Role of Panchvalkala Kwatha Dhawana Karma in the management of non-healing varicose ulcer – A case study

ABSTRACT Venous ulcers (varicose ulcers or stasis ulcers) are the wounds occurring due to inappropriate functioning of venous valves, commonly of legs. It is most common and serious chronic venous insufficiency complication. The overall incidence rate is 0.76% in men and 1.42% in women. When venous valve gets damaged, it prevents the backflow of blood, which causes pressure in the vein that leads to hypertension, which stretches the veins resulting in ulcer formation. If not treated properly, the ulcers may get infected leading to cellulitis or gangrene and eventually may need amputation of the part of limb. In Ayurvedic prospective, varicose ulcers can be correlated with ‘Siragata Dushta Vrana’. Acharya Sushruta has advocated the Shashthi upakrama 1 (60 procedures) for treating the dushta vrana, among which Dhawana/ Parishek2 become third upakrama/procedure that means parishek procedure is included in first top 3 procedures and is useful in infected and non-healing wounds. Patients with varicose ulcers was advised to take ‘Sukshma Triphala’ internally and ‘Panchavalkala Kwatha Dhawana’ over lower limb daily twice a day followed by cleaning and dressing of wound which proved very effective and the ulcer healed completely in 30 days.

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Valve reconstructions

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515569435 ◽

2015 ◽

Vol 30 (1_suppl) ◽

pp. 50-58 ◽

Cited By ~ 4

Author(s):

A Rosales

Keyword(s):

Venous Insufficiency ◽

Compression Stockings ◽

Venous Valve ◽

Venous Valves ◽

Venous Surgery ◽

Valve Reconstruction ◽

History Of ◽

Venous Valve Reconstruction

The history of venous valve reconstruction extends back to 1968 when Robert L Kistner performed the first internal valve plasty to treat deep venous axial reflux. Throughout the past 50 years other techniques of reconstructive deep venous surgery (RDVS) were developed, not only to repair but also to replace venous valves. And the fact that several surgeons and centers have undertaken RDVS in the treatment of chronic venous insufficiency (CVI) reporting outcomes, has added knowledge to define more clearly the role of this kind of specialized surgery. Patients who may benefit from RDVS are among those where conventional treatment with compression stockings combined with superficial surgery has failed. Ulcer-healing rates of up to 70% have been reported after RDVS and ulcer-free periods of up to 36 months have been generated. But during five-year follow-up, freedom from ulceration period and clinical improvement rates were reduced significantly. This raises then the issue and challenge of durability of RDVS since the average age of patients who can benefit from it is about 50 years.

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How to Measure Changes in Oedema in Patients with Chronic Venous Ulcers?

Phlebology The Journal of Venous Disease ◽

10.1177/026835559200700109 ◽

1992 ◽

Vol 7 (1) ◽

pp. 31-35 ◽

Cited By ~ 24

Author(s):

M. D. Barnes ◽

R. Mani ◽

D. F. Barrett ◽

J. E. White

Keyword(s):

Health Service ◽

Lower Limb ◽

Venous Insufficiency ◽

Bed Rest ◽

Impedance Plethysmography ◽

Limb Volume ◽

Water Displacement ◽

Venous Ulceration ◽

Venous Ulcers ◽

Impedance Plethysmograph

objective: To assess changes in limb volume and oedema in Patients admitted to hospital for treatment of venous ulceration. Design: Prospective study in thirteen patients. Setting: Health Service teaching hospital. Patients: Thirteen patients with venous ulceration for 2 years. Interventions: Patients were admitted to hospital for bed-rest and lower limb elevation for a period of 24 hours Main outcome measures: Limb volume was measured by water displacement and impedance plethysmography. Results: During limb elevation there was a mean reduction limb volume of 524 mls (95% CI 377–671 mls) after 24 hours of bedrest. This corresponded with a reduction in impedance measured by the impedance plethysmograph of 19–0 ohms (95% CI 24.3 to 15.6 ohms). Conclusion: Measurement of the lower limb volume by water displacement and by impedance plethysmography are likely to be useful methods in the investigation of Patients with chronic venous insufficiency.

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CONCEPT OF SHADKRIYAKAALA OF VRANA BY SUSRUTHA W.S.R TO VENOUS ULCER

International Journal of Ayurveda and Pharma Research ◽

10.47070/ijapr.v8i10.1636 ◽

2020 ◽

pp. 38-46

Author(s):

V.B. Binya ◽

M.M.Abdul Shukkoor ◽

N.H.Subi

Keyword(s):

Venous Insufficiency ◽

Venous Ulcer ◽

Chronic Ulcer ◽

Purulent Discharge ◽

Venous Obstruction ◽

Chronic Stage ◽

Venous Valves ◽

Venous Ulcers ◽

Specific Term ◽

Arterial Ulcer

Acharya Susrutha has described about the Samprapthi (pathogenesis) of Vrana (ulcer) in detail in Susrutha samhitha sutrasthana. All the ulcers like arterial ulcer, venous ulcer, trophic ulcer etc can be considered as Vrana. But no specific term has been made by Acharya for venous ulcer. Venous ulcers are the wounds occurring as a result of inappropriate functioning of venous valves or of venous obstruction by thrombus. While going through the characteristics of Dushtavrana (chronic ulcer) like Krishna/ Suklavarna (hyper/hypopigmented areas), Deerghakaala anubandhitwa (chronicity), Durgandhitha pooyasraava (foul smelling serous/ purulent discharge) etc, venous ulcer can be considered as a dushtavrana, particularly in its chronic stage. Sira (vein) is the deranged anatomical component in case of venous insufficiency as well as venous ulcer and this Sira has been told as one of the Vranasthaanaas (sites of Vrana) by Susrutha. Hence the term Sirajadushtavrana can be attributed to venous ulcer. Aetiopathogenesis of venous ulcer has striking similarities with that of Dushtavrana. In this article, a gentle attempt has been made to correlate the aetiopathogenesis of venous ulcer with the specific characteristics said in each stage of Shadkriyakala (aetiopathogenesis) of Vranasamprapthi (ulcer) as told by Acharya.

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Anatomy of the veno-muscular pumps of the lower limb

Phlebology The Journal of Venous Disease ◽

10.1177/0268355513517686 ◽

2014 ◽

Vol 30 (3) ◽

pp. 180-193 ◽

Cited By ~ 22

Author(s):

Jean-François Uhl ◽

Claude Gillot

Keyword(s):

Lower Limb ◽

High Speed ◽

Venous Return ◽

Femoral Vein ◽

Popliteal Vein ◽

Anatomical Dissection ◽

Venous Valves ◽

Venturi Effect ◽

A Chain

Objective To study the anatomy of the veno-muscular pumps of the lower limb, particularly the calf pump, the most powerful of the lower limb, and to confirm its crucial importance in venous return. Methods In all, 400 cadaveric limbs were injected with green Neoprene latex followed by an anatomical dissection. Results The foot pump is the starter of the venous return. The calf pump can be divided into two anatomical parts: the leg pump located in the veins of the soleus muscle and the popliteal pump ending in the popliteal vein with the unique above-knee collector of the medial gastrocnemial veins. At the leg level, the lateral veins of the soleus are the bigger ones. They drain vertically into the fibular veins. The medial veins of the soleus, smaller, join the posterior tibial veins horizontally. At the popliteal level, medial gastrocnemial veins are the largest veins, which end uniquely as a large collector into the popliteal vein above the knee joint. This explains the power of the gastrocnemial pump: during walking, the high speed of the blood ejection during each muscular systole acts like a nozzle creating a powerful jet into the popliteal vein. This also explains the aspiration (Venturi) effect on the deep veins below. Finally, the thigh pump of the semimembranosus muscles pushes the blood of the deep femoral vein together with the quadriceps veins into the common femoral vein. Conclusion The veno-muscular pumps of the lower limb create a chain of events by their successive activation during walking. They play the role of a peripheral heart, which combined with venous valves serve to avoid gravitational reflux during muscular diastole. A stiffness of the ankle or/and the dispersion of the collectors inside the gastrocnemius could impair this powerful pump and so worsen venous return, causing development of severe chronic venous insufficiency.

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Management of varicose ulcer using dressing with unprocessed Haridra, Ghruta,Madhu-a case study.

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v8i03.582 ◽

2020 ◽

Vol 8 (03) ◽

Author(s):

Bhave Shital Shashikant *1 ◽

Sonambekar Vinay2 ◽

Dixit Pankaj3 ◽

Pathak Santosh4

Keyword(s):

Quality Of Life ◽

Wound Healing ◽

Venous Pressure ◽

Venous Ulcer ◽

Venous Valve ◽

Adjuvant Therapies ◽

Varicose Ulcer ◽

Negative Effect

Varicose ulcer are the wound caused due to improper functioning of venous valve. Venous ulcer develop mostly along the medial distal leg can be painful,can bleed & get infected with negative effect on quality of life .When valve gets damaged,it prevents the backflow of the blood, increases local venous pressure &which turns into venous ulcer. After conservative & surgical treatment ,recurrence of venous ulcer is common ranging about 54-78% by the 5th year after wound healing. In Ayurveda varicose vein correlated with Sirajanyadushtyavrana.Acharya Sushruta more scientifically described wound & its management with help of these specific Ayurvedic adjuvant therapies this kind of ulcer may be treated. A 45 yrs male patient diagnosed with varicose ulcer daily dressing done with Unprocessed Haridra,Ghruta& Madhu for 5weeks.The symptom like Pain, Ankle flare, Discharge, Hyperpigmentation,Size of ulcer & Granulation tissue were assessed. Trial showed that unprocessed Haridra,Ghruta,Madhu is effective in the management varicose ulcer. Hence this study conclude Ancient Management is safe, easily available , devoid Complication & Hence better Acceptability.

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ROLE OF SHODHANA KARMA IN THE CONSERVATIVE MANAGEMENT OF VARICOSE ULCER: A CASE STUDY

International Journal of Research in Ayurveda and Pharmacy ◽

10.7897/2277-4343.06487 ◽

2015 ◽

Vol 6 (4) ◽

pp. 452-454

Author(s):

Ashutosh Chaturvedi ◽

Shruthi S ◽

Gayathry M S ◽

Ashvini M Kumar ◽

Gautam Shetty

Keyword(s):

Conservative Management ◽

Varicose Ulcer

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Mutations in FOXC2 Are Strongly Associated With Primary Valve Failure in Veins of the Lower Limb

Circulation ◽

10.1161/circulationaha.106.675348 ◽

2007 ◽

Vol 115 (14) ◽

pp. 1912-1920 ◽

Cited By ~ 134

Author(s):

Russell H. Mellor ◽

Glen Brice ◽

Anthony W.B. Stanton ◽

Jane French ◽

Alberto Smith ◽

...

Keyword(s):

Lower Limb ◽

Varicose Veins ◽

Duplex Ultrasound ◽

Fisher Exact Test ◽

Venous Valve ◽

Exact Test ◽

Venous Valves ◽

Number Of Patients ◽

Primary Lymphedema ◽

Deep Vein

Background— Mutations in the FOXC2 gene cause lymphedema distichiasis, an inherited primary lymphedema in which a significant number of patients have varicose veins. Because lymphedema distichiasis is believed to be caused by lymphatic valve failure (reflux), and FOXC2 is highly expressed on venous valves in mouse embryos, we tested the hypothesis that FOXC2 mutations may be linked to venous valve failure and reflux. Methods and Results— The venous system of the leg was investigated with Duplex ultrasound. Pathological reflux was recorded by color Duplex ultrasound in all 18 participants with a FOXC2 mutation, including 3 without lymphedema. Every participant with a mutation in FOXC2 showed reflux in the great saphenous vein (n=18), compared with only 1 of 12 referents (including 10 family members; P <0.0001, Fisher exact test). Deep vein reflux was recorded in 14 of 18 participants. Conclusions— FOXC2 is the first gene in which mutations have been strongly associated with primary venous valve failure in both the superficial and deep veins in the lower limb. This gene appears to be important for the normal development and maintenance of venous and lymphatic valves.

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Utilização da solução hipertônica de cloreto de sódio em ferida hipergranulada

Revista de Enfermagem UFPE on line ◽

10.5205/reuol.202-1995-3-ce.0302200916 ◽

2009 ◽

Vol 3 (2) ◽

pp. 317

Author(s):

Bruno Assis Quelemente ◽

Ana Beatriz Pinto da Sillva Morita ◽

Angelo Teixeira Balbi

Keyword(s):

Sodium Chloride ◽

Healing Process ◽

Middle Part ◽

Hypertonic Solution ◽

White Skin ◽

Clinical Case Study ◽

Venous Ulcers ◽

Varicose Ulcer ◽

Clinic Practice

ABSTRACTObjective: to verify the efficiency of hypertonic solution (NaCl/20%) on the hypergranulation due to the constant hypergranulating wound beds treated in venous ulcers in the daily clinic practice, which delays and disables cells epithelization. Methodology: clinical case study, performed in an outpatient’s clinic of Médio Vale do Paraíba, from February to March 2008. MCT, 60 years old, female, white skin, systematic arterial hypertension controlled, with wounds on the middle part and region of distal third of the left leg. Dressings were made with prior sterilization sores of sodium chloride to 0.9%, which was applied compress of gauze soaked with hypertonic solution (NaCl 20%) was applied on the region presenting hypergrantulation tissue and immediately occluded with dry gauze and fixed with crepe bandage and adhesive tapes. Results: on February 13, 2008, the first wound on the middle part of the left leg measured 3,5 x 2,3 inches (9x6 cm) and 2,7 9 inches (7 cm) of hypergranulation, and the second wound on the region of distal third of the left leg measured 5,5 x 5,1 inches (14x13 cm) and 5,1 inches (13 cm) of hypergranulation. After 22 days, the first wound measured 1,5 x 1,5 inches (4X4 cm) and 1,5 inches (4 cm) of hypergranulation and the second wound measured 4,3 x 3,9 inches (11X10 cm) and 2,3 inches (6 cm) of hypergranulation. Conclusion: the healing process presented a satisfactory evolution after applying hypertonic solution (NaCl/20%) improving the characteristic of the wound bed and diminishing the area where hypergranulation was present. Descriptors: sodium chloride; varicose ulcer; granulation tissue.RESUMOObjetivo: verificar a eficácia da solução hipertônica de Cloreto de Sódio (NaCl/20%) em paciente portador de úlcera venosas que apresentam hipergranulação no leito da ferida. Metodologia: estudo de caso clínico, realizado no ambulatório do Médio Vale do Paraíba, no período de fevereiro a março de 2008. MCT, 60 anos, sexo feminino, cor branca, hipertensão arterial sistêmica controlada, com feridas na região dos terços médio e distal da perna esquerda. Foram realizados curativos, com prévia assepsia da úlcera com cloreto de sódio a 0,9%, na qual era aplicada compressa de gaze impregnada com solução hipertônica (NaCl 20%) sobre a região que apresentava o tecido de hipergranulação, em seguida ocluída com compressa de gaze seca e fixado com atadura de crepe e fita adesiva. Resultados: em 13/02/2008 a ferida 1 na região do terço médio da perna esquerda mensurava 9x6 cm e 7 cm de hipergranulação, e a ferida 2 na região do terço distal da perna esquerda mensurava 14x13 cm e 13 cm de hipergranulação. Após 22 dias a ferida 1 media 4X4 cm e 4 cm de hipergranulação e a ferida 2 mensurava 11X10 cm e 6 cm de hipergranulação. Conclusão: o processo de cicatrização apresentou uma evolução satisfatória após a aplicação da solução hipertônica (NaCl/20%) melhorando a característica do leito da ferida e diminuindo a área em que apresentava hipergranulação. Descritores: cloreto de sódio; úlcera venosa; tecido de granulação.RESUMENObjetivo: confirmar la eficiencia de la solución hipertónica (NaCl/20%) el paciente portador de úlcera venosa que presentaba tejido de hipergranulación en el lecho de la herida. Metodologia: estudio del caso clínico realizado en el ambulatorio de una ciudad del Medio Vale do Paraíba durante el período de febrero a marzo de 2008. MCT, 60 años, sexo femenino, color blanca, hipertensión arterial sistémica controlada, con heridas en la región del tercio medio y la región del tercio distal de la pierna izquierda. Apósitos se hicieron antes de la esterilización con las llagas de cloruro de sodio al 0,9%, lo que se aplicó la compresa de gasa empapada con solución hipertónica (NaCl/20%) sobre la región que presenta el tejido de hipergranulación, en seguida ocluída con una compresa de gasa seca y asegurada con atadura de crepe y cinta adhesiva. Resultados: el 13/02/2008 la primera herida en la región del tercio medio de la pierna izquierda medía 9x6 cm y 7 cm de hipergranulación y la segunda herida en la región del tercio distal de la pierna izquierda medía 14x13 cm y 13 cm de hipergranulación. Después de 22 días, la primera herida medía 4X4 cm y 4cm=0cm de hipergranulación y la segunda herida medía 11X10cm y 6 cm de hipergranulación. Conclusión: el proceso de cicatrización presentó una evolución satisfactoria después de la aplicación de la solución hipertónica (NaCl/20%) mejorando la característica del lecho de la herida y disminuyendo el área que presentaba hipergranulación. Descriptores: cloruro de sódio; úlcera varicosa; tejido de granulación.

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