Butcher's broom
Two meta-analyses of placebo-controlled trials found Ruscus products, mostly combined with hesperidin methyl chalcone and vitamin C, reduced leg pain and heaviness in chronic venous disease. One found smaller ankle circumference and leg volume, while the other found no significant change in circumference. Case reports describe chronic diarrhea with colitis and one case of diabetic ketoacidosis.
- Status
- Dietary supplement in the US. Not FDA-approved for any condition.
- Also called
- Ruscus aculeatus, ruscus extract, ruscogenins, Cyclo 3 Fort, hesperidin methyl chalcone, HMC, box holly, knee holly
- Taken for
- chronic venous insufficiency, varicose veins, leg swelling, swelling, edema, heavy legs, hemorrhoids
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Shown to help2
- StrongShown to reduce leg pain, heaviness, tingling and fatigue in adults with chronic venous disease, across 10 placebo-controlled trials.
- ModerateShown to reduce ankle circumference and leg volume in adults with chronic venous disease, mostly for Ruscus combined with hesperidin methyl chalcone and vitamin C. One meta-analysis disagreed.
What people take it for, and what was found
Shown to help2
Leg pain, heaviness and other venous symptoms
Shown to reduce leg pain, heaviness, tingling and fatigue in adults with chronic venous disease, across 10 placebo-controlled trials.
The numbers and sources
- Effect
- In 10 placebo-controlled trials (719 patients), Ruscus reduced leg pain (RR 0.35), heaviness (RR 0.26), feeling of swelling (RR 0.53) and tingling (RR 0.27). As continuous measures, pain (SMD -0.80, 95% CI -1.21 to -0.39), heaviness (SMD -1.23, 95% CI -1.60 to -0.86) and fatigue (SMD -1.16) fell [1]. An earlier meta-analysis of Cyclo 3 Fort, with data from 10,246 people across 20 placebo-controlled and other studies, found that on a 0 to 3 severity scale pain fell by 0.44 points, heaviness by 0.53, tingling by 0.29 and cramps by 0.26 more than on placebo [2].
- Population
- Adults with chronic venous disease or insufficiency [1][2].
- Sources
- [1], [2]
- Caveats
- The feeling of swelling result had considerable heterogeneity [1]. The earlier analysis also drew on single-arm and comparator studies, and its authors note variable data quality and sample size [2].
Leg swelling
Shown to reduce ankle circumference and leg volume in adults with chronic venous disease, mostly for Ruscus combined with hesperidin methyl chalcone and vitamin C. One meta-analysis disagreed.
The numbers and sources
- Effect
- In placebo-controlled trials, Ruscus reduced ankle circumference (SMD -0.74, 95% CI -1.01 to -0.47) and leg or foot volume (SMD -0.61, 95% CI -0.91 to -0.31) [1]. In the Cyclo 3 Fort meta-analysis, edema severity (0.43 points), calf circumference (0.73 cm) and ankle circumference (1.17 cm) fell more than on placebo, but none of these differences was statistically significant [2]. In 148 women given a Ruscus-only extract for 12 weeks, leg volume fell 16.5 mL more than placebo at 8 weeks and 20.5 mL more at 12 weeks, with smaller ankle and leg circumference [3].
- Population
- Adults with chronic venous disease [1][2]. 166 women with chronic venous insufficiency, 148 analyzed [3].
- Sources
- [1], [2], [3]
- Caveats
- The two meta-analyses disagree on circumference [1][2]. Most trials tested Ruscus combined with hesperidin methyl chalcone and vitamin C [1][2].
Claimed, not studied in people1
Hemorrhoids
Not studied in people. The EU herbal committee accepts butcher's broom root for itching and burning of hemorrhoids on the basis of at least 30 years of use.
No study in people. This rests on documented traditional use.
The numbers and sources
- Effect
- The European Medicines Agency's herbal committee concluded that, on the basis of long-standing use, butcher's broom root preparations can be used to relieve itching and burning of hemorrhoids after a doctor has ruled out serious conditions. It states that no studies in patients with hemorrhoids have been carried out with butcher's broom, and that traditional use means the effect is plausible and there is a record of use this way for at least 30 years, 15 of them in the EU [6].
- Population
- A regulator's review of traditional use in the EU [6].
- Sources
- [6]
- Caveats
- Traditional use is a record of how long it has been used, not a test of its effect [6]. Old French and German reports on Ruscus in proctology were located but have no abstracts to read.
Doses studied
Cyclo 3 Fort capsules contain 150 mg Ruscus root extract, 150 mg hesperidin methyl chalcone and 100 mg ascorbic acid [2]. The Ruscus-only trial used the daily dose set by the German monograph for 12 weeks. The abstract does not state the amount [3].
Risks
Reported risks2
Chronic diarrhea and lymphocytic colitis
Case reports: three people developed lymphocytic colitis with chronic diarrhea during long-term use of a Ruscus combination product.
The numbers and sources
- Effect
- Three people developed lymphocytic colitis with chronic diarrhea during long-term use of Cyclo 3 Fort. In one, signs of immune activation in the bowel lining returned when the drug was restarted [4].
- Population
- Three case reports [4].
- Sources
- [4]
- Caveats
- Case reports cannot give a rate. The product combines Ruscus with hesperidin methyl chalcone and vitamin C, so the component involved is not known [4].
Diabetic ketoacidosis
Case reports: a woman with diabetes developed diabetic ketoacidosis 5 days after starting butcher's broom, and recovered with treatment.
The numbers and sources
- Effect
- A 39-year-old woman with diabetes developed diabetic ketoacidosis, with a blood pH of 7.02 and high potassium, 5 days after starting butcher's broom for mild ankle swelling. She recovered with fluids, insulin and calcium gluconate [5].
- Population
- One case report [5].
- Sources
- [5]
- Caveats
- A single case.
Checked, no increase found1
Adverse events in trials
One 12-week trial recorded 22 of 48 adverse events on Ruscus, with one judged unlikely to be related.
The numbers and sources
Sources
- Kakkos SK, Allaert FA. Efficacy of Ruscus extract, HMC and vitamin C, constituents of Cyclo 3 fort®, on improving individual venous symptoms and edema: a systematic review and meta-analysis of randomized double-blind placebo-controlled trials. International Angiology. 2017. https://doi.org/10.23736/S0392-9590.17.03815-9
- Boyle P, Diehm C, Robertson C. Meta-analysis of clinical trials of Cyclo 3 Fort in the treatment of chronic venous insufficiency. International Angiology. 2003. https://pubmed.ncbi.nlm.nih.gov/14612852/
- 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. https://pubmed.ncbi.nlm.nih.gov/12040966/
- Beaugerie L, Luboinski J, Brousse N, et al. Drug induced lymphocytic colitis. Gut. 1994. https://doi.org/10.1136/gut.35.3.426
- Sadarmin PP, Timperley J. An unusual case of Butcher's Broom precipitating diabetic ketoacidosis. The Journal of Emergency Medicine. 2013. https://doi.org/10.1016/j.jemermed.2012.11.087
- European Medicines Agency. Butcher's broom, Rusci rhizoma: herbal medicine overview and summary for the public. 2019. https://www.ema.europa.eu/en/medicines/herbal/rusci-rhizoma