➤ General comments
– In a recent survey on the German population, 70 % of all females and 50 % of all males over 30 years of age were found to have some type of venous disease. Up to 86 % of the US population will have venous disease at some time in their lives.
– Lack of physical exercise, prolonged sitting or standing on the job, and obesity contribute to the development of venous insufficiency (varicose veins). The disease occurs when the supporting and stabilizing connective tissue structures around the veins weaken due to congenital factors, fat deposition, or hormonal changes, resulting in damage to the venous walls and incompetence of the valves.
➤ Symptoms: Venous insufficiency develops gradually, with the first signs being tired and heavy legs and swelling of the ankles (edema) in the evening. Increased venous pressure and oxygen free radicals render the venous walls increasingly permeable, allowing fluids, leukocytes, and proteins to escape into the adjacent tissues. This results in edema formation and a reduced supply of nutrients and oxygen to the surrounding tissues. In severe cases, necrotic leg ulceration can also develop.
➤ General treatment measures
– It is important to start treatment early, that is, as soon as the first symptoms develop, to delay the progression of the disease.
– Physical treatment measures can be very helpful: for example, regular leg elevation, leg exercises, short exercise breaks to interrupt prolonged sitting activity, treading cold water, losing weight, and endurance sports.
– Elastic stockings should be used regularly, but most patients refuse to wear them.
– In certain rare cases, short-term treatment with diuretics may be necessary. Loop diuretics are not suitable for this indication.
➤ Clinical value of herbal medicine
– The efficacy of “vein ointments” has not been conclusively demonstrated. Use of these preparations should be limited to adjuvant therapy of varicose veins parallel to physical therapy and treatment with oral preparations.
– Treatment with herbal medicinal compounds should be initiated in the early stages of chronic venous insufficiency to maintain the decongestant effects of treatment. The herbal measures combine well with physical treatment measures.
Recommended Herbal Remedies (Overview)
External Remedies
➤ Witch hazel bark (Hamamelidis cortex), horse chestnut seed (Hippocastani semen), red or white grape leaf (Vitis viniferae folium).
– Action: These herbs reduce leakage from the capillaries and have astringent, antiphlogistic, and antiedematous effects.
– Dosage and administration: These preparations are gently applied to the affected area, several times a day. Gels are suitable for long-term use with elastic bandages and stockings. Ointments penetrate into the deeper tissues and are therefore more suitable for inflammatory processes.
Warning: Inflamed areas of the skin should not be massaged, to avoid the potential detachment of blood clots. Topical remedies should never be applied to mucous membranes or broken skin.
– Side effects: Although rare, allergic skin reactions may occur.
Internal Remedies
➤ Horse chestnut seed (Hippocastani semen).
– Action: The therapeutic action of horse chestnut seed can mainly be attributed to β-aescin, a complex saponin with antiexudative, membrane-stabilizing, antiphlogistic, diuretic, and venotonic effects. Preparations containing aescin stabilize the lysosomal membrane. The therapeutic effects should develop within around 3 to 5 days of oral administration.
– Contraindications: Pregnant or nursing mothers should not use preparations containing alcohol. High-dose horse-chestnut formulations should not be used in the last two trimesters of pregnancy or when nursing a baby unless absolutely necessary.
– Dosage and administration: One oral 50 mg dose, twice daily.
– Side effects: Horse chestnut seed can irritate the stomach and should therefore be administered as an enteric-coated, slow-release dosage form.
➤ Melilot (Meliloti herba): The herb is derived from Melilotus alba or M. officinalis (sweet clover).
– Action: Melilot contains antiedemic flavonoids and coumarins with antioxidant, antiphlogistic, antiedematous, antispasmodic, and lymphokinetic effects. The herb does not affect coagulation of the blood.
– Dosage and administration: Up to 30 mg coumarin per day (oral).
– Side effects: Headache is a rare side effect. Preparations with a high coumarin content can also cause hepatitis.
➤ Butcher’s broom (Rusci aculeati rhizoma).
– Action: Contains steroid saponins with antiexudative, antiphlogistic, and venotonic effects.
– Contraindications: None known.
– Dosage and administration: Oral commercial preparations should be used as directed on the product label. Daily dose: 7–11 mg total ruscogenins.
– Side effects: Although rare, gastrointestinal complaints and skin rashes may occur.
➤ Grape leaf (Vitis viniferae folium)
– Action: The herbal remedy contains caffeic acid derivatives, tannins, organic acids, and flavonoids such as quercetin-3-glucuronide and isoquercetin, and has antiedemic and antiphlogistic effects.
– Dosage and administration: Oral commercial preparations should be used as directed on the product label.
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