Vol. 2, Issue 2, Part A (2025)

Background: Varicose veins of the lower limbs are a common manifestation of chronic venous disease and are associated with pain, heaviness, edema and impaired quality of life. Conventional management relies on compression therapy and invasive procedures, which may be costly, infrastructure-dependent and not always acceptable to patients. In Ayurveda, varicose veins correlate with Sirāgranthi/Sirajgranthi, for which Jalaukāvacaraṇa (leech therapy), a form of Rakta-mokṣaṇa, is traditionally recommended.
Aim: To clinically evaluate the effectiveness and safety of Jalaukāvacaraṇa in the management of primary lower-limb varicose veins in an Ayurvedic hospital setting.
Materials and Methods: This prospective observational study was conducted in the Shalya-Tantra/Panchakarma unit of a tertiary-care Ayurvedic teaching hospital. Adults (18-65 years) with symptomatic primary lower-limb varicose veins (approximately CEAP C2-C4) were enrolled after duplex confirmation of superficial venous incompetence. Patients with deep vein thrombosis, bleeding disorders, severe anaemia, pregnancy, active infection or prior venous surgery in the target limb were excluded. A standardised Jalaukāvacaraṇa protocol (one to three leeches per sitting, repeated every 1-2 weeks) was administered for a median of four sittings. Outcomes assessed at baseline, mid-treatment and end of intervention included pain and heaviness on 10-cm visual analogue scale (VAS), limb circumference, semi-quantitative scores for engorgement, skin discoloration and functional limitation, global patient-reported improvement and adverse events.
Results: Forty-two patients completed the study. Mean pain VAS decreased from 7.3±1.1 to 3.1±1.4 and heaviness from 6.8±1.2 to 2.7±1.3 (p<0.001 for both); 71.4% and 69.0% of participants, respectively, achieved ≥50% reduction. Ankle and calf circumferences showed significant reductions, and clinical scores for engorgement, discoloration and functional limitation improved markedly. More than half of patients reported marked global improvement. Only minor, self-limiting adverse events (prolonged ooze, local pruritus, erythema) were observed; no serious complications occurred.
Conclusion: Serial Jalaukāvacaraṇa, delivered within a protocolised Ayurvedic framework, appears to be an effective and well-tolerated adjunctive therapy for symptomatic primary varicose veins, producing substantial relief in pain, heaviness and venous congestion. These findings support further controlled trials to compare leech therapy with standard conservative care and to clarify its long-term benefits and cost-effectiveness in chronic venous disease.