26/05/2023
47 yrs old patient was referred to us for pain relief of gouty arthritis of first tarso-metatarsal joint of right leg. His serum Uric Acid level was 10.1 mg/dl. But the real problem was his increased Serum cretin level which was 1.64 mg/dl, preventing the use of NSAIDS and other analgesics and anti-inflammatory drugs. Though there are some renal safe analgesics general practitioner felt if safe to refer this patient for leech application for decreasing pain and inflammation.
Gout: Metabolic disease in which there is excess of Uric acid in the blood Uratic deposits in the tissue and the joints and manifest like acute painful episodes of inflammation to joints particularly small joints of the extremity. Inflammation is caused by too much uric acid, which forms small crystals in and around the joints. Normal uric acid level in blood is 1-4 mg/dl while in case of gout this raises to 4 -10 . this patient was having 10.1 mg\dl.
Vatrakta ; In Ayurveda this gout can be correlated with Vatrakta which is having very similar symptoms and pathology at that of gout .
पादायोर्मुलामास्थाय कादाचीत हस्तायोरपी | आखोर्र्विश्मीव क्रुध्ह तत देह्मनुसर्पती || सु. नि. 1/48
Treatment
As this is metabolic disease specific treatment is advised in both Ayurveda and Allopath which is well known and established.
Here in this case as there was increase in serum creatinine levels analgesics anti-inflammatory drugs were contraindicated
To give relief to patient from severe pain and inflammation Ayurved treatment protocol of Raktmokshan was followed.
रक्तप्रबले अSपीएवलम बहुश्ष्य शोणीतमवसेचयेत ........................|| सु.चि. ५/९
As leech Saliva contains So many enzymes like Hirustatin, Eglins, Bledines which are anti inflammatory and analgesics . Hyaluronidase is the enzyme in the leech saliva which disperses the edematous fluid. This Hyaluronidase might be responsible for the removal of the urates deposits from the tissues and joints . Same happened in our case also. Leech application gave relief to the patient from severe pain and inflammation of the Gouty arthritis.
Photographic evidences are as follows.
