An Open Label Single Arm Clinical Study to Evaluate the effect of Kankshi Jala Prakshalana in Dushtavrana

Acharya Susruta has emphasised Dushtavrana while presenting the definition of Shalyatantra. **“Vrana Gaatra Vichurnane Vranayateeti Vrana|”**Vrana denotes wound, Gaatra denotes body tissue or part of the body, and Vichurnane denotes breakdown / discontinuity / destruction / rupture. The prevalence of the disease in an Indian epidemiological study states that, the chronic ulcer has the prevalence rate of 4.5/1000 population.

 Taking the Lakshana into consideration Vrana can be classified into Shuddhavranaand Dustavrana. Doshas and Dushyas that have accumulated excessively and been vitiated transform Shuddhavrana into Dustavrana.The Dustavranahas the clinical features like excessive discharge, foul smell, pain, itching, delayed wound healing etc. A healthy wound in a healthy body heals more quickly and leaves fewer scars than a wound that has been contaminated. There are 4 phases of wound healing, however prolonged cessation or slowdown of healing in any one of these phases cause the wound to become chronic, which can be correlated with Dustavrana that is delayed healing of the Vrana due to vitiated Dosha. Kankshi is one of the Uparasa which is used for Shodhana and Ropana of the Vrana as per Rasatarangini Rasaratnasamucchaya, and Ayurveda Prakasha.Nimba is known for its Krimighna and also Vranagna property.  Acharya Susruta has specified Shasti Upakrama for Dustavrana, including Alepa, Kashaya, Varti, kalka, Taila, Rasakriya etc. Among which Alepais the 2nd upakrama. Acharya Vargbhata, has mentioned Prakshalana, Alepa, Ghrita, Taila, Rasakriya, Churna, and Varti as the Dustavrana Saptavidha Chikitsa, of which the first and second    upakramas are Prakshalana and Alepa. Among various procedures explained Prakshalana and Lepaare economical, easy for the preparation, application and can be performed in outpatient department. The non-healing ulcer generally generates unpleasant symptoms which includes intense pain, exudates, and malodour that can also disrupt day-to-day causing social stigma. Thus, it is necessary to find a solution to overcome these factors. Hence this is an attempt to methodically evaluate the impact of Prakshalana by Kankshijala followed      by Nimbapatra lepa in Dustavrana.