Horse chestnut seed extract (HCSE) is widely used in Europe for chronic venous insufficiency (CVI), a syndrome that may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. Although traditionally recommended for a variety of medical conditions, CVI is the only condition for which there is strong supportive scientific evidence.

Side effects from HCSE have been similar to placebo in clinical trials. However, due an increased risk of low blood sugars, caution is advised in children and people with diabetes.

Horse chestnut flower, branch bark, and leaf have not been shown effective for any indication, and it is strongly advised that they be avoided due to known toxicity.

Synonyms

Aescin, aescine, aescule, buckeye, bongay, chestnut, conkers, Conquerors, eschilo, escin, escine, fish poison, graine de marronier d'Inde, H. vulgare Gaertnhestekastanje, Hippocastabi folium , Hippocastani semen , horsechestnut, horse chestnut seed extract, HCSE, Marron Europeen, Marronier, NV-101, Rokastaniensamen, rosskastanie, Spanish chestnut, superficial thrombophlebitis, Venastat®, Venoplant®, Venostasin®.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence

Chronic venous insufficiency

Chronic venous insufficiency is a condition that is more commonly diagnosed in Europe than in the United States, and may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. There is evidence from laboratory, animal, and human research that horse chestnut seed extract (HCSE) may be beneficial to patients with this condition. Studies report significant decreases in leg size, leg pain, itchiness, fatigue and "tenseness." There is preliminary evidence that HCSE may be as effective as compression stockings.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Antiangiogenic, benign prostatic hypertrophy (BPH), fluid in the lungs (pulmonary edema), gall bladder pain (colic), gall bladder infection (cholecystitis), gall bladder stones (cholelithiasis), bladder disorders (incontinence, cystitis), bruising, cough, vein clots (deep venous thrombosis), diarrhea, dizziness, fever, hemorrhoids, kidney diseases, leg cramps, liver congestion, lung blood clots (pulmonary embolism), menstrual pain, nerve pain, osteoarthritis, pancreatitis, rectal complaints, "rheumatism," rheumatoid arthritis, skin conditions, post-operative/post-traumatic soft tissue swelling, ringing in the ears (tinnitus), ulcers, varicose leg ulcers, whooping cough.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Horse chestnut seed extract (HCSE) products are often standardized to contain 16% to 20% triterpene glycosides calculated as escin (aescin) content.

Adults (18 years and older)

Oral (by mouth): 300 milligrams every 12 hours, for up to 12 weeks (containing 50 to 75 milligrams of escin per dose), has been taken by mouth. A dose of 600mg of chestnut seed extract per day has also been studied.

Topical (on the skin): A gel preparation of horse chestnut applied to the skin has been studied for bruising, without clear benefits.

Intravenous (through a vein)/intramuscular (injected into a muscle): Severe allergic reaction (anaphylactic shock) has been reported with intravenous use. Horse chestnut leaf has been associated with liver inflammation (hepatitis) after injection into muscle.

Children (younger than 18 years)

There is not enough scientific evidence to recommend use of horse chestnut in children. Deaths have been reported in children who ate raw horse chestnut seeds or tea made from horse chestnut leaves and twigs.

Safety

Allergies

Horse chestnut seed extract (HCSE) may cause an allergic reaction in patients with known allergy to horse chestnuts, esculin,or any of its ingredients (flavonoids, biosides, trisides of quertins, and oligosacharides including 1-ketose and 2-ketose). Anaphylactic shock (severe allergic reaction) has been reported with intravenous (through the vein) use.

Tags: Herbal Medicine

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