Varicose Vein and its Homoeopathic treatment

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GOVERNMENT HOMOEOPATHIC MEDICAL COLLEGE
THIRUVANANTHAPURAM

Varicose vein
DISSERTATION
SUBMITTED TOTHE DEPARTMENT OFSURGERY
FOR THE WINNING AWARD OF
THE DEGREE OF
BACHELOR OF HOMOEOPATHIC MEDICINE AND SURGERY
Submitted by

Dr. SHARY KRISHNA.B.S.
HOUSE SURGEON
2008BATCH

UNIVERSITY OF KERALA

2015

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GOVT HOMOEOPATHIC MEDICAL COLLEGE
THIRUVANANTHAPURAM

CERTIFICATE
This is to certify that the dissertation entitled "VARICOSE VEIN” and ITS
HOMOEOPATHIC MANAGEMENT has been carried out by. Dr.SHARY

KRISHNA B.Sunder my guidance and supervision in Govt. Homoeopathic
Medical College, Thiruvananthapuram. She has taken keen interest in the
work and has made a remarkable compilation on the subject.

Date:30.4.2015
Place: Trivandrum

Dr.Tessy Mole Mathew
Professor and Head of Department
Department of Surgery
Govt .Homoeopathic medical college
Thiruvananthapuram

Countersigned by:
Dr.ANILA KUMARI. C. T
.

Principal And Controlling Officer
Govt.Homoeopathic Medical College
Thiruvananthapuram

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OUR GREAT MASTER

Dr.CHRISTIAN FRIEDRICH SAMUEL HAHNEMANN

(1755-1843)

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AFFECTIONATELY DEDICATED TO
ALMIGHTY GOD,
MY MOTHER, MY FATHER, MY SISTER, MY
TEACHERS AND MY DEAR FRIENDS

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ACKNOWLEDGEMENT
First & foremost I would like to thank God, who has given me the
power to believe in myself & pursue my dreams.

I express my sincere gratitude to all teachers who taught me , as
well as my friends in the Govt. Homoeopathic Medical college , Trivandrum ,
whose presence guided & inspired me all through the days of my career.
I would like to thank Dr.AnilaKumari.C.T , Principal , Govt.
Homoeopathic Medical College, Trivandrum , for providing me an
opportunity for doing this work. I would also like to thank Dr.Jose M
Kuzhimthottyil , Superintendent , and Dr.Tessy Mole Mathew, Professor
,Department of Surgery for providing the necessary inspiration & guidance
for carrying out this work.
Words of appreciation are also to the staff at the college library for
all the help during my studies. There are so many others whom I may have
inadvertently left out and I sincerely thank all of them for their help.

Dr. SHARY KRISHNA B.S

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PREFACE

Within a score of decades of its advent, Homoeopathy
has gained widespread acceptance around the world. The intuition
and intellect of our master with the untiring work of our pioneers
remains as the bedrock of all these developments.

This dissertation is presented to the readers in the hope
that enables them to provide better understanding about varicose
vein and its homoeopathic management. I hope this will help the
readers to understand the disease, its medicines and also the
indications of important medicines.
Bowing at the footstep of Hahnemann, I am
submitting this humble work.

Dr.SHARY KRISHNA.B.S.

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INDEX
CONTENTS

Page no:

1
2
3
4
5
6
7
8
9
10
11
12
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14
15
16
17
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Introduction
Definition
History
Surgical anatomy
Venous physiology
Surgical pathology
Epidemiology
Predisposing factors
Classification
Etiology
Clinical features
Clinical examination
Investigation
Complication
Varicose ulcer
Treatment
Self-care at home
Prognosis

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9
9
10
15
16
18
19
20
21
23
24
30
33
35
39
43
45

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20
21
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HOMOEOPATHIC MANAGEMENT
Case taking
Plan of treatment in homoeopathic system of medicine
Miasmatic diagnosis of different stages of varicose vein and their
treatment
Therapeutics
Medicines and their differentiating features
Selection of potency
Selection of dose
Diet and regimen
Maintaining cause
Observation and follow up
Case discussion
Conclusion
Bibliography

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48
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57
68
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97
98

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INTRODUCTION
As far as a country like India is concerned, where people like manual
laborers live in co-ordination and intermingled with people of high dignity, a
place where large number of people of extreme socio-economic status live interdependently,there are limitations in covering medicial service to the whole
population. In a situation of high demand for manual laborer and cities with
mixed culture, we come through the ―age old disease‖ prevailing even today,
one among which is ―Varicose vein‖, a disease which was first described by the
Father of Medicine Hippocrates . It went through the lives of ancient farmers
underwent transformation and manifest even today in the working people of
modern India. In this scientifically advanced world, the new investigation
procedures and treatment methods have shown way to study and analyze the
disease in its full extent. When viewing in the angle of homoeopathic
perspective, the evolution of the disease gives an image or concept entirely
different from that of modern medicinal aspect.

Varicose vein is significant clinical problem and not just a ―cosmetic‖
issue because of their unsightly nature. Problem arises from fact that varicose
vein actually represent underlying chronic venous insufficiency with ensuing
venous hypertension. Venous hypertension leads to aspectrum of clinical
manifestations, ranging from symptoms to cutaneous findings like varicose
veins, reticular veins, telangiectasia, swelling, skin discoloration, and
ulcerations.

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DEFINITION
Varicose veins are veins that have become distended over time. Long,
tortuous and dilated veins of the superficial varicose system due to the pooling
of blood in the lower extremities.
PHYSIOLOGICAL DEFINITION - A varicose vein is one which permits
reverse flow through its faulty valves.
Varicose veins are manifestation of an underlying disease process not itself a
disease.
Varicose veins represent enlarged collaterals of saphenous venous system
affected by disease called superficial venous insufficiency of lower extremities.

History

"In the case of an ulcer; it is not expedient to stand; more especially if the
ulcer be situated in the leg"
Hippocrates (460-377 BC)
Description of varicose vein as clinical entity can be traced back as early as 5th
century BC.Forefathers of medicine including Hippocrates and Galen described
the disease and treatment modalities, which are still used.
Royle J et al Varicose vein ANZ J Surg. D2007;77(12):1120-7
As in many other medical events, Hippocrates gets first credit for varicose vein
treatment. He recommended multiple punctures and cautioned against cutting
directly into the varicosity and engorged tissues. He also suggested elevation
and compression bandages as appropriatetreatment. During the Roman time
treatment of bandaging with linen was advised by Celsus(25BC-50AC) and
applying wine to the ulcer was recommended by Galen (130-200AC)3
Throughout centuries, surgical treatments have evolved from large, open
surgeries to minimally invasive approaches.

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SURGICAL ANATOMY
Venous drainage of the lower limb can be conveniently described under 3
heads.
(I)
Deep veins,
(II) Superficial veins.
(III) Perforating or Communicating veins which connect the superficial
with the deep veins.
(I). Deep Veins
The deep veins of the lower limb accompany the arteries and their branches.
These veins possess numerous valves. The main veins are- The Posterior tibial
vein and their tributaries, the peroneal vein, the anterior tibial, the popliteal vein
and the femoral vein
The characteristic features of the deep veins are
1. There are numerous valves in these veins. These values direct the flow of the
blood upwards and prevent regurgitation of flow downwards.
2. Within the soleus muscle,which is the most powerful muscle of the calf there
and venous plexus or sinuses. These are devoid of valves. These veins empty in
segments in to the posterior tibial and the peroneal veins. These posterior tibial
veins and the peroneal veins also receive perforating or communicating veins
from the superficial veins and both these perforating veins and the soleus
venous plexuses or sinuses may enter the same sites of these veins.
II Superficial veins
These veins lie in the subcutaneous fat between the skin and the deep fascia.
These superficial veins of the lower limb are the long and short saphenous veins
and their tributaries.

Long (Great) Saphenous Vein.
It is the longest vein in the body. It begins in the medial marginal vein of
the foot and ends in the femoral vein about 3 cm below the inguinal ligament. It
ascends in front of the tibial malleolus, runs upwards crossing the lower part of
medial surface of the tibia obliquely to gain its medial border then it ascends a

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finger‘s breadth, behind the medial border of the tibia up to the knee. Here it
runs upwards on the posterior parts of the medial condyles of the tibia and
femur and alone themedial side of the thigh to the saphenous opening.
Saphenous opening lies about 3.5 cm below and lateral to the pubic tubercle. It
passes through the cribriform fascia of the saphenous opening and ends in the
femoral vein.
There are about 10 to 20 valves in this long saphenous vein which are more
numerous in the leg than in the thigh. Of these, two valves are almost constantOne lies just before the vein pierces the cribriform fascia and another at its
junction with the femoral vein (this valve is concerned with saphenofemoral
sufficiency).
Tributaries1. At the ankle:
It receives veins from the sole of the foot through the medial marginal
veins.
2. In the leg.
(i)
It communicates freely with the small saphenous vein.
(ii) Just below the knee it receives three large tributaries: (a) One
from the front of the leg (b) One from the region of the tibial
malleolus (which communicates with the perforating veins) and
(c) one from the calf which communicates with the small or
short saphenous vein.
(3)Inthethigh:
(i) A large accessory saphenous vein-which communicates below with the
small saphenous vein. This receives numerous tributaries from the medial and
posterior parts of the thigh.
(ii) A fairly constant large vein,sometimes called the anterior femoral
cutaneous vein –Commences from a network of veins on the lower part of the
front of the thigh and crosses the apex of the femoral triangle to enter the long
saphenous vein in the upper part of the thigh.
(4)Nearthesaphenousopening:
JustbeforethelongSaphenousveinpiercesthesaphenousopeningitisjoinedbyfourvei
ns-

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(i)Thesuperficialepigastric,(ii)Superficialcircumflexiliac,(iii)Superficialexternal
pudendaland(iv)thedeepexternalpudendalvein,whichjointsthegreetsaphenousvei
natthesaphenousopening.
Surgicalimportance
A. As there is Communication between the long and short saphenous veins
varicosities may spread from one system to the other
B. In case of varicosity of the long saphenous vein, the smell veins from the
sole of the foot and the ankle which drains in to this venous system
through the medial marginal vein become dilated and this gives rise to
swelling of ankle, which is known as ‗ankle flare‘.
Short(small)saphenousvein:Thisveinbeginsbehindthelateralmalleolusasacontinuationofthelateralmargi
nalveinofthefoot. It first ascends along the lateral border of the tendo Achilles
and then along the mid line of the back of the leg. It perforates the deep fascia
and passes between the two heads of the Gastrocnemius in the lower part of the
popliteal fossa and ends in the popliteal vein 3 to 7.5 cm above the level of the
knee joint.
In the leg it is in close relation with sural nerve.
This vein possesses 7 to 13 valves, one of which is always found near its
termination in the popliteal vein.
Tributaries:
It sends several tributaries upwards and medially to join the long saphenous
vein. The most important communicating branch arises from the small
saphenous veins before it pierces the deep fascia ad passes upwards and
medially to join the accessory saphenous vein. This Communication may
occasionally form the main continuation of the short saphenous vein.
III. Perforating or communicating veins –
These veins communicate between the superficial and deep veins. These
always pierce the deep fascia. There are values within these veins which under
normal conditions allow blood to flow from the superficial to the deep veins.
Only when these valves become incompetent blood may flow in the opposite
direction and thus leads to varicosity of the superficial veins.
When the calf muscles contract the blood is pumped upwards in the deep
veins and blood flow into the superficial veins is prevented by the valves in the

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perforating veins. During relaxation of the calf muscles blood is aspirated from
the superficial into deep veins. If the valves in the perforating vein become
incompetent these veins become ‗high pressure leaks‘ during muscular
contraction and this transmission of high pressure in the deep veins to the
superficial veins results in dilatation of the superficial veins producing varicose
veins. Perforating veins are of two types:
(a). Indirect perforators:
There are numerous small vessels which start from the superficial venous
system, pierce the deep fascia and communicate with a vessel in an
underlying muscle. The latter vessel in turn is connected with the deep vein.
These in direct perforators are mostly seen in the upper part of the leg.
(b). Direct Perforators.
These veins directly connect the saphenous veins or their tributaries to the
deep veins. A few of these direct veins are constant in number and site.
These are:
(i). In the thigh-Between the long saphenous and the femoral vein in the
adductor canal.
(ii) In the leg:- The perforators in the leg are divided into three groups:(a) Medial perforating veins: There are three constant medial leg perforators
situated in line with the posterior border of the tibia 2 inches, 4 inches
and 6 inches above the medial malleolus. The upper two enter the
posterior tibial vein where an unvalvedsoleal venous sinus also enters it.
The importance of this is that the soleal venous sinuses are devoid of
values. Moreover the clot arising in the soleal veins may extend in to the
posterior tibial vein and then into the perforating veins thus destroying
the valves of the perforators. The lowest perforator has a short course
connecting long saphenous with the posterior tibial vein.
(b) Central Perforating veins: - One or two veins connect the short saphenous
system to the veins in the gastrocnemius and soleus muscles. Where one
enters the muscle on the medial side close to its junction with the tendo
Achilles, the other is situated further up in the calf.
(c) Lateral perforating veins: - These are inconstant perforators at the
posterior border of the fibula. These are connected with the Peroneal
veins.

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VENOUS PHYSIOLOGY
The veins perform many functions that are necessary for a normal blood
circulation. They are capable of constricting and enlarging, of storing large
quantities of blood and making this blood available when it is required by the
remainder of the circulation, of actually propelling blood forward by means of
so called "venous-pump" and even of helping to regulate cardiac outputand
body temperature. Their main function is to transport blood from the capillaries
to the heart, and this venous return can be passive or active .The pressure in the
right atrium is frequently called the central venous pressure. The pressure in the
peripheral veins depends to a great extent on the level of this pressure, but with
superposition of hydrostatic pressure components. Factors that increase the
tendency of venous return are
1. increased blood volume,
2. increased large vessel tone throughout the body with resultant increased
peripheral venous pressure and
3. Dilatation of the arterioles, which decreases the peripheral resistance and
allows rapid flow of blood from the arteries to the veins.
VENOUS MUSCLE PUMP
The muscle pump mechanism facilitates the return of blood to the heart
during exercise. It has been calculated that 30% of the energy required to
circulate blood during strenuous exercise is supplied by this mechanism. In
addition, the muscle pump, by reducing peripheral pressures, decreases oedema
in the dependent tissues and prevents the accumulation of excessive quantitiesof
blood in the leg veins. The skeletal muscles act as the power source, and the
sinusoids, deep veins and superficial veins in the order of decreasing
importance, act as the bellows. As in any unidirectional pump, valves are vitally
important to ensure efficient performance. In a motionless upright subject, veins
simply collect blood from the capillaries and transport it passively to the heart,
the energy being supplied totally through the cardiac effect. During exercise,
contraction of the calf muscles compresses the venous sinusoids directly and the
other veins indirectly, forcing blood cephalad. Closure of the valves in the
perforating veins and in the deep veins below the calf precludes reflux of blood
into the superficial tissues or down the leg. When the muscles relax, a potential
space develops in the deep veins. Blood is "sucked" from the superficial veins

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through the perforators into the deep veins and the accumulated blood in the
peripheral veins moves cephalad into the more proximal veins. Reflux down the
leg is prevented by closure of the proximal valves. Closure of these valves
interrupts the hydrostatic blood column so that it no longer continues unbroken
from the periphery to the heart but extends for only a few centimetres above
each valve to prevent over distension of the thin-walledveins. Consequently,
hydrostatic pressure is markedly reduced. This reduction in venous pressure
increases the pressure gradient across the capillaries, thereby augmenting blood
flow. With cessation of exercise, capillary inflow gradually replenishes the
blood in the deep veins, extends the hydrostatic column and returns venous
pressure to its pre-exercise level. The calf muscle pump function is complex; it
is reflecting venous reflux, venous patency and muscular power.
SURGICALPATHOLOGY
Undernormalconditionsthebloodfromthesuperficialvenoussystemispassedt
othedeepveinsthrough the competent perforators and from the deep veins the
blood is pumped up to the heart by muscle pump, competent valves and
negative in intrathoracic pressure. But if this mechanism breaks down, either
due to destruction of the values of the deep veins (following deep vein
thrombosis), or of the perforators or of the superficial venous system, the blood
becomes stagnated in the superficial veins which become the pray of 'high
pressure leaks 'and thus becomes distended and tortuous to become varicose
veins. If an individual stands motionless for a long period of time, venous
pressure at the ankle 'may rise to 80 to 100 mmHg and gradually swelling
appears. Even with modest activity of the calf muscles and with competent
venous valves, this pressure is reduced to 20 or 30 mmHg.
VENOUSHYPERTENSION
Venous hypertension is present, when the patient is unable to sufficiently
reduce venous pressure by muscle pump activation. Calf muscle contraction
may force blood to flow cephalad in the deep veins; but during muscle
relaxation (pump diastole), regurgitation may occur through the perforators in
cases of superficial vein incompetence. A portion of blood in the leg is,
therefore, consigned to an inefficient circular pathway. If the valves below a
pump segment are incompetent, muscle pump activation forces blood in both

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directions increasing the pressure in the more distal veins. Incompetent valves
above the pump segment cause fast retrograde refilling of the veins, which,
contributes to the persistent venous hypertension.

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EPIDEMIOLOGY
Annual incidence of varicose veins is about 2%.Life-time prevalence of
varicose veins approaches 40%.
Varicosities are more common in women (about 2-3 times as prevalent in
women than in men)
10-20% actually are symptomatic enough to complain about their lower leg
varicose veins and seek treatment.
25 Million people suffer from venous reflux disease, the underlying cause for
most varicose veins.
Venous reflux disease is 2x more prevalent than coronary heart disease (CHD)
and 5x more prevalent than peripheral arterial disease (PAD)
Of the estimated 25 million people with symptomatic superficial venous reflux
• Only 1.7 million seek treatment annually
• Over 23 million go untreated

Incidence and prevalence in 1973, United States Tecumseh community health
study estimated about 40 million persons (26 million females) in US were
affected
Coon WW et al Circulation. Oct 1973;48(4):839-46
In 1994, a review byCallam found half of adult population have minor stigmata
of venous disease (women 50-55%; men 40-50%) and fewer than half have
visible varicose veins (women 20-25%; men 10-15%)
Callam MJ. Br J Surg. Feb1994;81(2):167-73
In 2004, these finding also seen in a French cross- sectional study that found
odds ratio per year for varicose veins 1.04 for women and 1.05 for men
Age and gender have been the only consistently identified risk factors for
varicose veins
For men working mostly in a standing position, the risk ratio for varicose veins
was 1.85 [95% confidence interval (95% CI) 1.33-2.361 in a comparison with
all other men. The corresponding risk ratio for women was 2.63 (95% CI 2.253.02). The results were adjusted for age, social group, and smoking.

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PREDISPOSING FACTORS

(a)

Prolonged standing-

During prolonged standing long column of
blood along with gravity puts pressure on the weakened valves of the
veins. This causes failure of the valves quickly giving rise tovaricosity of
the long or short saphenous vein.During prolonged standing the
calfmuscles also don‘t work quite often so the calf pump mechanism also
cannot push the venous blood upwards.

(b) Obesity –Excessive fatty tissue in the subcutaneous tissue offer poor
support to the veins. This leads to the formation of varicosity.
(c)

Pregnancy-

(d)

Old age- This causes atrophy and weakness the vein wall. At the same

Pregnancy is said to predispose the formation of
varicose vein. Varicose veins are often noticed in multiparous women.
Pregnancy acts in various ways(1) Progesterone causes dilatation and relaxation of the veins of the
lower limb. This may make the values incompetent. This
hormonal effect is maximum in the first trimester of pregnancy.
(2) Pregnant uterus causes pressure on the inferior venacava, thus
causing obstruction to the venous flow. This effect is mostly
been in the last trimester of pregnancy. After each pregnancy
both hormonal and mechanical effects are removed and there is
improvement of varicosity. During the subsequent pregnancy
these factors again cause the varicosities to develop in a bigger
way. That is why varicose veins are commonly seen in
multiparous women.
time with ageing the values in the veins becomes gradually incompetent.

(e)

Athletes:

Sometimes varicose veins are noticed among athletes.
Forcible contraction of the calf muscles may force blood through the
perforating vein in reverse direction. This will cause destruction of the
valves of the perforating veins and ultimately lead to formation of
varicose vein. Similarly Ricksawpullers often suffer from varicose veins.

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CLASSIFICATION
(CEAP) Classification from the American Venous Form, last revised
Clinical
C0 - No visible or palpable signs of venous disease
C1—Telangiectases or reticular veins
C2 – Varicose Veins
C3 – Edema
C4a –Pigmentation or eczema
C4b- Lipodermatosclerosis or atrophic blanche
C5- Healed venous ulcer
C6 –Active venous ulcer
Etiologic
EC –Congenital
Ep- Primary
Es- Secondary (Post thrombotic)
En –No venous cause identified
Anatomic
As- Superficial veins.
Ap- Perforator veins.
Ad – Deep veins
An- No venous location identified
Pathophysiologic
Pr- Reflux
Po –obstruction
Pr,oReflex and obstruction
Pn – No venous Pathophysiology identifiable

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AETIOLOGY
1.

Morphological factor - Varicose veins of the lower limbs are the
penalty the man has to pay for its erect posture. The veins have to drain
against gravity. The superficial veins have loose fatty tissue to support
them and thus suffer from varicosity.

2.

Primary Varicose Veins-

3.

Secondary varicose veinsoccur due to venous obstruction

These are more common. This
condition is mainly due to defect in the values. The defect may be
congenital or acquired (either due to thrombosis or due to inflammation is
the veins).
i.
Defect in the saphenofemoral valve leads to varicosity of the
long saphenous veins.
ii.
Defect in the sapheno-popliteal value leads to varicosity of the
short saphenous vein.
iii. Defect in the valves of the perforators lead to varicosity of
either long saphenous or short saphenous system.

i.

ii.
iii.
iv.
v.
vi.
vii.
4.

Mechanical factors eg: pregnancy or tumors in the pelvis (eg:
uterine fibroids, ovarian cyst, cancers of the cervix, uterus,
ovary or rectum).
Deep vein thrombosis leading to damage of the valves.
Hormonal causes: progesterone may cause varicosity in
multiparous females.
Acquired arteriovenous fistula (due to trauma or deliberate
shunting for dialysis).
Extensive cavernous (venous) haemangioma.
Retroperitoneal lymphadenopathy or retroperitoneal fibrosis.
Iliac vein thrombosis.

Congenital varicose veins

–Occasionally varicose veins may
develop below 20 years of age. These cases are mostly due to either
congenital arteriovenous fistula or cavernous (venous) haemangioma.

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CLINICAL FEATURES
(a) The commonest symptom is tired and aching sensation in the affected
lower limb, particularly in the calf at the end of the day. The severity of
symptoms depends mostly on the extent of high back pressure.
(b) Sharp pains may be complained of in grossly dilated veins.
(c) Some patients may suffer from cramp in the calf shortly after retiring to
bed. Such cramp is usually due to sudden change in the caliber of
communicating veins which stimulates the muscles through which they
pass.
(d) Pain may be bursting or severe in nature and may be particularly
localized to the site of the incompetent perforating veins. Such bursting
pain while walking indicates deep vein deficiency.
(e) Patients may presents with no other symptoms except dilated and tortuous
veins of leg.
(f) There may be other complaints or complications of the dilated and
tortuous veins. Such asi.
Ankle Swelling towards evening
ii.
The skin over the varicosities may itch. It may be pigmented
iii. Eczema of the affected skin.
iv.
Venous ulceration
(g) In the personal history one may find that the patient is involved in a job
of prolonged standing eg: bus or tram conductors.

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CLINICAL EXAMINATION
EXAMINATION OF VARICOSE VEIN
HISTORY
AGE – Though varicose vein can affect individuals of all agegroup, yet middleaged individuals are the usual sufferers.
SEX – Women are affected much more commonly in the ratio of10:1 .
OCCUPATION -- Certain jobs demand prolonged standing e.g. tram drivers,
policemen etc. and the persons involved in these jobs often suffer from varicose
veins. Varicose vein may also occur in individuals involved in excessive
muscular contractions e.g. Ricksaw-pullers and athletes.
SYMPTOMS
PAIN--The commonest symptom is the pain which is aching sensation felt in
the whole of the leg or in the lower part of the leg according to the position of
the varicose vein particularly towards the end of the day. The pain gets worse
when the patient stands for a long time and is relieved when he lies down.
Patient may complain of bursting pain while walking , which indicates deep
vein thrombosis . Night cramps may also be present. The ankle may swell
towards the end of the day and the skin of the leg may be itching. Varicose ulcer
may be seen on the medial malleolus
A few questions should be askedi.

Whether the patient is feeling difficulty in standing or walking, which
indicates presence of deep vein thrombosis
ii. The patient should be asked if he has any other complaint than varicose
vein itself. If the patient is suffering from constipation or a swelling in the
abdomen, it may be a case of secondary varicose vein.
7. Morrissey's cough Impulse Test veins
The limb is elevated to empty the varicose vein. The limb is then put to
bed and the patient is asked to cough forcibly. An expansive impulse is felt in
the long saphenous vein particularly at the saphenous opening if the saphenousfemoral valve is incompetent. Similarly bruit may be heard on auscultation.
PAST HISTOY

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Enquiry must be made if the patient had any injection treatment or
operation for varicose veins. Any serious illness or previous complicated
operation may cause deep vein thrombosis which is the case of varicose vein
now.
PERSONAL HISTORY
Women should be asked about obstetric history, like details of previous
pregnancies. Whether the patient suffered from ―white leg‖ during the previous
pregnancies. If the patient had contraceptive pills for quite a long time, as this
may cause deep vein thrombosis.
FAMILY HISTORY
It is not uncommon to find varicose veins to run in families. Often patient‘s
mother and sisters might have suffered from this disease.

PHYSICAL EXAMINATION
A. INSPECTION
1. VARICOS VEINS – Note, which vein has been varicose – long saphenous
or short saphenous or both. In case of the former a large venous trunk is
seen on the medial side of the leg starting from in front of the medial
malleolus to the medial side of the knee and along the medial side of the
thigh upwards to the saphenous opening. This venous trunk receives
tributaries in its course. In case of short saphenous vein varicosity the
dilated venous trunk is seen in the leg from behind the lateral malleolus
upwards in the posterior aspect of the leg and ends in the popliteal fossa.
2. Swelling.
a. Localized --varicose vein affecting a segment of superficial vein or the whole
trunk of a venous segment-either long or short saphenous Vein.
b. Generalized swelling of the leg is mostly due to deep vein thrombosis
3. Skin of the limb.
(i) Colour- local redness is usually due to superficial thrombophlebitis.
Generalized change of color may be white [phlegmasiaalbadolens] also known
as white leg. This is due to swollen limb from excessive edema or lymphatic
obstruction. When the skin of the limb becomes congested and blue then it is

26

due to deep vein thrombosis and this condition is called
phlegmasiaceruleadolens. In such severe venous obstruction the arterial pulses
may gradually disappear and venous gangrene may ensue.
(ii) TEXTURE.
(a) Skin is stretched and shiny due to edema following deep vein thrombosis
(b) Eczema or pigmentation of the skin affecting mostly the medial aspect of
the lower part of the leg
(c). Ulceration on the medial aspect of the lower part of the leg, known as
venous ulcer
(d) Scar may be seen on the lower part of the leg which may be healed venous
ulcer or previous operation of varicose vein
(e). Inspect the toes to note if there is loss of hair or brittleness of the nails due
to chronic varicosity which indicate impending venous gangrene.
4. The patient should be asked to cough and it is noted whether there is any
impulse on coughing at the saphenous opening (Saphena-varix.) This test is
known as Morrissey's test
B. PALPATION
Aim is to locate the incompetent values communicating the superficial and deep
1. BrodieTrendelenburg test
This test is performed to determine the incompetency of the saphenofemoral valve and other communicating systems.This test can be performed
in two ways.In both the methods, the patient is first placed in the recumbent
position and his legs are raised to empty the veins.This may be hastened by
milking the Veins proximally. The Sapheno-femoral junction is now
compressed with the thumb of the clinician ora tourniquet is applied just
below the sapheno-femoral junction and the patient is asked to stand up
quickly.(I) In first method, the pressure is released .If the varies fill very
quickly by a column of blood from above, it indicates incompetencyof the
sapheno-femoral valve. This is called a positive Trendelenburg test (2). To
test the Communicating system, the pressure is not releasedbut maintained
for about 1 minute.Gradual filling of the veins during the period indicates in
competency of the communicating veins mostlysituated on the medial side of

27

the lower half of the leg allowing the blood to flow from deep to the
superficial veins. This isconsidered as positive Trendelenburg test.
2. Tourniquet test
It can be called a varient of trendelenburg test. In this test the tourniquet
is tied around the tight or the leg at different levels after the superficial veins
have been made empty by raising the leg in recumbent position. The paint is
now asked to standup. If the veins above the tourniquet fill up and those
below it remain collapsed, it indicates presence of incompetent
communicating vein above the tourniquet. Similarly if the veins below the
tourniquet fill rapidly whereas veins above the tourniquet remains empty, the
incompetent communicating vein may be below the tourniquet. Thus by
moving the tourniquet down the leg in steps one can determine the position of
the incompetent communicating veins.
In case of In case of short saphenous incompetence –application of the
venous tourniquet to the upper thigh has the paradoxical effect of increasing the
strength the reflux, as shown by faster filling time. This sign is pathognomonic
of varies of the short saphenous system. The mechanism is: application of the
upper thigh tourniquet block off the normal internal saphenous system which is
carrying most of the superficial venous return and thus thrown into greater
prominence the retrograde leak for the saphenous popliteal junction.
Final definite proof of short saphenous incompetence is obtained through
following examination:- the sapheno-popliteal junction is marked with a pen
with the patient standing. The short saphenous vein is emptied by elevation of
the leg; Firm thump pressure is applied to the ink mark. The patient is made to
stand. The pressure is released and the vein will be filled immediately. It should
be remembered that there is no other incompetent perforating vein in the short
saphenous system.
3. Perthes’ test- The affected lower extremity is wrapped with elastic bandage.
With the elastic bandage on; the patient is instructed to move around and
exercise. Severe crampy pain is complained if there is deep vein thrombosis.
Arterial occlusive disease should be excluded.
4. Perthes’ test (Modified) –This test is primarily intended to know whether
the deep vein is normal or not. A tourniquet is tied round the upper part of
the thigh enough to prevent any reflex down the vein. The patient is asked to
walk quickly with the tourniquet in place. If the communicating and the deep

28

veins are normal the varicose vein will shrink whereas if they are blocked
the varicose veins will be more distended.
5. Pratt’s test-This test is performed to know the positions of leg perforators.
An elastic bandage is applied from toes to the groin. A tourniquet is then
applied at the groin. This causes emptying of the varicose veins. The
tourniquet is kept in position and elastic bandage is taken off. The same
elastic bandage is now applied from groin downwards. At the positions of
the perforators blow outs or visible varies can be seen. These are marked
with a skin pencil.
6. Morrissey's cough Impulse Test
The limb is elevated to empty the varicose vein. The limb is then put to bed
and the patient is asked to cough forcibly. An expansive impulse is felt in the
long saphenous vein particularly at the saphenous opening if the saphenofemoral valve is incompetent. Similarly bruit may be heard on auscultation.
7. Fagan’s method to indicate the sites of perforators:
In standing posture the places of excessive bulges within the varicosity are
marked. The patient now lies down. The affected limb is elevated to
empty the varicosed veins. The examiner palpates along the line of the
marked varicosities carefully and finds out gaps or pits in the deep fascia
which transmit the incompetent perforators.
8. One should look for pitting edema or thickening, redness or tenderness at the
lower part of the leg. These changes are due to chronic venoushypertension
following deep vein thrombosis. Sometimes a progressive sclerosis of skin
andsubcutaneous tissue may occur due to fibrin deposition, tissue death and
scarring this is known as lipoderamatosclerosis. And is also due to chronic
venous hypertension. This may follow formation of venous ulcer.
C. PERCUSSION1. Schwartz test. - In a long standing case if a tap is made on the long
saphenous varicose vein in the lower part of the leg an impulse can be
felt at the saphenous opening with the other hand. Sometimes the
percussion wave can be transmittedfrom above downwards and this
will imply absent or incompetent values between the tapping finger
and the palpating finger.

29

D. AUSCULTATION- The importance of auscultation is limited to the
arteriovenous fistula where a continuous machinery murmur may be
heard.
E. Regional lymph nodes [inguinal]. Are only enlarged if there be venous
ulcer and this is infected.
F. Other limb-should be examined for presence of varicose vein and
different tests to exclude deep vein thrombosis, incompetent perforators
and venous ulcer to plan treatment.
GENERAL EXAMINATION
Examination of the abdomen.Sometimes a pregnant uterus or intra-pelvic tumor [fibroid, ovarian cyst,
cancer of cervix or rectum] or abdominal lymphadenopathy may cause pressure
on the external iliac vein and becomes responsible for secondary varicosities.

30

INVESTIGATIONS
1) THOROUGH HISTORY
2) CLINICAL EXAMINATION–
a) Localize the anatomical location of the disease ,
b) Nature of the lesion, Rule out DVT
c) BRODIE TRENDELENBERG TEST
d) TOURNIQUET TEST
e) ASSESS SKIN CHANGES
f) PERIPHERAL PULSES
g) ABDOMINAL EXAMINATION
3) DOPPLER ULTRASOUND
4) DUPLEX ULTRASOUND
5) VENOGRAPHY
MAXIMUM VENOUS OUTFLOW (MVO)
Functional test; detect obstruction to venous outflow.It can help detect
more proximal occlusion of iliac veins and IVC, as well as extrinsic causes of
obstruction in addition to DVTs.MVO uses plethysmography (technique to
measure volume changes of leg) to measure speed at with which blood can flow
out of a maximally congested lower leg when an occluding thigh tourniquet is
suddenly removed.
MAGNETIC RESONANCE VENOGRAPHY (MRV)
Most sensitive and most specific test to find causes of anatomic obstruction.
MRV is particularly useful because unsuspected nonvascular causes for leg pain
and edema may often be seen on scan image when clinical presentation
erroneously suggests venous insufficiency or venous obstruction. This is
expensive test used only as adjuvant when doubt still exists.

31

TESTS USED TO DEMONSTRATE REFLUX
DUPLEX US WITH COLOR-FLOW IMAGING (SOMETIMES CALLED
TRIPLEX ULTRASOUND)
Special type of 2-dimensional ultrasound that uses Doppler-flow information to
add colour for blood flow in the image.Vessels in blood are coloured red for
flow in one direction and blue for flow in other, with a graduated colour scale to
reflect the speed of flow.
Venous valvular reflux is defined as regurgitant flow with valsalva that lasts
great than 2 seconds
Duplex ultrasound -Most useful tool for workup, replaced many of physical
examination maneuvers and physiological tests. Tests used to rule out deep vein
thrombosis obstruction as a cause of varicose veins. Noninvasive imaging with
good sensitivity and selectivity
DOPPLER AUSCULTATION
Doppler transducer is positioned along axis of vein with probe at angle of
45° to skin.When distal vein is compressed audible forward flow exists.If valves
are competent no audible backward flow is heard with release of compression.If
valves are incompetent an audible backflow exists.These compressiondecompression maneuvers are repeated while gradually ascending limb to level
at which reflux can no longer be appreciated.
VENOUS REFILLING TIME (VRT)

This is a physiologic test,using plethysmography. VRT is time necessary
for lower leg to become infused with blood after calf-muscle pump has emptied
lower leg. In healthy subjects VRT is greater than 120 seconds.In patients with
significant venous insufficiency VRT is abnormally fast at 20-40 seconds.VRT
of less than 20 seconds is markedly abnormal and is nearly always
symptomatic.If VRT is less than 10 seconds venous ulcerations are likely.
Muscle pump ejection fraction (MPEF)
Detect failure of calf muscle pump to expel blood from lower leg.Results are
highly repeatable but require skilled operator.Patient performs ankle
dorsiflexion 10-20 times, and plethysmography is used to record change in calf
blood volume. In healthy patients, venous systems will drain, but in patients

32

with muscle pump failure, severe proximal obstruction, or severe deep vein
insufficiency, amount of blood remaining within the calf has little or no change.
Tests used to define anatomy
Duplex US
Two-dimensional ultrasound forms an anatomic picture. Normal vessel appears
as a dark-filled, white-walled structure. Doppler-shift: measurement of flow
direction and velocity. Structural details that can be observed include – most
delicate venous valves, small perforating veins, reticular veins as small as 1 mm
in diameter and (using special 13-MHz probes) even tiny lymphatic channels
DIRECT CONTRAST VENOGRAM
Intravenous catheter placed in dorsal vein of foot, and radiographic contrast
material is infused into the vein. X-rays used to obtain image of superficial
venous anatomy. If deep vein imaging is desired, superficial tourniquet is
placed around leg to occlude superficial veins and contrast is forced into deep
veins. Assessment of reflux can be difficult because it requires passing a
catheter from ankle to groin, with selective introduction of contrast material into
each vein segment.Labor-intensive and invasive venous imaging technique with
a 15% chance of developing new venous thrombosis from the procedure itself.
Rarely used, and has been replaced by duplex ultrasound. Reserved for difficult
or confusing cases.

33

COMPLICATION
Complications of Varicose Vein1. HEMORRHAGEIt may occur from minor trauma to the dilated vein. The bleeding
may be profuse due to high pressure within the incompetent vein. Simple
elevation of the leg does a lot to stop such a bleeding.
2. PHLEBITIS:
This may occur spontaneously or secondary to minor trauma. Mild
phlebitis may be produced by the sclerosis fluid used in the injection
treatment. In this condition varicose vein becomes extremely tender and
firm. The overlying skin becomes red and edematous. Pyrexia and
malaise may be associated with.
3. ULCERATION: This is more due to deep venous thrombosis rather than varicose
vein alone. The patients often give previous history of venous thrombosis
suggested by painful swelling of the leg. After thrombosis has been
recanalized the values of the deep veins are irreparably damaged. The
deoxygenated blood gets stagnated in the lower part of the leg
particularly on the medial side where there are plenty of perforating
veins. The superficial tissue loses its vitality to certain extent and a
gravitational ulcer follows either spontaneously or following minor
trauma. The majority of patients with venous ulcers have incompetent
communicating veins. The arteries and veins should be examined to
exclude other causes of ulceration. These ulcers are commonly found at
the lower third of the leg, usually on the medial side end even on the foot,
but never above the junction of the middle and lower thirds of the leg.
Venous ulcer are shallow and flat. The edge of the ulcer is sloping and
pale purple-blue in color. The floor is usually covered with pink
granulation tissue. In chronic ulcers white fibrous tissue are more seen
than pink granulation tissue. This discharge is seropurulent with trace of
blood. The surrounding tissue show signs of chronic venous hypertension
i.e. induration, tenderness and pigmentation; these ulcers have ragged
edges.
If the ulcer is healing, a faint blue rim of advancing epitheliummay
be seen at the margin. Rarely malignancy can develop at the edge of a
long standing venous ulcer (Marjolin'ulcer). A patient when presents

34

with long history of venous ulceration with edge raised and elevated
inguinal lymph nodes are enlarged-it is suspicious of a Marjolin's ulcer or
different from the typical features of ulcer described above and when the
inguinal lymph node are enlarged it is suspicious of a Marjolin‘s ulcer
(Malignant change in a chronic ulcer.
4. PIGMENTATION: This is particularly seen in lower part of the leg.
Brownish to black pigmentation is noticed. This is due to hemosiderin
deposits from breakdown of RBC which have come out of the thin walled
veins
5. ECZEMA [CHRONIC DEMATITIS]:Due to extravasation and breaking
down of R.B.C‘s in the lower part of the leg, the skin may itch. The
patient scratches which may lead to eczema formation. Alternatively such
eczema may occur following minor trauma or as an allergic manifestation
resulting from various ointment applications.
6. LIPODERMATOSCLEROSIS: This means the skin becomes thickened,
fibrosed and pigmented. This is due to high venous pressure which causes
fibrin accumulation around the capillary and it also activates white cells.
7. CALCIFICATION OF VEIN:
8. PERIOSTITIS: In case of long standing ulcer over the tibia.
9. EQUINUS DEFORMITY: This only result from long standing ulcer.
When the patient finds that walking on toes relieves pain, so he continues
to do so and ultimately the Achilles tendon becomes shorter to cause this
defect.

35

VARICOSE ULCER
According to the Stockbridge study in Scotland17, chronic leg ulcer is
defined as "an open sore below the knee anywhere on the leg orfoot which
takes more than six weeks to heal".
Varicose ulcers/Venous ulcers result from loss of epithelial cells causing
exposure of the underlying tissue due to improper functioning of valves in the
veins usually of the legs.





They are found more commonly in females compared to males.
Common age group is 50-70 years.
Site-Lower 2/3rd of the lower leg (slightly higher on anterior and medial
aspect) and on parts of foot not supported by shoe.
Size-Variable. 18 to 20 cm square on the lower leg is quite common.
Occasionally may become very large and encircle the leg.

PREDISPOSING FACTORS Venous and lymphatic congestion associated with varicose vein
 Prolonged standing during work.
 Poor personal hygiene and malnutrition.
In patients with varicose veins, those with skin changes of chronic venous
insufficiency and deep vein incompetence are at greatly increased risk of
ulceration. Popliteal vein incompetence was an independent risk factor for
venous ulceration.
The poor calf muscle itself may be responsible for calf muscle pump
failure in some patients with chronic venous insufficiency and leg ulceration.
In patients with established venous disease, obesity was a significant risk factor
for ulceration
Cigarette smoking was associated with an increased risk of
ulceration.Subjects who had ever smoked cigarettes were almost twice as likely
to develop an ulcer compared with subjects who had never smoked.
PATHOLOGY:Due to failure of venous pump and lack of pumping action by
calf muscles, there is venous congestion. Venous hypertension alters the
hemodynamic at the capillary level and causes a shift towards the outflowof
capillary fluid and development of oedema. Excessive fluid in the interstitial

36

spaces inhibits the exchange of nutrients and removal of metabolic degradation
products. This problem is enhanced by the loss of protein into the interstitial
spaces. Maintenance of these conditions for a prolonged period will result in
stasis dermatitis, hemosiderin deposition and skin ulceration at the ankle
region.Nutrition of the tissue is decreased and the skin is devitalized.
Cellsnecrosis and skin breaks down. There is insufficient oxygen and nutrition
to promote healing and the area remains open.Bacteria may invade the area or
the dead cells may irritate the normal tissues, causing inflammation and the
ulcer spreads.
CLINICAL FEATURES
1-Floor of the ulcer may bea) PALE and ANAEMIC with watery discharge - indolent ulcer -static
and non-healing ulcer.
b)GREEN or YELLOW DISCHARGE-infected ulcer.
c) PINK, BUBBLY WITH RED SPOTS-granulating ulcer.
2-Edge of the ulcer(boundary between floor and the surrounding skin)may bea) Well defined, straight, red and shiny-spreading ulcer.
b) Hard, edematous and over hanging floor-chronic ulcer.
c)Shallow, slopping out from the floor-healing ulcer.
3-Base of the ulcer may showA) Gross induration (hardening), the extent of which varies according to
the severity and duration of the ulcer.
b)Pigmentation due to breakdown of RBC's .
c)Poor circulation.
d)Course skin texture with heavy scaling or papery thin and eczematous
tissue.
4-Edema of the base of the ulcer and the foot and ankle to shoe line.
5-Pain in infected ulcers. Increases with walking.
6-Decreased range of motion of the ankle and foot.
7-Muscle weakness and atrophy mainly of the calf muscles and loss of
pumping action. Prolonged inactivity and bed rest can lead to muscle atrophy,
contracture, and degenerative jointdisease. Muscles particularly affected by
resting the leg are the gastrocnemius soleus and the anterior tibialis, which acts

37

as a dorsiflexor. Those with an active ulcer had a lower range of movement at
12.5°
8-Push off missing in the gait.
VARICOSE ULCERS MORDERN MEDICAL TREATMENT
a)conservative
b)surgical
since physical therapist's role is limited to conservative treatment of skin
ulcer
Aims of Conservative/Physiotherapy Management of venous ulcer1-To relieve pain.
2-To relieve congestion and edema.
3-To improve general circulation of lower limb.The potential benefit of
exercise is that using the calf muscle pump reduces the ambulatory
venous pressure.
4-Soften induration of lower leg especially around the ankle area.
5-Mobilize joints of lower limb and improve strength.
6-To improve the condition of the skin of the lower limb.
Specific local aims Increase circulation to the ulcer to promote healing.
 Clear any infection.
 Reduce edema and induration around the ulcer.
 Free adherent ulcer from underlying tissue.
METHODS OF TREATMENT OF VARICOSE ULCER
1-Soft

tissue techniques-Remove the bandage and dressings, clean wound and cover with gauge swabs.
-Elevate leg to an angle of 45 degree at hip to aid venous drainage.
-Soft tissue techniques to the whole limb to decrease edema.
Effleurage, slow deep kneading, Picking up, wringing the thigh. Special
attention to dorsum of foot, region of tendocalcaneus and behind the malleoli
(as in this area vascular supply is less). Thumb kneading over the tibialis
anterior muscle.

38

The region of the ulcer is next treated with finger and thumb kneading to soften
the induration, working inward from the periphery to the edge of the ulcer.
2-UVR- a)FOR INFECTED ULCERS-to destroy the micro-organism and
increase the circulation to the area. Most commonly used is kromayer lamp and
mercury vapour lamp.
b)FOR HEALING ULCER-As ulcer heals, it grows inwards from the
edge or outwards from the middle.UVR is given to promote granulation
tissue formation.
c) FOR INDOLENT ULCERS-UV rays are given to stimulate the
circulation. Absorption of rays produces hyperemia in the congested area
and produces an increased exudate.
3-ULTRASOUND THERAPY
a) It promotes healing of the ulcer.
b) Soften the induration
c) Increase vascularity in the surrounding tissue.
Ultrasound is contraindicated in infected ulcers or in DVT.
4-LASER THERAPY-It increases vasodilation and increase the number of
fibroblasts.

39

TREATMENT OF VERICOSE VEIN
Conservative management
 For elderly unfit patients or with mild symptoms
 Elastic support, weight reduction, regular exercise, avoidance of
constricting garments and prolonged standing
 Elastic crepe bandage – stockings -30-40mm Hg
 Elevation of limbs -Above the level of heart
 Graded compression stockings
Compression Stockings
Wearing of graduated compression stockings with pressure of 30–
40 mmHg has been shown to correct swelling, nutritional exchange & improve
microcirculation in affected legs.Caution should be exercised in patients with
concurrent arterial disease.They are offered in different levels of
compression.They are constructed using elastic fibers or rubber which help
compress limb, aiding in circulation.
MORDERN MEDICAL TREATMENT
1.InjectionSclerotherapy
Inject directly to the superficial vein the 3 % sodium tetradecylesulphate. And
compression are applied
It destroys the lipid membrane of endothelial cells causing them to shed, leading
to thrombosis, fibrosis and obliteration (sclerosis).
It is not suitable for major saphenous incompetence.
Disadvantages
Anaphylaxis/shock,
Abscess,
Intravenoushematoma, Temporary ocular disturbances

Thrombophlebitis,

2. US guided foam sclerotherapy
In U/S guided sclerotherapy,USare used to visualize underlying vein so surgeon
can deliver and monitor injection.Air mixed with sclerosant and injected into
veins by US image
Complications: Extravasation: Skin ulceration, Escape into deep veins, DVT
Entering brain: Stroke, Headache

40

3. Surgery
a. Trendelenburg operation: It is a juxta femoral flush ligation of long
saphenous vein (i.e. flush with femoral vein), after ligating named
(superficial circumflex, superficial external pudendal, superficial
epigastric vein) and unnamed tributaries. All tributaries should be ligated,
otherwise recurrence will occur.
b. Stripping of vein:Using Myer‘s stripper vein is stripped off. Stripping
from below upwards is technically easier. Immediate application of crepe
bandage reduces the chance of bleeding and hematoma formation.
Complication is injury to saphenous nerve causing saphenous neuralgia.
Trendelenburg’s Operation
Stripping is not usually done for the veins in the lower part of the leg. Stripping
of the vein are more effective.
Inverting or invagination stripping‘ using rigid Oesch pin stripper is
better as postoperative pain and haematoma is less common and also there is
tissue damage. Vein should be very firmly fixed to the end of the stripper and
pulled out to cause the inverting of the vein.
Stripping of short saphenous vein is more beneficial than just ligation at
sapheno popliteal junction. It is done from above downwards using a rigid
stripper to avoid injury to sural nerve.
GSV Saphenectomy
Surgical removal of GSV have evolved from large open incisions to less
invasive stripping.Stripping consists of removal of all or part of saphenous vein
main trunk.Perforation-invagination (PIN) stripper is mainly used now a days.
SSV Saphenectomy
Removal of SSV is complicated by variable local anatomy and risk of injury to
popliteal vein &peroneal nerve
Stab or Ambulatory Phlebectomy

41

It is extremely useful for treatment of residual vein clusters after
saphenectomy& for removal of nontruncal tributaries when saphenous vein is
competent.
Subfascial Ligation of Cockett and Dodd
Perforators are marked out by Fegan‘s method. Perforators are ligated deep to
the deep fascia through incisions in antero medial side of the leg.
SEPS
Video techniques that allow direct visualization through small-diameter scopes
have made endoscopic subfascial exploration and perforator vein interruption
possible.The connective tissue between the fascia cruris and the underlying
flexor muscles is so loose that this potential space can be opened up easily and
dissected with the endoscope.This operation, done with a vertical proximal
incision, accomplishes the objective of perforator vein interruption on an
outpatient basis
NEW TECHNIQUES:
Radiofrequency ablation
Thermal energy is delivered directly to the vessel wall and destroys the
endothelial lining.
Endovenous radio frequency ablation (Closure procedure) is a minimally
invasive.In-office treatment alternative to surgical stripping of the great
saphenous vein. The skin on the inside of the knee is anesthetized and a
radiofrequency catheter is inserted into the damaged vein through a needle stick
in the skin. The catheter delivers Radiofrequency energy to the vein wall
causing it to heat. As the vein warms, it collapses and seals shut.
Endovenous laser ablation
A laser fiber produces endoluminal heat that destroys the vascular endothelium
and cause collapse.Seldinger technique is used to advance long catheter along
entire length of truncal varicosity to be ablated.Under U/S guidance tumescent
solution with local anesthetic is inj: around entire length of vessel.Firm pressure
is applied to collapse vein around laser fiber & laser is fired generating heat
leading to intraluminal steam bubbles,irreversible endothelial damage &
thrombosis.This process is repeated along entire course of vessel.

42

Complications of Surgery
a.
b.
c.
d.

Bruising
Sensory Nerve Injury
Deep vein thrombosis (rare)
Most common is Recurrence

43

SELF CARE AT HOME

1. Avoid standing still for long periods of time.
2. If your job entails standing keep compressing your calf muscles (i.e., by
moving your feet up and down for 5 minutes every hour).
3. Lie down with your ankles raised above chest level for at least half-an-hour
to aid circulation.
4. Take plenty of exercise and avoid being overweight, avoid tight
undergarments or garters. Constipation and straining to defecate are bad for
the blood flow in your legs, switch to a high fiber diet and try to avoid
being overweight. Varicose veins patients suffer from varicose veins which
show up as knots of colour in the legs.
5. A good whole food diet, plenty of exercise and hot and cold baths to aid
blood circulation will be suggested; some extra vitamin-E and vitamin-C
may be recommended.
6. The most helpful advise will be the provision of support stockings which
help prevent the veins from distending and blood from pooling, blood then
circulates in other veins, which however unfortunately may then become
distended themselves in years to come.
7. Straining during bowel movements puts intense pressure on the veins of the
lower body; over time, it can cause veins to weaken and enlarge.Regular
elimination is an important part of the treatment.
8. A high-fiber diet is your best weapon against varicose veins. Reduce your
risk of constipation by eating plenty of fresh vegetables and fruits, whole
grains, and nuts and seeds.
9. Saturated fats, along with hydrogenated or partially hydrogenated oils, slow
down your circulation and worsen the inflammation of the blood vessels.
Avoid them.
10.Sugar and other refined carbohydrates can lead to weight gain and
constipation. Dramatically reduce your intake of sweets and refined foods.
11.Caffeine and alcohol are dehydrating, and they worsen varicose veins or
varicosities.
12.There are avoidance techniques you may practice as well. Avoid prolonged
periods of time standing or sitting. Also, you should avoid high heels which
put undue pressure on your legs. Tight clothing or hosiery, which restricts
blood flow and disrupts circulation, should also be avoided to help prevent

44

varicose veins. You should also avoid excess heat on your legs. Heat
contributes to the swelling in varicose veins, so avoid hot tubs and baths
that are too hot.

45

PROGNOSIS
 Progression is related to aging
 Progression is worse in C2 patients with incompetent GSV or SSV
 Circumstantial evidence shows that:C2 patients with incompetent GSV or
SSV should be treated to prevent progression to venous ulceration.
Recurrent and residual venous incompetence after vein surgery

Varicose vein recurrence is still a problem despite skilled surgical
experience and reasons for recurrences after adequate varicose vein could be
new reflux in an early post-surgery phase or neovascularisation at a later stage.
Neovascularisation starts very often with a number of smaller vessels in parallel
and is today a well-established factor for recurrent venous insufficiency.
Incorrect or incomplete surgery might be a more important reason for
residual venous insufficiency, and "missed"tributaries in the groin are very
likely to be seen when no meticulous dissection of the sapheno-femoraljunction
has been performed.
All legs with residual venous incompetence might have a risk for ulcer
recurrence,but those with signs of better ambulatory muscle pump (APF% >40)
seem to be more protected. When excluding the patients with incomplete
surgery, 13% (14/104) suffered of ulcer recurrence.20% of the patients have a
calculated five year probability of recurrence of more than 25%, whereas quite
40% have a probability less than 4%.

46

HOMOEOPATHIC
MANAGEMENT

47

CASE TAKING
Questions to be asked in a case of varicose vein in order to
make a successful prescription
(1) Inspect whether the surrounding area is blue, black or red.
If it is blue with well-marked dilated veins, then think of Carbo Veg or
Hamamelis.
If it is red and inflamed then think of Belladonna and if purplish
blue,Lachesis. If black think of Ars alb.
(2) Enquire the side affinity of the varicose vein. If it is present in both leg
the enquire in which leg it first started.
If started in right leg and shifted to left leg think of Lycopodium. If it
started in left leg and go to right leg then think of Lachesis.If the pain
constantly shift from one part to another then think of Pulsatilla.
 Enquire whether these is varicose ulcer as a complication.
(3) Enquire whether the varicose ulcer is painful or painless.
If it is painfulthink of HeparSulph. If it is painless then think of Silicea.
Also ask about the discharge from ulcer,in the case of bleeding tendency
think of Lachesis,Hamamelis etc.
(4) Enquire about the subjective sensation.
Burning sensations-think of Sulphur, or Arsalb
If it is sore, bruised pain then think of Arnica Montana or Hamamelis.
If it is stinging pain then ApisMelifica or Pulsatilla.
(5) Enquire about the well-marked modality
<Hanging- Think of Pulsatilla or Vipera
>Warm application-Arsalb,Calcfluor
<Warmth-Pulsatilla

48

PLAN OF TREATMENT IN HOMOEOPATHIC
SYSTEM OF MEDICINE
Abstract: Considering the totality of symptoms ofVaricose
vein, we have to first look for the predominant presenting complaint
or enquire about the primary symptom (symptom which appeared
first) and consider the acute totality and prescribe based on that and
after subsiding the acute condition, follow up the case with antimiasmatic remedy (based on the stage of the disease) which again
should be completely corrected by constitutional remedy to eradicate
the tendency.
Eachcaseofthevaricoseveinshouldbeindividualizedbytheuncommonpeculi
archaracteristicsymptomandbythewellmarkedmodality.Wemustgivepriorimportancetothepeculiarsymptomsinthefirstvi
sit.Analyzeanddifferentiatebetweenthesymptomsofthepatientandcommonsympto
msofthedisease.Consideringthesymptomsofthepatient give more weightage to
the side affinity, (in which leg the varicose vein first appeared), the well-marked
modality and subjective sensation of the patient.
Differentiation of Acute and Chronic presentation
Consideration of acute presentation
Varicoseveinmaypresentaspectrumofclinicalsymptomsalonewiththesympt
omsofitscomplications.Butthepatientsittingbeforeyoumaypresent
oneortwoprominentsymptom.Inthefirstvisitweshouldfirstanalyzewhetherthepres
entingcomplaintisacuteandsevere.Ifitissevereespeciallywithpainandcomplication
slikeulcerationthenwehavetoaidandsupposetoamelioratetheacutesymptom.Insuc
hconditions,thechoice
of
remedy
willbe
thosehavingpredominantactiononvaricoseveinortheulcerasthecasedepend.
Consideration of chronic presentation
On the other hand, if the patient present with dilated vein, but not have any
severe subjective sensation or pain and also along with it the patient have a
number of complaints of mild severity affecting other systems of body then we
have to consider the totality of symptoms by extracting the uncommon peculiar

49

characteristics of the patient. This may cover the miasmatic tendency or the
constitution of the patient and thus ameliorate the whole symptom picture along
with the symptoms of varicose vein.
Medicines in Series.
In case of acute presentation of varicose vein; first we have to select the
medicine covering the most distressing symptom of the varicose vein that is
covering the acute totality.
Medicine covering the acute totality must be selected based on
(1)The subjective Sensation
(2) The side affinity of varicose veins or on which leg it first started.
(3) The exact time modality of subjective sensation.
If there is ulceration, the objective symptoms can be extracted and prescription
can be done with certainty.
After subsiding the most distressing symptoms of the acute presentation, the
patient had gone back to a chronic stage with mild symptom presentation. In
this stage we should analyze the miasm at which the patient now reached.
Prescribe anti miasmatic remedy and go to the constitutional remedy to correct
the tendency of the disease.
Sometimes the medicine selected based on acute totality during the first visit
may also cover the miasmatic and constitutional picture of the patient. This is a
rare situation in which the first selected remedy itself will correct the whole
case; and no change of medicine will be needed. The higher potencies of the
same remedy may completely clear the case.

50

MIASMATIC DIAGNOSIS OF DIFFERENT STAGES
OF VARICOSE VEIN AND THEIR TREATMENT

Stagesof varicose vein
1. Psoric(Inflammatory)
2. Sycotic(Proliferative)
3. Syphilitic (Ulcerative)
1. Psoricmiasm [ Inflammatory stage]
Patient complaints of aching pain in the whole leg.On examination there
will not be any evidence of incompetent valves or blow out. Patient may
complain of pain aggravated by prolonged standing and cramps in legs. It is
most common in patients having transparent skin, with visible vein, but not yet
dilated. In this case we should suspect for a future occurrence of varicose vein.
If it is leaved as untreated it may progress to a fully-flourished case of varicose
vein.
In such condition, as the pathology has not yet established, consider the
presenting acute totality, [that is the subjective sensation and its predominant
modality] and prescribe acute, short acting medicine. After subsiding the
distressing acute symptom, we should prescribe the anti-psoric remedy for
correcting its miasmatic tendency. The excellent antipsoric remedy covering the
burning pain and aggravation standing position is Sulphur. Prescribe higher
potency ieSulphur 1M and observe the changes in the follow up.

2. Sycoticmiasm [Proliferative stage]
In this stage there will be visible dilated vein, the intensity of the blow outs
has no relation to the intensity of the pain. The incompetency of the vein leads
to accumulation of venous blood in the superficial veins and cause blow outs.
Prescribe based on acute totality by considering, the objective symptom [like
side affinity, discoloration] and subjective symptoms [sensations and wellmarked modality]. After subsiding the acute symptoms, prescribe anti

51

sycoticremedy in higher potency ieThuja or Medorrhinum 1M [both should be
differentiated and prescribe according to symptom similarity].

3. Syphilitic miasm [Degenerative stage]
Patient may complain of varicose ulcer with pus and surrounding ischemic
change. This indicates syphilitic stage.
Here we have to first heal the ulcer, prevent infection by cleaning and
dressing the ulcer with all aseptic precaution. Prescribe based on symptoms of
ulcer [considering discoloration of surrounding area, nature of discharge,
absence or presence of pain]. Medicines that cover this acute stage are
HeparSulph, Silicea, Fluoric acid, Lachesis, Hamamelis or Merc sol.
Recurrent occurrence of ulcer and discharge of pus indicates combination of
psoric and syphilitic miasms. Medicine to avoid this recurrence of ulcer is
Tuberculinum 1M.

52

THERAPEUTICS
KENT’S REPERTORY
EXTREMITIES
EXTREMITIES - VARICES , - Lower Limbs
Ambr.arg-n.ARN.Ars.CALC.calc-f.calc-p.Carbn-s.CARB-V.cardm.Caust.clem.Crot-h.Ferr.ferr-ar.FL-AC.Graph.HAM.Hep.Kaliar.Kreos.lac-c.Lach.LYC.LYCPS-V.Natm.Plb.PULS.sabin.sars.sil.spig.Sulph.sul-ac.Thuj.vip.ZINC.
EXTREMITIES - VARICES , - Lower Limbs - painful agg.by warmth
FL-AC.SULPH.
EXTREMITIES - VARICES , - Lower Limbs - pregnancy,during -acon.apisArn.Ars.CARB-V.Caust.Ferr.FL-AC.Graph.Ham.Lyc.Mill.Nuxv.PULS.Zinc.
EXTREMITIES c.Puls.sep.Zinc.

VARICES

,

-

Thigh

--

Calc.ferr.HAM.lac-

EXTREMITIES - VARICES , - Leg
Calc.CARBN-S.CARB-V.CAUST.coloc.ferr.Flac.graph.HAM.LYC.Mill.Nat-m.PULS.sil.Sulph.ZINC.
EXTREMITIES - VARICES , - Leg – left -fl-ac.
EXTREMITIES - VARICES , - Leg – bleeding -- Ham.Puls.
EXTREMITIES - VARICES , - Leg – inflamed
arn.Ars.Calc.Ham.kreos.lyc.lycps-v.Puls.sil.spig.sulph.zinc.

--

EXTREMITIES - VARICES , - Leg – itching - Graph.
EXTREMITIES
VARICES
,
Leg
–
brom.Caust.Ham.Lyc.Mill.PULS.Zinc.
EXTREMITIES - VARICES , - Leg – painless -- calc.
EXTREMITIES - VARICES , - Leg
FERR.Ham.Lyc.Lycps-v.Mill.PULS.Zinc.

-

painful

pregnancy,during

--

-

53

EXTREMITIES - VARICES
ac.graph.Ham.lach.puls.

,

-

Leg

–

sensitive

--

Fl-

EXTREMITIES - VARICES , - Leg – stinging -- Apisgraph.Ham.PULS.
EXTREMITIES - VARICES , - Leg – ulceration -- ars.LACH.lyc.puls.sil.
EXTREMITIES - VARICES , - Leg – calf - clem.Plb.
EXTREMITIES
VARICES
,
Foot
ant-t.Ferr.lacc.lach.PULS.sulph.sul-ac.Thuj.
GENERALS
GENERALS
VARICOSE
veins
Alumn.Ambr.Ant-t.Argn.ARN.Ars.asaf.Bell.CALC.calc-f.calc-p.Carb-an.CARBV.Caust.clem.coloc.Crot-h.Ferr.ferr-ar.FLAC.Graph.HAM.Hep.Kreos.lach.Lyc.LYCPS-V.mag-c.mill.Nat-m.Nuxv.Paeon.Plb.PULS.sabin.Sep.sil.Spig.Sulph.sul-ac.thuj.Vip.Zinc.
GENERALS - VARICOSE veins – blue -Carb-v.Lycps-v.
GENERALS - VARICOSE veins – burning -ApisARS.Calc.
GENERALS - VARICOSE veins - burning – night -ARS.
GENERALS
VARICOSE
veins
–
inflamed
arn.Ars.Calc.Ham.kreos.lyc.Lycps-v.Puls.sil.spig.sulph.zinc.

-

GENERALS - VARICOSE veins – itching - Graph.
GENERALS - VARICOSE veins - net work in skin - berb.Calc.Carbv.Caust.clem.Crot-h.Lach.lyc.nat-m.ox-ac.plat.sabad.thuj.
GENERALS
VARICOSE
Brom.Caust.Ham.Lyc.Mill.PULS.sang.

veins

–

painful

-

GENERALS - VARICOSE veins - pimples,covered with - Graph.
GENERALS
VARICOSE
veins
FERR.Lyc.Lycps-v.Mill.PULS.Zinc.

-

pregnancy,during

GENERALS - VARICOSE veins – soreness - graph.Ham.puls.
GENERALS - VARICOSE veins – stinging - Apisgraph.Ham.PULS.

-

54

GENERALS - VARICOSE veins – stitching - kali-c.lyc
.
GENERALS - VARICOSE veins – ulceration - ars.LACH.lyc.puls.sil.
GENERALS - VARICOSE veins – swollen - Apisberb.Puls.

Borger Boenninghausen”s
characteristics and repertory
CIRCULATION - Blood-vessels – varicose - aesc.AMBR.Antt.ARN.ARS.bell-p.bufoCALC.Calc-f.carb-an.CARBV.CAUST.coloc.FERR.Ferr-p.FL-AC.formac.GRAPH.HAM.Kreos.LACH.LYC.Mag-c.mill.NAT-M.nuxv.phos.plb.PULS.Sep.Sil.SPIG.sul-ac.SULPH.THUJ.vip.ZINC.
CIRCULATION - Blood-vessels - varicose - and inflamed ARN.ARS.Calc.HAM.Kreos.LYC.nuxv.PULS.SIL.SPIG.SULPH.thuj.Zinc.
CIRCULATION - Blood-vessels
brom.caust.HAM.lyc.mill.Puls.sang.

-

varicose

–

painful

-

CIRCULATION - Blood-vessels - varicose – ruptured - vip.
CIRCULATION - Blood-vessels - varicose – sore - Ham.
CIRCULATION - Blood-vessels - varicose – ulcerating - antt.ARS.kreos.LACH.LYC.mez.PULS.SIL.Sulph.
CIRCULATION - Blood-vessels - varicose - veins, especially Aesc.agar.aloealum.am-c.ambr.ApisArn.ars.asaf.aur.bov.Calc-f.carban.carb-v.card-m.chel.chin.cocc.Crot-h.ferr.ferr-p.gels.Ham.kalin.Lach.Lyc.merc.mill.nat-c.Phos.Puls.pyrog.rhus-t.RutaSec.suli.Sulph.thuj.vip.Zinc.
BOERICKE’S REPERTORY
CIRCULATORY SYSTEM - Veins - Varicose
acet-ac.aesc.alumn.apisars.bell-p.calc.Calc-f.Calc-i.carb-v.Cardm.caust.coll.ferr-p.Fl-ac.graph.Ham.kali-ar.lach.Lyc.magn-gr.mur-ac.natm.paeon.plb.polyg-h.Puls.ran-s.rutascir.sep.Staph.stront-c.sulac.sulph.Vip.Zinc.

55

SKIN - Ulcers – Varicose - calc-f.calen.Carb-v.Card-m.clemvit.cund.eucal.Fl-ac.Ham.lach.phyt.psor.pyrog.Sec.

MURPHY’S REPERTORY
Legs - VARICOSE, veins, legs
Ambr.arg-n.ARN.Ars.CALC.calc-f.calc-p.CARB-V.Carbn-s.cardm.Caust.clem.Crot-h.Ferr.ferr-ar.FL-AC.Graph.HAM.Hep.Kaliar.Kreos.lac-c.Lach.LYC.LYCPS-V.Natm.Plb.PULS.sabin.sars.sil.spig.sul-ac.Sulph.Thuj.vip.ZINC.
Legs - VARICOSE, veins, legs – calf - clem.Plb.
Legs - VARICOSE, veins, legs – cramping - graph.
Legs - VARICOSE, veins, legs - distended, during menses ambr.lach.puls.
Legs - VARICOSE, veins, legs – drawing - graph.

Legs - VARICOSE, veins, legs - lower, legs -Calc.CARB-V.CARBNS.CAUST.coloc.ferr.Fl-ac.graph.HAM.LYC.Mill.Natm.PULS.sil.Sulph.ZINC.
Legs - VARICOSE, veins, legs - lower, legs – bleeding - Ham.Puls.
Legs - VARICOSE, veins, legs - lower, legs – inflamed arn.Ars.Calc.Ham.kreos.lyc.lycps-v.Puls.sil.spig.sulph.zinc.
Legs - VARICOSE, veins, legs - lower, legs – itching - Graph.
Legs - VARICOSE, veins, legs - lower, legs – left - fl-ac.
Legs - VARICOSE, veins, legs - lower, legs - network in skin berb.Calc.Carb-v.Caust.clem.Crot-h.Lach.lyc.nat-m.oxac.plat.sabad.thuj.
Legs - VARICOSE, veins, legs - lower, legs – painful brom.Caust.coloc.Ham.Lyc.Mill.PULS.sang.Zinc.
Legs - VARICOSE, veins, legs - lower, legs - painful - menses,
during - graph.
Legs - VARICOSE, veins, legs - lower, legs - painful - pregnancy,
during - mill.
Legs - VARICOSE, veins, legs - lower, legs – painless - calc.
Legs - VARICOSE, veins, legs - lower, legs - pimples, covered with Graph.

56

Legs - VARICOSE, veins, legs - lower, legs - pregnancy, during acon.apisArn.Ars.CARB-V.Caust.FERR.FL-AC.Graph.Ham.Lyc.Lycpsv.Mill.Nux-v.Phos.PULS.Sep.Zinc.
Legs - VARICOSE, veins, legs - lower, legs – pulsating ham.puls.ruta
Legs - VARICOSE, veins, legs - lower, legs – sensitive - Flac.graph.Ham.lach.puls.
Legs - VARICOSE, veins, legs - lower, legs – sharp - kali-c.lyc.
Legs - VARICOSE, veins, legs - lower, legs – soreness arn.graph.Ham.puls.
Legs - VARICOSE, veins, legs - lower, legs – stinging Apisgraph.Ham.PULS.
Legs - VARICOSE, veins, legs - lower, legs – swollen Apisberb.Puls.
Legs - VARICOSE, veins, legs - lower, legs – tearing - sul-ac.
Legs - VARICOSE, veins, legs - lower, legs – tension - graph.
Legs - VARICOSE, veins, legs - lower, legs – ulceration ars.LACH.lyc.puls.sil.
Legs - VARICOSE, veins, legs - lower, legs – ulcers - Aesc.Carbv.card-m.Graph.Ham.hydr-ac.kali-s.Nat-m.syph.
Legs - VARICOSE, veins, legs - painful, agg.by warmth - FLAC.SULPH.
Legs - VARICOSE, veins, legs - pregnancy, during acon.apisArn.Ars.CARB-V.Caust.FERR.FL-AC.Graph.Ham.Lyc.Lycpsv.Mill.Nux-v.Phos.PULS.Sep.Zinc.
Legs - VARICOSE, veins, legs – thigh - Calc.ferr.HAM.lacc.Puls.sep.Zinc.

57

MEDICINES AND THEIR
DIFFERENCIATING FEATURES
Medicine should be differentiated by its unique individualizing
symptoms and thus the logical totality of each drug differs from one
another. The most striking, singular, uncommon and peculiar
(characteristic)

signs

and

symptoms

of

the

remedy

arechiefly

considered here.

Pulsatillanigricans

Particular symptom

Physical generals

Concomitant
symptoms

Relation
ship

Varicose veins that
develop during
pregnancy.
Swollen veins in the legs,
Legs feel hot and painful at
night, with heaviness and
weariness.
Pain worse when the legs
are hanging down
without support.
Bluish hue with
soreness and stinging pain;
passive haemorrhage.
intense pain in the varicose

Chilly
thirstlessness
Dryness of mouth without
thirst
Pain appear suddenly leave
gradually
Symptoms ever changing
Restless
Feels better in open air.
modality
stinging pain that worsen in
hot weather
<Warmth and keeping legs
hanging.
>cold application and open
air.

Thick ,bland ,and
yellow green
discharge
Gastric difficulty
from pork, pastry
Diarrhea
changeable
Menses
suppressed by
getting feet wet
Flow more during
day
Mental
generals
Weep easily
>consolation

Comply
Kali m
Lyc
Sil
Sul ac
Kali m

58

Lachesismutus
Particular
Physical generals
symptom
Blue colour in area Hot patient
mainly on left side. Hotperspiration
Hot flushes
blue-red swelling
Climacteric ailments
of the varicose
Sensitive to touch
vein
Intolerance to
tightness
Veins tend to bleed Physical mental
rather easily.
exhaustion
Hemorrhagic
diathesis
Wants fanning from
a distance
Left side affinity

Mental generals
Long lasting grief
Sorrow
Fright
Jealousy
Great loquacity

Concomitant
symptoms
Allsymptoms <after
sleep
Head ache <sleep
Tonsillitis begin in
left <hot fluids
Constipation
sensation of
constriction of
sphincter
Menses at regular
time
Allpains>by flow

LYCOPODIUMclavatum
Particular
symptom
Drawing or tearing
pains are felt in the
legs, numb
sensation< when
the person is
keeping still, legs
may cramp at night
in bed.
affectingthe right
leg; varicose of
genital organs of
labia during
pregnancy, often of
hepatic origin;

Physical generals
Hot
patientpreferring
warm drinks
Right side affinity
Easy satiety –a few
mouthfuls fill up the
throat

Mental generals

Concomitant
symptoms
Ailments from anger Tonsillitis<cold
vexation
drinks
Irritable
Excessive
<contradiction
accumulation of
Verysensitive ,cries flatulence
even when thanked Fullness not>by
Fear of being alone belching
Red sand in urine
Fullness esply in
lower abdomen
Digestive problems,
sluggish liver
function, and poor
circulation.

59

Zincummetallicum

Particular symptom

Legs are fidgety and
restless, with weakness
in the muscles, must
move them constantly
Crawling sensations, and
a tendency to twitch.
Large varicose veins,
with pain and
soreness,<touch.Large
veins with sweaty and
restless feet
Ulcers discharging thin,
bloody, acrid.
Feet sweaty and sore
about toes

Physical
generals
All complaints
better when
menses begin
to flow, but
return after flow
ceases

Modality

Concomitant
symptoms

< from wine
< 5 – 7 pm

Worse from alcohol,
especially wine
twitching of
Single muscle all
over the body.
General trembling
Brain or nerve power
wanting
Relationship

> appearance
oferuptions,
> during
menses
> discharge
generally

Inimical : Cham and
Nux should not be
used before or after.

Vipera
Particular symptom

Physical generals

Concomitant
symptoms

Veins are swollen, sensitive and feel
as if they will burst unless the leg
is elevated
Inflammation of veins with great
swelling , sensitive and bursting
pain
Burning sensation >by elevating
parts
Severe cramps in legs

Hemorrhagic tendency:
blood black
Symptoms periodic,
Return every year
Persistent edema with
tendency to ulcers

Paralysis of foot
extending upwards
Enlargement of liver.

60

Fluoric acid
Particular symptom

Physical generals Modality

Varicose veins little
blue,
collection of veins in small
spots,
Varicose of legs tend to
ulceration flat naevus.
Varicose veins, often with
small areas of “spider
veins
Varicose ulcer: obstinate
,long standing cases
copius
discharge<warmth;
>cold ,violent pain like
steaks of
lightning,confined to small
sports
Itching especially in the
orifices and in
spots<warmth.
Ulcer over the tibia
Varicose vein following
pregnancy

HOT PATIENT
Feels as if
burning vapors
were emitted
from pores.
Offensive
perspiration
Degenerative
process
Syphilitic miasm
Burning pain
Crave cold water
and is continually
hungry

<warmth,
<morning
>cold
>walking

Concomitant
symptoms
All gone sensation
in the stomach
Morning diarrhea
Caries and
necrosis of long
bone
Relationship
Complementary
Coca ,Sil.
Inimical:
Merc sol

Calc. Fluorata
Particular symptom
Varicose veins and their
ulceration;enlarged, prominent veins
Veins hard and knotty. It helps to
restore the elasticity of the veins.
Hard elevated edge of ulcer
Secreacting thick yellow pus

Physical generals
Sensitive to cold
Swelling or indurations of
stony hardness
Induration threatening
suppuration

Modality
< rest
<change of
weather
>warm
applications

61

Calcareacarbonica
Particular
symptom
varicose veins
with
painlessness
burning
sensation in the
varicose veins ;
hurt while the
person is
standing or
walking
poor circulation,
sole of the feet
raw

Physical generals

Modality

Concomitant symptoms

Chilly patient
The hands and feet
remain cold and may
have excessive
sweating.
weak or flabby
muscles,
cravings for sweets
,eggs,indigestible
things
The patient is
malnourished but
obese.
Psoricmiasm
Increased ,cold, sore
,sweat
Sensitive to
cold,weakness

<from exertion
<ascending
<cold in every
form
<water
washing
<standing

Takes cold at every
change of weather
Profuse head sweat
Frequent sore eructation
Stiffness in all joints
Relationship

>dry climate
>lying on
painful side

Antidote ;camph
Nitric acid,Nux
Complymentary
Bell , Rhus , Lyco,Sil
Incompactable
Bry ,Sulphur should not
be given after calcarea

Carbovegetabilis
Particular symptom
Poor circulation with icy
coldness of the extremities,
and mottled skin with
distended veins and a bruised
or “marbled” look,
Legs feel weak and heavy
often itch and burn.
Veins are distended and itch
especially in the evening and
in bed<night
Ulcers of varicose veins.
Bluish discolouration

Physical generals
Old people with venous
congestions
Desire to be constantly
fanned
Craving for fresh or moving
air for older people, or
those who are slow to
recover from an illness.
Poor circulation.
Putrid septic condition
Burning sensation
Cold sweat

Modality
Itching<in
evening
<warm in
bed
<warm
damp
weather.
Evening,
Cold
>fanning

Relationship
Comply:
Kali carb
Antidot:
Ars ,Camph

62

Arsalb
Particular
symptom
Varicose vein:
itching ,burning,
swelling , edema,
<cold ,scratching
Cramps in calves
Trembling,spasm,
weakness
Varicose ulcers
with offensive
discharge
Burning
pain<midnight,
>from heat

Physical
generals
Chilly
Great thirst for
cold water drinks
often but little at a
time
Prostration
<aftermidnight,
1-2am
From cold drinks
or food
<lying on affected
side
>heat in general

Mental generals

Concomitant
symptoms
Anxious,Anguish,Irritab Complaints return
le
annually
Sensitive
Diarrhea after eating
Restless
and
Fear of death
drinking,offensive,foll
Mentally restless but
owed by prostration
physically too weak to Breathing
move ,cannot rest in
difficulty<after12pm,
one place ,changing
midnight>sit or bent
places
forward
continually,wants to be
moved from one bed to
another
Anxiety<aftermidnight

Hamamelisvirginica
Particular symptom

Physical
generals

Modality

Associated
symptoms

Varicose veins are large and sore,
They tend to bleed easily.
Pain is sore and bruiseslike, and
the legs look bruised and purple.
stinging feeling may be felt in the
irritated veins
The muscles of the legs feel
tired,heavy and are often cold.
Inflammation of the veins
(phlebitis)<from stepping sharply in
a way that jars the leg. Varicose
veins in the thighs and legs that
feels heavy and bruised.

Passive
hemorrhages
: profuse
dark
Weakness
from loss of
blood
Bruised
soreness of
affected part
Intense
soreness

<warm , moist develop varicose
air
veins in the genital
area or have a
Relationship tendency toward
bleeding
Antidote: Arn haemorrhoids
chill in hips
Comply:
extending down the
Ferr
legs

63

Sepiaofficinalis
Particular
symptom

Physical generals

Mental
generals

Concomitant
symptoms

Purple varicose
veins that are
congested and
have lost their
elasticity
For women with
this type of
varicose veins
that deal with
constipation
frequently.

Chilly patient
Offensive urine
Pain are from below
upwards
Easily fainting
Relationship
Complementary:
Nat mur,Phos , Nux
Inimical :
Lach ,Puls

Great sadness
and weeping
Indifferent
Indolent
Modality
<evening ,left
side
After sweat
>pressure,
Hot application,
Drawing limbs
up

All gone feeling in
epigastrium relieved by
eating.
Uterine prolapse >sit
close,cross limbs
Constipation,hard stool
Sense of ball in anus
not > by stool
Ball sensation in inner
parts

Ferrummetallicum
Particular
symptom
Legs look pale
but redden easily
on the least pain
or exertion.
Walking slowly
relieves the weak,
achy feeling.
Bleeding from
varicose ulcer
Restless when
keeping still.
Rending pain in
limbs>moving
quietly and gently

Physical generals

Modality

Hemorrhagicdiathesis;
blood light with dark
clots, coagulates
easily.
Craves bread and
butter
Beer,tea ,Meat
disagrees
Oversensitive to pain
Chilly patient

Always feels
better by walking
slowly about.
<Night, at rest,
while sitting
still.sweating
Pain and
suffering come
on during rest
Rapid motion
aggravates the
complaints.

Concomitant
symptoms
Anemic and weak
Extreme paleness
of face which
become red and
flushed on least
emotion
Every quick motion
aggravates
headache
Rheumatism of left
shoulder
Relationship
Antidote: Ars,Hep
Comply :Chin,Alum,
hamamel

64

Mercurius sol
Particular
symptom
Varicose ulcer with
infection, pus, and
foul-smelling
discharge.
Ulcers sting and
burn and have a
lardaceous
base,with yellow
green pus
Edematous
swelling of the feet

Physical
generals
Profuse sweat
without relief
Moist tongue
with intense
thirst
Offensive
breath
Sensitive to
heat and cold
Syphilitic
miasm

Modality

Concomitant
symptoms
<night,
Profuse
<perspiration offensive
<by warmth
salivation
< lying on right Tongue large
side
,flabby with
imprint of
teeth;mapped
tongue

Relationship
Follows well:
after Bell,
Hep, Lach,
Aur,
Sulph but
should not be
given before
or after
Silicea.

Belladonna
Particular
symptom
Phlebitis
Acute
inflammation
Red, hot, swollen,
and tender
varicose veins.
Dry,hot burning
Imparts a hot
burning sensation
to examining
hand

Physical generals

Modality

Sensitive to drafts of <touch,motion,after
air
3pm,night
Pain usually in short >rest
attacks;Pain come
suddenly last
infinitely and cease
suddenly

Relationship
Complementary:
Calcarea
Antidotes :Camph;
Coff; Opium;Acon
Incompatible :Acet
ac

Millifolium
Particular symptom
Painful varicose veins
occurring in pregnancy
when PAINFUL
Varicose ulcer:ooze a
bright red blood

Physical generals Modality
Hemorrhages:bright <exertion
red,painless
<coffee

Relationship
Follow well:after
Acon, and Arnica in
hemorrhages.

65

Arnica montana
Particular
symptom

Physical
generals

Mental generals

varicose veins
with sore and
bruised feeling
Bruising and
swelling associated
with trauma,
surgery or
overexertion.Feelin
g as if one has
been beaten.
bluish or blackish
discoloration of the
veins. Any exertion
aggravates the
trouble.

Everything on
which he lies
seems too hard;
complains
constantly of it
and keeps
moving from
place to place in
search of a soft
spot
Whole body over
sensitive
<rest lying down
>motion

Says there is
nothing matter
with him
Nervous Great
fear of being
touched or stuck
by persons
coming near him

Concomitant Relationsh
symptoms
ip
Heat of upper
part of body
coldness of
lower

Comply
Acon
Hyper
Rhustox

Causticum
Particular
symptom
Varicose
ulcer:Burning
,rawness ,and
sourness
Pain in limb>warmth
esply heat of bed
Restless at night
Itching in dorsum of
feet
Network of vein in
skin

Physical generals

Mental generals

Rawness and
soreness
Chilly patient
Preferring cold
drinks
<clear fine weather
>damp,wet weather

Intense sympathy
for the suffer of
other
Long lasting
grief,sudden
emotion
Melancholy mood

Concomitant
symptoms
Drooping of upper
eye lids
Constipation >stool
passes better when
standing
Involuntary urination
<coughing
Menses only on day
>on lying down
Cough >drinking
cold water
>expiration

66

Graphites
Particular symptom
Varicose veins with
itching.
Cramping pains in the
legs.
Varicoseulcer: oozes a
watery ,transparent, sticky
fluid.
burning pain with
numbness
Old ulcer with proud flesh
and burning ,itching and
stinging, ulcer with
indurated base and
margins

Physical generals
Chilly patient
Sensitive to draft of air
Suffering part
emaciate
Fidgety while sitting at
work
Offensive sweat and
breath
Craving for air
Weakness
The patient is usually
obese, constipated
and may have skin
problems

Modality
< At
night;<before
midnight
< during and
after menses
Motion
increases all
symptoms
except the
numbness

Relationship
Complementary:
Caust , Hep,Lyc
Graphites follows
well: After
Lyco,Puls;
after Calc in
obesity of young
women with
large amount of
unhealthy
adipose
tissue;followsSul
pher in skin
affections

Apismellifica
Particular symptom
Leg swollen shiny
Sensitive, sore, stinging pain
Feet swollen stiff
Edematous swelling ,Red rosy
hue
Extreme sensitive to touch
and general soreness.

Modality
<heat, touch,
pressure, late
in afternoon,
>Open air,
cold bathing

Physical generals
Thirstlessness
Right side affinity
Extreme sensitive to
touch
Pain :Burning
Stinging, Sore;
suddenly migrating
from one part to
another

Relationship
Complemetery
Nat mur
Inimical
Rhustox

Sulphur
Particular symptom
Bluish spots, swollen
varicose vein. Painful fatigue
Restless leg and feet,cramps
Burning pain in soles at night
Itching, burning,
Pruritus especially from
warmth. phlebitis

Modality

Physical
generals
<Scratching and Washing Burning
<When standing, Warmth Pain, Itching
in bed, 11 am, night > dry Standing is
warm Weather, lying on
the worst
Right Side.
position

Relationsh
ip
Compliment
ary
Psorin,
Acon

67

ThujaOccidentalisAnanti-sycoticMedicine,toremovethemiasmatictendency
in
cases
wheretheblowoutshaveappeared. There may be muscular twitching, weakness.
Pain in heels. Increased perspiration, Sensitive to touch, Coldness of one side,
Chilly Patient, < night, 3am, and 3 pm, Cold
Silicea terra–
In painless varicose ulcer. Cramps in calves and soles. icy cold and sweaty
feet. Offensive sweat on feet, varicose ulcer - with Offensive pus. Long lasting
suppuration. Itch only in day time and evening. <Lying on left side, Cold >
Warmth.
Ferrumphos:Varicose and haemorrhoids in young people; stool hard& difficult followed by
backache throbbing pain.
Bellisperennis–
Varicose veins that are bruised and sore, walking is difficult
Aconite napellus:
This remedy may be beneficial in cases that are usually brought on by long
periods of standing, painful, uncomfortable, restless legs as well as a feeling of
fatigue.

68

SELECTION OF POTENCY
Psoric stage.
In the psoric stage where the objective symptoms are absent, and the
patient complaints of only the subjective sensations like aching pain, burning
sensation, muscle cramps; then it indicates only functional disturbance and no
well-marked pathology is established. In this condition start the treatment with
higher potency like 200.
Sycotic and Syphilitic stage.
In the sycotic or syphilitic stages, where the valvular incompetency and
varicose ulcer are present, the pathology is well evident. Start the treatment with
30th potency and follow up to higher and higher potency as and when indicated.
The susceptibility of the patient
The more similar theremedy, the more clearly and positively the
symptoms of the patient take on the peculiar and characteristic form of the
remedy, the greater the susceptibility to that remedy and the higher the potency
required; that is when the symptoms of a case clearly indicate one remedy,
whose characteristic symptoms correspond closely to the characteristic
symptoms of the case, we give the high potencies- 200th , 1M or higher.
The nature and intensity disease.
In case of varicose ulcers with intense pain, we have to first aid and ameliorate
the pain as soon as possible, in such case go for low potency (30 th ). Another
advantage of 30th potency is that its action starts and stops rapidly and so if the
selected remedy was wrong, it will be soon evident and we can go to the next
indicated remedy based on present totality. At the same time if the case is not
yet progressed much, and the symptoms are of only mild character associated
with the symptoms in other systems then go for totality of symptoms ,and
prescribe in high potency.
The stage and duration of the disease.
In long standing case of varicose vein and venous ulcers, with well-marked
venous incompetency, thinkof low potency. On the other hand recently occurred
aching pain due to prolonged standing is considered as functional disorder and
gives higher potency.

69

SELECTION OF DOSE
For this purpose it is most convenient to employ fine sugar globules of
the size of poppy seeds, one of which imbibed with the medicine and put into the
dispensing vehicle constitutes a medicinal dose, which contains about the three
hundredth part of a drop, for three hundred such small globules will be
adequately moistened by one drop of alcohol. The dose is vastly diminished by
laying one such globule alone upon the tongue and giving nothing to drink.
Aphorism 285 foot note,Organon of Medicine

Dispensing one doseTo prepare the pellets to give to patients, one or a couple of such little
pellets are put into the open end of a paper capsule containing two or three
grains of powdered sugar of milk; this is then stroked with a spatula or the nail
of the thumb with some degree of pressure until it felt that the pellet or pellets
are crushed and broken then the pellets will easily dissolve if put into water.

The Chronic diseases their peculiar nature and their
homoeopathic cure
FREQUENCY OF REPETATION
NEVER REPEAT YOUR REMEDY SO LONG AS IT CONTINUES TO ACT
Every perceptibly progressive and strikingly increasing amelioration in a
transient (acute) or persistent (chronic) disease, is a condition which, as long as
it lasts, completely precludes every repetition of the administration of any
medicine what so ever, because all the good the medicine taken continues to
effect is now hastening towards its completion. Every new dose of any medicine
what so ever , even of one last administered, that has hitherto shown itself to be
salutary, would in this case disturb the work of amelioration.
Aphorism 245;6thedition ;Organon of Medicine
The dose of the same medicine may be repeated several times according
to circumstances, but only so long as until either recovery ensues, or the same
remedy ceases to do good and the rest of the disease, presenting a different
group of symptoms, demands a different homoeopathic remedy.
Aphorism 248 Organon of Medicine

70

Frequency ofrepetition also depends on the potency selected. For 30th
potency we have to give at least 1week to finish it action. For 200th potency we
should wait at least 2 weeks. 1M potency has action lasting as for more than
1month. As improvement is there; any repetitions is contraindicated.

DIET AND REGIMEN
Considering the minuteness of the doses necessary and proper in
homoeopathic treatment we can easily understand that during the treatment
everything must be removed from the diet and regimen which can have any
medicinal action, in order that the small dose may not be overwhelmed and
extinguished or disturbed by any foreign medicinal irritant.1
§ 259, Organon of Medicine.

Coffee; fine Chinese and other herb teas; beer prepared with medicinal
vegetable substances unsuitable for the patient‟s state; so-called fine liquors
made with medicinal spices; all kinds of punch; spiced chocolate; odorous
waters and perfumes of many kinds; strong-scented flowers in the apartment;
tooth powders and essences and perfumed sachets compounded of drugs; highly
spiced dishes and sauces; spiced cakes and ices; crude medicinal vegetables for
soups; dishes of herbs, roots and stalks of plants possessing medicinal qualities;
old cheese, and meats that are in a state of decomposition, or that passes
medicinal properties (as the flesh and fat of pork, ducks and geese, or veal that
is too young and sour viands), ought just as certainly to be kept from patients as
they should avoid all excesses in food, and in the use of sugar and salt, as also
spirituous drinks, heated rooms, woolen clothing next the skin, a sedentary life
in close apartments, or the frequent indulgence in mere passive exercise (such
as riding, driving or swinging), prolonged suckling, taking a long siesta in a
recumbent posture in bed, sitting up long at night, uncleanliness, unnatural
debauchery, enervation by reading obscene books, subjects of anger, grief or
vexation, a passion for play, over-exertion of the mind or body, especially after
meals, dwelling in marshy districts, damp rooms, penurious living, etc. All these
things must be as far as possible avoided or removed, in order that the cure may
not be obstructed or rendered impossible. Some of my disciples seem needlessly
to increase the difficulties of the patient‟s dietary by forbidding the use of many
more, tolerably indifferent things, which is not to be commended.
§ 260 Fifth Edition footnote, Organon of Medicine

71

MAINTAINING CAUSE
The factor which leads to occurrence, continuation and progress of the
disease should be first eliminated. Prolonged standing and lack of physical
exercises are the maintain cause for the persistence of varicose vein. In cases
where the maintaining factor has progressed the disease beyond a limit, then
even after the removal of the maintaining cause, the effect still persists as
pathological alternation, this cannot be reversed back to normal without the
administration of medicinal agent.
“Hence the careful investigation into such obstacles to cure is so much
the more necessary in the case of patients affected by chronic diseases, as their
diseases are usually aggravated by such noxious influences and other diseasecausing errors in the diet and regimen, which often pass unnoticed.”
§ 260 Fifth Edition

“Because the organism is endowed with either a faculty of provisionally
supplementing to a limited extent one stimulus by another, or with a kind of
elasticity,- a power of enduring for a certain time a disturbance of equilibrium
of these stimuli, and of rebounding to normal performance of function again so
soon as the natural proportion of the stimuli is restored or the deficiency made
up….
But, in the organism this elasticity has its limits. This
“vismedicatrixnaturae” is not inexhaustible. If the due proportion of the stimuli
remain too long disturbed, the functions of the organism become permanently
deranged –at least, to such an extent, that no restoration of the balance of the
stimuli will cause a return to their normal performance. The functions are and
remain deranged –disease has occurred; or, if we choose to call every direction
from a state of equilibrium disease, then we may say that now disease ensues
has no tendency to revert to health without the intervention of some extraneous
in Substance foreign to the organism and different from the general stimuli
aforesaid.”
Homoeopathy the science of therapeutics By C. Dunham

72

OBSERVATION AND FOLLOW UP
As far as homoeopathic method of treatment is concerned, a homoeopath
should use his intellect and discrimination more in the observation and
determining the curative effect of medicine in the follow up rather than
selection of medicine in the first visit.
The physician should have the clear idea regarding when to repeat or
change the medicine, when to change the potency and most importantly when to
wait to finish the action of previous medicine.
After the first prescription physician should observe and note down
1.
2.
3.
4.
5.

Which of the symptoms got ameliorated
Which one of the previous symptoms disappeared
Whether there is aggravation of previous symptoms
Whether there is appearance of old symptoms
Or appearance of new symptoms

Signs of improvement in a case after the administration of a Similimum
1. An improvement in the state of mind and disposition.
2. No appearance of any, unusualsymptoms [new symptoms].
3. Diminution of old symptoms or none of the old symptoms are
worse.
The state of aggravation in the patient is apprehended if he points out
some fresh accidents and a symptom of importance even though he might assure
his physician that he feels better.
Hahnemann's Observation
But should we find, during the employment of the other medicines in
chronic (psoric) diseases, that the best selected homoeopathic (antipsoric)
medicine in the suitable (minutest) dose does not affect an improvement, this is
a sure sign that the cause that keeps up the disease still persists, and that there
is some circumstance in the mode of life of the patient or in the situation in
which he is placed, that must be removed in order that a permanent cure may
ensue.
Aphorism 252,Organon of Medicine by Samuel Hahnemann

73

Amongthesignsthat,inalldiseases,especiallyinsuchasareofanacutenature,i
nformusofaslightcommencementofameliorationoraggravationthatisnotperceptibl
etoeveryone,thestateofmindandthewholedemeanourofthepatientarethemostcertai
nandinstructive.Inthecaseofeversoslightanimprovementweobserveagreaterdegre
eofcomfort, increasedcalmnessandfreedomofthemind,higherspiritsakindofreturnofthenaturalstate.Inthecaseofeversosmallacommencementofaggra
vationwehave,onthecontrary,theexactoppositeofthis:aconstrained,helpless,pitiab
lestateofthedisposition,ofthemind,ofthewholedemeanour,andofallgestures,postur
esandactions,whichmay be
easilyperceivedoncloseobservation,butcannotbedescribedinwords.
Aphorism 253,Organon of Medicine by Samuel Hahnemann

Butevenwithsuchindividualswemayconvinceourselvesonthispointbygoing
withthemthroughallthesymptomsenumeratedinournotesofthediseaseonebyone,an
dfindingthattheycomplainofnonewunusualsymptomsinadditiontothese,andthatno
neoftheoldsymptomsareworse.Ifthisbethecase,andifanimprovementinthedispositi
onandmindhavealreadybeenobserved,themedicinemusthaveeffectedpositivedimi
nutionofthedisease,or,ifsufficienttimehavenotyetelapsedforthis,itwillsooneffectit.
Now,supposingtheremedyisperfectlyappropriate,iftheimprovementdelaytoolongi
nmakingitsappearance,thisdependseitheronsomeerrorofconductonthepartofthep
atient,oronthehomoeopathicaggravationproducedbymedicinelastingtoolong(aph
orism157),consequentlyonthedosenotbeingsmallenough.
Aphorism 255,Organon of Medicine by Samuel Hahnemann

Ontheotherhand,ifthepatientmentiontheoccurrenceofsomefreshaccidentsa
ndsymptomsofimportancesignsthatthemedicinechosenhasnotbeenstrictlyhomoeopathiceventhoughheshouldgoodnaturedlyassureusthathefeelsbetter,[„asisnotinfrequentlythecaseinphthisicalpati
entswithlungabscess‟intheSixthEdition] we
mustnotbelievethisassurance,butregardhisstateasaggravatedasitwillsoonbeperfe
ctlyapparentitis.
Aphorism 256,Organon of Medicine by Samuel Hahnemann

74

DR. KENTS OBSERVATION
 In the follow up if there is long time aggravation followed by
amelioration of the symptoms and slow improvement then it indicates
marked pathologically advanced case. In case of valvular incompetency
in perforator veins complicated to venous ulcers , deep vein thrombosis
and in case of secondary varicose vein due to mechanical pressure from
tumors of pelvis[when no venous cause was identified], the period of
aggravation will be longer but general improvement in health in the
curable cases will be manifested .
 If the aggravation is quick, short, and strong with rapid improvement,
then it indicates that the choice of medicine was exactly correct
[similimum]. But the potency selected was slightly higher than needed.
This observation is specifically seen when there no secondary cause
behind varicose vein and case pertain to only venous cause [primary
varicose vein].
 If there is no aggravation at all, and rapid, gentle and permanent cure of
the patient occurs. Then it indicates that the choice of remedy and the
potency was exactly correct. This is the ideal homoeopathic cure which
occurs mainly in functional disorders without any tendency to organic
disease. This observation may be seen in C0 stage of varicose vein or that
develop due to the morphological factor [prolonged standing] .
 If the amelioration occurs in the first 3 or 4 days followed by aggravation,
then it indicates that the medicine selected was only partially similar.
Medicine selected was similar to most pronounced symptom but don‘t
cover the whole case. In such case retake the whole case, consider the
general symptoms of the patient and select the similimum according to
the present totality. This is also seen in pathological advanced
complicated case of varicose vein where palliation is only possible.
 If the amelioration is too short followed by aggravation immediately after
administration of remedy, then it indicates the interference with the action
of remedy by the patient unconsciously or deliberately and intentionally.
Or this observation is seen when the action of the remedy on the vital
force is exhausted. Amelioration is too short in cases of varicose
veinwere pathological changes have taken place.
 In some cases there may be appearance of old symptoms, or the
symptoms which was suppressed in the past, or symptoms of any

75

condition maltreated in the past, or appearance of any symptoms that you
have enquired in the history of past illness. If such old symptom appears
in the follow-up visit then this indicates the cure is going in the correct
direction and the remedy selected was exactly similimum covering the
root constitution or the miasm of the patient. Sometimes the whole case
becomes clear after appearance of the previously suppressed skin
symptoms.

FOLLOW UP BY ANTIMIASMATIC MEDICINE

A patient who has recovered from an acute disease by the use of these
non-antipsoric medicines, should never be regarded as cured; on the contrary,
no time should be lost in attempting to free him completely, by means of a
prolonged antipsoric treatment, from the chronic miasm of the psora, which, it
is true, has now become once more latent but is quite ready to break out anew;
if this be done, there is no fear of another similar attack, if he attend faithfully to
the diet and regimen prescribed for him.
Concept extracted fromAphorism 222

76

CASE DISCUSSION
CASE 1
NAME OF THE PATIENT
AGE/SEX
OCCCUPATION
ADRESS
I.P. NO:
DATE

Alphonsa
38 years/female
House hold job
Kottiyam
624
9-12-2014

PRESENTING COMPLAINTS
1. Ulcer in the inner aspect of left leg above the ankle( 2 months)
With burning pain and edema around the ulcer.
Associated with itching
< night , movement
>rest
HISTORY OF PRESENTING COMPLAINTS
1. The complaint started 5 months before; took homoeopathic treatment,
got relief. But the ulcer reopens 2 months back. Took allopathic
treatment got no relief. Now the ulcer becomes large and painful. Now
under homoeopathic treatment.
HISTORY OF PAST ILLNESS
1.
2.
3.
4.
5.

Varicose vein -5 years back – Allopathic treatment
Chicken pox – childhood – Homoeopathic treatment
Measles - childhood – Homoeopathic treatment
Intestinal ulcer – 12 years back - Homoeopathic treatment
Fibroid uterus – 7 years back-- Hysterectomy

FAMILY HISTORY
NP
PERSONAL HISTORY
PLACE OF BIRTH
Kottiyam
EDUCATION
OCCUPATION
MARITALSTATUS
HABITS AND
HOBBIES

5th standard
Housemaid
Un married
Nonvegetarian

SOCIAL STATUS
RELIGION
ECONOMIC STATUS
NUTRITIONALSTATUS

Middle
class
Christian
BPL
Moderate

77

PHYSICAL GENERALS
APPETITE
Good (desire warm
food)
THIRST
Good
SLEEP
Decreased due to pain
in leg
REACTION
TO
CONSTIT
UTION
PSYCHIC
FEATURES

Desire fanning
Lean thin emaciated

URINE

NP

BOWELS
SWEAT

Regular
Generalized

THERMAL
REACTION
SIDE
AFFINITY

Hot patient
Left side

MENSTRUAL HISTORY

Menarche – 13 years
Hysterectomy done 7 years before
due to hysterectomy

OBSTETRIC HISTORY

Nil

REGIONALS
Head ache < reading books
Heart burn < after eating banana, peas
PHYSICAL EXAMINATION
Built : well
Temperature :Afebrile
built
Respiratory rate :14/mit
Gait :steady
Pulse rate: 72/mit
No pallor
B.P- 130/82mmHg
Not cyanotic
Not icteric
No clubbing

78

SYSTEMIC /LOCAL EXAMINATION
EXAMINATION OF ULCER
INSPECTION
Position : Medial aspect of left leg above medial malleolus
Size: 2 cm
Shape
: Circular
Number :1
Swelling :Present
Discharge : Absent
Edge : Irregular
Floor : Infiltrated
PALPATION
Temperature : Absent
Tenderness :Present
Edge :Irregular
Base :No induration
Depth : 0.5 mm
Bleeding : Absent
Surround area of skin : Normal
INVESTIGATIONS
ESR = 25 mm/hr
Hemoglobin = 11.5g/dl
FBS=78 mg%
S . Cholesterol = 160mg %
Analysis (pathological)

PROVISIONAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS

FINAL DIAGNOSIS
TOTALITY OF SYMPTOMS
Fastidious
Desire fanning
Hot patient
Left side affinity

Ulcer on the the left leg above medial
malleolus
Associated with pain
Varicose ulcer
Traumatic ulcer
Malignant ulcer
Trophic ulcer

79

Prefer warm food and drinks.
Sleep decreased due to pain
Ulcer in the inner aspect of left leg above the ankle.
Burning pain
Associated with itching
<night
>rest
MIASMATIC EXPRESSION-syphiliyicmiasm
MANAGEMENT AND TREATMENT
ACCESSORY MANAGEMENT
Avoid standing still for long periods of time.
Avoid applying any external application on the ulcer. Keep the area of ulcer
clean and hygiene
Lie down with ankles raised above chest level for at least half an hour
Take moderate exercise
Avoid being over weight
BASIS OF PRESCRIPTION
Burning pain
Prefer warm food and drinks.
Sleep decreased due to pain
Ulcer in the inner aspect of left leg above the ankle.
Pain <night
REMEDY –
Rx
Arsenic Album 200 /1Dose.

FOLLOW UP
Date
20-12-14

Analyse
relief

28-12-14

Slight pain

Remedy
Rx
Sac lac
Rx
Arsalb 200/1 dose

80

CASE 2
NAME OF THE PATIENT
AGE/SEX
OCCCUPATION
ADDRESS
I.P. NO:
DATE

Jagadeshwaran
42 years / Male
Stationary shop owner
Thirunalveli
815/40154
11-3-2015

PRESENTING COMPLAINTS
1.Pain and swelling of right leg (1 week)
Associated with tiny vesicles
Stitching type of pain
< walking , standing , hanging the legs
>rest , keeping leg straight in the bed

HISTORY OF PRESENTING COMPLAINTS
Complaint started as swelling of leg with vesicle since 3 weeks. He took
homoeopathic treatment and got slight relief. Now complaints aggravated 3
days back after taking non vegetarian food items.

HISTORY OF PAST ILLNESS
1. RTA-3 years before.
2. Ear complaint-1year back.-- Allopathic treatment
3. Recurrent attack of Sneezing and Cold
4. Breathing difficulty-6 years –Allopathic treatment
5. Assault attack in jaw -14 years back –Plastic surgery

FAMILY HISTORY
Father: DM
Mother: RA

81

PERSONAL HISTORY
PLACE OF BIRTH
Chennai
EDUCATION
+2
OCCUPATION
Stationary
shop owner
MARITAL
Married,
STATUS
have 2
children

PHYSICAL GENERALS
APPETITE
Good (prefer
warm food)
THIRST
Decreased
[ Prefer warm
drinks]
SLEEP
Decreased

REACTION TO

THERMAL REACTION
CONSTITUTIONAL
PSYCHIC FEATURES

SOCIAL STATUS
RELIGION
ECONOMIC
STATUS
NUTRITIONAL
STATUS

Middle class
Hindu
APL
Moderate, Non
vegetarian.

URINE

NP

BOWELS

Regular

SWEAT

Increased all
over the body.

Desire Sweets.
Desire non-vegetarian food
Body feels hot.
Desire Cold climate
< hot climate
Hot Patient
Memory week
Desire Company
Easily angered.

REGIONALS
Breathing difficulty occur recurrently on exposure to cold season leading to
wheezing
Tongue-moist

82

PHYSICAL EXAMINATION
Built-well built
Temperature: Afebrile
Gait- Steady
Pulse rate: 70/ min
No pallor
B.P- 130/80mmHg
Not cyanotic
Not icteric
No clubbing
Edema present in Right lower leg.
No lymphadenopathy
SYSTEMIC /LOCAL EXAMINATION
EXAMINATION OF VARICOSE VEIN
INSPECTION
Varicose vein: slight dilatation on the medial side of the leg starting from in
front of the medial malleolus to the medial side of the right thigh
Swelling :present in right leg
Skin of the limb: evidence of inflammation present
Reddish discoloration,
Edema present
Two Small circular vesiclesruptures and oozing pus
PALPATION
Tenderness present in calf
Brodie-Trendelenburg test—Positive
Morrisey‖s Cough Impulse Test-Positive
ASCULTATION: murmur absent
REGIONAL LYMPH NODES: lymphadenopathy present
EXAMINATION OF ABDOMEN
No palpable mass
no abdominal lymphadenopathy

INVESTIGATIONS
14- 3 -2015
ESR: 30 mm/ hr
Urine sugar: NIL
RBC: 5.52×106 /µl
Platelet: 440×103 /µl
FBS: 75 mg %
S.cholestesol- 167 mg %
Triglyceride :163mg%
HDL :28mg %
LDL: 106 mg %
VLDL :33mg %

83

Doppler study of Right lower limb
Impression:
Right inguinal lymphadenopathy
Arteries of Right lower limb are normal
No hemodynamically significant stenosis or occlusion seen.
Saphenopopliteal junction is incompetent
Focal varicosities of tributaries of great saphenous vein at anterior medial leg
due to perforator in-competence.
Focal varicosities of tributaries of short saphenous vein at mid calf, lateral leg
due to perforator and Saphenopoplitealjunctionincompetence. All deep Vein
are patent.
PROVISIONAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS

Varicose vein
TAO
Phebitis

FINAL DIAGNOSIS
TOTALITY OF SYMPTOMS
Hot patient,
Desire sweets.
Pain and Oedema of Right leg.
< hanging legs.
> Keep leg in elevated position
MIASMATIC EXPRESSION-Trimiasmatic
MANAGEMENT AND TREATMENT
ACCESSORY MANAGEMENT
Avoid standing still for long periods of time.
Avoid applying any external application on the ulcer. Keep the area of ulcer
clean and hygiene
Lie down with ankles raised above chest level for at least half an hour
Take moderate exercise
Avoid being over weight
BASIS OF PRESCRIPTION
Oedema in right leg
Thirsty during complaint

84

REMEDY –
Rx
Apis 30/1dose

FOLLOW UP
Date
Analyse
26-3-2015
30-3 2015

Odema subsided but pain in legs
when hanging
Pain>

6-4-2015

Slight pain

29-4-2015

Relief
Itching in skin
Anti-miasmatic remedy

Remedy
Rx
Pulsatilla 200/1 Dose.
Rx
SacLac/1 dose
Rx
Pulsatilla1M/1 dose
Rx
Sulphur 1M/1Dose

85

CASE 3
NAME OF THE PATIENT
AGE/SEX
OCCCUPATION
ADRESS
O.P.NO.
DATE

Thambi
68 years/male
Engineer
Neyyattinkara
1560
18-4-2015

PRESENTING COMPLAINTS
1. Diatated vein on both leg (since 7-8 years)
More in the left leg
2. Pain in soles of both feet (since ) .
< raising from sitting position ,
>walking
HISTORY OF PRESENTING COMPLAINTS
Diatated vein in leg started since 7 -8 years, he took no treatment and used to
apply ayurvedic oil and got slight relief.
Known DM, since 35 years and used to take Allopathic medicine.
HISTORY OF PAST ILLNESS
1. Measles – childhood – homoeopathic treatment
2. Mumps - childhood – homoeopathic treatment
3. Recurrent stye – 16 years – homoeopathic treatment – cured
4. Bleeding piles – 65 years – ayurvedic treatment
5. Cataract in both eye – 2005 and 2008 --surgery
FAMILY HISTORY
DM – father ,mother and brother
RA – father , mother
CAD -- brother
PERSONAL HISTORY
PLACE OF
Neyyattinkara
SOCIAL
Middle class
BIRTH
STATUS
EDUCATION
Graduate
RELIGION
Hindu
OCCUPATION Engineer
ECONOMIC
Above poverty line
STATUS
MARITAL
Married (have 2
NUTRITIONA Moderate
STATUS
daughters )
L STATUS
Non vegetarian
HABITS AND
Farming ,
ADDICTIONS Smoking since 30
HOBBIES
gardening
years ;5 cigar/day
Tea ,5 times /day

86

PHYSICAL GENERALS
APPETITE Good
THIRST
Increased (desire cold
drink, large quanties at
2-3 hour intervel)
SLEEP
Good

REACTION TO

THERMAL REACTION
CONSTITUTIONAL
PSYCHIC FEATURES

URINE
BOWELS

Frequent urination
Regular

SWEAT

Generalized

DREAMS

Conflicts, anxious
dreams

Desire fanning ,
Intolerance cold climate
Complaints < cold climate
Desire sore and pungent food.
Hot patient
Lean thin,robust ,firm muscular fiber
Angry disposition < contradiction
Helping ,Emotionally sensitive
Sentimental ,Punctual ,Extrovert

REGIONALS
1. Dimness of vision
2. Hypo-pigmentation in the nape of neck, axilla and chest.
3. Cracks in both soles
4. Low back ache < night , lying on abdomen
>rest , lying on back
5. Head ache on left side < mental tension, night watching.
6. Sneezing and running nose < dust
7. Tooth ache, caries of crown of the of lower left molar teeth.
8. Warts on left hip , itching < after bathing

PHYSICAL EXAMINATION
No pallor
Afebrile
Not cyanotic
B.P-120/80 mmHg
Not icteric
No clubbing
No lymphadenopathy
SYSTEMIC /LOCAL EXAMINATION

87

EXAMINATION OF VARICOSE VEIN
INSPECTION
Varicose vein:seen on the medial side of the leg starting from in front of the
medial malleolus to the medial side of the thigh
Swelling :localized blow outs along the course of varicose vein
Skin of the limb: no evidence of inflammation
no discolouration,
no scar , no eczema
PALPATION
Brodie-Trendelenburg test—Positive
Morrisey‖s Cough Impulse Test-Positive
ASCULTATION
murmur absent
REGIONAL LYMPH NODES:No lymphadenopathy
EXAMINATION OF ABDOMEN
No palpable mass
no abdominal lymphadenopathy

INVESTIGATIONS
FBS: 150 mg %

PROVISIONAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS

Varicose vein
TAO
Thrombophebitis

FINAL DIAGNOSIS
TOTALITY OF SYMPTOMS
Angry disposition
< contradiction
Desire pungent food
Thirst increased
Desire cold drinks
Diatated vein on both leg
More in the left leg
Pain in soles of both feet.
< raising from sitting position ,
>walking
Hypo-pigmentation in the nape of neck, axilla and chest.

88

Cracks in both soles
Low back ache< night
> lying on back
Head ache on left side < mental tension, night watching.
MIASMATIC EXPRESSION-SycoticMiasm
MANAGEMENT AND TREATMENT
ACCESSORY MANAGEMENT
Avoid standing still for long periods of time.
Lie down with ankles raised above chest level for at least half an hour
Take moderate exercise
Avoid being over weight
Elastic crepe bandage – stockings -30-40mm Hg
Elevation of limbs -Above the level of heart
Graded compression stockings
BASIS OF PRESCRIPTION
MIND - ANGER,irascibility - contradiction,from
STOMACH - DESIRES - cold drinks
EXTREMITIES - VARICES , - Lower Limbs
BACK - PAIN - night.
HEAD - PAIN, - mental exertion, - from
EXTREMITIES - CRACKED skin, - Feet - heel
REMEDY –
Rx
NuxVom/30/1Dose
FOLLOW UP
Date
22-4-2015

Analysis
relief

Remedy
Rx
Sac lac

89

CASE4
NAME OF THE PATIENT
AGE/SEX
OCCCUPATION
ADRESS
I.P. NO./O.P.NO.
DATE

Santhakumari
50 years/ female
Business
Nedumangad
16/93024
9-4-2015

PRESENTING COMPLAINTS
1. Painful ulcer on medial aspect of the left leg(since 5 days)
Discoloration of skin
< hanging the leg, walking, fanning
>rest
HISTORY OF PRESENTING COMPLAINTS
1. Complaints started 3 years back, took allopathic medicineand got
temporary relief, then took homoeopathic treatment,and complaint
relived but now aggravated since 3 days .Ulcer first in the lateral
aspect of the leg, then on the medial side.
HISTORY OF PAST ILLNESS
1. Heart complaint – 4-5 years – allopathic medication
2. Nephrectomy –done for transplantation.
FAMILY HISTORY
NR
PERSONAL HISTORY
PLACE OF
Thiruvananthapuram SOCIAL
BIRTH
STATUS
EDUCATION
Nil
RELIGION
OCCUPATION
Business
ECONOMIC
STATUS
MARITAL
Married
NUTRITIONAL
STATUS
STATUS
HABITS AND
HOBBIES

DOMESTIC
RELATIONS
SEXUAL
RELATIONS

Middle
class
Hindu
APL
Good
Non vegetarian
Good

90

PHYSICAL GENERALS
APPETITE
Good (desire
cold food)
THIRST
Good
SLEEP
Good
REACTION TO

THERMAL REACTION
CONSTITUTION
PSYCHIC FEATURES

URINE

NP

BOWELS
SWEAT

Regular
Generalized

Aversion covering
Desire fanning
Desire cold food
Desire spicy food
Intolerance hot climate
Hot patient
Offended easily
Anxiety about others

MENSTRUAL HISTORY

Menarche – 14 years
Age of menopause :45 years

OBSTETRIC HISTORY

G3P2L2A1

REGIONALS
Dilated vein in both leg
Tongue: moist
PHYSICAL EXAMINATION
Built: moderate
Gait: Steady
Complexion: Dark
No pallor
Not cyanotic
Not icteric
No clubbing
Swelling: NIL
Rashes: NIL
No lymphadenopathy
Nail: Paranoychia

Temperature: Afebrile
Pulse rate: 72/min
Respiratory Rate: 14 /min
B.P-130/90mmHg

91

SYSTEMIC /LOCAL EXAMINATION
Examination of ULCER
Inspection
Number: Two
Location: Above medial malleolus of left leg
Shape: Round
Border: Regular
Surrounding Skin: Blackish discoloration
Discharge: Nil
Floor
: Reddish granulation tissue present
Palpation
Tenderness: Present++
Base: Round
Temperature: local rise in temperature.

INVESTIGATIONS
T3-0.8mg /ml
T4-7.92mg/dl
TSH. 3.94/ 10µ/ml
PROVISIONAL DIAGNOSIS
DIFFERENTIAL DIAGNOSIS

Varicose ulcer in left leg
Traumatic Ulcer
Arterial Ulcer.

FINAL DIAGNOSIS
TOTALITY OF SYMPTOMS
Anxious about others
Offended easily
Hot patient
Prefer Warm drinks
Desire Spicy food
Ulcer on medial side of left leg <fanning
Varicose Vein on both leg.
MIASMATIC EXPRESSION-syphilitic
MANAGEMENT AND TREATMENT
ACCESSORY MANAGEMENT
Avoid standing still for long periods of time.
Avoid applying any external application on the ulcer. Keep the area of ulcer

92

clean and hygiene
Lie down with ankles raised above chest level for at least half an hour
Take moderate exercise
Avoid being over weight
BASIS OF PRESCRIPTION
Offended easily
Hot patient
Desire spices
Painfulvaricose ulcer
REMEDY –
Rx
LACHESIS 200/1 dose

FOLLOW UP
Date
14- 4 -2015

Analyse
Pain in ulcer+

18-4-2015

Pain >

Remedy
Rx
HeparSulphur 200/1Dose
Rx
Sac Lac/2Dose

93

CASE5
NAME OF THE PATIENT
AGE/SEX
OCCCUPATION
ADRESS
O.P.NO.
DATE

Nusaiba
57 years/female
House wife
Ambalathara
31688
20-4-2015

PRESENTING COMPLAINTS
1. Dilated vein in both legs (Since 3-4 years)
Burning pain, Hot sensation in both feet as Coals of fire
Blow outs present
Associated with blackish discoloration in the lower part of both legs
with intense itching
2. Bleeding from vagina 3 years after menopause (Since 3 years)
associated with pain in left groin.
HISTORY OF PRESENTING COMPLAINTS
1. Dialated veins in both legs started during her 3ed pregnancy and
aggravated since 3-4 years. She used to have recurrent ulcers and skin
abscess in the lower part of the legs. She use to apply allopathic
ointment when there is active ulcer and gets temporary relief.
2. Post-menopausal bleeding started since 3 years. She consulted in W and
C. Under went D and C. Advised for regular follow up and test Pap
smear once in every year.
HISTORY OF PAST ILLNESS
FAMILY HISTORY
Fibroid uterus: Sister
Hypertension: Mother, Father.
CAD: Mother
PERSONAL HISTORY
PLACE OF
TVPM
BIRTH
EDUCATION
Nil
OCCUPATION
House Wife
MARITAL
STATUS

Married, have 3
children

SOCIAL STATUS

Low class

RELIGION
ECONOMIC
STATUS
NUTRITIONAL
STATUS

Muslim
BPL
Moderate

94

PHYSICAL GENERALS
APPETITE Good

URINE

THIRST

Increased (desire cold
drinks)

BOWELS

SLEEP

Decreased

SWEAT

REACTION TO

THERMAL REACTION
CONSTITUTION
PSYCHIC FEATURES

Has to wait to pass
urine
Hard stool, difficult to
pass stool frequent
urging to pass stool.
Increased + +

Hot Patient.
Desire to lie on cold floor.
Desire sour,
Pungent, Salt
Hot patient + +
Delicate, obese, fair complexion
Mental tension about children
Financial Problem

MENSTRUAL HISTORY

Menarche- 13 years.
Menopause -52 years
Post-menopausal bleeding since 3 years
Duration : 7 days
Associated with pain in left groin
Leucorrhea –Pale Yellow discharge

OBSTETRIC HISTORY

G3P3L3A0
Varicose vein duringpregnancy.
Measles during 3ed pregnancy.
3erd child is congenitally deformed

PHYSICAL EXAMINATION
No pallor
Not cyanotic
Not icteric
No clubbing
No lymphadenopathy

Afebrile
B.P-160/90mmHg

95

SYSTEMIC /LOCAL EXAMINATION
EXAMINATION OF VARICOSE VEIN
INSPECTION
Varicose vein: seen on the medial side of the both leg starting from in front of
the medial malleolus to the medial side of the thigh
Swelling :localized blow outs along the course of varicose vein
Skin of the limb: eruptions in the lower aspect of both leg
With blackish discoloration in the lower 1/3 of both leg
Small abscess in the medial aspect of the foot
PALPATION
Brodie-Trendelenburg test—Positive
Morrissey‘s Cough Impulse Test-Positive
ASCULTATION: murmur absent
REGIONAL LYMPH NODES: No lymphadenopathy
EXAMINATION OF ABDOMEN
Distended abdomen

INVESTIGATIONS
Ultra Sound Scan Abdomen and Pelvis
Balk uterus with endometrial growth 5.2 cm X 2.5 cm filling the cavity.
Renal Calculi left kidney, Fatty liver and Fatty Abdomen.
Left kidney -2 calculi 4 mm x 2mm and 2mm X 2 mm
Left ovary-Cyst
PROVISIONAL DIAGNOSIS
Varicose Vein
Endometrial CA
DIFFERENTIAL DIAGNOSIS
FINAL DIAGNOSIS

TOTALITY OF SYMPTOMS
Mental tension about children
Hot Patient.
Desire to lie on cold floor.
Desire sour,
Pungent, Salt
desire cold drinks
Dilated vein in both legs

96

Burning pain, Hot sensation in both feet as Coals of fire
blackish discoloration in the lower part of both legs
Post-menopausal bleeding
MIASMATIC EXPRESSION- Syphilitic Miasm
MANAGEMENT AND TREATMENT
ACCESSORY MANAGEMENT
Avoid standing still for long periods of time.
Avoid applying any external application on the eruption. Keep the area of
eruption clean and hygiene
Lie down with ankles raised above chest level for at least half an hour
Take moderate exercise
Avoid being over weight
BASIS OF PRESCRIPTION
Mental tension about children
Hot patient
Desire sore
Pungent food
Hot sensation in both feet as coals of fire
Blackish discoloration
Post-menopausal bleeding
REMEDY –
Rx
1.Lachesis 200/ 1 Dose
FOLLOW UP
Date
20/902014

Analysis
relief

Remedy
Rx
Sac lac

97

CONCLUSION
Homeopathy works very well for mild to moderate cases of varicose
veins. But treatment should be started at the earliest to cure it completely.
Medicines should be administered after proper analysis of the disease (nature
and origin) and sufferings.It helps to reduce pain, control further varicosity,
reduces swelling. It also helps significantly in the cases which have varicose
ulcers. The remedies often help to relieve discomfort that comes with varicose
veins, and may help to prevent their worsening.
Time taken for complete cure of the varicose vein depends on the stage of
the disease. So the diagnosis of the different stages of the varicose vein and
deciding the plane of treatment is very important. Recurrence rate can be
reduced by long term systematic and regular follow up with miasmatic and
constitutional remedy.
Alone with medicinal administration, general management and removal
of the maintaining cause is very important. Reference of the case complicated
with DVT at the correct time also needs to be appreciated as it may prevent life
threatening situations like pulmonary embolism or MI.
A physician high and only mission is to restore the patient to health, to
permanent cure. A physician should excel in the knowledge of the disease, its
maintaining cause and also the knowledge of medicine, dose, potency to be
administered, and its repetition, he is then the true practitioner of the healing art.
AUDAE SAPERE

Dr.SHARY KRISHNA.B.S.

98

BIBLIOGRAPHY
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

Bailey and Love‘s short practice of surgery, by Rains , Mann, 20th edition
A Concise Text book of Surgery –S. Das
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Borger Boenninghausen‖s characteristics and repertory
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Repertory of the homoeopathic MateriaMedica – J.T.Kent.
Allen‘s keynotes
Leaders in Homoeopathic therapeutics – Dr.E.B. Nash
Pocket manual of Homoeopathic materiamedica and repertory –William
Boericke
Organon of Medicine by Samuel Hahnemann
Organon of Medicine by Samuel Hahnemann , Introduction and
commentary on text by B.K. Sarkar.
Ruddock‖s Homoeopathic Vade-Mecum-by E.Harris Ruddock .M.D
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A Dictionary of Practical MateriaMedica- Clarke
ComparativeMatericaMedica –E.A. Farrington
The genius of homoeopathy, lectures and essays on homoeopathic
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INTERNET SOURCES
 file:///C:/Users/user/Downloads/varicoseveinsvishnu-120323090133phpapp01%20(2).pptx
 file:///C:/Users/user/Downloads/varicoseveinpptthu-130104093204phpapp01%20(1).ppt
 file:///C:/Users/user/Downloads/V%20V%20(1).ppt

99

 file:///C:/Users/user/Downloads/Varicose_Veins.ppt
 file:///C:/Users/user/Downloads/skaptanisvaricoseveins12554111412036-phpapp03.ppt
 file:///C:/Users/user/Downloads/advancesinvaricoseveintreatment-2100208151253-phpapp01.pptx
 file:///C:/Users/user/Downloads/whichvaricoseveinpatientsneedtreatment150319051243-conversion-gate01.pptx
 file:///C:/Users/user/Downloads/varicoseulcers-110423131514phpapp01.docx
 http://s3.amazonaws.com/ppt-download/managementofvaricoseveins121117234803-phpapp01.pptx?response-contentdisposition=attachment&Signature=4UmCgL2sdQZmD0YRpMnHPRN3
IIg%3D&Expires=1427003415&AWSAccessKeyId=AKIAIA7QTBOH2
LDUZRTQ
 http://faculty.ksu.edu.sa/73895/Documents/V%20V.ppt
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Standing at work and varicose veins
by Tüchsen F, Krause N, Hannerz H, Burr H, Kristensen TSThis article in
PubMed: www.ncbi.nlm.nih.gov/pubmed/11103840
 Assessment of Venous Insufficiency in Patients with Chronic Venous
Leg Ulcers.VenousHemodynamics before and after Surgery
Akademiskavhandling
 Risk factors for chronic ulceration in patients with
varicose veins: A case control study
Lindsay Robertson, BSc,a Amanda J. Lee, BSc,b Karen Gallagher,
BN,c Sarah Jane Carmichael, BSc,c
Christine J. Evans, MBChB,d Brian H. McKinstry, MBChB,a Simon
C. A. Fraser, MBChB,c Paul L.
Allan, BSc,a David Weller, MBChB,a Charles V. Ruckley, MB,aand
Francis G. Fowkes, MBChB,a
Edinburgh and Aberdeen, United Kingdom