Wound Management in Ayurveda: A Critical Review of Classical Principles, Therapeutic Strategies and Contemporary Evidence

Wound care occupies a central position in the surgical tradition of Ayurveda, and the Sushruta Saṃhita, the foundational text of classical Indian surgery, devotes sustained attention to the definition, classification, examination and treatment of the Vrana (wound). This critical review examines the classical framework of wound management in Ayurveda and evaluates its relationship to contemporary wound-healing science and clinical evidence. The review synthesizes classical textual sources, principally the Sushruta Saṃhita in the Bhishagratna translation, with peer-reviewed experimental and clinical studies identified through targeted searches of PubMed/MEDLINE and PubMed Central records. The classical system rests on a staged, individualized approach: cleansing (Vrana-Sodhana), promotion of healing Vrana-Ropana), and an enumerated repertoire of sixty therapeutic measures (Sashṭi Upakrama), supported by a detailed classification of wounds by origin (Nija and Agantu), by Dosha predominance, and by the distinction between clean (suddha) and vitiated (Dushta) wounds. Contemporary studies, including randomized trials of Panchavalkala preparations, Manjisthadi Ghrita, honey and the medicated seton (Ksharasutra), report promising results, yet the evidence base remains limited by small samples, single-arm designs, heterogeneous outcome measures and inconsistent product standardization. The review critically appraises these limitations, distinguishes classical textual claims from experimental and clinical evidence, and identifies priorities for future research, including adequately powered randomized trials, standardized formulations, validated outcome reporting and translational studies. Although direct equivalence between Ayurvedic categories and modern wound classifications should not be assumed, several classical principles, including staged wound preparation, infection control, and systemic and dietary support, show meaningful conceptual convergence with contemporary wound care.