Dear Editor,
A new prospective randomized controlled experiment caught our attention, as it looked closely at the “Combined effect of yoga and naturopathy in uncomplicated varicose vein disease” [1]. In light of this, we wish to provide some additional insights and observations regarding this article.
First, we would like to thank the authors for conducting a thorough investigation on the impact of combined yoga and naturopathy treatment options on uncomplicated varicose veins encompassing with three-month follow-up periods. The authors have notably presented precise inclusion criteria for C2 (varicose veins, differentiated from reticular veins by a diameter of 3mm or greater) and C3 (edema) clinical types, which are derived from the CEAP classification (Clinical, Etiological, Anatomical, and Pathophysiological) [2]. Varicose veins represent one of the most frequent vascular diseases and are in most cases benign [2]. In varicose veins, there are increased levels of inflammatory markers, indicators of endothelial damage, and increased procoagulant activity [3]. Additionally, studies have reported significantly elevated levels of interleukin-8 (IL-8) and monocyte chemotactic protein 1 (MCP-1) in blood samples taken from varicose veins, when compared to samples from other areas of the body [3,4]. The authors primarily included massage therapy (centripetal massage to lower limbs) in their intervention regimen. Massage therapy has been shown to be useful in treating varicose veins [5]. According to a recent Cochrane systematic review, the massage techniques move extravascular fluid without disrupting intravascular fluid, which reduces edema [5].
The authors also discussed how yoga helps to reduce the inflammation in patients with uncomplicated varicose veins. In addition, for even more benefits, we suggest combining aromatherapy with massage. Aromatherapy (i.e., use of essential oils extracted from plants to manage various health conditions) is one of the treatment modalities that is commonly practiced by Naturopathy physicians in India [6,7]. Available scientific evidences reported that, many essential oils have exhibited notable anti-inflammatory properties in various health conditions [8,9]. Among these essential oils, rosemary (Rosmarinus officinalis L.) provides a variety of health benefits, including antifungal, antiviral, antibacterial, anti-inflammatory, anticancer, antithrombotic, antinociceptive, antidepressant, and antioxidant properties. The positive benefits of rosemary oil are attributed to the presence of compounds such as carnosol, carnosic acid, ursolic, oleanolic, and rosmarinic acids [10]. Apart from its potent anti-inflammatory effects, rosemary also possesses unique cosmetic properties Additionally, it has anti-aging properties and provides ultraviolet (UV) protection. Moreover, rosemary exhibits anxiolytic properties, effectively combating stress and anxiety [10]. Particular attention should be paid to subjects with a history of past contact skin allergies before application of rosemary oil. Therefore, massage therapy combined with topical rosemary oil application may provide an additional impact for patients with uncomplicated varicose veins, strengthening the multimodal strategy suggested in the original study.
In conclusion, we suggest a viable road towards comprehensive patient care is a thorough investigation of the combined effects of yoga, naturopathy, massage therapy, and aromatherapy on uncomplicated varicose vein disease. By adopting these more dimensions to the treatment plan, we might be able to give patients an enhanced and effective approach of care, which would eventually enhance their health.
Source of funding
This study received no funding from any funding agency in public or commercial.
Authors contributions
All authors equally contributed to conceptualization, drafting and reviewing the study.
Declaration of generative AI in scientific writing
None of the AI tool used in scientific writing.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgement
We sincerely thank Dr. Venugopal Vijayakumar, Lecturer II/Assistant Medical Officer in the Department of Yoga at Government Yoga and Naturopathy Medical College, and Dr. Deenadayalan Boopalan, Research Associate at ICMR's National Institute of Epidemiology, for their valuable inputs and suggestions in crafting this comment.
Footnotes
Peer review under responsibility of Transdisciplinary University, Bangalore.
References
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