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This combination therapy consists of aescin, a saponin mixture derived from horse chestnut (*Aesculus hippocastanum*), and micronized purified flavonoid fraction (MPFF), which typically contains 90% diosmin and 10% other flavonoids such as hesperidin. The combination is being evaluated in a randomized controlled trial led by Chiang Mai University for the early control of bleeding and symptom management in patients with grade 1 and 2 acute internal hemorrhoids. Aescin provides anti-edematous, anti-inflammatory, and venotonic properties by facilitating ion entry into channels and elevating venous tension. MPFF complements these effects by augmenting venous tone, reducing capillary hyperpermeability, and inhibiting inflammatory mediators, thereby addressing the stagnation of blood and subsequent inflammatory response characteristic of hemorrhoidal disease.
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