MELILOTUS, RUTIN AND BROMELAIN IN PRIMARY AND SECONDARY LYMPHEDEMA

Abstract

As reported in the literature, benzopyrones
(alpha and gamma) have important effects on
the microcirculation through various mechanisms.
Coumarins are an alpha-benzopyrone
as derivatives of Melilotus Officinalis, while
bioflavonoids are a gamma-benzopyrone and
include Rutin. Alpha-benzopyrones have two
fundamental pharmacological effects: they
have pro-lymphokinetic action by activating
contractility of lymphangions; and the activation
of macrophages to provide a proteolytic
effect. Gamma-benzopyrones, such as Rutin,
have an important anti-exuding and membrane
stabilizing effect. Bromelain is known
for its anti-inflammatory effect. The present
study enrolled 52 patients with primary and/or
secondary lymphedema in clinical stages I or
II (according to the ISL classification) with 31
cases involving the lower limbs and 21 cases involving
the upper limbs. All subjects were given
for six months a natural compound consisting
of 100 mg of natural Melilotus, that contains
20 grams of Coumarin, 300 mg of Rutin and
100 mg of Bromelain. The following parameters
were studied at zero time (T0), after three
months (T1), and after six months of treatment
(T2): pitting, Stemmer's sign, measurement of
limb circumferences, measurement of superficial
tissue thickness in the affected limbs using
ultrasound, and blood tests to evaluate hepatic
function (ALT, AST, GGT, total and fractional
bilirubin). At the end of the treatment (T2), the
following results were observed: disappearance
of pitting in 72% of the cases; unchanged Stemmer's
sign; average decrease in limb circumferences
of 4.2 cm; and average reduction of
the superficial thickness of 29%. There was
no variation in the liver function parameters
examined. The combination of natural compounds
(Melilotus, Rutin, and Bromelain) has
been shown to be a valuable aid in the clinical
control of both primary and secondary lymphedema
of clinical stages I and II as well as in
control of inflammatory phenomena related
to chronic stasis. There were no side effects
and no alteration of liver function parameters
found.