Horse chestnut is used in extract form of the seed of the plant. Horse chestnut itself is a beautiful ornamental tree with lush palmate leaves and spikes of creamy-white and red spotted flowers. Horse chestnut and other members of the Aesculus genus are considered toxic, and only to be used in the standardized extract form. Native American’s however leached the nuts for several days to make a meal for breads, and other uses throughout history include as a fish intoxicant, in the preparation of gunpowder, as an ornamental, and in manufacturing furniture. It has also been used traditionally for treating congestion, backache, neuralgia, hemorrhoids, arthritis, strains, sports injuries, tendonitis, and rheumatism (McKenna et al., 2002).
In Europe horse chestnut is popular not only its extract form for the phytotherapy of chronic venous insufficiency, but also for its topical use in cosmetics, lotions and hand creams. A number of experimental models (preclinical) have supported its therapeutic benefits, such as anti-oedematous, anti-inflammatory, and venotonic properties (Sirtori, 2001).
Horse chestnut has yet to gain popularity in the U.S., but is well substantiated in its efficacy for treating chronic venous insufficiency, a condition for which few satisfactory treatment options now exist.
In a review of the clinical studies on the efficacy of horse chestnut for chronic venous insufficiency (CVI), studies involving the oral use of horse chestnut monotherapy compared with placebo were chosen. The reviewers found that horse chestnut appeared to be an efficacious and safe treatment for the short-term treatment of CVI (Pittler and Ernst, 2004). In an earlier meta-analysis, Pittler and Ernst (2002) came to the the same conclusion.
In an even earlier systematic review of the literature, Pittler and Ernst (1998) included double-blind, randomized controlled studies. All placebo-controlled studies found horse chestnut extract to be more effective than placebo, and 5 studies found horse chestnut to be equally effective to oxerutins.
Siebert et al. (2002) performed another systematic review of the literature on horse chestnut that included both randomized controlled trials and large-scale observational studies regarding for outcomes and adverse effects. Included in the review were 13 randomized clinical trials and 3 observational studies. The authors found that horse chestnut extract appeared to be a safe and effective treatment for CVI. They noted that longer-term studies were needed to evaluate the safety and effectiveness of horse chestnut extract.
In a randomized, partially blinded, placebo-controlled, parallel study, the efficacy of compression stockings and horse chestnut seed extract and compression stockings (class II) was tested. Significant reductions in oedema were found by both compression stockings and horse chestnut seed extract, and both therapies were shown to be equivalent (Diehm et al., 1996).
Rehn et al. (1996) conducted a double-blind, randomized, placebo-controlled clinical study in order to do a direct comparison of oxerutins and horse chestnut extract for the treatment of CVI. The patients were treated with either 1000 mg/d of oxerutins, 600 mg/d of horse chestnut, or 1000 mg/day of the oxerutins for 4 weeks followed by 500 mg/d of oxerutins for 12 weeks. Horse chestnut was found to be equivalent or better than the oxerutins.
In a placebo-controlled trial of escin in the treatment of acute hemorrhoids, escin (40 mg t.i.d) or placebo was given to patients for two months. Improvments in treatments were reported after six days of treatment, and the majority (81.6%) improved compared to those on placebo (32.4%) (Pirard et al., 1976).
Safety / Dosage
The usual recommended dosage of escin from clinical studies is 50 mg 2-3 times daily, therefore in normal commercial extracts that are standardized to 16% triterpene glycosides, calculated as escin, the corresponding dosage is 300-900 mg daily of a 16% extract (McKenna et al., 2002).
As horse chestnut is considered toxic in its raw form, it is important to use only standardized extracts. Dosages equivalent to 100 mg escin (250-313 standardized extract) in a delayed release form have been associated with few side effects. Side effects may include nausea, stomach discomfort and itching (McKenna et al., 2002).
1.Diehm C, Trampisch 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 Feb 3;347(8997):292-4.
2.McKenna, D.; K. Jones and K. Hughes. Botanical Medicines: The Desk Reference for Major Herbal Supplements. 2nd Ed. 2002 Haworth Press: Binghamton, NY. 1138 pp.
3.Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2004;(2):CD003230.
4.Pittler MH, Ernst E. Horse-chestnut seed extract for chronic venous insufficiency. A criteria-based systematic review. Arch Dermatol. 1998 Nov;134(11):1356-60.
5.Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Syst Rev. 2002;(1):CD003230.
6.Pirard J, Gillet P, Guffens JM, Defrance P. Double blind study of reparil in proctology. Rev Med Liege. 1976 May 15;31(10):343-5.
7.Rehn D, Unkauf M, Klein P, Jost V, Lucker PW. Comparative clinical efficacy and tolerability of oxerutins and horse chestnut extract in patients with chronic venous insufficiency. Arzneimittelforschung. 1996 May;46(5):483-7.
8.Siebert U, Brach M, Sroczynski G, Berla K. Efficacy, routine effectiveness, and safety of horsechestnut seed extract in the treatment of chronic venous insufficiency. A meta-analysis of randomized controlled trials and large observational studies. Int Angiol. 2002 Dec;21(4):305-15.
9.Sirtori CR. Aescin: pharmacology, pharmacokinetics and therapeutic profile. Pharmacol Res. 2001 Sep;44(3):183-93.
EDITOR'S NOTE: This monograph can be found in The Health Professional's Guide to Dietary Supplements (Lippincott, Williams & Wilkins) by Shawn M. Talbott, PhD and Kerry Hughes, MS.