Butcher's broom is an evergreen shrub native to Mediterranean Europe and Africa from the Azores islands, west of Portugal, to Iran in southwestern Asia (Der Marderosian, 1999; Tyler, 1987; Weiss, 1988). It has been used in European medicine for nearly two thousand years as a laxative and diuretic agent to treat urinary, gastrointestinal, and reproductive disorders (Der Marderosian, 1999; Foster and Tyler, 1999). Traditionally, the rootstock was decocted in water or wine as a treatment for abdominal complaints (Weiss, 1988). In the first century C.E., Greek physician Dioscorides reported its laxative effects as well as its use as a treatment for kidney stones (Bown, 1995; Foster and Tyler, 1999). Nicholas Culpepper, the seventeenth century English herbalist, reported that the decoction of the root taken orally, and a poultice of the berries applied topically, assisted in the knitting of fractured bones (Foster and Tyler, 1999; Tyler, 1987).
Today, it is used in Europe for disorders involving the venous system, including venous fragility or varicose veins, and clinical data supports claims that it has positive effects on circulation (Foster and Tyler, 1999). Ruscogenin, a sapogenin first isolated from butcher's broom root in the 1950s by French researchers H. Lapin and C. Sanni, is chemically similar to the steroid saponin diosgenin, which occurs in the Mexican yam root (Dioscorea species) (Reynolds, 1989; Tyler, 1987; Weiss, 1988). European preparations standardized to ruscogenin include Ruscorectal (Endopharm, Germany and Juste, Spain) rectal ointment and suppositories and Hemodren Simple (Llorens, Spain) indicated for local treatment of hemorrhoids (Reynolds, 1989; Weiss, 1988). In the United States, butcher's broom is not yet widely used, though capsules containing a combination of butcher's broom with rosemary oil have been found in health food stores (Tyler, 1987).
Several clinical studies have been documented. Human studies have investigated its effects on venous insufficiency of the lower limbs when taken in combination with trimethylhesperidine chalcone and ascorbic acid (Weindorf and Schultz-Ehrenburg, 1987), its use to treat lower limb venous disease in patients with chronic phlebopathy when taken in combination with hesperidin and ascorbic acid (Cappelli et al., 1988), its effects on venous tone and capillary sealing when taken in combination with hesperidine methyl chalcone (Rudofsky, 1989), its venoconstrictive action by local application (Berg, 1990), and its effects on retinopathy and lipids in diabetic patients (Archimowicz-Cyrylowska et al., 1996).
A Polish study tested an oral dose of 75 mg of the entire butcher's broom plant extract showing improvement in diabetic retinopathy (Archimowicz-Cyrylowska et al., 1996). The same study showed the extract inactive for hypocholesteremic activity and active in lowering triglycerides. In a double-blind placebo-controlled crossover trial, the effectiveness and tolerability of a venotropic drug (RAES) were evaluated in 40 patients (30 female, 10 male), between the ages of 28 and 74 years, suffering from chronic phlebopathy (venous insufficiency) of the lower limbs. Each RAES capsule dose contained 16.5 mg butcher's broom extract (presumably root) combined with 75 mg hesperidin and 50 mg ascorbic acid. There were two treatment periods of 2 months duration with an interim period of 15 days for wash-out. The daily dosage was 2 capsules, 3 times daily. The authors reported an overall trend toward improvement in the treatment group. Symptoms (e.g., edema, itching, paresthesias, leg heaviness, and cramps) and plethysmographic parameters improved immediately and significantly with the RAES treatment compared to placebo. (A plethysmograph is a device for finding variations in size due to vascular changes.) No side effects were reported (Cappelli et al., 1988).
The approved modern therapeutic applications for butcher's broom are supportable based on its long history of use in well established systems of traditional medicine, phytochemical investigations, in vitro studies and pharmacological studies in animals, and several modern clinical studies. Pharmacopeial grade butcher's broom has not been defined at this point.
Description
Butcher's broom is the dried rhizome and root of Ruscus aculeatus L. [Fam. Liliaceae], as well as its preparations in effective dosage. The rhizome and root contain the steroid saponins ruscin and ruscoside.
Chemistry and Pharmacology
Butcher's broom contains 46% of a mixture of steroidal saponin compounds including approximately 0.12% ruscogenin, neoruscogenin, ruscin and ruscoside (List and Hörhammer, 1979; Nikolov et al., 1976; Der Marderosian, 1999; Pourrat et al., 1983; Reynolds, 1989; Weiss, 1988); fatty acids, mainly tetracosanoic acid; flavonoids; sterols including sitosterol, campesterol, and stigmasterol; benzofuranes, including euparone and ruscodibenzofurane (Bruneton, 1995; ElSohly et al., 1974; ElSohly et al., 1975; Der Marderosian, 1999).
The Commission E reported increase in venous tone, electrolyte-like reaction on the cell wall of capillaries, antiphlogistic and diuretic actions from animal experiments.
Oral absorption may stimulate the post-junctional a-adrenergic receptors of the smooth muscle cells of the vascular wall. Preparations containing high doses of the vasoprotective butcher's broom have been shown to assist with symptoms of venous insufficiency and acute attacks of hemorrhoids. Butcher's broom has also demonstrated antiphlogistic and diuretic activity (Bruneton, 1995).
Uses
The Commission E approved its use as a supportive therapy for discomforts of chronic venous insufficiency, such as pain and heaviness, as well as cramps in the legs, itching, and swelling. It is also approved as a supportive therapy for complaints of hemorrhoids, such as itching and burning.
Contraindications
None known.
Side Effects
In rare cases, gastric disorders or nausea may occur.
Use During Pregnancy and Lactation
No restrictions known.
Interactions with Other Drugs
None known.
Dosage and Administration
Unless otherwise prescribed: Daily dosage: Extracts and their preparations for internal use equivalent to 7-11 mg total ruscogenin (determined as the sum of neoruscogenin and ruscogenin obtained after fermentation or acid hydrolysis).
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Nikolov, S., M. Joneidi, D. Panova. 1976. Quantitative determination of ruscogenin in Ruscus species by densitometric thin-layer chromatography. Pharmazie 31(9):611-612.
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This material was adapted from The Complete German Commission E Monographs—Therapeutic Guide to Herbal Medicines. M. Blumenthal, W.R. Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister (eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American Botanical Council; Boston: Integrative Medicine Communications.
1) The Overview section is new information.
2) Description, Chemistry and Pharmacology, Uses, Contraindications, Side Effects, Interactions with Other Drugs, and Dosage sections have been drawn from the original work. Additional information has been added in some or all of these sections, as noted with references.
3) The dosage for equivalent preparations (tea infusion, fluidextract, and tincture) have been provided based on the following example:
Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut or whole] [plant part]
Infusion: 2 g in 150 ml of water
Fluidextract 1:1 (g/ml): 2 ml
Tincture 1:5 (g/ml): 10 ml
4) The References and Additional Resources sections are new sections. Additional Resources are not cited in the monograph but are included for research purposes.
This monograph, published by the Commission E in 1994, was modified based on new scientific research. It contains more extensive pharmacological and therapeutic information taken directly from the Commission E.
Excerpt from Herbal Medicine: Expanded Commission E Monographs Copyright 2000 American Botanical Council Published by Integrative Medicine Communications Available from the American Botanical Council.