Heal with Horse Chestnut

Enlarge Image Image Gallery Injectable forms of horse chestnut seed extracts are used in German trauma centers for the treatment of acute head injuries or brain trauma. Steven Foster

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.