Introduction

Reactivation of the varicella-zoster virus (VZV) causes the acute viral illness known as herpes zoster. The symptoms linked with herpes zoster include a painful skin rash, vesicular eruption, and fever. Herpes zoster is 5–10% common worldwide and 2–6% common in India. Reduced immunity increases the risk of the varicella-zoaster. Weakened immune system also increases the risk of developing subsequent complications such post-herpetic neuralgia, encephalitis, motor nerve palsy, and secondary infections.[1] The diagnosis is made based on the patient's fundamental signs and symptoms. Postherpetic neuralgia is the primary complication of these diseases. Since herpes zoster is an acute illness, the aim of ayurvedic treatment is to minimize consequences like post-herpetic neuralgia and secondary infection while also giving the patient rapid relief from symptoms like burning sensation and lesion pain. The ayurvedic descriptions of Kaksha [3] by Acharya Sushrut and Visarpa, Agni[2] by Acharya Charak indicate a tight relationship between herpes zoster and these conditions. According to Kshudraroga, kaksha is one of the main skin conditions. Respected acharya says that agnivisarp is vattpittaj doshaj and kaksha is pittaj doshaj. Both herpes zoster and agni visarpa cause excruciating pain and burning sensations, and the ways in which the two diseases propagate throughout the body are comparable to those of kaksha. Pittaj Visarpa-like treatment for Kaksha vyadhi is described in Sushrut Samhita Chikitsasthan. [4] At times, Kaksha Vyadhi might be aashukari Vyadhi, meaning that it has an acute manifestation and requires immediate medical attention. When pitta dosha is aggravated, Acharya Charak in Visarp mentions Raktamokshan[5] as a course of treatment. The Sushrut Samhita describes three primary types of Raktamokshan based on dosha. We opted for Jaloukavacharana, also known as leech therapy, which is one of those types that is utilized in pittaj vyadhi. To assess the effectiveness of leech therapy for herpes zoster, more research is being done.

A CASE STUDY: A 36-year-old male patient, who works as a gym trainer in Amravati, arrived at our hospital's Shalyatantra Department complaining of excruciating pain, a burning feeling, and blister-like skin lesions that had been present for two days from the left side of his back to his chest. He was given a diagnosis of herpes zoster. In 20 days, Jalauka received healing when shaman medications were applied on site. Herpes zoster lesions were discovered to have fully cured after 20 days.

GENERAL EXAMINATION-

The patient had a pulse of 80 per minute and a blood pressure of 120/80 mm Hg. He had a pallid appearance. Blisters in the left side of his back to his chest.

SYSTEMIC EXAMINATION-

The results of the systemic assessment showed that the heart and lungs were both functioning normally. Patient's pupillary reflexes were within normal ranges, but he was restless and experiencing excruciating pain and burning at the nerve's location. Both superficial and deep tendon reflexes were normal.

MATERIALS AND METHODS

Ashtavidha Parikshan His Nadi (~pulse) was Vatpittaj, Jivha (tongue) was Sama (~coated), Aakriti was Madhyam (~medium built), bowel habit were regular and normal. Druk (~vision) was normal.

Vaat pittaj Prakruti, Madhyam Sarta, Alpa Satva, Madhyam Satmya Avara Vyayam Shakti, Vikruti Vaatpitta Pradhan, Abhyavaharan, and Jaran Shaki were Madhyam, according to the Dashvidha Examination.

Investigations :

Hb-10.9gm%, TLC-9,300/cmm, PLT-2,80,000/cmm

ESR-15 mm/hr, S.Urea-15mg/dl, S.creatinin-0.8mg/dl, BT-3 min, CT-5 min, HBsAg- negative, HIV- negative BSL-R- 104 mg/dl

S.Electrolyte: S.Sodium-133.3 mEq/L,S.Potassium-4.1 mEq/L,S.Chloride-101.2 mEq.

Urine Examination- Protein- +, Pus cells- 3-5/hpf Epithelial cells- 6-8/hpf, RBC’s-Nil

Materials:

• Jalouka used as an emergency treatment
• Tab Omnacortil [prednisolone] BD
• Tab Acivir [acyclovir]400mg QID
• Tab opiz D BDD
• Tab Renerve plus BD
• Tab pregabalin 75 mg BD

Methods

A 36-year-old male patient was chosen for the current clinical investigation. Patient data was gathered through interviews, and the Shalyatantra OPD was the site of the study.

Diagnosis

The full range of Herpes zoster signs and symptoms are used for diagnosis.

Treatment plan

Patient was treated on OPD basis. When patient came with above complaints as an emergency treatment Jalouka i.e. leech is used then medicine  is given and after that patient observed for follow up on alternate day  and  3 sitting of jaloukavacharan done on alternate day.

Discussion

OBSERVATIOS:

After the first Jalouka sitting, the patient experienced immediate relief from signs and symptoms such as burning sensation and pain; after the second Jalouka sitting, there was a relief from burning sensation and pain; and after the third Jalouka sitting complete relief from burning sensation and pain  the patient's Herpes Zoster blisters were completely crushed and healed in 20 days.

There is a description of Khsudraroga in the Nidansthan of the Sushrut Samhita. Among these, Kaksha vyadhi is one that Kshudraroga describes.Near the kaksha (axxila region), there occurs the development of red blisters that are extremely painful and burning. This condition is brought on by pittaprakopa, also known as kaksha vyadhi. While Acharya Charak and Vagbhat suggested vataj & pittaj dosha for Kaksha vyadhi, Sushruta mentions pitta dosha for Kaksha. Modern research suggests a correlation between herpes zoster and Kaksha vyadhi. intense pain, burning feeling, and Kaksha vyadhi, a condition resembling herpes zoster. The pittaj visarpa treatment described in Sushrut Samhita Chikitsasthan is comparable to that of Kaksha Vyadhi. Pittaj Visarpa describes raktamokshan therapy. Raktamokshan is the primary line of treatment for Kaksha vyadhi. In twaka, mansa, and snayu, kleda development occurs if Raktamokashan is not performed in an acute situation. Jalouka draws impure blood primarily from the surface but sometimes from deeper parts. Modern perspectives on calin and Hirudin state that Jalouka's saliva contains enzymes that act as anticoagulants and facilitate the easy suction of unclean blood. Additionally, Jalouka's salivary glands have anesthetic, antihistaminic, antibacterial, and antiviral properties. Following Jalokavacharana treatment for herpes zoster to cleanse impure blood, patients experienced instant alleviation from discomfort and burning sensations. The patient is administered Tab Omnacortil [prednisolone]BD, Tab Acivir [acyclovir] 400 mg QID, Tab Opez D BD, Tab Renerve plus BD, and Tab pregabalin 75 mg BD.

RESULT

Herpes zoster can be effectively treated with jalaoukavcharana, which provided instant pain alleviation and a burning feeling. At follow-up, none of the patients experienced any complications.

Conclusion

Leeches cause no discomfort to their victims when they take their blood. Leeches are therefore helpful in curing the illness by eliminating the bad blood, or dushit rakta as it is known in layman's terms. Leeches are effective analgesics. It aids in the elimination of skin lesions and the reduction of pain and swelling.  The level of pain and rash severity thereafter decreased. In ten days, the lesions were discovered to be fully squashed and healed. There was no sign of another eruption. Medication is also beneficial in reducing edema and inflammation. It is discovered during follow-up that post-herpetic neuralgia does not exist. The pain completely disappeared. The patient was discovered without any further issues. The study concludes that jalouka is a useful treatment for herpes zoster (kaksha) and relieves discomfort.