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Abstract
Introduction- Wound management is a critical aspect of surgical and clinical care, directly influencing
patient recovery and overall prognosis. Improper wound care can lead to chronic wounds, termed as
Dushta Vrana in Ayurveda. While conventional treatments focus on antimicrobial agents and surgical
debridement, there is growing interest in exploring traditional Ayurvedic therapies to enhance wound
healing. This study aims to evaluate the clinical efficacy of Nimb Haridra Tail Pichu (sterile gauze
impregnated with medicated herbal oil) locally, in managing Dushta Vrana. This research seeks to
provide scientific validation for its therapeutic potential in chronic wound management
Methods- A total of 30 patients diagnosed with Dushta Vrana were enrolled in this study. Nimb Haridra
Tail (medicated oil by Sneh Siddhi method) was prepared and impregnated to sterile gauze (Pichu).
Proper wound cleaning followed by sterile dressing was done on alternate day and the observations were
recorded respectively. Subjective (pain, itching) and objective (tenderness, size, smell, discharge,
granulation) parameters were assessed for wound healing using Wilcoxon Signed Rank Test for statistical
analysis.
Results- Significant clinical improvement was observed, with 66.0% of patients completely cured, 23.0%
markedly improved, 7 % moderately improved, while remaining 4% showed no improvement. The P-
value for all parameters was <0.001, indicated a highly significant effect of the treatment.
Discussion- Nimb Haridra Tail Pichu demonstrated remarkable wound-healing properties, including
Shodhana (cleansing), Ropana (healing), Vedana-sthapana (pain relief), and Shoth-har (anti-
inflammatory) effect. This study highlights the therapeutic potential of Nimba Haridra Tail Pichu in
managing Dushta Vrana (infected non-healing wounds), demonstrating its efficacy, safety, and cost-
effectiveness as a treatment alternative.
Keywords- Dushta Vrana, Nimb, Haridra, Wound Healing, Ayurvedic wound management
P
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INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding author: Dr.Dwivedi Amarprakash
Article Info: Published on : 15/04/2025
Impact Factor : 1.013
Management Of Dushta Vrana By Nimb Haridra Tail Pichu- A Case Study
Dr. Dwivedi Amarprakash
1
1
Professor , Dept. of Shalya Tantra,School of Ayurveda , D.Y.Patil Deemed to be University, Navi Mumbai,
Maharashtra , Bharat.
Cite this article as: - Dr.Dwivedi Amarprakash (2025) ; Management Of Dushta Vrana By Nimb Haridra Tail Pichu- A Case
Study ;Inter.J.Dignostics and Research 2 (3) 32-38, DOI : 1 0 . 5 2 8 1 / z e n o d o . 1 5 1 9 3 303
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Introduction:
The challenge of delayed wound healing has persisted
throughout human history and continues to be a
significant concern in modern medicine. Wounds can
arise from various traumatic events, including falls,
burns, and interpersonal conflicts. The process of
injury and subsequent healing is an inherent biological
function. Wound healing involves a complex interplay
of vascular and cellular responses. The vascular phase
includes transient vasoconstriction followed by
sustained vasodilation of arterioles, capillaries, and
venules, whereas the cellular response is characterized
by histiocyte activation, macrophage proliferation, and
leukocyte migration to the site of injury. The failure of
this coordinated physiological response leads to
chronic wound formation. Several intrinsic and
extrinsic factors influence wound healing, including
anatomical location, microbial contamination,
vascular insufficiency, radiation exposure, and
systemic conditions such as diabetes mellitus,
tuberculosis, immune deficiencies, and prolonged
corticosteroid therapy. These factors contribute to
delayed tissue repair, increasing the risk of wound
chronicity
[1]
.Comprehensive description of wounds
and management are documented in the classical
ayurvedic text of Sushruta Samhita. The scripture
provides a systematic classification, etiopathogenesis
and treatment modalities for wound management.
Acharya Sushruta has defined Vrana as an entity
which causes the destruction, rupture, or discontinuity
of body tissues leaving a permanent scar after
complete healing
[2]
.Further, acute traumatic wounds
(Sadhyo Vrana) typically remain uninfected
(Shuddha) initially but may develop into Dushta
Vrana (chronic, infected wounds) due to vitiation of
Doshas and secondary contamination by extrinsic
factor. Dushta Vrana exhibits characteristic features
such as abnormal discharge, malodor, pain, and
discoloration and if left untreated then these wounds
become chronic non-healing ulcers with scarring
[3]
.
The primary objective of treating Dushta vrana is to
convert it into a Shuddha Vrana through purification
(Shodhana) and followed by wound healing (Ropana).
Acharya Sushruta advocated Shashti Upakramas
(sixty therapeutic interventions) for wound
management, including purification therapies and
external applications of herbal formulations such as
Nimb, Karanj, Panchvalkal, Yashtimadhu, Haridra,
Triphala, Shigru etc. Among these, Nimb
(Azadirachta indica) and Haridra (Curcuma Longa
Linn), are well-documented medicinal plants which
are specifically indicated for the treatment of Dushta
Vrana due to their antimicrobial, anti-inflammatory,
and wound-healing properties
[4,5]
.
This study evaluates the efficacy of Nimb Haridra
Tail Pichu as a topical application for wound
purification (Shodhana) and healing (Ropana) thus
proving its potential in the management of Dushta
Vrana.
Material And Methodology :
Study design- Single Arm, Randomized Open clinical
study
Place of Study- Concerned Shalya Tantra OPD
Affiliated to Hospital.
Inclusion Criteria-
Age groups- 20 to 50 years,
Gender- Male and Female both
All types of Chronic wounds
Post-operative infected wounds
Non healing wounds
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Exclusion Criteria -
Malignant ulcers
Tripple H Positive patients – (HIV, HBsAg,
HCV)
Wounds having bony and deep tissue
involvement
Patient with Ulcer and systemic diseases such
as Anemia, Tuberculosis, Diabetes, Leprosy
etc.
Drug and Dosage – Nimb Haridra Tail Pichu (for
local wound dressing)Wound cleansing with normal
saline followed by dressing with Nimb Haridra Tail
Pichu (sterile gauze impregnated with medicated
herbal oil) - on every alternate day till complete healing.
Collection and Preparation of Drugs :
Fresh Leaf of Nimb and wet Roots of Haridra was
collected from the Herbal Garden in campus and the
drug identification and authentication was done by
Dravya Guna Department
Drug Preparation :
The collected drugs were grinded to make Kalka i.e.
paste and Nimb Haridra Tail was obtained asper
Sneha siddhi method with standard properties
mentioned in classical Ayurvedic texts
[6]
.
Wound care method :
Dushta Vrana was cleaned properly with sterile swabs,
followed by debridement of devitalized tissues wherever
required and then area was dried by a sterile gauze
piece. Nimb Haridra Tail Pichu (sterile gauze
impregnated with medicated oil) was applied over the
wound surface according to the size of Dushta Vrana,
and bandaging was done. Similarly, dressing was
changed on alternate day till the wound healed
completely.
Assessment criteria- The assessment criteria of
wounds healing was based on the symptomatology of
Dushta Vrana described by Acharya Sushruta which
included both Subjective Parameter (Pain, Itching)
and Objective Parameters (Tenderness, Foul Smell,
Floor/Granulation, Size, Discharge). The overall
therapeutic outcome was assessed by observing
improvement in set parameters.
Table No. 1: Showing assessment parameters and
gradation score
Param
eter
Gradation
Pain
No pain
0
Mild pain which does not
interferes with daily activity
1
Moderate pain which
interferes with daily activity
2
Severe pain disabling routine
daily activity
3
Itching
No Itching
0
Mild occasional itching
1
Moderate and localized
itching
2
Severe persistent itching
3
Tender
ness
No tenderness
0
Mild tenderness on pressure
1
Moderate tenderness on
slight pressure
2
Severe tenderness and
Resists to touch
3
Smell
No smell even after removing
the wound dressing
0
Mild Malodour after
removing the wound dressing
1
Evident Malodour upon
removing the dressing
2
Evident Malodour even after
intact dressing
3
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Floor/G
ranulati
on
Skin intact or partial
thickness wound
0
Bright, beefy red; 50% to
75% of wound filled
1
Pink, &/or dull, dusky red
&/or fills < 25% of wound
2
No granulation tissue present
3
Dischar
ge
No discharge
0
Serous discharge
1
Serosanguinous discharge
2
Bloody-Purulent discharge
3
Size
No discontinuity of skin
0
Length x width <5sq cm
1
Length x width 10-5 sq cm
2
Length x width More than 10
sq cm
3
Observation :
The study observation indicate that the majority of
patients (70%) experienced Grade-3 Pain, with lower
occurrences of Grade-2 (17%), Grade-1 (7%), and
Grade-0 (7%). Itching was most commonly reported at
Grade-1 (43%), followed by Grade-3 (33%), Grade-2
(20%), and Grade-0 (3%). Tenderness was
predominantly observed at Grade-3 in 73% of cases,
with lower grades reported less frequently. No healthy
granulation (Grade-3) was observed in 77% of
patients. Smell intensity was evenly distributed
between Grade-2 and Grade-1 (30% each), while 40%
of patients reported Grade-3. Discharge Discharge
was most frequently seen at Grade-3 (63%), followed
by Grade-2 (27%) and Grade-0 (10%). In terms of
wound Size, the majority (60%) had Grade-1 wounds,
with Grade-2 (37%) and Grade-3 (3%) observed in
fewer cases. The objective and subjective parameters
and their findings are mentioned in Table 2.
Subjective parameters: The application of Nimba
Haridra Tail Pichu significantly reduced both pain
and itching in wound healing. The median pain score
dropped from 3 before treatment to 0 after treatment,
with a mean reduction from 2.5 to 0 and an overall
decrease of 89% (p < 0.001). Similarly, itching
showed a median reduction from 2 to 0, with the mean
dropping from 1.8 to 0, resulting in a 96% decrease (p
< 0.001). These highly significant findings suggest
that Nimba Haridra Tail Pichu is an effective
therapeutic agent for alleviating wound-related pain
and itching.
Objective parameters: The application of Nimba
Haridra Tail Pichu demonstrated a significant
reduction in objective wound parameters such as
tenderness and smell granulation discharge and wound
size. The median tenderness score decreased from 3
before treatment to 0 after treatment, with the mean
dropping from 2.5 to 0.2, resulting in a 92% reduction
(p < 0.001).
The median smell score reduced from 2 to 0, with the
mean decreasing from 2.1 to 0.1, showing a 94%
reduction (p < 0.001).
The median for granulation score decreased from 3
before treatment to 0 after treatment, with the mean
dropping from 2.7 to 0.1, resulting in a 96.% reduction
(p < 0.001)
The median discharge score decreased from 3 before
treatment to 0 after treatment, with the mean dropping
from 2.4 to 0.3, resulting in a 88% reduction (p <
0.001)
The median wound size score decreased from 1 before
treatment to 0 after treatment, with the mean dropping
from 1.4 to 0.4, resulting in a 71% reduction (p <
0.001). These highly significant findings suggest that
Nimba Haridra Tail Pichu effectively improves
objective wound conditions (Pain, Itching, tenderness,
Granulation, Smell, Discharge and Size of wound),
supporting its role in wound management.
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Table No. 2 – Showing therapeutic efficacy of Nimba
Haridra Tail Pichu in wound healing
Parameter
Mean
Before
Treatment
Mean
After
Treatment
Percentage
Reduction
(%)
Pain
3
0
89%
Itching
2
0
96%
Tenderness
2.5
0.2
92%
Smell
2.1
0.1
95%
Granulation
2.7
0.1
96%
Discharge
2.4
0.3
87%
Size
1.4
0.4
71%
Result :
The application of Nimba Haridra Tail Pichu
demonstrated a highly significant impact on both
subjective and objective wound healing parameters.
Patients experienced a substantial reduction in pain
and itching, with pain scores dropping by 89.0% and
itching decreasing by 96.0%, indicating its
effectiveness in alleviating wound-related discomfort.
Additionally, objective parameters such as tenderness,
smell intensity, Granulation, Discharge and wound
size showed remarkable improvement, with
reductions of 92.0%, 95.0%, 96%, 87% and 71%
respectively. These findings strongly suggest that
Nimba Haridra Tail Pichu not only accelerates wound
healing but also enhances patient comfort, making it a
promising therapeutic option in wound management.
The overall therapeutic outcomes demonstrated a
highly significant improvement, with 66.0% of
patients achieving complete recovery, 23.0% showing
marked improvement, and 7.0% experiencing
moderate improvement. Only 4.0% of patients showed
no change in their condition. The statistical analysis
confirmed the robustness of these findings, with a P-
value < 0.001 across all parameters, highlighting the
strong therapeutic efficacy of the treatment.
Discussion :
Chronic wounds pose a substantial challenge in
clinical practice, often due to microbial contamination,
poor vascularization, and systemic conditions that
impair the natural healing process. The classical
Ayurvedic approach, as outlined in Sushruta Samhita,
emphasizes the conversion of Dushta Vrana into
Shuddha Vrana through Shodhana (purification)
followed by Ropana (healing process). The findings of
this study highlight the significant therapeutic
potential of Nimba Haridra Tail Pichu in the
management of Dushta Vrana (infected non healing
wounds)
[7,8]
.
A statistically significant reduction (p < 0.001) was
observed in both subjective and objective wound
parameters, indicating improved patient outcomes.
Pain and itching, the two primary subjective
complaints, showed an 89.0% and 96.0% reduction,
respectively, signifying substantial symptomatic relief.
These findings align with the documented analgesic
and anti-inflammatory properties of Nimba
(Azadirachta indica) and Haridra (Curcuma longa),
which are known to modulate inflammatory pathways
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and enhance tissue regeneration
[9,10]
.Furthermore,
objective wound characteristics such as tenderness,
foul smell, formation of healthy granulation tissue,
reduction in discharge and wound size showed a
significant improvement which supports the
antimicrobial and wound-healing effects of the herbal
formulation precisely of Nimba and Haridra
[11]
.
These results are in concordance with previous studies
that have explored the antiseptic, antioxidant, and
tissue-regenerative roles of Nimba and Haridra. Their
bioactive compounds, including nimbidin, curcumin,
and azadirachtin, are known to promote fibroblast
proliferation, angiogenesis, and extracellular matrix
remodelling—key factors in expedited wound
contraction
[12]
.
Clinical Implications :
The integration of Nimba Haridra Tail Pichu into
wound care protocols offers a natural, cost-effective,
and safe alternative to conventional wound
management strategies. Given the minimal risk of
adverse effects, this approach can be particularly
beneficial in chronic wound cases where prolonged
antibiotic use poses risks of resistance and side
effects.
Limitations & Future Scope :
While this study provides promising evidence, certain
limitations must be acknowledged. The sample size
was limited, and long-term follow-up data on
recurrence rates were not included. Future studies
should incorporate larger randomized controlled trials
(RCTs) to validate these findings and explore
comparative efficacy with modern wound care
treatments. Additionally, histopathological and
microbiological analyses could further elucidate the
mechanisms by which Nimba Haridra Tail Pichu
facilitates healing at the cellular level.
Conclusion :
The local application of Nimba Haridra Tail Pichu in
the management of Dushta Vrana significantly
improves both subjective and objective wound
parameters. The observed reduction in pain, itching,
tenderness, foul smell, granulation, discharge, and
wound size suggests that this Ayurvedic formulation
aligns with classical wound-healing principles and
provides scientifically validated clinical benefits.
These findings reinforce the therapeutic potential of
Ayurvedic medicine in modern wound management,
warranting further exploration through clinical trials
and integrative medicine approaches.
Conflict of interest- Nil
References :
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