Ayurvedic management of venous ulcer - a case report.

Vrana (ulcer), in Ayurveda is defined as a structural deformity in the skin and deeper structures (gaatra avachurnana), associated with ruja (pain), srava (discharge) etc and caused either by the vitiation of the doshas(humuors of the body) or by trauma. Vrana is basically of 2 types- Dushta vrana and Shudha vrana. Shudha Vrana (acute ulcer) is easily treatable, whereas Dushta vrana is a chronic ulcer, mostly unresponsive to any treatment. Acharya Sushruta has described sixty methods for treating such vranas (ulcers). In this case, symptoms like Deerghakalaanubandhi (chronic), Teevra ruja (painful), Teevra puti srava (smelly discharge) etc. were suggestive of Pitta pradhana Sarakta Tridoshaja Dushta vrana on the left leg. Studies from India about the prevalence of venous leg ulcers (VLU) are limited. The chronic wound management strategies include compression therapy and antimicrobial therapy (if infected). However, in unresponsive cases, surgery (skin grafting) is done. A 38-year-old non-diabetic, non-hypertensive female sought Ayurvedic treatment after a wound on her left leg did not respond to the conventional medicines even after 7 months of treatment. The ulcer was painful and foul-smelling, to the extent of disturbing her sleep and restricting her daily activities. Her Ayurvedic treatment comprised of Patoladi kashaya, Kaishora guggulu, Guduchyadi kashaya, Manjishtadi kashaya and Avipathi churna, orally and Vrana prakshalana (wound cleaning) and Vrana lepa (application of medicinal paste) externally. Ayurvedic treatment was effective in healing the Dushta vrana completely in this case. This suggests the efficacy of Ayurveda in the management of chronic ulcers. However, a detailed study of the same with larger sample sizes will help to formulate a treatment protocol for such cases.