According to various classical Siddha literature, the varicose ulcer is compared with the symptoms of Naalavibatha punn / Naalasurrutu punn / Naalaviruvu punn. Treat varicose ulcers by prescribing Siddha internal medicines and external therapies. On August 5, 2022, a 48-year-old female patient attended the OPD of Santhigiri Siddha Medical College and Hospital, Trivandrum, with the following complaints: dilatation of veins present in the right lower limb for 6 years; hyperpigmented lesion with itching and swelling above the medial malleolus of the right lower limb for 6 months; and an ulcer present above the medial malleolus for the last 3 months. She had a known case of varicose veins and had taken sclerotherapy three times but did not have satisfaction with the allopathic medication. The majority of the symptoms were significantly reduced in 60 days under the Siddha medications, such as a combination of Siddha preparation (Parangipattai Chooranam, Sangu Parpam, and Silasathu Parpam), Rasa gandhi mezhugu for internal, Padikara neer washing, wound dressing with Mathan thailam for external for 2 months, and attai vidal (leech application) done in 3 sittings in the gap of 10 days. No recurrence of any chronic varicose ulcer was observed during the 1 year of follow-up, and relevant preventive Siddha medication for Naalavibatha punn was given and advised the patient to do exercises that strengthen the legs and compression therapy. To summarize, the case report exhibited that Siddha leech therapy with both internal and external medications is very effective in the management of varicose ulcers.