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Horse Chestnut; Aesculus hippocastanum

Proposed Uses: Venous Insufficiency ; Hemorrhoids; Minor Injuries; Phlebitis

A superstition in parts of Europe suggests that carrying Horse Chestnut 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.

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 and St. John's wort. In Japan, an injectable form of horse chestnut is widely used to reduce inflammation after surgery or injury; however, it is not available in the United States, and it may present safety risks.

The active ingredients in horse chestnut appear to be a group of chemicals called saponins, of which aescin is the most important. Aescin appears to reduce swelling and inflammation. It's not exactly clear how aescin might work, but theories include "sealing" leaking capillaries, improving the elastic strength of veins, preventing the release of enzymes that break down collagen.

Horse chestnut is most often used as a treatment for venous insufficiency. This is a condition associated with varicose veins, when the blood pools in the veins of the leg and causes aching, swelling, and a sense of heaviness. While horse chestnut appears to reduce these symptoms, no studies have evaluated whether it can make visible varicose veins disappear, or prevent new ones from developing.

Because hemorrhoids are actually a form of varicose veins, horse chestnut is used for them as well, and one double-blind, placebo-controlled study suggests that it may be effective.

Dosage
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. Also, a delayed-release formulation must be used to prevent gastrointestinal upset.

Safety Issues
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.  After decades of wide usage in Germany, there have been no reports of serious harmful effects, and even mild reported reactions have been few in number.

Individuals with severe kidney problems should avoid horse chestnut. In addition, injectable forms of horse chestnut can be toxic to the liver.  Horse chestnut should not be combined with anticoagulant, or blood-thinning, drugs, as it may amplify their effect.

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