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Varicose veins, as the name suggests, refer to the enlargement, twisting, and even knotting of veins, which may bulge out from the skin surface. They are more common in the lower limbs but can also occur elsewhere, such as hemorrhoids in the anus, which are also a type of varicose veins, and varicose veins under the tongue.

The local factor causing the enlargement and twisting of veins is excessive venous pressure, much like inflating a balloon, which expands the veins. Further reasons include:

• The vein's own texture being excessively soft, making it easily expandable under slight pressure, which is common in individuals with weak constitutions or prolonged illnesses.
• Incompetent venous valve membranes. Large veins have valve membranes to prevent backflow (Figure 1). If these membranes are congenitally inherited or damaged and deformed, the venous blood that should flow towards the heart can easily backflow under the force of gravity when standing, increasing venous pressure. Even if the valve membranes were originally good, varicose veins and the enlargement of the vein diameter can also lead to valve incompetence.
• Insufficient cardiac propulsion or incompetent heart valve membranes. The heart is the source of blood flow throughout the body. If the heart has problems, venous return is poor, and venous pressure increases.

Varicose veins are more prevalent in the elderly, those who sit or stand for long periods, obese individuals, or pregnant women. Some cases are due to trauma, liver cirrhosis, heart disease, or family genetics, which are not within the scope of this discussion. Varicose veins not only affect appearance but also, due to poor circulation in the affected area, can lead to local inflammation, pigmentation, and even ulceration in severe cases. Severe venous stasis can also form thrombi, blocking the veins, and if the thrombus drifts to the lungs, it can cause pulmonary embolism.

Varicose veins are indeed a systemic issue, but modern medicine treatments only address the symptoms:

• Wearing compression stockings: This is the most "ostrich-head-in-the-sand" treatment. The leg veins are already swollen and enlarged due to high pressure and poor circulation. Putting tight compression stockings on the legs doesn't make the leg circulation worse? Has anyone considered that the heart's output pressure will greatly increase? The leg's poor circulation will degenerate faster?
• Sclerotherapy injection: Injecting a sclerosing agent into the varicose veins to harden the blood vessels. Indeed, hardened blood vessels won't varicose anymore...
• Vein stripping: Directly removing the varicose veins from the leg. Without veins, there certainly won't be varicose veins anymore...
• Endovenous laser treatment: Inserting a laser gun into the vein to burn the varicose area, making it dry, hard, and closed, indeed preventing varicose veins, with a strong sense of technology...

In Traditional Chinese Medicine (TCM), this disease can be divided into deficiency and excess aspects:

• Deficiency pattern: The patient's constitution is weak, or the original qi has not recovered after a major illness, making the vein tissue too soft. The venous pressure that is normal for ordinary people can cause the veins of such patients to bulge and varicose. Additionally, according to contemporary physiology, the pressure of the large veins returning to the heart depends on the heart's ability to pump blood. If the heart is strong, the pressure in the large veins is low, and vice versa. If the patient's heart is weak, TCM calls it "heart qi deficiency," which slows the return of venous blood, increases pressure, and easily leads to varicose veins.
• Excess pattern: The patient's blood circulation is poor, with many blockages or obstructions in the microcirculation. Although the heart pumps normally, the blood flow slows down and the pressure increases when it reaches the veins. After 40 to 50 years of use, the average person's body begins to accumulate metabolic waste, and the blockages in the circulatory system become increasingly apparent. Symptoms such as darkening of the eye circles, localized skin turning dull, and an increase in dark spots are all signs of worsening circulation. If high blood sugar or high blood lipids are also present, the blood becomes thicker, circulation worsens further, and varicose veins are more likely to occur.

In elderly individuals, the heart and blood vessels often show a certain degree of degeneration and stasis, with high blood sugar and blood lipids, and poor blood circulation. Therefore, both deficiency pattern and excess pattern are present, which in TCM is referred to as "deficiency/excess in complexity." Patients with chronic diseases are similar to the elderly, also exhibiting "deficiency/excess in complexity." In middle-aged individuals, conditions caused by heavy lifting, prolonged standing, or sitting are more likely to be "excess pattern," with less "deficiency pattern."

Deficiency should be supplemented. For those with qi deficiency and weak heart, they should be strengthened with qi tonic of Chinese medicinals; if the weak static vessel is due to lack of blood nourishment and belongs to blood deficiency, it can be replenished with blood tonic; for other various deficiencies, there are suitable tonics in TCM that can restore the patient's strength.

For excess pattern, poor circulation, and qi blood stasis obstruction, Blood-Invigorating and Stasis-Resolving or Blood-Stasis-Breaking to Resolve Mass medicinals should be used to dissolve stasis throughout the body, improve overall circulation, and reduce venous pressure.

Patients with varicose veins, after systematic treatment with TCM, will not only see healthy improvement in the varicose veins but also improvement in poor mental and physical strength and susceptibility to soreness, because the improvement in blood circulation will even make the complexion look better, and dark spots will reduce or disappear. It truly is "killing two birds with one stone" or "killing two birds with one stone, catching clams while washing pants."

Prevention is better than cure. Usually, avoid sitting or standing for long periods, moderate activity and walking can help venous blood return and reduce venous pressure. Do not wait until the veins are really varicose to think about treatment. At the slightest sign, immediately seek TCM for recuperation, and it will definitely not continue to worsen. Even the initial varicose veins can immediately stop falling and rise again.