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Sweet clover

Health Conditions1
Table of contents

Other Names

Annual Yellow SweetcloverBokhara CloverCalifornian LucerneCasse LunettesCommon MelilotCommon Sweet CloverCorn MelilotCouronne RoyaleDonnikField MelilotHart's CloverHart's TreeHay FlowerHerba melilotiHerbe aux PucesHexham ScentHoney CloverHubam CloverIndian Sweet CloverKing Island CloverKing Island MelilotKing's CloverLuzerne BâtardeMélilotMelilotMélilot CommunMélilot des ChampsMélilot JauneMélilot OfficinalMelilot TrefoilMélilot VulgaireMeliloti herbaMelilotoMelilotusMelilotus albaMelilotus albusMelilotus altissimusMelilotus arvensisMelilotus indicaMelilotus indicusMelilotus leucanthusMelilotus luteaMelilotus macrorrhizusMelilotus officinalisMelilotus vulgarisOfficial MelilotPetit-Trèfle JaunePlaster CloverPratelleRibbed MelilotSmall MelilotSmall-flowered MelilotSmall-flowered Sweet CloverSour CloverSweet LucerneSweet MelilotTall MelilotThé de JardinTrébol de OlorTree CloverTréfle des MouchesTrifolium macrorrhizumTrifolium officinaleWhite MelilotWhite Sweet CloverWild LaburnumYellow MelilotYellow Sweet CloverZieger kraut

Synopsis

Sweet Clover (Melilotus officinalis): A Comprehensive Reference

1. Identity and Botanical Profile

Taxonomy and Nomenclature

Melilotus (sweet clover) is a forage plant belonging to the family Fabaceae (legumes) and the subfamily Faboideae, classified within the Trifolieae tribe alongside clover (Trifolium), alfalfa (Medicago), and fenugreek (Trigonella). The primary medicinal species is Melilotus officinalis (L.) Lam., commonly called yellow sweet clover or yellow melilot. A closely related species, Melilotus albus Medik. (white sweet clover), shares a nearly identical phytochemical profile and is used interchangeably in many traditions.

The genus name comes from the Greek words mel (honey) and lotus (clover in the broad sense), reflecting the plant's importance as a source of forage for bees. Popular English names include Sweet Clover, King's Clover, Hart's Clover, Plaster Clover, Sweet Lucerne, and Wild Laburnum.

The epithet officinalis indicates that this is an old medicinal plant, because the "officina" is the sales room of a pharmacy, and officinalis means "used in the pharmacies."

Botanical Description and Habitat

It is an annual or biennial herb that grows up to 2 meters in height, characterized by slender stems, trifoliate leaves, and clusters of small yellow flowers. The plant is widely spread across Europe and Asia, growing along paths and around fields. It also grows throughout the United States and Canada, and is noted for its pleasant smell due to the presence of coumarin.

Plant Parts Used

Melilot is the common name for the above-ground parts of the plant Melilotus officinalis (L.) Lam. The EMA's Committee on Herbal Medicinal Products (HMPC) conclusions cover melilot preparations obtained by drying and comminuting or powdering the above-ground parts, or by putting the plant material in a solvent (such as ethanol or rapeseed oil) to form a liquid extract. Herbal medicines containing these melilot preparations are usually available as herbal tea to be drunk, in solid forms to be taken by mouth, and in semi-solid forms to be applied to the skin.

Official Pharmacopoeial Status

According to the European Pharmacopoeia, the herbal raw material referred to as Meliloti herba consists of the whole or cut dried aerial parts of Melilotus officinalis (L.) Lam., with a minimum coumarin content of 0.3%. Melilotus officinalis is mentioned in the French Pharmacopoeia (1989) and in the botanical companion to the British Pharmacopoeia (1996). Positive monographs on sweet clover-based preparations have been published by the European Scientific Cooperative on Phytotherapy (ESCOP, 1997) as well as by the German Commission E on phytotherapeutic substances (March 1986, 1990). The drug is also described in the monograph of the 14th edition of the Russian Pharmacopoeia.

2. Traditional and Historical Uses

Ancient World

Historically, melilot was already mentioned by figures of ancient medicine such as Hippocrates and Dioscorides for its effects on stomach and liver pain. Pliny and Galen prescribed sweet clover-based preparations to treat inflammation, ulceration, and swelling.

Medieval Europe

In the Middle Ages, its sedative properties were recognized. Medieval European herbalists, such as Hildegard of Bingen (1150s), integrated it into poultices, mixing the dried flower with barley flour for bruises and sprains, reflecting a folk remedy that carried into Renaissance apothecaries. The Russian military pharmacopoeia traditions were also extensive: the monograph for the flowers of Melilotus officinalis was included in the first Military Pharmacopoeia Castrensis Rossica (1765), and the meliloti patch for abscesses (emplastrum meliloti) was described in the Pharmacopoeia Rossica (1778).

Traditional Internal Uses

In traditional herbal medicine, sweet clover is used as an infusion to treat various conditions, including digestive issues, conjunctivitis, arthritis, bronchitis, haemorrhoids, stomach ulcers, and oedema of the lower limbs due to poor circulation. In traditional medicine, melilot was also used as a diuretic and to treat digestive disorders. It was traditionally used to reduce nervousness in adults and children, particularly for sleep disorders.

Traditional External Uses

Externally, it was applied to wounds, burns, and boils. Externally, it was used to treat bruises, sprains, and dislocations; for medical use, the plant drug was soaked in hot water, placed into canvas, and then applied to the affected body part. A bandage of the injured limb could also be made from canvas soaked in melilot infusion. "Softening" tissues and promoting resolution of purulence was a documented use, as was application in arthritis and rheumatic swelling in the form of preparations like Emplastrum Meliloti. Topically, melilot herb was used on inflamed breasts of breastfeeding women and in earaches such as otitis.

Traditional Chinese Medicine

In China, Melilotus officinalis is one of the species in the genus Fabaceae widely distributed in Asia and Europe, and it has been used as a traditional Chinese herb with functions of heat-clearing and detoxifying. Melilotus albus is used in China for reducing edema associated with hemorrhoids, traumatic injuries, thermal burns, and lymphedema in the limbs.

Avicenna and Islamic Medicine

Traditional Unani/Islamic medicine classified sweet clover as an anodyne and emollient used to move the blood and relieve swelling in conditions such as venous congestion, varicose veins, hemorrhoids, thrombosis, and lymphatic congestion; it was also traditionally used for hard tumours and night cramps of the legs, and to clear heat, resist poison, and ease pain — both internally and topically — in all types of swelling and inflammation.

3. Key Constituents and Active Compounds

Coumarin and Coumarin-Related Compounds

The plant contains coumarin, 3,4-dihydrocoumarin (melilotine), ortho-coumaric acid, ortho-hydroxycoumaric acid, and the ortho-glucoside of ortho-coumaric acid (melilotoside). Coumarin content in the aerial parts ranges from 0.2 to 0.45%, and its precursor is melilotiside; additional substituted coumarins present include umbelliferone and scopoletin.

Withering of the plant leads to enzymatic glycoside hydrolysis, and the resulting ortho-coumaric acid is spontaneously transformed to coumarin; the dried herb therefore smells strongly of coumarin. Coumarin is responsible for the sweet smell of hay and newly mowed grass; it has a bitter taste and possibly acts as a means for the plant to discourage consumption by animals.

Flavonoids

Both M. officinalis and M. albus are rich in phenolic compounds, including coumarins, phenolic acids, and flavonoids. The phytochemical profile of M. officinalis consists mainly of cinnamic acid, melilotoside, coumarin, melilotin, scopoletin, umbelliferone, kaempferol, and quercetin glycosides. Various polyphenolic compounds have been identified by LC-MS/MS in M. officinalis aerial parts including catechin, syringic acid, protocatechuic acid, and vanillic acid.

Differential Distribution by Plant Part

The highest coumarin content is found in the fresh flowers, followed by leaves and stems. No significant species-specific differences in the coumarin content were observed between M. officinalis and M. albus. However, the flowers of M. albus were a richer source of flavonoids, with the highest hyperoside content. The flavonoid profile in the leaf extracts was similar to that of the flowers, but the content was about four times lower in the leaves and even lower in the stems. Interestingly, the leaf extracts exhibited higher antioxidant activity than the flower extracts.

Important Chemical Distinction: Coumarin vs. Dicumarol

Coumarin (1,2-benzopyrone) is completely devoid of anticoagulant effects, unlike dicumarol and synthetic coumarins such as warfarin, which are vitamin K antagonists. Some mould fungi, including Penicillium, Aspergillus, Fusarium, and Mucor, can convert coumarin into dicoumarol, a toxic anticoagulant. This distinction is critical to understanding both the toxicological history of the plant and the safety of properly prepared herbal products.

4. Pharmacology and Mechanisms of Action

Lymphokinetic and Anti-Edematous Actions

Coumarins are alpha-benzopyrone derivatives of Melilotus officinalis. Alpha-benzopyrones have two fundamental pharmacological effects: they have pro-lymphokinetic action by activating contractility of lymphangions, and they activate macrophages to provide a proteolytic effect. Gamma-benzopyrones, such as rutin, have an important anti-exuding and membrane-stabilizing effect.

Melilot has notable effects on the vascular system, particularly due to its myotropic properties that actively stimulate the lymphatic and venous systems. The coumarins improve vessel tone by increasing the rate and force of lymphatic contractions while reducing capillary permeability. This action promotes better tissue oxygenation through a significant improvement in microcirculation, contributing to improved management of lymphedemas and an overall increase in lymphatic vascular activity.

Coumarin has antiedemic properties due to macrophagic action that stimulates proteolysis in the tissues affected by chronic lymphedema.

Anti-inflammatory Activity

Coumarin is characterized by anti-inflammatory, antioxidant, hepatoprotective, anxiolytic, antimicrobial, and antiproliferative properties. Natural coumarins demonstrate a wide spectrum of pharmacological activities, including anti-inflammatory, anticoagulant, anticancer, antibacterial, antimalarial, antifungal, antiviral, neuroprotective, and anticonvulsant effects.

The Dicumarol Connection and Warfarin Discovery

In the 1920s, cattle in Canada began dying of internal bleeding with no obvious precipitating cause. Frank W. Schofield, a veterinary pathologist in Alberta, found that the mysterious disease was connected to the consumption of spoiled sweet clover hay and noted a prolonged clotting time. This event started the isolation of the anticoagulant agent dicumarol, which was formed by microbial-induced oxidation of coumarin in the mouldy sweet clover hay. The causative agent dicoumarol was isolated in Link's laboratory in 1940, and a range of related compounds was then synthesized, the most popular of which proved to be warfarin. Coumarin in sweet clover is converted to dicumarol, which inhibits vitamin K epoxide reductase in the liver, reducing clotting factors II, VII, IX, and X. This pathway operates only in spoiled (mouldy) plant material and is not a property of fresh or properly dried sweet clover.

5. Scientific Evidence by Area of Use

5.1 Chronic Venous Insufficiency and Varicose Veins

Since 1960, studies have demonstrated sweet clover extract's benefits for patients suffering from venous insufficiency, varicose veins, thrombophlebitis, haemorrhoids, and lymphoedema of the lower limbs or following mastectomy. The European Medicines Agency's HMPC has classified sweet clover as a traditional herbal medicinal product for these indications. Melilot is traditionally used to relieve symptoms of heaviness in the legs associated with mild venous circulatory disorders, in accordance with the EMA's indication.

The European Medicines Agency recommends the use of the vegetal product for minor venous circulatory disturbances (orally) or for minor inflammation of the skin and feelings of heaviness in the legs (topically).

Evidence strength: The EMA classification is as a "traditional herbal medicinal product," meaning the evidence is based on established traditional use rather than well-controlled clinical trials specifically for the crude herb. Although studies have indicated coumarins may hold potential health benefits, no double-blind, placebo-controlled studies have been undertaken on sweet clover itself.

5.2 Lymphedema

The first studies addressing the use of coumarin in the treatment of lymphedema — a high-protein oedema caused by failure of the lymphatic system — date back to the 1970s.

A 2000 Italian open clinical study examined the coumarinic extract of Melilotus officinalis (CEMO) in post-mastectomy lymphedema. The aim was to verify the therapeutic activity of CEMO in patients with chronic lymphedema of the upper arm caused by lymphadenectomy for breast cancer. Coumarin has antiedemic properties due to macrophagic action that stimulates proteolysis in tissues affected by chronic lymphedema. In an open clinical study, 24 patients with chronic upper arm lymphedema due to post-lymphadenectomy were enrolled; 21 were eligible to receive 400 mg of CEMO containing 8 mg of coumarin in a single daily administration for 6 months. CEMO was effective in reducing lymphedema in 79% of the patients treated for a period of six months. The median reduction of upper arm circumference was modest (5% with respect to initial values) but statistically significant (p = 0.048).

A more recent prospective study used a combination formulation. This 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 (containing 20 mg of coumarin), 300 mg of rutin, and 100 mg of bromelain. Parameters studied at baseline, 3 months, and 6 months included pitting, Stemmer's sign, limb circumferences, superficial tissue thickness by ultrasound, and blood tests for hepatic function. At the end of treatment, results showed disappearance of pitting in 72% of cases; average decrease in limb circumferences of 4.2 cm; and average reduction of superficial tissue thickness of 29%. There was no variation in the liver function parameters examined.

In contrast, Loprinzi did not find that coumarin had any benefit in reducing arm volume or treating symptoms in his prospective, double-blind, randomized, crossover design study, in which he investigated the effects of 2 Ă— 200 mg oral coumarin or placebo for six months followed by 6 months of the other therapy in 140 women with unilateral lymphedema.

Evidence strength: The human evidence for Melilotus coumarin extract in lymphedema is preliminary and mixed. Small open-label studies show modest but statistically significant reductions in limb circumference. The most rigorous RCT (Loprinzi's crossover trial) found no benefit. Further well-controlled trials are needed.

5.3 Diabetic Foot Ulcers

M. officinalis is the major ingredient of Semelil (Angipars™), a herbal extract produced in oral, topical, and intravenous forms. Its capacity to accelerate ulcer healing was reported in recent studies, and it has been used for wounds of diabetic foot ulcers in humans.

A multicenter randomized controlled trial was conducted with the intravenous form. A multi-centric randomized controlled trial was conducted to evaluate intravenous Semelil for healing of diabetic foot ulcers. Sixteen diabetic patients were treated with intravenous Semelil, and nine other patients were treated with placebo as a control group. Both groups were otherwise treated by wound debridement and irrigation with normal saline solution, systemic antibiotic therapy, and daily wound dressing.

A separate randomized double-blind placebo-controlled trial in 61 subjects with diabetic foot ulcers found that administration of Semelil (Angipars™) was successful in the treatment of diabetic foot ulcers, and in addition it improves microcirculation and exerts anti-inflammatory effects.

A Phase I trial to determine maximum tolerated dose found that foot ulcer dramatically improved up to a dose of 10 cc per day, and phlebitis at the infusion site was observed at a dose of 13.5 cc per day; the maximum tolerated dose (MTD) for Semelil (Angipars™) was therefore established at 10 cc/day, with dose-limiting toxicity being phlebitis in the injection vein.

A double-blind clinical trial in 49 type 2 diabetes patients with different degrees of neuropathy evaluated Semelil (Angipars™) vs. placebo for 12 weeks, assessing Michigan neuropathy screening score, nerve conduction studies, vibration perception thresholds, monofilament testing, and visual analog scale. Michigan diabetic neuropathy score was decreased notably in the Angipars™ group.

Evidence strength: Multiple small randomized controlled trials suggest benefit of the Angipars™ extract on diabetic foot ulcer healing, with positive results on wound area reduction. Most trials are small, conducted by a single research group, and largely from Iran. Independent large-scale replication is lacking. Semelil (Angipars™) does not appear to have significant side effects or toxicity, suggesting it could become a routine part of diabetic foot ulcer therapy, pending further evidence.

5.4 Hemorrhoids and Thrombophlebitis

Melilot offers benefits due to its effects on the venous-lymphatic system. By improving vascular tone and increasing lymphatic flow, melilot helps reduce venous stasis, a key factor in the development of varicose veins and hemorrhoids. Activation of phagocytes by melilot contributes to reducing local inflammation, thereby providing relief in cases of varicose veins and hemorrhoids where inflammation and pain are often present.

Evidence strength: Evidence is principally from traditional use and in vitro/mechanistic studies, supported by pharmacological data on coumarin. Large controlled human trials specifically on hemorrhoids using Melilotus preparations are not well documented in the sources reviewed.

5.5 Skin Inflammation and Wound Healing (Topical)

When externally applied, M. officinalis exerts an emollient, phlebotonic effect and contributes to the relief of joint pain. The benefits of topical usage also involve alleviation of skin inflammation and the treatment of bruises and sprains. Active compounds such as coumarin in melilot reduce capillary permeability and improve microcirculation, which can help reduce swelling and accelerate the resolution of bruises. The EMA approves melilot for the treatment of minor skin inflammations, confirming its traditional use in these contexts.

Evidence strength: The EMA's traditional use recognition for topical application is supported by pharmacological plausibility (capillary permeability reduction, anti-inflammatory coumarin activity) but large controlled clinical trials specifically on topical Melilotus preparations are limited.

5.6 Antioxidant Activity

Both fresh and dried plant materials have been analyzed; total phenolic content and antioxidant activity have been evaluated using FRAP and DPPH· assays. Both species were rich in phenolic compounds, including coumarins, phenolic acids, and flavonoids. In vitro assays demonstrate that formulations containing M. officinalis exhibit marked antioxidant capacity and effectively inhibit key enzymes of the arachidonic acid cascade, supporting their ability to counteract oxidative stress and inflammatory signalling involved in oedema pathophysiology.

Evidence strength: Antioxidant evidence is in vitro only. Clinical significance in humans is not established.

5.7 Cardioprotective Potential

Considering that cardioprotective effects are associated with antioxidant mechanisms, and that knowledge of the effects of Melilotus species on the heart is limited, a study aimed to evaluate the cardioprotective potential of hydroalcoholic extracts of M. officinalis and M. albus aerial parts. The effect of pretreatment with Melilotus sp. extracts on isoprenaline-induced infarct-like lesion in rats was evaluated by ECG monitoring and assessment of serum oxidative stress markers and serum cardiac injury markers.

Evidence strength: Preclinical (animal model) only. No human clinical evidence is available for cardioprotective endpoints.

6. Body Systems and Health Areas

  • Venous-Lymphatic System: Withering of the plant leads to conversion of glycosides to coumarin; M. officinalis has been used to treat lymphedema and the edema of chronic venous insufficiency.
  • Skin and Wound Healing: Several studies indicate that Melilotus extract application on the skin and administration orally or intravascularly has beneficial effects in ameliorating skin aging, treatment of pimples, improvement of microcirculation, and anti-inflammatory effects.
  • Digestive System: In traditional herbal medicine, sweet clover is used to treat various conditions including digestive issues, stomach ulcers, and haemorrhoids.
  • Musculoskeletal System: For centuries, M. officinalis has been used for the treatment of neuralgias and venous circulatory disturbances, and when externally applied, the plant exerts an emollient, phlebotonic effect and contributes to the relief of joint pain.
  • Respiratory System: Traditional uses include treatment of bronchitis and conjunctivitis.

7. Dosage Forms and Reported Dosages

The German Commission E monograph for Melilotus officinalis specifies two preparations: an infusion for oral use, or other preparations in quantities corresponding to 3–30 mg of coumarin; and unguents and suppositories for rectal use.

The EMA Community herbal monograph lists the following dosing forms:

  • Single dose for standardized extract: 200 mg, twice daily.
  • Single dose for comminuted herbal substance: 1.14 g, three times daily.
  • Single dose for dry extract: 160 mg extract, three times daily.

To treat symptoms of venous insufficiency/varicose veins, a daily dosage of a sweet clover preparation or extract providing 3 to 30 milligrams (mg) of coumarin is taken internally.

In the post-mastectomy lymphedema clinical study, 21 patients received 400 mg of CEMO containing 8 mg of coumarin as a single daily administration for 6 months.

In the combination lymphedema study, all subjects were given for six months a natural compound consisting of 100 mg of natural Melilotus (containing 20 mg of coumarin), 300 mg of rutin, and 100 mg of bromelain.

No restriction on the duration of use has been specifically reported for Meliloti herba; however, as persistent symptoms require medical diagnosis and supervision, use is generally limited to 2 weeks for self-medication.

8. Safety Considerations and Interactions

Coumarin vs. Dicumarol: A Critical Safety Distinction

Coumarin itself has no anticoagulant activity, but the moulding of sweet clover can give it hemorrhagic potential by transforming coumarin to the anticoagulant dicoumarol. Therefore, properly dried or extracted (non-mouldy) sweet clover preparations do not carry the same anticoagulant risk as spoiled plant material. Nonetheless, the risk of mould contamination in improperly stored plant material is real, and properly regulated pharmaceutical products are recommended for internal use.

Hepatotoxicity

Coumarin is an effective treatment for primary lymphedema, as well as lymphedema related to breast cancer radiotherapy or surgery. However, its clinical use is limited in several countries due to the possible occurrence of hepatotoxicity, mainly in the form of mild to moderate transaminase elevation. Only a few cases of severe hepatotoxicity have been described in the literature, with no reported cases of liver failure.

Coumarin-induced hepatotoxicity is restricted to a small subset of patients, probably due to the activation in these individuals of alternative metabolic pathways involving specific CYP450 isoforms. Coumarin itself does have the potential to cause hepatotoxicity, perhaps in the small subset of people who take enough and have insufficient CYP2A6 activity to break coumarin down into safe catabolites.

Notably, in the combination lymphedema clinical trial reviewed above, there was no variation in the liver function parameters examined over six months, suggesting that properly dosed preparations may be hepatically safe in most individuals.

A case report in the literature has described severe liver dysfunction possibly caused by the combination of interferon beta-1b therapy and a melilot (sweet clover) supplement. Severe liver dysfunction was reported, possibly caused by the combination of interferon beta-1b therapy and a melilot supplement.

Interaction with Anticoagulant Therapy

Hypersensitivity to melilot or to coumarin is a contraindication. The EMA monograph states that melilot is not to be used together with anticoagulant therapy. While coumarin itself is devoid of anticoagulant activity, the possibility of dicumarol formation from mouldy plant material — combined with additive pharmacological effects on capillary permeability — warrants caution in patients on warfarin, heparin, or other anticoagulants.

Adverse Effects Reported in Clinical Use

Gastrointestinal complaints have been reported with melilot use; the frequency is not known. Allergic reactions have also been reported. No case of overdose has been reported in the EMA monograph.

In the post-mastectomy lymphedema study, three patients (14.2%) had transitory gastrointestinal side effects.

Pregnancy and Lactation

Safety during pregnancy and lactation has not been established systematically. Use of melilot extracts in combinations is mentioned by various authors, and no adverse effects have been reported from the use of these combinations as a medicinal product during pregnancy and lactation. However, information about delivered babies is lacking, and as there are no appropriate data available, use is not recommended.

Improperly Stored Plant Material: Livestock Risk

Two veterinarians — Frank Schofield (in Canada) and Lee Roderick (in North Dakota) — reported that massive hemorrhage and death occurred when cattle and sheep were fed moldy sweet clover hay. They reported that the bleeding defect could be corrected by blood transfusion or removing the moldy sweet clover from the diet. Although this is a veterinary toxicological issue arising from large quantities of mouldy silage, it has important implications for understanding the chemistry of the plant and reinforces the necessity of using properly produced herbal preparations free from mould contamination.

Drug Interactions

Coumarin in sweet clover can be converted to dicumarol, which inhibits vitamin K epoxide reductase in the liver, reducing clotting factors II, VII, IX, and X — primarily a risk if the plant is moulded. In properly prepared extracts, direct pharmacodynamic interaction with anticoagulant drugs via the coumarin-to-dicumarol pathway is low; however, given the case report of hepatotoxicity in combination with interferon beta-1b, caution is warranted with immunomodulatory or hepatically active co-medications.

References

Health Conditions

Health conditions that Sweet clover may help support.

  • Varicose VeinsTraditional

    Sweet Clover (Melilotus officinalis) has been used in European phytomedicine for CVI, varicose veins, and associated edema, and Germany's Commission E has approved its use for venous insufficiency. It contains coumarin and related compounds with venotonic and anti-inflammatory effects. Its traditional and regulatory recognition predates comprehensive RCT evidence, though pharmacological studies support its mechanism.

Body Systems

Body systems that Sweet clover may help support.

  • No body systems available.
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Sweet clover | Caring Sunshine