Horse ChestnutAesculus hippocastanum
The horse chestnut tree is widely cultivated for its bright white, yellow, or red flower clusters. Closely related to the Ohio buckeye, this tree produces large seeds known as horse chestnuts. A superstition in many parts of Europe suggests that carrying these seeds in your pocket will ward off rheumatism. More serious medical uses date back to nineteenth-century France, where extracts were used to treat hemorrhoids.
What Is Horse Chestnut Used for Today?
Serious German research of this herb began in the 1960s and ultimately led to the approval of a horse chestnut extract for vein diseases of the legs. Horse chestnut is the third most common single-herb product sold in Germany, after ginkgo
The active ingredients in horse chestnut appear to be a group of chemicals called saponins, of which aescin is considered the most important. Aescin appears to reduce swelling and inflammation.
Horse chestnut is most often used as a treatment for
Another double-blind study found that a topically applied gel made from horse chestnut may be helpful for bruises.
Finally, horse chestnut is sometimes used along with conventional treatment in cases where the veins of the lower legs become seriously inflamed (called
What Is the Scientific Evidence for Horse Chestnut?
More than 800 individuals have been involved in double-blind, placebo-controlled studies of horse chestnut for treating venous insufficiency. 6-14
One of the largest of these trials followed 212 people over a period of 40 days.
A better-designed double-blind study of 74 individuals also found benefit.
Good results were also seen in a partially double-blind, placebo-controlled study, which compared the effectiveness of horse chestnut to that of compression stockings, a standard treatment.
A double-blind, placebo-controlled study of 80 people with symptomatic hemorrhoids evaluated the use of a horse chestnut product providing 40 mg of aescin 3 times daily.
A double-blind study of 70 people found that about 10 g of 2% aescin gel, applied externally to bruises in a single dose 5 minutes after they were induced, reduced bruise tenderness.
The most common dosage of horse chestnut is 300 mg twice daily, standardized to contain 50 mg aescin per dose, for a total daily dose of 100 mg aescin.
Horse chestnut preparations should certify that a toxic constituent called esculin has been removed (see Safety Issues). Also, a delayed-release formulation must be used to prevent gastrointestinal upset.
Whole horse chestnut is classified as an unsafe herb by the FDA. Eating the nuts or drinking a tea made from the leaves can cause horse chestnut poisoning, the symptoms of which include nausea, vomiting, diarrhea, salivation, headache, breakdown of red blood cells, convulsions, and circulatory and respiratory failure possibly leading to death.
However, manufacturers of the typical European standardized extract formulations remove the most toxic constituent (esculin) and standardize the quantity of aescin. To prevent stomach irritation caused by another ingredient of horse chestnut, the extract is supplied in a controlled-release product, which reduces the incidence of irritation to below 1%, even at higher doses.
Properly prepared horse chestnut products appear to be quite safe.
In animal studies, horse chestnut and its principal ingredient aescin have shown a low degree of toxicity, producing no measurable effects when taken at dosages seven times higher than normal.
Individuals with severe kidney problems should avoid horse chestnut.
Horse chestnut should not be combined with anticoagulant, or blood-thinning, drugs, as it may amplify their effect.
5. 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;59:394-397.
8. Bisler H, Pfeifer R, Kluken N, et al. Effects of horse-chestnut seed extract on transcapillary filtration in chronic venous insufficiency [translated from German]. Dtsch Med Wochenschr. 1986;111:1321-1329.
10. Rudofsky G, Neiss A, Otto K, et al. Antiedematous effects and clinical effectiveness of horse chestnut seed extract in double blind studies [translated from German]. Phlebologie und Proktologie. 1986;15:47-54.
13. Diehm C, Trampisch HJ, Lange S, et al. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet . 1996;347:292-294.
17. Diehm C, Trampisch HJ, Lange S, et al. Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency. Lancet . 1996;347:292-294.
18. Calabrese C and 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;59:394-397.
20. Diehm C. The role of oedema protective drugs in the treatment of chronic venous insufficiency: a review of evidence based on placebo-controlled clinical trials with regard to efficacy and tolerance. Phlebology. 1996;11:23-29.
Last reviewed April 2009 by EBSCO CAM Review Board
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