Butcher's broom, varicose veins, and lymphedema.

More than 30 clinical trials over the past 30 years or so have demonstrated the benefit of the butcher's broom (Ruscus aculeatus) extract in the management of chronic venous insufficiency. It was often used in combination with a flavonoid and ascorbic acid. Chronic venous insufficiency is the symptom complex associated with the compromised return of venous blood from the legs due to varicose veins. In a recent meta-analysis that included 20 placebo-controlled, randomized, double-blind studies, five studies randomized against a comparison treatment, and six single-arm surveillance studies analyzed information from 10,246 patients. (1) On a four-point symptom-severity scale, the butcher's broom extract combination significantly reduced pain severity (0.44 [+ or -] 0.12), cramps (0.26 [+ or -] 0.08), heaviness (0.53 [+ or -] 0.11), and paraesthesia (0.29 [+ or -] 0.10), compared to placebo. There was also a significant reduction in venous capacity of 0.7 [+ or -] 0.19 mL/100 mL, which indicated better return of venous blood. Reductions in severity of edema and decreases in calf and ankle circumference did not achieve statistical significance. The authors concluded that their analysis was a strong and objective demonstration of the clinical efficacy of the butcher's broom extract combination in chronic venous insufficiency.

A recent high-quality study not included in this meta-analysis examined the activity of butcher's broom extract alone. In a well-designed, multicenter, double-blind, randomized, placebo-controlled trial, 166 women suffering from chronic venous insufficiency received either butcher's broom extract or placebo for 12 weeks. (2) Analysis of the 148 women who completed the trial revealed that the herbal treatment significantly reduced leg volume, ankle and leg circumferences, and subjective symptoms such as heavy, tired legs. Tolerability of both treatments was assessed as "good to very good." The authors concluded that butcher's broom was a safe and effective treatment for patients suffering chronic venous insufficiency.

Commentary

Butcher's broom is clearly an underestimated herb--one that has the backing of an impressive array of clinical trials--for the management of chronic venous insufficiency. Typical doses of extract used in the clinical trials corresponded to the equivalent of about 1.6 to 2.4 g per day of the root and rhizome. One novel application for butcher's broom is in the management of secondary lymphedema. This application is also supported by clinical evidence. Fifty-seven patients with secondary lymphedema of the upper limb after previous treatment for breast cancer participated in a double-blind, placebo-controlled trial of butcher's broom extract combination for a period of three months. All patients also additionally received manual lymphatic drainage twice a week for at least one month. A significant reduction in the volume of arm edema (12.9%, p<0.01) was observed in the treatment group compared to placebo. Decreased edema was more marked in the forearm compared to the upper arm, where there was increased fat deposition. (3)

1. 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; 22(3): 250-262.

2. Vanscheidt W, Jost V, Wolna P, 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(4): 243-250.

3. Cluzan RV, Alliot F, Ghabboun S, et al. Treatment of secondary lymphedema of the upper limb with Cyclo 3 Fort. Lymphology. 1996; 29(1): 29-35.