MADHUMEHA VRANA (DIABETIC FOOT ULCER): CLASSICAL CONCEPTS AND THE EVIDENCE FOR AYURVEDIC WOUND CARE AS AN ADJUNCT TO STANDARD MANAGEMENT
Background: Diabetic foot ulcers are a major cause of infection, amputation and death in people with diabetes, and India has one of the largest diabetic populations in the world. Classical Ayurvedic texts describe skin eruptions and wounds in Prameha (diabetes) and recognise their difficulty in healing. Ayurvedic wound care, including Panchavalkala washes, Jatyadi Taila, honey and leech therapy, is widely used for diabetic ulcers in India. Objective: To review the classical concepts relevant to diabetic foot ulcers, modern pathophysiology and evidence-based management, and the evidence for Ayurvedic wound care as an adjunct. Methods: Narrative review of Charaka and Sushruta Samhitas, international guidelines, systematic reviews and clinical trials. Results: Classical texts describe Prameha Pidaka, eruptions and abscesses in diabetes, and treat them with cleansing, healing and blood-purifying measures alongside control of Prameha. Modern management is based on offloading, debridement, infection control, revascularisation where needed, glycaemic control and education. A multicentric randomised trial found that cleansing with a Panchavalkala spray followed by Jatyadi Taila spray produced healing comparable to conventional antiseptic dressings in diabetic and varicose ulcers. Honey has unclear benefit in diabetic foot ulcers in a Cochrane review. Experimental studies support antimicrobial and pro-healing effects of Panchavalkala and Jatyadi Taila. Conclusion: Ayurvedic topical therapies may be reasonable adjuncts in diabetic foot ulcer care, but only within a framework that ensures offloading, infection management, vascular assessment and glycaemic control. Larger randomised trials with complete healing and amputation as outcomes are needed.
KEYWORDS: Madhumeha Vrana; diabetic foot ulcer; Prameha Pidaka; Panchavalkala; Jatyadi Taila; wound healing; amputation