Aescin is a mixture of saponins with anti-inflammatory, vasoconstrictor and vasoprotective effects found in Aesculus hippocastanum (the horse chestnut). Aescin is the main active compound in horse chestnut, and is responsible for most of its medicinal properties. High-quality evidence suggests aescin is a safe and effective treatment for chronic venous insufficiency. In one randomized controlled trial, horse chestnut extract was found to be as effective and well-tolerated as use of compression stockings. Aescin appears to produce effects through a wide range of mechanisms. It induces endothelial nitric oxide synthesis by making endothelial cells more permeable to calcium ions, and also induces release of prostaglandin F2α. Other possible mechanisms include serotonin antagonism and histamine antagonism and reduced catabolism of tissue mucopolysaccharides.
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