Primary superficial venous insufficiency of the lower limbs is a common disease that occurs mostly in prolonged standing work or manual labor. The main manifestation is that the superficial venous system of the lower limbs is in a state of anger, meandering and varicose. This disease has the highest incidence among peripheral vascular diseases. There are few symptoms in the early stage, and a few patients tend to walk with discomfort of lower limb i swelling, sometimes with mild edema of ankle in the evening. Local varicose vein stasis can cause trophic changes in the skin, hyperpigmentation, skin flaking, itching, breakage of long-lasting ulcers (commonly known as rotting legs, etc.), and sometimes also secondary eczema or bleeding. It has been proved that superficial veins, deep veins, superficial and deep veins traffic branch valve insufficiency, pregnancy and abdominal tumors can cause superficial varicose veins. Varicose veins are only diagnosed by symptoms, but their pathology includes primary superficial venous insufficiency, primary deep venous insufficiency, and secondary deep venous insufficiency. 1, etiology and pathology: under normal circumstances, the centripetal return of venous blood in the lower limbs is dependent on the synergistic effect of the heart beating and generating the diastolic force, the pumping effect generated by the muscles surrounding the deep veins in the deep fascia, and the negative pressure attraction in the thoracic cavity during respiratory exercise. Venous valves, on the other hand, play a unidirectional role in blood return. Congenital weakness of the venous wall or defective venous valves, and persistent elevation of pressure within the superficial veins are the main causes of superficial varicose veins. Congenital deficiencies, coupled with prolonged bouts of coughing or physical labor, and elevated intra-abdominal pressure can directly impact the saphenous vein valves at the junction of the saphenous vein and the femoral vein, resulting in damage to the valves, insufficiency of the valves, and blood reflux that results in a higher venous blood pressure, ultimately resulting in varicose veins at the distal end and in the geniculate branches. Prolonged standing for long periods of time also results in elevated venous pressure and more severe venous stasis. In the development of primary venous valve insufficiency, the weakness of the venous wall and the increase in venous pressure can interact to produce pathophysiologic and pathoanatomic changes. Since the smooth muscle fibers within the venous wall are arranged in annular and longitudinal rows, with varying amounts at each location, the degree of venous dilatation and its appearance are also irregular. The annulus muscle is particularly abundant in the valvular leaflet attachment, so it is not easy to dilate here, and the venous sinus annulus muscle is easy to dilate when it is rare, so it forms a cystic varicose vein. The dilated and tortuous veins have stagnant blood flow, and thus the malnutrition of the vein wall is more likely to form aseptic inflammation or infectious inflammation and then cause thrombosis. The formation and mechanization of thrombus also causes damage to the valves of the traffic branches, thus aggravating the varicose veins. The venous wall is inelastic, stiff and adheres to the surrounding tissues. The boundaries of the three layers of tissue in the venous walls also become indistinct, and the surrounding tissues are malnourished with fibroblastic proliferation. Diffuse fibrous degeneration of the subcutaneous tissue at the site of the lesion is accompanied by edema, and the edema fluid contains a large amount of proteins, which in turn cause fibroblastic hyperplasia. Damage to the lymphatic vessels also increases the protein in the edema fluid, which in turn aggravates the fibrosis, making the local tissues hypoxic, malnourished, and with low resistance, thus making the skin weak and prone to secondary lymphadenitis, dermatitis, and long-lasting ulcers or eczema. According to Chinese medicine, superficial venous valvular insufficiency of the lower limbs is caused by dampness and heat infiltration, blood stasis and stagnation of the veins and collaterals. Or due to the burden of heavy standing for a long time damage to the liver and kidneys, also impede the operation of local qi and blood. Plus trauma skin damage ulceration is difficult to heal. In Chinese medicine, it is called “tendon tumor”, “pollicized leg”, “skirt skin sores”, “old rotting leg” and so on. Clinical manifestations and signs The most common manifestation of primary superficial venous insufficiency of the lower limbs is varicose veins of the lower limbs, which include the great saphenous vein and the small saphenous vein, with the great saphenous vein varicose veins being the most common. It is most common in middle-aged people who have been standing for a long time. In the early stage, there is no obvious discomfort, but with the development of the disease, the patient may feel the heaviness of the limbs, acidity, distension, fatigue, etc. If the patient stands for a long time, the calves, legs and feet may become swollen. Standing for a long time, calves, ankles can appear swelling, sometimes appear calf muscle spasm phenomenon, to the late stage, can be complicated by chronic stasis ulcers in the calves, which are not easy to heal after a long time. (1) superficial varicose veins of the lower limbs: superficial varicose veins mostly occur in bilateral lower limbs, can also occur in unilateral lower limbs. In obese patients, the varicose veins of the affected limbs are often hidden and not obvious; in thin patients, the superficial veins of the affected limbs can be seen to be dilated, tortuous, bulging, and in severe cases, twisted into a mass, and the varicose veins are more obvious when standing, and the superficial varicose veins are deflated when the affected limbs are elevated while lying down. When the saphenous vein is involved, the varicose vein is distributed in the inner side of the lower limb, or extends to the front and back of the affected limb. Since the saphenous vein of the lower leg has a smaller diameter, thinner walls and is subjected to greater pressure, varicose veins of the lower leg are more serious than those of the upper leg. When the small saphenous vein is involved, the varicose veins are distributed at the back of the calf and may extend to the ankle and the dorsum of the foot. (2) Soreness and pain in the affected limbs: Due to varicose veins in the lower limbs, venous stasis occurs and venous pressure is further increased. With the aggravation of the condition, patients mostly have the feeling of soreness or distension of the affected limbs, and are easily fatigued, mostly occurring when standing for a long time. When lying down and elevating the limb, the feeling of soreness and distension disappears rapidly. (3) Swelling of the affected limbs: simple primary superficial venous insufficiency of the lower extremities caused by varicose veins, generally no swelling of the affected limbs. When accompanied by traffic branch valve insufficiency, or deep vein valve insufficiency, the ankle and calf can appear different degrees of swelling, the worse the deep vein valve function, the more obvious the swelling of the affected limb. If lymphatic vessels are involved and lymphedema occurs at the same time, the swelling of the affected limb is more obvious. (4) Complications: ① superficial thrombophlebitis: due to varicose veins of the lower limbs, the vein wall is severely degenerated and venous blood flow is stagnant, so superficial thrombophlebitis is often complicated, the varicose veins of the lower limbs are red, swollen, burning and painful, and along the varicose veins, a hard nodule or a cord can be palpated, and the pressure pain can be felt. If combined with periphlebitis, redness, swelling, heat and pain appear around the superficial veins. After the acute inflammation subsides, hard nodules or cords remain locally. ② Superficial vein hemorrhage: Due to varicose veins, the pressure of veins is extremely increased, the wall of veins is not thick or thin, and slight injury will lead to rupture and bleeding of veins. Due to high venous pressure, sometimes small veins can rupture spontaneously and cause bleeding. ③ Stasis dermatitis: due to stasis and hypoxia of the skin of the affected limbs, skin nutritional disorders occur, skin atrophy, dryness, desquamation, skin as thin as paper, pigmentation, oozing, itching, hardening of the skin and subcutaneous tissues, and sometimes eczema and ulcers appear. It mainly occurs in the lower 1/3 of the calf or lower 2/3 of the calf, and it is rare to occur in the upper 1/3 of the calf. ④Secondary infection: due to the weakened resistance of the affected limb, secondary infection is easy to occur. Commonly, there are thrombosed superficial phlebitis, dengue, acute cellulitis, etc. The patient may have high fever, malignant cold, yellow tongue coating and reddish tongue. Due to repeated attacks of salpingitis, lymphatic vessels are blocked, and finally elephantiasis occurs. ⑤ Stasis ulcer: the skin of the affected limb is aggravated by nutritional disorders, and chronic ulcers (stasis ulcers) of the lower leg can occur with slight trauma, which are difficult to heal. Stasis ulcers have a specific site, often occurring in the lower 1/3 of the medial (internal pollicized ulcers) and lateral (external pollicized ulcers).