Treatment of Varicose Veins with Individualized Homoeopathic Medicine - A Case Report

Introduction

Varicose veins are the dilated, tortuous veins often visible beneath the skin's surface. They represent a prevalent vascular condition affecting a significant portion of the population globally.¹ While primarily a cosmetic concern for some, varicose veins can manifest with symptoms ranging from mild discomfort to severe pain and complications such as venous ulcers. Conventional treatments for varicose veins include compression stockings, lifestyle modifications, and surgical interventions such as, vein stripping or laser therapy.² However, these approaches may not always provide satisfactory outcomes or may be unsuitable for certain individuals due to contraindications or personal preferences.

In recent years, there has been growing interest in complementary and alternative therapies for the management of varicose veins, among which homeopathy has garnered attention. Homeopathy is a system of medicine based on the principle of "like cures like" and individualized treatment tailored to each patient's unique symptomatology, constitution, and overall health profile. Despite skepticism in some medical circles, homeopathy has maintained a significant following and is often sought out by individuals seeking holistic and personalized approaches to health care.³

This case report aimed to document the efficacy of individualized homeopathic medicine in the treatment of varicose veins through an evidence-based approach. By presenting a detailed clinical case and outcomes, we seek to contribute to the growing body of literature exploring alternative therapies for varicose veins and to provide insights into the potential role of homeopathy in this context. Through a comprehensive evaluation of symptoms, treatment response, and patient-reported outcomes, we aim to elucidate the therapeutic benefits and safety profile of homeopathic treatment for varicose veins. Additionally, this report underscores the importance of personalized medicine in addressing the diverse needs and preferences of patients with varicose veins, offering a nuanced perspective on holistic care options beyond conventional interventions.

Case Presentation

Preliminary data

On June 20, 2022, a 42-year-old male of Hindu Maratha faith, married, residing in Jawan Quarters, Shubhash Nagar, belonging to the middle-income socioeconomic stratum, educated upto the middle school reported to the department.

History of presenting illness

The individual was experiencing discomfort characterized by inflammation and swelling of the veins in the left lower leg region, extending from the calf to the tip of the toe, persisting for the past year. Additionally, the patient had been experiencing troubling pain in the right leg for the past six months. Furthermore, the patient reported experiencing abdominal pain following meals.

Details of presenting complaints

The individual has been enduring discomfort in the left lower leg region for the past one year, with pain in the right lower leg noted six months ago. The pain was primarily localized in the calf muscle on the lateral side and near the big toe region. Additionally, there was noticeable swelling of veins in the calf region, extending downwards to the midpoint of the fibula region, along with swelling near the dorsal pedis artery. The onset of these symptoms was sudden. The pain exacerbated with prolonged standing or physical activity, and alleviated with warmth and on lying down.

Life space investigation

The patient was born and raised in a middle socioeconomic status family, and he was the only child without any siblings. The patient lost his father in the Kargil war, and was raised alone by the mother. After a few years, mother passed away due to illness, after which he was taken care by his paternal grandmother. He was reported to frequently become angry over the smallest issues and occasionally got into fights; he also didn't seem to care who he was confronting. He was noted to be extremely forgetful and had difficulty remembering things, causing him to struggle socially. He was usually involved in travel, which he enjoyed the most. He disliked being alone, with fear of darkness, and always preferred to be with someone, even when travelling. He completed his schooling with a lot of effort. Suddenly, he married his uncle's daughter at the request of his paternal grandmother, which resulted in the suppression of his enjoyments and beginning of responsibilities. Furthermore, there was no assistance from his family. After marriage, there were some minor troubles in his life, which prompted him to work and he chose to pursue a career as a cook. The patient has two children who are in school and lives in a nice home. The paternal grandmother, who was close to him and influenced him throughout his life, died unexpectedly of a heart attack when he was 40 years old. Following a year after the paternal grandmother's death, the complaint of varicose has begun.

Personal history

• Appetite- Good
• Diet- Mixed
• Sleep- Disturbed due to pain
• Dreams- N.S
• Thirst- Thirsty, drinks a lot of water, approx. 3 lit/day 
• Micturition- 4-5 t/day, 2-3 t/night 
• Stools - Two times a day, non-satisfactory

Personal history

• Thermal- Hot
• Desires- N.S 
• Aversion- N.S 
• Perspiration- Profuse on slightest exertion, generalised. 
• Habit- No habits

General physical examination 

• Built & Nourishment- Lean & thin and well nourished
• Hair- Black, evenly distributed
• Eyes:- Conjunctiva- pink, Sclera- white
• Ears- No discharge
• Nose- No Deviated Nasal Septum (DNS), no polyps
• Tongue- Clean, pinkish, and moist.

Vital signs

• Temperature- 97.1 °F
• Pulse- 78 b/min
• R/R- 18 r/min
• Height- 173 cm 
• Weight- 63 kg

Systemic examination

• RS- Breath sound vesicular, no rales, no rhonchi
• CVS- S1 S2 heard rhythmically
• CNS- Conscious and oriented
• GIT- Soft, bowel sounds heard
• Locomotor- Swelling of veins in right lower leg at the site of calf muscles
• Swelling of veins in left lower leg region
• Location- Medial side of calf muscles and big toe region. Swelling present in veins in calf region extended to mid of fibula region.

Differential diagnosis

• Saphenous vein varicosity
• Varicose veins
• Femoral artery aneurysm

Final diagnosis

Varicose Veins Grade 3

Analysis of symptoms

Mental generals

• Restlessness
• Bored easily
• Weak memory
• Likes to travel 
• Adamant 
• Disobedient 
• Rebellious
• Fear of being alone
• Fear of darkness
• Fear of animals such as dogs and cats.

Physical generals 

• Likes milk 
• Thirsty
• Profuse perspiration on slightest exertion 
• Hot patient

Particulars

• Involuntary urination at night
• Pain and swelling of veins in the left leg calf region. 
• Varicose veins in generals
• The pain exacerbates with prolonged standing or physical activity but alleviates with warmth and on lying down.

Evaluation of symptoms

• Mental General: Grade 1 - Restless, gets bored easily, likes to travel, adamant, disobedient, rebellious, fears being alone. Has fear of darkness, fears animals like dogs and cats.
• Grade 2- Weak memory
• Physical Generals: Desires milk, feels thirsty, profuse perspiration on slightest exertion, hot patient.
• Particular Generals:

Grade 1: Thirst- Thirsty, drinks a lot of water, approx. 3 lit/day

Grade 2: Involuntary urination at night

• Pain and swelling in veins in the left leg calf region.
• Varicose veins in generals.
• The pain exacerbates with prolonged standing or physical activity, but alleviates with warmth and on lying down.

Miasm: Predominantly Psoric Miasm

Totality of symptoms

• Mental General
• Restlessness
• Bored easily 
• Likes to travel
• Adamant
• Disobedient
• Rebellious
• Fear of being alone
• Fear of darkness
• Fear of animals like dogs and cats

Physical Generals 

• Desires milk
• Thirsty
• Profuse perspiration on slightest exertion
• Hot patient

Particular Generals

• Thirst- Thirsty, drinks a lot of water, approx. 3 lit/day
• No hypertension/ diabetes mellitus present.

Repertorial Totality (Figure 1)

• Mind] Anger, irascibility: Tendency:
• [Mind] Quarrelsome, scolding: 
• [Mind] Contrary: Parents, with: 
• [Mind] Disobedience: Children, in:
• [Mind] Travel: Desire to:
• [Mind] Memory: Weakness, loss of: 
• [Mind] Desires: Change, always:
• [Generalities] Restlessness, physical:
• [Mind] Fear: Alone, of being: 
• [Stomach] Thirst: Large quantities, for: 
• [Perspiration] Profuse. 
• Extremities: Varices: calf

Prescription remedy: RX

1. SULPHUR 30 water dose, 4-0-0 alternate days, early in the morning for six days.
2. SAC Lac 15 days 4-0-4.
3. PL LIQ with coconut oil application, external on legs, twice a day application.

• Follow up - 21/10/2022 after 20 days

Restlessness under control

Rest all complaints remained the same

Prescription -

R^X

1. SULPHUR 30 water dose 4-0-0 - Three days, alternate days.

2. SL LIQ with coconut water.

• 2nd follow up– 1/11/2022 after 20 days

Swelling of varicose veins decreased

All other complaints showed improvement.

Prescription- Placebo 4-4-4 for one week.

SAC LAC liquid with coconut oil, external application.

• 3rd follow up - 17/11/2022 after 15 days

• Condition showed improvement

• Swelling reduced

• Itching reduced

Prescription- SAC LAC liquid with coconut oil, external application on legs.

Placebo 4-0-4

4th follow up - 23/11/2022 after six days, patient visited on his own.

Sudden itching of varicose veins

Varicose veins extended to lower knee region on left side

Varicose in general appeared swollen

Prescription-

1. Sulphur 30 water dose 4-0-4 for six days

2. SAC LAC LIQ with coconut oil, external application on legs.

• 5th follow up - 05/01/2023 after one month.

Patient felt better and was late for the follow up, his complaints reduced.

Prescription- PL 4-0-4 for two weeks

• 6th follow up – 18/1/23 after 15 days

Patient felt better, no fresh complaints were noted, no swelling was noted.

Prescription- PL 4-0-4 for one week

Patient’s varicose veins reduced from grade 3 to grade 1. He was recommended to wear stockings while standing and performing work and to remove when resting. He was advised to use a pillow while sleeping to keep his legs elevated for better blood circulation and to avoid eating potatoes and brinjal in preference for green leafy vegetables, from the beginning of treatment.

Discussion

This case report presents a comprehensive overview of a middle-aged male patient who reported with discomfort in the lower extremities along with abdominal pain. The analysis included detailed history, physical examination, differential diagnosis, evaluation of symptoms, miasmatic analysis, reportorial totality, and treatment progression through homeopathic remedies. The presenting complaints of discomfort in the left lower leg, pain in the right leg, and abdominal pain following meals suggest a multifaceted clinical picture. The physical examination revealed swelling and inflammation of veins in the lower extremities, particularly the left leg, along with other general observations such as profuse perspiration and hot patient constitution.

The patient's personal and family history provided additional context, indicating a history of familial illnesses and traumatic events like the father's demise in the Kargil war and loss of both parents at an young age. These aspects could potentially contribute to the patient's mental and emotional state.

The reportorial analysis highlights several mental and physical symptoms, including restlessness, memory weakness, thirst, fear of being alone and of darkness, desire for travel, and disobedience. These symptoms, when correlated with the miasmatic analysis, predominantly suggest a Psoric Miasm. Based on the totality of symptoms, the prescription of Sulphur 30 in water doses along with supportive measures like Sac Lac and external application of PL LIQ with coconut oil on the legs was initiated. Subsequent follow-ups revealed gradual improvement in the patient's condition, with reduction in swelling, itching, and overall discomfort.

However, during the course of treatment, there were instances of aggravation of symptoms, such as sudden itching and extension of varicose veins to the lower knee region, which necessitated adjustments in the treatment plan. Despite these challenges, the patient's overall progress seemed positive, with a reduction in complaints and improvement in general well-being. The discussion of this case emphasized the holistic approach of homeopathy, where individualized treatment based on the patient's unique symptomatology and constitutional makeup was employed. It also underscores the importance of regular follow-ups and flexibility in treatment protocols to address evolving symptoms and ensure optimal therapeutic outcomes.

A case study on the effects of customized homoeopathic treatment on varicose veins by Sayani Ghosh, Atanu Ghosh, Dr. Jaharlal Barman, and Dr. Mayurakshimaitra indicates individualized and comprehensive homoeopathy is a kind of medication.⁴ It does not just cure the symptoms, but also takes care of the patients holistically. According to its "Similia Similibus Curentur" principle, varicose vein treatment significantly improved. Additionally, this case provides documented evidence that conservative, non-invasive therapy methods using homeopathic medications can effectively treat surgical disorders like varicose veins. However, as a single case study, it only demonstrates the benefits of homeopathic medications in this specific instance.⁴ Lower extremity chronic venous insufficiency (CVI) can present a range of clinical manifestations, from mild cosmetic issues to more serious symptoms.⁵ One important mode of treatment for chronic venous insufficiency is compression therapy.⁶ In certain individuals, the most impacted aspects included work restrictions, extended standing, appearance-related worries, and outfit selection.⁷

Based on the findings of this case study, it is possible to infer that homeopathy's holistic and customized approach produced good outcomes in a middle-aged male patient with lower extremity discomfort and abdominal pain. The complete treatment strategy, which included rigorous analyses and the use of Sulphur 30, resulted in a progressive improvement in symptoms. However, issues such as symptom worsening forced changes in the treatment strategy, highlighting the significance of flexibility and constant oversight in patient care. Future research should include randomized controlled trials with adequate sample size to evaluate the efficacy of homeopathic therapy in similar circumstances.

Conflict of interest

None