HOMOEOPATHIC THERAPEUTICS FOR VARICOSE VEINS

 

HOMOEOPATHIC THERAPEUTICS FOR VARICOSE VEINS 

Varicose veins

DEFINITION

•        They are dilated, tortuous, elongated veins in the leg.

•        There is reversal of blood flow through its faulty valves.

•         It is permanently elongated, dilated vein/veins with tortuous path causing pathological circulation.

RISK FACTORS

•        Heredity

•        female sex

•        occupation that demands prolonged standing

•        Immobility

•        raised intra-abdominal pressure like in sports

•        tight clothing

•        Pregnancy

•        raised progesterone level and altered estrogen-progesterone ratio

•        chronic constipation

•        high heels.

•        Prevalence of varicose veins is 35%

•        severe varicose veins is 10%

•        chronic venous insufficiency (CVI) is 8%

•        ulcer is 2%

CLASSIFICATION

Classification I

•        Long/great saphenous vein varicosity. 

•        Short/small saphenous vein varicosity.

•        Varicose veins due to perforator incompetence

Classification II

•        Thread veins (or dermal flares/telangiectasis/spider veins/Hypen veins are 0.5–1 mm in size):

•        Are small varices in the skin usually around ankle

•        which look like dilated, red or purple network of veins (Venulectasia)

•        Spider naevi/venous flares are common in females.

•        Reticular varices (1–3 mm in size)

•        Are slightly larger varices than thread veins located in subcutaneous/subdermal region.

•        Varicose veins

•        They are dilated, tortuous, elongated superficial veins located in the subcutaneous tissue (saphenous compartment)

•        equal or more than 3 mm in diameter measured in standing position.

•        Combination of any

       of the above

Classification III

•        classification of Lower Limb Varicose  Veins (2004)CEAP classification

•        C— clinical signs (grade 0–6);(A) for asymptomatic or (S) for symptomatic presentation

•        E— Etiological classification:

•        Congenital (Ec)

•        Primary (Ep)

•        Secondary (Es)

•        No venous etiology (En)

•        A— anatomic distribution:

•        Superficial (As)

•        Deep (Ad) or Perforator (Ap)

•        No venous location identified (An)

•        P— Pathophysiologic dysfunction:

•        Reflux (Pr)

•        Obstructive (Po)

•        Both or No pathophysiology identified (Pn)

GRADING CLINICAL SIGN

•        0—No visible or palpable signs of venous diseases

•        1—Telangiectases, reticular veins or malleolar flare

•        2—Varicose veins

•        3—Oedema without skin changes

•        4—Skin changes due to venous diseases like pigmentation, eczema or lipodermatosclerosis

•        4a—pigmentation

•        4b—lipodermatosis, atrophia blanche

•        5—Skin changes as above with healed ulceration

•        6—Skin changes as above with active ulceration

COMMON SITES

•        Lower limb

•        Pampiniform plexus of veins

•        Vulva, perineum

•        Sites of portosystemic anastomosis.

PRE-DISPOSING FACTORS

•        Age

•        Sex

•        Race

•        Obesity

•        Height

•        left > right

•        Occupation

•        family history

•        erect posture.

AETIOLOGY

•        common in lower limb

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because of erect posture & long column of blood has to be supported

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which can lead to weakness and incompetency of valves.

Primary varicosities due to:

•        Congenital incompetence or absence of valves. 

•        Weakness or wasting of muscles—defective connective tissue and smooth muscle in the venous wall.

•        Stretching of deep fascia.

•        Inheritance (family history) with FOXC2 gene. 

•        Klippel-Trenaunay syndrome

•        Avalvulia

•        Parkes-Weber syndrome.

•        Here varices are of atypical distribution. 

Secondary varicosities: 

•        Recurrent thrombophlebitis

•        Occupational—standing for long hours (traffic police, guards, sportsman)

•        Obstruction to venous return like abdominal tumour, retroperitoneal fibrosis, lymphadenopathy, ascites. 

•        Pregnancy (due to progesterone hormone)

•        Obesity

•        chronic constipation

•        AV malformations—congenital or acquired.  

•        Iliac vein thrombosis.

•        Tricuspid valve incompetence

PATHOGENESIS

•        Fibrin cuff theory

•        White cell trapping theory. Incompetence leads to stasis of blood

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Chronic amubulatory venous Hypertension

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Defective micro circulations

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RBC diffuses in to tissue

places- lysis of RBC

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Release of Haemosiderin

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release proteolytic enzymes which cause cell destruction and ulceration

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White cell trapping theory.

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Fibrin deposition, tissue death, scarring occurs together, called as

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Lipodermatosclerosis

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Secondary valvular failure

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venous reflux

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venous wall dilatation

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Effects

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Weakening of the venous endothelial wall and valves occur due to raised venous wall tension Venous system in the lower limb is maintained by—

•        (1) Valvular competence

•        (2) Venous patency

•         (3) Calf muscle pump which is venous channel/plexus within the soleus muscle

•        Chronic venous insufficiency (CVI) is a syndrome resulting from continuous chronic venous hypertension/ambulatory venous hypertension

•        Varicose vein is a condition of progressive deterioration even often with interventions

CLINICAL FEATURES

•        Dragging pain

•        postural discomfort

•        Heaviness in the legs 

•        Night time cramps—usually late night

•        Oedema feet, itching (feature of CVI)

•        Discolouration/ulceration in the feet/painful walk

•        It is more common in females (10 : 1)

•        Often it is familial.

•        Familial varicose veins begin in younger age group, seen bilaterally, involves all veins including deep veins.

SIGNS

•        Visible dilated veins in the leg with pain

•        Distress

•        nocturnal cramps

•        feeling of heaviness

•         pruritus.

•        Pedal oedema

•        Pigmentation

•        Dermatitis

•        Ulceration

•        Tenderness

•        restricted ankle joint movement.

•        Bleeding, thickening of tibia occurs due to periostitis.

•        Positive cough impulse at the saphenofemoral junction. 

•        Saphena varix—a large varicosity in the groin, which becomes visible and prominent on coughing.

SIGNS-TEST

Brodie-Trendelenburg test:

•        Vein is emptied by elevating the limb

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and a tourniquet is tied

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just below the saphenofemoral junction (or using thumb, saphenofemoral junction is occluded).

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Patient is asked to stand

quickly.

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When tourniquet or thumb is released

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rapid filling from above signifies saphenoemoral incompetence. This is Trendelenburg test I.

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In Trendelenburg test II, after standing tourniquet is not released

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Filling of blood from

below upwards rapidly

can be observed within 30–60 seconds

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It signifies perforator incompetence

Perthe’s test

•        The affected lower limb is wrapped with elastic bandage

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and the patient is asked to walk around and exercise

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Development of severe cramp like pain in the calf

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signifies DVT.

 

Modified Perthe’s test:

•        Tourniquet is tied just below the saphenofemoral junction

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without emptying the vein.

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Is allowed to have a brisk walk

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which precipitates bursting pain in the calf and

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also makes superficial veins more prominent.

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It signifies DVT

Three tourniquet test

•        To find out the site of incompetent perforator

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three tourniquets are tied after emptying the vein.

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At saphenofemoral junction.  Above knee level.  Another below knee level.

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Patient is asked to stand and looked for filling of veins and site of filling

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Then tourniquets are released from below upwards

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again to see for incompetent perforators

Schwartz test

•        In standing position

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when lower part of the long saphenous vein in leg is tapped

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impulse is felt at the saphenous junction

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or at the upper end of the visible partof the vein.

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It signifies continuous column of blood due to valvular incompetence

Pratt’s test

•        Esmarch bandage is applied to the leg

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from below upwards followed by a tourniquet at saphenofemoral junction

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After that the bandage is released

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keeping the tourniquet in the same position to see the “blow outs” as perforators.

Fegan’s test

•        On standing

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the site where the perforators enter the deep fascia bulges

and this is marked

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Then on lying down, button like depression (crescent like)

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in the deep fascia is felt at the marked out points

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which confirms the perforator site.

Morrissey’s cough impulse test:

•        The varicose veins are emptied.

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The leg is elevated and then the patient is asked to cough.

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If there is saphenofemoral incompetence, expansile impulse is felt at saphenous opening

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It is a venous thrill due to vibration caused by turbulent backflow. .

INVESTIGATION

•        Venous Doppler

•        Duplex scan

•        Ultrasound abdomen

•        peripheral smear

•        platelet count

•        other relevant investigations are done depending on the cause of the varicose vein

•        Plain X-ray of the part is taken to look for periostitis

TREATMENT

Conservative treatment: 

•        Elastic crepe bandage application from below upwards or use of pressure stockings to the limb—pressure gradiant of 30–40 mmHg is provided.

Elevation of the limb

•        relieves oedema.

•        Two short times, during day and full night

•        elevation of foot with feet above the level of heart and toes

•        above the level of nose is the method

Unna boots

•        provide nonelastic compression therapy.

•        It comprises a gauze compression dressings that contain zinc oxide, calamine, and glycerine that helps to prevent further skin break down.

•        It is changed once a week.  Pneumatic compression method .

•        Drugs used for varicose veins:  Calcium dobesilate—500 mg BD.

Injection—sclerotherapy:  Fegan’s technique:

•        By injecting sclerosants into the vein, complete sclerosis of the venous walls can be achieved.

Indications –

•        Uncomplicated perforator incompetence.

•        In the management of smaller varices—reticular veins, thread veins (telangiectasis).

•        Recurrent varices.

•        Isolated varicosities.

•        Aged/unfit patients

•        Sclerosants used are:

•        Sodium tetradecyl sulphate 3% (STDS)—commonly used

•        Sodium morrhuate

•         Ethanolamine oleate 

•        Polidocanol—3% or 1%

Mechanisms of action

•        Causes aseptic inflammation

•        Causes perivenous fibrosis leading to block

•        Causes approximation of intima leading to obliteration by endothelial damage

•        Alters intravascular pH/osmolality

•        Changes surface tension of plasma membrane

Contraindications for sclerotherapy

•        Saphenofemoral incompetence

•        Deep venous thrombosis

•        Huge varicosities—may precipitate DVT

•         Peripheral arterial diseases

•        Hypersensitivity/immobility

•         Venous ulcer—relative contraindication

Advantages of sclerotherapy

•        It can be done as an outpatient procedure.  

•        It does not require anaesthesia.

Disadvantages of sclerotherapy 

•        Inadvertent subcutaneous injection can cause skin necrosis or abscess formation. 

•        Anaphylaxis

•        vasovagal shock

•        Allergy

•        Hyperpigmentation.

Surgery

•        Trendelenburg operation

•        Stripping of vein 

Image

Homoeopathic Treatment

      Remedy alone will not aid in Cure. Along with that good Diet & Regimen is also essential . Homoeopathic choice of remedy must be based on the Totality of symptoms (The Outward manifestation of Internally deranged Vital Force) obtained from the patient & the dose must be based on the susceptibility of the patient.

Some of the homoeopathic remedy for varicose veins include,

1.Hamamelis virginiana

2.Pulsatilla

3.Calcarea fluoricum

4.Calcareum iodatum

5 Graphitis

6.Cardius marinus

7.Flouricum acidum

8.Millefolium achillea

9.vipera

 10.zicum mettalicum

Hamamelis virginiana

characteristic particulars

·       Hamamelis Virginiana is a highly effective remedy for varicose veins.

·       Its most prominent symptom indication is tiredness or aching in the legs.

·       Along with this, a tense feeling in the legs may be present.

·       The varicosities may look like hard and knotty swellings in the legs.

·       A dragging sensation in the legs may be present.

·        Pain in varicose veins from the slightest motion is another feature.

·       Soreness of varicose veins may also arise. Hamamelis Virginiana can help to reduce the engorgement of blood in veins and its related symptoms.

·       Deep-rooted, circular ulcers with stinging, pricking pain and high sensitivity are another prominent features for using the homeopathic medicine Hamamelis Virginiana.

·       Key Indications for using Hamamelis Virginiana for Varicose Veins,Tiredness or aching in the legs.

·       A tense feeling in the legs,Varicose ulcers with stinging and pricking pain.

Pulsatilla Nigricans

characteristic particulars

·      Pulsatilla Nigricans is an excellent remedy for varicose veins that are painful.

·      Heaviness or weariness in the legs along with pain, a tensed and drawing sensation in the legs, cramping in the legs (mostly in the evening) are the symptoms highly indicative of Pulsatilla Nigricans.

·      Hanging down the lower limbs worsens the complaints. Along with these symptoms, restlessness in the lower limbs may also appear.

·      Pulsatilla Nigricans is indicated for varicose veins in women when the symptoms worsen during menses and for varicose veins on lower limbs, forearms, and hands.

·      Key Indications for using Pulsatilla for Varicose Veins,Presence of painful varicose veins.

·      A tensed and drawing sensation in the legs.

·      A cramping sensation in the legs.

Modalities

·      < - from heat, rich fat food, after eating, towards evening, warm room, lying on left or on painless side when allowing feet to hang down. 

·      > - open air, motion, cold applications, cold food and drinks, though not thirsty.

Calcarea flouricum

characteristic particulars

·      Calcarea Fluor is a highly recommended remedy for varicose veins.

·      It is a biochemic medicine for varicose veins that work wonderfully in reducing the engorgement of blood in veins and improving blood circulation.

·      Few indications for using Calcarea Fluor are enlarged veins, hardened veins, knotty veins on lower limbs.

·      The attending features are dry, cracked skin on the legs.

·      Key Indications for using Calcarea Fluor for Varicose Veins Presence of hard varicose veins.

·      Presence of knotty varicose veins.

·      Dry, cracked skin on the legs.

Modalities

·      < - during rest, changes of weather. 

·      > -  heat, warm applications.

Calcarea iodatum

Characteristic particulars

·      It is also an best medicine for varicose veins

·      Itching in various parts, disappearing and reappearing in other parts, only  after much scratching.

Graphitis

Characteristic particulars

·      Graphites Naturalis is a highly recommended remedy for varicose veins attended with itching.

·      Itching in most cases gets worse at night time.

·      Little pimples may be present on the surrounding skin surface (affected by varicose veins).

·      Skin dryness may also be there to a high degree.

·      Other attending features are restlessness, heaviness, and tensed feeling in legs.

·      The tensed feeling gets worse upon extending the legs.

·      A congested feeling in legs and feet on standing may also be present.

·      Graphites Naturalis is also a helpful remedy for swelling in the legs with peculiar shooting pain as well as for varicose eczema.

Modalities

·      < -  warmth, at night, during and after menstruation. 

·      > -  in the dark, from wrapping up.

Cardius marinus

Characteristic particulars

·      It is a good medicine for varicose veins as well as for varicose ulcers

·      It is given in case of veins are dilated & tortourous and even cause complications such as Varicose ulcers.

·      Itching on lying down at night.

Fluoric acidum

characteristic particulars

·      Fluoric Acid is a valuable remedy for varicose veins treatment.

·      The most characteristic feature to use Fluoric Acid is painful varicose veins in the legs that are made worse by warmth.

·      Fluoric Acid is used to treat long-standing, obstinate cases of varicose veins.

·      Apart from the above symptoms, Fluoric Acid is useful for varicose ulcers with red margins.

·      Pain in ulcers is intense, and warmth worsens the pain while cold application relieves the pain.

Modalities

·      < - warmth, morning, warm drinks. 

·      > -  cold while walking.

Millefoilum achillea

characteristic particulars

·      Millefolium Achillea is an effective remedy for varicose veins arising during pregnancy.

·      It works well in cases of both painful and painless varicose veins.

·      A drawing pain is most prominently present in the legs.

·      Millefolium Achillea is also suitable for varicose veins that break and bleed easily.

Modalities

·      < - at menstrual period, from touch, between 5 to 7 pm; after dinner, from wine. 

·      > -  while eating, discharges, and appearance of eruptions.

Vipera berus

characteristic particulars

·      Vipera Berus is a well-indicated remedy for varicose veins with a marked ‘bursting’ feeling in the legs.

·      A pain of unbearable nature that gets worse on hanging down the legs is present.

·      Elevating the legs brings relief.

·      Severe cramping pain in the legs is also present.

·      Swollen, tender veins and blueness of overlying skin are highly indicative of using medicine Vipera Berus.

Modalities

·      < - warmth, morning, warm drinks. 

·      > - cold while walking.

Zincum metallicum

Characteristic particulars

·      Zincum Met is an effective medicine for large varicose veins on the legs.

·      A tight, full, congested feeling in the legs is prominent.

·       Tearing pain in the legs and formication (sensation like insects crawling over the skin) are also present in a few cases.

·      The person requiring  Zincum Met also complains of uneasiness and heaviness in the legs with constant motion of the legs.

·      Burning sensation and sweat on lower limbs are also common.

·      Apart from varicose of legs, Zincum Met is also indicated for varicose veins in the genital organs.

Modalities

·      < - warmth, morning, warm drinks.

·      > - cold while walking.

DIET & REGIMEN

1.    Varicose veins are common , for those who are obese &  have long- standing occupation like Teachers , Traffic police , Sales man , Photographers , Air hostess , Chefs etc., It would be better when they follow exercise in order to prevent varicose veins & maintain a healthy life.

2.    Hormonal factors such as Pregnancy, Menopause , & Use of the birth control pills  results in Varicose veins

3.    Varicose Veins are common in the first 3 months of pregnancy . Due to an increase in Hormonal levels during pregnancy , the blood volume increases which causes the veins to enlarge . Also the growing Uterus puts pressure on the veins

4.    Some of the Exercise include lifting your legs/elevating your legs , & Rocking feet ( rest your weight on the ball of your feet for a few seconds , then lower the heel) – all these aids in better circulation

5.    Eat Fiber rich food , which prevents portal venous congestion

6.    Have a Healthy Diet rich in Anti-oxidants – that prevents inflammation