Abstract
Chronic venous insufficiency (CVI) refers to a cluster of clinical syndromes resulting from pathological abnormalities in venous structure and function, which in turn lead to impaired venous return and elevated venous pressure. It is a common peripheral vascular disease in clinical practice. Its clinical manifestations primarily include a sensation of heaviness and distension in the lower extremities, aching discomfort, limb edema, tortuous and dilated superficial veins, skin pigmentation, and soft tissue malnutrition. In severe cases, it may be complicated by venous ulcers, and is characterized by a prolonged disease course and progressive deterioration. In modern medicine, surgical intervention serves as the primary treatment modality, supplemented by comprehensive approaches including pharmacotherapy and compression therapy. Nevertheless, these strategies are associated with limitations such as significant trauma, prolonged postoperative recovery, high medical expenses and a high recurrence rate—issues that not only cause physical and mental distress to patients but also impose a heavy burden on the social health care system. Given the large number of CVI patients encountered in my clinical practice, and taking the opportunity of your journal’s call for papers, I hereby share my traditional Chinese medicine (TCM) diagnosis and treatment insights for this disease with colleagues, aiming to “throw a brick to attract jade” and collectively advance academic progress in related fields.
In TCM theory, CVI falls into the category of “Jingliu” (tendon tumor). Its core pathogenesis involves congenital insufficiency of constitutional endowment, compounded by prolonged standing, prolonged walking, and excessive labor—factors that deplete healthy qi (zhengqi). This qi deficiency impairs the promotion of blood circulation, leading to blood stasis in the collaterals of the lower extremities. Prolonged internal stagnation of blood stasis predisposes the body to invasion by pathogenic dampness, ultimately resulting in a syndrome characterized by the intermingling of dampness and stasis that obstructs the collaterals. As the collaterals lose their patency, they become tortuous and dilated, thereby triggering the disease. Based on the aforementioned pathogenesis, the core therapeutic principles for CVI involve replenishing qi and activating blood circulation, as well as warming the meridians and dredging the collaterals. Acupoint selection is aligned with this pathogenesis and therapeutic principles, focusing on acupoints along the Spleen Meridian of Foot-Taiyin (SP) and Stomach Meridian of Foot-Yangming (ST) in the lower extremities. Warming acupuncture is the preferred stimulation technique. The specific diagnosis and treatment protocol are detailed as follows:
SELECTED ACUPOINTS
ST36 (Zusanli), ST40 (Fenglong), SP6 (Sanyinjiao), SP8 (Diji), CV4 (Guanyuan), CV6 (Qihai), CV12 (Zhongwan), GB39 (Xuanzhong), ST41 (Jiexi).
OPERATIONAL SPECIFICATIONS
Reinforcing Manipulation Combined with Suspending Moxibustion Group
(ST36 Zusanli, SP6 Sanyinjiao, SP8 Diji, CV4 Guanyuan, CV6 Qihai, CV12 Zhongwan):Perpendicular needle insertion (perpendicular to the skin surface) is performed at the selected acupoints, with an insertion depth of 30–50 mm. The reinforcing manipulation of “light insertion and heavy lifting” is employed. Once the patient experiences deqi (a subjective sensation of soreness, distension, and tightness), suspending moxibustion is applied to ST36 (Zusanli), SP6 (Sanyinjiao), and CV4 (Guanyuan). The ignited moxa cone is secured to the needle handle, and moxibustion is retained for 30 min. Throughout the procedure, the moxibustion temperature is closely monitored to prevent skin burns.
Even Reinforcing-Even Reducing Manipulation Group
(ST40 Fenglong, GB39 Xuanzhong, ST41 Jiexi):Perpendicular needle insertion (perpendicular to the skin surface) is performed at the selected acupoints, and the even reinforcing-even reducing manipulation is used. Once the patient experiences deqi (a subjective sensation of soreness, distension, and tightness), the needle is retained for 30 min.
ACUPOINT FORMULA EXPLANATION
For ST36 (Zusanli), CV4 (Guanyuan), CV6 (Qihai), and CV12 (Zhongwan): These acupoints replenish the congenital kidney and acquired spleen-stomach, which serves to replenish qi and blood, and strengthen the vessel channels.
For SP6 (Sanyinjiao) and SP8 (Diji): They promote blood circulation to dispel dampness and dredge stagnation in the lower limbs.
For ST40 (Fenglong) and ST41 (Jiexi): These acupoints clear dampness-turbidity and smooth the qi movement in the vessel channels.
For GB39 (Xuanzhong): It nourishes the liver and kidney, strengthens the muscles and bones, and consolidates the foundation of the vessel channels.
TREATMENT COURSE
Treatment is administered three times per week, with 10 times constituting one course. Completion of three consecutive courses is recommended.
CLINICAL EFFICACY
In outpatient treatment of CVI with this acupuncture protocol, patients reported relieved symptoms like lower limb edema and aching; combined with elastic stockings, their quality of life improved.
The protocol, validated by multiple cases (lacking large-sample data), offers a potential reference for CVI clinical management.