Usefulness of Hamamelis Virginica in the Treatment of Varicose Veins with homeopathy
Materia Medica Surgery

Usefulness Of Hamamelis Virginica In The Treatment Of Varicose Veins

USEFULNESS OF HAMAMELIS VIRGINICA IN THE TREATMENT OF VARICOSE VEINS

ABSTRACT
Varicose veins are one of the most common medical conditions in the western world with estimated prevalence in individuals older than 15 years being 10% to 15% in men and 20% to 25% in women with visible tortuous veins.
Varicose vein being a progressive disease starts early in life, but takes a silent progression from few months to several years. Hence, people present with symptoms or complications of chronic venous insufficiency, thus suffering from economic hardships leading to disability. The cost of surgical treatment for varicose veins is therefore a matter of concern for regulatory authorities. Homoeopathic medicines help in relieving of symptoms of the varicose veins without surgical intervention. Hamamelis virginica is one such remedy which has principal action on the inner coats of the veins, thus causing relaxation with consequent engorgement of the veins. Mainly indicated for Phlebitis and venous ulcers with stinging and pricking pains.
OBJECTIVES
1. To understand the usefulness of Hamamelis virginica in the treatment of Varicose vein through various Materia medica’s.
2. To identify rubrics related to varicose vein and Hamamelis virginica in various Repertories.

KEYWORDS:- Varicose vein, Hamamelis virginica
INTRODUCTION
Varicose veins are one of the most common medical conditions in the western world with estimated prevalence in individuals older than 15 years being 10% to 15% in men and 20% to 25% in women with visible tortuous veins.1
An epidemiological study conducted by The Edinburg Venous study over 1500 adults in UK, showed that 39.7% of men and 32.2% of women were suffering from varicose veins.2
A study conducted among the residents of adopted population by a tertiary care centre with 1012 sample size resulted in a significant increase in the prevalence of varicose veins in Uttar Pradesh. 46.7% of females and 27.8% of males were found to be suffering from varicose veins.3
In males unskilled work3 and prolonged standing3,6 hours at work place increases the risk for varicose veins.
Varicose vein being a progressive disease starts early in life, but takes a silent progression from few months to several years. Hence, people present with symptoms or complications of chronic venous insufficiency, thus suffering from economic hardships leading to disability.4
The cost of surgical treatment for varicose veins is therefore a matter of concern for regulatory authorities.1
In the other school of medicine the choice of treatment for varicose veins are Endovenous treatments (like endovenous laser ablation, radiofrequency ablation, foamsclero therapy) or high ligation and stripping of the veins. The outcome after 3yrs of treatment resulted in failure of stripping procedure and development of recurrent varicose veins.5
The search for more effective means of prevention and cure of varicose veins with assessment of treatment outcomes with quality of life is required.
Homoeopathic medicines help in relieving of symptoms and improve Quality of Life of the subjects. Homoeopathic medicines can be proved to be effective through proper clinical trial with suitable study design and appropriate parameters.
Hamamelis virginica has principal action on the inner coats of the veins causing relaxation with consequent engorgement. Veins, painful, varicose, sore, swollen inflamed. Painful, hard, knotty. Phlebitis and venous ulcers with stinging and pricking pains. Covering maximum signs and symptoms of varicose veins Hamamelis virginica is chosen as a specific remedy for the treatment of varicose veins.

VARICOSE VEIN

The World Health Organisation defines varicose veins as “saccular dilatation of the veins which are often tortuous”.7
Varicose vein is a degenerative disease of the venous system. It is caused due to defect in the strength of the vein wall with associated valvular dysfunction, thus resulting in reflux (reverse) flow of blood in affected areas. Commonly affects the superficial venous system of the legs.8
RISK FACTORS
Category Risk Factor Proposed Mechanism
Hormonal Female gender High estrogen state
Lifestyle Prolonged standing and/or sitting Venous hypertension
Smoking Venous endothelial injury
Acquired Obesity Venous hypertension
Pregnancy High estrogen state
Venous hypertension
Deep vein thrombosis Deep venous obstruction Venous valvular incompetence
Age Venous valvular incompetence
Inherited Family history Venous valvular incompetence
Tall height Venous hypertension
Congenital syndromes Venous valvular incompetence Venous hypertension
Deep venous obstruction

CLINICAL MANIFESTATIONS
Symptoms of varicose veins vary according to their size and extent. Initial symptoms and signs localized to the areas of varicose veins include aching or throbbing discomfort, burning, pruritus, and dry irritated skin.9
More advanced chronic venous disease (The CEAP classification for chronic venous disorders (CVD) classification) with venous valvular incompetence manifests with symptoms and signs such as leg heaviness and fatigue, large rope-like varicose veins along the right lower leg and left thigh, cramping, hyperpigmentation, edema, fibrotic skin changes (lipodermatosclerosis) and ulceration.
CEAP Clinical classification
C0: no visible or palpable signs of venous disease
C1: telangiectasies or reticular veins
C2: varicose veins
C3: edema
C4a: pigmentation or eczema
C4b: lipodermatosclerosis or atrophie blanche
C5: healed venous ulcer
C6: active venous ulcer
S: symptomatic, including ache, pain, tightness, skin irritation, heaviness, and muscle cramps, and other complaints attributable to venous dysfunction
A: asymptomatic

HOMOEOPATHIC APPROCH
In homoeopathy there are many different remedies indicated for the treatment of varicose vein. The symptoms of the remedy should match with the symptoms of the subject. Thus the following remedies can be indicated for varicose veins.
1. Arnica (Leopards Bane)
Arnica is utilized for varicose veins that vibe and look wounded, and are painful and swollen to contact. It allegedly mitigates swelling and pain connected with overexertion, injury, or medical procedure. An investigation distributed in Research in Complementary and Natural Classic Medicine in 2003 found that arnica was superior to anything a fake treatment for patients following varicose vein medical procedure. Change of pain was found in 43.3% of patients in the arnica gathering, and only 37.6% in the fake treatment gathering.
2. Aesculus Hippocastanum (Horse Chestnut)
Aesculus hippocastanum is utilized for stretched and purple veins that reason staying, hot pains. Side effects will compound from the frosty climate and strolling, while outside enhances indications. Discouragement and crabbiness are additionally basic in the individual that advantages from this cure. There may likewise be liver clog with obstruction.
3. Bellis Perennis (Daisy)
Bellis perennis is utilized for varicose veins that happen amid pregnancy, and make it hard to walk. There is likewise a profound wounding pain, alongside swollen tissues, substantial, tired appendages, and an inclination toward dying. Indications enhance with movement or rubbing; in any case, side effects exacerbate from warmth, contact, or strolling quick.
4. Carbo Vegetabilis (Vegetable Charcoal)
Carbo vegetabilis is said to be a decent cure when there is mottled skin with expanded veins. The individual’s leg will likewise feel nippy, frail, and overwhelming, alongside a consuming pain. The individual likewise has a tendency to be moderate and lazy both from a psychological and physical outlook. Side effects exacerbate from resting, drinking wine, and warmth, while they enhance from raising the feet.
5. Fluoric Acidum (Hydrofluoric Acid)
Fluoric acidum is utilized for perpetual varicose veins and ulcers, particularly in ladies who have had numerous youngsters. Consuming pain and feeble widened blood vessels are likewise normal. The individual likewise wants to walk quick. A cool shower will enhance manifestations, while they decline from contact, sitting, resting, warmth, and around evening time.51
6. Hamamelis (Witch Hazel)
Hamamelis is homeopathic witch hazel, and it is utilized for varicose veins of the legs and thighs with clog, swelling, greatness, or soreness. The cure may enhance flow, wounding, and overwhelming legs. There is regularly coldness, stinging, and irritation down the legs. Resting and movement enhances side effects; in any case, they exacerbate from jolting, warmth, contact, sitting, and weight.52
7. Lachesis (Bushmaster Snake)
Lachesis is a typical solution for the blue-red swelling related with varicose veins. The veins may likewise drain effectively, and the individual has a tendency to be hot and bigoted toward warm. Pregnancy or menopause will regularly cause side effects. The tied veins are additionally regularly found behind the knee, or in the foot, leg, or arms. The individual will have a suspicious, exceptional, and chatty identity. Manifestations will likewise compound from contact, warmth, liquor, or subsequent to dozing.
8. Pulsatilla (Wind Flower)
Pulsatilla is utilized for swollen veins in the legs, and may seem pale blue with a stinging pain, particularly amid pregnancy. There may likewise be varicose veins in the hands, lower arms, and legs, and there might swell in the feet. The side effects will likewise decline from warm, and enhance from rubbing and natural air. The individual has an inclination toward being enthusiastic and destitute.

9. Sepia (Ink of the Cuttlefish)
Sepia is utilized for congested and purplish veins that have lost their flexibility, and frequently turns into an issue amid pregnancy or menopause. The lady is likewise inclined to coldness and obstruction, and has desires for chocolate, salty, and acrid nourishments. There may likewise be greatness, dying, sewing pains, hemorrhoids, gloom, and slow guts. Side effects enhance from warmth and exercise.
10. Lycopodium (Club Moss)
Lycopodium is regularly the go-to solution for tearing pains felt in the legs that occasionally happen with deadness. The cure is regularly utilized for individuals that stress and experience poor dissemination and stomach related and liver issues. Indications have a tendency to intensify when the individual legs issue around evening time in bed, or while they keep still.53
HAMAMELIS VIRGINICA
Hamamelis virginica has symptoms of venous congestion, haemorrhages, varicose veins, with bruised soreness of affected parts, seem to be special sphere of this remedy. Acts on coats of the varicose veins causing relaxation with consequent engorgement. Phlebitis. Varicose veins and ulcers.10
Hamamelis virginica is indicated in various forms of varicose veins, this is the prince of remedies. The inner coat of the vein becomes congested and inflamed, thereby narrowing the calibre of the sanguinary channel, especially in the venous capillaries of the skin and mucous membranes. 6
According to Henry Clay Allen:-Hamamelis virginica is indicated for passive venous congestion of the skin and mucous membrane, phlebitis, varicose veins; varicose ulcers, with stinging, pricking pain.
Hamamelis virginica is indicated in varicose veins and venous ulcers. This remedy is of haemorrhagic diathesis, thus indicated for Phebitis, varicosis, venous haemorrhages. The local application of the tincture is known to set inflammation of veins, hence indicated for the treatment of varicose veins.11
Rubrics for Hamamelis virginica found In Various Repertories:
Boger’s repertory:
Under the chapter veins-sore: 2nd grade remedy12
A Concise repertory of homoeopathic medicines by Dr. S.R. Phatak:
Under the chapter legs
Varices -2nd grade remedy
Under the chapter blood vessels
Distended, full, varicose- 2nd grade remedy
painful- 2nd grade remedy13
Repertory of the homoeopathic material medica by Kent:
Under the chapter generalities
Varicose veins- 1st grade remedy
inflamed- 2nd grade remedy
painful- 2nd grade remedy
soreness- 2nd grade remedy
stinging- 2nd grade remedy14
Cases where hamamelis virginica is proved to be effective in the treatment of varicose vein:
CASE A
Mrs. A 58 years of age is a Teacher presenting with swelling of both the legs with heaviness and soreness sensation with severe cramps since 5 years. Has visible bluish dilated tortuous veins in both the legs (more on right leg). She is a Known case of Type 2 Diabetes Mellitus. Nothing significant noted in the personal and family history. Due to lack of peculiar and characteristic general and particular symptoms Hamamelis virginica 200 was prescribed in repeated doses based on presenting complaints. The initial dose itself gave her much relief which was observed as she could restore her daily activities to some extent. Subject improved during the course of treatment.
CASE B
Mr. R, 59 years of age is a Retired Police presenting with dilated tortuous veins with soreness on standing for long since 3years. He is a known case of Type 2 Diabetes Mellitus and Hypertension. Nothing significant noted in the personal and family history. No characteristic symptoms were present as such hence Hamamelis virginica 200 was prescribed in repeated doses based on presenting complaints. He felt better for the 1st follow up itself. After 2 months even the visible dilated veins were not to be seen.
CASE C
Mrs. T, 58 years of age is a Home maker presenting with dilated tortuous veins with soreness and Cramps since 9years. She is a known case of Hypertension, Type 2 Diabetes Mellitus and Osteoarthritis. Nothing significant noted in the personal and family history. Due to lack of peculiar and characteristic general and particular symptoms Hamamelis virginica 200 was prescribed in repeated doses based on presenting complaints. She felt better with the complaints like pain , soreness, cramps at night, but the dilated veins were still present.
REFERENCES
1. Agarwal V, Agarwal S, Singh A, Nathwani P, Goyal P, Goel S. Prevalence and risk factors of varicose veins, skin trophic changes, and venous symptoms among northern Indian population. International Journal of Research in Medical Sciences. 2016 Dec 30; 4(5):1678-82 (cited on 14-2-18).
Available online – http://msjonline.org/index.php/ijrms/article/view/780
2. V.Satyanarayan, Z.Sagar Clinical profile and management of varicose veins at tertiary care hospital, India. Int J Curr Res: 2016 Nov3;.8(11), 42362-42367(cited on 17-2-18).
Available online – http://www.gmferd.com/journalcra.com/sites/default/files/18890.pdf
3. Kurz X, Lamping DL, Kahn SR, Baccaglini U, Zuccarelli F, Spreafico G, Abenhaim L. Do varicose veins affect quality of life? Results of an international population-based study. Journal of vascular surgery. 2001 Oct 1; 34(4):641-8.(cited on 15-2-18).
Available online – https://www.ncbi.nlm.nih.gov/pubmed/11668318
4. Sell H, Vikatmaa P, Albäck A, Lepäntalo M, Malmivaara A, Mahmoud O, Venermo M. Compression therapy versus surgery in the treatment of patients with varicose veins: a RCT. European Journal of Vascular and Endovascular Surgery. 2014 Jun 1; 47(6):670-7 (cited on 15-2-18).
Available online – http://www.jvascsurg.org/article/S0741-5214(14)00850-7/fulltext
5. Prasad B.K clinical study of varicose veins and their management. IJBAR .2015.6(8) (cited on 17-2-18). Available online – http://ssjournals.com/index.php/ijbar/article/view/2384
6. Burt H.WM .Hamamelis virginica. Physiological material medica 3e New Delhi: B jain publishers (p) Ltd, 440-43.
7. Prerovsky I. Diseases of the veins. World Health Organisation, internal communication, MHO-PA 10964Google Scholar
8. THIBAULT P. Sclerotherapy and ultrasound-guided sclerotherapy. InThe vein book 2007 Jan 1 (pp. 189-199). Academic Press. ( Cited on 8th march 2020) Available online:- https://www.sciencedirect.com/science/article/pii/B9780123695154500235
9. Piazza G. Varicose veins. Circulation. 2014 Aug 12;130(7):582-7. ( Cited on 6th march 2020) Available online:- https://www.ncbi.nlm.nih.gov/pubmed/25114187
10. Boericke William. Pocket manual of homoeopathic materia medica. New Delhi: B Jain publishers; 1984.318-319.
11. Clarke JH. A dictionary of practical materia medica. In A dictionary of practical materia medica 1982. Health Science Press.
12. Boger C M. Generalities. A synoptic key to the materia medica LPE New Delhi: B Jain Publishers; 2002.364
13. Phatak SR. Concise Repertory of Homoeopathic Medicines. B. Jain Publishers; 2004.
14. Kent J T. generalities. Repertory of the Homoeopathic Materia Medica. 4th Indian. New Delhi: Indian books and periodicals Publishers; 2011. 1410-1411.

Dr Sravanthi E
Author: Dr Sravanthi E

A post graduate scholar in case taking and repertory from government homoeopathic medical college and hospital, bengaluru-79

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