Gojihva (Launaea nudicaulis [L.] Hook.f.), a potential herb for chronic wound healing: A case study

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© 2020 Journal of Ayurveda Case Reports | Published by Wolters Kluwer - Medknow 61
Gojihva (Launaea nudicaulis [L.] Hook.f.), a
potential herb for chronic wound healing: A
case study
Vishal Kumar, Shivani Ghildiyal, Rahul Sherkhane1, Tanuja Manoj Nesari
Abstract:
Chronic wounds are becoming challenge for scientific community due to their economical and
psychological burden. Contemporary science tried hard to cop up with this difficult situation by
the use of tissue engineering, cell‑based therapy, plasma therapy along with various dressings,
and surgical procedures, but the results are not very promising. Wounds are described under the
heading of Vranain Ayurveda along with various herbs and herbomineral preparations for their
management. Gojihva(Launaea nudicaulis[L.] Hook.f.) is an herb mentioned to be useful in various
diseases as well as for wounds. It is also practiced ethnomedicinally for wound management in
various countries. A60‑year‑old male having non‑healing wound on his dorsal surface of the
forearm for the past 45days was treated with dressing of Gojihva kwatha(~decoction) for
28days. Bates–Jensen Wound Assessment Tool (BWAT), wound tracing and digital photography
was used to asses wound healing on every week. BWAT score was 52 before treatment and 13
after the treatment. The surface area was 42.9 cm2 before treatment and nil after treatment. The
wound was completely healed in 28days without any complications.
KEYWORDS: Chronic wound, Ethnomedicine, Gojihva, Vrana
INTRODUCTION
Wound healing is a complex and
dynamic process of various biological
events; however, when wounds fail to achieve
sufcient healing after four weeks of standard
treatment and care, they are known as chronic
non-healing wounds.[1] Chronic wounds are
becoming more prevalent, difcult to treat,
and burden for patient as well as for medical
system.[2] Many factors are responsible
for delayed healing such as advanced
age, steroids like-glucocorticosteroid and
chemotherapeutic agents in large dosages,
metabolic disorders such as Diabetes
Mellitus (DM), nutritional deciencies such as
vitamin A, zinc, infections, trauma, smoking,
edema, and low oxygen.[3] In the conventional
medical system, the management of
wound depends on its site, cause, type
of wound and time duration, but few
common procedures are used such as
wound dressing (non-resorbable occlusive
dressings, hydrophilic, and hydrogels),
topical application of antimicrobials
(antibiotics, antiseptics, and superoxidized
solutions, for example – mupirocin,
neomycin, bacitracin, and silver agents),
growth factors (recombinant human platelet
derived factor, epidermal growth factors),
matrix‑forming agents (pure collagen,
hybrid collagen, and collagen-containing
dressings), enzymes (collagenase, papain–
urea combination), and surgical procedures
such as suturing, skin grafting, and aps.[4]
Address for correspondence:
Dr. Shivani Ghildiyal,
Department of
Dravyaguna, All India
Instute of Ayurveda,
New Delhi ‑ 110 076, India.
E‑mail: drshivanighildiyal@
gmail.com
Submied: 29‑Feb‑2020
Revised: 02‑Jul‑2020
Accepted: 04‑Jul‑2020
Published: 16‑Oct‑2020
Department of
Dravyaguna and
1Department of Shalya
Tantra, All India Instute
of Ayurveda, New Delhi,
India
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DOI:
10.4103/JACR.JACR_14_20
How to cite this article: Kumar V, Ghildiyal S, Sherkhane R,
Nesari TM. Gojihva (Launaea nudicaulis [L.] Hook.f.), a
potential herb for chronic wound healing: A case study.
J Ayurveda Case Rep 2020;3:61-5.
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Case Report
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Kumar, et al.: Gojihva, an herb for wound healing
62 Journal of Ayurveda Case Reports - Volume 3, Issue 2, April-June 2020
Table 1: Wound assessment by Bates‑Jensen Wound
Assessment Tool (BWAT)
Wound criteria 1st
day
7th
day
14th
day
21st
day
28th
day
Size 4 3 3 3 1
Depth 3 3 2 1 1
Edges 3 2 2 1 1
Under mining 3 2 1 1 1
Necrotic tissue type 2 1 1 1 1
Necrotic tissue amount 2 1 1 1 1
Exudate type 5 5 1 1 1
Exudate amount 5 4 3 2 1
Skin color surrounding wound 5 5 1 1 1
Peripheral tissue 5 4 3 2 1
Peripheral tissue induration 5 4 3 2 1
Granulation tissue 5 4 3 2 1
Epithelialization 5 4 3 2 1
Total score 52 42 27 20 13
Table 2: Surface area by tracing
Day Area (cm2)
0th day 42.9
7th day 30.45
14th day 24
21st day 21.56
28th day 0
Table 3: Pain assessment by Visual Analog Scale (VAS)
Day Pain score
0th day 6
7th day 4
14th day 2
21st day 0
28th day 0
Tissue engineering, cell-based therapy, and plasma therapy
are advances in the treatment of wound, but the gold
standard for wound management is not available
till date.[5] Thus, there is a need to adopt potential
references to wound management from well-established
systems such as Ayurveda. In Sushruta Samhita, vivid
description of wounds and their management is
described under the heading of Vrana.[6] Acharya
Sushruta had explained Vrana as the damage of tissues.[7]
In Ayurveda, the herb Gojihva [Figure 1] is mentioned
for various diseases, i.e., in Raktapitta (~hemorrhagic
disorders), Kushtha (~skin diseases), Prameha (~diabetes
mellitus), Shwaasa (~breathing problems), Kasa (~cough)
and Aruchi (~anorexia),[8] Vrana (~wounds) and
Visarpa (~erysipelas) in the form of Lepa (~external
application of pack) as well as other preparations such as
Churna (~powder) and Ghrita.[9] In the current study, the
herb Gojihva is taken as (Launaea nudicaulis [L.] Hook.f.)
on the basis of Bihar ki Vanaspatiyan of Thakur Balwant
Singh.[10] The herb was authenticated from the Botanical
Survey of India, Dehradun (Voucher Specimen No. 290).
A case of chronic non‑healing wound which healed in 28
days after application of Gojihva kwatha without internal
medicine is reported here.
CASE REPORT
A 60-year-old male came to Shalya Tantra OPD with
complaint of wound on the right forearm for the past
45 days with huge amount of watery discharge, pain, and
swelling. No history of DM, hypertension, tuberculosis,
thyroid, asthma etc., was found. The patient was taking
mixed diet and had addiction to alcohol and tobacco
chewing. Bowel, micturition, and sleep habits were normal.
Before 45 days, the patient was apparently healthy; however,
he got injured in an accident. The wound was sutured and
was prescribed with conventional medicine. However, the
wound does not heal after 45 days in spite of conventional
treatment. Thus, he visited the Shalya Tantra OPD for
Ayurvedic treatment.
Clinical findings
The patient was examined and detailed history was taken.
On local examination, a large (11 cm × 3.5 cm × 0.5
cm) single wound of irregular shape with punched out
edges and edematous margins was noted on the right
forearm between wrist joint and elbow. Foul smell, watery
discharge, pain, and swelling were present. The oor of
wound had white slough, and the surrounding area was
wrinkled with hyper-pigmentation. The skin and muscles
of affected area were involved. All the symptoms were
persistent from day one of registration. The patient has
four sutures and hypergranulation over the stitches was
seen. The patient was advised for daily dressing with Gojihva
kwatha (~decoction of Gojihva) for 28 days. No internal
medicines was given during this period.
Figure 1: Herb Gojihva (Launaea nudicaulis[L.]Hook.f.)withowering
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Kumar, et al.: Gojihva, an herb for wound healing
Journal of Ayurveda Case Reports - Volume 3, Issue 2, April-June 2020 63
Figure 6: Day 28 (completely healed wound)
Figure 5: Day 21 (wound fully covered with epithelial tissues)
Figure 2: Day 1 (wound with slough)
Figure 4: Day 14 (wound with epithelial tissue)
Figure 3: Day 7 (wound without slough and with granulation tissue)
Diagnosis
The patient has Ativivrita (~large wound), Puya (~pus),
Puti (~putrid smell), Amanogaya (~unpleasant to eyes),
Vedana (~pain), Sopha (~swelling), Deergha kalanubandhi
(~long duration), and irregular wound which was
non-healing for the past 45 days. On the basis of sign and
symptoms, it was diagnosed as Dushta vrana (~chronic
wound).
TIMELINE
The written consent from patient was taken for the
treatment. Sutures were removed with the help of surgical
blade and other surgical equipment at rst day of treatment.
The Gojihva kwatha from dried whole herb was prepared
as per the classical method,[11] which was used for wound
cleaning and dressing. The wound was cleaned every day
2–3 times in a single sitting with Gojihva kwatha soaked
gauze with gentle hands following aseptic precautions.
After that, Kwatha soaked gauze was applied over the
wound and dry sterilized gauze was placed over it and
then dressing was done. Similar dressing was done daily
for 28 days. No other oral medication was given during the
treatment. Wound assessment was done by Bates–Jensen
Wound Assessment Tool (BWAT),[12] pain was assessed
by Visual Analog Scale (VAS),[13] and wound tracing was
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Kumar, et al.: Gojihva, an herb for wound healing
64 Journal of Ayurveda Case Reports - Volume 3, Issue 2, April-June 2020
done with the help of butter paper and pencil at weekly
interval. The digital photography was also done for overall
assessment and comparison.
FOLLOW‑UP AND OUTCOME
The patient Responded well to the treatment and
assessment was done at weekly interval. Changes in
BWAT grading is shown in Table 1. The total score
was 52 before treatment and 13 after treatment, which
suggests good improvement in the wound. The surface
area was measured by tracing method as shown in Table 2.
The surface area was 42.9 cm2 before the treatment and
nil after treatment, which indicates complete healing
of wound. Pain score recorded on VAS scale [Table 3].
The pain score was six before treatment and nil after
the treatment, which indicates the pain reliving property
of the herb. All the clinical changes observed during
weekly examination are shown in Figures 2-6 which are
comparable. In the 1st week, the slough was reduced day by
day and disappeared by 7th day. The wound become more
clean, and by 7th day, healthy granulation tissues were seen.
In the 2nd week, the wound become dry, having only scanty
clean discharge; swelling and pain also reduced. Epithelial
tissues were seen on 14th day. In 3rd week, the discharge
was minimum. Pain was completely resolved, hyper-
pigmentation was reduced, and the wound was completely
covered by the epithelial tissues. Wound contraction was
also seen on each week and wound margins came closer.
In the last week, the wound margins attached with each
other and the wound was completely healed with 0.65 unit
healing time (unit healing time = numbers of days taken
in healing/initial surface area in square centimeters), and
all associated symptoms (pain, swelling, discharge, and
hyper-pigmentation) disappeared. The patient did not
developed any complications during the treatment and
after two months of follow-up.
DISCUSSION
The pharmacodynamic attributes of Gojihva i s
Kashaya (~astringent), Tikta (~bitter), Rasa (~taste),
and Sheetaveerya (~cold potency). As per the Ayurvedic
fundamental principles, Kashaya and Tikta rasa are having
moisture reducing action and property of drying,[14-16] which
may be helpful in reduction of excessive exudates in wound.
Further, Tikta rasa has the Krimighana (~antimicrobial)
property and it provides Sthirikarana (~stability) to
Tvak (~skin) and Mamsa (~muscular tissue).[14] The Kashaya
rasa has Sandhana (~tissue binding) and Ropana (~healing)
action.[17] These potentials of Gojihva may help to prevent
secondary infections and enhance healing. In addition
to these, herbs of Tikta and Kashaya rasa are of Sheeta
veerya[18] that has Stambhana (~styptic therapy) property.
Thus, pharmacodynamics of Gojihva indicates towards its
wound-healing potential. Further, Gojihva is also reported
to have pharmacological activities, i.e., antibacterial,[19]
antifungal,[19] and antioxidant,[20] which supports the wound
healing. The pain reduction was noted in the patient which
may be due to the analgesic effect of herb as it is reported
having analgesic compounds, i.e., thymol, trans-totrol,
eugenol, etc., by which it showed analgesic effect.[21]
The wound-healing property observed with this herb
may be ascribed to its ability to keep the wound free from
infection possibly through its antimicrobial effects and
to enhance wound healing through its pharmacodynamic
attributes as per Ayurveda. However, further studies are
needed to ascertain its mechanism of action on scientic
parameters.
CONCLUSION
The present case report reveals complete healing of chronic
non-healing wound by topical application of Gojihva kwatha
within 28 days without any adverse effect. This unexplored
novel herb may be developed as a cost-effective and potential
wound-healing drug through further vigorous preclinical and
clinical researches. The herb has potential in wound healing
and may be useful in other types of chronic nonhealing
wounds as well as acute wounds. The plant is easily available
as a weed, and it may be the answer of safe, cost-effective,
and potential wound-healing drug for rational use.
Declaration of patient consent
Authors certify that they have obtained patient consent
form, where the patient/caregiver has given his/her
consent for reporting the case along with the images and
other clinical information in the journal. The patient/
caregiver understands that his/her name and initials will
not be published and due efforts will be made to conceal
his/her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conicts of interest.
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