Deepa Patil, Sangeeta H. Jahagirdhar, and Hemant D. Toshikhane¹

SUMMARY

Venous ulcers (stasis ulcers, varicose ulcers) are wounds that occur due to inappropriate function of venous valves, specifically of the lower limbs. The damaged venous valves prevent the backflow of blood, which causes pressure in veins that leads to tension and this results in venous ulcers. Treating varicose ulcer is a difficult task to the physician and a nightmare for the suffering patient, though different types of treatment modalities are practiced in allied sciences. In Ayurveda, this condition is considered as duṣṭa vraṇa and better managed with specific śodhana therapy (Purification therapy). The treatment protocol is followed by administering Nitya virecana with Nimbamṛtadi castor oil and Manjishṭhādi basti karma in kāla basti format (course of 16 medicated enemas) to treat a diagnosed case of varicose ulcer. The findings of the study showed wound healing up to 80%.

INTRODUCTION

Venous ulcers (stasis ulcers, varicose ulcers) are wounds occurring due to improper functioning of venous valves, usually of the legs.[1] Damaged venous valves prevent the backflow of blood and cause pressure in the veins. Hence an arterial pressure reduces significantly than venous and therefore, blood is not pumped as effectively into the area.[2]

A venous ulcer will not usually heal without expert advice and treatment. Without cleaning and regular dressings, the ulcers usually spread quickly. Venous ulcers can be very painful and may limit mobility and quality of life. The longer the duration of the venous ulcer, the more is the damage to skin and greater the difficulty in healing. The annual prevalence of venous leg ulcer among the elderly is 1.69%. The overall incidence rate is 0.76% in men and 1.42% in women.[3]

In ancient Indian medicine, such conditions are considered as duṣṭa vraṇa (non-healing wounds) because they are produced by vitiated dośas inside the body. This can be treated successfully with śodhana (purification) and śamana (pacification) therapy. So, the fore mentioned benefits of Nitya virecana (liver and bowel cleansing therapy) and Manjishṭhā basti (decoction enema therapy) were assessed in alleviating the symptoms and in the healing process of varicose ulcer in the patient.Go to:

CASE REPORT

A 61-year-old male patient presented to KLE Ayurveda Hospital, Belgaum, Karnataka, with the complaint of reddish ulcers above lateral malleolus of the right leg for 2 weeks, associated with pricking pain, burning sensation around the ulcers, edema, and blackish discoloration over the right lower limb. For the last 5 years, the patient had been suffering from varicose veins, and 2 years back, he developed varicose ulcer on the medial aspect of the ankle joint on the same leg and was treated with biomedicines successfully. Patient was addicted to Bīḍi (Indian cigarette filled with tobacco flake and wrapped in a Bauhinia racemosa leaf tied with a string at one end) smoking for 20 years, but had stopped it for the last 2 years. He was habituated to standing for long hours in his job, i.e. about 8 to 10, hours for the past 22 to 30 years. There was no history of any chronic illness such as diabetes mellitus and hypertension.

On examination, a reddish large ulcer and many small oval ulcers with sloping edges were found, along with mild serous discharge around lateral malleolus of the right leg. The large ulcer measured 3 cm in length, 2 cm in width, and 1.75 cm in depth, with three to four small ulcers without granulation tissue. The patient also had swelling and blackish discoloration around right ankle joint and feet, with grade III tenderness around an ulcer. Varicosity on calf region of the right lower limb tested positive for Trendelenburg test and negative for Moses’ sign, but pedal pulse was present which was suggestive of varicose ulcer features [Figure 1].Figure 1

Before treatment

On the basis of symptoms such as attivivṛttavraṇa (spreading nature), utsanna (elevated margin), raktavarṇa (reddish), srāva (secretion), dāha (burning sensation), and shopha (swelling) present in the patient, he was diagnosed as having duṣṭa vraṇa with vātapradhānatridoshajavraṇa. Informed consent was obtained from the patient for documentation and publication of his case history.

Treatment

The following treatment schedule was executed:

1. Nimbāmr.tādi castor oil (processed castor oil with Azadirachta indica and Tinospora cordifolia) – 50 ml orally used for Nitya virecana with 50 ml Śuntṇ hīkashāyam for three continuous daysNitya virecana is the specific therapy in Ayurveda in which the medicine may be processed in oil or as decoction is administered orally for cleansing the bowel and liver system. This improves the Agni metabolism of the individual. This is the first and necessary step in any Basti therapy.
2. Next therapy is the main line of treatment, i.e. Basti karma (specific scheduled course of medicine administered through rectal route).

On day 4 of management, Mañjiṣṭhādi Basti karma was started with Balaguḍūcyādi Anuvāsana Basti (60 ml) in kāla basti pattern. The schedule was planned in accordance with the chart given below.

In the preparation of enema decoction, the above order was followed for the mixing of medicine, and decoction enema was usually administered on empty stomach.

In N2 Basti, Go arkam (distilled cow’s urine) is not added for the decoction and the Kaśāyam (decoction) preparation is changed to Kāyam (decoction) preparation is changed to Ks.īrapāka preparation.

Specific decoction processed in milk –Mañjiṣṭhā + Guḍūci + Yaṣṭhimadhu Kṣīrapāka (300 ml) used to prepare enema decoction.

AB, Anuvāsana Basti (enema for oleation consists of only the medicine processed in oil or ghee).

Outcome

The pain was measured on visual analogue scale (VAS), the edema was measured by figure-of-eight method of measuring ankle joint swelling,[4] and the ulcerated wound was assessed by measurement and granulation tissue formation.

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