Early Integrative Management of Visarpa (Herpes Zoster) with Jalaukavacharana (Leech Therapy): A Case Report

Background: Herpes zoster is a viral infection characterized by painful vesicular eruptions unilaterally with a propensity for post-herpetic neuralgia despite standard antiviral therapy. It resembles the features of Visarpa in Ayurveda, and Raktamokshana is indicated as a line of treatment. This is a peculiar case of early leech therapy as an adjunct to conventional treatment in herpes zoster for its neural complications as well as pain relief. Clinical Findings: A 25-year-old female had an episode of severe burning pain associated with erythema and grouped vesicular eruptions over the left side of the neck as well as the upper chest for 2 days. Pain was severe (7 on Visual Analog Scale-VAS). Eruptions were limited to left C3, C4 dermatomes with no secondary infection. Intervention: Patient was treated with 3 sittings of Jalaukavacharana along with Kaishora Guggulu, Mahamanjishthadi Kashaya, and Avipattikar Churna. Shatadhauta Ghrita was applied locally from the 7th day. Antiviral therapy (acyclovir for 5 days) was given concomitantly for supportive purposes. Outcome:  There is a considerable reduction in burning pain and erythema following initiation of integrative treatment, including Jalaukavacharana, internal Ayurvedic medications, and antiviral therapy. Vesicular lesions healed in due course. Lesions disappeared by 30 days. Overall, the VAS score was reduced to 0 by the 15th day. There were no episodes of post-herpetic neuralgia during the 6-month follow-up period. No adverse effects were noted. Conclusion: Early application of leech therapy sittings at alternate intervals along with internal ayurvedic medicines for 1 month and supportive antiviral therapy had rapid pain relief, increased healing, and prevented post-herpetic neuralgia without any adverse events. This highlights the role of integrative management and Jalaukavacharana as early intervention in herpes zoster in order to accelerate the healing process and avoid complications, including PHN. Further large-scale clinical trials are needed to validate these findings.