AYU (An International Quarterly Journal of Research in Ayurveda)

REVIEW ARTICLE
Year
: 2021  |  Volume : 42  |  Issue : 1  |  Page : 1--18

Pharmacodynamic appraisal of wound-healing herbs of Sushruta Samhita


Vishal Kumar, Tanuja Manoj Nesari, Shivani Ghildiyal, Rahul Sherkhane 
 Department of Dravyaguna, All India Institute of Ayurveda, New Delhi, India

Correspondence Address:
Shivani Ghildiyal
Department of Dravyaguna, All India Institute of Ayurveda, Sarita Vihar, New Delhi - 110 076
India

Abstract

Background: In Sushruta Samhita, various medicinal plants as single and compound formulations having Vrana-Shodhana (wound cleansing) and Vrana-Ropana (wound healing) potential are enumerated. There are no published data available on these wound-healing medicinal plants of Sushruta Samhita. The effectivee management of wound is necessary in the immunocompromised and chronic wounds patients as they take more time to heal. Aim: To review and systematically analyze wound-healing medicinal plants and their modus-operandi on the basis of pharmacodynamics attributes, i.e., Rasa (taste), Veerya (potency), and Vipaka (biotransformation) in the various stages of healing. Materials and methods: Review of Sushruta Samhita was done to gather wound-healing medicinal plants; pharmacodynamics attributes were gatherd from various Nighantus to understand their role in wound healing. The contemporary information about wound-healing mechanism was gathered from PubMed to interpitate the rational use of plants in the various stages of wound healing. Results: The study suggests that 43 medicinal plants have Vrana-Shodhana activity, 48 have Vrana-Ropana and 62 have both Vrana-Shodhana and Vrana-Ropana potential. Medicinal plants with Vrana-Shodhana category are having predominance of Katu (pungent), Tikta (bitter) and Kashaya (astriengent) Rasa. Plants under Vrana-Ropana are having Madhura, Kashaya Rasa (sweet taste), Madhura Vipaka (sweet biotransform) and Sheeta Veerya (cold potency). Conclusion: Plants having Tikta, Kashaya Rasa, Katu Vipaka, and Sheeta Veerya may be useful in the inflammatory stage, plants having Madhura, Kashaya Rasa and Sheeta Veerya may be useful in the prolifiratory stage and plants having Madhura Rasa, Sheeta Veerya, and Madhura Vipaka may be useful in the remodeling stage. The present review will help to give the directions to the researchers for the development of effective wound-healing medicines for wounds.



How to cite this article:
Kumar V, Nesari TM, Ghildiyal S, Sherkhane R. Pharmacodynamic appraisal of wound-healing herbs of Sushruta Samhita.AYU 2021;42:1-18


How to cite this URL:
Kumar V, Nesari TM, Ghildiyal S, Sherkhane R. Pharmacodynamic appraisal of wound-healing herbs of Sushruta Samhita. AYU [serial online] 2021 [cited 2023 Feb 8 ];42:1-18
Available from: https://www.ayujournal.org/text.asp?2021/42/1/1/362930


Full Text



 Introduction



The understanding of action of drugs is essential for their rational use. In Ayurveda, this is explained on the basis of Rasa (taste), Guna (properties), Veerya (potency) and Vipaka (biotransformation), known as pharmacodynamics attributes of the drugs. In the present scenario, extensive work has been done on medicinal plants, but the understanding of their action on the basis of classical Ayurveda doctrines is still lacking. This is also true for wound healing plants. Published literatures are available for wound-healing plants but the comprehensive review of medicinal plants (Vrana-Shodhana [wound cleansing] and Vrana-Ropana [wound healing]) mentioned in Sushruta Samhita along with pharmacodynamics and their modus-operandi is not available. It is reported that chemical constituents of plants i.e., tannins, flavonoids, sterols, polyphenols, saponins, and tri-terpanoids have specific role in wound healing due to astringent, antimicrobial, antioxidant, free scavenging activities, and improvement in vascularity.[1] Therefore, in the present study, an attempt has been made to gather the relevant information of wound-healing medicinal plants from Sushruta Samhita. In Sushruta Samhita; Nidana (causative factors),[2] Shatkriyakala (pathogenesis),[3] classification,[4] Lakshana (symptoms)[5] Shashtiupakarma (sixty therapeutic procedures)[6] of wound are described in detail. Thus, the elobarated description of wound and treasure of medicinal plants mentioned in Sushruta Samhita is a valuable assest in the effective management of wounds.

It is also evident that in the conventional medical system, few common procedures are used for wound management, i.e., wound dressing (non resorbable, occlusive dressings, hydrophilic, and hydrogels), topical application of antimicrobials (antibiotics, antiseptics and super oxidized solutions), enzymes (collagenase and papain-urea combination),[7] surgical procedures such as suturing, skin grafting, and flaps.[8] Many advance modalities have been also adopted by contemporary science such as negative pressure wound therapy, hyperbaric oxygen therapy, electrical stimulation, diathermy, growth factors, acellular matrix tissues, human dermis, human pericardium, placental tissues, bioengineered allogeneic cellular therapies, stem cell therapies and hyalomatrix (hyaluronan),[9] but still the gold standard of wound healing is lacking. The ancient treasure of wound-healing plants may be utilized for further researches to develop promising wound-healing drugs.[10] For more specific use of medicinal plants, it is also important to know that which medicinal plant is essential for a particular stage and type of wound. Therefore, modus-operandi of wound-healing medicinal plants on the basis of Ayurveda pharmacodynamics and also as per the various stages of wound healing is necessary for their rational use as Vrana-Shodhana (wound cleansing) and Vrana-Ropana (wound healing).

The present attempt may help to utilize the ancient wisdom of Sushruta Samhita to find out the favorable strategy for effective wound management. Further, it is also observed that among various wound-healing plants of Sushruta Samhita, only few have been screened for their wound-healing activity scientifically and many of them are still unexplored.[10] Therefore, the present review will fascinate the scientific community toward these unexplored potential Ayurvedic medicinal plants and their rational use in wound healing.

 Materials and methods



The review of medicinal plants enumerated for Vrana-Shodhana and Vrana-Ropana action was done from Sushruta Samhita Dalhana Tika (2014). The pharmacodynamic attributes (Rasa, Guna, Veerya and Vipaka) of selected medicinal plants was collected from various Ayurvedic Nighantus and reputed books of Dravyaguna, i.e., Dhanvantari Nighantu of Jharkhande Ojha (2004), Kaidev Nighantu of P V Sharma (2013), Madanpala Nighantu of Gayanendra Pandey (2012), Raj Nighantu of Indradeva Tripathi (2010), Bhavaparkasha Nigantu of K C Chunekar (2015), and Dravyagunavijyana part 2 of P V Sharma (2015). Recent scientific names and family of the plants were mentioned from “The plantlist.org.”[11] The contemporary review was done from the principles and practice of wound care,[7],[8] Schwartz's principles of surgery,[12] and the articles published in PubMed journals in recent 10 years. The entire information was systematically analyzed and evaluated on the basis of pharmacodynamics attributes. The plants are presented in alphabetical order according to their Sanskrit name with their pharmacodynamics attributes.

 Observations



The observations revealed that the plants mentioned under Nyagrodhadi,[13] Kakolyadi,[14] Surasadi,[15] Aaragvadhadi,[16] Arkadi,[17] Lakshadi[18] and Priyanguambasthadi Gana (group)[19] are attributed with Vrana-Shodhana and Vrana-Ropana potential.

Total 43 medicinal plants are attributed with Vrana-Shodhana activity and 48 medicinal plants are having Vrana-Ropana potential. However, 62 medicinal plants are having both Vrana-Shodhana and Vrana-Ropana potential. [Table 1], [Table 2], [Table 3] and [Figure 1]{Table 1}{Table 2}{Table 3}{Figure 1}

The dominant Rasa, Veerya and Vipaka in Vrana-Shodhana, Vrana-Ropana and Vrana-Shodhana-Ropana categories are presented in [Table 4], [Table 5], [Table 6] respectivly.{Table 4}{Table 5}{Table 6}

 Discussion



In Ayurveda action of any drug is defined under the umbrella of Dravyaprabhava (specific effect of drug) and Gunaprabhava (effect of drug due to its Rasa, Guna, Veerya and Vipaka attributes). Dravyaprabhava is the specific nature inherited in any drug due to the specific configuration of panchmahabhoot thus known as Dravyaprabhava. On the other hand, under Gunaprabhava, the actions of the drugs can be explained on the basis of Rasa, Guna, Veerya and Vipaka, known as pharmacodynamic attributes. Dravyaprabhava is specific to the drug and may not be explained by its pharmacodynamic attributes. Thus, for the judicious use of drugs, understanding of Dravyaprabhava and Gunaprabhava is nessesary.[20] This may help for rational and judicious use of these drugs with supported explanation for their action.

This principle of Ayurveda is also true for the medicinal plants mentioned in Sushruta Samhita under Vrana-shodhan, Vrana-Ropana, and Vrana-Shodhana-Ropana category. Acharya Sushruta, the father of surgery, has given 153 plants for the wound management in different forms in Sushruta Samhita which is particularly devoted toward injuries and wounds.

The literary meaning of Vrana Shodhana is cleansing of vitiated/contaminated wound[21] while Vrana Ropana is the process of wound healing.[22]

Thus, we may understand the pharmacodynamics of wound-healing herbs. It is observed that in Vrana-Shodhana category, most of the plants are having predominance of Katu, Tikta and Kashaya Rasa. Tikta and Katu Rasa have the Krimighana action (anti-bacterial and anti-fungal action).[23],[24] Thus, to start the management of chronic nonhealing wounds, Katu Rasadravya (medicinal plants) may be used first for Vrana-Shodhana. Katu Rasa also has Shothahara action (anti-inflammatory effect).[25] Tikta and Kashaya Rasa dravyas are beneficial because both have moisture reducing action,[26],[27] which may be helpful in reduction of excessive exudate and Tikta, Kashayarasa Dravyas also have the property of drying[28] which is also good in wound healing and reduces the long phase of inflammation which is a cause of delayed healing of wounds. Most of the Dravyas (substances) of Tikta and Kashaya Rasa are of Sheeta Veerya[29] and Sheeta Veerya has Stambhana (haemostasis) property so it is more important during the process of clotting at inflammatory phase.[29] It is also reported that most of the plants are from Arkadi Gana which is enumerated for its Krimighana and Vrana-Shodhana potential which means they help to make wound clean and free from infections.[17]

It is a well reported fact that wound healing takes place in three phases, i.e., inflammatory phase, proliferative phase and re-modeling phase (maturation phase) and each phase requires specific conditions for proper healing of wounds. Further infection leads to delay healing or nonhealing and most of the wounds are infected.[12] Thus, Vrana-Shodhana is essential initial step to be done to enhance wound healing. Katu Rasa, Ushna Veerya and Katu Vipaka plants can be utilized as most of Vrana-Shodhana plants are of these properties. [Table 4], [Table 5], [Table 6]

For the further processing of wound healing, the damaged Dhatu (tissue) needs to be replaced thus, proliferation of cells is needed for Vrana-Ropana. The analysis of Vrana Ropana herbs indicates predominance of Madhura, Kashaya Rasa plants having Madhura Vipaka and Sheeta Veerya. It may be due to the fact that Kashaya Rasadravyas due to their Sandhanakarma (tissue binding action) helps in wound closure[27] and Madhura Rasa helps in Dhatu Poshana (tissue regeneration).[30] Further Kashaya and Madhura Rasa also gives strength and tissue granulation to the wound[31] thus, helpful during the proliferative phase. Further for complete healing and remodeling phase, Madhura Rasa, Sheeta Veerya and Madhura Vipaka Dravyas may be taken because Madhura Rasa provides wound strength and also helpful in tissue granulation [Figure 2].{Figure 2}

TIME framework is the concept of wound healing in contemporary science which has been developed since the last decades.[32],[33] The pharmacodynamics of wound-healing herbs mentioned in Sushruta Samhita has provided insights on wound bed preparation fulfilling TIME framework as a practical tool.[33],[34] “T” stands for tissue management[33],[34] Shodhana (purification) herbs remove devitalized tissue from a wound through scrapping ability and in Kashaya (medicated decoction for cleansing) form thus, helps in debridement process and better prepration of wound bed either through autolytic or mechanical process along with Shashthi Upakramas.[34] “I” stands for the control of infection and inflammation.[33] It is reported that most of the wound-healing herb are also having anti-microbial potential.[35] Moisture balance is denoted by 'M' and is a significant factor for healing.[33] Tikta, Kashaya Rasa of herbs helps in moisture balance.[26],[27] Here among Shashthi Upakramas, Avachurnana (sprinkled with powder) helps in the absorption of exudate while other Varti (therapeutic wick for wound) and Tail (oil based medicines) helps in mostiure balance of dry wounds.[34] Kashaya Rasa helps in Ropana (healing) and plays a major role in healing process with the intent of wound closure[36] thus, takes care for Edge (E) factor.[34]

In this way, we may say that the rational and judicious collection of wound healing herbs of Sushrut Samhita can also be explained on the basis of many contemporary domines (chemical constituents, TIME framework) of science and extended studies on these herbs may pave a path for rearch of potential wound healing agents.

The present study is a review and objective evidences may be created on the basis of experimental and clinical studies on various wound-healing herbs of Shushruta Samhita.

In contemporary scicence, the pharmacodynamics of herbs is explained on the basis of chemical constituents and it is well-reported that plants rich in taninns, flavonoids, saponins, sterols, phenols, and triterpinoids are likely to be wound healer.[1] Thus, it may be said that a specific Rasa, Guna, Veerya and Vipaka of drugs indicate toward the presence of these specific phytochemicals. This is a matter of further investigation to explain, the pharmacodynamics of the drugs on the basis of their chemical constituents with relation to specific Rasa, Guna, Veerya and Vipaka. The antioxidant, anti-inflammatory, angiogenic and cell synthesis-modulating components enhance wound healing may also be explained further on this basis.[35],[37],[38] Studies also suggest that the components which enhance the collagen, tensile strength and angiogenesis while decrease the epithelialization period is effective in wound healing.[37],[39] Reviewed plants can be analyzed on the basis of these parameters.

The review was done from Sushruta Samhita as many other Ayurveda scripts having wound-healing plants can be reviewed and further studied in the same way.

 Conclusion



A total of 153 plants are described in Sushruta Samhita having Vrana-Shodhana, Vrana-Ropana and Vrana-Shodhana-Ropana properties. The pharmacodynamic attributes of the herbs indicate that Katu and Tikta Rasa are useful in Vrana Shodhana, Madhura, Kashaya and Tikta Rasa for Ropana and Tikta, Katu Rasa for Vrana-Shodhana-Ropana. However, the specific wound-healing potential of herbs is not only due to Rasa but also due to specific phytochemical constitutents. A reverse pharmacological approach may be taken to generate more scientific evidences for wound-healing potential of classical wound-healing herbs mentioned in Sushruta Samhita.The present comprehensive review may help reserches to work in the field of wound healing in a more precise way.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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