Horse chestnut Aescin.Horse Chestnut Extract.

  seminal trace...Horse chestnut Aescin.Horse Chestnut Extract.CAS.NO.090045-79-7.Aescin,Escin.beta-Escin.20.0%UV.CAS.NO:6805-41-0.M.F.:C55 H86O24.Extract of horse chestnut; Aesculus hippocastanum extract;Aesculus glabra,ext....

  Botanical Basic Data of Horse chestnut:Aesculus hippocastanum

 Botanical Source:Aesculuc chinensis Bge,;Aesculuc chinensis Bge.var.chekiangensis(Hu et Fang) Fang; or Aesculuc wilsonii Rehd.
 Family: Horse chestnuts are classified in the division Magnoliophyta,class Magnoliopsida,order Sapindales, family Hippocastanallae.
 Names Differentiation: Do not confuse with its North American relative Aesculusglabra, Buckeye.
 Common Names: Atkestanesi, Buckeye, Castagno D'India, Castanheiro Da India, Castano De India, Castano De Indias, Castogno D'India, Chataigne De Cheval, Common Horse Chestnut, Eschilo, Horse Chestnut, Ippocastano, Marronnier D'Inde, Paarde Kastanje, Rosskastanie, Seiyo-Toti-No-Ki, Spanish Chestnut, T'ien-shih-li, Wilde Kastanje
 Habitat: Native to Northern Asia but widely cultivated, common in Britain.
 Collection: The ripe chestnuts should be gathered as they fall from the trees in September
 Part Used: The fruit, that is the Horse Chestnut itself.
 Synonyms:Aescin, aescine, aescule, buckeye, bongay, chestnut, conkers, Conquerors, eschilo, escin, escine, fish poison, graine de marronier d'Inde, H. vulgare Gaertnhestekastanje, Hippocastabi folium , Hippocastani semen , horsechestnut, horse chestnut seed extract, HCSE, Marron Europeen, Marronier, NV-101, Rokastaniensamen, rosskastanie, Spanish chestnut, superficial thrombophlebitis, Venastat, Venoplant, Venostasin.
 Main Content: Aescin.
 Horse chestnut seed extract (HCSE) is widely used in Europe for chronic venous insufficiency (CVI), a syndrome that may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. Although traditionally recommended for a variety of medical conditions, CVI is the only condition for which there is strong supportive scientific evidence.
 Side effects from HCSE have been similar to placebo in clinical trials. However, due an increased risk of low blood sugars, caution is advised in children and people with diabetes.
 Horse chestnut flower, branch bark, and leaf have not been shown effective for any indication, and it is strongly advised that they be avoided due to known toxicity.
 


 Botanical Basic Data of Horse chestnut(Aesculus hippocastanum)
 Narrative Hisdtory of Horse chestnut(Aesculuc,Aesculus hippocastanum).
 Description of Horse chestnut(Aesculus hippocastanum).
 Active constituents and mechanism of aescin from horsechestnut.
 Historical and Scientifical use of Horse chestnut.
 Indications,Combinations and Dosage of Horse chestnut.
 Safety and Toxicity Study.
 Research Update:Horse chestnut and aescin


  Narrative Hisdtory of Horse chestnut(Aesculus,Aesculus hippocastanum):

 Horse Chestnut(Aesculus hippocastanum)
 The Horse Chestnut, Aesculus hippocastanum, which has also been known as Hippocastanum vulgare (Gaertn.), is an entirely different tree from the Sweet Chestnut, to which it is not even distantly related, and is of much more recent importation to English soil. It is a native of northern and central parts of Asia, from which it was introduced into England about the middle of the sixteenth century.
  Narrative Hisdtory of Horse chestnut(Aesculus,Aesculus hippocastanum):
 The name aesculus (from esca, food) was applied originally to a species of oak, which according to Pliny, was highly prized for its acorns, but how it came to be transferred to the Horse Chestnut is very uncertain; perhaps, as Loudon suggests, it was given ironically, because its nuts bear a great resemblance, externally, to those of the Sweet Chestnut, but are unfit for food. Hippocastanum (the specific name of the common sort) is a translation of the common name, which was given - Evelyn tells us - 'from its curing horses brokenwinded and other cattle of coughs.' Some writers think that the prefix 'horse' is a corruption of the Welsh gwres, meaning hot, fierce, or pungent, e.g. 'Horse-chestnut' = the bitter chestnut, in opposition to the mild, sweet one.
 The leaves are large and compound, in the form of a palm with the five or six leaflets spreading out like the fingers of a fat hand. The leaves fall in autumn to leave large horseshoe-shaped leaf scars.This is another origin of the word"horse chestnut from the human imagination erosed by sense."
  Origin of Horse chestnut(Aesculus,Aesculus hippocastanum):
 A native of the Balkan peninsula (Greece-Albania), it is now cultivated in many countries for shade and ornament. Other members of the family are native trees and shrubs of the north temperate zones and of South America.
 


  Description of Horse chestnut(Aesculus hippocastanum):

 It can reach 30 meters tall, and has striking candles of blooms in spring and early summer. Individual flowers have crumpled white petals with a yellow basal patch that changes to a dull red colour. The fruit has a lathery cae covered with short pickles. The seed are used to play conkers.
 The trunk of the tree is very erect and columnar, and grows very rapidly to a great height, with widely spreading branches. The bark is smooth and greyishgreen in colour: it has been used with some success in dyeing yellow. The wood, being soft and spongy, is of very little use for timber.
 The horse chestnut's scientific name is Aesculus hippocastanum. It grows naturally in the moist mountain valleys of parts of Albania and Greece. In the UK, horse chestnuts have been grown as ornamental trees, particularly in avenues or along roadsides for their spectacular "candles" of white flowers all over the tree in the spring.
 These trees are seen at their best when grown in the open reaching up to 35m (115ft) with the arching branches normally turned up at the ends. It is one of the largest flowering trees of the temperate world.
 The sturdy, many-ribbed boughs and thick buds of the Horse Chestnut make it a conspicuous tree even in winter. The buds are protected with a sticky substance: defended by fourteen scales and gummed together, thus no frost or damp can harm the leaf and flower tucked safely away within each terminal bud, which develops with startling rapidity with the approach of the first warm days after the winter. The bud will sometimes develop the season's shoot in the course of three or four weeks. The unfolding of the bud is very rapid when the sun melts the resin that binds it so firmly together.
  Horse chestnut leaves,flowers and fruit:
 The large leaves are divided into five or seven leaflets, spreading like fingers from the palm of the hand and have their margins finely toothed. All over the small branches may be found the curious marks in the shape of minute horse-shoes, from which, perhaps, the tree gets its name. They are really the leaf scars. Wherever a bygone leaf has been, can be traced on the bark a perfect facsimile of a horse-shoe, even to the seven nail markings, which are perfectly distinct. And among the twigs may be found some with an odd resemblance to a horse's foot and fetlock.
 The leaves are large and compound, in the form of a palm with the five or six leaflets spreading out like the fingers of a fat hand. The leaves fall in autumn to leave large horseshoe-shaped leaf scars.
 The flowers are mostly white, with a reddish tinge, or marking, and grow in dense, erect spikes. There is also a dull red variety, and a less common yellow variety, which is a native of the southern United States, but is seldom seen here.The flowers then give rise to the large globular green spiky fruit. These split open about September to reveal one to three large shiny, mahogany brown seeds or nuts - the "conkers".
 The fruit is a brown nut, with a very shining, polished skin, showing a dull, rough, pale-brown scar where it has been attached to the inside of the seed-vessel, a large green husk, protected with short spines, which splits into three valves when it falls to the ground and frees the nut.
  Cultivation of horse chestnut:
 The Horse Chestnut is generally raised from the nuts, which are collected in the autumn and sown in the early spring. The nuts should be preserved in sand during the winter, as they may become mouldy and rot. If steeped in water, they will germinate more quickly. They will grow 3 foot the first summer and require little care, being never injured by the cold of this climate. They thrive in most soils and situations, but do best in a good, sandy loam.
  Part Used Medicinally:
 The bark and the fruit, from both of which a fluid extract is made. The bark is stripped in the spring and dried in the sun, or by slight artificial heat, and when dry, occurs in commerce in flattened pieces, 4 to 5 inches long and about 1 to 1 1/2 inch broad-about 1 to 1 1/4 inch thick, greyish-brown externally, showing corky elongated warts, and on the inner surface pinkish-brown, finely striated longitudinally. The bark is odourless, but has a bitter astringent taste.
 Preparations:Fluid extract, fruit, 5 to 20 drops. Fluid extract, bark, 1/2 to 2 drachms.
 


  Active constituents and mechanism of aescin from horsechestnut.:

  Constituents of Horse chestnut(Aesculus hippocastanum):
 Analysis has shown that the nuts contain 3.04 per cent. water; 2.66 per cent. ash; 10.99 crude protein; oil, 5.34 per cent.; and 73 97 per cent. carbohydrates. Experiments conducted at Wye College proved that the most satisfactory way to prepare the Horse Chestnuts as food for animals was to soak partly crushed nuts in cold water overnight, then boil them for half an hour or so and strain off the water. The nuts were then dried, partially husked and reduced to a meal, which, though slightly bitter, had a pleasant taste and appearance. The meal was fed to a calf, a sheep and two pigs. The calf received up to 5 lb. of the meal per day and made good increase in live weight, and the sheep suffered no ill effects, but the pig refused to eat the food containing the meal.
 It is concluded that Horse Chestnuts are not poisonous to any of the farm animals experimented with, within the limits of what they can be induced to eat, and that they form a highly nutritious food. Chestnut meal is a fairly concentrated food, and contains about 14 per cent of starch, it being calculated that 1 Ib. of Horse Chestnut meal would be equivalent to 1 Ib. 1 OZ. of feeding barley, 1 lb. 4 OZ. of oats, 1 lb. 8 oz. of bran, and 3 lb. 5 OZ. of good meadow hay.
  Effective Constituents of Horse chestnut(Aesculus hippocastanum):
 Saponins,a complex mixture known as "aescin", composed of acylated glycosides of protoaesigenin and barringtogenol-C and including hippocaesculin and many others.
  Mechanism of aescin from horsechestnut:
 
 The seeds are the source of a saponin known as aescin, which has been shown to promote circulation through the veins. Aescin fosters normal tone in the walls of the veins, thereby promoting return of blood to the heart. This has made both topical and internal horse chestnut extracts popular in Europe for the treatment of chronic venous insufficiency and, to a lesser extent, varicose veins. Aescin also possesses anti-inflammatory properties and has been shown to reduce edema (swelling with fluid) following trauma, particularly following sports injury, surgery, and head injury.
 A topical aescin preparation is very popular in Europe for the treatment of acute sprains during sporting events.
 Other Phytochemicals:Horse chestnuts also contain flavonoids, sterols, and tannins,tianshic acid;fumaric acid;N-Acetyl-L-Glutamic Acid;Beta-sitosterol-3-O-glucoside;Beta-sitosterol,etc.


  Historical and Scientifical use of Horse chestnut.:

 Historical or traditional use of Horse chestnut (may or may not be supported by scientific studies):
  Medicinal Action and Uses of Horse chestnut(asculus,Aesculus hippocastanum):
 Horse chestnuts and buckeyes (a similar but often smaller North American species of the same genus) somewhat resemble true chestnuts in appearance but are edible only after careful preparation. The wood of the horse chestnut is soft and has been used for paper pulp and carpentry, woodenware, and other similar purposes. A compound derived from horse chestnut, aesculin, is a pharmaceutical agent used as an astringent and anti-inflammatory.
 There is an unproven believe that Horse Chestnut increases the strength & tone of the veins in particular, so it is often used to treat phlebitis, varicose veins, and haemorrhoids.
 The horse chestnut tree is native to Asia and northern Greece, but it is now cultivated in many areas of Europe and North America. The tree produces fruits that are made up of a spiny capsule containing one to three large seeds, known as horse chestnuts. Traditionally, many of the aerial parts of the horse chestnut tree, including the seeds, leaves, and bark, were used in medicinal preparations. Modern extracts of horse chestnut are usually made from the seeds, which are high in the active constituent aescin (also known as escin).
 The bark has tonic, narcotic and febrifuge properties and is used in intermittent fevers, given in an infusion of 1 OZ. to the pint, in tablespoonful doses, three or four times daily. As an external application to ulcers, this infusion has also been used with success.
 The fruits have been employed in the treatment of rheumatism and neuralgia, and also in rectal complaints and for haemorrhoids.
 Horse chestnut reduce fevers,educe pain and inflammation of arthritis and rheumatism:Horse chestnut leaves have been used by herbalists as a cough remedy and to reduce fevers. The leaves were also believed to reduce pain and inflammation of arthritis and rheumatism. In traditional herbal medicine, poultices of the seeds have been used topically to treat skin ulcers and skin cancer. Other uses include the internal and external application for problems of venous circulation, including varicose veins and hemorrhoids.
 Horse chestnut reduce the symptoms of chronic venous insufficiency:Double-blind and preliminary clinical trials have shown that oral horse chestnut extracts reduce the symptoms of chronic venous insufficiency, including swelling and pain. Those suffering edema after surgery have also found relief from topical application of horse chestnut extracts, according to preliminary studies.
  Horse Chestnuts as Fodder:
 In Eastern countries considerable use is made of Horse Chestnuts for feeding horses and cattle, and cattle are said to eat them with relish, though pigs will not touch them. The method of utilizing them is to first soak them in lime-water, which deprives them of the well-known bitter flavour inherent in the nuts, and then to grind them to a meal and mix them with the ordinary provender.
 Experiments made during the Great War proved that for every ton of Horse Chestnuts which are harvested, half a ton of grain can be saved for human consumption, and thus the Horse Chestnuts, though totally unfit for human food, can be utilized indirectly to increase the national food supply.
 The genus Pavia is so closely allied as to be now generally grouped with the aesculus. The Red Buckeye (. pavia) is a handsome small tree with dense and large foliage, together with bright red flowers in large loose clusters in early summer. Sometimes it rises from 15 to 20 feet high, but some of its varieties are only low-spreading or trailing shrubs. The Yellow Buckeye (. flava) is common and sometimes 40 feet high. It has somewhat the habit of the Red Horse Chestnut (. rubicunda), but has smoother leaves. The DWARF HORSE CHESTNUT (. parviflora) is a handsome shrub, 6 to 10 feet high, flowering in later summer. Its foliage is much like that of other asculi, and its small, white, fragrant flowers are in long, erect plume-flowers.

  Chronic venous insufficiency:Uses based on scientific evidence

 Chronic venous insufficiency is a condition that is more commonly diagnosed in Europe than in the United States, and may include leg swelling, varicose veins, leg pain, itching, and skin ulcers. There is evidence from laboratory, animal, and human research that horse chestnut seed extract (HCSE) may be beneficial to patients with this condition. Studies report significant decreases in leg size, leg pain, itchiness, fatigue and "tenseness." There is preliminary evidence that HCSE may be as effective as compression stockings.

  Uses based on tradition or theory:

 The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
 Antiangiogenic, benign prostatic hypertrophy (BPH), fluid in the lungs (pulmonary edema), gall bladder pain (colic), gall bladder infection (cholecystitis), gall bladder stones (cholelithiasis), bladder disorders (incontinence, cystitis), bruising, cough, vein clots (deep venous thrombosis), diarrhea, dizziness, fever, hemorrhoids, kidney diseases, leg cramps, liver congestion, lung blood clots (pulmonary embolism), menstrual pain, nerve pain, osteoarthritis, pancreatitis, rectal complaints, "rheumatism," rheumatoid arthritis, skin conditions, post-operative/post-traumatic soft tissue swelling, ringing in the ears (tinnitus), ulcers, varicose leg ulcers, whooping cough.
 


  Traditional remedy for leg vein health:

 Horse chestnut is a traditional remedy for leg vein health. It tones and protects blood vessels and may be helpful in ankle oedema related to poor venous return. Utilised extensively throughout Europe as an anti-inflammatory agent for a variety of conditions, in addition to being used for vascular problems. The plant is taken in small doses internally for the treatment of a wide range of venous diseases, including hardening of the arteries, varicose veins, phlebitis, leg ulcers, haemorrhoids and frostbite.
 Fluid accumulation is more common in the legs and far more likely in individuals who stand for extended periods of time. Prolonged standing and obesity can increase pressure within leg veins causing weak veins to swell, leak and deteriorate into varicose veins. Aescin, performs an antioxidant function and has a general vasoprotective role by protecting collagen and elastin (the two chief proteins that form the structure of veins). By protecting these key vessel proteins, veins and capillaries stay strong and maintain their structural integrity when exposed to stress.
 A study out of West Germany, reported in the early 1980s, showed one commercial horse chestnut product affected both the collagen content and architecture of the varicose vein and helped make the veins more normal.

  Astringent, anti-inflammatory :

 Horse chestnut is an astringent, anti-inflammatory herb that helps to tone the vein walls which, when slack or distended, may become varicose, haemorrhoidal or otherwise problematic. The plant also reduces fluid retention by increasing the permeability of the capillaries and allowing the re-absorption of excess fluid back into the circulatory system.

  Decongestant, expectorant and tonic:

 The seeds are decongestant, expectorant and tonic. They have been used in the treatment of rheumatism, neuralgia and haemorrhoids. A compound of the powdered roots is analgesic and has been used to treat chest pains. Extracts of the seeds are the source of a saponin known as aescin, which has been shown to promote normal tone in the walls of the veins, thereby improving circulation through the veins and promoting the return of blood to the heart.
 Veins that are either weak and/or under chronic stress are more likely to fail and therefore more likely to allow leakage of fluid from the vessels into the tissue space leading to swelling.

  Horse chestnut triterpene glycosides:

 Horse chestnut contains several triterpene glycosides, with aescin predominating in the seeds. Coumarin glycosides aesculin, fraxin, and scopolin and their corresponding aglycones, aesculetin, fraxetin, and scopoletin, are also found, along with flavonoids such as quercetrin. Allantoin, leucocyanidins, tannins, and the plant sterols sitosterol, stigmasterol, and campesterol have also been identified. The whole extract made from the Horse Chestnut is probably superior to the isolated Aescin. This is a commonly overlooked mechanism of most herbs. The combination of the entire plant components synergistically can often produce superior results as compared to a refined, isolated active ingredient of the herb

  Leg ulcers and frostbite:

 Horse chestnut has also been taken internally for leg ulcers and frostbite, and applied externally as a lotion, ointment, or gel. In France, an oil extracted from the seeds has been used externally for rheumatism. The topical preparation has also been used to treat phlebitis. Most studies have looked at the plant's use internally. But there is some evidence that applying an ointment to the affected area may also help.

  Reduce oedema (swelling with fluid) following trauma:

 Randomised double-blind, placebo-controlled studies have shown that horse chestnut can reduce oedema (swelling with fluid) following trauma, particularly those following sports injuries, surgery, and head injury. A clinical study compared horse chestnut extract to compression stockings and placebo for varicose veins. Both the herbal medicine and the stockings significantly reduced oedema of the lower legs compared to placebo. Feelings of tiredness and heaviness, pain, and swelling in the legs were alleviated by the extract, in comparison to placebo. In addition, common symptoms which accompany lower leg swelling; such as leg pain, heaviness and fatigue, are typically reduced in individuals taking horse chestnut seed extract.
 Trial studies suggest that Horse Chestnut may also be of value in treating lung conditions of infarction, embolisms and thrombosis.
 


  Indications,Combinations and Dosage of Horse chestnut:

 The unique actions of Horse Chestnut are on the vessels of the circulatory system. It seems to increase the strength and tone of the veinsin particular. It may be used internally to aid the body in the treatment of problems such as phlebitis, inflammation in the veins, varicosity and haemorrhoids. Externally it may be used as a lotion for the same conditions as well as for leg ulcers. King's Dispensatory gives the following specific indications and uses: visceral neuralgia, due to congestion; soreness of the whole body, with vascular fullness, throbbing, andgeneral malaise; throbbing, fullness, and aching in the hepatic region; rectal uneasiness with burning or aching pain; sense of constriction, with itching; large, purple pile-tumors; uneasy sensations and reflex disturbances depending upon haemorrhoids or rectal vascular engorgement.

  Combinations of Horse chestnut:  Other cardiovascular tonics such as Hawthorn, Linden, Ginkgo and Yarrow.

  Properties:  Anti-oxidant, anti-inflammatory, anti-rheumatic, analgesic, astringent, econgestant, expectorant, febrifuge, tonic, vasoprotective, venous tonic.

  Indicated for:  Chest pain, chronic venous insufficiency, frostbite, haemorrhoids, hardening of the arteries, improving connective tissue tone, leg ulcers, lung conditions (embolisms, infarction, thrombosis), lymphedema, neuralgia, oedema, phlebitis, rheumatism, sprains and other injuries, swollen ankles, varicose veins, varicose eczema, venous stasis.

  Preparations & Dosage of Horse chestnut(Aesculus hippocastanum):

 Infusion: pour a cup of boiling water onto l-2 teaspoonfuls of the dried fruit and leave to infuse for l0-l5 minutes. This should be drunk three times a day or used as a lotion. Tincture: take l-4 ml ofthe tincture three times a day.
 How much is usually taken? For treatment of chronic venous insufficiency horse chestnut seed extracts standardized for aescin content (16¨C20%), 300 mg two to three times per day, are recommended. Tincture, 1-4 ml taken three times per day, can be used though it is questionable whether a significant amount of aescin can be absorbed this way.Gels or creams containing 2% aescin can be applied topically three or four times per day for hemorrhoids, skin ulcers, varicose veins, sports injuries, and trauma of other kinds.
 Are there any side effects or interactions? Internal use of horse chestnut seed extracts standardized for aescin at recommended amounts is generally safe. However, in rare cases oral intake of horse chestnut may cause itching, nausea, and upset stomach.11 Based on reports of worsening kidney function in people with kidney disease who received intravenous aescin, horse chestnut should be avoided by anyone with kidney disease.People with liver disease should also avoid the use of horse chestnut. There are no known reasons to avoid horse chestnut during pregnancy.Topically, horse chestnut has been associated with rare cases of allergic skin reactions. Circulation disorders and trauma associated with swelling may be the sign of a serious condition. Therefore, a healthcare professional should be consulted before self-treating with horse chestnut.

  Dosage and Administrations

 The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

  Standardization: Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Horse chestnut seed extract (HCSE) products are often standardized to contain 16% to 20% triterpene glycosides calculated as escin (aescin) content.

  Adults (18 years and older):
 Oral (by mouth): 300 milligrams every 12 hours, for up to 12 weeks (containing 50 to 75 milligrams of escin per dose), has been taken by mouth. A dose of 600mg of chestnut seed extract per day has also been studied.
 Topical (on the skin): A gel preparation of horse chestnut applied to the skin has been studied for bruising, without clear benefits.
 Intravenous (through a vein)/intramuscular (injected into a muscle): Severe allergic reaction (anaphylactic shock) has been reported with intravenous use. Horse chestnut leaf has been associated with liver inflammation (hepatitis) after injection into muscle.

  Children (younger than 18 years):
 There is not enough scientific evidence to recommend use of horse chestnut in children. Deaths have been reported in children who ate raw horse chestnut seeds or tea made from horse chestnut leaves and twigs.

  Safety and Side Effects:

  Allergies : Horse chestnut seed extract (HCSE) may cause an allergic reaction in patients with known allergy to horse chestnuts, esculin,or any of its ingredients (flavonoids, biosides, trisides of quertins, and oligosacharides including 1-ketose and 2-ketose). Anaphylactic shock (severe allergic reaction) has been reported with intravenous (through the vein) use.

  Side Effects and Warnings :

 Unprocessed horse chestnut seeds, leaves, bark, and flowers contain esculin, which has been associated with significant toxicity and death. Symptoms found with horse chestnut poisoning may include vomiting, diarrhea, headache, confusion, weakness, muscle twitching, poor coordination, coma or paralysis. Horse chestnut seed extract (HCSE) standardized to escin content should not contain significant levels of esculin, and should not have the same risks.
 Standardized HCSE is generally considered to be safe in adults at recommended doses for short periods of time. Stomach upset, muscular (calf) spasm, headache, dizziness, nausea and itching have been reported. Contact skin irritation (dermatitis) has been reported following application of HCSE to the skin.
 Based on animal study, HCSE may cause lowered blood sugar. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a qualified healthcare provider, and medication adjustments may be necessary.
 In theory, horse chestnut may increase the risk of bleeding due to the hydroxycoumarin content of esculin. Properly extracted HCSE should not contain esculin, and therefore should not carry this risk. However, caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Monitoring is recommended and dosing adjustments may be necessary. There is a case report of liver toxicity associated with horse chestnut leaf that resolved after discontinuing the product. Kidney toxicity when high doses of escin were injected have been reported. Aflatoxins, considered to be cancer-causing agents, have been identified in commercial skin products containing horse chestnut, but not in HCSE.

  Pregnancy and Breastfeeding : There is not enough scientific research to recommend the safe use of horse chestnut or HCSE during pregnancy and lactation. One small study of pregnant women treated with HCSE did not report serious adverse effects after two weeks.

  Interactions:

  Interactions with Drugs:

 In theory, due to its esculin constituents, horse chestnut (but not horse chestnut seed extract, which when properly prepared does not contain esculin) may theoretically increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin) or heparin, anti-platelet drugs such as clopidogrel (Plavix), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil) or naproxen (Naprosyn, Aleve).
 In theory, and based on limited animal study, horse chestnut seed extract (HCSE) may have an additive effect when taken with drugs that cause hypoglycemia (low blood sugar levels). Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.
 Escin in HCSE may theoretically interfere with protein-bound drugs such as phenytoin (Dilantin), warfarin (Coumadin) or amiodarone (Cordarone), although no cases are reported in the available literature.

  Interactions with Herbs and Dietary Supplements:

 In theory, due to its esculin constituents, horse chestnut (but not horse chestnut seed extract, which when properly prepared does not contain esculin) may theoretically increase the risk of bleeding when taken with herbs or supplements that increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba , and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases. Some examples include: alfalfa, American ginseng, angelica, anise, Arnica montana , asafetida, aspen bark, bilberry, birch, black cohosh, bladderwrack, bogbean, boldo, borage seed oil, bromelain, capsicum, cat's claw, celery, chamomile, chaparral, clove, coleus, cordyceps, danshen, devil's claw, dong quai, evening primrose, fenugreek, feverfew, flaxseed/flax powder (not a concern with flaxseed oil), ginger, grapefruit juice, grapeseed, green tea, guggul, gymnestra, horseradish, licorice root, lovage root, male fern, meadowsweet, nordihydroguairetic acid (NDGA), onion, papain, Panax ginseng, parsley, passionflower, poplar, prickly Ash, propolis, quassia, red clover, reishi, Siberian ginseng, sweet clover, rue, sweet birch, sweet clover, turmeric , vitamin E, white willow, wild carrot, wild lettuce, willow, wintergreen, and yucca.

 In theory, and based on limited animal study, horse chestnut seed extract may have an additive effect when taken with other herbs or supplements that may lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment. Possible examples include: Aloe vera, American ginseng, bilberry, bitter melon, burdock,fenugreek, fish oil, gymnema, marshmallow, milk thistle, Panax ginseng, rosemary, Siberian ginseng, stinging nettle and white horehound. Agents that may raise blood sugar levels include: Arginine, cocoa, and ephedra (when combined with caffeine).
 


  Safety and Toxicity Study.

  Identification:Escin.
 Chemical Name: Escin.
 CAS No.6805-41-0.1394-90-7.Molecular Formula.C54-H84-O23. Molecular Weight:1101.38
 Synonyms:A-4700;Aescin;Aescusan;Amorphous aescin;Escina;Reparilu.

  Acute Toxicity:Escin.
 LD50-Lethal dose,50 percent kill.Oral.Rodent-rat.833 mg/kg. Details of toxic effects not reported other than lethal dose value.
 LD50-Lethal dose,50 percent kill.Intraperitoneal.Rodent-rat.10150 ug/kg.Details of toxic effects not reported other than lethal dose value.
 LD50-Lethal dose,50 percent kill.Subcutaneous.Rodent-rat.150 mg/kg.Details of toxic effects not reported other than lethal dose value.
 LD50-Lethal dose,50 percent kill.Oral.Rodent-mouse.165 mg/kg.Details of toxic effects not reported other than lethal dose value.
 LD50-Lethal dose,50 percent kill.Intraperitoneal.Rodent-mouse.6700 ug/kg.Details of toxic effects not reported other than lethal dose value.
 LD50-Lethal dose,50 percent kill.Intraperitoneal.Rodent-mouse.6700 ug/kg.Details of toxic effects not reported other than lethal dose value.
 LD50-Lethal dose,50 percent kill.Subcutaneous.Rodent-mouse.38590 ug/kg.Details of toxic effects not reported other than lethal dose value.
 Reference:KSRNAM Kiso to Rinsho.Clinical Report.V.1-1960-Volume(issue)/page/year:8,118,1974.

 LD50-Lethal dose,50 percent kill.Intravenous.Rodent-rat.1600 ug/kg.Details of toxic effects not reported other than lethal dose value.
 LD50-Lethal dose,50 percent kill.Intravenous.Rodent-mouse.2 mg/kg.Details of toxic effects not reported other than lethal dose value.
 Reference:BCFAAI Bollettino Chimico Farmaceutico.(Societa Editoriale Farmaceutica,Via Ausonio 12,20123 Milan,Italy)V.33-1894-Volume(issue)/page/year:115,272,1976.
 LD50-Lethal dose,50 percent kill.Intravenous.Rodent-rabbit.2500 mg/kg.
 Toxic effects:
 Liver.hepatitis (hepatocellular necrosis),diffuse.
 Kidney,Ureter,Bladder.changes in tubules (including acute renal failure,acute tubular necrosis)
 Blood.other hemolysis with or without anemia.
 Reference:ARZNAD Arzneimittel-Forschung.Drug Research.(Editio Cantor Verlag,Postfach 1255,W-7960 Aulendorf,Fed.Rep.Ger.)V.1-1951-Volume(issue)/page/year:10,280,1960.

  Other Multiple Dose Toxicity Data:Escin.
 TDLo-Lowest published toxic dose.Oral.Rodent-rat.9600 mg/kg/32D-C. Toxic Effects:Related to Chronic Data-death.
 TDLo-Lowest published toxic dose.Oral.Rodent-mouse.3 gm/kg/30D-C.
 Toxic Effects:
 Nutritional and Gross Metabolic:changes in sodium.
 Biochemical: Enzyme inhibition,induction,or change in blood or tissue.
 Levels: transaminases.
 Related to Chronic Data:death.
 Reference:KSRNAM Kiso to Rinsho.Clinical Report.V.1-1960-Volume(issue)/page/year:9,1270,1975.

 TDLo-Lowest published toxic dose.Intravenous.Rodent-rabbit.33 mg/kg/30D-I.Toxic effects: Blood.changes in erythrocyte(RBC) count.
 Reference:ARZNAD Arzneimittel-Forschung.Drug Research.(Editio Cantor Verlag,Postfach 1255,W-7960 Aulendorf,Fed.Rep.Ger.)V.1-1951-Volume(issue)/page/year:10,280,1960.

  Reproductive Data:Escin.
 TDLo-Lowest published toxic dose.Oral.Rodent-mouse.36 mg/kg.Sex/Duration.female 7-16 day(s) after conception.
 Toxic Effects: Reproductive.Specific Development Abnormalities-musculoskeletal system.
 Reference: BLLIAX Bratislavske Lekarske Listy.(PNS-Ustredna Expedicia a Dovoz Tlace,Gottwaldovo nam.6,813 81 Bratislava,Czechoslovakia)V.1-1921-Volume(issue)/page/year:87,76,1987.

 TDLo-Lowest published toxic dose.Oral.Rodent-rabbit.325 mg/kg.female 6-18 day(s) after conception.
 Toxic Effects:Reproductive.Effects on Embryo or Fetus-extra-embryonic structures(e.g.,placenta,umbilical cord)
 TDLo-Lowest published toxic dose.Oral.Rodent-rabbit.81250 mg/kg.female 6-18 day(s) after conception.
 Toxic Effects:Reproductive.Specific Development Abnormalities-musculoskeletal system.
 Reference:KSRNAM Kiso to Rinsho.Clinical Report.V.1-1960-Volume(issue)/page/year:9,1227,1975.


  Scientific References:

  1.Horse chestnut Aescin.Horse Chestnut Extract.