H
Dosages (Horse Chestnut) — 0.2–1.0 g fruit 3 ×/day (CAN); 1–2 g dry seed/day (MAB);^1 / 2 tsp
powdered seed/16 oz water (APA); 2–6 ml fluid seed extract (1:2)/day (MAB); 5–15 ml/day seed
tincture (1:5) (MAB); 2–4 ml liquid bark extract (PNC); 0.5–1.2 ml liquid fruit extract (PNC);
30–150 mg aescin/day (PHR); 90–150 mg aescin at first, then 35–70 mg (APA); 300–600 mg StX
( = 100 mg aescin) (SHT); StX tablets (200 mg concentrated 5:1 extract) to provide 40 mg escin,
2–3 ×/day (MAB); 2 (480 mg) capsules (StX with 257 certified potency extract with at least 18–22%
triterpenoid glycosides (calculated as aescin) synergistically combined with butcher’s broom, gin-
ger, and rutin), one with morning meal, one with evening meal (NH).
Contraindications, Interactions, and Side Effects (Horse Chestnut) — Not covered (AHP). Seeds
“poisonous” and must be specifically prepared before being used medicinally. Never consume them
in any form unless a knowledgeable manufacturer has processed them properly. Children have died
after ingesting untreated seed. Formerly an FDA herb of undefined safety. Strangely, APA gives the
internal usage their highest rating (1) and external usage less (3) (APA). Aesculin has caused contact
dermatosis. The no-toxic-effect dose is ca. 8 times the recommended therapeutic dose. The results
of animal studies are corroborated by decades of use in patients with no reports of harmful effects
due to overdosing. Tests for chronic toxicity (34 weeks in rats and dogs) showed no cumulative
toxic effects or any evidence of embryotoxic or teratogenic effects. Isolated cases of GI distress,
itch, and nausea are reported (SHT). Commission E reports rare GI disturbances (AEH). No con-
traindications or drug-drug interactions reported (PIP). Isolated cases of renal and hepatic toxicity
as well as anaphylactic reactions have been reported following intravenous administration, but these
appear to be exceptional (VET Herbs of Choice). Fleming (Herbal PDR, 1998) cautions that the
intake of too many horse chestnut seed (in one case, a child with 5 seed) can cause diarrhea, disorders
of consciousness and vision, enlargement of the pupils, flushing of the face, severe thirst, and
vomiting. In case of poisoning, Fleming recommends evacuation of the stomach and intestine (gastric
lavage, sodium sulphate) and administration of activated charcoal. Then symptom management
(PHR). Blumenthal et al. (1998) caution that other prescribed noninvasive treatments; e.g., leg
compresses, support stockings, or cold water applications, must be observed under all circumstances
(KOM). CAN cautions that aescin is nephrotoxic. Side effects include GI disturbance, impaired liver
function, mild nausea, shock, spasm, urticaria, and vomiting. Should be avoided by patients on
blood-thinning therapy, with hepatic or renal impairment, or lactating or pregnant. Large doses of
saponins can be fatally hemolytic in animals. LD50s range for aescin from 134 to 720 orally in
mice, rats, and guinea pigs. On ipr administration, the total saponin fraction (LD50 = 46.5 mg/kg
ipr mouse) was less toxic compared to isolated aescin (LD50 = 9.5 mg/kg ipr mouse) (CAN). LD50
of seed extract 990 mg/kg orl mouse, 2150 orl rat, 1530 orl rbt, 130 orl dog.
Extracts (Horse Chestnut) — The whole extract was more antiinflammatory than just aescin. In
addition, an extract excluding aescin also exhibited antiinflammatory activity suggesting antiin-
flammatory agents other than aescin (CAN). Aescin (the 13% mixture of saponins) may affect the
initial phase of inflammation by reducing the number and/or diameter of capillary pores effectively
sealing the capillaries (CAN). It antagonizes effects of bradykinin but is not a direct bradykinin
antagonist (PNC). Barringtogenol-C-21 and hippocaesculin have in vitro antitumor activity (PNC).
Clinical treatment of 15 varicose patients with 900 mg/day STX for 12 days reduced activity of
enzymes that breakdown proteoglycans (CAN). Unknowingly contributing to my argument for the
synergistic whole rather than the isolated silver bullet, CAN notes that the total saponin fraction
may be less toxic via peritoneal injection in mice than the isolated aescin (itself somewhat a mixture)
(LD50s 46.5 and 9.5 mg/kg, respectively).