INTRODUCTION
On this page we talk about venous insufficiency in the lower limbs which causes the appearance of varicose veins of the leg or thigh and venous disorders in the anus and rectum, anal hemorrhoids.
A LITTLE ANATOMIC REMINDER
The blood is propelled by the cardiac “pump” in our arteries, they divide into multiple small, very fine vessels, the capillaries.
These capillaries irrigate our entire body and then extend into a network of new, increasingly larger vessels, the veins which drain venous blood, depleted in oxygen and loaded with substances from metabolism, towards the heart.
The volume of the venous network is greater than that of the arterial network for two reasons: the veins have extensible walls and the venous return to the heart is slower, almost passive.
When we are standing, the veins of the lower limbs support the “weight” of the blood which must “rise” towards the heart. To allow and facilitate this venous circulation against a pressure gradient, the veins have small non-return valves, and the large veins located inside the muscular masses of the calf and thigh are compressed and undergo variations in the muscular pressure that propels blood upward.
However, there is also a superficial venous network which can swell abnormally (varicose veins) when the physiological anti-return mechanism does not work well and the walls of the veins are weakened.
At the level of the anal sphincter there is a well-developed venous network which can swell and become inflamed when abdominal pressure increases or in cases of inflammatory colitis (e.g. pregnancy, chronic constipation, repeated physical exertion, irritable bowel, colitis), then appear external hemorrhoids.
Other causes that can cause ruptures or inflammation of the veins in the internal part of the anal sphincter are internal hemorrhoids.
CLASSIC TREATMENT of VARICOSE VEINS and HAEMORROIDS
Western medicine combines:
- TREATMENT WITH MEDICINES mainly based on plant extracts.
- HYGIENO-DIETETICAL MEASURES:
monitoring your weight, slimming diet,
controlling possible diabetes,
treatment of constipation,
avoiding the abuse of pepper or chili peppers,
regular physical exercise, walking, swimming, not sitting for too long,
avoid pants that are too tight, and shoes that block blood circulation (especially boots that are too tight-fitting)
control body position when resting: sleep or rest with legs slightly elevated - CONTAINMENT OF DILATED VEINS: compression stockings, elastic fabric strips,
- Suitable SURGICAL TREATMENTS such as sclerosis of dilated veins or their ablation or that of large dilated superficial venous vessels (saphenous vein).
SPECIAL TREATMENT OF COMPLICATIONS: acute inflammation, hemorrhage, skin ulcer, associated trophic disorders.
PHYTOTHERAPY VARICOSE HAEMORROIDS VENOUS AND LYMPHATIC INSUFFICIENCY
WHAT PLANTS OR PLANT EXTRACTS are used in cases of VARICOSE VEINS, venous and lymphatic insufficiency of the lower limbs or HEMORROIDS?
FLAVONOIDS
These are very numerous compounds and present in all plants.
Let us cite those which are the most interesting for “protecting” or “strengthening” the walls of blood vessels:
RUTOSIDES (rutoside (or rutin)),:
Particularly present in rue (ruta) but also in non-toxic medicinal or food plants, examples:
blackcurrant, blueberry, onion, wild pansy, certain parts of buckwheat, sophora buds japonica (toxerutin), ginkgo leaves.
HESPERIDIN and DIOSMINE present in the external (colored) part of the peel of citrus fruits (the zest) and certain membranous parts of the interior of the fruits (orange, grapefruit, lemon).
COUMARINES
These compounds with a sweet and penetrating odor are present in many plants or seeds.
In herbal medicine, the use of MELILOT extracts (melilotus officinalis and related species) is recommended.
But coumarin or coumarin compounds are found in other common plants: corn husk, the root of sweetgrass (a variety of quackgrass), lavender.
Coumarin is used at low doses, it seems to promote lymphatic drainage and can thus reduce edema of the lower limbs due to venous stasis and poor venous circulation.
SAPONOSIDES or SAPONINS
These compounds present in many plants resemble soaps in their foaming property but have many other pharmacological or toxicological effects (hemolytic, anti-cancer, very toxic, particularly for fish).
Extracts from the underground parts of Ruscus aculeatus and other related species are very rich in medicinal saponins.
The bark and fruit of the HORSE CHESTNUT contain saponins (aescin or escin), a coumarin compound (aesculoside) and medicinal flavonoids.
The extracts of these plants increase venous tone, limit lymphatic exudation and have anti-inflammatory properties.
VEGETABLE TANNINS AND COLORANTS
Certain proanthocyanidol tannins (also called proanthocyanidolic oligomers) and anthocyanin pigments (which are part of the flavonoids), have numerous medicinal properties, notably anti-inflammatory, and act as protectors of blood vessels (small and large).
The list of plants containing these compounds is long, let us cite a few:
- Grapes whose leaves and fruits are very colorful (the RED VINE) , wines and very colorful grape juices coming from different grape varieties with high phenolic content and very colorful (notably malbec (=cot) and tannat, syrah, grenache ).
- Well-colored fruits: the different species of BLUEBERRY , cranberry, BLACKCURRANT , red-fleshed cherry, RASPBERRY , redcurrant, plums, “PISTAS” from the tropics , black-fruited aronia.
- Certain nuts or almonds: WALNUT , hazelnut, almond, pecan.
- But also certain legumes: common bean.
- Medicinal plants such as Virginia hazel: Hamamelis virginiana, certain rosaceae (examples BRAMBLE).
CONDUCT OF TREATMENT of varicose veins and hemorrhoids
VENOUS INSUFFICIENCY OF THE LOWER LIMBS AND HAEMORROIDS ARE “CHRONIC” PROBLEMS which, even after surgery, must be monitored and treated for a long time.
HYGIENO-DIETETIC MEASURES
The treatment first involves the “hygieno-dietary” measures described above.
THEY ARE FUNDAMENTAL.
GENERAL TREATMENT, by mouth
Phytotherapy treatment generally combines several plant extracts, but we can also use an extract from a single plant which may be sufficient to strengthen venous tone.
Medicines are found in pharmacies or drugstores which generally combine several plant extracts.
They have proven themselves even if for some time now this class of drugs has no longer been reimbursed by health insurance.
EXAMPLES OF PHYTOMEDICINES (non-limiting list):
Ginkor fort (Ginkgo, heptaminol, toxerutin),
Cyclo3 fort (ascorbic acid, Fragon, Hesperidin methylchalcone),
Daflon (flavonoids),
Diosmin,
Esberiven fort (sweet clover, rutoside),
Veinobiase (ascorbic acid , broom, hesperidin methylchalcone),
Histofluin (anemone, Pasteur’s purse, esculoside, witch hazel, horse chestnut)
Difrarel (carotene, blueberry),
Endothelon (grape (procyanidolic oligomers)),
and standardized PLANT EXTRACTS OR PLANT POWDER CAPSULES:
(sweet clover, horse chestnut, witch hazel, Ruscus, blackcurrant, red vine).
For the dosage of these phytomedicines or these plant extracts, follow the instructions of the manufacturer laboratory, the quantities of active substances varying depending on the medicines or preparations.
CHESTNUT EXTRACT
A word about CHESTNUT INTRAIT P especially used to treat hemorrhoids.
Its marketing was stopped then resumed, it is sometimes difficult to find but a laboratory offers a modified version: THE CHESTNUT INTRAIT “S”, a food supplement which combines extracts of the horse chestnut and extracts of grape seeds.
DOSAGE for these two chestnut extracts:
100 to 150 drops distributed two or three times during the day, courses of at least one month, regularly renewed.
ETHANOLIC TINCTURE, GLYCERINE MACERATION
We find in pharmacies and on the internet homeopathic tinctures, alcoholic tinctures or glycerinated macerations of buds of the main venotonic plants mentioned above which can be combined together (but without mixing them).
EXAMPLES: successive one-month cures with 15 days of therapeutic break (to be repeated at least 6 times):
Alcoholic blackcurrant tincture 30 to 50 drops in the morning,
Alcoholic tincture of sweet clover 30 to 50 drops at lunchtime,
Alcoholic tincture of ruscus 30 to 50 drops in the evening.
You can also use only one plant for extended treatment:
EXAMPLES:
- Glycerinated maceration of blackcurrant buds (Ribes nigrum) in first decimal place (1D): 50 drops 3 times a day for a one-month course, regularly renewed.
- Or homeopathic tincture of Hamamelis virginiana: 50 to 100 drops two to three times a day as a one-month course, repeated after stopping treatment for 15 days.
- Or homeopathic tincture of Ruscus aculeatus: 100 to 150 drops per day in two to three times.
INFUSION
We can also use certain venotonic plants in infusions:
EXAMPLES:
Infusion of chestnut bark (bark of small branches (diameter 1 to 4 cm) dry and divided), a teaspoon in a cup of very hot water, infuse for 15 minutes. one to two cups per day, stop in case of secondary constipation.
Infusion of blackcurrant leaves or bramble leaves: prepared like tea.
LOCAL TREATMENT associated with other classic treatments previously mentioned
Some examples of local treatments to treat or support the treatment of varicose veins and external hemorrhoids:
Gels or sprays containing venotonic and anti-inflammatory plant extracts (gingko, horse chestnut, cypress) can be found in pharmacies.
Apply to varicose areas or swollen legs using a gentle massage from the bottom to the top of the legs and thighs to facilitate venous return.
DO NOT USE in case of varicose ulcer or eczema patches due to varicose veins.
Application for 1/4 hour of a compress soaked in tincture of venotonic plant on the most important varicose veins
(be careful of the possibility of a change in skin color).
Application for 1/4 hour of a compress soaked in an aqueous infusion of chestnut bark on external hemorrhoids.
a traditional non-drug remedy for hemorrhoidal crisis or inflammation of a varicose vein: alternate a cold bath and a moderately hot bath of the leg or anal region, duration approximately 10 to 15 minutes for each bath. Repeat this treatment by alternating temperature twice a day until the inflammatory symptoms disappear.
COMPLICATIONS OF VARICOSE VEINS OR HAEMORROIDS
HEMORRHOIDAL CRISIS
External hemorrhoids can become swollen, inflamed and painful; leading to significant discomfort when defecating or even sitting still.
The hemorrhoidal crisis can calm down without treatment in a few days or become complicated: rupture (hemorrhage) of the hemorrhoid, formation of a blood clot (thrombosis) which will progress to sclerosis and leave flabby folds on the margin of the anus .
The thrombosed hemorrhoidal bundle can be large and very painful requiring surgical intervention (excision under local anesthesia).
THE CLASSIC DRUG TREATMENT of HAEMORROID CRISIS:
- general non-steroidal anti-inflammatory drugs (NSAIDs) of the type used for joint pain, for example,
- local anesthetic or anti-inflammatory treatment with a cream based on a corticosteroid or containing a local anesthetic.
- possibly an oral painkiller.
USE OF PLANT EXTRACTS:
Warm sitz bath to which we add:
a tablespoon of ethanolic tincture of black currant leaves, or hazelnut leaves, or horse chestnut bark,
or concentrated infusion of plants with medicinal tannin (example: bramble leaves, raspberry leaves, rose bush leaves) ; proportions, a handful of leaves per liter of very hot water).
TROPHIC CUTANEOUS DISORDERS, ECZEMA AND VARIOUS ULCERS
Poor blood circulation, venous stasis and the accompanying edema weaken the skin and subcutaneous tissue which are poorly irrigated and asphyxiated.
The skin of the legs becomes very fragile, thins, changes color (ochre dermatitis).
An itchy inflammatory skin reaction (eczema) may develop.
All it takes is a small wound, a shock, or scratching lesions for an ulcer to develop, very often in the ankle region or near the front of the leg.
This ulcer has great difficulty healing, again because of poor venous blood circulation and lymphatic exudate.
Sometimes it becomes infected, which delays healing even further.
THE TREATMENT OF THIS VARICOSE ULCER IS BOTH GENERAL AND LOCAL.
The GENERAL TREATMENT is that of varicose veins (hygiene-dietary measures + venotonic extracts, surgery), carefully check that there is no diabetes, if so, control the diabetes.
LOCAL TREATMENT:
Careful cleaning of the ulcer to avoid secondary infection and leave only the tissues alive.
Try to recreate a favorable environment first for the budding of subcutaneous tissues then for healing (reappearance of an epidermis).
“Modern” dressings such as duoderm are very effective, but they are expensive and not accessible in all countries, so medicinal plant extracts can be used.
MEDICINAL PLANTS AND VARICOUS ULCER
CENTELLA ASIATICA, hydrocotyl or gotukola has long been known for its healing qualities.
This small plant from warm countries can be used both orally and locally.
The local route is the most effective in cases of varicose ulcer: cream or ointment with 1 to 2% Centella asiatica extract applied daily.
In the absence of these preparations: daily application of sterile gauze soaked in a decoction of Centella asiatica (gotukola), a handful of plant for one liter of water, boiling for 10 minutes.
ALOE VERA and related species:
the central part of the aloe leaf or aloe gel can be useful to promote tissue budding and healing of a chronic ulcer by applying directly to the wound or by soaking in sterile gauze.
TANINS and medicinal phenolic substances:
In the case of a very oozing and inflamed ulcer, we can try to reduce the oozing by applying a gauze soaked in tannins:
Sterile aqueous extracts (decoction) of bark or roots or leaves:
EXAMPLES:
Mango tree bark, chestnut or chestnut bark.
Coconut palm roots.
Guava leaves, kinkeliba leaves , banana sap, bramble leaves or other rosaceae (agrimony), horsetail, etc.
ESSENTIAL OILS:
Because of the fragility of the skin and the risk of an allergic type reaction, we are not in favor of the use of essential oils in cases of trophic disorders or varicose ulcers except when there is obvious surinfection (use of tea tree essential oil).
COSMETIC AND SOFTENING VEGETABLE OILS, VEGETABLE BALM:
Applying a vegetable oil to weakened skin can be useful but you must be careful because all vegetable oils (and balms) contain potentially allergenic substances which can aggravate the situation ( especially in cases of eczema).
Try it first on a small part of the leg for a few days.
No oil or oily balm directly on ulcers.
It must be remembered that a leg ulcer is healed in a local “humid” environment which alone allows the budding of the subcutaneous tissue and the return of healthy skin, keeping a deep leg ulcer “dry” delays his healing.
Copyright 2024: Dr Jean-Michel Hurtel
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PHYTOTHERAPY, MEDICINAL PLANTS, AROMATHERAPY, ESSENTIAL OILS