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 Table of Contents    
CASE REPORT  
Year : 2010  |  Volume : 1  |  Issue : 4  |  Page : 271-273
Role of honey (Madhu) in the management of wounds (Dushta Vrana)


Department of Shalyatantra, I.P.G.T. and R.A. Gujarat Ayurved University, Jamnagar, Gujarat - 361 008, India

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Date of Submission10-Aug-2010
Date of Acceptance08-Jan-2011
Date of Web Publication16-Feb-2011
 

   Abstract 

Application of Madhu (honey) is one among the Shashthi Upakrama (sixty treatment modalities) described by Sushruta. Clinical observation has shown its effectiveness in treatment of Dushta Vrana (chronic wounds). We report a case of Dushta Vrana on the anterior aspect of the right leg that was treated successfully with local application of Madhu and Neem (Azadirachata indica) bark decoction.

Keywords: Dushta Vrana , Madhu, Neem bark, Shashthi Upakrama

How to cite this article:
Dudhamal TS, Gupta S K, Bhuyan C. Role of honey (Madhu) in the management of wounds (Dushta Vrana). Int J Ayurveda Res 2010;1:271-3

How to cite this URL:
Dudhamal TS, Gupta S K, Bhuyan C. Role of honey (Madhu) in the management of wounds (Dushta Vrana). Int J Ayurveda Res [serial online] 2010 [cited 2014 Apr 17];1:271-3. Available from: http://www.ijaronline.com/text.asp?2010/1/4/271/76793

   Introduction Top


In spite of the advances that have been made, the management of chronic wounds is still a challenge for the clinician. Sushruta was quite aware of the importance of wound management and has described Shashthi Upakramas (sixty measures) for Vrana Ropana (wound healing), of which the application of Madhu is one. [1] Many research studies have been carried out to examine the value of topical application of honey for wound healing. [2],[3],[4],[5] Madhu is commonly used as Anupana (i.e., given along with active medication to enhance activity) and also, sometimes, for its primary medical property systemically as well as locally, either alone or in combination with other drugs. It has been described to have properties like Lekhana (scraping), Sandhana (union), Shodhana (purification), Ropana (healing), and Tridoshaghna (pacifying all three Doshas: Vata, Pitta, and Kapha). [6] It is used as an external application in Vrana (wound), either alone or in combination with Sarpi (Goghrita, i.e., ghee made from cow's milk). [7],[8]

Honey is hygroscopic in nature, with a pH of 3.2-4.5. [9],[10],[11] It prevents colonization and bacterial growth in tissues due to this acidic nature. Most microorganisms do not grow in pure honey because of its low water activity (a w ) of 0.6. [12],[13] Honey also has antibacterial properties [14],[15],[16],[17],[18] The presence of hydrogen peroxide [19],[20] and a high osmotic pressure [21] also contribute to the antibacterial effect of honey. These natural properties of Madhu are said to make it suitable for use in wound management. We present a case where a chronic wound healed after the application of honey.


   Case Report Top


A 70-year-old female patient of Vata-Kaphaja Prakriti presented to us for treatment of a chronic infected wound that involved entire anterior tibial aspect of the right lower limb. She complained of burning pain in the wound as a result of a drug reaction, foul-smelling pus discharge, difficulty in walking, and occasional fever. On examination a large (22 Χ 4.5 cm) ugly-looking ulcer was present on the anterior aspect of the right leg, extending from the knee to the ankle joint. There was foul-smelling pus discharge and local swelling [Figure 1]. The pus culture report showed presence of Staphylococcus aureus. The patient had no systemic disease. She had been taking treatment for the wound without any relief. She had history of hypersensitivity reactions to ibuprofen and cotrimoxazole. All laboratory investigations were in the normal range. She was admitted in the female Shalya ward for further investigations and management.
Figure 1: Dushta Vrana on the anterior aspect of the right leg before treatment at the first consultation on 19-09-2009. The characteristics of Dushta Vrana are Ativivrita (broad base), Bhairav (ugly look), Putipuyamansa (pus discharge), Gandha (foul smell), Vedana (pain), Dirghakalanubandhi (chronicity).[38]

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Every morning the wound was first treated with freshly prepared lukewarm Neem bark decoction, which was poured on the wound while it was simultaneously cleaned with sterile swabs. After cleaning, Madhu (Dabur India Ltd., Solan, H.P., India) was applied in adequate quantity with the help of a spatula and the wound was covered with sterile gauze and loosely bandaged.

Along with the local wound treatment, the following drugs were given orally in powdered form 12 hourly: Yashtimadhu (Glycyrrhiza glabra Linn.) 2 g, Shatavari (Asparagus racemosus Willd.) 2 g, Gokshura (Tribulus terrestris) 2 g, and Guduchi [Tinispora cardifolia Willd (Miers)] 2 g. The drugs were administered along with lukewarm water. At the end of the 5 th week (the 35 th day) the wound had healed completely, leaving only a minimal scar [Figure 2].
Figure 2: Healed scar on the anterior aspect of the right leg after treatment (on 23-10-2009).

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   Discussion Top


Madhu has Vranaropak properties as per the principles of the sixty Upakramas of Vrana management described in the Sushruta Samhita. Madhu[22] is believed to act by 'pacifying' the three vitiated Doshas, i.e,. Vata, Pitta, and Kapha by multiple actions attributable to its Madhura (sweet) Rasa, Kashaya (astringent) Uparasa, Ruksha (dry) Guna, Sheeta (cold) Virya, Madhura Vipaka, and Sukshma Marga Anusari (ability to permeate in microchannels) Prabhava. Madhura Rasa gives nutrition to the tissue, which helps in granulation tissue formation, while Kashaya Rasa provides Lekhana (scraping) that helps in desloughing, preparing the wound for healing. Thus, Madhu has excellent properties to heal the wound by virtue of its Sodhana (purification), Ropana (healing), and Sandhana (union) actions.

At the time of presentation, the patient had pain, discharge, discoloration, etc., with predominating Vata Dosha. The Madhura Rasa of the honey reduced the vitiated Vata Dosha, leading to reduced pain and enhanced healing. Madhu has been described as having the ability to promote phagocytosis, detoxification, and proteolyses, all of which assist in cleaning the wound. [23],[24] Further, Madhu pacifies Pitta Dosha by virtue of its Madhura Rasa and Sheeta Guna. [25],[26] Kapha is taken care of with Kashaya Rasa and Ruksha Guna, which accelerate healing. Daily dressing of the wound with Neem bark decoction helped to inhibit the growth of microorganisms. [27],[28],[29],[30]

Honey is a hyperosmolar medium, preventing bacterial growth. Because of its high viscosity it forms a physical barrier, and the presence of the enzyme catalase gives honey antioxidant properties. [31] Honey has been shown to be useful in the prevention of hypertrophic scarring and post-burn contractures. [32] Honey is a very effective agent for dressing of split-thickness skin graft. [33] In our patient, healing occurred with minimal scar formation. The drugs that were administered internally in powdered form (Yashtimadhu, Shatavari, Gokshura, and Guduchi) have antioxidant, immunomodulating, and adaptogenic properties. [34],[35] These compounds exerts a Rasayana effect. As the patient was elderly, we gave Rasayana drugs to improve Rasa, Rakta, and Mamsa Dhatus (tissues). This might have contributed to the wound healing [36],[37] and helped the patient to attain and maintain good health.

There were no adverse events throughout the management and healing occurred uneventfully. The mode of treatment was found to be cost-effective, safe, and easy to implement.[38]

 
   References Top

1.Sushruta Chikitsa Sthan 1/8; Sushruta Samhita, Nibandha sangraha, Yadavji Trikamji. Reprint ed. Varanasi: Chaukhambha orientalia; 2009. p. 397.  Back to cited text no. 1
    
2.Marshall C. The use of honey in wound care: A review article. Br J Podiatry 2002;5:47-9.  Back to cited text no. 2
    
3.Marshall C, Manjooran QJ, Honey VS. Iodine following toenail surgery. Wounds United Kingdom 2005;1:10-8.  Back to cited text no. 3
    
4.McIntosh CD, Thomson CE. Honey Dressings versus Paraffin Tulle Gras following Toenail Surgery. J Wound Care 2006;15:133-6.  Back to cited text no. 4
    
5.Medhi B, A Puri, S Upadhyay, L Kaman Topical Application of Honey in The Treatment of Wound Healing: A Metaanalysis. JK Science, Journal of Medical Education & Research. 2008;10:166-9.  Back to cited text no. 5
    
6.Sushruta Sutra Sthan 45/132; Sushruta Samhita, Nibandha sangraha,Yadavji Trikamji. Reprint ed. Varanasi: Chaukhambha orientalia; 2009. p. 207.  Back to cited text no. 6
    
7.Sushruta Chikitsa Sthan 1/130; Sushruta Samhita, Nibandha sangraha,Yadavji Trikamji. Reprint ed. Varanasi: Chaukhambha orientalia; 2009. p. 407.  Back to cited text no. 7
    
8.Chand KA. A comparative study of sixty measures of vrana and the role of Madhu-Sarpi in vrana ropan. [dissertation] Jamnagar: Gujarat Ayurved University; 1981.  Back to cited text no. 8
    
9.White JW Jr, Riethof ML, Subers MH, Kushinir J. Composition of American Honeys. Tech. Bull. 1261. Agricultural Research Service. Washington, DC: USDA; 1962.  Back to cited text no. 9
    
10.Available from: http://bio.waikato.ac.nz/honey/honey_intro.shtml#Acidity. [Last accesed on 2010 Sep 29].  Back to cited text no. 10
    
11.Available from: http://en.wikipedia.org/wiki/Talk: Honey#The_antibacterial_activity [Last accessed on 2010 Aug 3].  Back to cited text no. 11
    
12.Prescott L, Harley JP, Klein DA. Microbiology. Boston: WCB/ McGraw -Hill; 1999 ISBN 0-697-35439-3.  Back to cited text no. 12
    
13.Honey Wikipedia [Home page on the internet] Available from: http://en.wikipedia.org/wiki/Honey. [Last accessed on 2010 Nov 2].  Back to cited text no. 13
    
14.Molan PC. The Antibacterial Activity of Honey. 1. The Nature of the Antibacterial Activity. Journal of Bee World 1992;73:5-28.   Back to cited text no. 14
    
15.Molan PC. The Antibacterial Activity of Honey. 2. Variation in the Potency of the Antibacterial Activity.Journal of Bee World 1992;73:59-76.  Back to cited text no. 15
    
16.Cooper R. Honey in wound care: Antibacterial properties. GMS Krankenhhyg Interdiszip 2007;2:51.  Back to cited text no. 16
    
17.Bulman MW. Honey as a Surgical Dressing. Middlesex Hosp J 1955;55:188-9.   Back to cited text no. 17
    
18.Hutton DJ. Treatment of Pressure Sores. Nurs Times 1966;62:1533-4.  Back to cited text no. 18
    
19.Kumar A, Sharma VK, Singh HP, Prakash P, Singh SP. Efficacy of some indigenous drugs in tissue repair in buffaloes. Indian Vet J 1993;70:42-4.   Back to cited text no. 19
    
20.Oryan A, Zaker SR. Effects of topical application of honey on cutaneous wound healing in rabbits. Zentralbl Veterinarmed A 1998;45:181-8.  Back to cited text no. 20
    
21.Bose B. Honey or sugar in treatment of infected wounds? Lancet 1982;1:963.  Back to cited text no. 21
    
22.Sushruta Sutra Sthan 45/132; Sushruta Samhita, Nibandha sangraha,Yadavji Trikamji. Reprint ed. Varanasi: Chaukhambha orientalia; 2009. p. 207  Back to cited text no. 22
    
23.Al-Waili NS. Investigating the antimicrobial activity of natural honey and its effects on the pathogenic bacterial infections of surgical wounds and conjunctiva. J Med Food 2004;7:210-22.  Back to cited text no. 23
    
24.Charde MS, Fulzele SV, Satturwar PM, Joshi SB, Kasture AV. Wound healing and antiinflammatory potential of madhu ghrita. Indian J Pharm Sci 2006;68:26-31.  Back to cited text no. 24
  Medknow Journal  
25.Zumla A, Lulat A. Honey - a Remedy Rediscovered. J Royal Soc Med 1989;82:384-5.  Back to cited text no. 25
    
26.Kundu S, Biswas TK, Das P, Kumar S, De DK. Turmeric (Curcuma longa) Rhizome Paste and Honey Show Similar Wound Healing Potential: A Preclinical Study in Rabbits. Int J Low Extrem Wounds 2005;4:205-13.  Back to cited text no. 26
    
27.Dorababu M, Prabha T, Priyambada S, Agrawal VK, Aryya NC, Goel RK. Effect of Bacopa monniera and Azadirachta indica on gastric ulceration and healing in experimental NIDDM rats. Indian J Exp Biol 2004;42:389-97.  Back to cited text no. 27
    
28.Rege NN, Dahanukar SA, Ginde VK, Thatte UM, Bapat RD. Safety and efficacy of Azadirachta indica in patients with second degree burns. Indian Pract 1999;52:240-8.   Back to cited text no. 28
    
29.Pai MR, Acharya LD, Udupa N. Evaluation of antiplaque activity of Azadirachta indica leaf extract gel, 6- week clinical study. J Ethnopharmacol 2004;90:99-103.  Back to cited text no. 29
    
30.Vanka A, Tandon S, Rao SR, Udupa N, Ramkumar P. The effect of indigenous Neem Azadirachta indica mouth wash on Streptococcus mutans and lactobacilli growth. Indian J Dent Res 2001;12:133-44.  Back to cited text no. 30
[PUBMED]    
31.Bangroo AK, Khatri R, Chauhan S. Honey dressing in pediatric burns. J Indian Assoc Pediatr Surg 2005;10:172-5.  Back to cited text no. 31
  Medknow Journal  
32.Baghel PS, Shukla S, Mathur RK, Randa R. A comparative study to evaluate the effect of honey dressing and silver sulfadiazene dressing on wound healing in burn patients. Indian J Plast Surg 2009;42:176-81.  Back to cited text no. 32
[PUBMED]  Medknow Journal  
33.Emsen IM. A different and safe method of split thickness skin graft fixation: Medical honey application. Burns 2007;33:782-7.  Back to cited text no. 33
    
34.Sabnis M. Chemistry and pharmacology of Ayurvedic medicinal Plants. 1st ed. Varanasi: Chaukhambha Amarbharati Prakashan; 2006. p. 119, 127, 207, 341, 348.  Back to cited text no. 34
    
35.Timm M, Bartelt S, Hansen EW. Immunomodulatory effects of honey cannot be distinguished from endotoxin. Cytokine 2008;42:113-20.  Back to cited text no. 35
    
36.Biswas TK, Mukherjee B. Plant Medicines of Indian Origin for Wound Healing Activity: A Review. Int J Low Extrem Wounds 2003;2:25-39.  Back to cited text no. 36
    
37.Ryan TJ. Use of Herbal Medicines in Wound Healing: A Perspective Paper. Int J Low Extrem Wounds 2003;2:22-4.  Back to cited text no. 37
    
38.Sushruta Sutra Sthan 27/7; Sushruta Samhita, Nibandha sangraha,Yadavji Trikamji. Reprint ed. Varanasi: Chaukhambha orientalia; 2009. P.108.  Back to cited text no. 38
    

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Correspondence Address:
Tukaram S Dudhamal
Department of Shalyatantra, I.P.G.T. and R.A. Gujarat Ayurved University, Jamnagar, Gujarat - 361 008
India
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DOI: 10.4103/0974-7788.76793

PMID: 21455457

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