Helping to conquer CVI

The game of conkers, played with the hard, shiny, dark brown fruit of the horse chestnut tree (Aesculus hippocastanum), dates back to the mid-19th century, and since 1965 the second Sunday in October has been the date for the World Conker Championships, held in Northamptonshire.

But the conker also has a long history in folk medicine, having been used for various conditions, including arthritis, rheumatism, pyrexia, diarrhoea, coughs, haemorrhoids, varicose veins, oedema, chilblains and bruises.  

In recent years, medical researchers have begun to take the conker seriously as a potential source of treatment for chronic venous insufficiency (CVI).

Its main active ingredient is aescin, a saponin that has been shown to be a mixture of triterpene glycosides. Several studies have demonstrated the effectiveness of aescin in CVI.

One randomised controlled trial found that a standardised conker extract was as effective and as well tolerated as compression hosiery in reducing lower leg swelling in serious cases of oedema. And a cost-benefit analysis of its use in the treatment of venous leg ulcers concluded that combining it with conventional therapy involving dressings and compression was significantly more cost-effective than using conventional therapy alone. This was because fewer dressing changes were needed, with a small saving in the cost of dressing materials but a much larger saving in the organisational costs of arranging nursing visits to replace patients’ dressings.

Research also suggests that aescin reduces symptoms such as leg pain, pruritus, fatigue and tenseness. Adverse effects seem to be comparable to placebo.  

It seems that aescin works partly by inhibiting the catalytic breakdown of proteoglycans in the capillary wall. By doing so it reduces vascular permeability and thus helps to prevent leakage of fluid into the surrounding tissue.