Herb to Know: Horse Chestnut

Aesculus hippocastanum is a natural remedy for varicose veins.

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S. Foster

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Horse Chestnuts—also known by the colorful name “conkers”—have a long history of folk use for healing. While modern minds may find conkers an unlikely source of medicine, scientific researchers suggest the idea may not be so far-fetched—except it’s probably better to take your conker as a pill.

“Conker” is British slang; they’re also known in some regions of the United States as buckeyes. In European tradition, horse chestnut (Aesculus hippocastanum) is best known for its ability to help with circulation ­problems such as chronic venous insufficiency, hemorrhoids, and in particular, varicose veins.

Varicose veins are enlarged superficial veins in the legs thought to be caused by weakness in the vein walls. Symptoms include aching, bulging veins or veins that appear twisted, as well as itching skin over the vein. Conventional treatments include support hose, injecting medicine into the vein (sclerotherapy), laser therapy, and, for more serious cases, surgery.

Studies attest to horse chestnut’s ability to improve circulation and reduce fra­gility of blood vessel walls. The largest of these studies—a randomized, double-blind, ­placebo-controlled clinical trial published in the April 1996 issue of the British Journal Lancet—showed that horse chestnut extract was almost as effective as compression stockings for 240 patients with chronic venous insufficiency. The extract contained 50 mg of aescin—the main active constituent in the seed—taken twice daily.

Aescin is an anti-inflammatory compound 300 times as strong as the bioflavonoid rutin, according to medical herbalist Amanda McQuade Crawford. Researchers have reported success using aescin, which is a complex mixture of triterpenoid saponin glycosides, for cerebral tumors, meningitis, encephalitis, cerebral edemas resulting from cranial trauma, and other brain-fluid problems.

Horse chestnut was first documented as a medicinal plant in 1565 in Dioscorides’s Materia Medica, according to medical herbalist Andrew Chevallier’s The Ency­clopedia of Medicinal Plants. Widely used in European traditional medicine since the sixteenth century, horse chestnut was imported from Persia by the Turks, who used it to treat bruises in horses. Horse chestnut lotions and creams have been used by traditional healers to speed healing of blunt sports injuries; the herb has also been used to treat aging skin, cellulite, and hair loss, though little research exists to support that its active compounds are absorbed through the skin.

The form of horse chestnut typically used in research is an aqueous-alcoholic extract of the seeds that is dried and standardized to a concentration of 16 percent to 21 percent triterpene glycosides, calculated as aescin, writes herb expert and Herbs for Health ­editorial adviser Varro Tyler, Ph.D., in his book Herbs of Choice. Initial oral dosage is equiva­lent to 90 mg to 150 mg of aescin, which may be reduced to 35 mg to 70 mg daily with improvement, he writes.

Until recently horse chestnut extracts were not available in the United States. Now companies such as Pharmaton are marketing products previously available only in Europe. The German Commission E endorses horse chestnut seed extract for treating chronic venous insufficiency and a heavy feeling in the legs.