Ruscus aculeatus

Ruscus aculeatus

Synonyms

No documentation

Vernacular Name

Sweet broom, Knee holly, Kneeholm, Pettigree.

Description

R. aculeatus or Butcher’s broom is a member of the Liliaceae family.  Its common name, Butcher’s broom, came from its use in Europe by butchers who would tie bundles of the stiff leaves together to use to sweep their work areas.  The root is used medicinally.

R. aculeatus has been used in traditional medicines in various parts of the world and is presently used in pharmaceutical products developed to treat venous disorders.  In the pharmaceutical preparations, R. aculeatus is combined with other ingredients and is not used as a single ingredient product.

R. aculeatus plant has tough striated stems, with no bark and produces rigid leaves which remain evergreen.  This dioecious plant flowers in late summer leading to the production of red berries which remain on the plant throughout the winter.

Origin / Habitat

Its origins are thought to be in the Mediterranean area and Africa.  It is now cultivated in various regions of the world and in some areas is considered a protected species.  It grows well in wooded areas and waste areas.

Chemical Constituents

Spirostanol saponins, furostanol saponins, flavonoids, sitosterol, sigmasterol, campesterol, tyramine, coumarins, glycolic acid, euparone, triterpenes. [1],[2],[3],[4],[5]  

Plant Part Used

Roots/rhizomes

Medicinal Uses

General

Venous insufficiency
Hemorrhoids
Vascular disorders
Inflammation
Oedema
Diabetic retinopathy

Most Frequently Reported Uses

Venous insufficiency
Hemorrhoids
Vascular disorders
Inflammation

Dosage

Dosage Range

Powdered root: 1800-2400mg
Extract: 60-450mg per day standardized extract

Most Common Dosage

Tea: Five teaspoons of root powder in 10 ounces of boiling water steeped for 30 minutes
Tincture:  3mL in a 1:2 ratio
Capsules: 150mg standardized powdered extract
Topical:  In ointment form, apply a small amount 1-2 times per day

Standardized to

The extracts are standardized to 10% saponins (7 to 11mg ruscogenins)

Pharmacology

Pre-clinical

Numerous animal and laboratory models have investigated the mechanism by which this herb is effective in treating venous disorders.[6] In a laboratory analysis using canine cutaneous veins, researchers found that temperature directly affects the constriction of the veins in response to R. aculeatus extract in an opposite manner than that of sympathetic nerve activation and that it is likely due to the indication that the extract causes contractions via alpha adrenergic activation.[7] An in vivo study followed up on earlier findings that ruscogenin extracted from this herb exhibits anti-inflammatory and anti-thrombic activities.  The results indicate that ruscogenin suppressed leukocyte migration in a dose dependent manner.[8] R. aculeatus extract has been found to inhibit the activation of endothelial cells by hypoxia and to inhibit the macromolecular permeability effects of histamine.[9],[10]

The investigations into the mechanism by which Ruscus extract acts has been examined in two studies using vein segments taken from patients for medical reasons and compared the varicose veins with controls.  The varicose veins showed greater levels of cyclic guanosine monophosphate and these levels were altered by use of the Ruscus extract.[11] In a similar analysis, using varicose veins and control veins from patients, researchers compared the effects of Ruscus extract and norepinephrine.  Both applications demonstrated contractions in the veins examined.  Contractions in response to the Ruscus extract were reduced by alpha2-adrenergic blockade in varicose veins but were not reduced in controls indicating a different distribution of the alpha adrenergic receptors in those with varicose disease.[12]

Clinical

R. aculeatus is a primary ingredient in several well studied drugs designed to treat venous insufficiency.  Typically these drugs use combinations of Ruscus extract, hesperidin and ascorbic acid in varying amounts.  Clinical studies have examined the efficacy of these preparations in a wide range of patients suffering from venous insufficiency and all have proven to be effective in both relieving symptoms and in improving measured parameters while being well tolerated.[13],[14],[15],[16],[17]

Clinical research on Ruscus extract as a single ingredient preparation has demonstrated similar positive results.  In a double-blind, placebo controlled study of 148 patients with venous insufficiency, examination at 8 and 12 weeks showed improvements in symptoms and measured parameters in the Ruscus group over the placebo group.[18]

Interaction and Depletions

Interaction with other Herbs

No documentation

Interaction with Drugs

Based on pharmacology, avoid using R. aculeatus in combination with anticoagulant and antiplatelet medications as the coumarin content of the herb may potentiate the effects of these drugs.

Based on pharmacology, avoid concurrent use with MAO inhibitors as R. aculeatus contains tyramine.[20]

Precautions and Contraindications

Side effects

R. aculeatus is considered to be safe if used as directed and under the guidance of a trained professional.  Occasional gastric upset and nausea may occur.[19]

Pregnancy

Not to be used by pregnant or nursing women.

Age limitation

Not to be used by children under 12.

Adverse reaction

No documentation

References

  1. ElSohly M, Knapp JE, Slatkin KF, Schiff PL Jr, Doorenbos NJ, Quimby MW.Constituents of Ruscus aculeatus. Lloydia. Mar-Apr1975;38(2):106-108.
  2. Nikolov S, Joneidi M, Panova D.Quantitative determination of ruscogenin in Ruscus species by densitometric thin-layer chromatography. Pharmazie. 1976;31(9):611-612.
  3. Dunouau C, Bellé R, Oulad-Ali A, Anton R, David B. Triterpenes and sterols from Ruscus aculeatus. Planta Med. Apr1996;62(2):189-190.
  4. Mimaki Y, Kuroda M, Kameyama A, Yokosuka A, Sashida Y.Steroidal saponins from the underground parts of Ruscus aculeatus and their cytostatic activity on HL-60 cells. Phytochemistry. Jun 1998;48(3):485-493.
  5. Mimaki Y, Kuroda M, Yokosuka A, Sashida Y.A spirostanol saponin from the underground parts of Ruscus aculeatus. Phytochemistry. Jul1999;51(5):689-692.
  6. Bouskela E, Cyrino FZ, Marcelon G.Effects of Ruscus extract on the internal diameter of arterioles and venules of the hamster cheek pouch microcirculation. J Cardiovasc Pharmacol. Aug1993;22(2):221-224.
  7. Rubanyi G, Marcelon G, Vanhoutte PM.Effect of temperature on the responsiveness of cutaneous veins to the extract of Ruscus aculeatus. Gen Pharmacol. 1984;15(5):431-434.
  8. Huang YL, Kou JP, Ma L, Song JX, Yu BY.Possible mechanism of the anti-inflammatory activity of ruscogenin: role of intercellular adhesion molecule-1 and nuclear factor-kappaB. J Pharmacol Sci. Oct 2008;108(2):198-205.
  9. Bouaziz N, Michiels C, Janssens D, Berna N, Eliaers F, Panconi E, Remacle J.Effect of Ruscus extract and hesperidin methylchalcone on hypoxia-induced activation of endothelial cells. Int Angiol. Dec 1999;18(4):306-312.
  10. Bouskela E, Cyrino FZ, Marcelon G.Possible mechanisms for the inhibitory effect of Ruscus extract on increased microvascular permeability induced by histamine in hamster cheek pouch. J Cardiovasc Pharmacol. Aug1994;24(2):281-285.
  11. Nemcova S, Gloviczki P, Rud KS, Miller VM.Cyclic nucleotides and production of prostanoids in human varicose veins. J Vasc Surg. Nov1999;30(5):876-883.
  12. Miller VM, Rud KS, Gloviczki P.Pharmacological assessment of adrenergic receptors in human varicose veins. Int Angiol. Jun2000;19(2):176-183.
  13. Cappelli R, Nicora M, Di Perri T.Use of extract of Ruscus aculeatus in venous disease in the lower limbs. Clinical – Venous insufficiency.Drugs Exp Clin Res. 1988;14(4):277-283.
  14. Weindorf N, Schultz-Ehrenburg U.Controlled study of increasing venous tone in primary varicose veins by oral administration of Ruscus aculeatus and trimethylhespiridinchalcone. Z Hautkr. 1Jan1987;62(1):28-38.
  15. Beltramino R, Penenory A, Buceta AM.An open-label, randomized multicenter study comparing the efficacy and safety of Cyclo 3 Fort versus hydroxyethyl rutoside in chronic venous lymphatic insufficiency. Angiology. Jul2000;51(7):535-544.
  16. Guex JJ, Enriquez Vega DM, Avril L, Boussetta S, Taïeb C. 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;24(4):157-165.
  17. Boyle P, Diehm C, Robertson C. Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency.Int Angiol. Sep2003;22(3):250-262.
  18. Vanscheidt W, Jost V, Wolna P, Lücker PW, Müller A, Theurer C, Patz B, Grützner KI. 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.
  19. Bloomenthal M, Goldberg A, Brinkman J. Expanded Commission E Monographs. Austin:Theime Publishers; 2000.
  20. Casileth B, Lucareli C. Herb-Drug Interactions in Oncology. Ontario: BC Decker:2003.63-64.