Horse chestnut (Aesculus)

Tier 3 — weak evidence · Venous insufficiency · Leg swelling

One of the best-studied herbal treatments for chronic venous insufficiency. A Cochrane review confirmed aescin-standardised extract reduces leg swelling and pain vs placebo. Works by reducing capillary permeability and improving venous tone. Raw horse chestnuts are toxic — only standardised extracts should be used. Avoid with blood thinners.

Dose: 300 mg twice daily standardised to 50 mg aescin; raw seeds are toxic and must never be eaten