About Herbs, Botanicals & Other Products

Scientific Name
Ruscus aculeatus
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Common Name

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

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Clinical Summary

Derived from the root of the plant. Taken orally or applied topically, this herb has been used to treat varicose veins, hemorrhoids, and lymphedema (1) (2) (3).
Ruscogenin, one of the major constituents of Butcher’s broom, 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 extract of butcher’s broom as main ingredient, has been reported to cause diarrhea and abdominal discomfort (7). Butcher’s broom may interact with MAO inhibitors (phenylzine (Nardil®), tranylcypromine (Parnate®)) and possibly anticoagulants.

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Purported Uses
  • Circulatory disorders
  • Constipation
  • Hemorrhoids
  • Inflammation
  • Leg cramps
  • Lymphedema
  • Promote urination
  • Varicose veins
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Constituents
  • Steroidal saponins (neoruscogenin ruscogenin)
  • Flavonoids
  • Tetracosanoic acid
  • Chrysophanic acid
  • Sitosterol, campesterol and stigmasterol
  • Coumarins
  • Sparteine
  • Tyramine
  • Glycolic acid
    (1)
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Mechanism of Action

Butcher’s broom steroidal saponins may be responsible for stimulating the post-junctional alpha-adrenergic receptors of the smooth muscle cells of the vascular wall and produce vasoconstriction. It may also have anti-inflammatory effects and increase lymphatic flow (2). Ruscogenin, one of the major components exerts anti-inflammatory effects (10) possibly by inhibiting TNF-alpha-induced over expression of ICAM-1 both at the mRNA and protein levels. It also suppressed NF-kappaB activation considerably by decreasing NF-kappaB p65 translocation and DNA binding activity (10).

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Adverse Reactions

Common: Diarrhea has been frequently reported with the product Cyclo-3, but is less common with use of other formulations of butcher’s broom (7).

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Herb-Drug Interactions

Monoamine Oxidase Inhibitors (MAO-I): Due to the tyramine constituent in butcher’s broom avoid concurrent use with MAO-I such as phenylzine (Nardil®), tranylcypromine (Parnate®).
Anticoagulant/Antiplatelet drugs: Butcher’s broom contains coumarins that may inhibit platelet activity and potentiate response to anticoagulants.

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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.

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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, et al. 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.

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How It Works

Bottom Line: Studies show benefits 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.

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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
    There are no data to back this clalim.
  • 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. No other evidence supports this use.
  • To promote urination
    There are no studies to validate this claim.
  • To treat varicose veins
    Although some clinical trials show that butcher’s broom can help improve the symptoms of other disorders of the veins, there is no evidence that this herb can treat varicose veins.
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Research Evidence

Lymphedema from breast cancer treatment
Lymphedema of the arms is a common side effect of breast cancer treatment. Fifty-seven patients were randomly assigned to take a butcher’s broom product called Cyclo 3 Fort or a placebo pill every day to observe the effect on their arm lymphedema. All of the women also underwent manual lymphatic drainage twice a week for at least one month. After three months, women taking Cyclo 3 Fort had a significantly greater decrease in arm edema, especially in the forearm, than women taking the placebo. This supports the use of Cyclo 3 Fort for reducing lymphedema, but women taking this supplement reported some minor side effects.

Chronic venous insufficiency
RAES is a product that contains butcher’s broom, hesperidin (a fruit extract) and ascorbic acid (vitamin C). 40 patients followed the following crossover study design: they took RAES or a placebo pill for two months, then had no treatment for 15 days (to “wash out” the effects), and switched to the other therapy (RAES or placebo pill) for the next two months. This way, the researchers could see how each person reacted to both RAES and placebo at different times. Overall, the patients’ conditions improved throughout the study, moreso when they were taking RAES.

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.

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Do Not Take If
  • You are taking a monoamine oxidase inhibitor (MAO-I) (Because butcher’s broom contains tyramine, it can cause adverse effects when combined with MAO-Is such as phenylzine (Nardil®) or tranylcypromine (Parnate®)).
  • You are taking warfarin or other blood thinners (Butcher’s broom may cause an increased risk of bleeding).
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Side Effects
  • Diarrhea has been frequently reported with the product Cyclo-3, but is less common with use of other formulations of butcher’s broom.
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Dosage (Inside MSKCC Only)
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Aliases
Ruscus Aculeatus
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E-mail your questions and comments to aboutherbs@mskcc.org.
Last updated: May 9, 2011