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Introduction

A medical disorder known as deep vein thrombosis (DVT) is brought on by a blood clot that forms in a deep vein. Although they can also happen in the arm, these clots typically form in the lower leg, thigh, or pelvis. After IHD and stroke, it is the third most prevalent vascular disease. The mechanism underlying DVT, known as Virchow’s triad, are venous stasis, hypercoagulability, and endothelial injury. The femoral and popliteal veins in the thighs and the posterior tibia and peroneal veins in the calves are most commonly affected. DVT risk factors include Long-term bed rest, like during a lengthy hospital stay, paralysis, vein damage or surgery, pregnancy, obesity, birth control pills (oral contraceptives) or hormone replacement therapy, smoking, cancer, heart failure, and prolonged sitting, like when driving or flying, are all possibilities. The Wells score can be used to determine whether a person has DVT. Additionally, a D-dimer test can aid in diagnosis. The diagnosis is confirmed by ultrasound of the suspicious veins. [1] As people age, VTE becomes significantly more prevalent. Although the illness is uncommon in children, it affects over 1% of people over 85 each year. [2] VTE rates in Asian populations are 15–20% higher than those in Western nations.[3] Standard therapies include the use of blood thinners such as warfarin, apixaban, and rivaroxaban. [4] [5] [6] Avoiding obesity through exercise and a healthy diet are two ways to prevent DVT. It is associated with Siragatavata, Vatarakta, and Raktavruthavata in Ayurveda. In the current case study, various Panchakarma techniques as well as oral and local medications were used.

SAMPRAPTI

Pitta vardhak hetu (Stubborn) ?                                          Prolonged sitting (Sedentary lifestyle) ?

Pitta prakop ?                                                                                                  Kaphadusthi?

Pitta ushna tikshna guna increase ?

Pitta sancharya with Rakt?

Rakt dusthi ?

Raktpitta?

Kapha anubandhi raktpitta

Samprapti Ghatak

Dosha - Pitta, kapha?

Dhatu – Rakta?

Strotas - Rasavaha,Raktavaha?

Updhatu- Asruja kandara

MATERIALS AND METHODS

Case Description

A patient named XYZ, 71 yrs Male was asymptomatic around 15 days back he developed pain in both lower limbs, Stiffness in medial side of left thigh, Pain on pressure, itching sensation?, Hardening and discoloration in lower limbs and was afraid to walk. Pain is persistent and cramp-like aching in nature on bilateral calf muscles (lt>rt) which get worsen on walking and long standing but doesn’t subside with rest. He got a mild relief in pain on elevating the lower limbs. But swelling doesn’t subside when the leg is elevated for an hour or overnight. So patient came in OPD of Shreerukma Ayurvedic Chikitsalaya for treatment. In Doppler sonography it was found to have thrombosis of great saphenous vein of left lower limb. Hence, the further management was done on OPD basis. Negative family history of stroke, hypertension, dyslipidaemia and cardio-vascular pathology  was found. At the time of examination patient’s vital functions were normal and patient was conscious, and oriented. Patient was able to walk with support. On general examination oedema was found on b/l ankle joint and distal third of leg which is pitting in nature (lt>rt). Patient was non-smoker, non-alcoholic, and not having allergy to any drug or food item.

History of Past Illness

Patient had a history of DVT Stenting in 2017 after similar complaints, Taking Ecosprin 75 mg since 8 Yrs.

Table 1: Personal History

Table 2: Ashtavidhapariksha

Systemic examination

CVS: S1S2 heard, No added sounds.

RS: Shape of chest-bilaterally symmetrical, Trachea centrally placed, Normal vesicular breaths sound, No added sounds

CNS-Conscious, well-oriented, Memory, intelligence-intact

Local examination

Diagnosis

Diagnosis of DVT is made, if venous USG is positive (Kesieme et al., 2011). Assessment was done on the basis of signs and symptoms and Doppler sonography. Total two assessments were taken, pretreatment (baseline) and post treatment (after 3 months completion of treatment)

Investigation Reports

TREATMENT

Panchkarma/ local karma?

• Jalaukavacharan -twice / week ?
• Kshar oil application with cotton strip?
• Ashwagandhaadhi lepa {la}?
• Gandush with dashmool kwath + sahachar oil ?
• Murdha dhara with kadamb oil?

Image. 1, 2 & 3 Jalaukavacharan Procedure

Pathya

• Shashtika Shali, Yava, Laja, Godhuma, Mudga

• Karavellaka, Adraka, Methika, Patola, Kushmanda

• Low-fat or fat-free dairy products, Cow milk, Goat milk

• Drink plenty of fluids, particularly hot water.

Apathya

• Avoid Masha, Kulattha, Dadhi, Brinjal, Ikshu, Spinach, Cauliflower

• Sleep during daytime& night awakening

• Exposure to heat

• Excess usage of spicy, salty junk food

• Excessive alcohol, meat, seafood

RESULTS

Better changes in blackish discolouration.

No itching, swelling reduced. Difficulty in standing- improved. Pain –reduced.,

Stiffness of leg- reduced.

Discussion

Mode of Action of Drugs and other procedure in the Management

Sama pitta pacha                       Ushna-tikshna guna shaman                              Pittavirechan                                

             Raktaprasadan

Conclusion

By understanding proper Nidana, Lakshana and Samprapti of Rakta-pitta one can very well keep DVT under the heading of Grathit Raktapitta and treat it successfully with Shamanoushadhi & Panchakarma treatment. With proper understanding of Dosha, Dushya and Vyadhi Avastha we can manage Raktapitta. In the present case, Panchakarma

procedures such as Jalaukavacharan along with oral medications is found to be effective. Pathyapathya is also the core of Ayurvedic treatment basically needed for cure as well as non-recurrence of pathology of disease. The above treatment showed remarkable result especially in swelling and pain