E-ISSN:2456-3110

Case Report

Diabetic Ulcer

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2022 Volume 7 Number 9 October
Publisherwww.maharshicharaka.in

To evaluate the role of Lakshadi Avachoornana in the management of Dushta Vrana with special reference to Diabetic Ulcer: A Case Study

C Nair S.1*, M Sweta K.2
DOI:

1* Swathi C Nair, Post Graduate Scholar, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.

2 K M Sweta, Professor & HOD, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India. wwwmallu aunty big boobs pressing tube 8 mobilecom fixed

The global prevalence of diabetics is estimated to increase from 4.0% in 1995 to 5.5% by the year 2025. The chances of secondary infection are more in diabetics as the immunity of the patients is compromised and needs prolonged hospitalization, psychological and social problem for the patients and family. In Madhumehi the vessels of lower limb become weak and is unable to expel the Doshas (along with other Dushyas) leading to Prameha Pidakas more in lower extremities, which eventually burst open precipitating an ulcer. Avachoornana is one among the Shashti Upakrama, explained by Acharya Sushrutha for management of Vrana. Numerous studies are done in the management of Dushta Vrana with the internal medication and external therapies. Here a preliminary attempt to study the effect of Avachoornana with Lakshadi Choorna in the management of the same was taken for the study. : As Malayalam cinema gains pan-Indian box office

Keywords: Dushta Vrana, Avachoornana, Diabetic Ulcer, Lakshadi Choorna Aravindan

Corresponding Author How to Cite this Article To Browse
Swathi C Nair, Post Graduate Scholar, Dept. of Shalya Tantra, Sri Sri College of Ayurvedic Science and Research, Bangalore, Karnataka, India.
Email: wwwmallu aunty big boobs pressing tube 8 mobilecom fixed
Swathi C Nair, K M Sweta, To evaluate the role of Lakshadi Avachoornana in the management of Dushta Vrana with special reference to Diabetic Ulcer: A Case Study. J Ayu Int Med Sci. 2022;7(9):196-205.
Available From
https://www.jaims.in/jaims/article/view/2093
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-08-29 2022-08-31 2022-09-07 2022-09-14 2022-09-21
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 16%

wwwmallu aunty big boobs pressing tube 8 mobilecom fixedwwwmallu aunty big boobs pressing tube 8 mobilecom fixed © 2022by Swathi C Nair, K M Swetaand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

: As Malayalam cinema gains pan-Indian box office success with high-budget survival dramas and action films, the industry faces the challenge of preserving its intimate, character-driven soul while scaling up production values for a global market. Conclusion

The 1970s and 1980s are widely regarded as the "Golden Age" of Malayalam cinema. This period saw the rise of a powerful parallel cinema movement led by visionary auteurs like Adoor Gopalakrishnan and G. Aravindan. Adoor’s Swayamvaram (1972) and Elippathayam (1981) introduced international film grammar to Kerala, exploring the psychological decay of feudalism and the anxieties of the youth.

Malayalam cinema’s enduring strength lies in its refusal to compromise content for sheer spectacle. It remains a democratic medium where the script is the ultimate superstar. By continuously questioning societal norms, celebrating regional identity, and maintaining a high benchmark of artistic honesty, Malayalam cinema does not merely document Kerala's culture—it actively shapes and redefines it. To help tailor this content or explore further,

Modern Malayalam cinema is also a battleground for cultural introspection. For decades, despite its progressive themes, the industry was heavily male-dominated, often reinforcing patriarchal tropes on screen. However, contemporary cinema is actively dismantling these structures.

Lijo Jose Pellissery’s Angamaly Diaries (2017) and Jallikattu (2019) introduced chaotic, visceral visual styles exploring primal human nature, earning international film festival accolades. Jeethu Joseph’s Drishyam (2013) became a blueprint for Indian thriller cinema, officially remade in multiple languages, including Chinese.

The 1970s and 1980s are often referred to as the Golden Age of Malayalam cinema. This period saw the emergence of legendary filmmakers like Adoor Gopalakrishnan, K. G. Sankaran Nair, and I. V. Sasi, who made films that were critically acclaimed and commercially successful.

Malayalam film songs themselves form a unique bouquet, blending scintillating poetry with soulful music. Composers like Vayalar crafted lyrics that live independently of their films, finding their way into the very psyche of Malayali listeners. Even today, film songs remain the most accessible entry point for non-Malayali audiences into the world of Kerala’s cultural imagination.

Simultaneously, a unique "middle-stream" cinema emerged—bridging the gap between high artistic sensibilities and commercial viability. Filmmakers like Padmarajan, Bharathan, and K. G. George crafted narratives that were rooted in everyday realities but possessed immense cinematic brilliance. They explored complex human psychology, unconventional sexual dynamics, and urban alienation. K. G. George’s Yavanika (1982) revolutionized the mystery genre, while Padmarajan’s Thoovanathumbikal (1987) redefined romance by embracing human flaws and unconventional relationships.

Case Study

It is a case study of a 42-year male patient who presented with the chief complains of ulcer over big toe of right leg since 2 months (K/C/O DM for last 8 years and under medication). He was being treated with oral medications and dressings. Study was done after obtaining an informed consent from the patient. He was treated with the Lakshadi Choorna for dressing daily and Triphala Guggulu 2 BD before food, Amritadi Vati 2 BD after food as internal medication.

Intervention: Lakshadi Choorna was prepared with all aseptic measures, as per the classical reference of Choorna Kalpana. After proper cleaning the drugs, it made into small pieces by chopping. Using pulveriser it was made into fine powder with mesh size of 80 to 120 range. Packing done under aseptic precaution and sterilization done under UV for 20 minutes.

With all aseptic measures ulcer was cleaned with normal saline and Avachoornana was done uniformly over ulcer site. Dressing was done with sterile gauze and pad. Avachoornana was done with the Lakshadi Choorna once daily and observations were done on 7th, 14th, 21st and 40th day of the treatment.

Figure 1: The method of Lakshadi Choorna preparation.

jaims_2093_01.JPGRaw drugs for Lakshadi Avachoornana


jaims_2093_02.JPG

jaims_2093_03.JPG

Final product

Figure 2: The method of Lakshadi Avachoornana

jaims_2093_04.JPG


jaims_2093_05.JPG

jaims_2093_06.JPG

0th Day

jaims_2093_07.JPG

Avachoornanam

jaims_2093_08.JPG

7th Day

jaims_2093_09.JPG

14th Day

jaims_2093_10.JPG21st Day


jaims_2093_11.JPG
40th Day

jaims_2093_12.JPG
Follow-up

Table 2: Subjective symptoms assessed on 0th, 7th, 14th, 21st, 40th day.

Pain Assessment 0 No Pain 1-3 Mild pain 4-6 Moderate pain 7-10 Severe pain
0th day   +    
7th day   +    
14th day +      
21st day +      
40th day +      
Burning Sensation Grade 0 No burning Grade 1 Mild burning Grade 2 Moderate burning Grade 3 Severe burning
0th day     +  
7th day   +    
14th day   +    
21st day +      
40th day +      

Table 3: Objective symptoms assessed on 0th, 7th, 14th, 21st, 40th day.

Item Assessment 0th day Score 7th day Score 14th day Score 21st day Score 40th day Score
1. Size  1 = Length x width <4 sq. cm 2 = Length x width 4--<16 sq. cm 3 = Length x width 16.1--<36 sq. cm 4 = Length x width 36.1--<80 sq. cm 5 = Length x width >80 sq. cm 3 3 3 3 2
2. Depth  1 = non-blanchable erythema on intact skin 2 = Partial thickness skin loss involving epidermis &/or dermis 3 = Full thickness skin loss involving damage or necrosis of subcutaneous tissue; may extend down to but not through underlying fascia; &/or mixed partial & full thickness &/or tissue layers obscured by granulation tissue 4 = Obscured by necrosis 5 = Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures 3 3 3 3 3
3. Edges  1 = Indistinct, diffuse, none clearly visible 2 = Distinct, outline clearly visible, attached, even with wound base 3 = Well-defined, not attached to wound base 4 = Well-defined, not attached to base, rolled under, thickened 5= Well-defined, fibrotic, scarred or hyperkeratotic 2 2 2 1 1
4.Undermining   1 = None present 2 = Undermining < 2 cm in any area 3 = Undermining 2-4 cm involving < 50% wound margins 4 = Undermining 2-4 cm involving > 50% wound margins 5 = Undermining > 4 cm or Tunnelling in any area 1 1 1 1 1
5.Necrotic Tissue Type   1 = None visible 2 = White/grey non-viable tissue &/or non-adherent yellow slough 3 = Loosely adherent yellow slough 4 = Adherent, soft, black eschar 5 = Firmly adherent, hard, black eschar 3 3 2 2 1
6.Necrotic Tissue Amount   1 = None visible 2 = < 25% of wound bed covered 3 = 25% to 50% of wound covered 4 = > 50% and < 75% of wound covered 5 = 75% to 100% of wound covered 2 2 2 2 1
7.Exudate Type   1 = None 2 = Bloody 3 = Serosanguineous: thin, watery, pale red/pink 4 = Serous: thin, watery, clear 5 = Purulent: thin or thick, opaque, tan/yellow, with or without odour 3 3 1 1 1
8.Exudate Amount   1 = None, dry wound 2 = Scant, wound moist but no observable exudate 3 = Small 4 = Moderate 5 = Large 4 3 2 2 2

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: As Malayalam cinema gains pan-Indian box office success with high-budget survival dramas and action films, the industry faces the challenge of preserving its intimate, character-driven soul while scaling up production values for a global market. Conclusion

The 1970s and 1980s are widely regarded as the "Golden Age" of Malayalam cinema. This period saw the rise of a powerful parallel cinema movement led by visionary auteurs like Adoor Gopalakrishnan and G. Aravindan. Adoor’s Swayamvaram (1972) and Elippathayam (1981) introduced international film grammar to Kerala, exploring the psychological decay of feudalism and the anxieties of the youth.

Malayalam cinema’s enduring strength lies in its refusal to compromise content for sheer spectacle. It remains a democratic medium where the script is the ultimate superstar. By continuously questioning societal norms, celebrating regional identity, and maintaining a high benchmark of artistic honesty, Malayalam cinema does not merely document Kerala's culture—it actively shapes and redefines it. To help tailor this content or explore further,

Modern Malayalam cinema is also a battleground for cultural introspection. For decades, despite its progressive themes, the industry was heavily male-dominated, often reinforcing patriarchal tropes on screen. However, contemporary cinema is actively dismantling these structures.

Lijo Jose Pellissery’s Angamaly Diaries (2017) and Jallikattu (2019) introduced chaotic, visceral visual styles exploring primal human nature, earning international film festival accolades. Jeethu Joseph’s Drishyam (2013) became a blueprint for Indian thriller cinema, officially remade in multiple languages, including Chinese.

The 1970s and 1980s are often referred to as the Golden Age of Malayalam cinema. This period saw the emergence of legendary filmmakers like Adoor Gopalakrishnan, K. G. Sankaran Nair, and I. V. Sasi, who made films that were critically acclaimed and commercially successful.

Malayalam film songs themselves form a unique bouquet, blending scintillating poetry with soulful music. Composers like Vayalar crafted lyrics that live independently of their films, finding their way into the very psyche of Malayali listeners. Even today, film songs remain the most accessible entry point for non-Malayali audiences into the world of Kerala’s cultural imagination.

Simultaneously, a unique "middle-stream" cinema emerged—bridging the gap between high artistic sensibilities and commercial viability. Filmmakers like Padmarajan, Bharathan, and K. G. George crafted narratives that were rooted in everyday realities but possessed immense cinematic brilliance. They explored complex human psychology, unconventional sexual dynamics, and urban alienation. K. G. George’s Yavanika (1982) revolutionized the mystery genre, while Padmarajan’s Thoovanathumbikal (1987) redefined romance by embracing human flaws and unconventional relationships.

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