By Dr. S.Kamalakar Puripanda1st year PG Scholar,

DEPT.OF SAMHITA SIDDHANTA

Grandhi literally means grandhana or knot, the mechanism being clotting or accumilation of dushita dathu or dosha locally

Vata associated with kapha ,getting aggravated,vitiate the muscles,blood and fat tissues and produce a round bulged swelling.

Types: Vataja ,pittaja ,kaphaja, medhoja ,siraja

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In person who are weak ,indulging in more of physical excersice ,vata gets aggravated, invades the network of veins,effect on walls gives rise to roughness in veins, elevated,quick devoloping and round swelling of veins .

Charaka defines grandhi has a pulsatile swelling ,mainly siraja gandhi can be pulsatile

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When a veins become dilated,elongated and tortuous,the vein is said to be varicose

SITES:THE COMMON SITES OF VARICOSITY ARE:

1.Superficial venous system of the lower limbs- affecting either the long saphenous or the short saphenous vein or the both.

2.Oesophageal varix: Affecting veins of the gastro-oesophageal junction

3.Varicosity of the haemorrhoidal veins-piles

4.Varicosity of the spermatic veins- varicoceole 4

The veins are the blood vessels that return blood at low pressure to the heart

The walls of the veins are thinner than those of arteries but have the same three layers of tissue.they are thinner because there is less muscle and elastic tissue in the tunica media

Veins possess valves,which prevent backflow of blood,ensuring that it flows towards the heart

The smallest veins are called venules

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The venous valves are abundant in the distal lower extremity and number of valves decreases proximally, with no valves in superior and inferior vena cava

Delicate structures Prevent reverse flow in the

veins Ensure that the blood is

pumped from the superficial to the deep system and back towards the heart when the patient is walking

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Connect superficial to deep veins at various levels.

Travel from superficial fascia through an opening in the deep fascia before entering the deep veins.

The direction of blood flow - from superficial to deep veins.

Guarded by valves so that the flow is unidirectional, i.e. Towards deep veins.

Reversal of flow occurs due to incompetence of perforators which will lead to varicose veins

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Superficial venous systemDeep venous systemVenous valvesPerforator veins

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LCIV

RFV

RPV

LLSV

LSSVRATV

RPTV

Under normal conditions the blood from the superficial venous system is passed to the deep veins through the competent valves and negative intrathoracic pressure

But if this mechanism breaks down, either due to destruction of the valves of the deep veins or of the perforaters or of the superficial venous system,the blood becomes stagnated in the superficial veins,thus becomes distended and tortuous to become varicose veins

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Athipravruthy (excessive flow..)Sanga (Stasis)Siranam gradhnanam (dilatation,

elongation, tortuosity & ‘cord like feel’)Vimargatho vaa gamanam (retrograde

flow)

Athipravruthy, sanga, siranam grandhanam, vimarga gamanam – in Varicose Veins

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Morphplogical factors: Varicose veins of the lower limbs are the

penality the man has to pay for its erect posture.The veins have to drain against gravity.The superficial veins have loose fatty tissue to support them and thus suffer from varicosity.There are 3 types of varicocity

PrimarySecondarycongenital

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This condition is mainly due to defect in the valvesDefect in the SephanoFemoral V alve leads to varicosity of the Defect in the SephanoPopliteal Valve leads to varicosity of the Defect in the valves of the perforators lead to varicosity of either LSV or SSV

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LSVLSV

SSVSSV

PROLONGED STANDING: During prolonged standing long column of

blood along with gravity puts pressure on the weakend valves of the veins.This causes failure of the valves quickly giving rise to varicosity

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OBESITY: Excessive fatty tissue in the subcutaneous

tissue offer poor support to the veins.this leads to the formation of varicosity

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OLD AGE: this causes atrophy and weakness of the vein wall.at the same time with ageing the valves in the veins become gradually incompetent

ATHLETS:Forcible contraction of the calf muscles may

force blood through the perforating veins in reverse direction.this will cause destruction of the valves of the perforating veins and ultimately lead to formation of varicose veins.

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The commenest symptom is tired and aching sensation in the affected lowerlimb ,particularly in calf ,at the end of the day

Dragging pain in the leg Night cramps occurs due to change in the diameter of

veinsSharp pains may be complained of in grossly dilated

veins Pain is relieved at night on taking rest or elevation of

limbsSudden pain in calf region with fever and odema of the

thigh and ankle region suggests deep vein thrombosis

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GRADE 1 GRADE 2 GRADE 3

GRADE 4 GRADE5 GRADE 6

RETICULAR VEINS VARICOSE VEINS

ODEMA WITHOUT SKIN CHANGES

SKIN CHANGES (PIGMENTATION,VENOUS ECZEMA)

ULCERATION

MORRISSEY’S TEST(COUGH IMPULSE):

This test should be done in the standing position

The examiner keeps the finger at SF junction and asks the patient to cough

Fluid thrill ,an impulse felt by the fingers,is indicative of SFI

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Fluid Fluid thrillthrill

TRENDELENBURG TEST:This test is done in 2 partsThe patient is asked to lie on the bed in the supine positionThe leg is elevated above the level of heart and the vein emptiedSF junction is occluded with the help of the thumb and the patient asked to standT1:Release the thumb immediately ,rapid gush of blood from above downwards indicates SFIT2:Without releasing the thumb, slow filling of the LS is the seen,it is due to PI

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Poor prognosis- If the siraja grandhi is freely movable,painful

Incurable- Severe painful,arises from a marma sthana

Easily curable- Swelling is stable, Painless

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Dopler ultrasoundDuplex ultrasound imagingVenography

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Apatarpana

AlepaParisekha Abyanga SwedaVimlapanaUpanaha PachanaVisravana Snehana Vamana Virechana

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Ocassionally ,a Grandhi may subside with some or all of the poorva karmas only.The surgeon has to use yukti in selecting the above mentioned 12 purvakarmas and thus needed not do all the poorva karmas for each and every grandhi.The scientific basis of adopting medicinal treatment for a surgical case is that,A disease which looks like a local abnormality,will certainly have it’s general source of pathogenisis either through out the body or in an unconcerned remote base

Shalya vignyanam .Dr.Ramasundar raoShalya vignyanam..Dr.RajneeshSusrutha samhita(ancient indian surgery

Prof.G.D.Singhal)Manipal manual of surgery 3rd editonA consice text book of surgery.7TH

edition.S.DasRoss and wilson Anatomy and physiology

24THANK UTHANK U