Case Report

Varicose Ulcer

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb

A case study on Varicose Ulcer with Maggots by Jatyadi Taila - A Case Report

Kumar PH P.1*, Gopikrishna B.2, N Rao P.3

1* Pavan Kumar PH, Post Graduate Scholar, Dept. of Shalya Tantra, SDM College of Ayurveda, Hassan, Karnataka, India.

2 BJ Gopikrishna, Professor, Dept. of Shalya Tantra, SDM College of Ayurveda, Hassan, Karnataka, India.

3 Prasanna N Rao, Principal and Professor, Dept. of Shalya Tantra, SDM College of Ayurveda, Hassan, Karnataka, India.

Venous ulceration occurs in the gaiter area in 95% of cases especially, around the malleolar region. The tiny veins on the medial aspect of the ankle dilate due to the increase in pressure. This is known as ankle flare and also causes atrophy of the veins, which are prone to damage, especially around the lower ankle area. Lipodermato sclerosis is a term used to describe the combination of changes in the lower leg from Venous hypertension. As a result of venous congestion and the loss of intercellular fluid balance, the skin can become very dry and flaky. The build-up of hyperkeratotic skin is also an indicator of high venous pressure. In venous disease, ulcers are usually located in the gaiter area between the ankle and the calf, often on the medial aspect of the leg. A diagnosed case of Varicose Ulcer on Right leg with maggots was admitted for mild pain, edema, serous discharge, blackish discoloration of the skin with foul smell. Aims and objective: To evaluate the efficacy of Jatyadi Taila in the management of Dushta Vrana. Methodology: Wound debridement was done by removing maggots. Vrana Prakshalana with Panchavalkala Kwatha, Vrana Basti was done using Jatyadi Taila followed by dressing with Jatyadi Taila. Along with this the patient was given Shodhana (Virechana). After Shodhana, Vrana Prakshalana with Panchavalkala Kwatha, Vrana Basti was done followed with dressing with Jatyadi Taila in the morning and only dressing with Jatyadi Taila in the evening. Patient was also given with oral medications. Conclusion: Virechana improves potency of individual cell of the body, increases sensitivity of the cells in the ulcer site towards Shodhana and local application i.e., Jatyadi Taila and hence accelerates the wound healing.

Keywords: Dushta Vrana, Shodhana, Virechana, Vrana Prakshalana, Vrana Basti, Jatyadi Taila

Corresponding Author How to Cite this Article To Browse
Pavan Kumar PH, Post Graduate Scholar, Dept. of Shalya Tantra, SDM College of Ayurveda, Hassan, Karnataka, India.
Pavan Kumar PH, BJ Gopikrishna, Prasanna N Rao, A case study on Varicose Ulcer with Maggots by Jatyadi Taila - A Case Report. J Ayu Int Med Sci. 2022;7(1):334-338.
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Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-27 2022-01-29 2022-02-05 2022-02-12 2022-02-19
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 17%

© 2022by Pavan Kumar PH, BJ Gopikrishna, Prasanna N Raoand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].


Venous ulcers are caused by venous valves that do not properly prevent the backflow of blood, or venous reflux, where perforating veins traverse the muscular fascia to connect superficial and deep veins. Any condition that causes blood to pool in the veins of the leg s a potential cause of venous ulcers, Including varicose veins, deep vein thrombosis or heart failure. A venous ulcer is defined as: full-thickness defect of the skin, most frequently in the ankle region, that fails to heal spontaneously and is sustained by chronic venous disease. Venous ulcers usually occur at the malleolar region both on the medial and lateral aspects of the ankle. However, they are also known to occur on the supra-malleolar and infra-malleolar regions of the leg and foot, respectively. Varicose ulcer is a complication of varicose veins or deep vein thrombosis. Varicose veins or DVT which eventually causes chronic Venous hypertension. Causes hemosiderin deposition in the subcutaneous plane from lysed RBC’s results in Eczema, Dermatitis, Lipodermatosclerosis[2], Fibrosis, Anoxia and finally results in Ulceration.

In Ayurveda Prakupita Vata Dosha compresses, raises and squeezes the network of veins and is considered as Krichhra Sadhya Vyadhi (curable with difficulty) in early stage and Asadhya in late stages affecting the vital parts of the body. Sushruta’s school of thought considers the Rakta (blood) as Dosha because the blood plays main role in the pathogenesis of many disorders. Because blood vessels are involved, there is definitive involvement of Pitta Dosha. Along with Pitta, Vata alone or Vata and Kapha are vitiated in their site of affliction, i.e., in weight bearing area like calf and ankle. Ultimately the imbalanced Doshas disturb the vessels and the blood of that particular area (venous blood). Thus the blood is stagnated due to obstruction of the pathway of the blood vessels leading to the cause of Dushta Vrana.[1] This can be treated successfully with Shodhana (purification) and Shamana (pacification) therapy. So, the fore mentioned benefits of Virechana and Vrana Basti were assessed in alleviating the symptoms and in the healing process of varicose ulcer in the patient.

Case Report

A male patient of 34 years

who was a Chicken vendor by profession, came with a complains of Non healing ulcer in the right lower limb with maggots since 3 months associated with mild pain, mild swelling, blackish discoloration around the wound with foul smell.

History of present illness: Patient was apparently healthy 3 months back. Gradually he developed with a blister in the anterio-medial aspect of the right lower limb. After 1 month he developed ulcer with mild pain, edema, serous discharge, blackish discoloration of the skin with foul smell noticed. Then patient consulted nearby doctor and took medicines (details not available) and did wound dressing.

After 3 months he found little maggots at the wound site with mild bleeding so he consulted for the same complaints and got admitted in our hospital for further management.

History of past illness

  • No H/O DM, HTN or any other medical / surgical illness in the past.

Treatment history

  • Patient was doing self-wound dressing without aseptic precautions.

Personal History

Diet: Non-vegetarian

Appetite: Regular

Bowel: Once a day, normal

Micturition: 7-8 times

Sleep: Disturbed

Habits: No h/o alcohol intake, no h/o smoking, no h/o tobacco chewing

Examination of the patient

General examination

GC: Fair

Pallor: Absent

Icterus: Absent

Lymphadenopathy: Mild edema in Right lower limb

Cyanosis: Absent

Clubbing: Absent

Oedema: Absent


Pulse: 80 bpm, Regular

BP: 120/80 mm of Hg

Temperature: Afebrile, 97.4°F

Respiratory rate: 18/min

Systemic examination

CVS: S1S2 heard

CNS: Intact, Conscious, oriented to time, place and person

P/A: Soft, non-tender, No Organomegaly

RS: Bilateral equal air entry, Normal vesicular breath sounds, no added sounds

Wound examination of Right leg


Number - 1

Location - Anterio-medial aspect of Lower 1/3rd of the right leg

Size - 10X6X0.5 cms

Shape - Oval

Discharge - Serous

Odour - Foul smell

Edge - Sloping

Surrounding skin - Blackish discoloration present, mild edema present

Foreign body - Maggots around 20 present


Temperature - Mildly raised

Mild tenderness - Present

Bleed on touch - Absent


Hb - 14.2 gm%

TC - 7,900 cells/cmm

DC- N-60, L-33, M-2, E-5

ESR - 50mm 1st hour

RBS - 100.9 mg/dl

S.Creatinine - 0.9 mg/dl

Lipid Profile - WNL

Right lower limb Venous Doppler Study

jaims_1708_01.JPGGrade 1 Sapheno-Femoral Incompetence, SVT involving GSV at lower 1/3rd of leg and cellulitis, No evidence of DVT.

Right lower limb Arterial Doppler study

jaims_1708_02.JPGNormal study, no stenosis/occlusion

Diagnosis: Varicose ulcer with maggots on the anterio medial aspect of lower 1/3rd of Right Leg. (Dushta Vrana).

Treatment given

Patient was given with Virechana - 21 Vegas.

Deepana Pachana with Panchakola Phanta and Chitrakadi Vati.

Snehapana with Panchatikta Guggulu Ghritha.

Virechana with Avipattikara Churna and Triphala Kashaya.

For Vrana - Vrana Prakshalana by Panchavalkala Kwatha BD followed by Vrana Basti with Jatyadi Taila for 1 hour per day was done for 28 days.

Then wound dressing with Jatyadi Taila.  Foot end elevation.

Internally: Kaishora Guggulu 2 BD After food

Mahamanjistadi Kwatha 15 ml BD with lukewarm water after food

jaims_1708_03.JPGjaims_1708_04.JPGjaims_1708_05.JPGDay 1 - At the time of Admission


Day 3


Day 10


Day 19


Day 28


  • Complete healing of varicose ulcer on 28th
  • All previous signs and symptoms are relieved.
  • No post treatment complications.
  • No any complications associated with Varicose ulcer.


  • The management of Varicose ulcer is very effective through Vrana Basti with Jatyadi Taila.
  • The main aim of treatment must be the control of venous hypertension and avoid stasis of blood in the veins.
  • Venous hypertension and draining of blood was achieved by giving foot end elevation.
  • Daily Vrana Prakshalana with Panchavalkala Kwatha, Vrana Basti with Jatyadi Taila efficiently improves the granulation and fastens the wound healing.
  • It is a powerful anti-septic which also has anti-inflammatory properties. It is also an efficient anti-microbial, anti-bacterial and anti-fungal. Panchavalkala Kwatha Churna is the dried powder form of 5 different herbs Vata, Udumbara, Ashwatha, Parisha and Plaksha. It is effective in reducing Kapha. This formulation has specific actions on the Meda Dhatu and thus effectively treats the adipose tissue.
  • Jatyadi Taila dissolves hard fibrous tissue and generates healthy base for healing and also promotes healing of ulcer.
  • Jatyadi Taila contains Jati patra, Nimba Patra, Patola, Karanja patra, Kusta, Manjista, Lodhta, Yastimadhu, Daruharidra, Katuki, Sariva, Padmaka, Tuttha and Tila Taila.
  • These ingredients are found to have antioxidant property along with Vitamin K, Vitamin B6, Magnesium, Copper, Calcium, Iron and Zinc.


Varicose ulcer is one of the serious complications of Varicose veins which can lead to various manifestations like Septicemia, Cellulitis, Venous Eczema, Osteomyelitis, Periostitis ankylosis of ankle joint, rarely Malignancy and will affect day to day routine work.

The prevalence of Varicose ulcer is on the increase with chronic venous insufficiency being the main culprit. A detailed accurate assessment of leg ulcer in patients is essential to ensure starting of timely and appropriate treatment. It should be an ongoing continuous assessment as signs and symptoms can rapidly change thereby requiring progressive evaluation. Good and accurate quality patient assessment will save time and cost by an enforcement of appropriate treatment regimens.

This approach accelerates the wound healing causing less hospitalization, less economic burden ultimately leading to a healthy life.


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