Repertorial Study of Varicose Veins from Synthesis Repertory

Abstract:

Varicose veins are dilated, elongated, tortuous veins affecting the lower extremities due to venous stasis and venous incompetence. In homoeopathy, it is scientifically proved that it helps in curing the underlying condition through individualization where remedies are selected on the basis of person’s specific symptoms. Synthesis repertory guides remedy selection through it comprehensive and clinically reliable representation of varicose vein rubrics and sub rubrics. The rubrics are given based on its location, sensation, causation, modalities, clinical presentation, complication and other associated symptoms.       

Introduction: 

Varicose veins are mostly seen over lower limb causing reversal of blood flow through its faulty valves. It is easily recognized by their twisted, bulging and superficial appearance on the lower limb. It can also be found in nose, rectum, esophagus, over tongue, genitalia etc. Varicose veins are very common. The prevalence rate is 40% in men and 32% in female of 18-64 years aged people. The risk factors includes heredity, female sex, occupation, high heels, tight clothing, pregnancy due to progesterone hormone, chronic constipation etc. 

Etiology:

It is most common in lower limbs due to erect posture and long column of blood has to be supported which can lead to incompetency and weakness of valves.

PRIMARY VARICOSITIES	SECONDARY VARICOSITIES
Absence of valves or Congenital incompetence	Recurrent thrombophlebitis
Wasting of muscles	Occupational – Traffic police, Guards, Sportsman
Stretching of deep fascia	Pregnancy, Obesity, Chronic constipation
Inheritance (family history) with FOXC2 gene	Obstruction – abdominal tumor, lymphadenopathy, ascites etc.
Klippel-Trenaunay syndrome	AV malformation
	Tricuspid valve incompetence
	Iliac vein thrombosis

Classification:

Classification I 

1. Long saphenous vein
2. Short saphenous vein
3. Varicose vein due to perforator incompetence

Classification II

1. Thread veins – Small varices in the skin (Dilated, red or purple network of veins), Size: 0.5-1 mm
2. Reticular veins – Slightly larger varices than thread veins (Subcutaneous/ sub-dermal region), Size: 1-3 mm
3. Varicose veins – Dilated, elongated, tortuous, superficial veins (Subcutaneous tissues), Size: => 3mm

Classification III 

This classification is based on clinical severity, etiology, anatomical location and pathophysiology of varicose veins.

CEAP Classification of lower limb 

C – Clinical signs (grade 0-6)

0 – No visible or palpable signs of venous disease 

1 – Telangiectases, reticular veins or malleolar flare

2 – Varicose veins

3 – Oedema without skin changes

4 – Skin changes due to venous disease like pigmentation, eczema or 

      Lipodermatosclerosis 

5 – Skin changes as above with healed ulceration

6 – Skin changes as above with active ulceration 

E – Etiological classification

Ec – Congenital

Ep – Primary

Es – Secondary

En – No venous etiology

A – Anatomic distribution

As – Superficial

Ad – Deep

Ap – Perforator

An – No venous location identified

P – Pathophysiologic dysfunction

Pr – Reflux

Po – Obstructive 

Pn – No pathophysiology identified or both

Clinical Manifestation:

• Aching pain, Drawing pain get worse after sitting or standing for long a time
• Heaviness in legs, Tender area around the legs 
• Throbbing or cramping, night time cramps – usually late night
• Discolouration – veins are blue or dark purple.
• Darkening of the skin and loss of skin texture of skin 
• Rash i.e. itchy or irritated
• Oedema of feet
• Venous eczema : Skin of affected area is red, dry and itchy
• A minor injury to the affected area may result in longer bleeding than normal

Important Rubrics Of Varicose Veins From Synthesis Repertory:

CHAPTERS	RUBRICS
GENERALES	Varicose veins, accompanied by; epistaxis
GENERALES	Varicose veins, black
GENERALES	Varicose veins, bleeding
GENERALES	Varicose veins, blue
GENERALES	Varicose veins, break easily
GENERALES	Varicose veins, burning
GENERALES	Varicose veins, bursting; as if
GENERALES	Varicose veins, congested
GENERALES	Varicose veins, eczema
GENERALES	Varicose veins, itching
GENERALES	Varicose veins, large
GENERALES	Varicose veins, menses; during
GENERALES	Varicose veins, networks in skin
GENERALES	Varicose veins, painful
GENERALES	Varicose veins, ulcerative
GENERALES	Varicose veins, pimple, covered with
GENERALES	Varicose veins, pink
GENERALES	Varicose veins, portal congestion; from
GENERALES	Varicose veins, pressure agg
GENERALES	Varicose veins, purple
GENERALES	Varicose veins, ruptured
GENERALES	Varicose veins, soreness
GENERALES	Varicose veins, standing agg
GENERALES	Varicose veins, stinging
GENERALES	Varicose veins, stitching
GENERALES	Varicose veins, swollen
GENERALES	Varicose veins, ulceration
GENERALES	Varicose veins, ulceration, cicatrize; late to
GENERALES	Varicose veins, ulceration, old people; in, men; old
GENERALES	Varicose veins, warmth agg
GENERALES	Varicose veins, young people; in
GENERALES	Inflammation, blood vessels, veins
GENERALES	Inflammation, blood vessels, veins, accompanied by, swelling
GENERALES	Inflammation, blood vessels, veins, chronic
GENERALES	Inflammation, blood vessels, veins, thrombophlebitis
EXTREMITIES	Milk leg (phlegmasia alba dolens)
EXTREMITIES	Milk leg, left
EXTREMITIES	Milk leg, contractions, with
EXTREMITIES	Milk leg, delivery; after
EXTREMITIES	Blood, rush of blood to legs, veins, varicose
EXTREMITIES	Blood, rush of blood to legs, veins, varicose, >menses; before
MIND	Insanity, varicose veins, after
MIND	Insanity, varicose vein, with
EYE	Varicose veins, lids
NOSE	Veins, varicose
NOSE	Veins, varicose, tip
FACE	Veins distended, varicose
MOUTH	Varicose veins
MOUTH	Varicose veins, ulceration
MOUTH	Varicose veins, tongue
ABDOMEN	Veins distended, varicose
FEMALE GENITALIA	Veins, varicose
FEMALE GENITALIA	Veins, varicose, accompanied by, abortion
FEMALE GENITALIA	Veins, varicose, burning, menses; during
FEMALE GENITALIA	Veins, varicose, labia
FEMALE GENITALIA	Veins, varicose, vulva

CONCLUSION: 

Repertorial studies of varicose vein from Synthesis repertory conclude that it covers major rubrics and remedies for varicose veins. This repertory offers practical clinical insights for the holistic management of case through individualization, gives symptomatic relief for the pathological condition through its ability to highlighting rare clinical rubrics with classical symptoms. 

REFERENCES:

1. Khanaj, P. D. (2018). Reperire, 5th edition. New Delhi: Indian Books & Periodicals publishers.
2. Lobo, B. j. (2021). journal of integrated standardized homoeopathy, 49 – 54.
3. M, S. B. (2019). SRB’s Manual of Surgery, 6th edition. New Delhi: Jaypee Brothers and publishers.
4. Rana, N. (2017). Varicose Vein. International Al Journal of practical Nursing, 105 – 111.