• Users Online: 121
  • Print this page
  • Email this page


 
 
Table of Contents
CASE REPORT
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 52-58

Management of varicose veins through therapeutic purgation and bloodletting therapy: a case study


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

Date of Submission27-Nov-2020
Date of Decision25-Feb-2021
Date of Acceptance29-Jan-2021
Date of Web Publication16-Apr-2021

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

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_110_20

Rights and Permissions
  Abstract 

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 15];9:52-8. Available from: https://www.joinsysmed.com/text.asp?2021/9/1/52/313696




  Introduction Top


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.[1] 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.[2] 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).[3],[4]

In this article, a case study of varicose vein management through Virechana (purgation therapy) and Raktamokshana by Siravedhana is presented.


  Materials and methods Top


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 Top


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].
Table 1: Examination of patient through OSCE guidelines

Click here to view


General Examination

Ashtavidha Pariksha (8-fold examination) is described in [Table 2].
Table 2: Astavidha Pariksha of the patient

Click here to view


Dashavidha Pariksha (10-fold examination) is described in [Table 3].
Table 3: Dashavidha Pariksha of the patient

Click here to view



  Treatment protocol Top


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].
Table 4: Treatment given to the patient during hospitalization

Click here to view
Table 5: Internal medication given to the patient

Click here to view


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 Top


By adopting scoring pattern based on severity, [Table 6] is given.
Table 6: Scoring pattern based on severity

Click here to view



  Observations Top


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].
Table 7: Subjective parameters

Click here to view
Table 8: VCSS assessment done during and after treatment

Click here to view



  Assessment for low backache Top


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].
Graph 1: Changes in VAS scale

Click here to view



  Result Top


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

Click here to view
Graph 2: Changes seen in subjective parameter

Click here to view
Figure 3: During Siravedhana

Click here to view
Graph 3: Changes in VCSS scale

Click here to view
Figure 4: After the treatment, dilatation and discoloration is reduced

Click here to view



  Discussion Top


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,[3] 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).[5]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.

Purva Karma

Deepana-Pachana

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).

Snehapana

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[6] 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.[7]

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[8] and also acts as Raktaprasadana.

Pradhana Karma

Virecahana

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.[9]

Raktamokshana

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.[9]Raktamokshana is beneficial in the elimination of vitiated Dosha through blood, which helps in pacification of pain, swelling, burning sensation, and skin discoloration.[10][17] Probable mode of action of drugs used is described in [Table 9].
Table 9: Probable mode of action of internal medication

Click here to view



  Conclusion Top


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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jamir A, Dharmarajan P, Bhatted S. A systematic ayurvedic approach on the management of varicose veins: A case series. Int Ayur Med J2019;7:2122-8.  Back to cited text no. 1
    
2.
Evans CJ, Fowkes FG, Ruckley CV, Lee AJ Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh vein study. J Epidemiol Community Health 1999;53:149-53.  Back to cited text no. 2
    
3.
Shashtri A, editor. Granthiapachiarbudagalagandanaam, Nidanasthana 11/8-9. In: Dalhanaacharaya Shri, Sushrut. Susruta Samhita of Maharsi Susruta. Varanasi: Ayurveda Tattva Sandipika Hindi Commentary, Chaukhamba Sanskrit Sansthan; 2010. p. 368.  Back to cited text no. 3
    
4.
Rudolph S, Prasanth D, Sharma A A case study on the Ayurvedic management of varicose vein. Global J Res Med Plants Indigen Med2016;5:41-8. ISSN 2277-4289. Available from www.gjrmi.com.  Back to cited text no. 4
    
5.
Acharya YT, editor. Chikitsasthana; chapter 28/28, 29. In: Commentary: Ayurveda Deepika Sandipika Hindi Commentary of Chakrapani on Charaka Samhita. Reprint ed. Varanasi, India: Chaukhamba Surbharati Prakashan; 2013. p. 617.  Back to cited text no. 5
    
6.
Acharya YT, editor. Sutrasthana; chapter 13/23–25. In: Commentary: Ayurveda Deepika Sandipika Hindi Commentary of Chakrapani on Charaka Samhita. Reprint ed. Varanasi, India: Chaukhamba Surbharati Prakashan; 2013. p. 835.  Back to cited text no. 6
    
7.
Acharya YT, editor. Sutrasthana; chapter 26/43. In: Commentary: Ayurveda Deepika Sandipika Hindi Commentary of Chakrapani on Charaka Samhita. Reprint ed. Varanasi, India: Chaukhamba Surbharati Prakashan; 2013. p. 144.  Back to cited text no. 7
    
8.
Acharya YT, editor. Chikitsasthana; chapter 29/123. In: Commentary: Ayurveda Deepika Sandipika Hindi Commentary of Chakrapani on Charaka Samhita. Reprint ed. Varanasi, India: Chaukhamba Surbharati Prakashan; 2013. p. 632.  Back to cited text no. 8
    
9.
Acharya YT, editor. Siddhisthana; chapter 1/17, 18. In: Commentary: Ayurveda Deepika Sandipika Hindi Commentary of Chakrapani on Charaka Samhita of Agnivesha. Reprint ed. Varanasi, India: Chaukhamba Surbharati Prakashan; 2013. p. 680.  Back to cited text no. 9
    
10.
Shashtri A, editor. Shonitavarniya Adhyaya: Sutrasthana 14/34. In: Shri Dalhanaacharaya, Sushrut. Susruta Samhita of Maharsi Susruta. Ayurveda Tattva Sandipika Hindi Commentary. Varanasi: Chaukhamba Sanskrit Sansthan; 2010. p. 71.  Back to cited text no. 10
    
11.
Shri Siddhi Nandan Mishra, editor. Amlapittadhikara 56/24-28. In: Siddhiprada Hindi Commentary on Bhaisajya Ratnavali of Govind Das Sen K. Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 903.  Back to cited text no. 11
    
12.
Vidyasagar Pandit Parshuram Shastri, editor. Madhyamakhanda 2/137-142. In: Commentry: Dipika of Adhamalla and Gudarthadipika of Kashirama on Sharangdhar Samhita of Acharya Sharangdhara, Reprinted edition. Varanasi: Chaukhamha Surbharati Prakashan; 2018. p. 162.  Back to cited text no. 12
    
13.
Vidyasagar Pandit Parshuram Shastri, editor. Madhyamakhanda 7/70-81. In: Commentry: Dipika of Adhamalla and Gudarthadipika of Kashirama on Sharangdhar Samhita of Acharya Sharangdhara. Reprinted edition. Varanasi: Chaukhamha Surbharati Prakashan; 2018. p. 203.  Back to cited text no. 13
    
14.
Shri Siddhi Nandan Mishra, editor. Shotharogadhikara 42/191–195. In: Siddhiprada Hindi Commentary on Bhaishajya Ratnavali of Govind Das Sen K, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 786-7.  Back to cited text no. 14
    
15.
Shri Siddhi Nandan Mishra, editor. Prameha pidka adhikara 38/22-27. In: Siddhiprada Hindi Commentary on Bhaishajya Ratnavali of Govind Das Sen K, Varanasi: Chaukhamba Surbharati Prakashan; 2017. p. 722.  Back to cited text no. 15
    
16.
Krushnachandra Chunekar, editor. Haritakyadi Varga 42-43. In: Savimarsh Hindi Commentry on Bhavaprakashnighantu of Bhavamishra. Varanasi: Chaukhamba Bharati Academy; 2015. p. 12.  Back to cited text no. 16
    
17.
Trikamji VY, Sangraha SY Vatarogadhikara 20/17. Allahabad: Shri Baidyanath Ayurved Bhavan; 2013.  Back to cited text no. 17
    


    Figures

  [Figure 1], [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
Materials and me...
Examination of p...
Treatment protocol
Assessment
Observations
Assessment for l...
Result
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed168    
    Printed2    
    Emailed0    
    PDF Downloaded27    
    Comments [Add]    

Recommend this journal