Integrative Ayurvedic Approach in Recurrent Nāḍīvrana (Hidradenitis Suppurativa) Using Virechana, Jalaukāvacaraṇa and Kṣārasūtra: A Case Report

Abstract

Hidradenitis Suppurativa (HS) is a chronic, recurrent inflammatory disorder of apocrine gland-bearing areas characterized by painful nodules, abscesses, sinus tract formation, and scarring which can be crelate with Nāḍīvraṇa, in Ayurveda Conventional surgical and antibiotic therapy has a high recurrence rate, necessitating an integrative approach. A 37-year-old male presented with recurrent painful nodules and discharging sinus tracts involving both axillae and inguinal regions for 3 years. He had a history of bipolar disorder and type 2 diabetes mellitus under stable medication. Clinical examination confirmed multiple indurated swellings with interconnected sinus tracts consistent with Hidradenitis Suppurativa (Hurley Stage 3), which can co-related with sannipataja nadivrana Management included Kṣārasūtra application for controlled debridement and tract healing, Jalaukāvacaraṇa for reducing Rakta duṣṭi and inflammation, Virecana for systemic Doṣa Śodhana, along with internal medications such as Guggulu Tiktaka Kaṣāya, Triphala Guggulu, trayandyadi kasaya and Avipattikāra Cūrṇa. The treatment resulted in complete closure of sinus tracts, cessation of purulent discharge, significant reduction in pain and inflammation, and no recurrence during a 3-month follow-up period. This case demonstrates that an integrative Ayurvedic approach based on the principles of managing Nāḍīvrana, especially using jaloukavacharan Śodhana therapies and Kṣārasūtra, can effectively manage recurrent HS and prevent relapse. Further controlled studies are warranted.