Synopsis

Source of validity: Traditional
Rating (out of 5): 2

Pentacyclic triterpenoids, a broad class of plant-derived compounds, have a history of use in traditional medicine for treating hemorrhoids. The most well-studied among them, such as escin (from horse chestnut) and betulinic acid (from birch bark), have been included in topical creams and oral formulations aimed at alleviating symptoms like swelling, pain, and inflammation. The traditional use stems from their reputed anti-inflammatory, astringent, and venotonic (vein-strengthening) properties. In particular, horse chestnut seed extract, which contains escin, has been recognized in European phytotherapy for managing chronic venous insufficiency and hemorrhoidal symptoms.

However, scientific evidence specifically targeting pentacyclic triterpenoids in the treatment of hemorrhoids is limited and generally of low quality. Most available studies focus on chronic venous insufficiency rather than hemorrhoids directly, and many trials are small, poorly controlled, or do not isolate the triterpenoid component. While animal and in vitro studies suggest anti-inflammatory and vascular-protective effects, robust clinical trials in hemorrhoid patients are lacking. Thus, while traditional use is established, scientific validation remains insufficient, and their use for hemorrhoids is primarily supported by historical and anecdotal evidence rather than rigorous clinical research.

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