Horse Chestnut (available from numerous manufacturers), Horse Chestnut-Power, Venastat, Standardized Horsechestnut Extract
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.
Loading ...