|Year : 2021 | Volume
| Issue : 1 | Page : 52-58
Management of varicose veins through therapeutic purgation and bloodletting therapy: a case study
Harshal Bramhanwade, Swarnakant Jena, Pratik D Bahute, Santosh Kumar Bhatted, Prasanth Dharmarajan
Department of Panchakarma, All India Institute of Ayurveda, New Delhi, India
|Date of Submission||27-Nov-2020|
|Date of Decision||25-Feb-2021|
|Date of Acceptance||29-Jan-2021|
|Date of Web Publication||16-Apr-2021|
Dr. Harshal Bramhanwade
Department of Panchakarma, All India Institute of Ayurveda, New Delhi.
Source of Support: None, Conflict of Interest: None
Background: Varicose veins are enlarged, swollen, and tortuous veins, which mainly affect lower limbs (legs and feet). There may be involvement of superior veins or deep veins. Varicose veins are not a threat to life but it affects day-to-day activities and conditions worsen with chronicity. In contemporary medicine, compressing and stripping by surgery are mainly used treatments for varicose veins. Varicose veins are described as Siragranthi in Ayurveda. Virechana followed by Raktamokshana and internal medication (Manjishthadi Kwatha and Kaishore Guggulu) are found to be useful in the treatment of Siragranthi. Materials and Methods: This case study of a 40-year-old patient of varicose veins includes Virechana and Raktamokshana (bloodletting), which showed significant relief in Shoola (pain), Shotha (swelling), and Daha (burning sensation). Results: After a total of 18 days of treatment, the VCSS score reduced from 8 to 3 and the VAS score reduced from 5 to 2. This proves the significant effect of classical Ayurveda Panchakarma treatment like Virechana and Raktamokshana in varicose veins.
Keywords: Siragranthi, Siravedhana, varicose veins
|How to cite this article:|
Bramhanwade H, Jena S, Bahute PD, Bhatted SK, Dharmarajan P. Management of varicose veins through therapeutic purgation and bloodletting therapy: a case study. J Indian Sys Medicine 2021;9:52-8
|How to cite this URL:|
Bramhanwade H, Jena S, Bahute PD, Bhatted SK, Dharmarajan P. Management of varicose veins through therapeutic purgation and bloodletting therapy: a case study. J Indian Sys Medicine [serial online] 2021 [cited 2021 Jun 14];9:52-8. Available from: https://www.joinsysmed.com/text.asp?2021/9/1/52/313696
| Introduction|| |
Varicose veins are swollen, tortuous, and enlarged veins. Usually, they occur on the legs and feet. They may blue or dark purple and are often lumpy, bulging, or twisted in appearance. Varicose veins can be caused by incompetence of the veins or weakened walls of the veins or by inflammation in the veins (phlebitis). The venous drainage of the lower limb is done by superficial and deep venous systems; any pathology causing these valves to not function properly may lead to the formation of varicose veins. Varicose veins can be correlated with Siragranthi described in Ayurveda. Vataprakopaka nidanas (causative factors which aggravate Vata) such as heavy or excessive exercise, physical exertion, and straining can cause Siragranthi by obstructing the veins of debilitated person (due to aggravated vata), which in turn causes Sankocha (compression), Sampeedana (squeezing) and Vishoshana (drying up) and produces Granthi (protruded nodule-like structure).,
In this article, a case study of varicose vein management through Virechana (purgation therapy) and Raktamokshana by Siravedhana is presented.
| Materials and methods|| |
A 40-year-old male patient visited the OPD of All India Institute of Ayurveda (AIIA), New Delhi, India and was admitted in the IPD of AIIA from 14 December 2019 to 31 December 2019. He was presented with complaints of pain in the lower limbs from calf to the dorsum of foot of both legs and had prominent, dilated, tortuous veins at the postero-lateral aspect of the calf region of both legs (more on right leg) since last 10 years. He also had complaints of pain in lower back (Katishoola) since last 3 years. He had a dull aching pain associated with throbbing sensation in the foreleg and ankle region of both the legs as well as burning sensation. Personal history of the patient reveals that by profession he is a shopkeeper where he has to stand 4–5 h daily. He had no any addiction of smoking or alcohol intake. No relevant medical history found.
| Examination of patient|| |
Both physical and systematic examination was done. As patient had all general features of varicose veins, special tests are done to elucidate any severe illness like deep vein thrombosis. Thus examination was done by OSCE guidelines for varicose veins and described in [Table 1].
Ashtavidha Pariksha (8-fold examination) is described in [Table 2].
Dashavidha Pariksha (10-fold examination) is described in [Table 3].
| Treatment protocol|| |
After admission in the IPD, the patient underwent some treatment procedures described in [Table 4]. Virechana assessment was done with Vaigiki, Antiki, and Laingiki Shuddhi criteria: Vaigiki Shuddhi, 16 vegas; Laingiki Shuddhi, PraptishchaVit-Pitta-Kapha-Anilanam, Laghutwa (lightness), Agnidipti (enhancement of digestive fire), Anamyatwam (free from diseases); Antiki shuddhi: Kaphant. Considering the above Shuddhis, the patient was advised Samsarjana Krama according to Madhyama Shuddhi. On discharge, the patient was advised to continue internal medicines, described in [Table 5].
With the internal medicine prescribed as above, three sittings of Siravedhana (Venesection) was done as a next procedure. On the first day of Siravedhana, an aliquot of 120 mL of blood was removed, on the second day 100 mL blood was removed, and on third day 80 mL of blood was removed. A gradual relief in symptoms like pain and burning sensation was observed after Virechana followed by Samsarjana. VCSS (Venous Clinical Severity Score) was used for the assessment of relief in pain during and after the treatment.
| Assessment|| |
By adopting scoring pattern based on severity, [Table 6] is given.
| Observations|| |
Changes in parameters such as pain, burning sensation, inflammation, tortuosity, and skin changes are given in [Table 7]. The VCSS is useful to monitor the changes in venous diseases during and after the treatment, as described in [Table 8].
| Assessment for low backache|| |
For the assessment of lower back pain, OSWESTRY score is used. OSWESTRY score was 24% before starting the treatment. It is reduced to 14% after the treatment. The VAS scale is used to assess the change in low back pain during and after completion of treatment. The VAS score was reduced from 5 to 2 after the completion of treatment, shown in [Graph 1].
| Result|| |
At the time of starting the treatment, the patient was having dilated veins and hyperpigmentation at posterolateral aspects of calf region and lateral aspect of ankle region shown in [Figure 1] and [Figure 2]. Changes in pain, burning sensation, swelling, and skin changes after the completion of treatment are shown in [Graph 2]. Amount of blood removed and reduced discolouration is shown in [Figure 3]. Changes in VCSS score are shown in [Graph 3]. Reduction in dilatation of veins and discoloration are shown in [Figure 4].
|Figures 1 and 2: Before treatment—dilated, tortuous veins with discoloration|
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| Discussion|| |
Varicosity makes a greater impact in day-to-day life with its unavoidable symptoms such as severe pain and fear of other complications. Ayurveda described varicose veins as Siragranthi, among them is one of the major relations which have to consider. Considering the main symptoms, Katishoola was origin due to Vegonirodha (suppression of natural urges), which leads to Pakvashayagata Vata (the chief factor involved in the causing of varicose veins).Varicose veins might have developed due to standing for 4–5 h daily (which leads to Vataprakopa).
Considering the Nidana and Lakshana (Shrama, Dourbalya, Shoola, Shotha, Daha), first line of treatment was planned for Shodhana to treat Pakvashayagatavata followed by Siravedhana to treat the chief complaints.
Before undergoing any Panchakarma procedure, it is necessary to attain Nirama state of body. All the ingredients of Panchakola have Laghu, Ruksha and Sukshma Gunas, Ushna Virya, Katu Rasa, Katu Vipaka, and Kaphahara properties. Nagarmotha Choorna possesses Laghu, Ruksha Guna and Tikta, Katu and Kashaya Rasa, Katu Vipaka as these properties possess Aampachana action, which in turn corrects the Aagnimandhya (diminished digestive fire).
During Snehapana, it was observed that the patient was unable to take Sneha due to Tikta rasa and was also not able to follow the dietetic regimen during Snehapana; therefore, he was administered with Pravicharana Sneha in the form of Anuvasanabasti. Snehapana was done with Tiktaka Ghrita as it is mentioned in Pittajanya Vyadhis. Most of the drugs used in Tiktaka Ghrita are having Tikta Rasa and it is said to have Daha Prashamankara (reducing burning sensation) and Pittahara (elimination of morbid Pitta) property.
Sarvanga Abhyanga and Swedana
After the Samyak Snigdha Lakshana was observed, Sarvanga Abhyanga was done with the Pinda Taila for the next 3 days as it has been described for the management of pain in Vatarakta and also acts as Raktaprasadana.
Virechana was given in Jirnannam and after the Kaphakala in empty stomach with Trivrit Avaleha having Kaphapittaghna property. Nimbaamrutadi Erandam Taila is useful in Vatarakta as mentioned in Ashtanga Hridaya. The adopted treatment Virechana eliminates Pitta and Kapha Dosha.
Raktamokshana (Siravedhana) is useful to eliminate impure Rakta. Excessive physical work and straining in debilitated person are the causes for Vata Prakopa, which increase Shoola due to Avarana of Vata by Pitta, Kapha Dosha. Virechana Karma helps to eliminate these Doshas and causes Vatanulomana and therefore pacification of pain.Raktamokshana is beneficial in the elimination of vitiated Dosha through blood, which helps in pacification of pain, swelling, burning sensation, and skin discoloration. Probable mode of action of drugs used is described in [Table 9].
| Conclusion|| |
As per Ayurveda, varicose veins can be correlated with Siragranthi. According to Acharya Sushruta Raktamokshana is stated as Ardhachikitsa (half treatment of total treatment). Virechana is beneficial for Pittajavyadhi, Pittanubandhi Vatavyadhi, and Raktadushtijanya vyadhi. As there is Dushti of Raktadhatu and Vata Prakopa in Siragranthi, Virechana, and Siravedhana along with Raktashodhak (removes toxins from blood), Raktaprasadana (improves quality of blood) and Vatanulomak Aushadhas (promotes regular movement of Vata) were given as internal medicine. Together Virechana, Siravyadhyam, and internal medicines show significant relief in pain, burning sensation, swelling, and skin discoloration. From this, it can be concluded that Virechana, Raktamokshana, and Raktaprasadana are highly effective in varicose veins (Siragranthi).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]