A single case study on Varicocele

[Find the meaning and references behind the names: Manjunath, Sudha, Ayush, Sridhar, Rao]

CASE REPORT July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 350 A single case study on Varicocele Dr. Sudha H M 1 , Dr. Sridhar Rao 2 , Dr. Chandrashekar Siddapur 3 1 Post Graduate Scholor, 2 Professor & HOD, Dept. of Shalya Tantra, Govt. Ayurvedic Medical College, Bengaluru, 3 Medical Officer, Dept. of Ayush, Karnataka, INDIA. I NTRODUCTION Varicocele is the dilated and tortuous veins of the pampiniform plexus. The varicocele prevalence in the general population is estimated to be 15% - 20%, however the prevalence of 40% among the men seen with primary infertility and 81% among men with secondary infertility [1] Varicocele [8-11] is associated with a progressive and duration dependent declinein testicular function. Elevated intrascrotal temperature resulting in reduction of testosterone synthesis, injury to germinal cell membranes and altered protein metabolism. Impaired venous drainage results in hypoxia, poor clearance of gonadotoxins and elevated level of oxidative stress [2] Address for correspondence: Dr. Sudha H M Post Graduate Scholor, Dept. of Shalya Tantra, Govt. Ayurvedic Medical College, Bengaluru, Karnataka, INDIA. E-mail: sudharani.manjunath@gmail.com Submission Date: 12/07/2019 Accepted Date: 22/08/2019 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/ This condition can be correlate to Sirajagranthi of Vrushanakosha. [3,4] Siragranthi is a type of deformity. Granthi refers to cystic swelling. When Granthi occur anywhere in the Sira (veins or blood vessels), they are called Siragranthi . According to Acahrya Sushruta, in the pathogenesis of Siragranthi, Vata and Pitta Dosha are predominant [2],[3] So, the dilated and tortous veins in the scrotum can be correlated to Sirajagranthi of Vrushanakosha which are majorly caused due to Vata and Pitta . The etiological factors like, Abalasyavyayamajaate - A weak person who undergoes excessive exercise, Vyayaamatpratantasya - One who does excessive exercise, effects Vyanavayu , the vitiated Vata accumulates in the vascular bundles i.e. Siras , which in turn compresses ( Sampeedya) , squeezes (Samkochya ) and dries it up ( Vishoshya ) produces Granthi within less time which is raised circular Sirajagranthi. [4],[5] Acharya Vagbhata adds that vitiated Vata playing a major role, will exerts its influence on Sira and Rakthadhatu , causing Sampeedana, Sankochana and Vishoshana of Siras resulting in formation of Granthi which is non-pulsating and painless [4],[5] Chakradatta opines that, because of Nidana , not only Vata but Kapha, Rakta and Pitta also get vitiated which then A B S T R A C T A varicocele is a dilatation and tortuosity of Pampiniform venous plexus within the spermatic cord. The condition is important etiological factor in male infertility. References are not available in Ayurvedic classics about particular disease which resembles the clinical picture of varicocele. Varicocele can be correlated to Sirajagranthi of Vrushanakosa . This helps to draw some conclusions regarding the treatment plan-up for varicocele. Jalaukavacharana is very much effective in Sirajagranthi. Hence Jalaukavacharana is tried in varicocele which can be correlated to Sirajagranthi of Vrishanakosha . It is safe and affordable. In present study total 4 sittings of Jalaukacharana was done. Marked reduction in the symptoms like pain and swelling was observed after second sitting. Jalaukacharana is very much effective in management of varicocele. Key words: Varicocele, Jalaukavacharana, Sirajagranthi, Vrushanakosha.

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Dr. Sudha H M. et al. A single case study on Varicocele ISSN: 2456-3110 CASE REPORT July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 351 enter the blood vessels, get lodged there and produce obstruction and causing granthi. [6] Varicocelectomy, the surgical procedure done to correct the varicocele has complications like hydrocele, hematoma, infection and injury to scrotal tissue. An alternate to surgery is embolization is minimum invasive but it is costly. Raktamokshana is the main line of treatment in the management of Sirajagranthi, in which Jalaukavacaharana is cost effective, easy and safe method of treatment. Jalauka sucks vitiated blood, reduces the local temperature and the enzymes and chemical compounds of leech helps in blood circulation and reduces the congestion [7] C ASE R EPORT A 28 year old male visited in Shalyatantra OPD of GAMC and SJIIM Hospital ,Bangalore on 24-12-2018. He presented with the complaints of pain and swelling in scrotum since 4 months. He is working as engineer and his work demands standing for more than 8 hours daily and also has night shifts of work. Patient also complains of discomforting pain in the scrotal region while walking and suffering from constipation since 3 months. Tenderness in left side of scrotal root ++ Cord like structure felt in left side of scrotal root. Investigations Hb% - 15 gm%, CT- 4’ , BT - 2’20”, ESR - 10 mm 1 st hr, RBS - 112 gm/dl, HIV & HbsAg - Non reactive, USG scrotum report - Grade 2 varicocele. Jalaukavacharana procedure After proper investigation,leech therapy was planned as the first line of treatment in this case. Cleaning of the site to which leech is going to be applied was done. The whole procedure was explained in detail to the patient, in his own language and written consent was taken. The patient was put on supine position and advised to come with clean shaved scrotal region. The scrotum was cleaned with betadine and distilled water. Then the leeching area was identified and leech was kept to bite over the site. Then leech stuck and started sucking the blood which was evident by hood like structure of leech. Cover the leech with wet gauze piece. While sucking the blood following signs appear in the body of leech. a Gradual distension in the central portion of the body b Itching and burning sensation at the site of bite c Pulsations on the body of leech may be visible After 30-45 minutes the leech detached by itself, then the leeched site was given soft pressure by a gauze piece without hurting the patient. The bleeding stopped in two to three minutes, then the wound was applied with Jatyadi Taila and scrotal bandage was done. The leech that is applied to the lesion undergoes a process of Vamana . For the Vamana of leech, turmeric powder is applied over the mouth of leech. The leech vomits out all the blood sucked. After proper Vamana , leech should be put in fresh water. Replace the leech in a clean jar. The patient was advised to take following internal medicines Tab . Kaishora Guggulu 1 TID A/F Tab. Sarivadivati 1 TID A/F Assesment Criteria Jalaukavacharan a 1 st sitting 2 nd sitting 3 rd sitting 4 th sitting Blood let out 5 ml 5 ml 4 ml 5 ml Pain* VAS- 2 VAS- 1 VAS- 0 VAS- 0 Varicocele** Grade -2 Grade -2 Grade -1 Grade -0 *Visual Analogue Scale : 3 - discomforting pain, 2 - moderate pain, 1 - mild pain, 0 - absent ** Varicocele grading - Subclinical - seen on ultrasound but not visible or palpable on physical examination, Grade - 1 - not visible but palpable with performance of Valsalva maneuver, Grade -2 - Not visible but palpable without Valsalva maneuver, Grade- 3 Visible on examination [12]

Dr. Sudha H M. et al. A single case study on Varicocele ISSN: 2456-3110 CASE REPORT July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 352 O BSERVATION AND R ESULTS After treatment there is total reduction in the pain along with reduction in the size of cord like structure felt at the site and USG Report shows Grade-0 after 4 Sittings of Jalaukacharana . After first sitting, there was marked reduction of pain but the feeling of cord like structure persisted. After second sitting, there was further reduction in pain and slight reduction in the cord like feeling on palpation. After third sitting there was no pain and slight cord like structure was still palpable. After fourth sitting both pain and cord like structure palpable was absent. DISCUSSION Jalauka is very much beneficial in Dooshitha Rakta Vikara , it sucks vitiated blood from selected part of the body. Acharya Sushruta describes Jalaukacharana as Anushashtra . It is much safer and less invasive non complicated procedure. The saliva of leeches contains variety of bioactive constituents like Hirudin which inhibits blood coagulation by binding thrombin, Bdellins causes anti-inflammatory action by inhibiting Trypsin, Plasmin, Hyaluronidase increases interstitial viscosity, antibiotic action. Elgins inhibit the activity of chemotrypsin act as anti-inflammatory, Histamin like substance and acetylcholine act as vasodilators. Leeches are Sheeta in nature commonly used in Raktaja and Pittaja disorders. Leech therapy induce pain relief through anti nociceptive effects. The jaws of leech penetrates into deeper tissue and diffusion of these pharmacological active substances into tissue. CONCLUSION Jalaukacharana helps in reducing local inflammation, ischaemic and localized venous congestion,there by reduces the need for surgical intervention in varicocele. Hence Jalaukacharana is helpful in treating varicocele. As compare to costlier surgery, it is very

[Find the meaning and references behind the names: Williams, Sri, Christopher, Sharma, Ram, Murthy, Anna, Love, Pandey, Norman, Nil, Med]

Dr. Sudha H M. et al. A single case study on Varicocele ISSN: 2456-3110 CASE REPORT July-Aug 2019 Journal of Ayurveda and Integrated Medical Sciences | July - Aug 2019 | Vol. 4 | Issue 4 353 costeffective and affordable to common people. In Jalaukacharana sucking of blood considered as microsurgery of Ayurveda. REFERENCES 1 SRB’ s Manual of Surgery,4 th edition, by Sri Ram Bhat M., pg no-1157-1159. 2 Agarwal A, Makker Sharma, Clinical relevance oxidative stress in male factor infertility on update AMJ Reprod Immunol 2008;59,2-11. 3 Sushrutha samhita by sushrutha with Nibandha Sangrahya Commentory of Sri Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya on Nidanasthana, Edited by Vaidya Jadavaji Trikamaji Acharya from beginning to the 9 th ch of chikitsasthana, Published by Chaukhambha Surabharati Prakashana, Reprint 2002. 4 Astangha Hridaya; by Acharya Vahbhata with commentaries Sarvanga Sundari of Ayurveda Rasayana of Hemadri. Collated by Dr Anna Moreshwara Kunte and Kh-30 th .ri shna shastriNavare, edited by pandith Harisadashiv shastri paradakar, published by Chaukhambha Sanskrit sansthan, Varanasi, reprint 2014, uttarasthana pg no-884,ch-30 th . 5 Haritha Samhita; by Vaidyajaimini pandey, 1 st edition 2010, sutra sthana 6 th ch, pg no-512. 6 Sushruta samhita by sushrutha with Nibandha Sangraha Commentory of Sri Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacharya on Nidanasthana, Edited by Vaidya Jadavaji Trikamaji Acharya from beginning to the 9 th ch of chikitsasthana, Published by Chaukhambha Surabharati Prakashana,Reprint 2002,Nidhana sthana ,pg no- 315,ch-12,5 th shloka. 7 Astangha Sangraha by Acharya Vagbhat, English translation by K .R. Srikantha Murthy,reprint edition 2012-uttaratantra pg no-308,35 th ch,13 th shloka. 8 Concise text book of surgery, S Das, 4 th edition, 2006, pg no-1299-1302. 9 Bailey and Love, Short practice of surgery, edited by Norman’s Williams, Christopher J.K Bulstrode and P Ronan, 25 th edition, pg no-1380-1383. 10 SRB’ s Manual of Surgery, 4 th edition, by Sri Ram Bhat.M,pg no-1157-1159. 11 A Manual on clinical surgery, 6 th edition,by S Das ,pg no-449,ch-39. 12 www.semanticscholor.org, varicocele grading. ******************************* How to cite this article: Dr. Sudha H M, Dr. Sridhar Rao, Dr. Chandrashekar Siddapur. A single case study on Varicocele. J Ayurveda Integr Med Sci 2019;4:350- 353. http://dx.doi.org/10.21760/ Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2019 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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