Scientific Name(s): Ruscus aculeatus
Common Name(s): Box holly, Butcher's broom, Jew's myrtle, Knee holly, Kneeholm, Pettigree, Sweet broom
Butcher's broom is a low-growing common evergreen shrub. It is widely distributed, from Iran to the Mediterranean1 and the southern United States.2 The plant develops edible shoots from rhizomes that are similar to asparagus in form.3 Butcher's broom has tough, erect, striated stems with false thorny leaves called cladophylles.4 The Asparagaceae family is formerly known as Liliaceae (lily). The nomenclature of this plant should not be confused with broom (Cytisus scoparius L.) or Spanish broom (Spartium junceum L.).
R. aculeatus was given its common name, butcher's broom, because its stiff twigs were bound together and used by butchers in Europe to keep their cutting boards clean. The plant has a long history of use; more than 2000 years ago, it was noted as a laxative, diuretic, and a phlebotherapeutic agent.5 Extracts, decoctions, and poultices have been used throughout the ages, but the medicinal use of this plant did not become common until the last century. Early investigations during the 1950s indicated that extracts of the rhizomes of butcher's broom could induce vasoconstriction and therefore might have use in the treatment of circulatory diseases. The increasing popularity of natural and herbal remedies in Europe in the 1970s reaffirmed its position in modern medicine. Novel uses for this plant have included its use as an anti-inflammatory agent and to prevent atherosclerosis. Butcher's broom is the active component in several drug formulations and topical treatments for venous disease. Structural elucidation of active compounds and the discovery of new pharmacological activity, particularly as a cytotoxic agent, demonstrate the need for continued research on butcher's broom.
A variety of compounds have been isolated from butcher's broom. The 2 primary saponin compounds are ruscogenin and neoruscogenin.6 The ruscogenin content in underground and aboveground parts is approximately 0.12% and 0.08%, respectively.7 The plant also contains numerous furanostanol and spirostanol saponins.8, 9 Two bisdesmosidic spirostanol saponins, aculeoside A and aculeoside B, also have been isolated.9 In addition, a variety of flavonoids, a fatty acid mixture composed primarily of tetracosanoic acid and related compounds, chrysophanic acid, sitosterol, campesterol and stigmasterol, have been isolated from the roots.3 Butcher's broom also contains triterpenes, coumarins, sparteine, tyramine, and glycolic acid.10 The benzofuran euparone7 and the phenolic ruscodibenzofuran11 have been isolated. Plant extracts have revealed the presence of sulfated steroid saponins12 and the steroid glycosides, rusin and ruscoside.4
Constituents of butcher’s broom display alpha-adrenergic stimulating properties. The vasoconstrictive actions of ruscogenin and neoruscogenin have been attributed to the release of norepinephrine stored in the adrenergic nerve endings.13
Uses and Pharmacology
A group of researchers reported on animal studies conducted in the 1990s, suggesting that compounds in Ruscus activated alpha-1 and alpha-2 receptors in smooth muscle, with resultant vasoconstrictive effects.5, 14, 15, 16, 17 Ruscogenins present in the extracts are ineffective on hyaluronidase activity but show exceptional anti-elastase activity.18
Quality clinical studies evaluating the effectiveness in venous insufficiency are limited. Studies evaluating multi-ingredient preparations (commonly Ruscus extract, hesperidin, and ascorbic acid) report positive findings.2, 19, 20, 21, 22, 23 A case report notes the potential use for butcher’s broom extract in orthostatic hypotension.5
Formulations of Ruscus extract are being investigated for the treatment of hemorrhoids, and the use of butcher's broom for haemorrhoids is approved by the German Commission E.24 An older study reported positive findings for the use of butcher’s broom extract in microvascular-associated retinopathy.25
Researchers have found that when a Ruscus extract is applied topically, a dose-dependent inhibition of the macromolecular permeability-increasing effect of histamine occurs.26Ruscus extract given IV (5 mg/kg) inhibits the macromolecular permeability-increasing effect of bradykinin, leukotriene B4, and histamine.26
The combined action of flavonoids, sterols, and proteolytic enzymes found in the root has been shown to reduce dextran and carrageenan-induced rat paw edema, indicating that the extract may have anti-inflammatory activity.29
Butchers broom has been used in clinical trials for chronic venous insufficiency standardized to 7 to 11 mg of ruscogenin.30 Hesperidin methyl chalcone has also been used as a marker for standardization in certain commercial multi-ingredient preparations. Extracts have been dosed at 16 mg daily for chronic phlebopathy, while a topical cream formulation was used to apply 64 to 96 mg of extract daily.20, 31, 32
A 100 mg extract is reported to contain 0.5 mg of active ruscogenins.17
Pregnancy / Lactation
Information regarding safety and efficacy in pregnancy and lactation is lacking. Avoid use.
Preparations have been studied in pregnancy-related variscosities; however, safety has not been established.24
None well documented. However, Ruscus extract exhibits alpha-adrenergic stimulating activity.13
The German Commission E approves oral use of the rhizome for supportive therapy for the discomfort of chronic venous insufficiency and complaints of hemorrhoids and reports no known interactions.30 In a clinical trial, no adverse events were attributable to therapy by the 40 patients evaluated19; however, reports of edema, nausea, and abdominal pain from multi-ingredient preparations exist.
Allergic contact dermatitis has been reported with topical formulations, whereas oral administration has been associated with GI side effects (ie, chronic diarrhea, lymphocytic colitis, and cytolytic hepatitis).13
Oral ingestion of Butcher’s broom was suspected to have led to precipitation of diabetic ketoacidosis in a 39-year-old woman with poorly controlled diabetes previously in good health. She was admitted 5 days after she started Butcher’s broom for mild ankle swelling; 48 hours prior to admission she experienced vomiting and diarrhea before becoming acutely unwell. Improvement was noted within 12 hours of supportive treatment with IV fluids, an insulin drip, and calcium gluconate; she recovered fully.13
In animal studies, adverse events appear to be associated with the route of administration and the use of roots versus rhizomes. The extract from roots was found to be more toxic than from rhizomes and led to convulsions, paralysis, GI inflammation, and dysentery. Severe visceral congestion led to fatal respiratory failure.13
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