Leg Swelling — What Do Herbalists and Doctors Say?

Aim of the study: Venoactive drugs (VADs) are considered an important component of the medical (conservative) treatment of chronic venous disorders (CVDs). However, the efficacy of certain VADs on one or more individual leg symptoms may not have been studied extensively enough to justify a high level or grade of recommendation in CVD guidelines.

Results: Based on high-quality evidence, Ruscus extracts are highly effective in reducing symptoms and edema in patients with CVD.

Aim of the study: Chronic venous insufficiency (CVI) is common in adults. Some complications include skin changes, edema, heavy legs, muscle cramps, pain, and varicose veins. In traditional medicine, red vine leaf extract (AS 195) has been used to treat the symptoms of CVI. This systematic review aimed to assess the effects of AS 195 in patients with CVI.

Results: Of the 56 studies, 5 trials were selected according to our inclusion criteria. Red vine leaf extract significantly improved several outcomes (lower-leg volume, calf and ankle circumference, tiredness, heavy legs, tingling, pain, the sensation of tension in the legs, cutaneous microcirculation, and transcutaneous oxygen pressure) in only some trials. Tolerability of red vine leaf extract was reported as good or satisfactory. Red vine leaf extract had a beneficial therapeutic role in patients with CVI. Further high-quality trials are needed to provide strong evidence.

Aim of the study: Forty patients with chronic venous insufficiency (CVI) and varicose veins in the legs were selected and randomly assigned, under double-blind conditions, to treatment with Pycnogenol (French maritime pine bark extract), 100 mg x 3/day, or a placebo for 2 months, according to a double-blind experimental design.

Results: Approximately 60% of patients treated with Pycnogenol(R) experienced complete disappearance of edema (the symptom that disappeared most rapidly) and pain by the end of treatment, while almost all patients reported reduced leg heaviness, which disappeared in approximately 33% of patients. These changes were statistically significant. No effect was observed in the subjects treated with placebo. No effect on venous blood flow was observed in either experimental group.

Aim of the study: Extracts from the seed of the horse chestnut (Aesculus hippocastanum L.) have traditionally been used to treat patients with chronic venous insufficiency and to alleviate its associated symptoms, including lower-leg swelling. The efficacy of preparations containing horse chestnut seed extract (HCSE) is believed to be due largely to an inhibitory effect on the catalytic breakdown of capillary wall proteoglycans.

Results: The efficacy of preparations containing horse chestnut seed extract (HCSE) is believed to be due largely to an inhibitory effect on the catalytic breakdown of capillary wall proteoglycans. Aesculaforce is a fresh-plant HCSE available as an oral tincture, tablets (20 mg or 50 mg), and a topical gel. Four clinical trials in patients with chronic venous insufficiency and 1 study in patients with varicose veins demonstrated the effectiveness of these preparations through the objective measure of reduced lower-leg edema and the subjective relief of leg pain, heaviness, and itching. Safe, well tolerated, and acceptable to patients, the fresh-plant HCSE preparation Aesculaforce offers a real alternative for treating patients with mild to moderate venous insufficiency.

Aim of the study: Chronic venous insufficiency (CVI) is the consequence of venous valve reflux and/or venous flow obstruction and resulting venous hypertension in the lower extremities. The aim of this prospective supplement registry study was to evaluate the efficacy of compression stockings or Pycnogenol® in controlling symptoms and edema in CVI, and their efficacy on microcirculatory parameters.

Results: Elastic compression was less well tolerated than Pycnogenol®, with 12 subjects unable to follow the compression routine. No side effects due to supplementation were observed; tolerability of the supplement was optimal. Ambulatory venous pressure (AVP) and refilling time (RT) at inclusion indicated a significant increase in venous pressure and reflux (refilling time <16 seconds). AVP and RT did not change after 4 months. Microcirculatory and clinical measurements were comparable at inclusion between the 2 groups. After 4 months, skin resting flux (RF) and skin PO<inf>2</inf>-PCO<inf>2</inf> were significantly improved with Pycnogenol® compared with compression (P<0.05). The significant increase in skin PO<inf>2</inf> and decrease in PCO<inf>2</inf> after Pycnogenol® intake were attributed to the decrease in abnormally high skin resting flux, a sign of better perfusion and skin nutritional supply.

Aim of the study: Background: Chronic Venous Disorders or Diseases (CVD) of the lower extremities are common, affecting almost 90 % of the adult population. CVD includes varicose veins with a prevalence of approx.

Results: AS195 was well tolerated in studies and in everyday therapy. There are no known interactions with other medications. In later stages, it can be used in combination with compression, complementing the beneficial haemodynamic effects of compression at a cellular level. AS195 is an addition to compression and fills a therapeutic gap, especially for patients who cannot use compression stockings but still require CVD therapy.

Aim of the study: Saireito (TJ-114) is a traditional Japanese herbal medicine that has been used to treat edema and inflammation in diseases such as nephritic disease. This study investigates the effect of TJ-114 on postoperative edema and inflammation after total hip arthroplasty (THA).

Results: Although no significant difference in lower-extremity edema was observed between the two groups, swelling of the upper part of the leg in Group A was found to be less than in Group B. Furthermore, 3 weeks after surgery, measurements at every point in the lower extremity showed that TJ-114 tended to reduce postoperative swelling compared with measurements in patients who did not take TJ-114. Serum C-reactive protein (CRP) levels in 6 out of 8 patients in Group A decreased and became negative 2 weeks after surgery; however, no patients in Group B had negative CRP levels after 2 weeks. In conclusion, TJ-114 is safe and useful for preventing postoperative leg edema and supporting early recovery after THA, and is associated with a rapid reduction in CRP.

Aim of the study: Elephantiasis nostras verrucosa (ENV) is a rare dermatological disease associated with chronic lymphedema caused by obesity, soft tissue infection, or chronic venous insufficiency. Although surgical debridement may be sufficient to treat the skin manifestations of ENV, treatment should focus on reducing lymph stasis to improve skin changes and prevent recurrence.

Results: In this case report, we present the case of a 79-year-old woman who developed obesity-associated ENV in the lower leg. She was successfully treated with a combination of lymphaticovenous anastomoses and the oriental herbal medicine Bofutsushosan. To our knowledge, this is the first reported case of obesity-associated ENV in which the skin condition not only healed, but both edema relief and weight loss were achieved. A treatment combining surgery and the herbal medicine could be a potential therapeutic option for obesity-associated ENV.