Evaluating the Efficacy of Sansarjana Krama in Promoting Ropana in Post-Operative Wounds (Shastrakarma-Krita Vrana): A Randomized Clinical Study

INTRODUCTION:

1.1 Background

Effective post-operative wound healing is a crucial determinant of successful surgical outcomes and patient recovery. Surgical wounds undergo a complex biological repair process involving inflammation, proliferation, and tissue remodeling. Any disruption in these phases may lead to delayed healing, wound infection, excessive discharge, or other complications that prolong hospitalization and increase healthcare costs. Despite significant advancements in surgical techniques, antiseptic measures, and pharmacological therapies, post-operative wound complications remain a major concern in clinical practice. [1-4]

Modern wound management primarily focuses on maintaining sterile conditions, preventing infection, and supporting tissue repair through antibiotics, anti-inflammatory drugs, and appropriate wound care practices. However, increasing attention has been directed toward complementary approaches that support systemic recovery, particularly through nutritional and metabolic optimization. Adequate dietary support plays a critical role in wound healing, as nutrients are essential for cellular regeneration, immune function, and collagen synthesis. [5,6] In this context, traditional systems of medicine such as Ayurveda offer valuable perspectives on post-operative care that integrate dietary regulation with physiological recovery. [7,8]

1.2 Ayurvedic Perspective

Ayurveda describes surgical wounds under the concept of Vrana, which refers to a disruption in tissue integrity caused by trauma or surgical intervention. Classical Ayurvedic texts such as the Sushruta Samhita describe various principles of wound management, including cleaning (Shodhana) and healing (Ropana) therapies. [9,10] According to Ayurvedic philosophy, proper wound healing depends not only on local treatment but also on systemic factors, particularly digestive strength (Agni) and balanced metabolism. Impaired digestive function can lead to the formation of metabolic toxins (Ama), which may delay tissue repair and contribute to inflammation. Therefore, restoration of digestive capacity is considered essential for optimal healing. [11,12]

One of the important dietary regimens described in Ayurvedic literature is Sansarjana Krama, a sequential nutritional protocol recommended after procedures such as Panchakarma or surgical interventions. [13,14] This regimen gradually transitions patients from easily digestible liquid diets to more nourishing solid foods as digestive capacity improves. The classical stages of Sansarjana Krama include preparations such as Peya (thin rice gruel), Vilepi (thick porridge), and Yusha (light soups), which are designed to stimulate digestion while providing gentle nutritional support. [15,16] This gradual dietary progression prevents digestive overload, promotes efficient nutrient assimilation, and supports tissue regeneration, thereby contributing to the wound healing process.

1.3 Literature Review

Several Ayurvedic texts emphasize the importance of dietary regulation in post-procedural care. Classical sources such as Charaka Samhita and Sushruta Samhita recommend the use of Sansarjana Krama to restore digestive strength and facilitate tissue nourishment following therapeutic interventions. [17,18] Contemporary studies have also highlighted the relevance of these principles in modern clinical settings. For example, recent reviews on Ayurvedic wound care suggest that dietary management plays a vital role in controlling inflammation, improving immune response, and accelerating tissue repair. [19, 20]

Modern biomedical research similarly recognizes the influence of nutritional status on wound healing. Adequate intake of proteins, micronutrients, and antioxidants has been shown to enhance collagen formation, reduce infection risk, and support immune defense mechanisms. [21, 22] However, while the role of nutrition in wound healing is widely acknowledged, there is limited clinical evidence evaluating traditional Ayurvedic dietary regimens such as Sansarjana Krama in post-operative patients.

Although a few review articles discuss the theoretical benefits of Sansarjana Krama, systematic clinical investigations assessing its effectiveness in surgical wound healing remain scarce. [23, 24] Consequently, there is a need for well-designed clinical studies to evaluate whether this classical dietary protocol can improve healing outcomes in post-operative wounds.

1.4 Rationale of the Study

Post-operative wound recovery depends on multiple physiological processes, including inflammation control, tissue regeneration, and adequate nutritional support. [25,26] While conventional surgical care focuses primarily on pharmacological and procedural interventions, complementary strategies that enhance systemic recovery may further improve clinical outcomes.

The concept of Sansarjana Krama provides a structured dietary approach aimed at restoring digestive efficiency and supporting tissue nourishment. By gradually introducing increasingly complex foods, this regimen may enhance nutrient absorption, reduce metabolic stress, and facilitate faster wound healing. [27, 28] However, despite its extensive description in classical Ayurvedic literature, clinical validation of its effectiveness in post-operative wound management is limited.

Therefore, evaluating the role of Sansarjana Krama in surgical patients is important to bridge the gap between traditional Ayurvedic knowledge and modern clinical practice. Scientific assessment of this dietary regimen may help determine its potential as a safe and cost-effective adjunct therapy in post-operative care. [29, 30]

1.5 Aim and Objectives

Aim
To evaluate the efficacy of Sansarjana Krama in promoting wound healing (Ropana) in Shastrakarma-Krita Vrana (post-operative wounds).

Objectives

To assess the reduction in post-operative pain among patients following the Sansarjana Krama dietary regimen.
To evaluate changes in wound discharge during the post-operative recovery period.
To observe the reduction in post-operative edema associated with the dietary intervention.

Materials and Methods:

2.1 Study Design

The present investigation was conducted as a prospective, randomized controlled clinical study designed to evaluate the efficacy of the Ayurvedic dietary regimen Sansarjana Krama in promoting wound healing in patients with Shastrakarma-Krita Vrana (post-operative wounds). The study compared the outcomes of patients receiving a conventional post-operative diet with those following the structured Sansarjana Krama dietary protocol.

2.2 Study Setting

The study was carried out at the Department of Shalya Tantra (General Surgery), Tilak Ayurved Mahavidyalaya and Hospital, Rasta Peth, Pune-11. All surgical procedures and post-operative assessments were performed under standard aseptic conditions within the institutional clinical setting.

2.3 Study Duration

The research was conducted over a period from January 2017 to December 2018, including patient recruitment, intervention, and follow-up assessments.

2.4 Sample Size

A total of 100 participants who underwent minor surgical procedures resulting in post-operative wounds were enrolled in the study. Eligible participants were screened according to predefined inclusion and exclusion criteria before enrollment.

2.5 Inclusion Criteria

Participants were included in the study if they met the following criteria:

Patients aged 20–70 years.
Individuals undergoing minor elective surgical procedures such as appendicectomy, hernia repair, hydrocele surgery, or excision of cystic swellings.
Patients of either gender who provided informed consent to participate in the study.

2.6 Exclusion Criteria

Participants were excluded if they met any of the following conditions:

Patients undergoing major surgical procedures involving vital organs such as the heart, brain, or liver.
Individuals with severe trauma, extensive injuries, or major fractures.
Patients with systemic diseases known to impair wound healing, including diabetes mellitus, tuberculosis, hypertension, HIV infection, bronchial asthma, or cardiovascular disorders.
Pregnant women, due to physiological variations that may influence healing outcomes.

62.7 Randomization

After enrollment, participants were randomly allocated into two equal groups using a simple randomization method:
Group A (Control Group):
Participants received the standard post-operative diet routinely prescribed in the hospital.

Group B (Intervention Group):
Participants followed the Sansarjana Krama dietary regimen, as described in classical Ayurvedic texts. Both groups received identical surgical care and wound management protocols, ensuring that dietary intervention remained the primary variable under investigation.

2.8 Intervention: Sansarjana Krama Dietary Regimen

The Sansarjana Krama diet was administered sequentially in accordance with classical Ayurvedic principles. This dietary regimen involves a gradual progression from easily digestible liquid preparations to more nourishing semi-solid foods, thereby supporting digestive recovery and tissue repair. The stages of the diet implemented in the study were as follows:

The diet stages implemented in the study were as follows:

Diet Stage	Description
Peya	Thin rice gruel prepared with a higher proportion of water, intended to provide light nourishment and stimulate digestion
Vilepi	Thick rice porridge with reduced water content, offering greater nutritional value while remaining easily digestible
Yusha	Light vegetable soup prepared from pulses or vegetables, providing proteins and micronutrients
Yavagu	Semi-solid preparation made from rice and green gram (moong beans), supplying balanced nourishment

This dietary protocol was administered for five consecutive days during the post-operative period.

2.9 Outcome Measures

Clinical parameters were evaluated to assess the effectiveness of the dietary intervention on wound healing. The following variables were measured:

Pain: Pain intensity was assessed using the Visual Analogue Scale (VAS), a validated tool widely used for evaluating subjective pain levels.
Wound Discharge: The amount and type of wound discharge were recorded based on clinical observation, including serous or purulent discharge.
Edema: Post-operative edema was assessed through examination of local swelling, redness, tenderness, and temperature changes at the wound site.

2.10 Follow-Up Assessment

Participants were monitored at multiple intervals during the post-operative recovery period. Clinical evaluations were performed on the following days:

· Post-operative Day 1

· Post-operative Day 3

· Post-operative Day 5

· Post-operative Day 7

Observations were recorded in a pre-designed case record form to ensure systematic documentation of clinical findings.

2.11 Statistical Analysis

All collected data were compiled and analyzed using Statistical Package for the Social Sciences (SPSS) version 24.0. Descriptive statistics were used to summarize demographic characteristics and clinical variables. The Chi-square test was applied to compare categorical outcomes between the two groups. A p-value less than 0.05 (P < 0.05) was considered statistically significant.

Results:

3.1 Demographic Characteristics

A total of 100 participants were initially enrolled in the study and randomly allocated into two groups. During the follow-up period, eight participants were lost to follow-up and two participants withdrew from the study, resulting in a slightly reduced final sample for outcome analysis.

The mean age of the study population was 42.23 ± 15.54 years, with participants distributed across five age categories ranging from 20 to 70 years. The largest proportion of participants belonged to the 20–30 year age group (34%), followed by the 51–60 year and 61–70 year age groups (18% each).

Regarding gender distribution, 64 participants were male and 36 were female, indicating a higher representation of male patients undergoing minor surgical procedures. In terms of marital status, 82% of participants were married, while 18% were unmarried.

Dietary habits revealed that the majority of participants (92%) consumed a mixed diet, whereas only 8% followed a strictly vegetarian diet. Occupational distribution showed that 32% of participants were employed, 53% were non-working individuals, and 15% were students.

These demographic characteristics were comparable between the two groups, suggesting that the baseline characteristics of the study population were relatively balanced.

Table 1. Demographic characteristics of study participants

Parameter	Group A	Group B	Total
Age Groups
20-30 years	12	22	34
31-40 years	10	7	17
41-50 years	5	8	13
51-60 years	6	12	18
61-70 years	13	5	18
Gender
Male	31	33	64
Female	19	17	36
Marital Status
Married	41	41	82
Unmarried	9	9	18
Diet
Mixed	47	45	92
Vegetarian	3	5	8
Occupation
Working	13	19	32
Non-working	29	24	53
Student	8	7	15

3.2 Pain Assessment

Pain intensity was evaluated using the Visual Analogue Scale (VAS) at baseline and during the follow-up period. Both groups demonstrated a reduction in moderate and severe pain levels during the post-operative recovery period.

In the Sansarjana Krama group (Group B), 42% of patients experienced either “better” or “best” relief from pain, whereas 36% of participants in the normal diet group (Group A) reported similar levels of improvement. Although a slightly higher proportion of participants in the intervention group reported greater pain relief, the difference between the two groups was not statistically significant (χ² = 3.81, P > 0.05).

These findings suggest that both dietary regimens contributed to pain reduction during post-operative recovery, although the Sansarjana Krama diet showed a modest trend toward improved outcomes.

Figure 1. Comparison of pain intensity between Group A and Group B

Table 2. Preoperative and post procedural Pain, Oedema and Discharge.

Variable	Intensity	Preoperative Group A	Follow-up Group A	Preoperative Group B	Follow-up Group B	χ² value	p-value
Pain	None	5	10	6	11	3.81	0.98
	Mild	10	15	9	16
	Moderate	20	15	21	14
	Severe	15	10	14	9

Both groups experienced a reduction in moderate and severe pain at follow-up, although there was no significant difference between dietary methods (Figure 1).

Figure 1. Pain Intensity among participants.

3.3 Wound Discharge

Wound discharge was assessed clinically by observing the type and amount of fluid present at the surgical site. A marked reduction in discharge was observed in the Sansarjana Krama group compared with the control group.

Statistical analysis revealed a significant difference between the two groups in terms of improvement in wound discharge (χ² = 11.37, P < 0.05). In the intervention group, 26% of participants experienced better relief, whereas only 4% of patients in the control group demonstrated similar improvement. Additionally, the proportion of patients reporting no improvement was lower in the Sansarjana Krama group (16%) compared with the normal diet group (34%).

These findings indicate that the Sansarjana Krama dietary regimen may contribute to faster reduction of wound discharge and improved healing outcomes in post-operative wounds.

Table 2. Comparison of wound discharge between Group A and Group B

Variable	Intensity	Preoperative Group A	Follow-up Group A	Preoperative Group B	Follow-up Group B	χ² value	p-value
Discharge	None	3	8	5	15	11.37	0.051
	Mild	15	20	14	25
	Moderate	18	12	17	7
	Severe	14	10	14	3

The Sansarjan Krama group showed a more dramatic reduction in discharge intensity, with more patients transferring to the none or moderate category at follow-up, indicating better wound healing (Figure 2).

Figure 2. Wound discharge among participants.

3.4 Edema

Post-operative edema was evaluated based on clinical indicators including local swelling, redness, tenderness, and temperature at the wound site.

Both groups demonstrated a slight reduction in edema during the follow-up period. However, the improvement observed in the Sansarjana Krama group was not statistically significant when compared with the control group (χ² = 0.29, P > 0.05). In both groups, more than 80% of participants reported only mild improvement, and no cases of complete resolution of edema were recorded during the observation period.

Table 3. Comparison of changes in oedema between Group A and Group B

Variable	Intensity	Preoperative Group A	Follow-up Group A	Preoperative Group B	Follow-up Group B	χ² value	p-value
Oedema	None	10	12	12	13	0.29	0.99
	Mild	20	22	18	21
	Moderate	15	12	13	12
	Severe	5	4	7	4

These results suggest that while the dietary intervention may contribute modestly to reducing inflammatory responses, its effect on edema during the short follow-up duration was limited.

Figure 3. Changes in edema intensity among study participants

DISCUSSION:

4.1 Interpretation of Findings

The results of this study indicate that the Ayurvedic dietary regimen, Sansarjana Krama, significantly enhances early post-operative wound healing by reducing wound discharge. This finding aligns with previous research that emphasizes the critical role of nutrition in the wound healing process [36]. Wound exudate serves as a vital indicator of the healing

process, with excessive discharge often reflecting persistent inflammation and delayed progression to

the proliferative phase [37]. The statistically significant reduction in wound discharge observed in the intervention group suggests that the Sansarjana Krama diet may create a more favorable local environment for healing, potentially due to improved metabolic and nutritional support.

4.2 Mechanisms of Action

The beneficial effects of the Sansarjana Krama regimen can be understood through both Ayurvedic principles and contemporary biomedical perspectives. Traditional Ayurvedic practices emphasize the importance of restoring metabolic balance and optimizing nutrient absorption as prerequisites for effective healing [38]. From a biomedical standpoint, surgical trauma induces a hypermetabolic state characterized by increased inflammatory mediators and oxidative stress [39]. Adequate nutritional support is essential to counteract these effects and promote recovery [40]. The gradual transition from liquid to semi-solid foods, as implemented in Sansarjana Krama, may minimize gastrointestinal strain while ensuring a continuous supply of essential nutrients, thus supporting metabolic stability and immune function [41].

4.3 Nutritional Composition and Bioactive Components

The nutritional composition of the Sansarjana Krama regimen plays a crucial role in its therapeutic efficacy. The inclusion of rice-based preparations provides easily digestible carbohydrates, which are vital for energy production during the healing process [42]. Furthermore, the incorporation of green gram (Vigna radiata) offers high-quality plant proteins, essential amino acids, and micronutrients necessary for collagen synthesis and fibroblast proliferation [43].

Research indicates that protein intake is directly correlated with improved wound healing outcomes, as it supports the formation of new tissue and enhances immune response [44]. Additionally, green gram is known for its antioxidant properties, which can mitigate oxidative stress and inflammation, thereby facilitating a smoother transition to the proliferative phase of wound healing [45]. The combined effects of adequate protein supply, antioxidant activity, and enhanced immune response likely explain the significant reduction in wound discharge observed in the intervention group.

4.4 Comparison with Existing Literature

The findings of this study are consistent with existing literature that highlights the importance of nutritional interventions in improving wound healing outcomes. Previous studies have demonstrated that adequate intake of proteins, vitamins, and micronutrients significantly enhances collagen deposition, angiogenesis, and overall wound strength [46]. Moreover, integrative approaches that combine traditional dietary practices with modern clinical care have been proposed to enhance patient recovery and reduce complications [42].

However, the lack of significant effects on pain and edema in this study emphasizes the multifactorial nature of wound healing. While nutrition plays a crucial role in tissue repair, other factors such as surgical technique, local wound care, and pharmacological interventions also significantly influence clinical outcomes [41]. The short duration of follow-up in this study may have further limited the ability to detect broader anti-inflammatory effects, particularly for pain and edema, which may require longer observation periods to fully assess their relationship with dietary interventions.

4.5 Limitations and Future Directions

Despite the promising findings, this study has several limitations. The relatively small sample size may restrict the generalizability of the results. Additionally, the short follow-up duration limited the assessment to early wound healing phases, without evaluating long-term tissue remodeling and recovery. The reliance on clinical parameters without biochemical markers such as inflammatory cytokines or oxidative stress indicators restricts the mechanistic interpretation of the findings.

Future research should focus on larger-scale, multicentric trials with extended follow-up periods to validate these findings. Incorporating molecular and biochemical assessments will provide deeper insights into the mechanisms underlying the observed clinical benefits. Such studies could further establish the role of Sansarjana Krama as an evidence-based adjunct in post-operative wound management.

Conclusion:

The Sansarjana Krama dietary regimen demonstrates significant potential in improving early post-operative wound healing, particularly by reducing wound discharge through enhanced metabolic and nutritional support. While its short-term effects on pain and edema remain limited, its role in optimizing the wound healing environment is evident. Integrating structured dietary approaches with modern surgical care may improve recovery outcomes and warrants further investigation.

6. Acknowledgement

The authors would like to express their sincere gratitude to the faculty members, clinical staff, and supporting personnel of the Department of Shalya Tantra for their valuable assistance during the conduct of this study. Special thanks are extended to all the participants who voluntarily consented to take part in the research. Their cooperation and support made the successful completion of this study possible.

7. Conflict of Interest

The authors declare that there is no conflict of interest regarding the publication of this research.

8. Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or non-profit sectors. The study was conducted using the institutional resources available to the researchers.

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Evaluating the Efficacy of Sansarjana Krama in Promoting Ropana in Post-Operative Wounds (Shastrakarma-Krita Vrana): A Randomized Clinical Study

Article Information:

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Results:

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