A Critical Review On Traditional Herbal Drugs: An Emerging Alternative Drug For Varicose Veins

World Journal of Pharmaceutical Research
Palanisamy et al. World Journal of Pharmaceutical

SJIFResearch
Impact Factor 8.074
Volume 7, Issue 05, 316-338. Review Article ISSN 2277–7105
A CRITICAL REVIEW ON TRADITIONAL HERBAL DRUGS: AN

EMERGING ALTERNATIVE DRUG FOR VARICOSE VEINS
Jaiganesh Kandasamy Palanisamy*1, Sivakumar Ponnu2, Sivasankar Mani3 and

Sreedharren Balakrishnan4
1
Division of Pharmacognosy & Phytochemistry Research Laboratory, Nehru College of
Pharmacy, Pampady, Thiruvilwamala, Thrissur, Kerala, India.
ABSTRACT
Article Received on
08 Jan. 2018, Herbal medicine is a natural remedy for all the disease. Varicose veins
Revised on 29 Jan. 2018, are dilated, tortuous, elongated superficial veins that are usually seen in
Accepted on 19 Feb. 2018
DOI: 10.20959/wjpr20185-11141 the legs. A large UK population study has shown age adjusted
prevalence‘s of 40% in men and 32% in women, although women
more often are getting affected by varicose veins. The patient will
*Corresponding Author
Dr. Jaiganesh Kandasamy come across various signs and symptoms and diagnosis to find out the
Palanisamy problem and get prescribed to some of allopathic medicines which are
Division of Pharmacognosy harmful to humans. Furthermore, in spite of substantial progress in the
& Phytochemistry Research
study of the biological and physical manifestations of kidney stones,
Laboratory, Nehru College
there is no satisfactory drug to use in clinical therapy in the
of Pharmacy, Pampady,
Thiruvilwamala, Thrissur, management of varicose veins. The present review therefore critically
Kerala, India. evaluates the potential usefulness of herbal medicines in the
management of varicose veins.
KEYWORDS: Varicose veins, Herbs, Therapy.
INTRODUCTION
The World Health Organization (WHO) has recently defined traditional medicine (including
herbal drugs) as comprising therapeutic practices that have been in existence, often for
hundreds of years, before the development and spread of modern medicine and are still in use
today. Herbal medicine is still the mainstay of about 75–80% of the world population, mainly
in the developing countries, for primary health care because of better cultural acceptability,
better compatibility with the human body and lesser side effects.[1] Varicose veins is a
www.wjpr.net Vol 7, Issue 05, 2018. 316

Palanisamy et al. World Journal of Pharmaceutical Research
common health complaint in people like security guards, watchmen, cops, soldiers, vehicle
pullers, porters, rikshaw pullers, launderers, drivers, teachers etc.[2]
The prevalence of these two conditions is astonishing. In population studies the prevalence of
varicose veins has been reported to be 10-15 percent for men and 20-25 percent for women.[3]
In a recent cross-sectional study, the age-adjusted prevalence of varicose veins was 58
percent for men and 48 percent for women.[4] Over three-quarters of individuals in the United
States have hemorrhoids at some point in their lives, and about half of the population over
age 50 requires treatment.[5] The Merck Manual defines hemorrhoids as ―Varicosities of the
veins of the hemorrhoidal plexus, often complicated by inflammation, thrombosis, and
bleeding‖.[6]
Need and Importance of Herbal Medicine

As we mention above the cure of diabetes mellitus is mentioned in Ayurveda. Ayurvedic
researches undertaken during the last 50 years have not been very rewarding, except for the
extremely useful exercise of literary research. This is the big question mark on synthetic
drugs for answering the varicose veins.
Etiology of Varicose veins, Cure and Strategy

Epidemiological Factors
Chronic venous disease of the lower limbs is one of the most common medical conditions
seen in clinical practice.[7] Definitions range from ―any prominent superficial vein in the
lower extremity‖ to ―a vein which has permanently lost its valvular efficiency and, as a result
of continuous dilation under pressure, in the course of time becomes elongated, tortuous,
pouched and thickened.‖ Callam, reviewing an analysis of published data on the
epidemiology of varicose veins, assessed all of the studies with regard to age range and
distribution of study population; criteria used to diagnose varicose veins; geographical site of
the study population; and methods used to assess venous disease. He reported half of the
adult population manifesting minor venous disease, and less than half (women 20-25%; men
10-15%) having visible varicose veins.[8]
Pathogenesis and Etiological Factors[3, 9]

The pathogenesis of varicose veins is thought to include increased venous and capillary
pressures, increased capillary permeability, chronic edema, repeated inflammation, and stasis.
Some of the risk factors associated with developing varicose veins are obesity, high systolic

blood pressure, cigarette smoking, low levels of physical activity, pregnancy, abdominal or
pelvic asses, ascites, and occupations that require prolonged standing.
Aggravating factors
Genetic predisposition, chronic constipation, tight clothing, sedentariness or lack of exercise,
pregnancy, obesity and aging all contribute.
Sedentariness
Standing in one place for extended periods or sitting for long periods of time can cause
venous pooling in the lower legs since the flow of blood is not being assisted by the muscular
pump. In addition, the weight of your legs pressing your veins against the chair can impede
the flow of blood and crossing your legs while sitting will add to the problem.
Tight clothing
Constrictive clothing can block the flow of blood in the venous system adding to the venous
distention.
Chronic constipation
This can lead to hemorrhoids although it can also be a factor in varicose veins of the legs and
groin area. While most veins have valves to prevent back flow of blood, the veins extending
from the anus to the liver lack them. Gravity imposes a constant burden and any abdominal
pressure makes it worse. Straining during the lifting of a heavy object, coughing or straining
at stool can cause pressure build up in the rectal area. Since chronic constipation causes
straining at stool, it can lead to hemorrhoids.
Liver dysfunction
The rectal veins lead to the portal vein of the liver via the mesenteric vein; liver dysfunction
can cause a blockage in the flow of blood from the rectal veins to the portal vein which, in
turn, can cause a back flow with possible venous distention. Since hemorrhoids often
accompany sluggish livers, it is common in oriental medicine and naturopathic medicine to
treat the liver while treating an individual with varicosities.
Pregnancy
Pregnant women are often plagued by varicose veins, edema and hemorrhoids since the
woman‘s legs are bearing greater weight than ever before. At later stages of pregnancy, there
also can be compression of veins, depending on the position of the fetus. Her blood volume

will increase by 30- 40% placing an added stress on her veins and there is an increase in the
hormone, progesterone, which will slow down her gastrointestinal tract, thereby leading to
constipation. Decreased exercise will also add to the problem.
Symptoms
Leg swelling
This is an uncommon symptom of varicose veins- other causes are much commoner.
Unilateral swelling of a leg with big varicose veins is the most typical presentation.
Thrombophlebitis
Superficial thrombophlebitis (―phlebitis‖) can complicate varicose veins. The risk of deep
vein thrombosis is remote, but in a case series it occurred very occasionally if phlebitis
extended above the knee.[10]
Veins may sometimes remain permanently occluded. Treatment of the varicose veins may be
appropriate if phlebitis is recurrent or severe, or if the veins also cause other symptoms. Note
that thrombophlebitis is not caused by infection, and treatment with antibiotics is
unnecessary: drug treatment should be limited to anti-inflammatory analgesics.
Bleeding, skin changes, and ulcers[11]

These are the complications of varicose veins that mandate consideration of treatment. They
are all associated with high venous pressure in the upright position, as a result of incompetent
venous valves.
Bleeding is uncommon and usually occurs from a prominent vein on the leg or foot with thin,
dark, unhealthy skin overlying it.
―Skin changes‖ range from eczema, through brown discoloration, to flori

lipodermatosclerosis with induration of the subcutaneous tissues. Sometimes this can become
painfully inflamed -―inflammatory liposclerosis‖- which is often misdiagnosed as phlebitis or
infection. If neglected, lipodermatosclerosis can lead to ulceration, which can be chronic and
troublesome: treatment of ulcers will not be considered in this review.

Strategy for Treatment of Varicose veins

Conventional Treatment
Standard treatment for varicose veins is mechanical compression, sclerotherapy, or surgery.
Compression therapy is achieved with lightweight hosiery for small, mildly symptomatic
varicose veins. Advanced cases require a heavier elastic support stocking. Mechanical
compression is inconvenient, uncomfortable, and subject to poor compliance.
Medicine for Treatment of Varicose veins

Additionally patients can apply the elastic bandage too tightly, producing a tourniquet effect.
Even when applied correctly, bandages can rapidly loosen and become ineffective.[6]
Injection sclerotherapy is used to treat all degrees of primary varicose veins. The aim of
sclerotherapy is to destroy the vein by fibrosis. Sodium tetradecyl sulfate 1% solution is
injected, while the vein is emptied of blood, causing damage to the intima of the vein and
permanent fibrosis.
Therapy
Sclerotherapy does not require hospitalization, and the patient resumes normal activity after
the procedure. Painful varicose veins with recurrent phlebitis or skin changes are considered
indications for surgery.[6] General practitioners must refer to a vascular surgeon for surgery
and should consider this only if indicated.
Dietary and Hydrotherapy Approaches

Dietary Recommendations
Diet therapy is a widely accepted modality in the management of varicose veins. Many
physicians consider the first line of therapy to be a high fiber diet with commercial fiber
supplements and enough oral fluids to produce soft, but well formed and regular bowel
movements. A low fiber diet can result in small hard stools that can cause patients to strain
during bowel movements.
This strain increases intra-abdominal pressure, subsequently increasing pressure on the veins
of the lower legs. Over time this can deteriorate vascular integrity. A high fiber diet is an
important component to the prevention and treatment of varicose veins. This in addition to
hydrotherapy and avoiding activities that require the patient to strain are the foundation of the
approach of many family practitioners to these conditions.

Prevention of varicosities & treatment[12]

To assist the body‘s circulation, exercise is vital. Aerobic exercise such as walking, running,
bike riding, or cross country skiing would be best, but a brisk 20 minute walk daily is a
simple and easy exercise.
Diet
It is also important. Eat simple nourishing meals. Keep your bowels regulated by the food
you eat. A diet with 65-70% complex carbohydrates, 15-20% protein and 15% oil is
necessary for optimal health. Include a daily minimum of one serving of green leafy
vegetables and two uncooked fruits or vegetables.
Vitamins and minerals

The following nutrients are known to be beneficial to the structure and integrity of the blood
vessels. It is best to get nutrients from food and use supplements as a last resort. Foods high
in that particular nutrient are listed below.
Vitamin A (10,000 IU)

Liver, Carrots, dandelion greens, spinach, parsley, plantain, nettles, your basic green foods
and yellow-orange vegetables, liver.
Vitamin B complex (10-100 mg)

Yeast, grains, organ meats, nuts, legumes.
Vitamin C (500-3,000 mg)to bowel tolerance is best

Currants, broccoli, rose hips, berries, fruit in general, parsley, brussel sprouts, green veggies.
Vitamin E (200-600 IU)

Extra virgin olive oil, leafy greens and watercress, nuts in general, egg yolks, wheat germ.
Zinc (15-30 mg)

Oysters, whole grains, brewer's yeast, spinach, sunflower seeds, pumpkin seeds.
Bromelain (500-750 mg TID at 1,500 MCU)

Best to use a supplement.

Flavonoids (100-1000 mg mixed flavonoids)

Fruits high in flavonoids are cherries, blueberries, hawthorne berries (and other berries which
are blue-red), Saint John‘s Wort, Calendula, lemons, oranges and rosehips. The flavonoids in
these foods reduce capillary fragility and increase the integrity of the venous walls. Rutin,
hesperidin and quercetin are examples of flavonoids.
Other foods which aid the circulatory system are okra, oats, beets, artichokes, wheat germ,
green leafy vegetables, raw garlic, onions and foods high in lecithin, such as soybeans. These
last three are good to eat daily as they help regain and retain elasticity in the blood vessels.
Constipation
Fiber, Fiber, and more Fiber
Remember that little saying ―An apple a day keeps the doctor away?‖ It applies in the case of
hemorrhoids.
Psyllium seeds
1 teaspoon seeds in 1/2 cup water, let sit 15 minutes, drink and follow with one cup water.
Use a few times per day or as often as necessary. Can also use Pectin, Guar gum, Slippery
elm, etc.
Warm lemon water

Drink a cup in the morning before breakfast.
Ginger tea
Drink one cup warm water with 1 teaspoon ginger before bed.
Laxatives (should always be a last resort)

For herbs to really get the bowels going: Yellow dock (milder), Oregon grape, Rhubarb,
Cascara, Buckthorn, Senna, Aloe. Most bitter herbs will stimulate the bowels to move.
Hot baths, hot water bottles and abdominal massage can also relieve constipation.
FIRST AID FOR VARICOSE VEINS
Baking soda
Can be applied externally, wet or dry, to take the itch away. It may burn or feel hot for a short
time.

Grated raw potatoes or apples

Can be applied to ease swelling and pain.
Witch hazel, Oak bark or other astringent herbs

Can be applied to reduce swelling, pain, and curb bleeding.
Red rose petals

Can be made into a poultice and applied to reduce swelling and bleeding. It is astringent &
Vulnerary.
An herbal sitz bath

Use one of each of the following
1. An astringent herb such as witch hazel, yarrow, oak bark, or geranium.
2. A vulnerary herb such as calendula, rose petals, or plantain.
Apple cider vinegar

Can also be used as a wash to ease the pain of varicosities.
Poultices, fomentations, suppositories

Use astringent and vulnerary herbs.
MORE TIDBITS OF ADVICE

Varicose Veins of the Leg
Support Stockings
Go all the way up to the hips, raise legs high for 10 minutes prior to putting them on.
Leg Massage
A 5-10 minute daily massage, working with the flow of blood, will improve circulation.
Inverted yoga postures

The head stand, plow or shoulder stand.
Cold morning bath (For all varicosities.)

Vigorously rub your entire body with a cold wet towel, then a dry one, to improve
circulation.

Sitz baths for hemorrhoids

Hot and cold alternating sitz baths. Sit in a pan of hot water for 3 minutes, then a cold pan for
30 seconds. The water needs to cover your entire pelvic area. Do this for 10-20 minutes, 3
times per day. Always end with the cold treatment.
TO BE AVOIDED
Obesity, tight clothing, crossing legs, sitting or standing for long periods, high heeled shoes
(they do not allow full natural contraction of leg muscles), knee high stockings, constipating
food, lifting heavy objects incorrectly and straining at the toilet.
HERBS FOR VARICOSITIES

External applications
The following herbs can be used as poultices, sitz baths, oils, suppositories or fomentations.
Witch hazel, Geranium, Oak bark, Yarrow

These plants are largely effective because of their astringent action which causes tissue
constriction, including the veins. See astringent herbs below.
Saint John’s wort, Calendula, Ruta, Arnica

These herbs support normal venous tissue integrity and are anti-inflammatory.
Comfrey, Slippery elm, Plantain

These plants are mucilaginous and have a demulcent effect thereby soothing and healing
irritated tissues. All three of these plants are well known for their ability to speed the healing
process when applied to irritated tissue.
Butcher’s broom
Ruscogenins in this plant have been shown to inhibit inflammation and induce venous
constriction.
Internal applications (detailed descriptions of these herbs follow this list)

Stone root, Butcher‘s broom, Cinnamon, Gotu kola, Witch hazel, Geranium, Oak bark,
Yarrow, Saint John‘s wort, Calendula, Horse chestnut, Liver herbs (see below), Cayenne,
Garlic, Onion, Ginger.

INTERNAL HERBS FOR VARICOSITIES

1. Butcher’s broom - Ruscus aculeatus[13, 14]
Family: Liliaceae or Lily family.
Part used: root.
Taste/smell: soapy taste.
Dosage: 1 heaping teaspoon per cup water (decocted) or 5-30 drops 1:5 dry liquid extract, 1-3
times per day in a little water.
Use: Anti-inflammatory, vasoconstrictor, antihemorrhagic. Butcher‘s broom acts upon the
venous system and is used for varicosities, especially hemorrhoids. It causes the swelling of
hemorrhoidal varices to go down and has a tonic effect on the rectal blood vessels.
Constituents: Contains ruscogenin and neoruscogenin which have been shown to have anti-
inflammatory and vasoconstrictive activities.
2. Gotu kola - Centella asiatica[15, 16]

Family: Umbelliferae or Parsley family
Part used: whole plant
Taste/Smell: spicy, fragrant
Dosage: 1 tablespoon per cup water (infused) or 20- 60 drops of 1:1 fresh liquid extract, 1-4
times per day.
Use: Anti-inflammatory, diuretic, laxative, vulnerary, antiseptic, circulatory stimulant,
increases endurance and energy. Ingestion helps prevent scarring. Gotu kola is used
externally and internally to accelerate the healing time in wounds and ulcers. It is also used
for sluggish digestion, to improve memory, high blood pressure, abscesses, rheumatism,
fever, ulcers, leprosy, general skin eruptions, varicose veins, nervous disorders and jaundice.
It has a calming and supportive effect on the nervous system. Centella has the potential to
enhance connective tissue integrity, elevate antioxidant levels in wound healing, and improve
capillary permeability.
Constituents: Centella asiatica) are combinations comprised of asiatic acid (30%),
madecassic acid (30%), and asiaticoside (40%). The centella extract TTF (total triterpenic
fraction) is comprised of asiatic acid and madecassic acid (60%) in a ratio not clearly defined,
in combination with asiaticoside (40%).
3. Horse chestnut - Aesculus hippocastanum[17, 18]

Family: Hippocastanaceae.

Part used: ripe chestnut and bark

Taste/Smell: bitter, slightly pungent
Dosage: 1-5 drops of 1:5 dry liquid extract, 1-3 times per day in a little water.
Use: It is astringent, improves vascular resistance and reduces pathologically induced
capillary wall permeability.
Constituents: It contains aescin which is antiexudative, anti-edematous, anti-inflammatory
and decreases capillary permeability (apparently due to inhibition of lysosomal enzymes).
4. Stone root - Collinsonia canadensis

Family: Lamiaceae or Mint family
Part used: root
Taste/smell: astringent
Dosage: 1-2 teaspoons herb per cup water (decocted) or 20-60 drops of 1:4 dry liquid extract,
1-4 times per day.
Use: Alterative, diuretic, astringent, stimulates and tones the alimentary mucous membranes,
suitable for atonic conditions. Vaso-contracting to the portal system so is indicated for
pelvic/rectal congestion secondary to portal back-pressure and venous stasis. Used for gastro-
enteritis with diarrhea, hemorrhoids and laryngeal inflammation. Stone root causes emesis if
the aerial parts are used, but the root has long been used for hemorrhoids, specifically in
patients with hard dry stools.
5. Cayenne, Garlic and Ginger are used for their fibrinolytic quality. (Fibrin and fat are
deposited in tissue near varicose veins which cause the skin to become hard and lumpy.)
These herbs also decrease the risk of thrombus formation in thrombophlebitis.
6. Agrimony - Agrimonia spp.

Family: Rosaceae or Rose family
Part used: aerial parts
Taste/smell: slightly bitter, astringent
Dosage: 1 heaping teaspoon per cup water (infused) or 10-40 drops of 1:1 fresh liquid
extract, 3 times per day in a little water.
Use: Diuretic, astringent, stimulating gastrointestinal tonic. It is also used for hepatic atony,
enuresis or urinary incontinence due to atony.

7. Bayberry - Myrica cerifera

Family: Myricaceae or Wax Myrtle Family
Part used: bark
Dosage: 1 teaspoon per cup water (decocted) or 1- 30 drops of 1:5 dry liquid extract, 1-3
Use: Astringent, styptic, tonifying for atonic tissues with discharges due to over-relaxation.
Used for passive hemorrhages, ulceration of the mucous membranes and digestive tract,
venous atony and congestion.
Contraindications: The wax on young branches can be irritating and there are constituents in
the wax which are reported to be carcinogenic. Contraindicated in pregnancy.
8. Cinnamon - Cinnamomum spp.

Family: Lauraceae
Part used: inner bark
Taste/Smell: pungent, aromatic, sweet
Dosage: 1 teaspoon per cup water (infused 25 minutes) or 10-60 drops of 1:4 dry liquid
extract or 1-5 drops essential oil—the larger doses are used for hemostatic effects. Do not use
these larger doses repetitively.
Use: Astringent, aromatic stimulant, carminative, hemostatic, antiseptic, flavoring,
antibacterial,
antifungal, gastrointestinal tonic and warming herb. Also used for passive pulmonary, gastric,
intestinal and renal bleeding. It stimulates and then depresses the nervous system, corrects
nausea and vomiting, and is used in small amounts for digestive irritation.
Contraindications: Contraindicated in pregnancy and for those allergic to cinnamon.
9. Geranium - Geranium maculatum

Family: Geraniaceae
Part used: root
Taste/Smell: astringent
Dosage: 1 teaspoon per cup water (decocted) or 10- 60 drops 1:3.5 dry liquid extract, 1-4
Use: Used as a styptic and for atonic tissues with discharges due to over-relaxation, passive
hemorrhages, ulceration of the mucous membranes and digestive tract, venous atony and

congestion. This herb‘s astringency makes it useful in any instance where there are abundant
and debilitating discharges.
Constituents: Contains gallic acid, tannic acid, gum, pectin, starch, resin. Tannin is highest
in spring roots collected prior to flowering.
10. White oak (other oaks can be used) - Quercus alba

Family: Fagaceae or Oak family
Part used: bark
Dosage: 1-2 teaspoons per cup water (decocted) or 10-60 drops of 1:5 dry liquid extract, 1-4
times per day.
Use: Used as an astringent, styptic, for mucous membrane irritation, passive hemorrhages and
for venous laxity and congestion, such as bleeding hemorrhoids and other varicosities.
Contraindications: Contraindicated for external use with extensive skin surface damage.
Strong, full baths contraindicated in cardiac insufficiency stages III and IV (NYHA), febrile
infectious disorders and weeping eczema over a large area.
11. Witch Hazel - Hamamelis virginiana

Family: Hamamelidaceae family
Part used: bark
Dosage: 1-2 teaspoons per cup water (decocted) or 10-60 drops of 1:4 dry liquid extract, 1-4
times per day.
Use: Used as an astringent, styptic, for passive hemorrhages, wounds and local
inflammations. Used for venous laxity and congestion, such as hemorrhoids and other
varicosities.
Contraindications: In sensitive individuals, irritation of the stomach may occur. In rare
cases, witch hazel‘s tannins may cause liver damage.
12. Yarrow - Achillea millefolium

Family: Asteraceae or Aster family
Part used: flowers, leaves
Taste/smell: Bitter, aromatic, pungent
Dosage: 1 teaspoon per cup water (infused) or 10-30 drops of 1:1 fresh liquid extract, 1-4
times per day.

Use: Yarrow is a bitter tonic, antiseptic, styptic, stimulating diaphoretic, anti-inflammatory

and anodyne. It is used for atonic and relaxed tissues where there is free discharge or massive
bleeding of bright red blood, and for diarrhea. Also used for bleeding hemorrhoids, excessive
menstrual flow and vaginitis.
Constituents: Contains achilletin and achilleine (hemostatic), beta iso-thujone, coumarin,
chamazulene, apigenin and steroidal B-sitosterol.
Contraindications: Beta iso-thujone can cause vomiting, stomach and intestinal cramps,
retention of urine and in serious cases, renal damage, vertigo, tremors and convulsions. Beta
iso-thujone is alcohol soluble so aqueous extracts contain less of it. Allergic contact
dermatitis can occur with external use of yarrow on sensitive individuals. Discontinue
external use if a rash occurs. Contraindicated in pregnancy.
13. Slippery elm - Ulmus spp. (rubra, fulva)

Family: Ulmaceae or Elm family
Part used: inner bark
Taste/smell: a little like maple syrup without the sweetness, astringent, mucilaginous
Dosage: 1 tablespoon powdered herb per cup water mixed into a slurry.
Use: A mucilaginous demulcent, diuretic, and antiinflammatory. Used for soothing mucous
membrane irritation in the gastrointestinal tract, respiratory tract and urinary tract. Used
internally for inflamed respiratory tract disorders, inflammation of the mouth, throat,
stomach, intestines, bladder, urethra. Used externally for wounds, burns, ulcers, and all skin
disorders with inflammation.
14. Psyllium - Plantago arenaria /ovata/asiatica

Family: Plantaginaceae or Plantain family
Part used: seed
Taste/smell: mucilaginous, bland, no noticeable smell
Dosage: 1-2 teaspoons are soaked in a cup of water. Drink and follow by a second cup of
water. If constipated, drink 2 glasses of water after taking the herb.
Use: Used to soothe gastrointestinal mucosa, as a demulcent, bulking agent, used for both
constipation and diarrhea.
Contraindications: Contraindicated in bowel obstruction. It is important to take adequate
liquid with these seeds.

15. Flax seed - Linum usitatissimum

Family: Linaceae
Part used: seed
Taste/smell: mucilaginous, oily
Dosage: 1 tablespoon crushed seeds per cup cold water, let sit until partially dissolved, then
drink. Follow with a second cup of water. Externally, used as a poultice by powdering the
herb and adding enough water to make a paste.
Use: Mucilaginous, bulking and lubricating agent used in chronic constipation and also used
in the treatment of many chronic diseases, such as arthritis and psoriasis. Because it is high in
omega-3 fatty acids, it can be used in the prevention of arteriosclerosis.
Contraindications: Take with plenty of liquid. Contraindicated in bowel obstruction.
Vulnerary Herbs
Vulneraries decrease inflammation and heal irritated tissue. These herbs are primarily used
externally as pastes, poultices, oils, suppositories or sitz baths.
16. Calendula - Calendula officinalis

Part used: flowers prior to fully opening
Taste/smell: slightly bitter, salty
Dosage: 2-3 heaping tablespoons in 1 cup water (infused) or 20-50 drops 1:5 dry liquid
extract, 1-4 times per day in a little water. Fresh plant succus is best for external use on
wounds.
Use: Antiseptic, anti-inflammatory, choleretic, demulcent, vulnerary, immune stimulant, anti-
viral, supports creation of normal connective tissue structure. Used for healing wounds,
burns, bruises, boil, rashes. It promotes the formation of granulation tissue.
Constituents: Contains essential oil, flavonol glycosides, saponins, triterpene alcohols,
sterols, carotenes and xanthophylls, polysaccharides, tannins and other constituents.
17. Comfrey - Symphytum officinalis

Family: Boraginaceae or Borage family
Part used: root and main rib of leaf have the most mucilage and allantoin
Taste/Smell: mucilaginous, nutritious tasting, bland
Dosage & Use: Useful externally as a poultice, paste or fomentation for contusions, sprains,
dislocations, wounds, burns, ulcers and all inflammatory skin disorders. Used to decrease

inflammation of thrombophlebitis and phlebitis. This herb decreases the healing time for all
manner of skin wounds and irritations.
Constituents: It contains 6-8% allantoin, .02-.07% pyrrolizidine alkaloids, 4-6% tannins,
intermedine, aetylintermedine, lycopsamine, acetyllycopsamine, symphytine, mucilage,
starch, triterpenes (isobauerenol) and sterols (sitosterol).
Contraindications: Not to be used internally due to possible pyrrolizidine poisoning.
18. Plantain - Plantago spp.

Family:Plantaginaceae or Plantain family
Part used: leaf
Taste/smell: nutritious, mucilaginous, slightly bitter, salty Dosage: 1 tablespoon (infused)
per cup water or 15-40 drops of 1:1 fresh liquid extract, 1-4 times per day.
Use: Used as an antiseptic, astringent, antiinflammatory, vulnerary and mucilaginous agent.
Cooling agent for use with hemorrhoids.
19. Saint John’s wort - Hypericum perforatum

Family: Guttiferae
Parts used: flowering tops (best used fresh) when they are a mix of buds and open flowers
Dosage: 10-60 drops of 1:1 fresh liquid extract, 1-4 times per day.
Use: Antiviral, anti-inflammatory, astringent, antibacterial, vulnerary, nervine, sedative,
trophorestorative. It is used for hemorrhoids, especially with sharp radiating pain.
Lymphagogues
Lymphagogues support the lymphatic organs and stimulate activity of the lymph system,
hereby improving the removal of wastes from cells and the reception of nutrients.
20. Cleavers - Galium aparine

Family: Rubiaceae or Madder family
Parts used: fresh succulent aerial parts in flowering/ seed forming stage
Taste/Smell: fresh, pleasant taste
Dosage: 30-60 drops of 1:1 fresh+dry liquid extract, or add a handful of fresh herb into your
juicer when you make a fresh vegetable juice.
Use: A relaxing diuretic, nutritive, vulnerary, hypotensive, lymphagogue. It supports the
immune

system, corrects inability to pass normal catabolic wastes, and is a vulnerary. Used for
bladder and kidney problems, such as benign prostatic hypertrophy, and it acts to reduce
stones. Also used for enuresis in children.
21. Red root -Ceanothus americanus

Family: Rhamnaceae or Buckthorn family.
Part used: Root.
Taste/smell: Astringent.
Tendencies: Drying.
Dosage: Decoction: 1-2 teaspoons per cup of water; or 1:4 dry strength liquid extract: 20-40
drops 1-4 times per day.
Mental picture and specifics: It is indicated for stagnation of fluids, turbid lymph, mucus,
swollen glands and poor nutrition to the tissues. Consider red root when the person is
melancholic and the tongue is enlarged, swollen, with a dirty white or yellow coating.
Use: (a) Astringent, (b) Lymphagogue, (c) Expectorant. Red root is used in lymphatic,
splenic and liver congestion, enlarged lymph nodes, sinusitis, tonsillitis, laryngitis,
pharyngitis, chronic post-nasal drip and mononucleosis. It also can increase platelet counts
and is specific for reducing cysts. This herb is best suited for subacute and chronic
conditions.
Contraindications: Information unavailable at this time.
Liver Herbs
Supporting the liver decreases blockage in the flow of blood from the rectal veins to the
portal vein and therefore decreases venous distention and hemorrhoids due to liver
disfunction.
22. Burdock - Arctium lappa

Part used: root
Taste/smell: sweetish initially, bitter later, slightly mucilaginous
Dosage: 1 heaping tablespoon per cup water (decocted) or 20-60 drops of 1:1 fresh liquid
extract, 1-4 times per day in a little water.
Use: Alterative, diuretic (especially the seeds), digestive stimulant, blood and lymph cleanser,
liver tonic, choleretic and mild laxative. Burdock stimulates the natural flow of lymphatic
fluid thereby supporting excretion of toxic byproducts from cells. It helps the skin, kidneys,

liver, gall bladder, mucous and serous membranes to remove accumulated byproducts of
catabolism.
Constituents: Seeds contain a glycoside (arctine) and fatty oil. The root contains volatile
oils, inulin, mucilage and minerals, including calcium, phosphorus, sodium and iron. It also
contains vitamins, including thiamine, riboflavin, niacin and ascorbic acid.
Contraindications: Long term use or excessive doses of the seed can cause urinary tract
irritation.
23. Dandelion - Taraxacum officinalis

Family: Asteraceae or Aster family.
Part Used: whole plant, leaves, flowers, roots.
Taste/Smell: leaf and root are somewhat bitter but also slightly sweet taste in the root.
Dosage: 1 heaping teaspoon of root (decocted) or 1 heaping tablespoon of leaf (infused) in 1
cup water, or 1-60 drops of 1:1 fresh+dry liquid extract, 1-4 times per day in a little water.
Use: Whole plant acts as a diuretic (especially the leaf), stomachic, mild laxative, cholagogue
and choleretic. Used to lower blood pressure and cholesterol, decrease edema, normalize
blood sugar, and in arthritis and gout. Useful for many female conditions, as well as skin
diseases, because of it‘s effect on the liver. Autumn roots can be roasted and used as a coffee
substitute.
Constituents: Contains bitter substances, eudesmanolides, germacranolides, triterpenes,
sterols, carotenoids, flavonoids, carbohydrates (root), fructose (18% in spring), mucilage,
4.5% potassium (greens), inulin (2%, in spring, which increases to as much as 40%, in
autumn).
Contraindications: Physical contact with the fresh latex in Dandelions can cause contact
dermatitis.
24. Licorice - Glycyrrhiza glabra

Family: Fabaceae or Legume family
Part used: Root
Smell/Taste: sweet, nutritious
Dosage: 1 teaspoon per cup water (decocted) or 20- 60 drops of 1:3 dry liquid extract, 1-4
times per day.
Use: A demulcent, adaptogen, adrenal-modulator, antibacterial, antiviral, expectorant with
secretolytic and secretomotor activity, anti-inflammatory, nutritive, spasmolytic, antioxidant,

estrogenic, immune stimulant, liver tonic and protectant. Most known for the effect on
mucous membranes. It is effective for many chronic liver conditions with high liver enzymes.
Makes a nice addition to formulas which are unpalatable. Glycyrrhizinic acid and aglycone
glycyrrhetinic acid are essential active components. They decrease inflammation by
enhancing movement of leucocytes towards inflamed areas. Glycyrrhizin inhibits the activity
of phospholipase A and the formation of prostaglandin E2 in activated peritoneal
macrophages.
Contraindications: Contraindicated in high blood pressure, kidney disease, liver cirrhosis
and cholestatic liver disorders. Chronic use mimics aldosteronism by increasing sodium
resorption and potassium excretion by the kidney. Avoid using with pre-existent
hypertension. The toxic symptoms are hypertension, edema, hypokalemia, vertigo and
headache. This ceases when Glycyrrhiza is withdrawn or by concurrent use of anti-
aldosterone agents. Standard licorice doses of 5-15 grams per day should not be taken for
more than 6 weeks unless under the guidance of a physician. Persons with high blood
pressure, cardiac or renal impairment should consult a physician before taking licorice
preparations. Licorice potentiates the activity of anthraquinone drugs, or herbs containing
anthraquinones (such as Cascara, Senna and Buckthorn) by increasing the wettability of the
bowel contents because of the high surfactant activity of glycyrrhizin.
25. Milk thistle - Silybum marianum

Part used: seed
Smell/Taste: bitter
Dosage: 1-2 teaspoons crushed seed (decocted) or 20-60 drops of 1:2.5 dry liquid extract, 1-4
times per day.
Use: Antioxidant and hepatoprotectant used in liver disease, such as hepatitis, fatty liver,
cirrhosis, for liver protection and regeneration immediately after exposure to liver toxins; best
used as a protectant before exposure to liver toxins. Silymarin changes the outer membrane
cell structure, preventing certain toxins from entering the liver cells. It also stimulates RNA
polymerase A (polymerase I) which enhances ribosome protein synthesis and activates the
regenerative capacity of the liver cells.
Constituents: Contains 1.5-3% silymarin which mostly consists of silybin, a combination of
silibinin, silychristin and silydianin.

26. Turmeric - Curcuma longa

Family: Zingiberaceae or Ginger family
Part used: rhizome
Taste/smell: Warming, bitter, slightly pungent
Dosage: 10-40 drops of 1:0.85 fresh liquid extract, 1- 4 times per day.
Use: Anti-inflammatory, antiarthritic, antibacterial, antifungal, hypotensive, anti-
atherosclerotic, cholagogue, choleretic, emmenagogue, lowers cholesterol, stimulates
digestive enzymes, carminative, hepatoprotective, vulnerary, anticoagulant (inhibits platelet
aggregation). Used for flatulence, jaundice, menstrual difficulties, gallstones, hemorrhage,
toothache, bruises, colic, arthritis, sprains, wounds, anticancer agent.
Constituents: Contains polysaccharides: Ukonan- A (phagocytosis activating factor) and
Ukonan-D (reticuloendothelial system-potentiating activity), 4-5% orange-yellow volatile oil
mainly composed of turmerone, atlantone and zingiberone, 0.3-5.4% curcumin (antioxidant,
antiedemic effect), disaccharides: glucose 28%, fructose 12%, arabinose 1%, various resins,
proteins, vitamins and minerals.
Contraindications: Contraindicated in pregnancy (uterine stimulant).
27. Corylus avellana[19-22]

Family: Betulaceae.
Parts used: Fruit
Taste: bitter
Use: This plant has a venotonic action being used on varicose veins and edema caused by
venous insufficiency. Dietary fiber has an important therapeutic implication, as exhibit a
protective effect against hypertension, chronic heart diseases120.
Constituents: The compounds of this plant are tannins; flavonoids; essential oil; fat (mainly
oleic acid); proteins; carbohydrates; dietary fibre; vitamins; minerals; phytosterols (mainly β-
sitosterol) and antioxidant phenolics. The leaves of this plant contain phenolic compounds
such as flavonoids, caffeic acid and diaryl ether heptanoids derivates.
28. Vaccinium myrtillos[23-25]

Family: Ericaceae
Parts used: Fruit (Wild blueberries)
Taste: bitter

Use: They are medical use at venous insufficiency by varicose veins and hemorrhoids. The
leaves present tannins (between 5% and 10%); flavonoids (quercetin derivates); triterpenic
acids (ursolic, oleanolic); phenolic acids and iridoids; ANCs pigments; mineral salts (iron,
magnesium and chromium) and quinolizidine alkaloids. Other compounds of this plant are
catechins, pectins, myricetin, caffeic acid and ρ-coumaric acid. Pharmacological studies have
shown an effective treatment for vascular disorders. Others studies shown that ANCs are
responsible for a decrease of blood pressure in models of hypertension.
Constituents: The fruit of this plant are tannins (about 10%), mainly soluble in water;
oligomeric procyanidins; ANCs pigments (0,5%) by heterosides forms (delphinidin, cyanidin,
petunidin, peonidin and malvidin); organic acid; carbohydrates (oses, inositol); pectin;
carotenes; flavonoids (rutin ). This plant is a good natural source of ANCs. The fruits have
properties of vitamin P of ANCs, flavonoids pigments, phenolic compounds other than
flavonoids (flavonols, phenolic acids and pro-anthocyanidins) and vitamins C and E that
increase and decrease of capillary permeability.
CONCLUSION
All drugs which we have discussed in this review have a significant in their mode of action
and therapy of Varicose veins, in contrast of plants bioactive phyto-molecules are less known
about their mode of action but there is no doubt about the role of plants to treating Varicose
veins. It is also important to screening the world‘s plant diversity extensively for more and
specific bioactive phytomolecules which are helpful in treating varicose veins. On the other
hand the traditional formulation of drugs must be researched and re-standardized by using
new techniques and methods for managing the varicosis. Furthermore these drugs will be
accessible to the people who are unable to purchase the costly synthetic drugs. Hence herbal
drugs may be an emerging alternative of synthetic drugs to curing varicose veins.
ACKNOWLEDGEMENT
The authors are highly thankful to The Chairman and Managing Trustee, Adv. P. Krishna
Das, LLB, MBA, BEM, DR. P. Krishna Kumar, CEO & Secretary, Nehru College of
Pharmacy, Pampady, Thiruvilwamala, Thrissur, Kerala, for providing all the facilities to
analyze this study.

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World Journal of Pharmaceutical Research

Palanisamy et al. World Journal of Pharmaceutical

Volume 7, Issue 05, 316-338. Review Article ISSN 2277–7105

A CRITICAL REVIEW ON TRADITIONAL HERBAL DRUGS: AN

Jaiganesh Kandasamy Palanisamy*1, Sivakumar Ponnu2, Sivasankar Mani3 and

www.wjpr.net Vol 7, Issue 05, 2018. 316

Need and Importance of Herbal Medicine

Etiology of Varicose veins, Cure and Strategy

Pathogenesis and Etiological Factors[3, 9]

www.wjpr.net Vol 7, Issue 05, 2018. 317

www.wjpr.net Vol 7, Issue 05, 2018. 318

Bleeding, skin changes, and ulcers[11]

―Skin changes‖ range from eczema, through brown discoloration, to flori

www.wjpr.net Vol 7, Issue 05, 2018. 319

Strategy for Treatment of Varicose veins

Medicine for Treatment of Varicose veins

Dietary and Hydrotherapy Approaches

www.wjpr.net Vol 7, Issue 05, 2018. 320

Prevention of varicosities & treatment[12]

Vitamins and minerals

Vitamin A (10,000 IU)

Vitamin B complex (10-100 mg)

Vitamin C (500-3,000 mg)to bowel tolerance is best

Vitamin E (200-600 IU)

Zinc (15-30 mg)

Bromelain (500-750 mg TID at 1,500 MCU)

www.wjpr.net Vol 7, Issue 05, 2018. 321

Flavonoids (100-1000 mg mixed flavonoids)

Warm lemon water

Laxatives (should always be a last resort)

www.wjpr.net Vol 7, Issue 05, 2018. 322

Grated raw potatoes or apples

Witch hazel, Oak bark or other astringent herbs

Red rose petals

An herbal sitz bath

Apple cider vinegar

Poultices, fomentations, suppositories

MORE TIDBITS OF ADVICE

Inverted yoga postures

Cold morning bath (For all varicosities.)

www.wjpr.net Vol 7, Issue 05, 2018. 323

Sitz baths for hemorrhoids

HERBS FOR VARICOSITIES

Witch hazel, Geranium, Oak bark, Yarrow

Saint John’s wort, Calendula, Ruta, Arnica

Comfrey, Slippery elm, Plantain

Internal applications (detailed descriptions of these herbs follow this list)

www.wjpr.net Vol 7, Issue 05, 2018. 324

INTERNAL HERBS FOR VARICOSITIES

2. Gotu kola - Centella asiatica[15, 16]

3. Horse chestnut - Aesculus hippocastanum[17, 18]

www.wjpr.net Vol 7, Issue 05, 2018. 325

Part used: ripe chestnut and bark

4. Stone root - Collinsonia canadensis

6. Agrimony - Agrimonia spp.

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7. Bayberry - Myrica cerifera

8. Cinnamon - Cinnamomum spp.

9. Geranium - Geranium maculatum