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| CASE REPORT |
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| Year : 2022 | Volume
: 10
| Issue : 1 | Page : 62-65 |
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Varicose ulcer and stasis eczema ayurveda perspective: A case report
Gautam Subhashchand Jogad, Sumeeta G Jain
Department of Panchakarma, BMA College, Nagpur, Maharashtra, India
| Date of Submission | 20-May-2021 |
| Date of Decision | 06-Jan-2022 |
| Date of Acceptance | 16-Dec-2021 |
| Date of Web Publication | 31-Mar-2022 |
Correspondence Address:
Dr. Gautam Subhashchand Jogad
Department of Panchakarma, BMA College, Butibori, Nagpur, Maharashtra.
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JISM.JISM_43_21
Varicose ulcers occur due to chronic venous occlusion. This insufficiency leads to ischemia in the vascular supply of the leg, which results in regurgitation of blood through venous valves. When this happens in the cephalous group of veins, it results in varicose ulcers of the leg. The prevalence of chronic venous ulcers in the leg is 70%–80%. If these ulcers are ignored, they can land into cellulitis, gangrene. In Ayurveda perspective, varicose ulcers can be defined as with Vrana developed due to Siragat Vat and also with Vatatrakta. Varicose ulcers can be treated with Ayurveda principles effectively. Its recurrence is common so it also can be prevented by Ayurveda principles. This case was treated on the line of Vatarakta and Dushta Sirajanyavrana. The first target was to correct the Vrana so the drug having property to Vrana Shodhan and Ropan (wound healing and cleaning) was selected. Kleda Nashak and Shothahar (edema), and Raktashodhak and Prasadana (blood purify and circulation). Raktamokshan (bloodletting) helps in the removal of Utkleshit (vitiated) Dosha of site of disease and thus cures the disease faster. By applying these principles, this case shows a marked improvement in all clinical presentations of varicose ulcer and stasis eczema. These are the outcomes of this case. Present case was treated with Ayurveda principle and less period of time, details of case are discussed here. Allopathic medicine can leads to recurrence of diseases as shown in the present case but with the help of Ayurveda treatment chances of recurrences are minimized that is why this is unique case. This case report proposes an innovative treatment protocol to treat varicose ulcers, which needs to study on large scale. Keywords: Ayurveda, Siragat Vat Janya Vrana, stasis eczema, varicose ulcer, Vatarakta
How to cite this article:
Jogad GS, Jain SG. Varicose ulcer and stasis eczema ayurveda perspective: A case report. J Indian Sys Medicine 2022;10:62-5 |
| Introduction | |  |
Varicose ulcers occur due to chronic venous occlusion. This insufficiency leads to ischemia in the vascular supply of the leg, which results in regurgitation of blood through venous valves. When this happens in the cephalous group of veins, it results in varicose ulcers of the leg. The prevalence of chronic venous ulcers in the leg is 70%–80%. If these ulcers are ignored, they can land into cellulitis, gangrene.[1] This occurs due to the low-oxygen-carrying capacity of veins. Even after treating these ulcers, they can cause recurrence, which is present approximately 54%–78% of cases.[1]
The etiological factors include increased intravenous pressure, secondary to deep vein thrombosis, chronic constipation, and long-standing occupation.[2] The pathogenesis starts with persistently increased intravenous pressure, which damages the venous wall and results in stretching, loss of elasticity hyper lipodermatosclerosis, and finally ulcer formation.[3]
In the Ayurveda perspective, varicose ulcers can be defined as with Vrana developed due to Siragat Vat and also with Vatatrakta.[3] As Charak Acharya has mentioned, there is obstruction of Vata due to Rakta and vice versa it results in Vatarakta. In Updrava of Vatarakta Koth (gangrene like) like condition is mentioned by Charak. Therefore, we can treat this by the combination of these diseases. Allopathic medicine can lead to the recurrence of diseases as shown in the present case but with the help of Ayurveda treatment chances of recurrences are minimized that is why this is a unique case.
| Objective | | |
The aim of this work was to study the effect of Ayurveda medicine in the case of varicose ulcers with stasis eczema. A 58-year-old patient came in outpatient department (OPD) with complaints given in the following chart.
Symptoms of patient Details of symptoms (right leg above malleolus and lower knee joint)
[Table 1] shows the symptoms of the patient’s first OPD visit. The patient was suffering from varicose vein since 8 years. Later he developed varicose ulcer, and oozing and itching started in a severe manner. Patient consulted to surgeon but after taking 2 months treatment there is no improvement so the patient has consulted. The patient was on antihypertensive medicine.
General examination
Nadi-paittik, Mal-vibandha (constipation), Mutra-prakriti, Jivha-niram,
Sparsha-khar, Druk-proper vision, Akruti-medium built, Kshudha–prakruta nidra–improper.
Weight 60 kg. Height 160 c.m. BP 130/90 Prakriti-Pitta Vata.
On physical examination, long-dilated veins were observed on both legs. Deep vein thrombosis was not reported, localized swelling was found, mild tenderness was also noted, and varicosity of vein was confirmed positive by Trendelenburg’s test.[1] The patient was a store keeper so the long-standing nature of work was present as a causative factor. The patient was assessed on clinical symptoms present and photographs of ulcers on follow-up (shown below) the case was treated on the line of treatment of Sirajanya dushta vranaand vatarakta. As Charak has described when vitiated Rakta is obstructing to movement of Vata and vice versa, then symptoms of Vatarakta increased and gangrene, Kotha like Vrana can be observed as Updrava of Vatarakta,] means due to varicose vein there is derangement of Dosha and ulceration -Vrana was formed in this patient, details of Vrana Chikitsa Is mentioned in Shushrut. Venous leg ulcer is also called as stasis ulcer, these ulcer in lower leg are difficult to heal as antigravity motion of blood.
Dosha, Dushya, and Sthana involvement was assessed based on all symptoms by Trividha Pariksha. Ayurveda protocol was decided in this patient was advised to give follow-up after every 15 days and analyzed as shown in table details of treatment given to patient.
| Therapeutic Intervention | | |
Internal medication
- Kaishor Guggulu 500 mg two times (Vatarakta Adhikar) a day.
- Panchatikta Ghrut Guggulu 500 mg two times a day.
- Rakta Prasadaka Yoga 20 mL two times a day.
- Trifala Guggulu 250 mg two times a day.
All medicines were given after meals.
External medication
- Cleaning of wound with Trifala Kwath with Tankana and application of Jatyadi Tail Gandhaka Druti once a day.
- Raktamokshana.
Follow-up after 15 days
Raktamokshana was done; 50 mL of stagnant blood (Dushta Rakta) was removed. Internal along with same above medicine for external application only Jatyadi tail and Gandhakadruti was advised.
- Follow-up after 30 days: 1, 2, and 3 same Medication
- Follow-up 60 days: Medications 1, 2, and 3 given along with Raktamokshana by Siravedha was done,40 mL Dushta Rakta was removed.
- Follow-up 90 days: Internal medication 1, 2, 3,4 was given and Raktamokshana 40 mL done follow-up of symptoms mentioned in chart.
- Follow-up of patient was done after 15 days, 30 days, 60 days and 90 days.
| Outcomes | | |
After 90 days of treatment discharge, pain, itching, and burning were subsided. Ulceration healed completely varicosity was also reduced. Hyperpigmentation was also reduced up to mark [Table 2]. Along with clinical symptoms, the patient was analyzed through the photographs [Figure 1][Figure 2][Figure 3][Figure 4], which shows improvement in clinical presentation.  | Figure 1: Showing symptoms on varicose vein on the patient’s first visit
Click here to view |
 | Figure 4: Showing improvement in clinical presentation after 90 days (final stage)
Click here to view |
| Discussion | | |
This case was treated on the line of Vatarakta and Dushta Sirajanyavrana.[4] Our first target was to correct the Vrana so we selected the drug having property to Vrana Shodhan and Ropan (wound healing and cleaning). Kleda Nashak and Shothahar, Raktashodhak, and Prasadana (blood purify and circulation). Drug acting on Snayu, Kandara, Sira and Rakta Dhatu. Raktamokshan helps in removal of Utkleshit dosha of site of disease and thus cures the disease faster.
| Probable Mode of Action | | |
Kaishor Guggulu:[5]Kaishor Guggulu is recommended in the musculoskeletal system for healthy joints and muscles. It is known as Raktashodak, that is, blood purifier. It has antiallergic and antibacterial properties that are useful in Vatarakta.
Panchatikta Ghrit Guggulu.[6] It is Kapha Vat Har, Kleda Har, Vrana Shodhan, and Rakta Prasadan. It has blood purifying and anti-inflammatory properties. Thus, it helps in wound healing and cleaning wounds.
Trifala Guggulu.[7]Trifala Guggulu is antimicrobial having property of Kledahara and Vrana Shodhana, which is useful in Stravi condition of ulcer and eczema.
Rakta Prasadaka Yog: This formulation helps in the proper circulation of blood that is obstructed in the varicose vein. It also helps in the proper functioning of Vyan Vayuand Rakta Dhatu.
Jatyadi Tail.[8] It is useful in wound healing due to its Vrana Ropak property.
Gandhak Druti is a well-known topical application in skin disorder to treat Kandu (itching) and stasis eczema as well.
| Conclusion | | |
Varicose ulcers can be treated with Ayurveda principles effectively. This case was treated on the line of Vatarakta and Dushta Sirajanya Vrana. Its recurrence is common so it also can be prevented by Ayurveda principles. By studying the above case, it can be concluded that varicose ulcers can be treated with ease of treatment and in less time and economical as well. As compared to other medicines, ayurved treatment shows less recurrence. We need such study on large scale. Raktamokshan helps in the removal of Utkleshit (vitiated) dosha of site of disease and thus cures the disease faster. By applying these principles, this case shows a marked improvement in all clinical presentation of varicose ulcer and stasis eczema. These are the outcomes of this case.
This case report proposes an innovative treatment protocol to treat varicose ulcers, which needs to study on large scale.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
| References | | |
| 1. | Ratha KK, Dighe D, Delhi N, Panda AK Management of venous ulcer through Ayurveda: A case report. J Res Ayu Sci 2019;2:202-8.  |
| 2. | Moger M, Belavadi SN Ayurvedic management of Switra: A case study. Int J Res Ayurveda Pharm 2020;11:36-9. |
| 3. | Amarprakash D Management of non healing varicose ulcer in ayurveda. Int Ayurvedic Med J 2013;1:1-6. |
| 4. | Shrikantmurthy KR Sushruta Samhita. Sutra Sthana 23/ 6. Varanasi: Choukhamba Prakashana; 1999. p. 171. |
| 5. | Tripathi I Chakrapani with Vaidyaprabha commentary. Chikitsa Sthana 23 / 41. 4th ed. Varanasi: Chaukhamba Sanskrit Sansthan; 2002. p. 162. |
| 6. | Tripathi I Chakrapani with Vaidyaprabha Commentary. 4th ed. Chikitsa Sthana 50/119. Varanasi: Chaukhamba Sanskrit Sansthan; 2002. p. 289. |
| 7. | Tripathi I Chakrapani with Vaidyaprabha Commentary. 4th ed. Chikitsa Sthana 44/ 68. Varanasi: Chaukhamba Sanskrit Sansthan; 2002. p. 263. |
| 8. | Tripathi I Chakrapani with Vaidyaprabha Commentary. 4th ed. Chikitsa Sthana 44/ 74. Varanasi: Chaukhamba Sanskrit Sansthan; 2002. p. 264. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]
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