HORSE CHESTNUT

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Horse Chestnut

Parts used and where grown: 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).

Horse chestnut has been used in connection with the following conditions (refer to the individual health concern for complete information):

Rating	Health Concerns
	Chronic venous insufficiency
	Hemorrhoids Sprains and Strains (topical) Wound healing (topical)
	Edema (water retention) Varicose veins
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

Historical or traditional use (may or 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.

Active constituents: The seeds are the source of a saponin known as aescin, which has been shown to promote circulation through the veins.² 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.^{3 4} 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.^{5 6} Those suffering edema after surgery have also found relief from topical application of horse chestnut extracts, according to preliminary studies.⁷

How much is usually taken? 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.^{8 9} 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.¹⁰ 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.

Are there any side effects or interactions? 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.¹¹ 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.^{12 13} People with liver disease should also avoid the use of horse chestnut. There are no known reasons to avoid horse chestnut during pregnancy.¹⁴ 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.

Are there any drug interactions? Certain medications may interact with horse chestnut. Refer to the drug interactions safety check for a list of those medications.

1. Chandler RF. Horse chestnut. Canadian Pharm J 1993 Jul/Aug:297, 300.

2. 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.

3. 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.

4. 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.

5. Pittler MH, Ernst E. Horse Chestnut seed extract for chronic venous insufficiency: A criteria-based systematic review. Arch Dermatol 1998;134:1356–60.

6. 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.

7. Wilhelm K, Felmeier C. Thermometric investigations about the efficacy of beta-escin to reduce postoperative edema. Med Klin 1977;72:128–34 [in German].

8. Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press, 1994, 112–3.

9. 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.

10. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum and Beaconsfield, UK: Beaconsfield Publishers Ltd., 1988, 188–9.

11. 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.

12. Hellberg K, Ruschewski W, de Vivie R. Medikamentoes bedingtes post-operatives Nierenversagen nach herzchirurgischen Eingriffen. Thoraxchirurgie 1975;23:396–9.

13. Wilhelm K, Feldmeier C. Postoperative und posttraumatische Oedemprophylaxe und -therapie. Laborchemische Untersuchungen ueber die Nierenvertraeglichkeit von beta-Aescin. Med Klin 1975;70:2079–83.

14. 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.

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