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40 g Varicose and Venous insufficiency. In varicose veins blood pools within the vein and apply pressure against walls of the veins and capillaries (see table below). Venous insufficiency is a closely related condition to varicose veins affecting larger veinsdeep within the leg. Both conditions are often characterised by pain, aching, swelling, and feelings of heaviness and fatigue. Varicose veins may also present a cosmetic problem with bulging, often ropy, blue or purple lines visible on the skin of the lower legs. Numerous double- blind placebo-controlled studies, involving more than 2,000 patients have examined the effectiveness of Troxerutin for the management of varicose veins and venous insufficiency. All but one found that troxerutin significantly more effective than placebo, giving substantial relief from swelling, aching, leg pains, and other uncomfortable symptoms, while causing no significantside effects (1-70). Hemorrhoids. Hemorrhoids are swollen but normally present blood vessels in and around the anus and lower rectum that stretch under pressure, similar to varicose veins in the legs. Like varicose veins several studies have shown that Troxerutin may be beneficial in reducing symptoms. In one study a marked improvement of symptoms such as pain, bleeding, pruritus and discharge were observed in several placebo controlled studies evaluating the efficacy of Troxerutin at 0.6-2 g/day for 3-4 weeks in a total of 189 patients with mild to severe haemorrhoids (67,68,69). These studies showed that 96-97% of patients treated with active drug had relief from bleeding Vs 62-82% of placebo treated patients, relief of pruritus (90-94% active treatments vs. 42-67% placebo), reduction of remitted discharge (88-100% active drug vs. 37-88% placebo) and reduced inflammation (95% active vs. 80% placebo). Overall 85-94% of patients receiving Troxerutin were symptom free or had improved objective appearance of haemorrhoids compared to 23-60% of placebo treated patients. Lymphoedema (Swelling). Lymphoedema is the swelling that often occurs in the recovery period following surgery. In one double-blind trial, researchers gave Troxerutin or placebo for 5 days to 40 people recovering from minor surgery or other minor injuries, and found Troxerutin significantly helpful in reducing swelling and discomfort. Results from another study involving two randomised placebocontrolled trials in 62 patients with lymphoedema of the arm or the leg (72,73) showed that hydroxyethylrutosides (Troxerutin) at 1 g TID significantly reduced the limb volume and circumference, increased limb softness and reduced elevated skin temperatures. The treatment with hydroxyethylrutosides (Troxerutin) also significantly improved the sensation of limb swelling, bursting pain, heaviness, tension and mobility. Overall 97% of patients had an increased general well being with Troxerutin therapy vs. 4% of patients treated with placebo (p<0.0001).

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