Horse Chestnut extract (HCE) is a German Commission E approved phyto-medication for treatment of symptoms of chronic venous insufficiency (CVI) and associated conditions such as edema, varicose veins, postthrombotic syndrome, leg pain and cramps, and hemorrhoids.
CVI is the pooling of blood in the lower leg, due to the inability of lower leg veins to transport blood back to the heart. This occurs due to damage to the one-way valves in the leg veins, and leads to increasing pressure within the veins of the leg. Common signs of CVI include tired and aching legs, dry scaly skin, brown discoloration of the skin, edema, eczema, varicose veins, hard, woody feeling skin, and leg ulcers. Although pain is not necessarily a symptom of CVI, some people experience severe pain in the calf when walking, leg muscle pain after prolonged standing, or pain from leg ulcers.
It has been estimated that between 20-25% of adult women and 10-15% of adult men suffer from CVI. Incidence increases with age. CVI may also be known as post-phlebitic syndrome or post-thrombotic syndrome. Conventional treatment is vascular surgery and/or drugs and compression stockings that help the blood move back up the leg.
Varicose veins develop under the skin and are characterized by their bulging, knotted, and twisted appearance. They occur most commonly in the legs, particularly the back of the knee, the back of the calf, and on the inner leg and thigh. Women are four times more likely than men to develop varicose veins and are at particular risk during pregnancy. The chance of developing varicose veins increases with age and occurs in about 50% of those 50 years old or older. The development varicose veins also tends to be hereditary. Prolonged sitting standing can cause an increased risk of varicose veins. Obesity causes increased intra-abdominal pressure, which can affect blood flow resulting in varicose veins.
Aescin is the primary active substance in HCE. It has diuretic and antiexudative effects that strengthen veins and reduce their permeability, sealing off tissues from infiltration by fluids of the venous and lymphatic systems. Aescin works in additional ways. CVI results in an accumulation of white blood cells (leukocytes) in the lower leg veins. The presence of a high concentration of leukocytes causes the activation and release of certain enzymes (elastase and hyaluronidase) that may breakdown the proteins of the venous capillary walls, resulting in symptoms associated with CVI. Studies have shown that aescin inhibits the action of these enzymes.
HCE may also be beneficial in hemorrhoids, vein inflammation (phlebitis), enlarged prostate, eczema, menstrual pain, soft tissue swelling, hay fever, and arthritis. No serious side effects are associated with the use of HCE. The German Commission E recognizes HCE as a botanical medicine; it is the third most commonly sold herbal product in Germany.
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