Clinical Pearl: Management of Chronic Venous Insufficiency Through Acupuncture and Chinese Herbs

Chronic venous insufficiency (CVI) is a prevalent, persistent, and often underestimated condition that encompasses a wide range of venous disorders in which the flow of superficial or deep venous blood is impaired, leading to venous hypertension.^1,2 Its prevalence ranges from 25% to 40% in women and 10–20% in men, with an annual incidence of 2–6% in women and approximately 1.9% in men. ³ In CVI, there is a reverse flow of blood, which develops as a result of valvular damage, dysfunction, and impaired muscle pump function. It triggers leukocyte endothelial interaction, extravasation of red blood cells, causing hemolysis and a chronic inflammatory state. ⁴ It manifests as pain, swelling, cracked skin, heaviness, itching, and claudication and is often accompanied by varicose veins, pigmentation, lipodermatosclerosis, and venous scarring. If left untreated, skin atrophy and venous ulcers may develop due to inflammatory blockage of small veins and arteries, along with vascular fibrosis and tissue degeneration. ⁵ The risk factors include genetic predisposition, advanced age, prolonged standing, previous thrombophlebitis, leg trauma, female sex, obesity, physical inactivity, hypertension, smoking, and pregnancy. ⁶ The most commonly used nonpharmacological intervention is the use of compression stockings. The management of CVI includes pharmacological (venoactive drugs that inhibit the inflammatory cascade), ⁷ surgical (vein stripping, sclerotherapy, radiofrequency, and laser ablation), and nonpharmacological (compressing stockings and exercises) interventions, which are given based on the severity of the condition. ⁸ Persistent inflammation, microcirculatory dysfunction, and nociceptive signaling further exacerbate symptoms and impair quality of life, ⁹ underscoring the need for interventions that target both hemodynamic and inflammatory pathways.

Acupuncture is one of the complementary and alternative medicines widely applied in several diseases, which modulates the autonomic activity, inflammation, and blocks the nociceptive signals to the brain.^10,11 According to acupuncture theory, CVI may arise from several interrelated mechanisms. The core pathological features include stagnation of Qi and blood within the vessels, which impairs circulation. Prolonged spleen-yang deficiency further disrupts fluid movement, leading to the accumulation of dampness and subsequent kidney-yang deficiency. Weakened kidney-yang and spleen yang impairs the body’s ability to transport and transform fluids effectively, resulting in fluid retention and edema in the lower extremities. Thus, the key therapy is primarily aimed at warming and reinforcing the qi of the spleen and kidney to ultimately exhaust the dampness. ¹² To nourish the kidney yang and tonify Qi, the following acupuncture points can be provided: BL 23 (Shenshu), KI 7 (Jing Gu), BL 52 (Zhishi), DU 4 (Mingmen), and Ren 6 (Qihai). ¹³ Since spleen-yang deficiency often stems from spleen-qi deficiency, the acupuncture points to reinforce the spleen yang and eliminate dampness can be given: SP 9 (Yinlingquan), resolves dampness in the lower burner; SP 3 (Taibai), Yuan source point of spleen; SP 6 (Sanyinjiao), tonifies the spleen along with moxibustion; ST 36 (Zusanli), Ren 9 (Shuifen), ST 28 (Tiaokou), and BL 20 (Pishu), (the back transporting point for the spleen), stimulates the spleen to transform and transport fluids. Along with this, LU 9 (Tai yun), an influential point for blood vessels, combined with CV 17 (Shanzhong), can be given as a distal point to address poor circulation. ¹⁴

Moxibustion applied to specific acupoints helps tonify Qi, expel dampness, and blood. ¹⁵ This stimulation effectively improves vascular permeability, reduces blood viscosity and cellular aggregation, and mitigates inflammatory responses, thereby reducing pain. ¹⁶ The duration of treatment varies from 20 to 30 min twice a week for 4 weeks. It varies depending on the severity of the condition. A previous study showed that fire needling, along with bloodletting at ST 36 (Zusanli) and BL 57 (Chengshan), was effective in reducing blood stasis, vasospasm, and lowering pressure on venous valves, thereby facilitating the repair of damaged veins and valve structures. ¹⁷ Another study showed that electrical stimulation at ST 36 (Zusanli), SP 6 (Sanyinjiao), and SP 9 (Yinlingquan) accelerated the blood flow of the external iliac veins, femoral veins, popliteal veins, and deep calf veins, thus preventing deep vein thrombosis and venous insufficiency. In addition, the study showed a reduction in the D-dimer level (an indicator of microclot formation due to blood stasis), suggesting its role in anticoagulant and anti-inflammatory processes. ¹⁸

Previous literature indicates that Chinese herbal formulations, such as Zhi Tong Sheng Ji powder and Sheng Ji Xiang Pi plaster, are used alongside acupuncture to alleviate pain and promote healing in leg ulcers. ¹⁹ Buyang Huanwu decoction (Radix Astragali seu Hedysari, Lumbricus, Flos Carthami, Radix Paeoniae Rubra, Radix Angelicae Sinensis, Semen Persicae, and Rhizoma Ligustici Chuanxiong) was administered at 180 mL twice daily for 14 days to enhance blood circulation and relieve collateral obstruction. ²⁰ Hence, acupuncture, moxibustion, and Chinese herbal medicines might serve as potential adjunct treatments for CVI. However, future clinical trials are recommended to corroborate its efficacy in managing CVI.