Horse chestnut seed extract (Aesculus hippocastanum) - Horse chestnut seed extract (HCSE) has been used extensively in Europe for both preventing and treating varicose veins and other venous disorders. Standardized HCSE has been safely used in controlled clinical trials involving over 700 patients and is approved for use by the German Commission E for the treatment of chronic venous insufficiency (CVI)—a common but often underdiagnosed cause of leg pain and swelling, frequently associated with varicose veins. A systematic review of clinical trials published in 2012 also concluded that HCSE is an effective and safe short-term treatment option for CVI, with additional studies recommended to confirm long-term results. HCSE tones and strengthens blood vessels and inhibits the action of enzymes that can damage capillary walls. HCSE also promotes blood circulation through the veins, reduces achiness, inflammation and fatigue in the legs, and counteracts the development of edema by decreasing capillary filtration and sealing capillary walls to prevent the leakage of fluid into surrounding tissues. For pre-existing edema, HCSE helps reduce swelling by stimulating fluid excretion. HCSE is standardized to contain the active ingredient aescin (also called escin), which has been shown to provide strong anti-inflammatory and antioxidant properties, as well as the ability to increase venous tone. HCSE is contraindicated for individuals with existing kidney or liver impairment or bleeding disorders. Due to the natural content of coumarin derivatives, HCSE should be used with caution by those taking aspirin, warfarin or other anticoagulants, as the effects of such medications may be enhanced.5,13-19