What do the Germans know that we don’t? If you looked into the first-aid kit of most soccer teams in Europe, you would find a tube of horse chestnut (Aesculus hippocastanum) gel, ready to ease pain, bruising and swelling from sprains and other contusions or sports injuries.
In the United States, you have to search a little harder to find topical horse chestnut products. For more than a decade, the ever-present tube of gel in my home medicine chest has come from Germany. This product (Reparil) contains the single most dramatic phytomedicine that my family has used. Whenever my children (or I) close a finger in a door, twist an ankle, drop something on a foot, or suffer other types of injuries that cause bruising or swelling, we head straight for the horse chestnut gel. It reduces pain and swelling almost immediately and prevents bruising.
In Germany, horse chestnut extracts are used for another purpose as well—to treat vascular problems. The extracts reduce phlebitis (vein inflammation) and increase vein tone in cases of chronic venous insufficiency (CVI). CVI is a condition characterized by leg tiredness, tension and heaviness, as well as nocturnal cramping of calf muscles, itching, pain and swelling. Horse chestnut extracts also can help improve symptoms of leg swelling and pain associated with varicose veins, which can be an early sign of CVI.
Convincing Clinical Evidence
The clinical research on horse chestnut focuses on CVI. At least 13 such studies—all placebo controlled and double-blind—have been published since 1973. Most used 600 mg of an extract (equivalent to 100 mg a day of aescin, the group of compounds thought to be biologically active) and showed positive results.
A recent review of these studies concluded that horse chestnut seed extract is safe and effective for decreasing symptoms of CVI, including reducing lower-leg volume (circumference at the calf and ankle), leg pain, itching, fatigue and muscular tension in the legs. Five of these clinical trials compared horse chestnut extract against treatment with a standard drug. The reviewers concluded that horse chestnut extract was superior to placebo and just as effective as the standard (European) treatment. Another trial suggested that horse chestnut extract is as effective as compression stockings.
Where to Find Horse Chestnut
So how can you find this herb in the United States? Well, it’s not always easy. In the rest of the world, topical horse chestnut extract products usually are sold as over-the-counter drugs. In the United States, they’re primarily found as cosmetics because of labeling restrictions. Oral horse chestnut forms are becoming increasingly common and can be found in health-food stores and even some grocery stores. These products are intended to reduce venous insufficiency and are marketed to help reduce varicose veins. A few pharmacological studies show that horse chestnut can both prevent and treat varicose veins. However, treatment for varicose veins with horse chestnut has not been adequately addressed in human clinical studies.
Here are some tips for selecting good horse chestnut products.
Start with standardization. Horse chestnut seed extracts, used in both oral and topical forms, are complex phytomedicine. Extracts are made through an exacting process that can’t be duplicated by consumers in the kitchen or by backyard herbalists.
The extract is made from the seeds of the European horse chestnut. It is then calibrated to contain 16 to 20 percent of a group of compounds called triterpene glycosides. This group of compounds collectively is known as aescin (also spelled escin).
Tablets and capsules.
An average therapeutic dose of horse chestnut should contain 100 mg of aescin, according to the German Commission E monograph on horse chestnut. This amount of aescin commonly is found in formulations of 250 to 312 mg and usually is split into two doses per day. The extract usually comes in timed-release tablets.
Gels, creams and balms.
Topical products containing aescin act by diminishing the number or diameter of tiny openings in capillary walls, helping to "seal" the outflow of fluid surrounding tissue, hence thwarting swelling and bruising. This unique mechanism of action makes it very useful for the topical treatment of bruises, sprains, and contusions. Look for aescin on the label. If it’s not there, you don’t know how much you’re getting.
In both the European and American markets, product forms such as liquid extracts that differ from those stated in the German regulatory text are formulated to deliver an equivalent amount of aescin. Research has focused on standardized extract forms, but non-standardized tinctures are also made in the United States. Follow label instructions on any product you use.
How Aescin Works
The "cement" between cells can be broken down by lysosomal enzymes, which in turn leads to increased capillary permeability and edema (collection of fluids in tissue). Aescin has been shown in various pharmacological studies to inhibit these enzymes, shrinking the size and quantity of tiny pores in capillary walls that regulate the flow of fluids. German and Italian researchers also suggest that, in cases of CVI, the lysosomal enzymes increase the number of white blood cells in the blood, a condition similarly reduced by aescin.
In addition, horse chestnut extract improves vein tone by helping to increase the contraction of elastin fibers in the vein walls. This activity, called a venotonic effect, counteracts a relaxation of vein tissue that can lead to varicose veins.
CVI is a serious health problem that requires medical attention. Horse chestnut seed extracts are scientifically based herbal medicines that, in proper formulas and controlled dosages, have proven effective and safe. Don’t combine horse chestnut with warfarin (Coumadin) unless you are supervised by a knowledgeable health-care provider, and don’t use it during pregnancy or while nursing. In rare instances, oral forms might cause stomach upset, nausea or itching. Timed-release tablets reduce the chance of stomach upset.
Caution: Unprocessed horse chestnut (including bark, leaves and seeds) potentially can be toxic, and fatalities have been reported from eating relatively small amounts of the raw seeds. Use standardized, manufactured preparations only.
Steven Foster is the author of 15 books on medicinal herbs, including A Desk Reference to Nature's Medicine (with Rebecca Johnson, National Geographic Books, 2006).