DESCRIPTION

Medicinal Parts: The medicinal parts are the dried Horse Chestnut leaves, the oil extracted from the peeled fruit capsules (seeds) and dried chestnut seeds.

Flower and Fruit: The white flowers are in stiffly upright panicles gradually thickening near the distal end. Most of the flowers are male, but a few are female or androgynous. The calyx is fused and bell-shaped with 5 irregular tips. The petals are 10 to 15 mm long with a yellow spot, which turns red. There are 3 upward petals and 2 downward, which are folded at the edge. The flower is ciliate and cordate (heart shaped) at the base and contains 7 S-shaped, bending stamens with red anthers that are longer than the petals. The ovary is trivalved, superior, and velvety. The fruit capsules are green and globular with soft spines and fine hairs. There are 1 to 3 red-brown seeds (Chestnuts) within the capsules, which are shiny brown with a yellowish gray-brown navel and a tough shell.

Leaves, Stem, and Root: The seasonal tree is up to 35 m high; it includes a large regular crown and widely spread roots. The trunk is initially smooth but later has thinly scaled, peeling, and fissured bark. The young twigs are yellowish to red-brown and are initially covered with brown hairs. The buds gradually thicken near the distal end and are extremely sticky with dark red bud scales to protect the seed plant bud. The leaves are long, 5 to 7 palmate, with a 20-cm long grooved petiole. The leaflets are initially red-haired, 20 cm long, cuneate-obovate, acute, and dentate. The leaflets are rich green above and beneath are light green.

Habitat: Although the herb is indigenous to the mountains of Greece, Bulgaria, the Caucasus, northern Iran and the Himalayas, it is cultivated elsewhere, especially in northern Europe, including the British Isles, Denmark, Scandinavia, and Russia (Narva and St. Petersburg).

Production: Horse Chestnut leaf consists of the fresh or dried leaf of Aesculus hippocastanum. A dry extract is manufactured from Horse Chestnut seeds standardized to a content of 16-20% triterpene glycosides (calculated as anhydrous aescin).

Not to be Confused With: The leaves of the Horse Chestnut are commonly confused with those of Sweet Chestnut.

Other Names: Buckeye, Common Horse Chestnut, Conqueror Tree, Spanish Chestnut

ACTIONS AND PHARMACOLOGY

COMPOUNDS: HORSE CHESTNUT LEAF

Triterpene saponins

Hydroxycoumarins: chief component is aesculin, in addition fraxin and scopolin

Flavonoids: including rutin, quercitrin, and isoquercitrin

Tannins

EFFECTS: HORSE CHESTNUT LEAF

The main active principles of the anti-exudative effect and improvement of venous tone are hydroxycoumarins (aesculin and fraxin), triterpene saponins in the petioles and leaf veins, flavonoids, and a rich supply of tannins. Although the drug is said to have an anti-exudative effect and improve venous tone, there is a lack of clinical data to support the efficacy.

COMPOUNDS: HORSE CHESTNUT SEEDS

Triterpene saponins (3-5%): The triterpene saponine mixture known as aescin (also escin) consists of diacylated tetra-and pentahydroxy-beta-amyrin compounds.The compounds bear a glucuronic acid remnant substituted with 2 monosaccharide remnants in position 3 at the OH-group. Aglycones, protoescigenin and barringtogenol C, are bonded like esters onto the OH-group at position 21 with either angelic or tiglic acid, or with either alpha-methyl butyric or isobutyric acid remnants. The OH-group in position 22 (beta-escin) or 28 (cryptoescin) is acetylated, and both positional isomeric compounds remain in equilibrium though migration of the acetyl remnant.

Flavonoids: in particular biosides and triosides of the quercetins

Oligosaccharides: including 1-kestose, 2-kestose, stachyose

Polysaccharides: starch (50%)

Oligomeric proanthocyanidins, condensed tannins: (only in the seed-coat)

Fatty oil (2-3%)

EFFECTS: HORSE CHESTNUT SEEDS

As found in different animal tests and preclincal investigations, the principal ingredient of Horse Chestnut seed extract, triterpene glycoside mixture (aescin), has an anti-exudative, vascular tightening effect, and reduction of vascular permeability which result in an antiedemic effect. The vein-toning properties of the Horse Chestnut extract also demonstrated improvement of venous return flow. A significant reduction of transcapillary filtration was seen in a placebo-controlled human pharmacological trial (Bisler, 1986). Significant improvement in the symptoms of chronic venous insufficiency was demonstrated in diverse, randomized, double-blind and cross-over studies (Calabrese, 1993; Steiner, 1990).

There are indications that Horse Chestnut seed extract reduces the activity of lysosomal enzymes, which increases in chronic pathological conditions of the veins. The enzymes will break down glycoacalyx (mucopolysaccharides) in the region of the capillary walls, allowing proteins to leak into the interstitium. The activity of the enzymes is reduced by the aescin and so the breakdown of glycoacalyx is also inhibited. The transcapillary filtration of low-molecular proteins, electrolytes, and water into the interstitium is inhibited through a reduction of vascular permeability by the aescin.

CLINICAL TRIALS

The efficacy and safety of Horse Chestnut seed extract, given as Venostasin retard (50 mg aescin) twice daily, was compared to mechanical compression involving bandages and stockings in a randomized, placebo-controlled clinical study. The study consisted of 240 patients with chronic venous insufficiency over a 12-week period. The results determined a similar decrease of lower leg volume of approximately 25% and noted compression treatment is uncomfortable, not convenient and subject to poor compliance (Diehm, 1996).

Venostasin retard was administered to 52 pregnant women with edema due to venous insufficiency in a placebo-controlled, double-blind, crossover study. A significant reduction of edema and greater resistance to edema provocation was demonstrated in the Venostasin retard group. There were also less severe symptoms of pain, fatigue, swelling, and itching with patients receiving Venostasin retard therapy (Steiner, 1990).

A randomized, placebo-controlled, double-blind study was conducted on 40 patients with venous edema in chronic deep vein incompetence to determine the edema-reducing effect of Horse Chestnut seed extract. The edema reduction effect and reduction of leg volume with edema provocation of the Horse Chestnut seed extract were both statistically significant (Diehm, 1992).

INDICATIONS AND USAGE

HORSE CHESTNUT LEAF

Unproven Uses: Eczema, superficial and deep varicose veins, leg pains, phlebitis, hemorrhoids, pains before and during menstruation. In folk medicine, the leaves are used as a cough remedy, as well as for arthritis and rheumatism.

HORSE CHESTNUT SEEDS

Approved by Commission E:

* Venous conditions (chronic venous insufficiency)

Treatment of symptoms found in pathological conditions of the veins of the legs (chronic venous insufficiency), for example pain and a sensation of heaviness in the legs, nocturnal cramps in the calves, pruritis, and swelling of the legs.

Unproven uses: Horse Chestnut seeds are used for symptoms of post-traumatic and post-operative soft tissue swelling. Further indications are painful injuries, sprains, bruising, pain syndrome of the spine, edema, rheumatic disease, and varicose veins.

Homeopathic Uses: Homeopathic treatments include hemorrhoids, lumbar and low back pain, venous back pressure.

PRECAUTIONS AND ADVERSE REACTIONS

HORSE CHESTNUT LEAF

General: Health risks or side effects following the proper administration of designated therapeutic dosages are not recorded. One case of liver damage following intramuscular administration of an extract of the drug (origin details of the drug uncertain) is known.

Drug Interactions: Horse Chestnut leaf has a coumarin component and may interact with warfarin, salicylates, and other drugs with anti-coagulant properties.

HORSE CHESTNUT SEEDS

Health risks following the proper administration of designated therapeutic dosages are not recorded. Susceptible patients may nevertheless experience mucous membrane irritations of the gastrointestinal tract (e.g. nausea) following intake of the drug; decrease in kidney function with pre-existing renal insufficiency and acute nephrotoxicity. Hepatotoxicity and urticaria have also been observed. I.V administration of aescin can lead to anaphylactic reactions.

OVERDOSAGE

HORSE CHESTNUT SEEDS

The intake of larger quantities of Horse Chestnut seeds (in one case of a child with 5 seeds) can bring about vomiting, diarrhea, severe thirst, reddening of the face, enlargement of pupils, vision and consciousness disorders. Following stomach and intestinal emptying (gastric lavage, sodium sulfate) and the administration of activated charcoal, therapy for poisonings consists of diazepam for spasms, atropine for colic, electrolyte replenishment, and sodium bicarbonate infusions for any acidosis that may arise. Intubation and oxygen respiration may also be necessary.

DOSAGE

HORSE CHESTNUT LEAF

Mode of Administration: Extracts of the drug are contained in “vein teas” or “hemorrhoid teas,” as well as in pharmaceutical preparations for the treatment of venous symptoms.

Preparation: One ampule corresponds to 4 mg flavones in 0.9% NaCl.

Daily Dosage:

Infusion (as a tea)–Pour boiling water over 1 tsp. of finely cut drug and strain after 5 to 10 minutes (1 tsp = 1 g drug).

Intravenously–1 to 2 ampules daily.

Intramuscularly–1 ampule daily.

HORSE CHESTNUT SEEDS

Mode of Administration: Available in liquid and solid preparations for internal use; semi-solid preparations for external use; and parenterally for homeopathic use.

How Supplied:

Ampules

Capsules–250 mg, 300 mg, 375 mg, 485 mg

Drops

Liquid extract

Ointment/Gels

Tablets

Tincture

Preparation: Stabilized extract of Horse Chestnut is standardized for aescin; tincture of Horse Chestnut  with 75% ethanol; isolated aescin.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using: Tell your doctor if you …

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
• are pregnant or plan to become pregnant while using this medicine
•  are breastfeeding
•  have a history of depression, breast cancer, have pheochromocytoma, or ulcers
•  have any other health problems, such as high blood pressure or heart or blood vessel disease

Dosage: Talk with your caregiver about how much Shark Cartilage you should take. The amount depends on the strength of the medicine and the reason you are taking Shark Cartilage. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine: Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Warnings:

• Before taking Shark Cartilage, tell your doctor if you are pregnant or breastfeeding
• Use Shark Cartilage with caution if you have liver disease 

Side Effects: Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it.

• Breathing problems or tightness in your throat or chest
• Chest pain
• Skin hives, rash, or itchy or swollen skin

Other Possible Side Effects: You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• Upset stomach, vomiting, or constipation
•  Hepatitis (liver disease)