Siravedhan in Refractory Herpes Zoster Ophthalmicus: An Ayurvedic Case Report

Herpes Zoster Ophthalmicus (HZO) is a painful, often sight-threatening condition resulting from reactivation of latent varicella-zoster virus in the ophthalmic division of the trigeminal nerve. Conventional management can be done with antiviral therapy and analgesics, yet complications like post-herpetic neuralgia (PHN) remain challenging to prevent and treat. This case report presents Ayurvedic interventions, particularly Siravedhan (therapeutic venepuncture), in managing acute HZO. A 74-year-old male presented with acute unilateral vesicular eruptions over the left forehead, periorbital region and ear, severe burning pain (VAS 8/10), photophobia, swelling and positive Hutchinson's sign. The patient received three sittings of Siravedhan performed above the Kshipra Marma on the affected side, alongside oral Ayurvedic formulations (Sutshekhar Rasa, Arogyavardhini Vati, Gandhak Rasayan and Mahatikta Ghrita) and local application of Shatadhauta Ghrita. The patient experienced immediate relief from burning pain after the first Siravedhan procedure. By day 7, swelling and photophobia were resolved. By Day 14 vesicular lesions had crusted and healed; by Day 21, only mild discoloration remained. The patient resumed normal activities with no evidence of post-herpetic neuralgia. This case shows the potential of Ayurvedic interventions, particularly Siravedhan, in managing HZO by providing rapid symptom relief and possibly preventing post-herpetic neuralgia. It suggests that more clinical studies are warranted to validate these findings.