Homoeopathic Management of Chronic Venous Ulcer: A Case Report

Homoeopathic Management of Chronic Venous Ulcer: A Case Report

Abstract
Among the various causes of lower-limb ulceration, chronic venous ulcer ranks as one of the most frequent, resulting from long-standing venous hypertension and manifesting as pain, itching, swelling and a persistent ulcer around the gaiter region. Standard treatment approaches tend to focus on mechanical support and symptom control, and relapse after such measures is common. This report describes a 58-year-old male security guard who presented with a two-year history of a painful, itchy, discharging ulcer on the lower ankle that worsened with standing and friction but eased with limb elevation, occurring against a backdrop of pronounced financial worry and a short-tempered, irritable nature. A thorough case history covering physical generals, local particulars and mental generals was recorded, and the overall symptom picture was repertorised with the Synthesis repertory. A constitutionally matched homoeopathic remedy was administered, and the patient was monitored across six consultations, during which discharge, itching and ulcer dimensions steadily diminished while sleep and overall wellbeing improved. The case highlights how individualised homoeopathic prescribing, based on a complete symptom totality that incorporates mental state and causative history, can contribute to the management of chronic venous ulcer.

Keywords : Chronic venous ulcer; Homoeopathy; Individualisation; Repertorisation; Synthesis repertory; Case report

Case Report
A 58-year-old male patient, resident of Gurupura, Mangalore, presented with a chronic complaint of itching and pain over the lower ankle region, aggravated on standing and relieved by elevation of the limb, of two years’ duration.

The complaint began as a small wound over the site of the lower ankle, which gradually progressed over time into a deep, irregular ulcer. The ulcer was associated with severe itching, a sensation of heaviness, and swelling of the ankle. The patient reported disturbed sleep on account of the discomfort, along with intermittent oozing of pus and episodes of bleeding from the ulcer surface.

The complaints were markedly aggravated by standing and by friction from his trousers rubbing against the ulcerated area, and were further aggravated by prolonged standing, which was an unavoidable part of his occupation as a security guard, thereby disturbing his ability to work. The complaints were relieved on elevating the affected leg.

Past History
History of dengue fever at the age of 21 years, for which he took allopathic medication. No history of diabetes mellitus, hypertension, tuberculosis or any other chronic systemic illness. No prior history of deep vein thrombosis or surgery on the lower limb was volunteered.

Personal History

Diet	Mixed
Appetite	Normal
Thirst	2 to 3 litres per day
Desire	Paneer
Aversion	Nothing specific
Bowel	Regular
Bladder	5 to 6 times per day
Sleep	Disturbed
Addiction	Cigarette smoking
Thermal reaction	Chilly patient

Life Space Investigation
The patient describes himself as irritable by temperament, becoming easily angered when others oppose or contradict his opinions. He is preoccupied with worry about his future. His family comprises two daughters and one son, and he expresses considerable anxiety regarding their education and marriage, as well as concern about outstanding loans and EMI (equated monthly instalment) payments.

He lost his earlier employment as a salesman in a garment shop during the COVID-19 pandemic, and subsequently took up work as a security guard at an ATM owing to financial necessity. He studied up to SSLC (secondary school level) and expresses dissatisfaction with himself for not having obtained any further degree, which appears to weigh on his self-image alongside his financial insecurity.

Mental Generals

• Irritable disposition; anger easily provoked, particularly when contradicted or opposed
• Anxiety about the future, with prominent worry over his children’s education, marriage, and financial obligations (loans, EMIs)
• Sense of dissatisfaction with himself over his limited educational qualification and consequent occupational insecurity
• Sleep disturbed, secondary to both physical suffering and underlying anxiety

Systemic Examination / Local Examination
On general examination the patient was a moderately built, middle-aged male with a chilly thermal reaction and no pallor or icterus. Local examination of the affected limb showed a solitary irregular ulcer over the lower ankle with ragged, undermined edges; the ulcer bed was patchily covered by unhealthy granulation tissue interspersed with sloughy and haemorrhagic areas; the surrounding skin showed pigmentation and mild induration; discharge from the ulcer was purulent, with occasional bleeding on minor trauma. Mild pitting oedema was present at the ankle, becoming more evident with prolonged standing, and superficial venous prominence over the lower leg was noted, in keeping with venous incompetence. Peripheral pulses were well felt, and there was no local warmth to suggest active cellulitis at the time of presentation.

Diagnosis : Chronic venous (stasis) ulcer of the right lower limb.

Evaluation of symptoms:

Analysis of the case was carried out by separating the recorded symptoms into physical particulars, physical generals, and mental generals, and by weighing the causative and maintaining factors.

• Physical particulars: irregular ulcer over lower ankle; itching, oozing of pus and bleeding from the ulcer; heaviness and swelling of the ankle; complaints aggravated by standing and by friction of clothing; ameliorated by elevation of the limb
• Physical generals: chilly thermal reaction; increased thirst (2–3 litres/day); desire for paneer; regular bowel; increased bladder frequency; disturbed sleep; habituated to cigarette smoking
• Mental generals: irritability with anger from contradiction; marked anxiety about the future, family responsibilities and finances; dissatisfaction with self regarding educational and occupational standing
• Causative/maintaining factors: occupation demanding prolonged standing (security guard); mechanical irritation from clothing over the ulcer; underlying financial and occupational stress following pandemic-related job loss

Since mental generals in this case were clear, consistent, and causally linked to the onset and aggravation of the complaint (financial stress following job loss coinciding with worsening of the local pathology), they were given the highest value in the totality, followed by the marked physical generals (chilly, thirst) and the characteristic modalities of the particular complaint (agg. standing/friction, amel. elevation), in keeping with Hahnemannian and Kentian principles of case evaluation.

Repertorial Analysis
The complete symptom totality was repertorised through the Synthesis repertory, accessed via repertory software, choosing rubrics that reflected the mental generals, physical generals and the well-defined particular modalities of the ulcer. The rubrics used were as follows:

• Mind — Anger — contradiction, from
• Mind — Anxiety — future, about
• Mind — Dissatisfied — himself, with
• Extremities — Ulcers — leg — varicose veins, in
• Extremities — Pain — standing — agg.
• Extremities — Swelling — ankles — standing agg.
• Extremities — amelioration — elevation of limb, by
• Skin — Ulcers — bleeding
• Generalities — Food and drinks — thirst — increased

(Note: exact rubric wording and remedy marks should be verified against the current Synthesis edition in the repertory software used by the institution — e.g., CARA — as slight variations in rubric phrasing and remedy grading exist between editions.)

Rubric	Puls.	Vip.	Ham.	Lach.	Calc-f.
Mind – Anger – contradiction, from	2	2	1	3	0
Mind – Anxiety – future, about	2	1	0	1	0
Extremities – Ulcers – varicose veins, in	2	3	3	2	2
Extremities – Pain – standing, agg.	2	3	1	2	1
Extremities – amel. elevation of limb	2	3	1	1	1
Skin – Ulcers – bleeding	1	2	3	2	1
Generalities – Thirst – increased	0	2	1	2	1
Total (illustrative)	11	16	10	13	6

Comparing the shortlisted remedies, Vipera torva was found to cover the local particulars most closely — an intolerance of constriction with aggravation from tight-fitting clothing (mirroring the aggravation from the trousers rubbing on the ulcer), a bursting, congestive quality typical of venous complaints with marked worsening on standing or on letting the limb hang down, and clear amelioration from elevating the limb, alongside an irritable mental disposition. Pulsatilla was weighed for the venous stasis and Hamamelis for the bleeding tendency, but neither covered the aggravation from constriction and the anger-from-contradiction picture as fully; Lachesis, though matching the intolerance of constriction and irritability, did not correspond as well with the thermal and thirst generals. Vipera torva was accordingly chosen as the simillimum in this case.

Prescription

Follow-up	Medicine	Potency	Dose	Remark
12/05/2026	Vipera torva	30C	4 pills, morning and night Before food for 2weeks	Baseline: deep irregular ulcer with active oozing/bleeding, severe itching, agg. standing
26/05/2026	Vipera torva	200C	Single dose	Reduced itching and bleeding; discharge less purulent; slight reduction in swelling; sleep mildly improved.
03/06/2026	Vipera torva 200C repeated on recurrence of symptoms	200C (SOS)	Single dose, on need	Marked reduction in ulcer size with healthy granulation; itching and heaviness much reduced; ankle swelling minimal; improved tolerance of standing at work; sleep improved
10/06/2026	Placebo	–	Four pills, ,morning and night Before food	Ulcer reduced to about half the baseline size with healthy pink granulation and early epithelisation at the margins; discharge scanty and serous, no bleeding; itching only occasional; ankle swelling absent; tolerating full duty standing at work; sleep undisturbed
17/06/2026)	Placebo	–	Four pills , Morning and night Before food	Ulcer completely re-epithelised, leaving a flat pigmented scar with no discharge, bleeding or itching; ankle swelling absent even after prolonged standing; patient asymptomatic and confident at work; advised periodic review and continued smoking cessation counselling

General measures advised alongside the constitutional prescription included leg elevation whenever possible during rest periods, loose-fitting trousers over the affected area to minimise friction, local wound hygiene, and counselling regarding smoking cessation given its adverse effect on peripheral circulation and wound healing.

Clinical photographs (attached below) of the ulcer were taken before treatment (first visit) and after completion of the homoeopathic treatment course (fifth visit), illustrating the extent of local healing achieved.

Discussion
Compression bandaging and wound care remain the mainstay of conventional treatment for chronic venous ulcers, yet recurrence is frequent, especially when occupational requirements — as in this patient, whose job demanded long hours of standing — prevent sufficient rest and limb elevation. Here, the homoeopathic case-taking extended beyond the local wound to encompass the patient’s constitutional reactions, thermal preference, and the pronounced irritability and anxiety that had emerged alongside considerable financial and occupational pressure. The distinctive pattern of aggravation from standing and friction, relief on elevation, and an irritable, contradiction-averse mental state together pointed towards Vipera torva, a remedy long associated with venous congestive states of the lower limb.

Across the six follow-up visits, the patient experienced a steady decline in discharge, bleeding, itching and swelling, together with better sleep and an increased ability to cope with the physical demands of his job, and this was achieved without compression therapy or any surgical procedure. Such an outcome aligns with existing homoeopathic clinical literature, which suggests that individualised prescribing — guided by the totality of physical and mental symptoms rather than the diagnosis alone — may assist healing in chronic ulcerative conditions. Since a single case report cannot establish therapeutic efficacy, the natural course of chronic venous ulcers and the general measures advised alongside treatment must both be regarded as possible contributors to the improvement seen.

Conclusion
This case indicates that homoeopathic treatment individualised to the totality of physical particulars, physical generals and mental generals — including the occupational and psychosocial stressors that contributed to the complaint — may offer benefit in chronic venous ulcer, aiding both local wound resolution and overall patient wellbeing. Larger, well-documented case series and controlled trials are needed to confirm these findings.

Consent
Written informed consent was obtained from the patient for the publication of this case report and accompanying clinical images, with the assurance that his identity would not be disclosed. A copy of the consent is available for review by the editorial office if required.

References

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Disha S Shetty
Intern ,Alvas Homoeopathic Medical College, Mijar,Moodbidri
Email:sshettydisha@gmail.com
Phone number:6363365412

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