Comparative Study of Yashtimadhusiddha Ghrita (Glycyrrhiza glabra Medicated Ghee) and Silver Sulphadiazine Local Application in Agnidagdha Vrana Management”

ABSTRACT- In all over the world, out of all accidental death 2.10% males and 3.40% females died due to burns.  It is a major socio-economical problem related to dowry deaths, so it is necessary to study this problem with depth so taken as a study topic.

Burn is commonly met casualty in surgical wards of hospital.It occurs due to accidential spillage of hot water, oil, curry etc .Depending upon thickness of skin involved, burns are classified as 1 ^st  ,2^nd ,  3^rd  and 4^th degrees. In 1^st degree burn the skin looks red and is painful ,no blisters are seen. In 2^nd degree burn the skin is mootled, red, painful with blisters. It is further divided into superficial burn which heals by causing pigmentation and deep burn which heals by causing pigmentation and scarring. 3^rd burn is characterised by charched, insensitive,painfull skin whereas 4^th degree burn is characterised by involvement of muscles, bones,etc. Aarcharya Sushruta has mentioned plushtam dagdha characterised by discolouration and severe burning,dur dagdham  by blisters, redness, pain, etc.Hence it resembles 1^st and 2^nd burns described by modern context.Aarcharya Sushruta has mentioned the use of Yashtimadhu, Rodhra,Manjistha,Chandan siddha grita as uttam vranaropak in burn.Yashtimadhu has Dahashamak,Vedanasthapak ,Vrana-ropak properties.

 Hence I have decided to study the Dahashamak, Vrana-ropak properties of Yashtimadhu Ghrit  on burn as compared with silver sulphadiazine and to evaluate the efficacy of Yashtimadhusiddha Ghrit.

Hence there is a need to find such a therapy which gives better relief without any side or toxic effect and also natural, cost effective and easily available .hence the study was selected.

Key words - Dagdha, Yastimadhu Grita, Burn, Daha.

       

INTRODUCTION :

 Ayurveda is an applied science and time-tested health system with vast scope of trials to prove certain principles as well as therapeutic effects of the medicines, which is the need of the hour to make theAyurveda more acceptable globally.

 Ayurved Science is being practised in eight cults of “Ashtang Ayurved”. Shalya Tantra offers quicker and faster solution for diseases than other branches. Father of surgery Sushrutacharya has explained in Sushrut Samhita- Agnikarma Vidhi and Dagdha Vrana¹.  Sushruta has also explained Shit Dagdha (Frostbite) & ushana dagdha (sunburn) included in Dagdha vrana². In Ayurved burn may be grouped under four distinct heads via. 1. Plushtam 2. Dur-dagdham 3. Samyag-dagdham 4. Ati- dagdham^{3 .}

1.  Plushtam:- A burn characterized by discoloring of its seat and extreme burning and marked by absence of any vesicle or blistes⁴ is called plusta.

2. Dur Dagdha:- A burn which is characterized by eruption of large vesicle or blister and assumes a red colour and is characterized by excessive burning and of drawing pain and which suppurates and takes a long time to heal  called the Dur-dagdha (bad burn or scald).

3. Samyag Dagdham:-  A burn which is not deep (superficial) and assumes the colour of ripe tala fruit, and does not present a raised or elevated aspect and develops the preceding symptoms is called Samyag Dagdham.

4. Ati Dagdham:- A burn in which the flesh hangs down and where the veins and nerves, bones are destroyed a companied with fever burning thirst fainting and such like disturbances which leads to permanent disfigurations is called as Ati Dagdha^.

    In 1^st degree burn the skin looks red and is painful ,no blisters are seen. In 2^nd degree burn the skin is mootled, red, painful with blisters⁴.

Whereas the1st & 2^nd degree burn descried in modern science can be correlated with plushta and durdaghdha angnidagdha because it also produces the same sign and symptom.

AIM AND OBJECTIVES:

1-   To evaluate the efficacy of Yashtimadhu siddha Ghrit in burn    management for local application.

2-   To find out possibilities in combine therapy in burn patient.

DRUG REVIEW:            

  Name : Yashtimadhu

 Guna : guru, Snigdha

 Rasa : Madhur

 Vipaka  : Madhur

 Veerya : Sheet

 Modern Aspect

 English Name :Liquorice 

 Latin name         :  Glycyrrhiza glabra

 Family                : Leguminosae

 Habitat               :  Northern India

 Plant: 1. tree up to 6 feet in ht.

Other Properties: Pittashamak,vatshamak,Kaphanisarak,vedna sthapak   .

 Properties- Dahashamak,  Vranya,Shonitasthapan^3,

MATERIALAND METHODS :

The present clinical study is an open randomized comparative study. The aim of the clinical study is to assess the efficacy of prepared Yashtimadhu siddha Ghrit in burn management for local application.

Material:      1) Yashtimadhu siddha Ghrit.

                   2) Silver sulphadiazine ointment

                  3) Distilled water,Dressing material

Method:

Yashtimadhusiddha  grita was poured in a steel sterile container  containing sterile gauze piece.The container was closed with lid properly and was given for auto-claving.The auto-claved gauze pieces were used for dressing in pts of 1^st and 2^nd degree  burns after cleaning with distilled water. The Blisters if present were drained prior to the application of ghrita and ointment.

Duration: 15-30 days

Follow-up: Daily, the dressing was changed after 24 hrs.Gradations  were noted on  0,7^th,14^th,^, 21^st days.

 Before starting treatment routine investigation were done as necessary.

 Antibiotic and Analgesics were given as required.

 The patients were treated and observed, comparative study was  done in   two groups.

 1. Group 'A'(Experimental Group of 15 pts) -      patients were treated with local application of      yashtimadhu ghrit.

 2. Group 'B'(Comparative Group of 15 pts) - patients were treated with local application of silver Sulphadiazine Ointment.

 Criteria for selection of patient

(A)Inclusive Criteria-      

                                     1. Patient having 1^st and 2^nd   degree burn.

                                        2. Superficial burn (Twacha, Maunsa dagdha) .                                                                            

                                        3. Irrespective of sex and occupations.

                                        4. Age group 6yr to 65yr.

 (B) Exclusive Criteria-

 1. Patient having 3^rd and 4^th degree burn

 2. Deep burn (Sira, Snayu, Asthi, Sandhi dagdha).

  3. Diabetic, Lepromatus, HIV, HBSAG positive    patients.

  4. above 65 ages and below 6yr.age

                

Place of Work: -   SOPD    of   R A Podar Medical College worli,Mumbai  .

CRITERIA FOR ASSISMENT  :

 Subjective criteria

    I.        VEDANA(pain) by VAS scale :

a)   No pain                                  0

b)   Mild pain                                1

    c)  Moderate pain                        2

    d)  Severe pain                           3

  II.        DAHA (Burning ) :

a)   No burning                         0

b)   Mild burning                       1

c)   Moderate burning               2

d)   Severe burnig                    3

Objective criteria:

III.        Parinam(Size):

1.   Original wound                 0

2.   Healed by 25% - 50%       1

3.   Healed by 50% - 75%       2

4.   Healed by 75% - 100%     3

a)    

IV.        Vranawarna (Colour of wound) :

a)   Normal  reddish colour        0

b)   Pinkish red                         1

c)   whiten yellow colour Starting of slough formation 2             

d)   yellow slough formation   

   V.        Strava (Secretion) :

a)   No Strava                        0

b)   Alpa strava                      1

c)   Madhyam strava               2

d)   Ati strava                         3

RESULT-

1.   As per Ayurvedic text,Dagdha vrana is a common word, which is used for medicosurgical condition which is produced due to vitiated Pitta and Rakta. In such condition, Yatimadhu grita is one of the best treatments⁴.

2.   All obtained data were analyzed statistically with help of INSTAT GRAPHPAD software.

3.   By applying yastimadhu grita highly significant result were obtained in Daha with significant improvement.

4.   Highly significant results were obtained burning, regain of colour of skin,compliance with dressing, prevention of hypertrophied scar formation .

DISCUSSION: 

     30 patients were randomly selected in two groups as Yashtimadhu Ghrit    and Silver Sulfadiazine Ointment as a local application therapy. In silver sulfadiazine all patient shows good result in  wound healing process ,discharge, slough,  etc in a short duration but burning , regain of colour of skin,compliance with dressing, prevention of hypertrophied scar formation cannot be achieved in the silversulfadiazine group  whereas they were achieved in Yashtimadhusiddha Ghrit group .The  Yashitimadhusiddha Ghrit has shown less efficacy  in control of discharge, slough thus a slower healing was observed. So finally from the above observation we can conclude that Yashtimadhu Ghrit will be useful with the silversulfadyzine in the modern era.

CONCLUSION:

       This study showed the significant result of Yastimadhu grita application in dagdha vrana 1^st and 2^nd digree .

Symptoms like pain, burning and regain of colour of skin,compliance with dressing, prevention of hypertrophied scar formation reduced a lot.

ACKNOWLEDGEMENT –

I am very much thankful to Dr. K.R. Reddy, Associate Professor, Shalyatantra dept. of R.A.PODAR Medical (AYU.) College Worli for encourage and guidance to me. I am also thankful to Dr.Amrita mishra Dr Vivek,Dr Pallavi, Dr Leena  MD Scholar for moral support and valuable guidance in this project work.