Concern guide
Herbs for Varicose Veins
Horse chestnut, butcher’s broom and other herbs for heavy, aching, swollen legs, rated by evidence, with when to see a doctor.
5 herbs reviewed
Updated October 12, 2026
Varicose veins are swollen, twisted veins under the skin, usually on the legs. They happen when the valves inside a vein stop working properly, so blood pools and stretches the vein. They are very common, especially in women, older adults, people who are overweight or pregnant, and people who stand or sit for long periods, and they often run in families. Many cause no trouble, but some bring aching, heavy or swollen legs, itching, and skin changes, symptoms that doctors group under chronic venous insufficiency (CVI). Symptoms are usually worse after standing and better with the legs raised.
Herbs can ease some of those symptoms, but none can make varicose veins disappear. The best-studied is standardized horse chestnut seed extract, which reduced leg pain, swelling and itching compared with placebo in short trials and which the European Medicines Agency (EMA) accepts as well-established for CVI symptoms. Butcher’s broom has one good trial of its own, and pine bark and gotu kola extracts have smaller or weaker studies. For veins that cause symptoms, the UK’s NICE guideline recommends referral to a vascular service for an ultrasound scan, with endothermal ablation, a procedure that seals the faulty vein from inside, as the first-choice treatment. Herbs are best seen as symptom relief alongside that care, walking, leg elevation and, where advised, compression stockings, not as a substitute.
The list starts with the herbs that have the strongest evidence, then those with weaker or more traditional support. Each rating applies to vein symptoms such as heaviness, aching and swelling, not to how veins look. The trials were short, usually 8 to 16 weeks, and used specific standardized extracts, so a product that matches the one studied gives the best idea of what to expect. Nothing here is medical advice.
02 The shortlist
The herbs, from best studied to time-honored
How to read the ratings
- Good clinical evidence
- Promising clinical evidence
- Early or mixed evidence
- Long traditional use
Ratings show how much research backs each herb for this particular concern. Every herb links to its full monograph, with preparations, safety notes, and sources.
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01 Horse Chestnut
Good clinical evidenceAesculus hippocastanum
Horse chestnut seed extract, standardized to escin, has the most evidence of any herb for heavy, aching, swollen legs. A Cochrane review of 17 trials found less leg pain, swelling and itching than with placebo, and in a 240-patient trial it reduced leg swelling about as much as compression stockings. A later trial by the same manufacturer in more advanced disease did not beat placebo. Raw seeds are poisonous, and rare liver injury has been reported.
Read the horse chestnut monograph →
Evidence review: Horse Chestnut for Varicose Veins -
02 Butcher's Broom
Promising clinical evidenceRuscus aculeatus
Butcher’s broom root is a traditional European remedy for heavy legs. In a 12-week trial in 166 women with chronic venous insufficiency, a Ruscus-only extract reduced leg volume by about 20 ml more than placebo and eased heavy, tired legs, though EMA kept it at traditional use. Many studies test a combination with hesperidin methyl chalcone and vitamin C, which has stronger evidence. MSKCC advises people with diabetes not to take it.
Read the butcher's broom monograph →
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03 Pine Bark
Early or mixed evidencePinus pinaster
French maritime pine bark extract, mostly sold as Pycnogenol, is promoted for leg swelling. In a 40-person trial, 100 mg three times daily for two months reduced swelling, heaviness and pain compared with placebo, and Cochrane’s review of vein medicines found it reduced pain, heaviness and swelling. But Cochrane’s pine bark review rated the venous trials very low certainty, and the maker funded most of the research. It reduces platelet clumping, so check first if you take blood thinners.
Read the pine bark monograph →
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04 Gotu Kola
Early or mixed evidenceCentella asiatica
A purified extract of gotu kola’s triterpenes, sold as TECA or TTFCA, is authorized in several EU countries for heavy, swollen legs. A 2013 review of eight trials found better microcirculation and less ankle swelling, but most studies were poorly reported, and Cochrane found only two usable trials. EMA refused any oral use of the plant itself, citing liver injury reports, so use only standardized extracts and with medical advice.
Read the gotu kola monograph →
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05 Ginkgo
Long traditional useGinkgo biloba
EMA lists ginkgo leaf as a traditional remedy for heavy legs and cold hands and feet once a doctor has ruled out serious disease, but no good trial has tested it for varicose veins. A Cochrane review found no clinically important benefit for leg pain on walking, a different circulation problem caused by narrowed arteries. Ginkgo adds to bleeding risk with blood thinners and should be stopped before surgery.
Read the ginkgo monograph →
03 Caution
Using these herbs safely
Some leg symptoms need prompt medical care rather than an herb. A swollen, painful calf or sudden swelling of one leg can be a deep vein thrombosis (DVT), a clot that needs same-day assessment, and sudden breathlessness or chest pain with it is an emergency. A bleeding varicose vein needs urgent medical help. See a doctor for a sore on the leg that has not healed within two weeks, hard, painful veins (superficial vein thrombosis), skin that is darkening, thickening or itchy over the veins, or veins that are getting worse. Leg swelling can also come from heart or kidney failure, so new swelling deserves a check before you treat it as a vein problem.
Most vein herbs are well tolerated in short trials, but each has specific cautions. Horse chestnut must be a processed, standardized seed extract: raw seeds, bark, leaves and flowers are poisonous, especially to children. It has rarely caused liver injury after weeks of use, and MSKCC advises against it with kidney or liver disease. Butcher’s broom has been linked to diabetic ketoacidosis in a case report, and MSKCC advises people with diabetes to avoid it. Gotu kola taken by mouth has been linked to liver injury. Pine bark, ginkgo and, in theory, horse chestnut can add to bleeding risk with warfarin, other anticoagulants and antiplatelet drugs, so check with your prescriber or pharmacist first, and stop ginkgo before surgery.
Medicinal doses of horse chestnut, butcher’s broom, gotu kola and ginkgo are not recommended in pregnancy or breastfeeding, and pine bark has too little data to be considered safe, even though varicose veins are especially common in pregnancy; the NHS suggests compression stockings for leg swelling in pregnancy and notes that varicose veins often improve after the baby is born. None of these herbs is meant for children. Single-herb products that name the plant part and standardization, such as horse chestnut extract standardized to escin, match the research far better than unlabeled “vein support” blends, which make it impossible to know which ingredient helped or caused a problem.
Compression stockings are not suitable for everyone. They are not suitable if the arteries in the legs are narrowed, so ask a doctor to check your circulation first, and a doctor or pharmacist can help you choose the right type. Simple habits help whatever else you use: walking and regular exercise, raising the legs when resting, avoiding long periods of standing or sitting, keeping to a healthy weight, not smoking, and moisturizing dry, itchy skin over the veins.
04 Questions
Frequently Asked Questions
Horse chestnut seed extract has the strongest evidence. A Cochrane review of 17 short trials found less leg pain, swelling and itching than with placebo, and EMA accepts standardized extracts as well-established for these symptoms; our evidence review of horse chestnut for varicose veins covers the trials in detail. Butcher’s broom comes next, with one good trial in 166 women. Both ease symptoms rather than removing the veins.
No. Trials of horse chestnut, butcher’s broom and other herbs measured leg swelling, pain, heaviness and itching, not whether veins shrank or disappeared. Once a vein valve has failed, the vein does not return to normal on its own. Procedures such as endothermal ablation, foam sclerotherapy or surgery are the treatments that close or remove varicose veins, and NICE recommends referral to a vascular service for veins that cause symptoms.
Follow your clinician’s advice. In one 240-patient trial, horse chestnut extract reduced leg swelling about as much as compression stockings over 12 weeks, but in a later trial in more advanced vein disease, stockings worked and the extract did not beat placebo. NICE now recommends a procedure rather than stockings for most people with symptomatic varicose veins, and stockings for those who cannot have one. The extract can be an option for people who cannot tolerate stockings, with a doctor’s agreement.
They are a traditional option with little trial evidence. EMA accepts horse chestnut gels as a traditional remedy for heavy legs and for bruises, but the trials behind the well-established rating used capsules taken by mouth. Gels should not go on broken skin, near the eyes or on mucous membranes. Moisturizing dry, itchy skin over varicose veins is also helpful, and a sore that does not heal within two weeks needs a doctor.
It is best not to. EMA does not recommend horse chestnut in pregnancy or breastfeeding because safety has not been established; the same applies to butcher’s broom, gotu kola and ginkgo, and pine bark has too little pregnancy data to be considered safe. The NHS suggests compression stockings for leg swelling from varicose veins in pregnancy, and notes that the veins often improve after the baby is born. Procedures are not usually done during pregnancy.
Diosmin and hesperidin come from citrus fruit rather than an herb. A purified form called micronized purified flavonoid fraction (MPFF), sold as a medicine in many countries, and a combination of butcher’s broom extract with hesperidin methyl chalcone and vitamin C had the highest-quality evidence for vein symptoms in a 2025 review of vein medicines. Cochrane’s review of vein medicines as a group found they probably reduce leg swelling slightly but make little or no difference to quality of life or ulcer healing.
05 References
Sources
These references support the claims in this guide. Each herb’s monograph carries its own full source list.
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Varicose veins
NHS, 2026
Symptoms, causes and complications of varicose veins; self-care advice; when to see a GP or get urgent help; endothermal ablation as the usual first-choice treatment; compression stockings in pregnancy.
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Varicose veins: diagnosis and management (CG168)
National Institute for Health and Care Excellence (NICE), 2013
Recommends referral to a vascular service for symptomatic varicose veins, duplex ultrasound, endothermal ablation first, and compression hosiery only when interventional treatment is unsuitable.
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Horse chestnut seed extract for chronic venous insufficiency
Cochrane Database of Systematic Reviews (PubMed 23152216), 2012
Supports the good rating for horse chestnut: 17 randomized trials; leg pain reduced in six of seven placebo-controlled trials and leg volume about 32 ml lower than placebo in six trials with 502 people; adverse events mild and infrequent.
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Comparison of leg compression stocking and oral horse-chestnut seed extract therapy in patients with chronic venous insufficiency
The Lancet (PubMed 8569363), 1996
Diehm et al.: 240 patients for 12 weeks; lower leg volume fell 43.8 ml with extract and 46.7 ml with compression stockings and rose 9.8 ml with placebo.
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Rational therapy of chronic venous insufficiency: chances and limits of the therapeutic use of horse-chestnut seeds extract
BMC Cardiovascular Disorders (PubMed 11747472), 2001
Reports a second manufacturer trial in 355 patients with more advanced CVI, in which compression beat placebo but horse chestnut extract did not in the main analysis; one author was employed by the extract’s maker.
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Efficacy and safety of a Butcher’s broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency
Arzneimittel-Forschung (PubMed 12040966), 2002
Supports the some rating for butcher’s broom: 166 women with CVI for 12 weeks; leg volume 20.5 ml lower than placebo at 12 weeks, with less heaviness and tension.
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Efficacy of Ruscus extract, HMC and vitamin C, constituents of Cyclo 3 fort, on improving individual venous symptoms and edema: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials
International Angiology (PubMed 28225220), 2017
Kakkos and Allaert: 10 trials of the three-ingredient combination, not butcher’s broom alone; improvements in symptoms and edema versus placebo.
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The role of venoactive compounds in the treatment of chronic venous disease
Journal of Vascular Surgery: Venous and Lymphatic Disorders (PubMed 40348378), 2025
Gloviczki et al.: MPFF and Ruscus extract with hesperidin methyl chalcone and vitamin C had the highest, mostly level A, evidence for venous symptoms; graded the horse chestnut leg-volume effect level A. Two authors disclosed ties to a supplement company.
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Phlebotonics for venous insufficiency
Cochrane Database of Systematic Reviews (PubMed 33141449), 2020
Martinez-Zapata et al.: 56 trials with data, including two on Centella asiatica and two on French maritime pine bark; vein medicines probably reduce leg swelling slightly, with little or no effect on quality of life or ulcer healing.
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Treatment of chronic venous insufficiency with pycnogenol
Fitoterapia (PubMed 10844161), 2000
Supports the mixed rating for pine bark: 40 patients, 100 mg three times daily or placebo for two months; less swelling, heaviness and pain, with no change in venous blood flow.
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Pine bark (Pinus spp.) extract for treating chronic disorders
Cochrane Database of Systematic Reviews (PubMed 32990945), 2020
Rated the two venous insufficiency trials it included, 60 people in total, very low certainty; the manufacturer funded 20 of 27 trials across all conditions.
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A systematic review of the efficacy of Centella asiatica for improvement of the signs and symptoms of chronic venous insufficiency
Evidence-Based Complementary and Alternative Medicine (PubMed 23533507), 2013
Supports the mixed rating for gotu kola: eight randomized trials showed improved microcirculation and ankle swelling, but most were poorly reported with unclear risk of bias.
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Ginkgo biloba for intermittent claudication
Cochrane Database of Systematic Reviews (PubMed 23744597), 2013
Found no clinically important benefit of ginkgo over placebo for leg pain on walking, an arterial rather than venous problem.