FWD 2 Expanded Commission E: Butcher's Broom

Herbal Medicine: Expanded Commission E

Butcher's Broom

Latin Name: Ruscus aculeatus
Pharmacopeial Name: Rusci aculeati rhizoma
Other Names: box holly


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.


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).


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.


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).

Solid dosage forms: Dry native extract containing 7-11 mg total ruscogenin.


Archimowicz-Cyrylowska, B. et al. 1996. Clinical effect of buckwheat herb, ruscus extract and troxerutin on retinopathy and lipids in diabetic patients. Phytother Res 10(8): 659-662.

Berg, D. 1990. Venenkonstriktion durch lokale Anwendung von Ruscusextrakt. [Venous constriction by local administration of Ruscus extract]. Fortschr Med 108(24):473-476.

Bown, D. 1995. Encyclopedia of Herbs and Their Uses. New York: DK Publishing, Inc. 345.

Bruneton, J. 1995. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier Publishing.

Cappelli, R., M. Nicora, T. Di Perri. 1988. Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Drugs Exp Clin Res 14(4):277-283.

Der Marderosian, A. (ed.). 1999. The Review of Natural Products. St. Louis: Facts and Comparisons.

ElSohly, M.A. et al. 1974. Euparone, a new benzofuran from Ruscus aculeatus L. J Pharm Sci 63(10):1623-1624.

ElSohly, M.A. et al. 1975. Constituents of Ruscus aculeatus. Lloydia 38(2):106108.

Foster, S. and V. Tyler. 1999. Tyler's Honest Herbal, 4th ed. New York: The Haworth Herbal Press.

List, P.H. and L. Hörhammer (eds.). 1979. Hagers Handbuch der Pharmazeutischen Praxis, 4th ed. Vol. 6. Berlin-Heidelberg: Springer Verlag. 200-201.

Nikolov, S., M. Joneidi, D. Panova. 1976. Quantitative determination of ruscogenin in Ruscus species by densitometric thin-layer chromatography. Pharmazie 31(9):611-612.

Pourrat, H., J.L. Lamaison, J.C. Gramain, R. Remuson. 1983. [Isolation and confirmation of the structure by 13C-NMR of the main prosapogenin from Ruscus aculeatus L.] [In French]. Ann Pharm Fr 40(5):451-458.

Reynolds, J.E.F. (ed.). 1989. Martindale: The Extra Pharmacopoeia, 29th ed. London: The Pharmaceutical Press.

Rudofsky, G. 1989. Venentonisierung und Kapillarabdichtung. Die Wirkung der Kombination aus Ruscus-Extrakt und Trimethylhesperidinchalkon bei gesunden Probanden unter Warmebelastung [Improving venous tone and capillary sealing. Effect of a combination of Ruscus extract and hesperidine methyl chalcone in healthy probands in heat stress]. Fortschr Med 107(19):52, 55-58.

Tyler, V.E. 1987. The New Honest Herbal. Philadelphia, PA: George F. Stickley Company. 5152.

Weindorf, N. and U. Schultz-Ehrenburg. 1987. Kontrollierte Studie zur oralen Venentonisierung der primaren Varikosis mit Ruscus aculeatus und Trimethylhesperidinchalkon [Controlled study of increasing venous tone in primary varicose veins by oral administration of Ruscus aculeatus and trimethylhespiridinchalcone]. Z Hautkr 62(1):28-38.

Weiss, R.F. 1988. Herbal Medicine. Beaconsfield, England: Beaconsfield Publishers.

Additional Resources

Bouskela, E., F.Z. Cyrino, G. Marcelon. 1994. Possible mechanisms for the inhibitory effect of Ruscus extract on increased microvascular permeability induced by histamine in hamster cheek pouch. J Cardiovasc Pharmacol 24(2):281285.

. 1993. Effects of Ruscus extract on the internal diameter of arterioles and venules of the hamster cheek pouch microcirculation. J Cardiovasc Pharmacol 22(2):221-224.

Facino, R.M., M. Carini, R. Stefani, G. Aldini, L. Saibene. 1995. 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) 328(10):720-724.

Harborne, J.B. and H. Baxter. 1993. Phytochemical Dictionary: A Handbook of Bioactive Compounds from Plants. Washington, D.C.: Taylor & Francis.

Marcelon, G., T.J. Verbeuren, H. Lauressergues, P.M. Vanhoutte. 1983. Effect of Ruscus aculeatus on isolated canine cutaneous veins. Gen Pharmacol 14(1):103-106.

Rubanyi, G., G. Marcelon, P.M. Vanhoutte. 1984. Effect of temperature on the responsiveness of cutaneous veins to the extract of Ruscus aculeatus. Gen Pharmacol 15(5):431-434.

Salzmann, P. et al. 1977. [Ruscus aculeatus L. Butcher's broom, a therapeutic agent in proctology] [In German]. Fortschr Med 95(21):1419-1422.

Vanhoutte, P.M. 1986. Advances in Medicinal Phytochemistry. New York: John Wiley & Sons, Inc.

Werbach, M.R. and M.T. Murray. 1994. Botanical Influences on Illness: A Sourcebook of Clinical Research. Tarzana, CA: Third Line Press.

This material was adapted from The Complete German Commission E MonographsTherapeutic 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.