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Background: Varicose veins are common, particularly in people who stand for long periods, and can progress to skin changes and venous ulcers. Sushruta described a condition called Siraja Granthi, in which veins become swollen, tortuous and knotted, and prescribed bloodletting, oleation and other measures. Modern management has evolved rapidly with endovenous techniques. Objective: To review the classical concept of Siraja Granthi and to evaluate modern and Ayurvedic approaches to the management of varicose veins within an integrative framework. Methods: Narrative review of Sushruta Samhita, vascular guidelines, randomised trials, Cochrane reviews and Ayurvedic clinical reports. Results: Sushruta attributes Siraja Granthi to Vata vitiation following exertion in weak individuals, describing compression and twisting of veins. Modern understanding emphasises valve incompetence and venous hypertension, classified by the CEAP system. Randomised trials show that endovenous ablation and surgery improve quality of life and that early endovenous ablation speeds healing of venous ulcers. Cochrane reviews suggest that phlebotonic drugs and horse chestnut seed extract modestly reduce oedema and symptoms. Structured exercise improves calf-muscle pump function. Leech therapy was associated with ulcer healing and reduced oedema in a small study of complicated varicose veins. Evidence for Ayurvedic oral formulations is limited to case reports. Conclusion: An integrative approach can combine evidence-based modern interventions with Ayurvedic measures such as leech therapy, exercise, diet and herbal support. Ayurvedic practitioners should assess venous disease severity and refer appropriately, and Ayurvedic interventions should be tested in controlled trials.

KEYWORDS: Siraja Granthi; varicose veins; chronic venous insufficiency; CEAP; endovenous ablation; leech therapy; phlebotonics; compression