Effect of Multimodal Ayurvedic Treatment and Jalaukavacharana (Leech Therapy) in Superficial Thrombophlebitis with Cellulitis: A Case Report

Abstract

Cellulitis, commonly caused by Streptococcus pyogenes, affects nearly 200 per 100,000 population globally and may coexist with superficial venous thrombosis (SVT), an inflammatory-thrombotic disorder seen in 3–11% of the general population, particularly women. In chronic venous insufficiency, this coexistence perpetuates a cycle of venous congestion, oedema, inflammation, and recurrent infection that often responds poorly to conventional therapy. In this case, a 55-year-old female with a 23-year history of progressive bilateral lower-limb oedema and recurrent pruritic, oozing wounds around both ankles, accompanied by intermittent fever. She had received prior allopathic and homoeopathic treatment with only temporary relief. Clinical examination and laboratory findings confirmed active local inflammation with elevated inflammatory markers. She underwent a six-week multimodal Ayurvedic protocol comprising internal medications Rasnaerandadi kashaya 90ml, Punarnavadi kashaya 90ml, and Manjishtadi Kashayam 60 ml; Kaishora Guggulu 2 bd; Punarnavasavam 25ml bd  and proprietary anti-inflammatory formulations, sequential external therapies (Lepa and Kashaya Dhara), and three sittings of Jalaukavacharana (medicinal leech therapy). Progressive improvement was observed after each sitting, with pain reducing from 8 to 2 on the Visual Analogue Scale, complete wound healing, resolution of itching and discharge, improved skin texture, and marked reduction in inflammatory markers, with no recurrence on follow-up. This case suggests that an integrated Ayurvedic approach incorporating Jalaukavacharana may offer sustained benefit in chronic cellulitis complicated by superficial thrombophlebitis and warrants further clinical investigation.