Butcher's Broom

Health Care Professional Information

Scientific Name
Ruscus aculeatus
Common Name

Box holly, sweet broom, knee holly, pettigree, jew’s myrtle, thorny fragon

Clinical Summary

Butcher's broom is a short evergreen shrub of the Liliaceae family. Both the leaves and rhizome of the plant are considered to have diuretic and mild laxative properties. Today, the plant extracts are widely used to treat varicose veins, hemorrhoids, and lymphedema.
Ruscogenin, one of the major constituents, demonstrated anti-inflammatory effects in vivo (10).
Clinical studies have revealed efficacy of butcher broom extracts in controlling lymphedema and chronic venous insufficiency (4) (5) (6) (8) (9) (11).

Cyclo-3, a product that contains an extract of butcher's broom as the main ingredient, has been reported to cause diarrhea and abdominal discomfort (7).

Purported Uses
  • Circulatory disorders
  • Constipation
  • Hemorrhoids
  • Inflammation
  • Leg cramps
  • Lymphedema
  • Promote urination
  • Varicose veins
Constituents
  • Steroidal saponins (neoruscogenin, ruscogenin)
  • Anthocyanins
  • Furostanol saponins
  • Sulphated glycosides
  • Phenyl-1-benzoxepinols
    (10) (12) (13) (14)
Mechanism of Action

Ruscogenin, one of the major components of butcher's broom, exerts anti-inflammatory effects (10) likely by inhibiting TNF-alpha-induced over expression of ICAM-1 both at the mRNA and protein levels. It also suppresses NF-kappaB activation considerably by decreasing NF-kappaB p65 translocation and DNA binding activity (10). In another in vitro study, ruscogenin was shown to inhibt elastase, one of the enzyme systems involved in the turnover of the main components of the perivascular amorphous substance (15).
The phenolic compounds and saponins isolated from butcher's broom decreased the thrombin-induced hyperpermeability of human microvascular endothelial cells (HMEC-1) in vitro (16).

Contraindications
  • Diabetes: Diabetic ketoacidosis has been reported in a 39-year-old diabetic woman 5 days after starting butcher's broom for mild ankle swelling. Her condition stabilized following conventional treatment with intravenous fluid, insulin, and calcium gluconate (17).

Adverse Reactions
  • Diarrhea has been frequently reported with the product Cyclo-3, but is less common with use of other formulations of butcher's broom. (7)
Literature Summary and Critique

Vanscheidt W, et al. Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung 2002;52:243-50
A multicenter, double blind, randomized, placebo-controlled trial. 148 women with chronic venous insufficiency were studied. The treatment group received capsules containing 36.0-37.5 mg of dry butcher's broom extract twice daily for 12 weeks. Changes in leg volume, circumference of the lower leg and ankle, subjective symptoms and quality of life were monitored. At 8 and 12 weeks, significant improvements on all parameters were noted in the treatment group as compared to the placebo. Few adverse effects were reported. The number of subjects studied was large enough to provide statistically significant results. However, it only involved female patients and lasted only 12 weeks. Future studies should include men; long-term effects should also be monitored.

Dosage (Inside MSKCC Only)
This field is only visible to only OneMSK users.
References
  1. Blumenthal M, et al. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council; 1998.
  2. Foster S, et al. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies, 3rd ed. New York: Haworth Herbal Press; 1993.
  3. Blumenthal M, et al. Herbal Medicine Expanded Commission E Monographs, 1st ed. Austin: American Botanical Council; 2000.
  4. Vanscheidt W, et al. Efficacy and safety of a Butcher's broom preparation (Ruscus aculeatus L. extract) compared to placebo in patients suffering from chronic venous insufficiency. Arzneimittelforschung 2002;52:243-50.
  5. Cluzan RV, et al. Treatment of secondary lymphedema of the upper limb with CYCLO 3 FORT. Lymphology 1996 Mar;29(1):29-35.
  6. Cappelli R, Nicora M, DiPerri T. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 1988;14(4):277-83.
  7. Thomas-Anterion C, et al. Unexplained chronic diarrhea, apropos of 4 new cases under Cyclo 3 fort and review of the literature. Rev Med Interne 1993 Apr;14(4):215-7. Review.
  8. Boyle P, Diehm C, Robertson C. Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. Int Angiol. 2003 Sep;22(3):250-62.
  9. Guex JJ, Enriquez Vega DM, Avril L, Boussetta S, Taïeb C. Assessment of quality of life in Mexican patients suffering from chronic venous disorder - impact of oral Ruscus aculeatus-hesperidin-methyl-chalcone-ascorbic acid treatment - 'QUALITY Study'. Phlebology. 2009 Aug;24(4):157-65.
  10. Huang YL, Kou JP, Ma L, et al. Possible mechanism of the anti-inflammatory activity of ruscogenin: role of intercellular adhesion molecule-1 and nuclear factor-kappaB. J Pharmacol Sci. 2008 Oct;108(2):198-205.
  11. Guex JJ, Avril L, Enrici E, et al. Quality of life improvement in Latin American patients suffering from chronic venous disorder using a combination of Ruscus aculeatus and hesperidin methyl-chalcone and ascorbic acid (quality study). Int Angiol. 2010 Dec;29(6):525-32.
  12. De Marino S, Festa C, Zollo F, Iorizzi M. Novel steroidal components from the underground parts of Ruscus aculeatus L. Molecules. 2012 Nov 26;17(12):14002-14.
  13. Longo L, Vasapollo G. Determination of anthocyanins in Ruscus aculeatus L. berries. J Agric Food Chem. 2005 Jan 26;53(2):475-9.
  14. Barbič M, Schmidt TJ, Jürgenliemk G. Novel phenyl-1-benzoxepinols from butcher's broom (Rusci rhizoma). Chem Biodivers. 2012 Jun;9(6):1077-83.
  15. Facino RM, Carini M, Stefani R, Aldini G, Saibene L. Anti-elastase and anti-hyaluronidase activities of saponins and sapogenins from Hedera helix, Aesculus hippocastanum, and Ruscus aculeatus: factors contributing to their efficacy in the treatment of venous insufficiency. Arch Pharm (Weinheim). 1995 Oct;328(10):720-4.
  16. Barbič M, Willer EA, Rothenhöfer M, Heilmann J, Fürst R, Jürgenliemk G. Spirostanol saponins and esculin from Rusci rhizoma reduce the thrombin-induced hyperpermeability of endothelial cells. Phytochemistry. 2013 Jun;90:106-13.
  17. Sadarmin PP, Timperley J. An unusual case of Butcher's Broom precipitating diabetic ketoacidosis. J Emerg Med. 2013 Sep;45(3):e63-5.

Consumer Information

How It Works

Bottom Line: Studies show benefit of Butcher's broom in patients with chronic venous insufficiency of the legs.

Butcher's broom contains chemicals called saponins that scientists think cause constriction of arteries and veins. Butcher's broom may also reduce inflammation and increase lymphatic flow, but these effects have not been fully confirmed in humans.

Purported Uses
  • To treat circulatory disorders such as chronic venous insufficiency
    A few clinical trials show that products containing butcher's broom can help improve the symptoms of chronic venous insufficiency, but the long-term safety and effectiveness of these products are not known.
  • To treat constipation
    No scientific evidence supports this use.
  • To treat hemorrhoids
    Butcher's broom is known to have effects on veins in general, but it is not known what effect they would have on the swollen veins that cause hemorrhoids.
  • To reduce inflammation
    Lab studies show that compounds in butcher's broom have anti-inflammatory effects.
  • To relieve leg cramps
    No scientific evidence supports this use.
  • To treat lymphedema
    One clinical trial showed that Cyclo 3 Fort, a butcher's broom product, reduced lymphedema in women who had undergone therapy for breast cancer.
  • To promote urination
    There are no studies to validate this claim.
Research Evidence

Chronic venous insufficiency
In a randomized controlled trial, 148 women with chronic venous insufficiency were divided into two groups. One group took butcher's broom capsules (total ~75 mg daily), and the other group took a placebo pill. After 12 weeks, women taking butcher's broom had improvements in leg volume, circumference of the lower leg and ankle, symptoms and quality of life compared to the placebo group. There were few side effects. However, this results of this study are not applicable to men with chronic venous insufficiency, nor do they tell us if butcher's broom is safe and effective when taken for longer than three months.

Do Not Take If
  • You have diabetes (butcher's broom was reported to cause diabetic ketoacidosis, characterized by high levels of compounds called ketones in the blood.)
Side Effects
  • Diarrhea has been reported with the product Cyclo-3, but is less common with use of other formulations of butcher's broom.
E-mail your questions and comments to aboutherbs@mskcc.org.