Ayurvedic approaches in wound healing

Introduction

Wound healing is a dynamic and tightly regulated biological process involving coordinated interactions between the vascular system, cytokines, and multiple cellular components such as keratinocytes, fibroblasts, endothelial cells, and immune cells. These elements collectively contribute to hemostasis, pathogen elimination, inflammatory regulation, tissue proliferation, and re-epithelialization. The overall objective of wound repair is restoration of skin integrity and functional tissue regeneration.

In Ayurveda, wound management is primarily described under the concepts of Vrana Shodhana (cleansing of wounds) and Vrana Ropana (healing and tissue restoration). These approaches integrate herbal formulations, mineral preparations, and procedural therapies aimed at reducing inflammation, enhancing granulation tissue formation, and accelerating epithelial regeneration. Despite extensive traditional use, many herbal remedies employed in wound care remain insufficiently validated through rigorously controlled clinical studies.

Phases of wound healing: modern and Ayurvedic correlation

Modern wound healing is classically divided into four overlapping phases:

• Hemostasis
• Inflammation
• Proliferation
• Remodeling

Ayurvedic literature correlates these phases with sequential restoration of Rakta dhatu (blood tissue), resolution of dosha vitiation, and regeneration of twak (skin). Key therapeutic objectives include:

• Removal of necrotic tissue and toxins (Shodhana)
• Control of infection and inflammation
• Promotion of granulation and epithelialization (Ropana)
• Restoration of tissue strength and pigmentation

Mechanisms of Ayurvedic wound healing interventions

Ayurvedic wound healing therapies act through multiple biological pathways:

• Anti-inflammatory modulation through suppression of pro-inflammatory mediators
• Antimicrobial activity against wound pathogens
• Promotion of fibroblast proliferation and collagen synthesis
• Enhancement of angiogenesis and microcirculation
• Acceleration of epithelial cell migration and tissue remodeling
• Antioxidant activity reducing oxidative tissue damage
• Immunomodulatory effects supporting balanced inflammatory response

These multimodal actions make Ayurvedic interventions relevant in both acute and chronic wound management.

Birch bark (Betula species) and betulin in wound healing

The molecular elucidation of betulin’s wound-healing properties demonstrates a beneficial effect across all three major phases of wound repair: inflammation, proliferation, and remodeling [48]. Betulin exerts anti-inflammatory, antimicrobial, and tissue-regenerative actions, contributing to improved wound closure dynamics.

In a split-thickness wound model, the first clinical evidence supporting betulin’s wound-healing efficacy was obtained through topical application of a water-free betulin oleogel. This formulation demonstrated enhanced re-epithelialization and improved wound barrier restoration.

Subsequently, betulin oleogel was evaluated in multiple multicenter, randomized, controlled clinical trials involving second-degree burns and superficial wounds, where it showed significant improvement in wound healing outcomes compared to standard care. These findings provide strong translational evidence supporting its clinical relevance in dermatological wound therapy.¹

Psidium guajava and Eucalyptus camaldulensis in wound repair

Several medicinal plants traditionally used in wound management have demonstrated pharmacological activity relevant to tissue repair. Notably, Psidium guajava and Eucalyptus camaldulensis possess significant wound-healing properties.²

Their therapeutic actions include:

• Antibacterial activity against wound-associated pathogens
• Anti-inflammatory effects reducing local tissue damage
• Antioxidant properties supporting cellular repair mechanisms
• Enhancement of collagen deposition and wound contraction

These activities contribute to improved wound closure and reduced infection risk.

Allium cepa (onion) and scar modulation

Onion extract (Allium cepa) has been investigated for its effect on scar formation in a randomized placebo-controlled study involving 58 participants who underwent minor dermatological surgical procedures such as punch biopsies and skin tumor excisions.

Following three weeks of primary wound healing, patients were administered either onion extract or placebo twice daily for ten weeks. The study demonstrated that onion extract significantly improved overall scar appearance, including reductions in redness, roughness, and textural irregularities when compared with placebo treatment.

These findings suggest a beneficial role of Allium cepa in modulating post-inflammatory fibrosis and improving cosmetic outcomes in wound healing.

Therapeutic role of Ayurvedic interventions in wound healing

Ayurvedic wound healing approaches contribute to multiple stages of tissue repair through:

• Reduction of microbial load and infection control
• Acceleration of granulation tissue formation
• Enhancement of epithelial regeneration
• Regulation of excessive inflammation and fibrosis
• Improvement in collagen remodeling and scar quality
• Restoration of local tissue homeostasis

These effects support both functional recovery and improved aesthetic outcomes in wound management.

Advantages of Ayurvedic wound healing therapies

• Multitarget pharmacological action (anti-inflammatory, antimicrobial, regenerative)
• Support for natural tissue repair mechanisms
• Potential reduction in scarring and fibrosis
• Biocompatible and generally well-tolerated topical applications
• Synergistic action of phytochemicals in polyherbal formulations
• Suitability for adjunct use with conventional wound care strategies
• Potential benefits in chronic and non-healing wounds

Conclusion

Ayurvedic approaches in wound healing represent a comprehensive therapeutic framework integrating herbal pharmacology, bioactive phytochemicals, and traditional procedural interventions. Experimental and clinical evidence, including studies on betulin from birch bark, Allium cepa, and other medicinal plants, supports their role in enhancing wound repair, reducing inflammation, and improving scar outcomes.

However, despite promising findings, many traditionally used wound-healing agents still require rigorous clinical validation through well-designed randomized controlled trials. Integration of Ayurvedic wound care principles with modern biomedical insights may provide a more effective and holistic strategy for acute and chronic wound management.

References:

1. 1. Agrawal R, Jurel P, Deshmukh R, et al. Emerging Trends in the Treatment of Skin Disorders by Herbal Drugs: Traditional and Nanotechnological Approach. Pharmaceutics. 2024;16(7):869. Published 2024 Jun 28. doi:10.3390/pharmaceutics16070869. https://pmc.ncbi.nlm.nih.gov/articles/PMC11279890/
   2. Aleksic Sabo V, Knezevic P. Antimicrobial activity of Eucalyptus camaldulensis Dehn. plant extracts and essential oils: A review. Ind Crops Prod. 2019;132:413-429. doi:10.1016/j.indcrop.2019.02.051. https://pmc.ncbi.nlm.nih.gov/articles/PMC7126574/