History of the present and past illness of the patient
Six years ago, one fine day, the patient felt mild dilatation of veins in the right lower limb, followed by severe pain present while walking. The pain began gradually and intensified over time. She suffered from dragging-type pain that became worse when she stood for a long period and went away when she lay down. In the beginning, she consulted at St. Thomas Hospital, Chethipuzha, Changanassery, Kerala, where she was diagnosed with varicose veins and suggested following the treatment. So, she underwent allopathic treatment with internal medication and external treatment like sclerotherapy three times (6/01/18, 15/9/18, and 12/9/19) and got a mild recovery. Then, after doing heavy work, the dilatation of veins progressed well, leading to the development of an ulcer in the medial malleolus of the right lower limb with mild oozing, redness, and swelling. It started slowly and developed over time. It was modest initially and got bigger over time. Trauma has never occurred in the past. There was pain around the ulcer and discharge which was sero-purulent in nature, scanty in amount, and not foul-smelling from the ulcer. There was hyperpigmentation of the skin around the ulcer. There was no associated fever or any other significant findings. As the days passed, she felt more pain, and itching and the ulcer was spreading and it was aggravated over the last 3 months. Then, she approached the Outpatient Department of Santhigiri Siddha Medical College and Hospital, Trivandrum, Kerala, at her friend’s suggestion. After a proper interrogation of her and a proper evaluation of the state of the patient, she was admitted to the IPD. All the personal history and general examination of the patient were observed and noted. Local examinations of ulcers in the skin and assessment for varicose veins were observed and noted in Table 1. Assessment criteria for varicose ulcers were evaluated by the VCS Score before treatment and noted in Table 2. After evaluating the Siddha aspects, the results were examined and recorded in Table 3.