Horse chestnut seed extract for chronic venous insufficiency.(Alternative medicine: an evidence-based approach)

History and Rationale for Use

Extracts of the Aesculus hippocastanum seed have been used in Europe since the 19th century in the treatment of chronic venous insufficiency, varicose veins, and hemorrhoids. The leaves have been used for cough, fever, and arthritis; poultices of the seeds have been ad ministered topically for skin ulcers.

The active component of horse chestnut seed ex tract is escin, a triterpenic saponin. Escin inhibits the activity of elastase and hyaluronidase, enzymes that are involved in pro teoglycan degradation and vascular leakage. The herb's venoprotective effects also may reflect decreased lysosomal enzyme activity, which is thought to contribute significantly to chronic venous insufficiency (CVI). Escin also has anti-inflammatory effects, and a topical formulation is commonly used in Europe for acute sprains.

CVI afflicts about 10%-15% of men and 20%25% of women …