E-ISSN:2456-3110

Case Report

Varicose Ulcer

Journal of Ayurveda and Integrated Medical Sciences

2025 Volume 10 Number 6 JUNE
Publisherwww.maharshicharaka.in

A Single Case Study of Varicose Ulcer treated with application of Pratisaraniya Apamarga Kshara followed by Jalauka Avacharana

Meher R1*, Prasad CB2
DOI:10.21760/jaims.10.6.58

1* Rajashree Meher, Post Graduate Scholar, Department of Shalya Tantra, KATS Ayurvedic College and Hospital, Ankushpur, Berhampur, Odisha, India.

2 Chinmay Bhabani Prasad, Professor and HOD, Department of Shalya Tantra, KATS Ayurvedic College and Hospital, Ankushpur, Berhampur, Odisha, India.

In present era, varicose veins are more common ailments causing physical impairments in daily activities. Many years of venous disease follow the formation of varicose Ulcer, mostly in the gaiter’s zone. So, the varicose ulcers are most commonly seen in the age group between 40 years to 60 years. In the present study a 55-year-old male, non-hypertensive, non – diabetic patient complaint of painful non healing ulcer having slough & exudate with surrounding hyperpigmentation and itching above the ankle in the left leg. After 7 months of conventional treatment using antibiotics & anti-inflammatory drugs there was no improvement in the wound condition. As per sign & symptoms, the case was diagnosed as Pitta Pradhan Sarakta Tridosaja Dusta Vrana. So, for proper debridement, Pratisaraniya Apamarga Kshara was applied in the ulcerated lesion and for Pitta Samana & Rakta Shodhana, Jalaukavacharana was conducted along with internal administration of drugs like Arogyavardhini Vati, Gandhak Rasayan, Guggulu Tiktaka Kasaya, Kaishora Guggulu, Cap. Viscovas. After ayurvedic intervention the wound gets completely healed within 36 days. This shows the importance of ayurvedic treatment in chronic ulcers.

Keywords: Varicose Ulcer, Dusta Vrana, Pratisaraniya Ksara, Jalauka Avacharana

Corresponding Author How to Cite this Article To Browse
Rajashree Meher, Post Graduate Scholar, Department of Shalya Tantra, KATS Ayurvedic College and Hospital, Ankushpur, Berhampur, Odisha, India.
Email: 		Meher R, Prasad CB, A Single Case Study of Varicose Ulcer treated with application of Pratisaraniya Apamarga Kshara followed by Jalauka Avacharana. J Ayu Int Med Sci. 2025;10(6):412-417.
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https://jaims.in/jaims/article/view/4454/

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2025-05-08 2025-05-24 2025-06-04 2025-06-14 2025-06-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Not required 12.52

© 2025 by Meher R, Prasad CB and 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].

J Ayu Int Med Sci 2025;10(6)412
Download PDFBack To ArticleIntroductionCase ReportObservation and ResultsDiscussionConclusionReferences
Rajashree M et al. A Single Case Study of Varicose Ulcer

Introduction

Varicose veins are one of the most common conditions causing a physical impairment in the quality of life.[1] Majority of Varicose Ulcers which mostly occur in the gaiter’s zone (the area above the medial malleolus & below the calf muscles) due to presence of large numbers of perforators follow many years of venous disease. So, the patients are usually of the age group of 40 years to 60 years.[2] Women are affected far more than men.

Two main aetiologies are responsible for formation of Varicose Ulcer. Firstly, Ulceration may be associated with visible varicose veins and secondly such Ulceration may follow thrombosis and phlebitis in the deep & perforating veins.[3] Mostly the varicose Ulcers are having sloping edge with healthy granulation tissue covered by slough & exudate in the ulcerated lesion. Almost all venous ulcers are having surrounding haemosiderosis seen as hyperpigmentation and inflammatory lesion. The most chronic ulcer develops lipodermatosclerosis with associated fibrosis of subcutaneous tissue.[4]

Based on the symptoms, the present case may be compared with Pitta Pradhan Sarakta Tridosaja Dusta Vrana as it is associated with symptoms like Ragata (inflammation), Krishna Rakta Varnata (blackish red colouration), Vedana (painful), Putisrava (purulant discharge), Kandu (itching) with presence of slough.

So, In this case study for proper debridement of Ulcer application of Pratisaraniya Apamarga Kshara was done. Pittahara & Rakta Shodhana treatment like Jalaukavacharana was planned along with internal administration of some Tridoshahara drugs.

Case Report

A 55 year old male, vendor, complaint of non healing ulcer with surrounding red irritated skin rash above the ankle on the left leg & pain in the ulcerated lesion since 7 months.

H/O present illness

Patient was apparently healthy 7 months ago. Gradually he developed itching & redness above the medial malleolus in the left leg and an ulcer was formed. During long standing & walking, he felt pain in the ulcerated lesion. He went through various modern medication i.e. antibiotics & analgesics,

but there was no improvement on wound healing so that the patient visited the Shalya Tantra OPD of KATS Ayurvedic College & Hospital, Ankushpur, Berhampur on Dt. 28/09/2024.

H/O Past illness

  • The patient has the history of Varicose vein since 5 years.
  • P/H/O skin grafting was done on the ulcerated lesion in the left hand on Dt. 27/12/2023.
  • No family history rela. to disease was detected.

Personal history

  • Diet - mixed
  • Appetite - moderate
  • Sleep - Good, 7-8 hours/ day ,2-3 hours in the afternoon
  • Micturition - 5-6 times / day
  • Bowel - regular, twice / day
  • Habit - tea - 2 cups / day

Rogi Pareeksha

General Examination

  • Tongue - uncoated
  • Pulse - 76/min
  • BP - 130/80 mm Hg
  • Temperature - 98.4 °F
  • Respiratory rate - 16 cycles /min
  • Height - 142 cm
  • Weight - 60 kgs

Systemic Examination

  • Cardiovascular system examination: S1, S2 heard, no added murmurs
  • Respiratory System examination: Normal vesicular breath sound heard
  • Per abdomen examination: Soft, Tenderness absent, organomegaly not found.
  • Central Nervous System Examination - Conscious, Orientation to time, place, person

Examination of Ulcer

History

  • Mode of onset - spontaneous
  • Duration - 7 months

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Rajashree M et al. A Single Case Study of Varicose Ulcer

  • Pain - present
  • Discharge - No
  • Associated disease - Varicose vein

Local Examination

Inspection

  • Size: 3.5 cm × 3 cm × 2.5 mm was present, the anterior part of ulcer measures about 2.5 cm
  • Shape - oval
  • Number - one
  • Position - above the medial malleolus on left leg
  • Edge - slightly indurated
  • Floor - Slough present
  • Discharge - purulent
  • Amount - scanty
  • Smell - absent
  • Surrounding area - Hyper pigmented

Palpation

  • Edge - Slightly indurated
  • Margin - Slightly thickened
  • Base - slightly indurated
  • Depth - 3 mm
  • Bleeding - on touch absent
  • Surrounding skin - No marked increased temperature
  • Tenderness - present at the medial aspect of Wound
  • Fixity to deeper structure - absent

Investigation:

  • Hb - 11.4 gm %
  • FBS - 94 mg/dl
  • PPBS - 150 mg/dl
  • HIV - Non reactive
  • HbsAg - Non reactive

Methods

Application of Pratisaraniya Apamarga Kshara

The Apamarga Kshara was applied in the ulcerated lesion followed by irrigation of lemon juice to neutralize effect of Kshara. [Refer Fig 1 (a) & 1 (b)]

Jalaukavacharana (Hirudo therapy)

  • At first the collected Jalauka was transferred to the water added with a pinch of turmeric.
  • After the Jalauka get activated, they were taken out from the water & kept over the ulcerated site.
  • The leech after getting attached to the ulcerated area attained a horse shoe shaped over the neck region.
  • A wet gauze piece was spread over the body of leech to provide wet & humid environment.
  • Leech was allowed to stay over the site for 45 min. If it didn’t detach by itself within 45 minutes / if any pain has been occurred while sucking blood, then leech was detached by putting a small pinch of turmeric over its mouth end.
  • The site of leech bite was cleaned well and the site was packed with turmeric and bandaging was done. (Refer Fig. 2)

Treatment:

Internal administration

1. Arogyavardhini Vati - 2 tab BD BF with LWW
2. Gandhak Rasayana - 2 tab BD BF with LWW
3. Kaishora Guggulu - 2 tab BD AF with LWW
4. Viscovas - 1tab TDS AF with LWW
5. Guggulu Tiktaka Kasaya - 15 ml BD AF with equal quantity of water

External administration

  • 1st 3 days - dressing done with conventional medicines
  • 4th day - 1st sitting of Pratisaraniya Ksara application was done
  • 5th day - Normal dressing with Vrana Ropana Taila
  • 6th day - 2nd sitting of Pratisaraniya Ksara application
  • 7th - 10th day - dressing with Vrana Ropana Taila
  • 11th Day - 1st sitting of Jalauka Avacharan
  • 18th Day - 2nd sitting of Jalauka Avacharan
  • 23rd day - 3rd sitting of Jalauka Avacharan
  • Other days - Dressing done with Vrana Ropana Taila

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Rajashree M et al. A Single Case Study of Varicose Ulcer

Observation and Results

  • On the day of admission - wound was lodged with exudate and slough with purulent discharge (Refer fig 3)
  • On 7th day - after application of 2nd sitting of Pratisaraniya Kshara, complete debridement was achieved. (Refer fig. 4)
  • On 11th day - after 1st sitting of Jalaukavacharana: there was reduction in the depth of wound, formation of marked granul-ation tissue, absence of discharge. (Refer fig 5)
  • On 19th day - after 2nd sitting of Jalaukavacharana: Reduction in wound size, Increased formation of granulation tissue having sloping edge were observed. (Refer fig. 6)
  • On 24th day - after 3rd sitting of Jalaukavacharana; Wound size along with surrounding inflammation & edema of the leg were reduced. (Refer fig. 7)
  • On 30th day - Marked reduction in wound size & depth of wound along with formation of healthy granulation tissue were noticed (Refer fig. 8)
  • On 36th day - on the day of discharge : there was complete reduction in the pedal edema along with surrounding inflammation. Formation of scar tissue was initiated. (Refer fig. 9)

jaims_4454_01.JPG
Figure 1 (a)

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Figure 1 (b)

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Figure 2

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Figure 3

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Figure 4

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Figure 5


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Rajashree M et al. A Single Case Study of Varicose Ulcer

jaims_4454_07.JPG
Figure 6

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Figure 7

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Figure 8

jaims_4454_10.JPG
Figure 9

Discussion

Acharya Sushruta has mentioned the application of Pratisaraniya Kshara in Dusta Vrana.[5] Due to Lekhana, Shodhana & Ropana properties of Kshara, complete debridement was achieved after application of 2 sitting of Pratisaraniya Kshara.[6]

Due to Madhura & Sita Guna, Jalauka are used in the treatment of Pittaja rakta dusti.[7] Because of presence of certain chemicals in leech’s saliva like Hirudin (potent anticoagulant), Bdellin & Eglin (anti- inflammatory drugs), Hyaluronidase (having antibiotic action), acetylcholine (vasodilator) and some anaesthetic agents, Jalaukavacharana promotes blood circulation, provide capillary tissue exchange & raises the nutrition to tissue which ultimately help in regeneration of tissue. As Vrana Ropana Taila is indicated in Dusta Vrana & it’s almost ingredients are having Shodhana & Ropana properties, so regular dressing with it gave tremendous result in wound healing.

Conclusion

In varicose Ulcer, venous hypertension followed by deposition of fibrin around the capillary bed cause tissue hypoxia leading to severe uncontrolled inflammation & preventing proper regeneration of wound. The present case study due to its long association eventually caused Raktadusti & chronicity paved the way for vitiation of vata resulting pain in the ulcerated lesion. So as per Ayurvedic point of view this was diagnosed as Pitta Pradhan Sarakta Tridosaja Dusta Vrana. Hence Pittahara, Rakta Shodhana & Tridoshahara treatment was planned by administering some internal medication with application of Pratisaraniya Apamarga Kshara & Jalaukavacharana. The chronic varicose Ulcer which had not healed for 7 months despite of many courses of antibiotics and anti-inflammatory therapy, healed in 36 days with ayurvedic intervention which suggests the efficacy of ayurvedic treatment in the healing of chronic ulcers.

References

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2. Das S. A Manual on Clinical Surgery. 16th ed. Kolkata: S Das Publications; 2023. Chapter 4, p.73 [Crossref][PubMed][Google Scholar]

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