From Maggots to Recovery: Exploring an Integrative Medicine Approach to Chronic Non-Healing Ulcer with Leech Therapy and Panchvalkal Ointment: A Case Study

BACKGROUND: Chronic, non-healing ulcers, referred to as dushtavrana in Ayurveda present a challenge in medical care since ancient times. Ayurvedic literature, notably Acharya Susrutha Chikithsa Sthana, dedicated a chapter to the treatment of dushtavrana, encompassing sixty procedures (shashti upakramas). Chronic ulcers, influenced by diverse factors, resist a singular therapeutic approach. The inflammatory stage is critical, and disruptions in the order of stages of healing can lead to chronicity. Despite conventional treatments, many ulcers remain resistant, causing physical, financial, and emotional distress to patients. In the context of wound healing in Ayurveda, Jalaukavcharan or leech application emerges as a unique and effective method, especially in challenging cases involving elderly or frail individuals. In addition, Panchvalkal ointment is also an evidence based ayurvedic formulation, showing notable results in wound healing. CASE STUDY: This case study involves a 78 years old male patient having a chronic non-healing ulcer with maggots on the planter surface of foot since last 3 years with foul smell, pain, and difficulty in walking. OBJECTIVE: The integration of leech therapy and Panchvalkal ointment as a holistic and potentially transformative approach to address the complexities of chronic non-healing wound. MATERIAL AND METHOD: Leech therapy once a day for 7 days and dressing with Panchvalkal ointment twice a day for 3 months over wound site after wound debridement. Antibiotic and analgesics were given for 7 seven days to prevent infection and pain management. RESULT: Wound healing was achieved, along with improved physical and emotional status of patient. Result was assessed using Bates-Jensen wound assessment tool with initial score of 49 which reduced to 14 after 90 days of treatment. CONCLUSION: Leech therapy and Panchvalkal ointment offers a promising, holistic solution for chronic non-healing wounds. However, further research is warranted to validate its efficacy. KEYWORDS: chronic non-healing ulcer, leech therapy, panchvalkal ointment, wound debridement, integrative medicine, case report.

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