Evidence Based Management of Dushta Vrana (~Diabetic Foot Ulcer) with Guna Pratyanika Chikitsa (~Antagonistic Therapy): A Case Study

Background: Dushta Vrana, analogous to a diabetic foot ulcer, is a frequent and serious complication of diabetes mellitus. Treatment can be exceedingly expensive, particularly when surgical procedures such as skin grafting become necessary. Clinical presentation: A 52‑year‑old male shopkeeper presented to the outpatient department with a persistent ulcer on the lateral aspect of the right ankle. The lesion measured approximately 6 cm × 5 cm, extended to a depth of 4 cm, and had been present for one month. The ulcer exhibited indurated and edematous margins, purulent exudate, localized tenderness, and surrounding erythema. Despite receiving high‑dose oral hypoglycemic agents, the patient’s glycemic control remained unsatisfactory. Surgical debridement was performed, and skin grafting was recommended. However, financial limitations prevented this intervention, prompting referral for alternative care. Diagnosis: The ulcer was Ati‑Vivakta (~wide‑mouthed), Ati‑Mridu (~excessively soft), with Ati‑Sheeta (~sensory loss), Puti‑Puya‑Maansa‑Siraa‑Snaayu‑Prabhrita (~underlying veins, ligaments, and tissues were exposed with sloughing of flesh and fetid discharge), with Deergha‑Kaal‑Anubandhee (~a chronic, persistent nature), consistent with the Ayurvedic description of Dushta Vrana. Intervention: A personalized, holistic Ayurvedic regimen was initiated, utilizing Guna Vipreet Chikitsa (~antagonistic therapy). Internally, two formulations were administered at a time (e.g., Varanadi Kashayam, Panchanimba Churna, Shatdharana Churna, Triphala Guggulu). Externally, the ulcer was irrigated with Triphala decoction and dressed with Triphala powder bandage. Dietary modifications (~Aahar) and lifestyle interventions (~Vihar) were concurrently implemented. Outcome: By day 7, discharge had ceased and by day 15, healthy granulation tissue had developed. With optimized glycemic control, complete re‑epithelialization occurred by Week 11. The wound was assessed using the BWAT. Conclusion: This case underscores the clinical utility of an Ayurvedic protocol for Dushta Vrana as a safe, economical, and effective alternative in the management of diabetic foot ulcers.