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Varicose veins are swollen and enlarged veins, usually blue or dark purple in colour. Although it can happen to any superficial veins in the body, the lower limbs are most commonly affected due to increased venous pressure. This vascular medical condition affects around 30% of the adult population. Middle-aged women, people engaging in prolonged periods of standing or sitting at work, elderlies, obese people and pregnant ladies are at higher risk.

Varicose veins or spider veins (the milder variation) are more often than not just a cosmetic concern. They usually do not require any medical attention or intervention. However, in some people, varicose veins can cause aching pain or discomfort, and in extreme cases, lead to more serious complications. In such situations, please seek medical help as soon as possible.

Common presentations of varicose veins

The iconic symptom, of course, is the bulging veins of varying degree, appearing like worms on the legs. In most mild cases, these veins do not cause any pain or discomfort. However, as the condition develops, symptoms may occur:

Muscle aches or cramps

Worsening pain after long period of inactivity

Heavy feeling in legs

Swollen feet

Dry and itchy skin

Symptoms often worsen in warm weather or after long periods of standing, and improve after walking or raising of legs. If the condition is left untreated and continues to progress, complications, such as skin discoloration, blood clots and ulcers, may develop.

Disease progression of varicose veins

According to CEAP classification of chronic venous disorders, the different stages of varicose veins include:
C0: No visible or palpable veins, but discomfort in legs after prolonged periods of standing
C1: Spider veins
C2: Varicose veins
C3: Swollen legs
C4: Skin pigmentation or dry and itchy skin
C5: Healed venous leg ulcer
C6: Active venous leg ulcer

Pathogenesis of varicose veins

To better understand the formation of varicose veins, we need to learn about the basics of blood circulation in the human body. Arteries carry oxygenated blood from the heart to the rest of the body while veins carry deoxygenated blood from the body back to the heart. However, for the blood in the lower legs to return to the heart, the lower limb venous system has to work against gravity. To overcome this problem, contracting calf muscles work as a secondary pump to drive the blood upwards and unidirectional valves in the veins prevent backflow.

However, when the venous valves are weakened or damaged, blood will backflow and pool in the legs, increasing the venous pressure and stretching the venous wall. This results in the formation of varicose veins, which in turn weakens the valves further and forms a vicious cycle.

TCM understanding of varicose veins

Traditional Chinese Medicine (TCM) believes that there are 3 main causes of varicose veins, namely physically demanding labour, prolonged exposure to wind, cold and water, and external injury. These factors can all result in Qi stagnation and blood stasis, which are commonly recognized as the core pathogenesis of this condition.

Therefore, TCM treatment focuses on promoting blood circulation. Herbs, such as szechuan lovage rhizome (Chuan Xiong), amur corktree bark (Huang Bo), cyathula root (Chuan Niu Xi), common peony root (Chi Shao), and figwort root (Xuan Shen), are commonly used in combination to manage this disease.

In addition, acupuncture is also very effective in improving blood circulation and relieving discomfort. Common acupoints include:

Yin Ling Quan (SP-9) - Located on the inner side of the leg, below the knee

Cheng Shan (BL-57) - Located on the midline of the calf, directly below the belly of the calf muscles

Xue Hai (SP-10) - Located on the inner thigh, 3 fingers-width above the patella

As the saying goes, prevention is better than cure. Apart from TCM treatment methods, daily self-care habits are equally important to slow down the development of varicose veins and reduce any discomfort. Here are some tips:

Elevate your legs 3 to 4 times a day for 5 to 15 minutes each time

Wear compression stockings

Do leg exercises such as standing calf raises regularly

Change position frequently and avoid prolonged standing or sitting

Maintain a healthy diet and adopt regular bowel habits

   

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