INTRODUCTION:

Varicose veins are the clinical class of chronic venous illness, according to the CEAP (Clinical, Etiological, Anatomical and Pathological Elements)^1,2. More than 33 percent of adults suffer from the prevalent venous disease of the lower extremities, varicose veins. Extended or widened, twisted, and enlarged veins are called varicose veins³. These days, varicose veins are a frequent ailment. This is primarily a disorder of lifestyle. Lower limbs are a common site of varicosity⁴. One-way valves found in veins guarantee that blood flows correctly in the direction of the heart.

When these valves fail to work properly, blood can flow backward through the veins, which increases pressure when standing⁵. The veins enlarge as a result of the increased pressure, making it difficult for them to close correctly. These veins subsequently carry blood back into the leg, where varicose veins grow⁶. Prolonged standing and elevated abdominal pressure, such as during pregnancy or abdominal tumours, are risk factors for varicose veins. Additionally, varicose veins in an obese person may be subtle, whereas typical superficial veins in a thin person may appear massive^7,8. The spermatic cord's varicose vein mass is known as a varicocele. Varicoceles are aberrant dilations of the flexuous, involute, mazy, sinuous, snaky, vermiculate, zigzag veins of the convoluted venous plexus that are connected to the ovarian or spermatic veins that drain the testis. Varicocele is a condition that can be felt when examining the spermatic cord. Varicose vein is not recognized as a distinct disease in Ayurvedic literature; instead, it is referred to as Sira Vikriti, or venous disorder and named Kutilsira or Sirakautilya. It is caused by an intensified Vata dosha and is associated to Sira granthi (Granthi meaning protruding nodule-like structure and Sira meaning Vein). Vein ramification can be caused by abrupt changes in temperature, vitiation of the Vata and Pitta doshas, and Rakta dhatu (blood tissue), according to Ayurveda.⁹

Types of varicose vein:

Fig. No. 1: Types of varicose vein

Table No. 1: Types of varicose veins

Sr. No.	Types of varicose vein
1	Truncal varicose vein
2	Varicosities of extremities
3	Reticular varicose veins
4	Side branch varicose vein
5	Telangiectasia varicose vein
6	Spider vein

Sign and symptoms of varicose veins:

· Easily tired legs.

· Heaviness in the affected area

· Swelling in the affected area

· Darkening of the skin

· Numbness in the legs or scrotum

· Itching or irritating rash in the legs or scrotum

· Burning sensations.

· Night cramps.

· Bulging, rope-like, bluish veins indicate superficial varicose veins.

Risk factors:^10,11

Chances of getting varicocele and varicose veins might be raised by certain risk factors, such as:

· Gender: Varicose veins are more common in women than in men. According to research, this could be because of high level of estrogen.

· Age: In the older person there is high risk of varicose vein due to veins start losing their elasticity.

· Being overweight: Excessive weight increases the pressure in veins, it is responsible for the difficulty in the circulation of blood to heart. This may result in more pressure on the valves, increasing the swollen legs

· Occupation: There is high risk of varicose veins when the long period of blood flow is slowly in legs.

· Pregnancy: In Pregnancy the womb starts growing as the womb expands it create pressure on vein in pelvic area this may sometimes lead to cause varicose veins.

Pathophysiology:

The superficial veinscontinuously elevated blood pressure is the cause of varicose veins. Blood flow is generally prevented from going backward through a one-way bicuspid valve system that gates veins. Varicose veins are primarily caused by venous hypertension, venous valvular incompetence, structural modifications in the vein wall, inflammation, and changes in shear stress. Reflux resulting from venous valve incompetence, venous outflow obstruction, or calf-muscle pump failure is the cause of venous hypertension. Superficial and Deep veins are the two subsystems of the limb venous system that are separated by fascia. Perforating veins that passthrough fascia connect these two venous systems sporadically. The deep veins are a system of high-pressure veins that are kept from abnormally dilatation by deep fascia and muscle. The muscles that round the deep veins also aid in the blood's pumping action towards the heart. The perforating collateral veins allow blood from superficial veins to enter deep veins through one-way valves and the negative pressure created by deep veins emptying.^12,13,14

Herbal treatment for varicose veins:

Now a days, herbs are used to treatment so many chronic and acute conditions and problems such as cardiovascular disease, prostate problems, depression, inflammation, and to boost the immune system. From the past to still now plants are used as a source of medicine. By using different processes and methods herbs and plants can be taken in different way and in different forms. They include the whole herb, teas, syrup, essential oils, ointments, salves, rubs, capsules, and tablets that contain a ground or powdered form of a raw herb or its dried extract.¹⁵ The herbs or plants have less side effects or adverse effects as compare to synthetic drugs.

Garlic: Scientific name- Allium sativum Family- Amaryllidaceae Garlic is very useful and effective medicine in many diseases. It has so many health benefits. The chemical constituents of garlic are allicin, allin, ajoene, dailypolysulfides, S-ally cysteine, saponins, glycosides, amino acids, vitamins and minerals. It is used as a antioxidant, anti-inflammatory, blood thinner. It's anti-inflammatory characteristic it is use to reduce the inflammation in varicose veins. It also helps break up harmful toxins in the blood vessels and improve circulation. It has protein breakdown property so the protein is distributed in whole body and hence increases the supply of protein in lower limb. It is naturally used as a blood thinner. It helps to relieve stress on veins and throughout the body.¹⁶

Amla: Scientific name-Emblica officianalis Family- Phyllanthaceae The Amla plant, also referred to as the Indian gooseberry, is a significant Ayurvedic medication with a plethora of health advantages. Because it is high in calcium, iron, and vitamin C, it has strong antioxidant or free radical scavenging properties that protect skin. This aids in the prevention of potential infections and ulcers. Additionally, it is possible to treat the issues linked to high blood pressure by controlling it. By recycling the sugar moieties, the low molecular weight hydrolysable tannins provide defence against the damaging effects of free radicals. Amla's activity is reliant on its chemical components, including pedunculagin, punigluconin, and emblicanin A and B. Because of the high ascorbic acid content, it is also claimed to have anti-inflammatory properties. Vitamin C contributes to the improvement of capillary fragility. In this approach, taking Amla in addition to a regular diet mayhelp alleviate varicose veins and their symptoms.¹⁷

Parsley: Scientific name- Petroselinum crispum Family- ApiaceaeParsley is rich in vitamin C, a powerful antioxidant that encourages the production of collagen and aids in cell repair and reproduction. It also contains rutin, which plays a key role in strengthening the capillaries and hence is very useful in reducing symptoms of varicose veins.¹⁸

Turmeric: Scientific name- Curcuma longa Family- Zingiberaceae The chemical constituents of turmeric are curcuminoids, curcumin III, curcumin II and dihydrocurcumin, volatile oils such as limonene, terpinene, terpinolene, caryophyllene, linalool, isoborneol, β-curcumin. It shows the action such as anti-inflammatory, antiarthritic, antibacterial, hypotensive, anti-atherosclerotic, choleretic, lowers cholesterol, stimulates digestive enzymes, carminative, hepatoprotective, vulnerary, anticoagulant. Used for flatulence, jaundice, menstrual difficulties, gallstones, haemorrhage, toothache, bruises, colic, arthritis, sprains, wounds, anticancer agent. It's anti-inflammatory action it may be useful in varicose veins. It also have anticoagulant property it helps to prevent the coagulation of blood in the veins.¹⁹

Manjistha: Scientific Name-Rubia cordifolia Family– Rubiaceae The Manjistha is also known as Indian Madder. The manjistha contains quinones, iridoids, oleananes, triterpenoid, bicyclic hexapeptides and anthraquinones. It having anti-inflammatory property which help to lower the swelling and pain in the lower legs. This herb balances the pitta dosh. It also improves the blood circulation in injured vein. Improvement in blood circulation it increases the blood supply to the veins and in this way this manjistha may be effective for treatment of varicose veins.²⁰

Cayenne Pepper: Scientific Name- Capsicum annuum Family-SolanaceaeCapsaicin is the most active ingredient in cayenne. It encourages fibrinolytic activity and prevents factors that lead to the formation of blood clots. Cayenne pepper is considered a miracle treatment for varicose veins. Being a very rich source of vitamin C and bioflavonoids, it increases blood circulation and eases the pain of congested, swollen veins.²¹

Butcher’s Broom: Scientific Name- Ruscus aculeatus Family- RuscaceaeThe characteristic constituents of butcher's broom extract are steroidal saponins based upon ruscogenin and neoruscogenin, such as ruscoside, ruscin, deglucoruscoside and deglucoruscin. Butcher’s broom ishelpful for relieving the aches and discomfort of varicose veins. This herb contains compounds known as ruscogenins that help reduce inflammation while constricting the veins due to its anti-inflammatory and anti-elastase activity. The nutrients present in it will help tighten, strengthen and decrease inflammation in the veins as well as improve blood flow up the legs.^22,23

Witch Hazel: Scientific Name-Hamamelis virginiana L Family- Hamamelidaceae The characteristic constituents of Witch Hazel include tannins, specifically gallotannins, and to a lesser extent flavonoid including procyanidins, catechins, and flavanols. Witch hazel is a very effective herb for strengthening blood vessels and hence can reduce symptoms of varicose veins. Apart from being an astringent, it also containsgallic acid and several essential oils that can help reduce the swelling as well as the pain.²⁴

Gutu kola: Scientific Name- Centella asiatica Family-Umbelliferae The characteristic constituents of Gutu kola include pentacyclic triterpenes, mainly asiaticoside, madecassoside, asiatic and madecassic acids. Gutu kola contains a chemical called triterpenic fraction of Centella asiatica (TTFCA). It is particularly beneficial for varicose veins since it stimulates the production of collagen and elastin. Its anti-inflammatory activity showed positive effect in the treatment of varicose veins. It is helpful to reduce swelling and improves the blood flow.^25,26

Marigold: Scientific Name-Calendula officinalis Family-Asteraceae The major components were identified as cis-ocimene, (E)-oscimene, l-limonene, (E)-tagetone, b-caryophyllene, and dl-limonene. The beautiful marigold flower is a rich source of flavonoids and vitamin C that stimulate the production of collagen and aid in cell repair and reproduction. It also helps improve blood circulation, thus helping alleviate various symptoms of varicose veins.^27,28

Ayurvedic Treatment Protocol: (Table-2)^{29,30,31,32,33,34}

Abhyangam: (Gentle massage or application of oil) Is an ancient relaxing massage technique originating in Ayurveda for 14 days. Daily application of medicated oils around the affected part helps to reduce pain, swelling and it improves blood circulation.

Swedana: Shashtika Shali Pinda Sweda is form of sweat inducing massage treatment mainly to provide strength and rejuvenate the tissues and also to provide relief from pain, inflammation, and stiffness (catch) associated with bone, joint, neuromuscular and or musculoskeletal pains, improve muscle strength.

Meru Vasti: It is special massage therapy especially designed to treat acute back pain and innumerable disorders by using ayurvedic oils and steam bath. There is a wide range of complementary therapies that people used to maintain positive mental, physical health and wellbeing which include yoga, taichi, relaxation and therapeutic massage.

Lepam Therapy: A combination of herbs and medicated oils are mixed to form a thick herbal paste. This herbal paste is applied to the affected area of the body and it is left there to dry. Once it gets dry, it is removed using warm water. The herbal paste, which contains a blend of medicated oils and herbs, reduces the pain and swelling on the affected area, and leaves the muscles relaxed. Upon applying the herbal paste the patient feels a heating sensation, but it helps relieve the pain. Lepam therapy is a safe and effective method to cure varicose veins in adults with no side effects.³⁵

Leech Therapy: Leech therapy is a must-try natural treatment for varicose veins since it eliminates the problem before it becomes worse. First purify the leeches by putting them in turmeric mix water for 5 minutes then keep in fresh plain water for 5 minutes. Clean the use site thoroughly with plain water and adequate numbers of leeches are applied to the area of maximal congestion. When jaluka starts sucking the blood it attains shape of Ashvakhuravadanana. Its mouth end becomes the hoof of horse by raising its neck region. Put wet gauze covering the leeches body and continuously pouring of fresh water is done. Once the leech attached, it will remain safely in place until fully distended and then detached itself. This procedure is used by Ayurvedic practitioners to treat severe varicose veins since it is safe. The veins in the legs return to normal after leech therapy, and they can comfortably convey deoxygenated blood. There are no negative side effects or complications associated with this treatment. The pressure of blood accumulating on the lower area of the feet is lessened when the leeches suck the blood. Bleeding may continue for a few hours after the leech has been removed from the body, although this is not dangerous.^{36,37,38,39,40}

Regular Exercise and Yoga: Walking, leg raises, rocking, cycling are best exercises to help get rid of or prevent varicose veins. These exercise increases circulation, helps maintain healthy blood pressure, and strengthens your bones and muscles. Yoga is one of the most effective ways to prevent varicose veins. The greatest advantage of yoga is it helps relieve your mind and body without much physical effort. Certain yogic postures like Virasana (hero pose), Sarvangasana (shoulder stand) and Bhujangasana (cobra pose) can be performed regularly to prevent varicose vein.^41,42,43

DICSCUSSION AND CONCLUSION:

Now a days, Varicose Veins are the most commonly seen problem in the world. But it does not have any permeant treatment. The different ayurvedic herbs are used to treat it. Also, different ayurvedic treatments and therapies are used to control it. These herbs, treatments and therapies does not treat varicose veins permently but it reduces the discomfort of the patient and it reduces the signs and gives the comfort to the patients.

ACKNOWLEDGMENT:

The authors would like to acknowledge Dr. V. K. Redasani, Director and Principal of YSPM, YTC Satara for her encouragement and guidance.

CONFLICTS OF INTEREST:

No conflict of interest was declared by the authors. The authors alone are responsible for the content and writing of the paper.

DATA AVAILABILITY STATEMENT:

There is no data set associated with this submission.

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Received on 09.05.2024 Revised on 01.08.2024

Accepted on 13.09.2024 Published on 07.12.2024

Available online on December 30, 2024

Res.J. Pharmacology and Pharmacodynamics.2024;16(4):291-296.

DOI: 10.52711/2321-5836.2024.00050

Sr. No.	Treatment	Process	Purpose
1	Snehana	Abhyangam for 14 days with Mahanarayanatailam, Dhanwantharamtsilam, Ksheerabalstsilam.	Massage with warm oil, reduce muscle stiffness, promoting circulation, healing, relaxation.
2	Swedana	Shashtika Shali Pinda Swedam for 14 days	Provide strength, Relief from pain, stiffness associated with bone, improve muscle strength.
3	Vasti	Madhu, saindhavam, satapushpa, gomutraBalamoolaqwatha, Dasha moola qwatha, ashwagandha, rasna, mahanarayanataila, Ksheerabalataila for 11 days	Vasti is one of the panchakarma procedures for purpose of management of pain as analgesic, anti-inflammatory, antioxidant, anti-rheumatic, and reduces stress and anxiety.
4	Meru vasti	Maha vishagarbha Tailam + Ksheerabala Tailam for 14 days	Meru vasti used in Ayurvedic Treatment of Disease due to vata dosha, Stiffness, Tightness in back and limb
5	Lepam Terapy	Maha vishagarbha Tailam + Ksheerabala Tailam for 14 days	Lepam reduces the pain and swelling on the affected area, and leaves the muscles relaxed. It helps relieve the pain.
6	Physiotherapy	Physiotherapist to follow on the progression of Orthotics, Splinting, Taping, Management of contractures, Exercise and activity	Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability.

A Review on Varicose Vein