The horse chestnut tree is native to Asia and northern Greece, but it is now cultivated in many areas of Europe and North America. The tree produces fruits that are made up of a spiny capsule containing one to three large seeds, known as horse chestnuts. Traditionally, many of the aerial parts of the horse chestnut tree, including the seeds, leaves, and bark, were used in medicinal preparations. Modern extracts of horse chestnut are usually made from the seeds, which are high in the active constituent aescin (also known as escin).
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3 StarsReliable and relatively consistent scientific data showing a substantial health benefit.
2 StarsContradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
This supplement has been used in connection with the following health conditions:
Chronic Venous Insufficiency
Standardized extract providing 50 mg aescin two to three times per day
According to an extensive overview of clinical trials, standardized horse chestnut seed extract, which contains the active compound aescin, has been shown to be effective in double-blind and other controlled research, supporting the traditional use of horse chestnut for venous problems.2 In these trials, capsules of horse chestnut extract containing 50 mg of aescin were given two to three times daily for CVI. The positive effect results in part from horse chestnut’s ability to strengthen capillaries, which leads to a reduction in swelling.3
Take a standardized herbal extract providing 90 to 150 mg aescin daily
Horse chestnut extracts have been reported from a double-blind trial to reduce symptoms of hemorrhoids.4 Some doctors recommend taking horse chestnut seed extracts standardized for aescin (also known as escin) content (16–21%), or an isolated aescin preparation, providing 90 to 150 mg of aescin per day.
Sprains and Strains
Apply a 2% gel every two hours
Horse chestnut contains a compound called aescin that acts as an anti-inflammatory and reduces edema (swelling with fluid) following trauma, particularly sports injuries, surgery, and head injury.5 A topical gel containing 2% of the compound aescin found in horse chestnut is widely used in Germany to treat minor sports injuries, including sprains and strains.6 The gel is typically applied to affected area every two hours until swelling begins to subside.
Horse chestnut contains a compound called aescin that acts as an anti-inflammatory and reduces edema (swelling with fluid) following trauma, particularly sports injuries, surgery, and head injury.7 A topical aescin preparation is popular in Europe for the treatment of acute sprains during sporting events.
Refer to label instructions
Aescin, isolated from horse chestnut seed, has been shown to effectively reduce post-surgical edema in preliminary trials.8, 9 A form of aescin that is injected into the bloodstream is often used but only under the supervision of a qualified healthcare professional.
Refer to label instructions
Horse chestnut seed extract can be taken orally or used as an external application for disorders of venous circulation, including varicose veins.10 Preliminary studies in humans have shown that 300 mg three times per day of a standardized extract of horse chestnut seed reduced the formation of enzymes thought to cause varicose veins.11 Topical gel or creams containing 2% aescin can be applied topically three or four time per day to the affected limb(s).
Traditional Use (May Not Be Supported by Scientific Studies)
Horse chestnut leaves have been used by herbalists as a cough remedy and to reduce fevers.1 The leaves were also believed to reduce pain and inflammation of arthritis and rheumatism. In traditional herbal medicine, poultices of the seeds have been used topically to treat skin ulcers and skin cancer. Other uses include the internal and external application for problems of venous circulation, including varicose veins and hemorrhoids.
How It Works
How It Works
The seeds are the source of a saponin known as aescin, which has been shown to promote circulation through the veins.12 Aescin fosters normal tone in the walls of the veins, thereby promoting return of blood to the heart. This has made both topical and internal horse chestnut extracts popular in Europe for the treatment of chronic venous insufficiency and, to a lesser extent, varicose veins. Aescin also possesses anti-inflammatory properties and has been shown to reduce edema (swelling with fluid) following trauma, particularly following sports injury, surgery, and head injury.13, 14 A topical aescin preparation is very popular in Europe for the treatment of acute sprains during sporting events. Horse chestnuts also contain flavonoids, sterols, and tannins.
Double-blind and preliminary clinical trials have shown that oral horse chestnut extracts reduce the symptoms of chronic venous insufficiency, including swelling and pain.15, 16 Those suffering edema after surgery have also found relief from topical application of horse chestnut extracts, according to preliminary studies.17
How to Use It
For treatment of chronic venous insufficiency horse chestnut seed extracts standardized for aescin content (16–20%), 300 mg two to three times per day, are recommended.18, 19 Tincture, 1–4 ml taken three times per day, can be used though it is questionable whether a significant amount of aescin can be absorbed this way.20 Gels or creams containing 2% aescin can be applied topically three or four times per day for hemorrhoids, skin ulcers, varicose veins, sports injuries, and trauma of other kinds.
Interactions with Supplements, Foods, & Other Compounds
At the time of writing, there were no well-known supplement or food interactions with this supplement.
Although there are no specific studies demonstrating interactions with anticoagulants, the following herbs contain coumarin-like substances that may interact with heparin and could conceivably cause bleeding.21 These herbs include dong quai, fenugreek, horse chestnut, red clover, sweet clover, and sweet woodruff. People should consult a healthcare professional if they’re taking an anticoagulant and wish to use one of these herbs.
The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.
Internal use of horse chestnut seed extracts standardized for aescin at recommended amounts is generally safe. However, in rare cases oral intake of horse chestnut may cause itching, nausea, and upset stomach.22 Based on reports of worsening kidney function in people with kidney disease who received intravenous aescin, horse chestnut should be avoided by anyone with kidney disease.23, 24 People with liver disease should also avoid the use of horse chestnut. There are no known reasons to avoid horse chestnut during pregnancy.25 Topically, horse chestnut has been associated with rare cases of allergic skin reactions. Circulation disorders and trauma associated with swelling may be the sign of a serious condition. Therefore, a healthcare professional should be consulted before self-treating with horse chestnut.
2. Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency: a criteria-based systematic review. Arch Dermatol 1998;134:1356–60.
3. Bisler H, Pfeifer R, Klüken N, Pauschinger P. Effects of horse-chestnut seed extract on transcapillary filtration in chronic venous insufficiency. Deutche Med Wochenschr 1986;111:1321–9 [in German].
4. Nini G, Di Cicco CO. Controlled clinical evaluation of a new anti-hemorrhoid drug, using a completely randomized experimental plan. Clin Ther 1978;86:545–59 [in Italian].
5. Guillaume M, Padioleau F. Veinotonic effect, vascular protection, anti-inflammatory and free radical scavenging properties of horse chestnut extract. Arzneimittelforschung 1994;44:25–35.
6. Pabst H. Kleine MW. Prevention and therapy of sports injuries. Experiences with an escin-containing gel. Fortschr Med 1986;104:44–6.
7. Guillaume M, Padioleau F. Veinotonic effect, vascular protection, anti-inflammatory and free radical scavenging properties of horse chestnut extract. Arzneimittelforschung 1994;44:25–35.
8. Dini D, Bianchini M, Massa T, Fassio T. Treatment of upper limb lymphedema after mastectomy with escine and levo-thyroxine. Minerva Med 1981;72:2319–22 [in Italian].
9. Wilhelm K, Feldmeier C. Thermometric investigations about the efficacy of beta-escin to reduce postoperative edema. Med Klin 1977;72:128–34 [in German].
10. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, TX: American Botanical Council and Boston: Integrative Medicine Communications, 1998, 149.
11. Kreysel HW, Nissen HP, Enghofer E. A possible role of lysosomal enzymes in the pathogenesis of varicosis and the reduction in their serum activity by Venostasin. Vasa 1983;12:377–82.
12. Guillaume M, Padioleau F. Venotonic effect, vascular protection, anti-inflammatory and free radical scavenging properties of horse chestnut extract. Arzneim-Forsch Drug Res 1994;44:25–35.
13. Guillaume M, Padioleau F. Venotonic effect, vascular protection, anti-inflammatory and free radical scavenging properties of horse chestnut extract. Arzneim-Forsch Drug Res 1994;44:25–35.
14. Calabrese C, Preston P. Report of the results of a double-blind, randomized, single-dose trial of a topical 2% escin gel versus placebo in the acute treatment of experimentally-induced hematoma in volunteers. Planta Med 1993;59:394–7.
15. Pittler MH, Ernst E. Horse Chestnut seed extract for chronic venous insufficiency: A criteria-based systematic review. Arch Dermatol 1998;134:1356–60.
16. Diehm C, Trampish HJ, Lange S, Schmidt C. Comparison of leg compression stocking and oral horse chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet 1996;347:292–4.
17. Wilhelm K, Felmeier C. Thermometric investigations about the efficacy of beta-escin to reduce postoperative edema. Med Klin 1977;72:128–34 [in German].
18. Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press, 1994, 112–3.
19. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 148–9.
20. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum and Beaconsfield, UK: Beaconsfield Publishers Ltd., 1988, 188–9.
21. Miller LG, Murray WJ, eds. Herbal Medicinals: A Clinician’s Guide. New York: Pharmaceutical Products Press, 1999, 313–5.
22. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 148–9.
23. Hellberg K, Ruschewski W, de Vivie R. Medikamentoes bedingtes post-operatives Nierenversagen nach herzchirurgischen Eingriffen. Thoraxchirurgie 1975;23:396–9.
24. Wilhelm K, Feldmeier C. Postoperative und posttraumatische Oedemprophylaxe und -therapie. Laborchemische Untersuchungen ueber die Nierenvertraeglichkeit von beta-Aescin. Med Klin 1975;70:2079–83.
25. Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, MA: Integrative Medicine Communications, 1998, 148–9.
The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2014.
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