Ayurvedic management of ischemic ulcer in peripheral arterial disease using Panchakarma and leech therapy: A case report

Abstract BACKGROUND: Peripheral arterial disease (PAD) is a progressive atherosclerotic condition affecting the lower limb arteries, leading to reduced blood flow and ischemic symptoms. Despite its increasing global prevalence, PAD often remains underdiagnosed and inadequately managed. Treatment options for PAD encompass lifestyle modifications, management of cardiovascular risk factors, pharmacological therapy, and, in advanced cases, endovascular procedures or surgical interventions. Ayurveda treatment has been utilized in clinical practice for the management of the disease and also to improve the quality of life. PATIENT INFORMATION: A 30-year-old Indian female farmer presented with a non-healing ischemic ulcer on the left second toe, along with tingling, hyperaesthesia, and nocturnal foot pain, with a past history of self-amputation of the left great toe due to gangrene. The patient had no history of any addiction. The patient had no conventional risk factors, and she had been managing the condition at home without medical supervision until the presentation. Based on clinical assessment and arterial Doppler study of the lower limbs, she was diagnosed with PAD. INTERVENTION: The patient was managed through an integrative Ayurvedic approach comprising medicated Ghee-based internal Snehapana , Virechana (therapeutic purgation), medicinal leech therapy for localized bloodletting, local wound cleansing, wound dressing, and oral administration of Ayurvedic formulations, including Kaishora Guggulu , Haritaki Churn a, and Pippali Churna. RESULT: By the 43rd day, the patient got relief from pain and hyperesthesia, and the wound healed completely. CONCLUSION: In this young patient without conventional risk factors, a comprehensive Ayurvedic treatment protocol resulted in the healing of ischemic ulcer associated with PAD. This case suggests that Ayurveda may offer an effective non-invasive therapeutic approach for managing PAD-related complications, potentially reducing the need for more invasive vascular interventions.