRODUCTION

Burn injuries present significant challenges due to their potential for severe morbidity and mortality. They trigger immune responses, metabolic changes, and distributive shock, which is particularly problematic in geriatric patients with compromised immunity and physical strength. These injuries impact physical health, emotional well-being, and quality of life. Diabetes mellitus exacerbates these challenges, leading to slow wound healing and complications like chronic non-healing ulcers, often neglected in diabetic patients, potentially necessitating amputation. Identifying burn severity based on depth and duration is crucial for effective treatment.[1]

As outlined by Sushruta, treatment approaches emphasize a comprehensive 60-step process to manage thermal injuries, aiming to accelerate healing and preserve tissue function and appearance. Ayurvedic therapies, predominantly plant-based, play a crucial role in wound healing, supported by mineral and animal-based treatments.[2] This case highlights the effectiveness of Panchagavya Chikitsa, utilizing animal-derived medicines, in managing burn wounds in elderly patients.

PATIENT’S INFORMATION

An 83-year-old female presented with significant symptoms related to burn wounds on her right thigh and abdomen over the course of three months. She endured severe pain (rated 3+), persisting for 45 days, accompanied by a burning sensation (rated 3+) and edema (rated 2+) for the same duration. The wound site was tender (rated 3+) for 45 days, with blackish discoloration and foul odor (rated 2+) present for 15 days. Itching (rated 2+) also persisted for 15 days. Associated symptoms included mild nausea, fatigue, and a mild fever, each lasting 15 days.

PROGRESS OF DISEASE

The patient was in good health until one and a half months ago, when she suffered a severe acute burn injury from hot, boiling water used for vaporization. This caused scalds (blisters) and intense burning, hindering her ability to walk and sit. Despite being an insulin-dependent diabetic, her blood sugar levels spiked due to the burn injury. Treatment included oral antibiotics (Moxclav BD), analgesics, and anti-inflammatory drugs (serratiopeptidase and diclofenac sodium) for 15 days. A general surgeon drained serum from the blisters, causing the skin to adhere to the wound, leading to sepsis exacerbated by her diabetes. Later, the burned skin was surgically removed, leaving the wound open. Persistent infection necessitated high-potency antibiotics, resulting in nausea, fatigue, fever, increased slough, and a foul odor. Consequently, skin grafting was recommended after one and a half months. The progression of the disease is depicted in Image 1.

Image 1.

Status of local examination of the patient before treatment

PATIENT’S HISTORY

The patient has a 35-year history of diabetes mellitus on insulin therapy and hypertension, with no history of trauma or tuberculosis. Her family history includes diabetes, hypertension, ischemic heart disease, and osteoarthritis. She follows a vegetarian diet, consumes oily and sweet foods despite her diabetes, experiences interrupted sleep due to pain, has no addictions, and has reached menopause.

EXAMINATIONS

Local examination [Image 2] showed open, irregular-shaped second-degree burn wounds on the anterior right thigh (30,152 cm) and abdomen (1,572 cm). The classic signs of Vrana included edema, blackish skin discoloration, a raw base, and crust formation. There was a profuse blackish-yellowish slough, initial difficulty in removal, tenderness near the lesion, elevated local temperature, and surrounding indurations. No varicosity was observed in any limb.

Image 2.

Wound progress during and after treatment

Diagnosis

The identified burn wound was second-degree partial-thickness burns.

THERAPEUTIC INTERVENTION

The treatment involved twice-daily local applications of Gomutra Dhawan, Jatyadi Ghrita (post Gomutra Dhawan and bandaging), and Chandanadi Yamak for 60 days, along with internal administration of Gomutra Arka with warm water for 15 days.

Therapeutic outcome

Initially, the patient experienced severe pain ((visual analog scale) VAS 3+), burning sensation (3+), tenderness (3+), severe serous discharge, foul smell (2+), and itching (2+). By the 15^th day, pain reduced to 2+, burning sensation to 1+, tenderness to 1+, and foul smell and itching were absent. By the 60^th day, all symptoms were absent.

The wound size initially measured 30,152 cm on the right thigh and 1,572 cm on the abdomen. After 15 days, it was reduced to 1,572 cm and 2.851 cm, respectively. By the 60^th day, no wounds remained. The initial profuse serous discharge stopped by day 15, with crust formation and complete healing by day 60. Significant edema was present initially, minimal by day 15, and absent by day 60. The wound base transitioned from red and raw to pinkish-white skin without contractions, as shown in Image 2.

DISCUSSION

Jatyadi Ghrita is a renowned Ayurvedic ghee-based formulation used externally to treat cuts, ulcers, insect bites, burns, and deep wounds. According to Ashtanga Hrudayam Uttarasthana 25/67, it contains Neemba (Azadirachta indica) and Haridra (Curcuma longa), known for their antimicrobial properties.[3] It incorporates Manjistha and Karanja for their documented wound cleansing abilities[4] and Naktahva (Pongamia pinnata) for antioxidant benefits and wound healing.[5] Jati, Patola, and Sikta contribute to its wound-healing actions, while Kushta (Saussurea lappa) provides anti-inflammatory effects.[6] Madhuka (Glycyrrhiza glabra) soothes and heals skin lesions, and Nymphaea stellata offers astringent and antiseptic properties. In Jatyadi Ghrita (JG), Tuttha (copper sulfate) promotes Vascular endothelial growth factor (VEGF) expression in wounds.[7]

Jatyadi Ghrita promotes antimicrobial, antioxidant, and anti-inflammatory properties, facilitating re-epithelialization, neovascularization, and cell migration in wounds. Its lipophilic composition in Chandanadi Yamak enhances drug penetration, prevents dry eschar formation, and reduces discomfort. Cow urine in Panchgavya, used internally and externally as Ark Kalpana, aids wound healing by clearing debris, promoting collagen development, and enhancing wound contraction and granulation tissue formation, which is particularly beneficial for diabetic wounds.[8] Patented for its bio-enhancing and therapeutic properties,[9] cow urine accelerates wound healing by stimulating neovascularization and fibroblast proliferation.

CONCLUSION

This case study demonstrates that dressing burn wounds with Chandanadi Yamaka and Jatyadi Ghrita, preceded by regular Gomutra washing and internal Gomutra Arka administration, promotes effective and rapid healing without post-healing complications. Panchagavya Chikitsa is cost-effective, safe, and easily implemented at the Out patient department (OPD) level for geriatric diabetic patients. Future studies with larger samples are anticipated.

Conflicts of interest

Nil.

Funding Statement

Nil.