• Users Online: 106
  • Print this page
  • Email this page


 
 
Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 217-224

A case study on Ayurveda interventions in lipodermatosclerosis


Department of Panchakarma, All India Institute of Ayurveda, Saritavihar, New Delhi, India

Date of Submission20-Jun-2020
Date of Decision08-Sep-2020
Date of Acceptance09-Oct-2020
Date of Web Publication11-Nov-2020

Correspondence Address:
Dr. Latika Kundra
Department of Panchakarma, All India Institute of Ayurveda, Saritavihar, New Delhi.
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_56_20

Rights and Permissions
  Abstract 

Introduction: Chronic venous insufficiency raises as an issue in the medical system with its different stages. The incidence is more common in females than males. The cutaneous changes are a common feature of chronic venous insufficiency, which include lipodermatosclerosis. It refers to the pain, skin induration, inflammation, tenderness, and hyperpigmentation of the legs. It is observed that the clinical features of lipodermatosclerosis have striking similarities with the clinical presentation of Vatarakta, which is characterized by pain, tenderness, suppuration, and discoloration of skin. In modern science, treatment of lipodermatosclerosis is limited to compression therapy with either graded stockings or elastic bandages. There is no permanent and safe cure with modern medicine, except long-term care and management. So there is need of safe noninvasive treatments that can promise a good relief and healthy life. Keeping these factors into consideration, a case study was carried out based on Ayurveda principles and practice. Materials and Methods: This clinical study is a case report on the efficacy of Ayurveda principles through Shamana (pacification) medication along with certain Panchakarma therapies such as Virechana (Purgation), Basti (enema), and Raktamokshana (bloodletting) in the management of a patient diagnosed as varicose vein complicated with lipodermatosclerosis Result and Conclusion: There was significant relief in pain, tenderness, swelling, and induration in bilateral lower limbs. Revised chronic venous insufficiency score improved from 28 to 21 and quality of life improved from 61 to 42 according to CIVIQ 20. The results of this study suggest that Ayurveda medicine along with Panchakarma therapies can provide an efficient result for managing lipodermatosclerosis.

Keywords: Chronic venous insufficiency, lipodematosclerosis, Raktamokshana, Vatarakta


How to cite this article:
Kundra L, Verma P, Dharmarajan P, Bhatted SK. A case study on Ayurveda interventions in lipodermatosclerosis. J Indian Sys Medicine 2020;8:217-24

How to cite this URL:
Kundra L, Verma P, Dharmarajan P, Bhatted SK. A case study on Ayurveda interventions in lipodermatosclerosis. J Indian Sys Medicine [serial online] 2020 [cited 2020 Dec 1];8:217-24. Available from: https://www.joinsysmed.com/text.asp?2020/8/3/217/300491




  Introduction Top


Lipodermatosclerosis is a condition, which is linked with changes in the lower limbs due to venous disorder or insufficiency. In total, 10% of people with venous insufficiency developed skin changes.[1] In the presentation of the disease, redness, swelling, skin pigmentation, and skin induration are commonly found in the affected lower limb. It may be present as an acute or chronic condition. The pathophysiology is unknown; there is hypothesis that it is related to venous hypertension, venous incompetence, and obesity. Due to venous incompetence, intravascular fluid gets extravasate which deprives tissues and cells. The damaged tissue causes microthrombi formation and infarction, in the end leading to granulation tissue and forming fibroblasts.[2] Ayurveda due to similarities in clinical symptoms disease can be correlated with Vatarakta. Aggravated Vata is obstructed by aggravated Rakta and in turn vitiates the Rakta which produces clinical symptoms such as severe pain, tenderness, inflammation, and burning sensation which disturbs the day-to-day life of the person. If neglected, the disease proceeds and leads to severe complications. Lipodermatosclerosis is a difficult condition to treat. Its management includes compression stocking and steroids.[3] However, Ayurveda principles proves valuable result in treating intractable lipodermatosclerosis.


  Case Report Top


A 65-year-old female patient UHID no. 39341 came with complaints of pain, tenderness, swelling, and hyperpigmentation of bilateral lower limbs (Right > Left) since 2 years. She was a diagnosed case of varicose veins of B/L lower limbs. Initially, the pigmentation and induration were less and only limited to right leg, but gradually these increased.

The patient was clinically diagnosed as a case of Vatrakta (lipidermatosclerosis) and planned for Panchakarma, Shodhana Karma along with Raktamokshana, and oral Ayurveda medications.

Past History

Hypertension––20 years.

Diabetes mellitus––20 years.

Hypothyroidism––20 years.

Diagnosis

The case was diagnosed under C4b, Ep.Ap. Po of CEAP Classification.[4]

The Ashtavidha Pariksha eight places f examination, (Ten types of examination) and local examination of bilateral lower limb of the patient are detailed in [Table 1],[Table 2],[Table 3].
Table 1: Asthavidha Pariksha

Click here to view
Table 2: Dashwida pariksha

Click here to view
Table 3: Local examination of bilateral legs

Click here to view


Color Doppler

Bilateral lower limb (venous) 22 July, 2019

Incompetent perforators and superficial varicosities in bilateral lower limbs.

Right medial mid leg-1 left medial lower leg-1.

Right medial mid leg-1 left lateral mid leg-1.

Right lateral mid leg-1.

Assessment criteria

  1. Revised venous chronic insufficiency scale.


  2. CIVIQ 20 (quality-of-life scale).[5]



  Materials and Methods Top


Type of Study

This study is a case report on the prospective study of Ayurveda treatment administered to a patient diagnosed Vatarakta (lipodermatosclerosis).[6]

Source of Data

A patient referred to the Department of Panchakarma, AIIA, Sarita Vihar, New Delhi 110076.

Treatment plan adopted with drugs, doses, and time period for 34 days are detailed in [Table 4]. The schedule followed and assessment during Snehapana and Virechana Karma during treatment are detailed in [Table 5] and [Table 6].
Table 4: Treatment plan

Click here to view
Table 5: Schedule of Snehapana with Tiktak ghrita

Click here to view
Table 6: Virechana karma observation

Click here to view


Observation and Result

The reduction in parameters such as pain, itching, tenderness, swelling, and pigmentation is assessed on completion of each therapy [Table 7].
Table 7: Basti Karma observation

Click here to view


The changes in revised venous chronic insufficiency scale of bilateral lower limb are shown in [Graph 1].
Graph 1: Improvement in the revised venous clinical severity scale. Some of the points of the scale are not applicable to the patient, so are not shown in the graph

Click here to view


Detailed assessment and observation before and after treatment are given in [Table 8] and [Table 9].
Table 8: Observation during treatment

Click here to view
Table 9: Revised venous clinical severity score[15]

Click here to view



  Results Top


The assessment was made before treatment and on completion of treatment. During this period, the patient did not develop any other complaint. Before treatment, the induration and pigmentation are more in the right leg than the left leg: lateral aspect [Figure 1], anterior aspect [Figure 2], and medial aspect [Figure 3], after completion of Virechana Karma, Basti Karma, Raktamokshana, and external therapies. The final assessment was done on 34th day, which shows a significant reduction in induration and pigmentation over lateral, anterior, and medial aspects of bilateral lower limb [Figure 4],[Figure 5][Figure 6].
Figure 1: Before treatment

Click here to view
Figure 2: On 15th day

Click here to view
Figure 3: On 21st day

Click here to view
Figure 4: On 28th day

Click here to view
Figure 5: On 34th day

Click here to view
Figure 6: After treatment

Click here to view



  Discussion Top


In Ayurveda, Vatarakta is explained as a disease manifested due to the pathology of Avarana. The scenario of Vatarakta occurred owing to Margavarna, which can very well be correlated with lipodermatosclerosis. The present case of Vatarakta having predisposing factors such as diabetes mellitus and hypertension is co-morbitized.

Shamana Chikitsa

Mahamanjisthadi Kwatha: Its main contents are Manjistha (Rubia cordifolia), Nagarmotha (Cyperus rotundus), Giloy (Tinospora cordifolia), Neem (Azadirachta indica), Haldi (Curcuma longa), Kutki (Picrorhiza kurroa), Amla (Emblica officinalis), and Bakuchi (Psoralea corylifolia), which possess Aam Pachana, blood purifier, antioxidant, and anti-inflammatory properties. It reduces pain and swellings and purifies the blood.

Sarivadyasava-Sariva: Its main contents are Amalaki, Guduchi, Usheera, Padmaka, and Mustaka, which help relieve the inflammation and swelling. It has Raktashodhaka (blood purifier) and Rakta Prasadaka properties. Hence, it improves circulation, which may help reduce pigmentation in lipodermatosclerosis.

Kaishore Guggulu: Its main contents are Guggulu, Guduchi, Trivrit, and Shunthi, which possess anti-inflammatory property, and Amalaki and Shunthi, which have an analgesic property that helps relieve the pain.

Gandhaka Rasayana: It has antipuritic and anti-inflammatory properties, which help in reducing the itching and in the healing of the skin. It mainly acts on Rakta and Twacha and also purifies the blood.

Panchakarma Therapies

Intially, Rookshana was done by Udwartana (dry powder massage) then Aampachana with Katu Tikta drugs, followed by Shodhana (purification) with Virechana karma. Brihmana and Raktaprasadana are done via Manjisthadi Ksheera Basti and Jaloukavcharana along with Shamana Chikitsa.

Udwartana was done with Triphala Churna, which possesses Shoshana, Kapha, and Vatahara properties that remove Avarana and Srothavarodha. Hence, it is suitable for Aamaavastha. It also removes the stagnation and stimulates the circulation.

Abhayanga

Pinda Taila possesses topical analgesic and anti-inflammatory properties. Its cooling effect makes it suitable in Pitta and Vata Dosha. Hence, in lipodermatosclerosis Abhyanga boosts the circulation and encourages fresh oxygen and blood to that area.

Sthanik Panchavalkal Kashaya Dhara

It consists of components such as tannins and flavonoids that are primarily responsible for an antiseptic, anti-inflammatory, antioxidant, antibacterial, antimicrobial, astringent, wound purifying, and healing properties. It helps in reducing the affected part’s pain, redness, and swelling.

Virechana karma

It eliminates vitiated Dosha from body especially Pitta Dosha due to Ashryaashriya Bhava. It also corrects Rakta Dushti. Here in lipodermatosclerosis the pigmentation of the skin may be mostly due to the vitiation of Pitta Dosha and Rakta Dhatu. This is relieved to a great extent by Virechana.

Basti

Acharya Charaka and Vagbhata have explained a Basti given with Ksheer and Ghrita in context of Vaatarakta Chikitsa. Ksheer basti mainly indicated where involvement of Pitta and Rakta Dosha prevails. Manjisthadi Tikata Ksheera Basti selected due to its Mridu Dosha harana, Brimhana, and Rakta Prasadak properties. Manjishthadi Kwatha has Tikta, Katu Rasa and Ushna Guna properties, which acts as Tridosha hara and Rakta Prasadaka. In Anuvasana Basti Balaguduchyadi Taila used due to Vata and Pittahara Guna.

Raktamokshana

Blood-letting by leech removes obstruction of vitiated blood. In this case, it improves the circulation of the affected part ultimately removing the main causative factor.[16] Skin pigmentation in lipodermatosclerosis is believed to be caused due to formation of fibrin-cuff, which blocks the minute capillaries. Due to this, there is an increase in venous capillary pressure leading to its rupture. The stagnant blood gets deoxygenated leading to brownish depigmentation of the skin. Blood-letting results in the elimination of impure blood along with a reduction in venous congestion. The saliva of Hirudo medicinalis contains thrombolytic agents such as Destabilase, which may help in the lysis of the fibrin cuff and thus promoting microcirculation.

Lepa chikitsa

The lepa drug has cold potency, analgesic, and anti-inflammatory properties, which penetrate into cells and can enter into circulation very quickly where it is absorbed and pacifies the elicited Dosha.[17]


  Conclusion Top


Ayurveda principles and practice are found to be effective in the management of varicose veins complicated with lipodermatosclerosis. It is found to be beneficial in the reduction of induration and pigmentation in lipodermatosclerosis. This study is used to be well worth documenting; studies with large sample are required to develop the desired treatment protocol for lipodermatosclerosis.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.



 
  References Top

1.
Bergan JJ, Schmid-Schönbein GW, Coleridge Smith PD, Nicolaides AN, Boisseau MR, Eklof B Chronic venous disease. Minerva Cardioangiol 2007;55:459-76.  Back to cited text no. 1
    
2.
Khan AF, Chaudhri R, Ashraf MA, Mazaffar MS, Zawar-ul-Imam S, Tanveer M Prevalence and presentation of chronic venous disease in Pakistan: A multicentre study. Phlebology 2013;28:74-9.  Back to cited text no. 2
    
3.
Eberhardt RT, Raffetto JD Chronic venous insufficiency. Circulation 2005;111:2398-409.  Back to cited text no. 3
    
4.
Bergan JJ, Schmid-Schönbein GW, Smith PD, Nicolaides AN, Boisseau MR, Eklof B Chronic venous disease. N Engl J Med 2006;355:488-98.  Back to cited text no. 4
    
5.
Launois R, Mansilha A, Lonzano F Linguistic validation of the 20 item chronic venous disease quality-of life questionnaires (CIVIQ-20). Phebology 2014;29:484-7.  Back to cited text no. 5
    
6.
Singhal G.D and colleagues, editor. Sushruta Samhita, Chikitsa Sthana.Adhayaya 37 /56–57. 2nd ed. Varanasi, India: Chaukhamba Sanskrit Pratishtha; 2014. p.316-7.  Back to cited text no. 6
    
7.
Duffill M Lipodermatosclerosis. DermNet NZ; 2013. Available at http://www.dermnetnz.org/vascular/lipodermatosclerosis.html.  Back to cited text no. 7
    
8.
Robertson L, Evans CA, Fowkes FG Epidemiology of chronic venous disease. Phlebology 2008;23:103-11.  Back to cited text no. 8
    
9.
Lochan Kanjiv , editor. Bhaishajya Ratnavali of Govinda Dasji Bhisagratna Commented upon by Vaidya Shri Ambika Datta Shastri. Vol. 2, Chapter 54/71–72. Varanasi, India: Chaukhamba Sanskrit Pratishtha; 2014. p. 49-50.  Back to cited text no. 9
    
10.
Lochan Kanjiv , editor. Bhaishajya Ratnavali of Govinda Dasji Bhisagratna Commented upon by Vaidya Shri Ambika Datta Shastri. Vol. 2, Chapter 38/22–27. Varanasi, India: Chaukhamba Sanskrit Pratishtha; 2014. p. 549-50.  Back to cited text no. 10
    
11.
Srikanth Murthy K.R , editor. Sharangadhar Samhita, Chapter 7/70–81. Varanasi, India: Chaukhamba Orientalia; 2016. p. 107.  Back to cited text no. 11
    
12.
Tiwari P.V, kumara Asha , editor. Yogaratnakara. Chapter 76/28–35. Varanasi, India: Chaukhambha Vishvabharati; 2010. p. 1249. Reprint.  Back to cited text no. 12
    
13.
Lochan Kanjiv , editor. Bhaishajya Ratnavali of Govinda Dasji Bhisagratna Commented upon by Vaidya Shri Ambika Datta Shastri. Vol. 2, Chapter 47/8, 2014. p. 747.  Back to cited text no. 13
    
14.
Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL Venous severity scoring: An adjunct to venous outcome assessment. J Vasc Surg 2000;31:1307-12.  Back to cited text no. 14
    
15.
Sharma R.K, Bhagwandas , editor. Vatashonita Chikitsa: Chapter 29, verse 40. In: Chikitsasthana. Charak Samhita. Vol. 5. Varanasi, India: Chaukhambha Surbharati Prakashan; 2015. p. 98.  Back to cited text no. 15
    
16.
Bhramanand T, Samhita S, Vidhi V . Chapter 4, Varanasi, India: Chaukhambha Subharti Prakashan; 2008. p. 342-43.  Back to cited text no. 16
    
17.
Sharma P, Charaka Samhita of Agnivesha, Reprint edition, Varanasi, India: Chaukhamba Orientalia. Vol. 2, Siddhi Sthana Ch. 1/11; 2008. p. 588.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Case Report
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed122    
    Printed10    
    Emailed0    
    PDF Downloaded13    
    Comments [Add]    

Recommend this journal