Hygeia journal for drugs and medicines


Editorial - Phytotherapy of Chronic Venous Insufficiency

        Phytotherapy of Chronic Venous Insufficiency


                 Head, R&D,CARE keralam Ltd, KINFRA Small Industries Park, Nalukettu Road, Kerala, India.680309.


  Chronic venous insufficiency (CVI) is primarily a vascular diseasecharacterized by insufficient blood flow, edema and heavy legs. It is a resultof age, lifestyle and obesity. As functional valves are required to provide forefficient blood return from the lower extremities, CVI often occurs in veins ofthe legs. Itching is a common symptom, along with hyper pigmentation of legs.Symptoms also include phlebetic lymphoedema and chronic swelling of legs. Thereis also increased risk of ulcers and cellulites.The description of varicose veins as a clinical entity can be traced backas early as the fifth century B.C. The ancient physicians Hippocrates and Galendescribed the disease and treatment modalities, which are still used today. It was Hippocrates whorecommended bandaging to treat it.
  Physical training is considered thebest therapy. However, many older patients are limited in this respect.Compression stockings and diuretics may provide some relief, but their effectis only symptomatic. Topically applied creams and ointments give short-termrelief to itching of inflammation. There is no convincing orally administered syntheticdrug that can cure CVI.
  Nevertheless, many herbal medicineshave the ability to cause considerable reduction in the severity of the disease.Extract of the seeds of the horse chestnut is used traditionally to treat CVI.Escin, the major component of the extract inhibits the catalytic breakdown ofcapillary wall proteoglycan.  More than adozen clinical trials show that the extract is effective in improving objectivesymptoms like pain and leg volume.
  Japanese pagoda tree (Styphnolobium japonicum) contains highamount of the flavonoid rutin, which has significant antioxidant property.Oxerutin improves symptoms of CVI stages I and II. The therapeutic effect ofoxerutin persists even after the cessation of the treatment. Rutin derivatives(fagorutin) isolated from buck wheat (Fagopyrumesculentum) are also good alternatives.
  Extract of red wine leaf (Vitis vinifera folium) is rich in flavonoides,offering therapeutic benefit to patients of CVI.  The extract administered once daily in 360 mgor 720 mg doses significantly reduces edema and circumference of the lower leg.

 Extract of the french maritime pine bark (Pinus maritima)  is shown tobe effective in improving resting  flux,rate of ankle swelling and edema .
  Ayurveda does not describe CVI asa distinct disease entity and experienced traditional physicians consider it asvatarakta, and variants of ulcers. Nevertheless,modern researches have shown that the ayurvedic herb Centella asiatica has remarkable ability to cure CVI. The totaltriterpene fraction of C.asiatica hasbeen found to be effective in CVI and varicosities by improvingmicrocirculation and metabolic activity of the vascular and perivascularconnective tissue.

   In addition to its variedbeneficial biochemical effects, the fraction positively influences lymphaticfunction in patients with lymphatic and post-phlebetic oedema. Many clinical studiescarried out with the extract report that it is a venoactive substance which mayact on different phases of CVI and slow down the development of the degenerativeprocess of the venous system associated with CVI.

Dr.D.Sureshkumar MSc, PhD
Head,R&D, CARE keralam Ltd, KINFRA Small Industries Park, Nalukettu Road,Kerala, India.680309.


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