Herbs for Lymphedema

Herbs for Lymphedema

Just google “herbs for lymphedema” and you will be taken to all kinds of websites eager to take your money in exchange for some herbal products. I’m sure you would gladly pay if the herbal medicine will help you improve your lymphedema. But do they work?

I’ve once again put my researching skills to the task to reveal which herbs for lymphedema have actually been studied and what the results were.

I’m doing this to help you decide if a herb for lymphedema is right for you. But, this blog does not substitute for medical advice and you should consult your medical care team before taking herbal products. Also, to be clear, I have no financial interest in any supplement company, nor do I sell any of these lymphedema herbs.

As I review the research on herbs for lymphedema, I’m limiting my reporting to human studies only. I am not reporting on any animal studies and I’m focused on studies done in lymphedema, not chronic venous insufficiency or other types of swelling conditions.

You can read this post from top to bottom, or navigate using this Table of Contents 

Lymphedema Herbs Research

There was a Cochrane Review published in 2004 from researchers in the UK who undertook a comprehensive search for all research that used one of the benzo-pyrones as a treatment for lymphedema. In all, 15 published research studies were included in the final analysis (Badger, 2004).

Benzo-pyrones may be 100% plant extracts or partially or fully man-made. Benzo-pyrones are classified as alpha and gamma benzo-pyrones as follows;

Benzo-pyrones

Alpha-benzo-pyrones

  • Coumarin

Gamma-benzo-pyrones

  • Flavonoids
    • Flavones
    • Flavonols
      • Diosmin
      • Rutin
    • Flavanes
      • Hesperidin

They were originally used with patients with blood vessel leakage and worked to reduce the permeability of the blood vessels.

The studies in the Cochrane Review on benzo-pyrones were done in the 1980’s and 90’s. After a thorough review of the studies, the authors concluded that “it is not possible to draw conclusions about the effectiveness of benzo-pyrones on lymphedema”.

Interestingly, they point out that the main mechanism of action of these compounds is to limit fluid filtration – which is why they are were originally used in venous insufficiency. But lymphedema does not result from an increased filtration of fluid, but because of a reduced ability to drain fluid. In this way, the drugs seem to be of limited usefulness.

While this result is certainly discouraging for people with lymphedema looking for additional support, this topic was also examined again in detail in a 2020 publication from the PhD thesis of Dr. Sheikhi-Mobarakeh from the school of Traditional Medicine at the University of Medical Sciences in Tehran, Iran (Sheikhi-Mobarakeh, 2020).

The review paper reports on the findings on 90 research studies of lymphatic system herbs. In this very thorough paper, the author describes research on various herbs to treat lymphedema including; coumarin, hesperidin, diosmin and ginkgo biloba.

In addition to the pure substances, there are several brand name preparations that contain either benzo-pyrones or other herbal products, either alone or in combination that are promoted for use with lymphedema. Those products include;

  • Cyclo 3 Fort®
    • Developed by French pharmacist Pierre Fabre in 1959 using butcher’s broom to help with vein disorders
  • Daflon 500®
    • Micronized purified flavonoid fraction made from immature oranges
  • Goreisan®
    • This is a traditional Japanese medicine (Kampo) made up of 5 different herbs
  • Linfadren®
    • Available as tablets and a topical cream
    • Contains diosmin, sweet clover dry extract and uva ursina dry extract
  • Paroven®
    • The active ingredient in Paroven is 250 mg of Oxerutins and it is used for chronic venous insufficiency
  • Venoruton®
    • This product is also oxerutins
    • There have been a few studies comparing Venoruton vs. Daflon to see which one performed better for chronic venous insufficiency and the Venoruton (oxerutins) performed better (Belcare, 2002 and Cesarone, 2006)
  • Venastat®
    • This product is made from the horse chestnut tree the active ingredient from horse chestnut is esculin
    • It works by thinning the blood and making it harder for fluid to leak out of the veins and blood capillaries and can also have a weak effect on promoting an increase in urination and prevent water retention
  • Reparil®
    • This product is 20 mg of Aescin from horse chestnut
    • It is available as a tablet and a topical cream
  • Troxerutin
    • The generic name of oxerutin and rutin that is found in rue (an evergreen shrub), tobacco, buckwheat and other plants

I will summarize the findings from the PhD thesis on the herbal products, then if you keep reading, I’ll go into more details on specific products that were tested against lymphedema;

Coumarin for Lymphedema

Of all the herbs, this one has been studied the most for lymphedema. But, coumarin is a herb with a troublesome reputation. It is found naturally in some foods including tonka beans and cassia cinnamon but it has been banned by the FDA for concerns over liver toxicity (McGill, 2017).

However there is pushback against the ban as the amount of coumarin that would be needed to cause liver toxicity is 0.1mg/kg per day. Cassi cinnamon (also called Chinese and Indonesian cinnamon) is 1% coumarin.

For an adult that weighs 70 kg (154 lbs) they would have a safety limit of 7 mg of coumarin, which at 1% coumarin by weight, ¼ tsp. of cinnamon (1,250 mg) would have about 12.5 mg of coumarin. While you might consume this once is a while, would you be eating this much cinnamon every day?

If you are eating generous amounts of cinnamon every day and are concerned about coumarin in your cinnamon, then change to Ceylon cinnamon (also called ‘true cinnamon’) which has only 0.004% coumarin (McGill, 2017).

In all, eight studies in this review tested coumarin (including one topical) either alone or in combination with other herbs against lymphedema. This is a summary of the findings:

  • All 8 studies reported an improvement in lymphedema volume
  • 5 reported an improvement in lymphedema symptoms
  • 2 studies showed an improvement in infection
  • 1 study showed no improvement in infection

There were some side-effects reported including;

  • Itching
  • Gastrointestinal upset
  • Giddiness
  • Headache
  • Nausea
  • Dizziness
Cassia cinnamon sticks
Cassia cinnamon and Tonka beans are two sources of coumarin. Image by Дарья Яковлева from Pixabay

Diosmin Lymphedema

Diosmin is extracted from citrus fruits. Daflon 500® is the brand name of a product made by creating a micronized purified flavonoid fraction (MPFF) from citrus fruits, which is considered a semi-synthetic version of diosmin.

Micronizing the compound makes it much smaller and improves the intestinal absorption and bioavailability (Albert-Adrien Ramelet, 2017).

Diosmin and Daflon 500® improve the tone of the vein by inhibiting the breakdown of noradrenaline. It is currently indicated for use in chronic venous insufficiency, it has not been fully studied in lymphedema (Albert-Adrien Ramelet, 2017).

The Iranian review cites three studies that used Diosmin and two that used Daflon, and the results appear to be positive for treatment of lymphedema but they did not prevent lymphedema from developing after breast cancer.

Hesperidin for Lymphedema

Hesperidin is a natural plant compound also found in citrus peel. It is also contained in Daflon 500® as well as another herbal preparation called Cyclo 3 Fort.

Two studies of hesperidin and lymphedema were included in the review paper. The research showed improvements in lymph volume and circulation, symptom improvement and quality of life. But there were side-effects including gastrointestinal, lymphangitis and miscellaneous complaints.

oranges on a tree
Diosmin and Hesperidin are extracted from immature oranges. Photo by Erwan Hesry on Unsplash

Rutin for Lymphedema

Two studies that used rutin, or more precisely oxerutin against a placebo were included in the PhD thesis. Both showed improvement in lymphedema volume and symptoms. But some side-effects were also reported, including skin rash, upset stomach and migraine.

Rue plant
The rue is an evergreen shrub that is the source of rutin. Photo from pxhere.com

Ginkgo Biloba for Lymphedema

Gingko biloba is one of the oldest tree species and the herbal product by the same name is made from its fan-shaped leaves.

Gingko biloba contains flavonoids which are anti-oxidants and terpenoids which help to improve microcirculation. So, it makes sense that it would be tested for lymphedema (MayoClinic, 2020).

There was one study that used a preparation of ginkgo biloba, hydroxyethylrutoside and heptaminol but it did not reduce the lymphedema.

Gingko Biloba leaves
The leaves of the Gingko biloba tree are the source of the gingko biloba tree. Image by Marzena P. from Pixabay

More Research on Lymphedema Herbs

There are too many studies to go into detail on each herb, but I am reporting on a sampling of the studies. I have included a full reference list at the end of this blog if you want to continue to research on your own.

Daflon 500® for Lymphedema

Daflon 500® is a blend of 450 mg of diosmin, and 50 mg of herperidin – both of which are extracted from citrus. This supplement is known as a “phlebotonic”, in other words, a tonic for the veins.

This study included 94 women with mild to severe arm lymphedema following breast cancer treatment. Forty six received Daflon 500® and forty eight took a placebo, two tablets daily for six months (Pecking, 1997).

Participants had lymphoscintigraphy at the beginning and end of the treatment and the results of the two tests were compared. In addition, limb volume was measured every two months. At the end of the trial the change in lymph volume was not different between the placebo or the Daflon 500® group.

In a group of 24 patients with more severe lymphedema (>= 2cm difference in the lymphedema arm and healthy arm), however, there was a difference in outcomes, in the Dafon 500 group compared to placebo, as follows;

  • Improved lymphatic migration speed by 0.84 cm per minute in Daflon 500® compared to 0.14 cm/minute with placebo
  • Improved colloidal clearance of 2.18 micro litres per minute +/- 3.1 but only 0.11 microlitres per minute in placebo (during lymphoscintigraphy, a rhenium colloid with technetium is injected into the lymph nodes and allows the lymph fluid to be seen as a glowing green colour)

There was no significant difference in the lymphedema volume.

When it came to evaluating to qualitative results. Both the Daflon 500® and placebo groups reported an improvement in discomfort, but only the Daflon 500® group had a significant improvement in reported heaviness. There was no change in body weight in either group.

Bottom Line for Daflon 500® and Lymphedema

While the authors of this 1997 study conclude that “Daflon 500® is highly suggested in patients with severe lymphedema”, I’m not so sure I would make the same conclusion.

While the difference in movement of lymphatic fluid was statistically significant between Daflon 500® and placebo, is moving lymphatic fluid by 0.84 cm per minute that significant clinically? I ask the same question for the colloidal clearance. This was measure in micro litres. The Daflon 500® moved 2.18 micro litres per minute – that’s 0.00218 ml (or 0.0004 of a teaspoon).

Let’s consider the cost of 2 tablets a day of Daflon 500®. When I check on-line, Daflon 500® costs 19 Euros ($28 Canadian dollars and $23 US dollars) for 60 tablets, which is a one month supply.  Is it really cost effective to pay $30 a month for six months to move 0.00218 ml per minute (or 0.13 ml per hour or 3 ml in 24 hours)?

While the participants also reported that their arm was less heavy, doing your own manual lymphatic drainage will cause your arm to feel less heavy too, and you can do that on yourself for free.

On the up side, there didn’t seem to be any negative side effects to taking Daflon 500®, so the risks are low. It seems the greatest risk is wasting your money.

Goreisan® for Lymphedema 

No surprise that this study took place in Japan where Goreisan® is part of traditional Japanese medicine (Kampo). Goreisan® is also used in Chinese medicine where it is called wullingsan and in Korea where it is called oryeongsan. Goreisan® contains five different plant ingredients including cinnamon bark (tsumara.co.jp, 2017).

Nineteen women with lower leg lymphedema following pelvic surgery for gynecological cancer were included in the trial (10 with cervical cancer, 7 with endometrial cancer and 1 with ovarian cancer) (Yoshikawa, 2020).

These women, aged 20+ had stage I or II lymphedema but otherwise healthy and were asked to give themselves lymph drainage therapy and perform exercise daily. They also received complex decongestive therapy by lymphedema therapists and wore compression garments.

Half of these women were given Goreisan® extract granules 7.5 grams three times per day (Tsumura & Co, Japan). The other half did not take the Goreisan® , but it was not a randomized trial and the evaluators knew who was taking the Goreisan®  and who wasn’t.

Results

There was no significant difference between the two groups of women with regards to their body weight , BMI (body mass index), or estimated body volume.

However, there was a significant different in the extracellular water:total body water ratio in both the total body and the lymphedema leg between that group that received the Goreisan® extract and those that didn’t.

Conclusions

The authors concluded that this study has shown that Goreisan® has been demonstrated as being effective in the treatment of lymphedema. They recommend ongoing randomized controlled trials, which I agree is a great recommendation.

I am encouraged to see that this study is a first to test Goreisan® against lymphedema in humans and I can only hope that this is a positive trend in ongoing research to aid in lymphedema management.

Box of Goreisan Japanese herbal supplement
Goreisan Japanese herbal supplement is part of traditional Japanese medicine. It is also part of Korean and Chinese medicine.

Oak Wood Extract for Lymphedema

Robuvit® is the brand name of an herbal supplement made from the French Oak tree species Quercus Robur. The wood in French oak trees contains roburins and other flavonoids and ellagitannins (https://www.Robuvit®.com/faq).

In this study, which took place in Italy, 65 people with primary lymphedema in one leg attended a briefing that discussed standard lymphedema management and then the use of Robuvit® was suggested as a possible addition (Belcaro, 2015).

The study participants were allowed to self-select if they would like to take the Robuvit®. In addition, they all began “standard management” which consisted of:

  • Compression with 30-40 mm Hg for at least 9 hours per day
  • Regular exercise
  • If edema develops then Lasix, a diuretic (furosemide) 25 mg once per day
  • Low salt diet
  • Antibiotics for 2 weeks for any redness, swelling or pain
  • Daily leg elevation (when possible)
  • Walking regularly
  • Massage regularly
  • Skin hygiene and moisturizing

There were not enough details on “standard management” for me, and it sounds like it wasn’t well controlled as the study said things like “professional lymphatic drainage when available”.

Also, I was surprised by the use of Lasix, a diuretic “if edema develops” without any discussion of who actually took Lasix during the 8 weeks. In my thinking, this would further concentrate the lymph protein and should have been detailed in the final analysis. But, I would just consider this to description of standard therapy to mean that they tried to keep a certain standard for everyone, but it was not exactly the same for every participant.

There was no placebo used in this study and the participants were distributed as follows:

  • 22 people did not take a supplement and were considered the ‘control group’
  • 23 people took 300 mg Robuvit® once per day
  • 20 people took 300 mg Robuvit® twice a day (600 mg total)

Results of 8 weeks of Robuvit® on Primary Lymphedema 

Lymphedema Fluid Protein Levels

One hallmark of lymphedema fluid is that it is high in protein. These researches used a needle biopsy to extract some fluid from the foot at the beginning and end of the trial period. They compared the amount of protein in the lymphedema foot to that individual’s blood plasma protein.

These are the results, at the beginning of the study. The number represents the difference in lymphedema protein content compared to plasma protein;

  • Control – 18% higher
  • 300 mg Robuvit® – 17.6 % higher
  • 600 mg Robuvit® – 17.7 % higher

After the 8 weeks on Robuvit®, the results show that the protein in the lymphedema fluid reduced to;

  • Control – 3.2% higher
  • 300 mg Robuvit® – 12.3% lower
  • 600 mg Robuvit® – 19.2% lower

To understand these results, I will describe what this means. In the control group at the beginning of the study, they had 18% higher protein in their lymphedema foot compared to their blood plasma protein content. But after eight weeks of standard therapy it had reduced to be only 3.2% higher.

In the 300 mg Robuvit® group, they began the study with 17.6% more protein in the lymphatic fluid that plasma, but by the end of the eight week trial, the protein concentration was 12.3% lower than their blood plasma level. Similarly for the 600 mg which was 19.2% lower protein concentration compared to blood plasma.

Skin Thickness

Skin is often thickened in lymphedema and this is measured by ultrasound. In this study, skin thickness was measured before and after the trial. The skin thickness reduced in all three groups as follows;

  • – 6% controls
  • – 10.3% in 300 mg Robuvit®
  • – 11.8% in 600 mg Robuvit®

Leg Volume

This is the result that will be most noticeable for people with lymphedema whose main goal is usually to reduce their lymphedema.

After 8 weeks, results in leg volume were as follows

  • Standard group lost 6.2%
  • 300 mg Robuvit® lost 15%
  • 600 mg Robuvit® lost 18.9%

There were other outcomes measured too, like fungal infections and skin breaks which were not significantly different between the groups. There were no side-effects reported.

Bottom Line for Robuvit and Lymphedema

In the end, these researchers concluded that Robuvit® can be effective in helping with lymphedema but that 8 weeks is a short trial and longer trials with more patients are recommended.

I would agree. This trial seemed really promising to me and the reduction in skin thickness, protein content and especially volume without any reported side-effects seem really promising.

French countryside with home and trees
The French oak tree is the source of Robuvit. Image by Marzena P. from Pixabay

Bottom Line for Lymphedema Herbs

I think this area of research is exciting and offers potential for those with lymphedema. But I think the selenium offers more consistent results for lymphedema and I would suggest anyone considering a supplement for lymphedema also consider sodium selenate. You can read more about that in my blog Medicines and Selenium Supplements for Lymphedema.

Also, be sure to pay attention to your Lymphedema Diet to help manage your lymphedema.

Future Research with Herbs for Lymphedema

Russian Trial of Diosmin

Researchers in Russia are currently studying whether Diosmin will be effective in 120 patients with lower limb lymphedema. The trial is set to finish August, 2022 (ClinicalTrials.gov, 2020)

Hydroxytyrosol and Lymphedema

Hydroxytyrosol is a plant compound extracted from olives and present in extra virgin olive oil. It is a small compound that quickly penetrates tissues and has anti-oxidant and anti-inflammatory abilities.

It can be made from olives, olive leaves, olive pomace or olive mill wastewaters. A publication by Italian researchers details their hypothesis that hydro hydroxytyrosol would be helpful in lymphedema and they suggest that laboratory and animal studies be undertaken to test their hypothesis (Bertelli, 2020).

Olive trees
Hydroxytyrosol can be made from olives, olive leaves, olive pomace or olive mill wastewaters. Photo by Flor Saurina on Unsplash

Additional Support for Lymphedema

To help you manage your lymphedema, here are two excellent resources;

Lymphedema Nutrition School

  • There is a live and self-study version of this program, designed to take you through the lymphedema nutrition research one topic at a time
  • This is evidence-based information to help you manage your lymphedema, lose weight (if desired), reduce cravings and improve your overall health

The Complete Lymphedema Management and Nutrition Guide

Book Cover for The Complete Lymphedema Management and Nutrition Guide
Like this blog, The Complete Lymphedema Management and Nutrition Guide details all of the research on diet and physical therapies for lymphedema in an easy to read format with lots of photos and delicious anti-inflammatory recipes.

 

References for Herbs for Lymphedema

Belcaro G, Cesarone MR, Bavera P, Ricci A, Renton S, Leon M, Ippolito E, Dugall M, Acerbi G. HR (Venoruton1000, Paroven, 0-[beta-hydroxyethyl]-rutosides) vs. Daflon 500 in chronic venous disease and microangiopathy: an independent prospective, controlled, randomized trial. J Cardiovasc Pharmacol Ther. 2002 Jul;7(3):139-45. doi: 10.1177/107424840200700303. PMID: 12232562.

Belcaro G, Dugall M, Hu S, Ledda A, Ippolito E. French Oak Wood (Quercus robur) Extract (Robuvit) in Primary Lymphedema: A Supplement, Pilot, Registry Evaluation. Int J Angiol. 2015 Mar;24(1):47-54.

Bertelli M, Kiani AK, Paolacci S, Manara E, Dautaj A, Beccari T, Michelini S. Molecular pathways involved in lymphedema: Hydroxytyrosol as a candidate natural compound for treating the effects of lymph accumulation. J Biotechnol. 2020 Jan 20;308:82-86. doi: 10.1016/j.jbiotec.2019.11.017. Epub 2019 Nov 30. PMID: 31794783.

Cesarone MR, Belcaro G, Pellegrini L, Ledda A, Vinciguerra G, Ricci A, Di Renzo A, Ruffini I, Gizzi G, Ippolito E, Fano F, Dugall M, Acerbi G, Cornelli U, Hosoi M, Cacchio M. Venoruton vs Daflon: evaluation of effects on quality of life in chronic venous insufficiency. Angiology. 2006 Mar-Apr;57(2):131-8. doi: 10.1177/000331970605700201. PMID: 16518519.

MayoClinic. Ginkgo. Last updated Nov 18, 2020. Accessed May 11, 2021

McGill, Office for Science and Society Separating Sense from Nonsense. 2017. Coumarin, the illegal chemical causing Americans to miss out on a sweet treat. Last updated July 4, 2017. Accessed May 10, 2021.

HealthLinkBC. Ketoprofen- Oral. Last updated, October 2018. Accessed April 28, 2021.

Pecking AP, Février B, Wargon C, Pillion G. Efficacy of Daflon 500 mg in the treatment of lymphedema (secondary to conventional therapy of breast cancer. Angiology. 1997 Jan;48(1):93-8. doi: 10.1177/000331979704800115. PMID: 8995350.

Robovit.com FAQ What is Robovit? Accessed May 5, 2021.

Sheikhi-Mobarakeh Z, Yarmohammadi H, Mokhatri-Hesari P, Fahimi S, Montazeri A, Heydarirad G. Herbs as old potential treatments for lymphedema management: A systematic review. Complement Ther Med. 2020 Dec;55:102615. doi: 10.1016/j.ctim.2020.102615. Epub 2020 Nov 9. PMID: 33221590.

Albert-Adrien Ramelet. Diosmin and Micronized Purified Flavonoid Fraction. Sclerotherapy (Sixth Edition), 2017. Accessed May 11, 2021.

Tsumura.co.jp. Information Sheet for Customer Tsumura-Kampo Goreisanryo Extract Granules. Last updated Feb 11, 2017. Accessed May 11, 2021.

Woodman HM. Cabbage leaves: cabbage leaves are poor man’s poultice. BMJ. 2003 Aug 23;327(7412):451. doi: 10.1136/bmj.327.7412.451-c. PMID: 12933752; PMCID: PMC188519.