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As the name suggests, varicose veins refer to veins that have become enlarged, twisted, or even knotted into clusters, bulging out from the skin surface. They are more common in the lower limbs but can occur elsewhere, such as hemorrhoids in the anus (which are also a type of varicose vein) or varicose veins under the tongue. This article primarily discusses those in the legs.

According to surveys, approximately 20% to 60% of the adult population has visibly noticeable varicose veins, with the prevalence sharply increasing in middle-aged and elderly populations. Modern medicine has identified the following common contributing factors:

• Hereditary and Congenital Factors: (1) If parents have varicose veins, their children have a higher probability of developing them. (2) Congenital weakness or absence of venous valves.
• Women are affected due to hormonal changes, such as during pregnancy, menopause, or from oral contraceptives/hormone therapy, which cause excessive relaxation of the venous walls. Additionally, increased blood volume during pregnancy and pressure from the uterus on pelvic veins collectively lead to a significant rise in venous pressure in the lower limbs. The likelihood of women developing varicose veins is about 2:1 to 3:1 higher than in men.
• Prolonged Standing or Sitting: Occupations requiring long periods of standing (e.g., teachers, nurses, retail clerks) or prolonged sitting (e.g., office work, long flights) impair venous return from the legs, keeping them under sustained high pressure.
• Obesity: Excess weight increases the burden on the lower limbs and raises intra-abdominal pressure, hindering blood return.
• Others: Deep vein thrombosis, chronic constipation, chronic cough, trauma, liver cirrhosis, heart disease, lack of exercise, or a preference for wearing overly tight clothing.

Varicose veins caused by other diseases or strong family predisposition are beyond the scope of this article.

The local factors causing veins to enlarge and twist are primarily related to excessive venous pressure, akin to blowing up a balloon. The main reasons include:

• The vein wall itself is too soft or has weakened elasticity, allowing even slight pressure to distend it. This is common in the elderly, those with weak constitutions, or those with chronic illnesses.
• Venous valve insufficiency. Major veins have valves preventing backflow (Figure 1). If these valves are congenitally defective or damaged/deformed, gravity when upright can cause blood meant for the heart to flow backward (reflux), increasing venous pressure. Valves that were originally functional can also become insufficient due to the vein dilating from varicosity.
• Insufficient cardiac pumping force or heart valve insufficiency. The heart is the power source for systemic blood flow. If heart function is compromised, venous return is poor, leading to increased venous pressure.

Varicose veins not only affect appearance; because circulation in the affected area is poor, severe cases can lead to local inflammation, pigmentation, and even ulceration. Severe blood stasis within the veins can also form thrombi (clots), blocking the vein. If a clot travels to the lungs, it can cause a pulmonary embolism.

Western Medicine Primarily Focuses on Alleviating Symptoms and Appearance

Varicose veins are essentially a systemic issue. However, Western medical treatments mainly aim to eliminate the varicose veins, improve appearance, and relieve local discomfort.

• Wearing compression stockings: Increases the return flow of deep venous blood and supports the expanded vein walls.
• Sclerotherapy injection: Injecting a sclerosing agent into the varicose vein causes it to become fibrotic, shrink, and eventually turn into a tough fibrous tissue without a lumen.
• Vein stripping: Uses surgery to remove the varicose veins from the leg.
• Endovenous laser therapy: A laser fiber is introduced into the varicose vein, and the laser burns the varicose section, causing it to dry, harden, and close.

These methods can effectively eliminate existing varicose veins, improve appearance, and alleviate discomfort. However, their goal is not to fundamentally alter the root cause of varicose veins from a constitutional perspective.

The Holistic View of Traditional Chinese Medicine

Ancient medicine did not have the name "varicose veins," but there was a similar term — "Tendon Lumps", meaning twisted, bluish veins on the legs clustered like tumors. Traditional Chinese medicine (TCM) views its fundamental pathogenesis as "Root Deficiency and Manifestation Excess".

• Root Deficiency: The "Root" refers to the "foundation" or "essence" of the body; "Deficiency" signifies low energy or lack of vital substances. The patient's constitution is generally weak, or their vitality hasn't recovered after a major illness, leading to overly soft venous tissue. For such patients, venous pressure considered normal for others can cause their veins to bulge and become varicosed. Furthermore, according to modern physiology, the pressure in the major veins returning to the heart depends on the heart's pumping ability. If the heart is strong, the pressure in the great veins is low, and vice versa. If a patient's heart is relatively weak, termed "Heart Qi Deficiency" in TCM, venous return is slower, pressure is higher, and varicose veins are more likely.
• Manifestation Excess: The "Manifestation" refers to the "affected area" or branch. "Excess" reflects blockage and stagnation of Qi and Blood in the affected area, or inflammation and swelling. The patient's blood circulation is poor, with many microcirculatory blockages. Even if the heart pumps normally, blood flow slows down in the veins, increasing pressure. After 40-50 years of use, most bodies begin to accumulate metabolic waste, and blockages in the circulatory system become more apparent. Worsening dark circles under the eyes, localized skin turning dull, and increased age spots are all signs of deteriorating circulation. If combined with high blood sugar or high blood lipids, the blood becomes more viscous, circulation worsens further, making varicose veins more likely.

Older adults often have some degree of cardiovascular degeneration and stasis, along with potentially high blood sugar/lipids and poor circulation, so they typically exhibit both Deficiency and Excess patterns, termed "Deficiency-Excess Complex" in TCM. Chronic disease patients are similar to the elderly, also presenting with a "Deficiency-Excess Complex." In younger, stronger individuals caused by heavy lifting or prolonged standing/sitting, the "Excess" pattern is more dominant, with less "Deficiency."

For Deficiency, it must be tonified. Those with Qi Deficiency or a weak heart should be strengthened with TCM Qi-Tonifying Medicinals. If weak venous walls are due to lack of nourishment from blood, belonging to Blood Deficiency, Blood-Tonifying Medicinals can be used to replenish it. For other various types of deficiency, TCM has suitable Tonic Medicinals to help patients recover their strength.

For the Excess pattern — poor circulation, Qi and Blood stasis — Blood-Activating and Stasis-Dispelling or Softening Hardness and Scattering Nodules medicinals should be used to resolve stasis throughout the body, improve overall circulation, and reduce venous pressure.

After systematic TCM treatment, patients with varicose veins will not only see healthy improvement in the varicosities but also experience improvement in pre-existing issues like poor energy, fatigue, and susceptibility to aches and pains. Due to improved blood circulation, even complexion will become better, and age spots may reduce or disappear—truly "killing two birds with one stone" or "getting two things done at once".

Chinese Medicine External Therapies

Acupuncture: Directly stimulates points on the legs to achieve the goal of activating blood and unblocking collaterals.

Bloodletting Therapy: For patients with severe local blood stasis, dark purple coloration, or accompanied by swelling and pain, a three-edged needle or lancet can be used to prick the varicosed vessel or surrounding area for bloodletting. This allows "stagnant blood to be removed and new blood to regenerate," quickly relieving swelling and pain.

Herbal Wash/Steaming: Using herbs that activate blood, dispel stasis, and warm the channels (such as Safflower, Mugwort, Cinnamon Twig, Clematis Root, etc.) decocted into a liquid, then used to wash or steam the affected limb while hot, promoting local blood circulation.

Tuina Massage and Daoyin: Using specific massage techniques, pushing and pressing from the ankle towards the thigh to assist venous return.

Summary

Chinese medicine treats varicose veins holistically, considering the whole person. Through pattern differentiation, it analyzes the patient's constitutional characteristics to create a personalized treatment plan. It uses internal herbs to regulate the body's overall Qi and Blood state, combined with external methods like acupuncture, bloodletting, and tuina to directly address the affected area. This alleviates symptoms, prevents complications, and shrinks the varicosities. Mild cases may even have the hope of returning to normal.

However, for veins that are already excessively dilated, twisted, deformed, or have lost valve function, the treatment goal shifts to reducing their size, eliminating pain, preventing further deterioration, and preventing complications. While completely eliminating their appearance is difficult, it can significantly improve quality of life.

Prevention is better than cure. Usually avoid prolonged sitting or standing; moderate activity and walking can help venous blood return and reduce venous pressure. Don't wait until veins are truly varicosed before seeking treatment. At the slightest sign, immediately seek TCM conditioning—it will definitely prevent it from worsening. Even newly emerging varicose veins can immediately "stop the decline and rebound".