Lymphoedema: Pathophysiology and management in resource-poor settings - relevance for lymphatic filariasis control programmes

Abstract

Low cost reduction of morbidity in lymphoedema is an essential goal in the management of lymphatic filariasis. This review emphasises the role of movement and elevation, and refers to the literature on the effects of these on the venous and lymphatic system. The patient with lymphoedema becomes increasingly immobile and the affected limb is often in a permanently dependent position causing venous hypertension and resultant overloading of the failing lymphatics. The evidence that breathing exercises are important for reducing venous hypertension and inducing lymphatic flow is discussed.The contribution of a damaged epidermis to lymphatic failure is emphasised. Loss of barrier function encourages penetration of bacteria and stimulates repair mechanisms that generate cytokines, which, in turn lead to inflammation. Management programmes that improve the health of the epidermis play a part in reducing lymphatic load.In taking morbidity management of lymphoedema into the general health services there are benefits in promoting skin hygiene and self-help regimes that can ameliorate many diseases along with lymphoedema.

Yoga for correction of lymphedema′s impairment of gait as an adjunct to lymphatic drainage: A pilot observational study

“…[ 15 ] Breathing (inhalation or exhalation) through the right nostril in suryabhedana stimulates the sympathetic nervous system. [ 16 17 ] Controlled diaphragmatic breathing as in Bhastrika , creates pressure differences in both abdomen and thoracic region and allow lymph to drain towards the thorax. The stroke of continued exhalation in Bhasthrika has maximum lymphatic clearance and at the same time forceful movements over the abdomen lead to peripheral drainage.…”

Integrative medicine selects best practice from public health and biomedicine

“…The article by Vaqas and Ryan[4] could not refer to any studies of breathing, because none exist in diseased humans. Those who oppose CAM would quickly find this to be a good reason for increasing their opposition.…”

“…It was necessary to take from Indian systems of medicine self-help from Yoga and Ayurvedic practice, the availability of herbals which reduced inflammation of the skin and in addition a system of heating the skin all of which combine to diminish elephantiasis. I hypothesized that[4] lymph flow would be encouraged by the breathing practices of Yoga which empty the great veins in the thorax. Stimulation of the nervous control of lymphatic contractility was another possible effect.…”

“…In this article, I will give a personal view based on experience, some of it in the Department of Dermatology in Oxford but recently with Saravu Narahari at the IAD in Kerala managing elephantiasis with a mixture of Yoga and Ayurvedic Medicine, taking those practices which can be integrated with allopathic physiology theory that Vaqas and Ryan[4] identified when advising the Global Alliance for the Elimination of Lymphatic Filariasis on morbidity control. At the IAD best practice for a severely disabling condition has astonished those who have struggled to control elephantiasis, not just because it is easy to see the change in the affected limb, but because careful measurement borrowed from allopathy has provided the evidence so much wanted to demonstrate in an evidence-based way that traditional therapy can be effective.…”

Collaboration culture in medicine

“…He hypothesized the combined use of locally available ancient systems such as ayurveda and yoga. [7] This led to the development a self-care integrative treatment for lymphatic filariasis, a disease affecting over 20 million poor in India. [89] In India, there is a decade of spending on CAM research by scientists, modern doctors; Golden triangle partnership (with science, ayurveda, and allopathy) schemes of government[4] and presence of multispecialty doctors and advanced centers for reverse pharmacology.”[10] (See ‘Evidence Based Integrative Dermatology’ in this issue page no.…”