Effectiveness of Ayurvedic Interventions in the Management of Chronic Ulcers: A Protocol for Systematic Review (Preprint)

<sec> <title>BACKGROUND</title> Chronic ulcers—including diabetic foot ulcers, venous leg ulcers, arterial ulcers, and pressure injuries—pose a global health challenge due to prolonged healing, high recurrence, and risk of infection, amputation, and mortality. Conventional wound care technologies have improved outcomes but remain variably effective, particularly in resource-limited settings. In India, Ayurveda continues to be practiced for wound care, with classical texts such as the Sushruta Samhita detailing descriptions of Dushta Vrana (chronic ulcers) and therapeutic modalities including herbal formulations, irrigation, debridement, fumigation, and surgical interventions. While these interventions are widely applied in practice, the evidence base remains fragmented, heterogeneous, and insufficiently synthesized. A systematic review is warranted to critically appraise available literature on Ayurvedic interventions in chronic ulcer care. </sec> <sec> <title>OBJECTIVE</title> This review aims to systematically identify and synthesize evidence on Ayurveda-based interventions for chronic ulcers, focusing on (1) diagnostic criteria, (2) assessment parameters, (3) treatment rationale, (4) topical and systemic therapies used, and (5) reported outcomes. </sec> <sec> <title>METHODS</title> We will include randomized controlled trials, non-randomized studies, and case reports involving human participants with chronic ulcers of any etiology. Interventions include Ayurveda-based topical or systemic therapies, alone or in combination with other treatments. Primary outcome is wound healing; secondary outcomes include healing rate, unit healing time, epithelialization, neovascularization, antimicrobial activity, and recurrence. Databases searched will include PubMed, Embase, CENTRAL, Scopus, AYUSH Research Portal, DHARA, and Shodhganga, alongside grey literature. Risk of bias will be assessed using RoB 2 for RCTs and ROBINS-I for non-randomized studies. Data synthesis will follow PRISMA 2020 guidelines, with meta-analysis where feasible and narrative synthesis otherwise. </sec> <sec> <title>RESULTS</title> As this is a protocol, results are not yet available. </sec> <sec> <title>CONCLUSIONS</title> This systematic review will provide a consolidated evaluation of Ayurvedic interventions in chronic ulcer management, identify research gaps, and inform the development of evidence-based integrative wound care strategies. </sec> <sec> <title>CLINICALTRIAL</title> PROSPERO registration No- CRD420251077147 </sec>