Horse Chestnut Overview

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.

Venous Insufficiency

More than 800 individuals have been involved in double-blind, placebo-controlled studies of horse chestnut for treating venous insufficiency. ^{1 2 3 4 5 6 7 8} One of the largest of these trials followed 212 people over a period of 40 days. ⁹ In this crossover study, participants initially received horse chestnut or placebo, and then were crossed over to the other treatment (without their knowledge) after 20 days. The results showed that horse chestnut produced significant improvement in leg edema, pain, and sensation of heaviness. However, the design of this study was not quite up to modern standards.

A better-designed double-blind study of 74 individuals also found benefit. ¹⁰ 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. ¹¹ This study followed 240 people over a course of 12 weeks. Compression stockings worked faster at reducing swelling, but by the end of the study the results were equivalent, and both treatments were better than placebo.

However, a small double-blind trial suggests that oligomeric proanthocyanidins (OPCs) from pine bark are more effective than horse chestnut for the treatment of venous insufficiency. ¹²

Hemorrhoids

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. ¹³ The results indicated that use of horse chestnut produced noticeable subjective improvements in pain, bleeding, and swelling within a week; within 2 weeks, the benefits were visible by objective examination.

Bruises

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. ¹⁴

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.

1. Friederich HC, Vogelsberg H, Neiss A. Evaluation of internally effective venous drugs [translated from German]. Z Hautkr. 1978;53:369-374.
2. Neiss A, Bohm C. Demonstration of the effectiveness of the horse-chestnut-seed extract in the varicose syndrome complex [translated from German]. MMW Munch Med Wochenschr. 1976;118:213-216.
3. 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.
4. Lohr E, Garanin G, Jesau P, et al. Anti-edemic therapy in chronic venous insufficiency with tendency to formation of edema [translated from German]. Munch Med Wochenschr. 1986;128:579-581.
5. 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.
6. Steiner M, Hillemanns HG. Investigation of the anti-edemic efficacy of Venostatin?  [translated from German]. Munch Med Wochenschr. 1986;128:551-552.
7. Alter H. Medication therapy for varicosis [translated from German]. Z Allgemeinmed. 1973;49:1301-1304.
8. 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. 347(8997):292-4.
9. Neiss A, Bohm C. Demonstration of the effectiveness of the horse-chestnut-seed extract in the varicose syndrome complex [translated from German]. MMW Munch Med Wochenschr. 1976;118:213-216.
10. Lohr E, Garanin G, Jesau P, et al. Anti-edemic therapy in chronic venous insufficiency with tendency to formation of edema [translated from German]. Munch Med Wochenschr. 1986;128:579-581.
11. 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. 347(8997):292-4.
12. Koch R. Comparative study of Venostasin and Pycnogenol in chronic venous insufficiency. Phytother Res. 16 Suppl 1():S1-5.
13. Sirtori CR. Aescin: pharmacology, pharmacokinetics and therapeutic profile. Pharmacol Res. 44(3):183-93.
14. 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. 59(5):394-7.