Varicose vein syndrome comprises varicose veins of lower limbs, epidermal dermatitis, and varicose calf ulcers. Mostly due to the local blood circulation disorder, it usually occurs in the lower leg, often unilateral.
What causes varicose veins in lower limbs?
Modern medicine
Lower limb varicose veins are related to genetic factors. The incidence rate of long-term standing or heavy manual labor is higher and is also related to sex hormones, age, obesity, etc.
Any condition that increases the internal pressure of the iliac vein, such as pregnancy, large abdominal or pelvic tumors, can be caused.
Venous hypertension can lead to venous dilatation, valve regurgitation, valve dysfunction, and venous wall changes. Capillary hypertension caused by venous hypertension can lead to capillary leakage and tissue edema.
All these injuries can cause inflammatory reactions, which play an important role in the occurrence and development of venous lesions, ultimately leading to skin changes and venous ulcers.
Traditional Chinese Medicine
TCM believes that varicose veins of lower limbs are the syndrome of dampness-heat evil. Due to the dampness and heat, the meridians are blocked, the Qi and blood are congested, the skin loses its nourishment, and the skin will fester and break into sores over time.
Clinical manifestations of varicose veins of lower extremities
Edema of the calf and ankle, local congestion, and exudation of red blood cells cause pigmentation of the calf, which becomes light brown or dark brown. Eczema-like changes occur locally, with itching, scaling, and hypertrophy, followed by lichen-like changes, and sometimes it can be manifested as acute eczema-like changes. It is called stasis dermatitis.
Minor trauma is easy to cause ulcers that are difficult to heal, which are called varicose ulcers. Most of these ulcers occur in the lower third of the calf, especially on the inner side and the ulcer area varies in size.
There are dark red and purple red granulation tissue on the surface of the ulcers, which is covered with thick smelly liquid. The pain tends to be mild. Eczema-like changes may occur around the ulcer.
Diagnostic basis of varicose veins of lower limbs
The varicose veins of lower extremities have significant varicose veins, mostly in the lower extremities, with local eczema-like changes such as hyperpigmentation and hypertrophy or chronic ulcers.
Differential diagnosis of varicose veins of lower extremities
Thromboangiitis obliterans
It mainly occurs in the lower limb, especially the left lower limb, and occasionally in the upper limb. Intermittent limb pain and walking difficulty, aggravated during activity, decreased or disappeared pulse of dorsalis pedis artery, gangrene, positive compression test, and limb position test can help diagnose.
Hard erythema
It is commonly found in young women and is often complicated with tuberculosis in other body parts. The tuberculin test was positive, but few tuberculosis bacilli were isolated from the skin lesions.
In the beginning, several subcutaneous nodules about the size of peas occur symmetrically in the lower part of the leg. After a few weeks, the nodules gradually increase, and the skin is slightly elevated, dark red, with obvious infiltration, unclear boundaries, and fixed and hard.
How to treat varicose veins of lower limbs
TCM treatment
1) Dialectical governance
Syndrome of excessive dampness and heat
Main symptoms:
- the affected limb is swollen,
- the ulcer surface is covered with yellow secretion,
- the granulation is purple and dark
- the surrounding skin is slightly red;
- The tongue is reddish,
- the fur is white or yellow
Treatment: clearing away heat and detoxifying, removing dampness, and unblocking collaterals.
Prescriptions: dandelion, forsythia, honeysuckle, red adzuki bean, Phellodendron, the root of Fangji, achyranthes bidentata, red peony root, Angelica tail.(蒲公英、连翘、忍冬藤、赤小豆、黄柏、防己、牛膝、赤芍、归尾)
Addition and subtraction:
For obvious pain, add Chuanzizi (川楝子)and Yuanhu(元胡);
For local purplish dark congestion, obviously with blood; Add Spatholobus Stem(鸡血藤), FLOS CARTHAMI (红花).
if the skin does not fall off, add Salvia miltiorrhiza(丹参), fried Pangolin(炒山甲), and Chinese Honeylocust Spin(皂刺);
For those with more secretions, add Alisma(泽泻) and Hoelen(云苓).
Qi and Blood Deficiency Syndrome
Main symptoms:
- the patient is swollen,
- the sore surface is not fresh,
- the granulation is grayish-white,
- the limbs are cool;
- The tongue is pale or has ecchymosis,
- the fur is thin and white,
- the pulse is thin and weak.
Treatment: invigorate qi and blood, promote blood circulation and dredge collaterals.
Prescriptions: Codonopsis pilosula, Atractylodes macrocephala, Poria cocos, Alisma orientalis, White mustard seed, dried ginger, Achyranthes bidentata, papaya, Fangji, Cinnamomum cassia, Caulis spatholobi.(党参、白术、茯苓、泽泻、白芥子、干姜、牛膝、木瓜、防己、桂枝、鸡血藤)
Add or subtract:
add astragalus membranaceus(黄氏), yam(怀山药), and lentil(扁豆) if the lower limb edema is obvious;
add cinnamon(肉桂) If the granulation is dark and the color around the sores is not white,
2) Chinese patent medicine
- Forsythia Antidote Pill(连翘败毒丸)
- Rhubarb Insect Pill (大黄蛰虫丸)
- Shenling Baizhu Pill(参苓白术丸)
- Bazhen pill(八珍丸)
2. External treatment
1) Early stage: fresh purslane or Chinese cabbage is pounded and mixed as powders for external use.
2) Chronic ulcer: Detoxifying powder, purple Juchuang ointment (紫色疽疮膏)for external use.
3) The sore surface is not closed for a long time, and the granulation is dull: use a three-edged needle to prick the area around the sore mouth (to the extent of bleeding), sprinkle amber powder, and apply purple Juchuang ointment (紫色疽疮膏) externally.
Modern medicine treatment
General therapy
Avoid standing for a long time, and lift the affected limb to rest during sleep and sitting to reduce congestion and pain. Patients with ulcers should stay in bed.
Using elastic bandages or wearing elastic stockings can promote venous reflux. A diet rich in protein and vitamin C will help heal ulcers.
Systemic therapy
Large doses of vitamin E and vitamin P can promote ulcer healing. If the plasma zinc concentration decreases, zinc sulfate or zinc gluconate should be given to accelerate ulcer healing.
Patients with bacterial infections should be given adequate antibiotic treatment. Thrombosis is a common cause of venous insufficiency, so anticoagulants can be used to treat it.
Local therapy
In case of exudation and swelling in patients with varicose ulcers, dilute Burrow solution can be used as cold wet compress.
Antibiotic solutions can be used locally, such as 0.1% neomycin solution, 1% resorcinol solution, or 1:5000 nitrofurazone solution.
Antibiotic ointment and sponge rubber can also be used to compress, and then an elastic bandage can be used, or a sterile gauze bandage can be used to bind from the foot to the knee, and it can be replaced every 1-2 days.
Physical Therapy
Ulcer wounds can be treated with ultraviolet rays, ammonia neon laser, or low-dose X-ray irradiation to promote healing.
Acupuncture and moxibustion treatment of varicose veins of lower limbs
[Therapeutic principles] It can dispel evils and congestion, dredge tendons and remove knots.
[Total prescription] Dazhui(大椎), Zhiyang(至阳), Mingmen(命门), Zhongwan(中脘), Shenque(神阙), Guanyuan(关元), Taiyuan(太渊), acupuncture or cupping.
Method 1:
[Taking the main acupoint] Ashi acupoint, Fuliu(复溜).
[Points matching]:
those with blood dryness and fire are added to the Shu（膈俞）, Blood Sea（血海） and Xingjian(行间);
Those with cold coagulation and blood stasis are added with Shenshu（肾俞）, Guanyuan（关元）, and Sanyinjiao（三阴交）.
[Ashi point] It is at the place where the green tendons are flexed or coiled into a mass.
[Treatment] The skin is routinely disinfected, and the main point is quickly pricked with a needle. Go along the flexion and prick a needle every 1-cun; if the veins are coiled into a group, 2 to 4 needles according to their size.
After the needle, dark brown congestion can flow out without stopping bleeding; let it stop bleeding by itself. If there is too much blood or the patient feels uncomfortable and sweats out, the patient can stop bleeding by pressing the hole of the needle. The matching acupoints were pricked with cupped for bleeding. Treating once every one week or so and five times is a course of treatment.
[Note] Traditional Chinese medicine believes that the disease is caused by disharmony of qi and blood and drooping of blood vessels. It has a good effect on acupuncture, removing congestion and dredging channels to relieve pain.
However, due to the poor blood circulation of the lower limbs and low resistance to disease, it is easy to be infected and difficult to heal after infection. During the treatment, strict disinfection should be carried out, and postoperative protection should be paid attention to prevent infection. At the same time, postoperative recuperation should be done well.
Method 2:
[Point selection] Zusanli（足三里）, Jiexi（解溪）, Sanyinjiao （三阴交）Yinlingquan（阴陵泉）, Ashi (varicose vein part).
[Treatment] The patient leans upright and puts his weight on the affected limb to fill varicose veins; The doctor fixed the affected limb with his left hand, held the needle with his right hand, and used his wrist to form a hitting force.
First, Go along the stomach meridian from Zusanli(足三里) to Jiexi（解溪）, and then go along the spleen meridian from Sanyin（三阴交） to Yinling Spring(阴陵泉) at a speed of 3-5 times.
Then, the doctor fixed the pressure on the top of the varicose vein mass (near the heart) with his left thumb, starting from the far end of the varicose vein, stabbing vertically, gradually reaching the near end, that is, to the local uplift of the varicose vein mass, the blue earthworm like varicose mass disappeared, and there was a temperature rise (local redness or hand touch fever). Treat once every 15 days. Three times is a course of treatment.
[Note]Before the operation of this method, a deep venous reflux test shall be conducted, and those with good reflux can be treated.
Treatment of varicose veins with a leg ulcer.
[Main point selection] Local Ashi point and Weizhong point（委中）.
[Matching points]: Jiexi(解溪), Sanyinjiao（三阴交）, Rangu（然谷）.
[Therapy] Puncture and cupping for bleeding.
Physical therapy equipment treatment
High-frequency electroacupuncture
Point selection
Main point: Ashi’s point
Ashi point: varicose site.
Method：
The patient lies flat, local routine disinfection and anesthesia with 0.25% ～ 1.25% procaine. Adjust the high-frequency electroacupuncture, and use the electroacupuncture to prick the varicose vein with a needle distance of about 1mm.
Make the needle penetrate the anterior wall of the blood vessel and reach the posterior wall without injuring healthy tissues. The depth of the needle should be the same. The needle usually stays in the blood vessel for 3 to 5 seconds.
If there is bleeding after the needle is pulled out, spark discharge will occur when the electric needle is about 1mm away from the skin, which cauterizes the skin to stop bleeding and prevent infection.
The way of discharging is to move the electroacupuncture horizontally and then vertically to weave the wound into a bottom shape so that no or only slight scar can be left. The varicose veins with long varicose parts can be treated by segment pricking;
For the nodule or mass part, first, prick around the nodule, then prick at the center. After treatment, the wound must be bandaged.
Applied once a day for six days as a course of treatment, with an interval of 2 days.
This method should be checked before the operation to ensure that there is no deep and shallow venous obstruction and thrombosis, but only superficial varicose veins. It can not be used for cardiovascular and cerebrovascular, or hemophilia patients.
Comprehensive method
Point selection
Main point: Ashi point.
Method:
It adopts He Puren’s three-way method, which is a combination of micro method (filiform needle), warm method (fire needle), and strong method (pricking and bleeding).
During the treatment, the method of warming and strong method was first used. The varicose part was taken as Ashi point, and the front and middle segments of the tungsten manganese alloy fire needle with a diameter of 0.5mm and a length of 5cm were burned red, aligned with the point, and the varicose vein was punctured quickly;
For those with severe varicose veins, use a tourniquet to tie the upper part of the varicose veins, use a fire needle to prick and bleed, and then release the tourniquet and let the blood flow naturally without pressing with a dry cotton ball.
After the bleeding stops, wipe the pinhole with a dry cotton ball. Afterwards, the micro-penetration method is used to puncture the xuehai(血海) acupoints with needles. After the needle is inserted, twist it or level it to make up and level it. After getting Qi, retain the needle for 20 minutes.
In each treatment, the three methods are used together twice a week, four times as a course of treatment, and the effect is observed after one course of treatment.
Instruct the patient to keep the local clean and do not bathe within 24 hours after the acupuncture to avoid infection. After treatment, the patient can wear elastic nylon stockings or elastic ribbons to make the varicose veins in a shrunken state.
Fire needle plus moxibustion
Point selection
Main point: Ashi point.
Ashi point location: varicose veins and surrounding ulcer tissues.
Method:
After the wound surface and surrounding skin are routinely disinfected, burn the 0.5 mm diameter and 5 cm long fire needle on the alcohol lamp, aim it at the varicose part, and then prick it to bleed so that the blood will flow out naturally.
Use cotton balls to gently compress the blood vessels around the needle hole to prevent local subcutaneous congestion. At the same time, gently prick the tissues around the ulcer with a fire needle at an interval of about 1cm to release a small amount of interstitial fluid.
After the needle is finished, wipe it with a sterilized dry cotton ball, place the moxa stick at the affected area, and moxibustion for 10 to 15 minutes at a distance of about 2 to 3 cm from the skin.
It is appropriate to have a local feeling of warmth without burning pain. The above method was performed once a week for four times as a course of treatment.
Conclusion:
Varicose veins of lower extremities refer to a disease characterized by vein bulge, expansion, bending, or snaking due to obstruction of blood flow of superficial veins of the lower extremities.
It usually occurs in women who are engaged in standing work, manual labor, or pregnant women.
In the early stage, there were few symptoms. A few patients suffered from lower limb soreness after more walking. Later, the veins could curl up due to venous congestion. Traditional Chinese medicine believed that the cause of the disease was mainly due to standing for a long time with heavy load, exhaustion of Qi and blood, depression of qi, and retention of collaterals due to congestion.
The above methods for treating varicose veins are for research reference only. Non-professionals should not try them. If you have mild varicose veins, you can try using creams to see if they can relieve symptoms.
