Protocol · Cardiovascular Health
Chronic Venous Insufficiency (CVI) Protocol
Horse Chestnut Seed Extract and Gotu Kola (Centella asiatica) are the core of this stack, with 4 supporting supplements. Each row gives the amount the protocol lists and the grade our evidence database holds for that supplement in Chronic Venous Insufficiency (CVI).
We are re-verifying the studies cited on protocol pages; only confirmed citations are shown.
The stack
6 supplements · 5 graded · 3 graded A · 1 confirmed study
| Grade | Supplement | Amount listed | Why it’s in the stack | Evidence on file | Shop |
|---|---|---|---|---|---|
| Primary stackThe core of this protocol | |||||
| Horse Chestnut Seed Extract | Amount listed: 300 mg twice daily (standardized to 50 mg aescin per dose) | Aescin reduces capillary permeability, improves venous tone, and decreases leg swelling and pain
| Grade A for Chronic Venous Insufficiency Signs297 people | ||
Confirmed studies for Horse Chestnut Seed Extract (titles as PubMed lists them) | |||||
| Gotu Kola (Centella asiatica) | Amount listed: 60–180 mg triterpenes daily (standardized extract) | Triterpenes strengthen connective tissue, improve microcirculation, and reduce venous hypertension
| Grade A for Chronic Venous Insufficiency Signs5 studies · 363 people | ||
| Supporting stackListed as additions to the core | |||||
| Pycnogenol (Pine Bark Extract) | Amount listed: 100–150 mg daily | Strengthens capillary walls, reduces edema, and improves microcirculation
| Grade B for Chronic Venous Insufficiency Signs1 study · 126 people | ||
| Butcher's Broom (Ruscus aculeatus) | Amount listed: 150 mg twice daily (standardized to ruscogenins) | Ruscogenins have venotonic effects, reducing venous stasis and improving symptoms
| Grade C for Chronic Venous Insufficiency Signs1 study · 110 people | ||
| Diosmin-Hesperidin (Micronized) | Amount listed: 500 mg twice daily or 1,000 mg once daily (micronized form) | Bioflavonoids that reduce capillary permeability, improve venous tone, and reduce inflammation
| Grade A for Leg Edema Reduction | ||
| Grape Seed Extract | Amount listed: 100–300 mg daily | Proanthocyanidins strengthen vascular walls and reduce edema | Not graded yet | ||
Shop the evidence-backed picks
The collection holds the supplements we grade A or B for its theme, in third-party tested products where the catalog has them. It opens in our Fullscript store. You can look through it without signing in; Fullscript asks for a free account to order.
Or shop one supplement
The 4 supplements in this protocol graded A or B. Each opens third-party tested products, matched to the dose above where we can.
- Grade A
- Grade A
- Grade B
- Grade A
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How this protocol works
In plain language
Chronic venous insufficiency (CVI) occurs when the veins in the legs don't efficiently return blood to the heart, usually due to damaged valves. Blood pools in the legs, causing symptoms like heaviness, aching, swelling, skin changes, and in severe cases, venous ulcers. CVI affects up to 40% of women and 17% of men. While compression stockings and leg elevation are foundational treatments, several well-studied plant extracts can significantly improve symptoms.
IMPORTANT: CVI should be evaluated by a healthcare provider to assess severity and rule out deep vein thrombosis. Compression therapy remains the cornerstone of treatment. These supplements can provide additional benefit.
- Horse Chestnut Seed Extract is one of the most studied natural treatments for CVI. Its active compound, aescin, reduces the permeability of tiny blood vessels (so less fluid leaks into tissues), improves venous tone, and has anti-inflammatory effects. A Cochrane review found it as effective as compression stockings for reducing leg swelling and pain.
- Gotu Kola (Centella asiatica) contains triterpenes that strengthen the connective tissue in blood vessel walls. It improves microcirculation and reduces venous pressure. Studies show it significantly reduces symptoms like heaviness, pain, and swelling, and may help prevent progression to more severe disease.
- Pycnogenol (French maritime pine bark extract) contains powerful antioxidants that strengthen capillary walls and reduce inflammation. Studies show it improves symptoms of CVI including swelling, heaviness, and discomfort. It may also help prevent the leg skin changes associated with chronic venous disease.
- Butcher's Broom contains ruscogenins that have direct venotonic effects—they cause veins to constrict, improving blood return to the heart and reducing venous pooling. European guidelines include it as a treatment option for CVI.
- Diosmin-Hesperidin (often sold as MPFF or Daflon) is widely used in Europe for venous disorders. These citrus-derived bioflavonoids improve venous tone, reduce capillary permeability, and have anti-inflammatory effects. The micronized form is better absorbed. Multiple studies show it reduces symptoms and improves quality of life.
- Grape Seed Extract contains proanthocyanidins that strengthen blood vessel walls and reduce fluid leakage into tissues. It may help reduce leg swelling and discomfort.
Expected timeline: Horse chestnut: 2-4 weeks for symptom improvement. Gotu kola: 4-8 weeks. Pycnogenol: 4-8 weeks. Diosmin: 2-4 weeks. These work best combined with compression therapy and lifestyle measures (leg elevation, exercise, avoiding prolonged standing).