Clinical Cases

Ischemic Leg Ulcer

Dr. J. Kathiravan shares a case of ischemic leg ulcer in a woman of 56. Fear of being along, desires sweets, sleeplessness and family history of diabetes led to a nosode as the simillimum.

Ischemic ulcers (wounds) can occur when there is poor blood flow in the legs. The overlying skin and tissues are then deprived of oxygen, killing these tissues and causing the area to form an open wound. Most ischemic ulcers occur on the feet and legs. Ischemic ulcers are characterized by a punched-out look, usually round in shape, with well-defined, even wound margins.

A number of risk factors may contribute to the development of an ischemic ulcer including the following comorbidities and conditions:

  • Diabetes mellitus
  • Foot deformity and callus formation resulting in focal areas of high pressure
  • Poor footwear that inadequately protects against high pressure and shear
  • Obesity
  • Absence of protective sensation due to peripheral neuropathy
  • Limited joint mobility


Chief Complaint:

A 56 years old female came with complaint ofulcer in the right leg since one month, with gradual onset of complaint. A round, painful, non-oozing ulcer was present over right leg near shin bone. She is known to have uncontrolled diabetes mellitus.

She is also having complaint of sleeplessness since 1 year. Continuous thoughts about her health makes her not to sleep.

Past History

Undergone appendicectomy at the age of 24 years. No other significant histories.

Family History:

          Father – 85 years old -known to have diabetes mellitus and hypertension.

          Mother – 78 years old – known to have diabetes mellitus

Physical Generals and Personal History:

Appetite –   Good

Thirst – 2-3 litres /day

Urine – Frequent. more at night. 3-4 times /night

Stool -1/ day, regular & satisfied

Sleep – Sleeplessness.

Dreams – not specific

Desire – sweets

Aversion – not specific

Perspiration – good

Thermal Relation – chilly patient

Menses – attained menopause at the age of 48 years.

Diet – mixed diet

Habit – 2 cup tea / day

Addiction – nil

Obstetric History:

She has one son and one daughter. Both were normal full term hospital deliveries. No history of puerperal complication or abortion.

Mental Generals:

Patient is worried about her health due to uncontrolled diabetes mellitus and leg ulcer. Fear of losing her legs if the ulcer is not cured. Always thinking of it (a physician threatened her like that). Soft in nature. Fears to be alone.

Vital sign: 

BP- 130/90

Pulse – 70/min

Temperature – afebrile at the time of examination

RR- 14/min

Investigation : 10-02-2021

FBS – 273 mg/dl

PPBS – 366 mg/dl

HbA1C – 8.2

Totality of symptoms:

  1. Worried about her health
  2. Continuously thinking about her complaints
  3. Fears to be alone
  4. Mild in nature
  5. Desire for sweets
  6. Sleeplessness
  7. Family history of diabetes mellitus

Repertorial Totality using synthesis:

Repertorial Result:

Carcinocinum – 7/7       

Phos 6/12   

Ars 5/10

Basis of Prescription:

Considering the repertorial totality and also with reference to Materia Medica, Carcinocinum in 1M potency wasselected.Bbeing a nosode it also covers the fundamental and dominant miasmatic states of the individual.

Prescription :

Carcinocin 1M – 1 dose st

BT 2-2-2  AF       * 2 weeks

Follow Up

23-02-21 Sleep better. Ulcer started to dry   Rx,   Placebo – 1 dose BT  2-2-2 *2weeks
11-03-21 Sleep better. Ulcer size reduced   Rx,   Placebo – 1 dose BT  2-2-2 *2weeks
25-03-21 Sleep is Good. Ulcer Completely healed Rx,   Placebo – 1 dose BT  2-2-2 *2weeks


Homeopathy is a safe option for treating skin diseases as it treats without any side-effects.

About the author

Jayaraman Kathiravan

Dr. J. Kathiravan BMHS, MD(Hom) is Assistant Professor – Department of Organon of Medicine and Homoeopathic Philosophy RVS Homoeopathy Medical College and Hospital, Coimbatore.

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