ASTERACEAE

[Formerly known as Compositae]

This is the largest plant family with some 25,000 species worldwide.

Asteraceae are distinguished by the uniformity of the inflorescence in which many tiny flowers, called florets, are clustered together to form a flower-like head or capitulum, surrounded by calyx-like bracts called involucral bracts.

The florets are arranged on the apex of the stem, the receptacle, which may be flat, conical or concave, with or without scales subtending each floret.

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Disc floret Ray floret

The florets are usually bisexual and complete; possessing calyx, corolla, stamens and ovary, but one or more of these organs may be absent.

The calyx is often reduced to a ring of simple or branched hairs, bristles or scales and becomes the pappus in the fruit.

The five stamens are fused by their bases to the corolla, and the anthers are fused together to form a tube around the style.

The ovary is inferior and one-seeded. There are two stigmas.

The fruit is a one-seeded nutlet, usually crowned by a pappus of scales, simple hairs, or branched feathery hair, or the pappus may be absent.

The corolla is of two basic types:

a) bell-shaped with 5 short teeth—this type of floret is called a disc floret or tubular floret

b) strap-shaped with a long narrow limb—this type is called a ray floret or ligulate floret.

Flower heads may be composed of disc florets only e.g. Tanacetum vulgare; or of a central group of disc florets surrounded by a peripheral row of ray florets, e.g. Tanacetum parthenium; or all florets may be ray florets e.g. Taraxacum officinale.

The Asteraceae are a highly successful family because of their high reproductive rate and ability to adapt. They occur in all habitats and every continent except Antarctica.

Because it is such a large family it is divided into two subfamilies, the Lactucoideae with 7 tribes and the Asteroideae with 6 tribes.

Medicinal plants in the Asteraceae include:

Tribe Lactuceae

The lettuce tribe, which all have a basal rosette of leaves, differ from other Asteraceae in having latex, a white fluid, which exudes from cut ends of leaves and stalks. The flowers are all ligulate (ray florets) and mostly yellow.

Cichorium intybus chicory
Sonchus oleraceus sow thistle
Lactuca virosa wild lettuce
Taraxacum officinale dandelion
 

Tribe Cynareae

Most of this tribe are thistle-like with spiny bracts and leaves. The flower heads consist of only disc florets which are mostly purplish or pink.

Arctium lappa burdock
Cynara scolymus globe artichoke
Cnicus benedictus blessed thistle
Silybum marianum Mary's milk thistle
 

Tribe Eupatorieae

Eupatorium cannabinum hemp agrimony
E. perfoliatum boneset
E. purpureum gravel root
 

Tribe Senecioneae

This is one of the largest groups. They have alternate leaves, the flowers are usually yellow, and fruits usually have a hairy pappus.

Senecio jacobaea ragwort
Senecio aureus life root
Petasites hybridus butterbur
Tussilago farfara coltsfoot
 

Tribe Heliantheae

Most of these have opposite leaves and are not scented. Flowers are usually yellow or white, Echinacea being an exception.

E. angustifolia purple coneflower
E. pallid pale purple coneflower
Arnica Montana arnica
E. purpurea purple coneflower

Tribe Inuleae

Inula helenium elecampane
 

Tribe Anthemideae

Most of these have alternate leaves and are strongly scented. The flowers are generally yellow or white and there may or may not be ray florets. The disc florets have short corolla lobes and the flower head is surrounded by two or more rows of bracts.

Achillea millefolium yarrow
Artemisia abrotanum southernwood
A. absinthium wormwood
A. vulgaris mugwort
Chamaemelum nobile perennial chamomile
Matricaria recutita annual chamomile
Tanacetum parthenium feverfew
T. vulgare tansy

Tribe Calenduleae

This tribe usually has alternate leaves and the plants are strongly scented. There are no scales on the receptacle, no pappus and no latex.

Calendula officinalis marigold

Tribe Astereae

These plants mostly have alternate leaves, and are without scent. Most members have both ray and disc florets.

Bellis perennis lawn daisy
Grindelia camporum Grindelia, gumplant
Solidago spp. golden rod

Asteraceae—general precaution

Allergic reactions from using medicinal members of the Asteraceae such as asthma, urticaria and rhino-conjunctivitis are possible in people with sensitivity to the daisy family.1–6

Standard tests carried out on allergic individuals have shown a low incidence7—around 1.4%—to Astercaeae this occurring mostly in older people or those who suffer extrinsic atopic dermatitis to other agents. However a person with sensitivity to one member has a fairly high probability of reacting to others.2–9 The sesquiterpene lactones are considered highly likely to contribute.

Achillea millefolium

Yarrow

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Family Asteraceae, Tribe Anthemideae

Description

Perennial rhizomatous herb, with short non-flowering rosettes often forming dense mats. Strongly scented. Stems usually erect up to 80 cm tall, ribbed and striate, hairy especially above, usually not branched except to form the inflorescence. Basal leaves petiolate, lanceolate, moderately hairy, 2-pinnate with segments again 1–2 pinnatisect, usually 6–15 × 1–2 cm. Primary leaflets in 18–30 pairs; ultimate segments subulate, not all in one plane giving a feathery appearance to leaf; rachis c. 1–2 mm diameter, flattened, sometimes slightly winged, not toothed. Cauline leaves similar to basal, but above becoming apetiolate, less divided, smaller and with fewer leaflet pairs. Corymbs usually more or less flat-topped or slightly convex, to 15 cm across, with numerous, closely packed capitula. Involucral bracts glabrous to sparsely hairy, 1.5–4 mm long; margin brown, hairy. Capitula 5–10 mm in diameter. Ray florets 4–7; ligule and disc florets usually white, sometimes pink to deep red. Flowers from summer to autumn. Achenes grey-brown, c. 2 mm long; wings narrow pale brown.

Odour—aromatic; taste—bitter and faintly aromatic.

Habitat and cultivation

Originally from Europe, SW Caucasia, Iran, Siberia and the Himalayas, Achillea is naturalised elsewhere in waste places. Grown from root division or seed; prefers deep, friable lime soil in a sunny situation. Drought and frost resistant.

Parts used

The flowering herb gathered just as the flowers begin to open, from late spring to autumn. In Switzerland both herb and flowers are used officially.

Nutritional constituents

Vitamins: A, C, E, and K

Minerals: Manganese, copper, potassium, iron and iodine

Active constituents

Achillea is geographically widespread and variable as it displays polyploidy,10 the chromosome number can be diploid, tetraploid or hexaploid, the latter being the most common form. The chemical make-up can vary significantly according to the chromosome number, habitat,11 level of maturation of the plant12 and the method used to analyse these constituents.12 This makes it very difficult to characterise precisely the constituents of any one preparation.

1) Volatile oil (max. 1.5%) present in all parts of the plant and highest during flowering. The colour of the oil varies with the quality, increasing from light to dark blue. More than 60 volatile components have been identified.13 Monoterpenes in the oil increase relative to sesquiterpenes as the plant matures.12 The monoterpenes α- and β-pinene and sabinene occur in most Achillea samples.14 The hexaploid plant oil is mainly made up of oxygenated monoterpenes of which either linalool (26%) or camphor (18%) predominate, with 1,8—cineole and borneol also being significant.15,16 The tetraploid oil is mainly comprised of sesquiterpenes of which chamazulene may be an important one, representing around 25%.15 Achillea millefolium L. ssp. collina Becker has a high level of chamazulene reported at 53%,16 however the chamazulene content has also been reported as insignificant where steam distillation was not used12 and here there were instead significant amounts of β-bisabolene, α-bisabolol and δ-cadinene. Also present in the tetraploid oil are β-caryophyllene, sabinene, α- and β-pinene and trace amounts of thujone.15 Eucalyptol and α-terpineol were identified in A. millefolium ssp. millefolium Afan as well as camphor, β-pinene and borneol17

2) Sesquiterpene lactones including the guaianolides achillicin (considered a prochamazulene), achillin, leucodin and their 8 α-angeloxyderivatives, desacetylmatricarin,18,23 α-peroxyachifolids19,20 (up to 0.6% in dried flowers and 0.05% in leaves21) and β-peroxyisoachifolid,20 achimillic acids A, B and C22 and germacranolides

3) Bitter glyco-alkaloid called achilleine. Also stachydrine, choline and betaine

4) Tannins (up to 4%)

5) Flavonoids (0.5–1.8%) including free aglycones apigenin, luteolin and centaureidin,23 and their glucosides, also rutin,24 artemetin and casticin25

6) Cyanogenic glycosides

7) Sterols including β-sitosterol, stigmasterol, campesterol, cholesterol and triterpenes—α- and β-amyrin, taraxasterol and pseudotaraxasterol26

8) Hydroxycoumarins

9) Phenolic acids including caffeic, salicylic and isovalerianic acids25

Saponins have also been reported.26

Nutritional constituents

Vitamins: Folic acid and C

Actions

Achillea has a wide range of actions.

1) Astringent

2) Antimicrobial

3) Diaphoretic

4) Hypotensive

5) Antipyretic

6) Spasmolytic

7) Antispasmodic

8) Anti-inflammatory

9) Haemostatic

10) Diuretic

11) Antiseptic

Scientific information

The medicinal use of Achillea dates back to before 1000 BC and its use has been commonly associated with Achilles who used it to staunch bleeding in his soldiers on the battlefield. Chemical analyses of the herb were undertaken over a 200 year period but much less interest has been shown in it recently. German Commission E has approved internal use of the flowers to stimulate appetite and for dyspepsia and its external use, as a sitz bath, for cramps of psychosomatic origin in the pelvic area.

In vitro—The volatile oil has strong anti-oxidant properties and antimicrobial activity against Streptococcus pneumoniae, Clostridium perfringens, Candida albicans, Mycobacterium smegmatis, Acinetobacter lwoffii and Candida krusei.7 The herb however was inactive against Staphylococcus aureus, Bacillus subtilis, Pseudomonas aeruginosa, Escherichia coli and Candida albicans.27

Achillea is cytotoxic to a number of different liver cancer cell lines.28

In vivo—Recent investigations of Achillea have been largely associated with its chemical constituents. A combination of Achillea, Eleutherococcus senticosus and Lamium album as a topical treatment for atopic dermatitis gave improvements, both subjective and objective, but they were not significantly different from placebo.29

Medicinal uses

Cardiovascular system

BHP specific for thrombotic conditions with hypertension including those affecting coronary and cerebral circulation.

Respiratory tract

As an astringent it is used in all catarrhal conditions:

Gastro-intestinal tract

Urinary tract

Reproductive tract

Achillea is considered a menstrual regulator. Used for:

Musculoskeletal

Pharmacy

Three times daily  
Infusion of dried herb –   2–4 g
Tincture 1:5 (45%) –   2–4 ml
Fluid Extract (25%) –   1–2 ml

As the flowers contain more volatile oil, if they are used on their own the anti-inflammatory, antispasmodic and diaphoretic activity is amplified, whereas the whole herb has a relatively higher tannin and bitter content and therefore greater astringency and choleretic activity.

To generate azulene as described above, the plant must be subject to steam distillation and this may be achieved by adding boiling water to it and using as a steam inhalation e.g. in asthma, or by covering the cup so that steam condenses back thus preserving the azulene that is formed.

Precautions and/or safety

Achillea is used in cosmetic products and at a concentration of 2% is non-irritating and does not produce phototoxicity.30 Rarely, an allergic dermatitis has resulted from lying on new mown grass in which Achillea has been growing, and if skin is wet a rash may develop with pustules and hive-like lesions. The sensitiser of extrinsic dermatitis to Achillea is believed to be α-peroxyachifolid, although other sesquiterpene lactones probably also contribute19,20 (see General Precaution p. 25).

Large doses of the fresh herb can cause vertigo and headache or those conditions for which it is generally used.

Historical uses

Heal-all; for melancholy; blood purifier; kidney disorders. Externally inserted into nose to relieve migraine; nose bleeds; toothache; baldness (as a wash); mouth and eye wash; healing agent for all kinds of wounds and ulcers.

Arctium lappa

Burdock

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Family Asteraceae, Tribe Cynareae

Description

A biennial which dies down in winter. In the first year it forms a basal clump with long peduncles. Basal leaves broadly deltoid to ovate, green and sparsely hairy above, whitish and densely hairy beneath, 20–40 × 20–35 cm; base truncate to cordate; apex sub-acute to obtuse; margin dentate with apiculate vein endings; petioles solid. Upper leaves, (2nd year), alternate, similar to basal, becoming smaller. In the second year plants become openly branched, 1–1.5 m tall. Stems grooved, glabrous or with cobwebby glandular hairs. Inflorescence corymbose; peduncles 4–9 cm long. Capitula 20–25 × 30–40 mm, broadly ovoid. Involucral bracts in several series, straw yellow or yellow-green, linear, imbricate, glabrous or with sparse cobwebby hairs, the outer recurved at fruiting; margins smooth, apex spinous, inwardly hooked. Florets male and female, all tubular, corolla five-lobed, reddish purple. Achenes 6–7 mm long; pappus 1.5–3.5 mm long. Flowers in summer; fruits late summer to autumn.

Taste—the root becomes soft on chewing and tastes sweet and mucilaginous at first, becoming bitter later.

Habitat and cultivation

Originally from Europe, burdock is naturalised elsewhere along roadsides and waste places. It grows only from seed, likes deep, friable soil and flowers in its second year. It is a noxious weed in pasture because its burrs ruin sheep fleeces. Drought tender and frost resistant.

Parts used

The roots harvested in autumn of the first year or spring of the second year before the flowering stem develops. Leaves, heads and seeds have also been used. The leaves are gathered in the first year.

Active constituents

Root

1) Inulin (up to 45%) including a low molecular weight fructofuranan,31 and a xyloglucan consisting of repeating units of hepta-, nonaand deca-saccharides32

2) Phenolic acids including chlorogenic, isochlorogenic and caffeic acids47

3) Polyacetylenes some containing sulphur (0.1%–0.002%)33—including arctinone-a, arctinols and arctinal

4) Essential oil (up to 0.4%) comprising a large number of constituents34

5) Bitter glycosides—arctiopicrin—a germacranolide

6) Flavonoids including baicalin35

Additional constituents include condensed tannins, resin, PABA, amino acids including γ-guanidinobutyric acid and mucilage.

Leaf

1) Sesquiterpenes including fukinone, arctiol and taraxasterol

2) Arctiopicrin, a germacranolide

3) Lignans including arctiin and its aglycone arctigenin36

Also contains mucilage, tannins and inulin.

Fruits/seeds

These are used in traditional Chinese medicine and have not been part of modern western use.

1) Lignans including arctiin37 (around 49%),38 arctigenin, neoarctin, mataiesinol, lappaol39 and dilignans40

2) Phenolic acids including chlorogenic acid41

Additional constituents include daucosterol, gobosterin, essential and fatty oils.

Nutritional constituents

Vitamins: A, B2, B3, C, E and P

Minerals: Iron, calcium, copper, iodine, silicon, sulphur and zinc 12% protein, 70% carbohydrate.

Actions

1) Depurative

2) Diuretic

3) Orexigenic

4) Antibacterial (fresh root preferable)

The seeds have a reported hypoglycaemic action and are used in the Chinese tradition to cool and decongest.

Scientific information

The roots have been an official medicine in some European countries as a diuretic and diaphoretic.42 They are eaten in Japan as they are a good source of dietary fibre and are also very nutritious. There has not been much recent research into their constituents or pharmacological activity.

In vitro—The root is anti-inflammatory and anti-oxidant43,44 and one of its constituents is antimutagenic.45 Chlorogenic acid is a strong antioxidant,46 its presence in the root is concentrated in the skin.47

Arctium's use in Brazilian traditional medicine prompted its screening as an antimicrobial. It has activity against Staphylococcus aureus, Bacillus subtilis, Escherichia coli and Pseudomonas aeruginosa and also antifungal activity against Candida albicans.48 It has apparently been used by some traditional healers to treat AIDS, it inhibits the integration of HIV into cells.49 The herb also has a moderate inhibitory effect on tumour growth.50

Recent studies indicate that arctiin's conversion to metabolites with phyto-oestrogenic potential may occur via transformation by gut flora.51

Inulin offers a number of potential health benefits including enhanced immune function, improved bowel flora52,53 and decreased inflammation of the intestinal mucosa (see Cichorium).54

Medicinal uses

Arctium is believed to achieve its main actions through its ability to help the body detoxify.

Gastrointestinal tract

Urinary tract

Musculoskeletal

As a depurative and diaphoretic the herb may open up channels of excretion—bowel, kidney, lungs and skin:

Skin

Externally

Used topically for the treatment of the above skin conditions as an ointment, it seems to increase the skin's ability to repair itself. Used as a poultice for:

Pharmacy

Three times daily  
Decoction of dried root –   2–6 g
Infusion of dried leaf –   2–6 g
Tincture 1:10 (45%) –   8–12 ml
Fluid Extract (25%) –   2–8 ml

The depurative action of Arctium may best be achieved by use of infusions or decoctions as this aids kidney elimination.

Precautions and/or safety

Side-effects are rare, there is reference to a case of contact dermatitis55 (see General Precaution p. 25) and also a case of poisoning with burdock tea,56 the latter has since been attributed to contamination of the root with Atropa belladonna root.57

Interactions

Animal studies suggest Arctium may exacerbate diabetes however the root is in common use in Italy as an aid to the treatment of this disease58 and in countries where the root is eaten no interactions have been reported.

Historical uses

In the Middle Ages it was used for stones (Grieve) though whether this refers to gall-bladder or urinary tract is not clear. To cure old ulcers and sores; to help with “serpent bites” or the bites of mad dogs; to relieve sciatica; aid the healing of burns.

Arnica montana

Arnica

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Family Asteraceae, Tribe Heliantheae

Description

A perennial mountain plant with a stout creeping rhizome and a flower stalk reaching 20–60 cm tall. Basal leaves in a rosette, slightly toothed, oval to lance-shaped, 5–17 cm long, glandular hairy and aromatic. Stem leaves much smaller, downy, in one to two opposite pairs. Flower heads rich yellow, large, 4–8 cm across, usually solitary but may be up to 4 on stout erect stems. Ray florets, female, toothed, wide spreading, in a single row, as long as or longer than the width of the disc; disc florets, hermaphrodite, the same yellow; involucral bracts equal in 2 rows. Fruit an achene, 7–9 mm long, ribbed; hairy; pappus a row of long hairs. Flowers in Europe from spring to mid-summer.

N.B. Arnica may be distinguished from the similar Doronicum by its opposite stem leaves. Stem leaves of Doronicum are alternate.

Habitat and cultivation

Arnica is native to mountainous regions in Europe, growing in pastures, heaths and wastelands from Latvia and Norway south to Portugal. It is propogated by seed sown outside in autumn or root division in spring and prefers a mix of peat, loam and sandy soil.

Parts used

The whole flowers are harvested in full bloom and used fresh or dried. The rhizomes have also been used, though less commonly, and these should be harvested in spring or autumn.

Active constituents

1) Sesquiterpene lactones (0.4%) including predominantly the pseudoguaianolides helenalin and its derivatives (approx. 50%), dihydrohelenalin and its derivatives59 and arnifolin.60 This fraction is considered largely responsible for the action of Arnica however the content of the 2 major lactones have been found to vary with time of harvest and part of flower used. Helenalin is highest in the disc florets descending in amount through ray florets, receptacle and stem, whereas dihydrohelenalin is highest in stems. Lactones increase in amount as the flowerheads mature, the total content being highest in withered flowers61

2) Essential oil including thymol and esters of arnidiol, faradiol, maniladiol and calenduladiol60,62

3) Flavonoids including eupafolin, patuletin and spinacetin Also contains mucilage, carotenoids,63 a bitter principle (arnicin), resins, tannins and polysaccharides.

Actions

1) Anti-inflammatory

2) Counter-irritant

Scientific information

Arnica is a well recognised anti-inflammatory and has been an official medicine in many countries in Europe. The pharmacopoeia uses listed for both flowers and rhizomes are for bruises and sprains.42

Anti-inflammatory

In vitro—The sesquiterpene lactones are considered central to the anti-inflammatory effect of Arnica. They inhibit transcription factors that initiate inflammation, even at low concentrations,64 in a dose-dependent manner.65 Helenalin has the strongest anti-inflammatory effect its mode of action being different from that of non-steroidal anti-inflammatory drugs, indomethacin and acetyl salicylic acid.66 Both helenalin and dihydrohelenalin inhibit platelet aggregation, thromboxane and 5-hydroxytryptamine secretion, probably by reducing phospholipase A2 activity.67

In vivo—Topical application of Arnica and hydroxyethyl salicylate gave a greater analgesic effect than either substance alone.68 Arnica gel did not significantly improve bruising after laser surgery69 but it reduced pain and stiffness in mild to moderate osteoarthritis of the knee70 (6 weeks applications).

A combination of homeopathic Arnica internally and Arnica ointment topically used post-operatively for carpal tunnel release surgery reduced pain but had no affect on swelling and/or muscle strength.71

Other

In vitro—The sesquiterpene lactones have significant activity against Plasmodium falciparum, the organism causing malaria, helenalin was stronger than artemisinin72 from Artemisia annua currently being used to treat resistant forms of the disease. They also have activity against the African Trypanosoma brucei rhodesiense and American T. cruzi.73 Arnica itself has long been considered an antimicrobial and shows good antibacterial activity against most periodontal organisms.74

The polysaccharides stimulate phagocytosis75,76 and TNF-α secretion from macrophages.77

Helenalin is cytotoxic to small lung carcinoma and colorectal cancer cells.78

Medicinal uses

Externally

Pharmacy

ARNICA IS NOT USED INTERNALLY OR ON BROKEN SKIN

Applied as required

Tincture BPC (1949) 1:10 (45%) as a compress Cream or ointment up to 25% v/w.

Some pharmacopoeias recommend an extraction medium of ethanol:water of 60–70%.42

Precautions and/or safety

Internally—Arnica can irritate mucous membranes causing severe gastroenteritis, hypotension, tachycardia, dyspnoea, coma and possibly death.

Externally—there is the potential for allergic dermatitis reactions (see General Precaution p. 25)7 probably due to the sesquiterpene lactones79–81 which are well absorbed through the skin.82 The estimated level of allergy to Arnica could be just over 1%.83

A review into its safety has concluded that there is insufficient data available of the effects of long term exposure to topical preparations. Standard animal based safety tests undertaken by this review found no cause for concern from short term use.84

Historical uses

Arnica is mentioned by Hildegarde of Bingen (12th century) and has been used extensively in European folk medicine. Weiss states its use, like that of Crataegus, is as a circulatory stimulant but for acute conditons i.e. for senile heart and heart disease. [Goethe (1749–1832) apparently drank Arnica tea to ease angina pain.] Also for fevers; paralytic affections; slow healing wounds; leg ulcers. As a gargle for sore throat, pharyngitis; smoker's cough.

NB It is no longer recommended for internal use.

Artemisia absinthium

Wormwood

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Family Asteraceae, Tribe Athemideae

Description

Herbaceous perennial, dying back more or less to woody stem bases each winter. Stems numerous ascending to erect, densely sericeous, becoming glabrous below, ribbed, up to about 1 m long, much branched towards the base. Leaves scattered along stems, densely sericeous on upper and lower surface, appearing silvery-white. Lower cauline leaves petiolate, 1-pinnate with leaflets usually 2 pinnatisect, up to about 30 × 20 cm in lower leaves; ultimate segments oblong-ovate, obtuse, 5–10 × 2–4 mm, with only the central vein evident. Inflorescence paniculate, with leaves similar to cauline leaves but becoming apetiolate and 1-pinnatisect, finally reduced to less than 1 cm long and not lobed. Flowers arranged in a panicle, outer involucral bracts herbaceous or with a membranous apex, sericeous; inner bracts sparsely hairy, with broad membranous margins and apex. Capitula 2–4 mm in diameter; receptacle pilose; florets many, dull yellow, glabrous. Achenes 0.8–1.3 mm long, brown, ovoid, more or less terete, smooth; no pappus. Flowers from mid-summer to autumn. Cultivars of A. absinthium e.g. “Powis Castle” are not used medicinally.

Odour—aromatic, sweet and bitter; taste—aromatic and intensely bitter.

Habitat and cultivation

Native to Eurasia and North Africa, wormwood grows in waste places and rocky screes. It is naturalized elsewhere in dry, sunny situations. It is grown from seed or cuttings and is frost tender and does not survive prolonged drought.

Parts used

Leaves and flowering tops collected as the plant comes into flower.

Active constituents

1) Essential oil (max. 1%) predominantly monoterpenes, including, α- and β-thujone, epoxyocimene, linalool, sabinene, 1,8-cineole, chamazulenes and their derivatives.85–87 There is considerable variation in the constituent make-up according to origin.88 Immature leaves contain a high level of sabinyl acetate as well as α-thujone and sabinene89

2) Bitter sesquiterpene lactones including absinthin, matricin, anabsinthin, artabsin, absintholide90 and santonin

3) Terpenoids including homoditerpene peroxides91

4) Triterpenoids

5) Flavonoid glycosides (many)

6) Hydroxycoumarins

7) Polyacetylenes

Also tannins, resin, choline and organic acids including chlorogenic acid and amino acids (significant levels of histidine92) have also been identified.

Nutritional constituents

Vitamins: B complex and C

Minerals: Manganese, calcium, sodium, potassium and silicon

Actions

This is a herb with an enormous number of active constituents that give it a wide range of actions.

1) Bitter tonic

2) Stomachic

3) Choleretic

4) Anthelmintic

5) Anti-inflammatory

Scientific information

Wormwood has been a recorded medicine since at least 1552 BC and its common name gives a clear indication of its anthelmintic properties. It has been an official medicine, its bitter properties being used to stimulate appetite and improve digestive function.42

In vitro—The herb and/or its constituents have:-

Thujone was identified as the constituent that caused absinthe “intoxication”. It was believed at one time to act via cannabinoid receptors, however animal studies indicate this is unlikely.100 A-thujone (which is the more toxic of the two thujones) may affect the nervous system by:

a) blocking the inhibitory effect of γ-aminobutyric acid leading to excitation of neurones

b) inhibiting serotonin receptors101

c) causing a porphyric crisis in cases where its metabolic breakdown is too slow101

It is, however, unlikely that either thujone isomer was responsible for the observed effects of “absinthism” (see Precautions).

Santonin is listed as an official vermifuge.42

In vivo—A combination of herbs predominantly composed of wormwood improved the standard medical treatment of patients with Crohn's disease, enabled a reduction and/or cessation of steroid treatment and improved mood and quality of life.95 Thujone at high enough levels can reduce mental performance and negate the anxiolytic effect of alcohol.102

Old research had demonstrated that wormwood stimulated digestive secretions from both pancreas and liver.103

The herb is used traditionally in the West Indies to treat worms104 and it is a frequently used agent in rural Italy against parasites and as an insect repellent.105

Medicinal uses

Gastrointestinal tract

It has a reputation for use in poor digestion and lack of energy resulting from inadequate nutrition.

Reproductive tract

Regarded as a stimulant of uterine muscle and antispasmodic the herb is used for:

Musculoskeletal

Pharmacy

Three times daily  
Infusion of dried herb –   1–2 g
Tincture 1:5 (45%) –   1–2 ml (suggested guidelines)
Fluid Extract (25%) –   1–2 ml

The herb is used in small doses to tone the digestive tract and stimulate the appetite and in larger doses to act as a vermifuge and toxin cleanser. The powder is used in 4–10 g doses for intestinal worms.

Artabsin, like achillin in Achillea and chamazulene in Matricaria recutita, will generate azulene on steam distillation and should be prepared accordingly (see Achillea) if the anti-inflammatory properties are required. Diluted oil may be used externally for local pains.

Extracts may be standardised on absinthin content. Available commercially in wine and aperitifs e.g. Vermouth.

CONTRAINDICATIONS—Pregnancy.

Precautions and/or safety

The essential oil of Artemisia absinthium was the basis of the French liqueur absinthe which had a narcotic and hallucinogenic effect attributed to thujone. It was banned because it was deemed to cause damage to the central nervous system. Interestingly due to the recent re-instatement of absinthe to the market, an analysis of the content of thujone in vintage absinthe and absinthe made according to old recipes was undertaken using sensitive tests. The amount of thujone present was well below current maximum allowable levels. The authors’ deduced thujone at most would have made a very minor contribution to the symptoms of absinthism.106 They speculate that this phenomenon was a result of adulterants in the spirit e.g. colouring agents or chronic alcoholism possibly (it was extracted into high strength alcohol101).

In excessive amounts the herb may cause insomnia, nightmares, vomiting and convulsions. It should therefore not to be used for long term therapy and the maximum weekly dosage must not be exceeded. Toxicity due to thujone is rare101 and used properly wormwood is a valuable and safe herb.

There is a possibility of allergy (see General Precaution p. 25), which could also be linked to the high levels of histidine.100

Historical uses

Counteracting the effects of poisons including hemlock and toadstools. Cancer; colds and fevers; rheumatism; to deter insects; epilepsy; melancholy; nervine; colic; jaundice (for which Culpeper rates this herb most highly), hepatitis and congestive states of the liver; diuresis; for treating bruises and contusions; scabs and itches; as a face wash to make the face “fair”. There has been some speculation that Vincent van Gogh did not suffer from a psychosis but an overuse of absinthe and liking for terpenes of the thujone type (camphor and pinene).107

Artemisia vulgaris

Mugwort, cronewort

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Family Asteraceae, Tribe Anthemideae

Description

An erect, aromatic, much branched perennial, 60–120 cm high, dying back every winter. Rhizomes branched, nodular. Stems grooved, reddish, erect but tending to flop as flowering begins. Basal leaves 5–8 cm long, stalked, pinnately lobed, stem leaves stalkless and clasping the stem, once or twice pinnate with ultimate segments lance-shaped, dark green and glabrous above, very white underneath. Inflorescence erect, forming a long, leafy terminal panicle, each head containing 12–20 complete florets and a few female ones, all fertile. Florets ovoid 3–4 mm reddish-brown, with cottony involucres. Achenes obovate without any pappus. Flowers mid-summer to autumn.

Odour—aromatic; taste—spicy and a little bitter.

Habitat and cultivation

Native to all Europe and much of Asia from the Arctic Circle to the Tropics in waste places. Cultivated elsewhere from seed or root division, forming large clumps in sunny places. Drought and frost resistant.

Parts used

The flowering herb.

Active constituents

1) Volatile oil which varies with geographical location and time of harvest.108,109 In Europe the oil appears to be predominantly comprised of camphor (up to 47%) with significant amounts of myrcene, 1,8-cineole, borneol, terpinen-4-ol, sabinene, caryophyllene and β-thujone;87 Indian and Moroccan oil is mainly camphor but also α-thujone (max. 56%) and β-thujone; Cuban oil mainly caryophyllene oxide (up to 31%), Vietnamese mainly 1,8-cineole, α-terpineol and camphor with increasing levels of α- and β-pinene as the plant reaches flowering. Previously β-caryophyllene, β-cubebene and β-elemene had been identified. Camphor and α-terpineol levels were found to be fairly constant through maturation of the flowers but other constituents such as borneol, myrtenol and carveol decrease with flowering. Leaf and flower oil are similar

2) Sesquiterpene lactones—vulgarin110

3) Coumarins including scopoletin111

4) Triterpenes including β-sitosterol

5) Phenolic acids including hydroxycinnamic, chlorogenic, dicaffeoylquinic and eudesmane acids112–114

6) Cyanogenic glucoside—prunasin115

Also contains flavonoids, tannins, polyacetylenes,116,117 eudesmane dialcohol112 and fernenol.118 The species of Artemisia from which vulgarin was first isolated has more recently been identified as A. verlotorum Lamotte.119

Nutritional constituents

Vitamins: Niacin and C

Minerals: Chromium, iron, manganese, phosphorous and potassium

Actions

1) Emmenagogue

2) Orexigenic

3) Choleretic

4) Stomachic

5) Anthelmintic

Scientific information

There is not a great deal of modern research on this herb however it has been used in both western and eastern traditions of herbal medicine. In the west it was used as an insect repellent and flavouring for drinks, in the east it is used for the preparation “moxa”.

In vitro—The essential oil of mugwort has a similar antimicrobial activity to that of wormwood.87 Extracts of the whole herb and the volatile oil, in particular, have the following activities:-

Prunasin is an inhibitor of DNA polymerase.115

In vivo—Artemisia vulgaris in combination with 7 other herbs was used as an irrigant following prostatectomy and effectively reduced the incidence of bladder infection and bleeding without side-effects.125

The obvious similarities to A. absinthium indicate similar medicinal uses for this herb but generally mugwort is considered weaker and with a more specific application for the female reproductive tract. In the Philippines it is used as an anti-inflammatory.

Medicinal uses

Gastrointestinal tract

Mugwort has a similar effect on the digestive tract to wormwood and is used for the same conditions, as a bitter tonic to stimulate the appetite, improve digestive function and as an anthelmintic. It is considered to be carminative.

Nervous system

Reproductive tract

It seems to be able to exert a toning, as well as stimulating effect, on the uterus:

BHP specific for mugwort are for functional amenorrhoea and dysmenorrhoea.

Pharmacy

Three times daily  
Infusion of dried herb –   0.5–2 g
Tincture 1:5 –   2–4 ml (suggested guidelines)
Fluid Extract (25%) –   0.5–2 ml

CONTRAINDICATIONS—Pregnancy.

Precautions and/or safety

Mugwort pollen seems to be commonly implicated in allergic rhinitis and/or asthma. Large doses of the herb should be avoided (see also General Precaution p. 25).

Historical uses

Used in beer making before being replaced by hops. To treat urinary stones; dropsy and jaundice; expel poisons including those from an over indulgence of opium and from infections e.g. boils; sciatica; “hysterical fits”; palsies. Fevers. Externally to treat wens and hard knots and kernels around the neck and throat; as a warm wash to treat pains of the sinews and cramps.

Calendula officinalis

Marigold, pot marigold

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Family Asteraceae, Tribe Calenduleae

Description

Erect or ascending annual or short-lived perennial, sometimes with a woody base, 15–50 cm tall. Stems clothed in short erect glandular hairs usually becoming glabrous below, much branched. Leaves, basal and lower cauline sparsely to moderately hairy, ciliate, usually narrow-obovate, sometimes elliptic/orbicular, entire with a few minute, scattered teeth, obtuse to acute and mucronate, apetiolate and long-cuneate, 6–20 × 1.5–5 cm. Upper cauline leaves similar but becoming smaller, oblong to lanceolate, broad-based and often amplexicaul. Capitula solitary, 35–85 mm diameter. Involucral bracts in 2 rows, glandular and ciliate, lanceolate, acuminate 10–15 mm long, the inner with more conspicuous margins. Ray florets 40–60, in 1-several rows; ligules usually orange or shades of yellow, clearly exceeding bracts, 12–30 mm long. Disc florets numerous, usually orange or shades of yellow, rarely brownish-black. Achenes glabrous or sparsely hairy, usually of 3 types:

a) outermost achenes strongly incurved, longbeaked, 12–18 mm diameter, with small stout spines on back, usually alternating with

b) shorter, short-beaked, broadly 3-winged, tuberculate or smooth-backed achenes

c) inner achenes enclosed by outer, tuberculate on back, 4–7 mm diameter.

Flowers all year in many areas with the main season late spring to late autumn.

Odour—faint but characteristic; taste—somewhat bitter and salty.

Habitat and cultivation

Native to Mediterranean Europe and grown in other countries from seed. Self-sows freely in sunny open situations with adequate water. Removing dead flower heads encourages more flowers and sturdy plants. Humidity can cause mildew. Drought and frost resistant.

Parts used

Flowers or ray florets gathered when fully opened. May be used fresh or dried.

Active constituents

1) Triterpenes

a) alcohols and esters which are based on monol, diol and triol alcohols.126 Faradiol (85%) monoesters and calenduladiol are the main diols,127,129 arnidiol and maniladiol are present in much smaller quantities.128 The triterpendiols are the main lipophilic constituents128,129 and the diol esters make up between 2–4% of the dry mass of flower. Monols include Ψ-taraxasterol,130 taraxasterol, helianol,131 α- and β-amyrin and lupeol, and triols include heliantriol, ursatriol and longispinognine. The levels of esters are highest in the ray florets, present to a lesser extent in the disc florets and lower still in the involucral bracts. None are present in the receptacle132

b) triterpenoid saponins including calendulosides A–F, based on oleanolic acid and representing 2–10% of the dry mass of flowers126,133

2) Carotenoids—(1.5–3%) mainly flavoxanthin and auroxanthin.134 The constituents differ with petal colour135 and in quantity with geographical origin136

3) Essential oil—(0.02%) including ionone glucosides and sesquiterpene oligoglycosides (officinosides)137

4) Flavonoids—(0.3–0.8%) derivatives of isorhamnetin and quercetin including astragalin, hyperoside, isoquercitrin and rutin126

Also contains sterols, mucilage, resin, chlorogenic acid and polysaccharides.138

Nutritional constituents

Vitamins: A, C, E and coenzyme Q10

Minerals: Phosphorus and calcium

Actions

1) Anti-inflammatory

2) Vulnerary

3) Spasmolytic

4) Emmenagogue

5) Antihaemorrhagic

6) Antiseptic†

7) Styptic

In addition this herb is also credited with being a mild diaphoretic, a circulatory stimulant and a sedative.

Scientific information

Calendula was once an official medicine and has been used in the west as well as in Asia. It is approved by German Commission E for the treatment of oral mucosa inflammation and topically as a cicatrizing agent for healing skin injuries. Although recent research has gone into identifying the constituents of Calendula not a great deal of new information has emerged to support the traditional use of this effective and frequently used herb. It is also used in the food industry as a colouring agent.

Antimicrobial

In vitro—The contstituents of Calendula and, to a limited degree, the whole extract have antimicrobial activity including:-

The herb also has potential immunomodulatory activity.147,148

In vivo—Calendula used clinically with acyclovir in treating herpetic keratitis (the result of HSV-1 infection affecting the cornea) was more effective at healing ulceration then acyclovir alone.149

Anti-inflammatory and vulnerary

In vitro—The triterpenoid esters are considered to be largely responsible for the anti-inflammatory activity of the herb,128 especially faradiol which is present in high levels.129 The flavonoids based on isorhamnetin inhibit LOX.150

In vivo—Calendula was one of a combination of herbs used to successfully treat:-

Internally:-

Externally:-

Apart from a number of animal based experiments which have examined the wound healing properties of Calendula its use for this purpose is based on tradition and anecdotal evidence.140

Other

In vitro—Calendula has significant anti-oxidant activity,155 aqueous extracts being superior to methanolic ones.156

The herb and some constituents are cytotoxic to a range of cancer cells including colon, melanoma and leukaemia lines.126,148

The polysaccharides have a strong immunostimulatory activity, enhancing phagocytosis.138,139,157

Medicinal uses

Cardiovascular system

Calendula has a reputation for improving varicose veins and is used both internally and externally. It also benefits the lymphatic system.

Respiratory tract

Gastrointestinal tract

The local healing, anti-haemorrhagic and bitter properties give the herb a broad use in the GIT:

Reproductive tract

Externally

The combination of Calendula's actions make it applicable for the treatment of many skin problems:

The specific action according to the BHP is for enlarged and inflamed lymph nodes, sebaceous cysts, duodenal ulcers and acute and chronic inflammatory skin lesions.

Pharmacy

Three times daily  
Infusion of dried herb –   1–4 g
Tincture 1:5 (90%) –   0.3–1.2 ml
Fluid extract (40%) –   0.5–1 ml

The oleoresin, containing the triterpenes, is considered to contribute significantly to Calendula's beneficial effects but it requires 90% alcohol to solubilise it.

Internally—infusion and tincture. Externally—infusion as a wash or applied as an oil, ointment or cream.

Precautions and/or safety

There is potential for Calendula to cause allergic reactions79 (see General Precaution p. 25) with an estimated incidence of around 2% in sensitive individuals.158

The tincture is usually prepared at high alcohol concentrations so care is needed when using it on abraded tissues such as peptic ulcers. An alternative in the acute phase of therapy may be to use infusions.

Calendula extracts have been tested for irritant effects and safety according to the standards used by the cosmetic industry and are classified safe. Human safety is based on tradition.159 It is both genotoxic and anti-genotoxic as well as displaying cytotoxicity in some standard non-human models. However it is not mutagenic.160–162

Historical uses

Bites of wild animals; liver and spleen congestion; stomach complaints; cancer treatment. The juice was used externally for psoriasis; swollen glands; warts; contusions and bruises. To strengthen the heart; smallpox; measles; headaches; jaundice; red eyes; toothache; ague; plague. Leaves eaten fresh for scrofula in children.

Cichorium intybus

Chicory, succory

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Family Asteraceae, Tribe Lactuceae

Description

Perennial rosette herb. Stems erect, 40–120 cm tall, branched above, finely ribbed, glabrous or with short crisped hairs. Leaves, rosette and lower stem leaves petiolate, oblanceolate, simple, toothed, shallowly or deeply pinnatifid, 10–30 × 2–7 cm, margin dentate. Upper leaves alternate, sessile, smaller than lower leaves, becoming less lobed, lanceolate with amplexicaul base, distantly toothed. Capitula in sessile clusters or terminal on short peduncles 2–6 cm long. Involucre 11–13 mm long: bracts with sparse, long, glandular hairs or glabrous, enclosing achenes tightly at fruiting. Florets few, corolla usually blue, sometimes white, about twice the length of the involucre, tube less than ligule. Achenes angular-obconic, flat at apex, glabrous, pale or mottled 2.5–3 mm long. Flowers mid-summer to autumn. Flowers open with the morning sun and close about midday.

Habitat and cultivation

Originally from Europe, West Asia and North Africa Cichorium is naturalised in other countries in cultivated and waste lands. It is an important permaculture crop. Grown from seed set 30 cm apart and transplants easily when young. Cut flowering stems back in autumn. Clumps can be dug in autumn and roots with a crown divided and replanted. Drought and frost resistant.

Parts used

Root harvested in autumn, in the second year of growth or thereafter.

Active constituents

1) Sesquiterpene lactones of the guaianolide group including lactucopicrin (intybin), lactucin and 8-deoxylactucin,163–165 these are the predominant sesquiterpene lactones. Also present are eudesmanolides including magnolialide and germacranolides165,166

2) Triterpenes including α-amyrin, taraxerone, β-sitosterol,167 taraxasterol and daucosterol170

3) Coumarins including cichoriin and glycosides of esculetin

4) Flavonoids including apigenin and quercitin

5) Pseudotannins

6) Inulin (up to 58%) consisting of linear fructan polymers, 2–60 units (average 12 units) in β (2,1) linkage168

Other constituents isolated from Cichorium include furofuran lignans,169 phenolics including syringin, chlorogenic and cichoric acids,164,169 azelaic and other carboxylic acids,170 mannitol and the alkaloids harman and norharman.

Nutritional constituents

Vitamins: A, B, C, K and P

Minerals: Calcium, potassium, sodium and magnesium

Actions

1) Bitter tonic

2) Diuretic

3) Laxative

Scientific information

The herb has been recorded as a medicine since 1550 BC although today it is perhaps better known as a food. The leaves are eaten in salads or as a cooked vegetable and the roots, roasted and ground, are used in coffee powders. It is used in the East as an anti-inflammatory. In Turkey Cichorium is a traditional treatment for stomach pain whilst in India183 and Peru185 it is used for treating gastro-intestinal infections.

Similarities exist between its constituents and those of Taraxacum but Cichorium does not have the stature in the British herbal tradition that dandelion enjoys, although it is more highly valued in Europe. There are many varieties of C. intybus used commercially.

Anti-oxidant

In vitro—The leaves171,172 and root extract173 have both demonstrated anti-oxidant activity.

Digestive tract

In vitro—Current research has focussed on the benefits of inulin, derived mainly from Cichorium root, as a functional food. Inulin is water-soluble but it is not amenable to digestion in the gut due to the way the fructose units are linked.168 It ferments in the digestive tract forming short chain fatty acids and lactic acid which are absorbable.174 Inulin is described as a “prebiotic”, because it has the potential to make improvements to gut flora, without containing any flora itself and without being absorbed. This leads to improvement in metabolic function, stimulation of the growth of beneficial bacteria, like bifidobacteria, and a reduction in the levels of harmful organisms.175 The short chain fatty acids may play a role in this action.168

The sesquiterpene lactones are bitter.164

In vivo—Inulin enhances the absorption of calcium, reduces blood lipid levels including triglyceride and cholesterol.168 Human faecal flora show increased levels of bifidobacteria after supplementing with partially hydrolysed inulin.175 However all fructans, including inulin itself, are bifidogenic.176 In addition as a soluble fibre it bulks out stools, increasing their water content and improving bowel function with less associated discomfort than lactulose.177

Inulin may also help to regulate food intake and blood glucose levels though this is yet to be established in humans.178

Other

In vitro—The root extract and/or the main sesquiterpenoids inhibit acetylcholinesterase,179 have potential to be anti-inflammatory (through inhibition of COX-2 induction and activity)180 and also to be immunomodulatory.147

Inulin fructans and magnolialide inhibit the growth of several tumour cell lines, modulate differentiation and reduce metastatic activities.174,181

Cichorium has been used traditionally as a treatment for malaria in Afghanistan and lactucin and lactupicrin are antiplasmodial against Plasmodium falciparum.182 The herb has antimicrobial activity against a variety of bacteria including a multi-drug resistant species of Salmonella typhi183,184 (but not against Vibrio cholerae185) and antifungal activity against the dermatophytes Trichophyton rubrum and T. tonsurans.164

In vivo—Inulin's various actions on the bowel include its potential, through the short chain fatty acids like butyrate, to reduce colon cancer and a project was due to assess its protective benefits to patients at high risk of developing this disease.186

A meta-analysis spanning 30 years of clinical trials found an Ayurvedic formulation containing Cichorium was beneficial in the treatment of hepatitis A.187 This same formulation was also hepatoprotective in patients with liver cirrhosis.188

Medicinal uses

Gastrointestinal tract

Urinary tract

Musculoskeletal

The herb encourages the excretion of metabolic waste through increased bile secretion and is also attributed with the ability to increase uric acid excretion. Used in the treatment of:

Pharmacy

Three times daily  
Decoction –   8–12 g (suggested guidelines)
Tincture 1:5 –   2–4 ml

The root may be juiced when fresh and a suggested dosage is 10–15 ml three times daily. Trials on the benefits of inulin used 4–20 g daily.

Note: Inulin is extracted from the root in hot water, it is only slightly soluble in cold water or alcohol, and therefore it is not a major active constituent in the tincture.

Precautions and/or safety

For allergic potential see General Precaution p. 25. Cichorium leaves have caused a few cases of oral, cutaneous and respiratory allergy.189,190

Historical uses

This herb has been used largely as a salad food and beverage and it is possible its addition to coffee may help counter the excitatory effects of caffeine. Anaemia and debility with weakness and fatigue.

Cynara scolymus

Globe artichoke

Description

Perennial, rosette plant, 1–2 m tall in flower. Stems stout, ridged, sometimes branching, with fine white hairs. Basal leaves deeply pinnatifid, 30–60 × 15–40 cm, with lanceolate lobes becoming smaller near the base, smooth greyish-green above, tomentose beneath, viscid. Midrib stout and ridged. Stem leaves similar but becoming smaller and less divided. Capitula usually solitary, 8–12 cm in diameter, in terminal heads. Involucre globose to hemispheric, with fleshy outer and middle bracts. Corolla 50–65 mm long comprised of all disc florets, rich lilac blue in colour. Achenes 6–9 × 3–5 mm, obovoid, usually pale and spotted with a 30–50 mm long pappus. Blooms and fruits in late summer.

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Family Asteraceae, Tribe Cynareae

Habitat and cultivation

Cynara is native to, and originally cultivated in, the Mediterranean region probably evolving from selected C. cardunculus which were not spiny and had fleshier involucral bracts. It is cultivated in many countries as a gourmet food. Grown from seed or division of clumps. Likes deep, rich, alkaline garden and dies back after flowering. Drought tender, frost resistant.

Parts used

The leaves, which are at their most bitter just before flowering.

Active Constituents

1) Sesquiterpene lactones (0.5–4%) of the guaianolide type, mainly cynaropicrin, and others including cynarascolosides A–C191

2) Phenolic acids (up to 2%) the main ones being mono- and di-caffeoylquinic acids including chlorogenic acid, caffeic acid and cynarin (1,5-dicaffeylquinic acid).192–195 Cynarin may be an artefact of aqueous extraction196

3) Flavonoids (0.1–1%) based largely on luteolin also cynaroside and apigenin derivatives193,195

Also contains coumarins, alkaloids, phytosterols (taraxasterol), pseudotannins, polyacetylenes and a curdling enzyme—cynarase.

Nutritional constituents

Vitamins: Provitamin A, B1, B2 and C

Minerals: Iodine

Actions

1) Hepatoprotective

2) Choleretic

3) Cholagogue

4) Diuretic

5) Liver trophorestorative

6) Hypolipidaemic

Scientific information

Cynara was cultivated in ancient Rome and Greece. It has been an official medicine and was listed in a number of European countries as a diuretic and choleretic.42 It is approved by German Commission E for use in dyspeptic conditions.

Anti-oxidant

In vitro—The phenols and especially luteolin and cholorgenic acid are significant anti-oxidants.197 Both aqueous and particularly ethanolic extracts display anti-oxidant properties superior to the lipophilic fraction.198,199

Circulation

The action of artichoke leaves on lipid levels although newer to medicine than that of its choleretic properties has nonetheless been appreciated for some decades.

In vitro—The phenolic constituents are considered important to activity within the cardiovascular system and they may be central to the herb's apparent ability to prevent atherosclerosis. Cynara has the following actions:-

In vivo—Cynara lowered cholesterol, triglycerides and soluble adhesion molecules (markers of lipid disorders) and increased flow-mediated vasodilation in hyperlipaemic people.201–203 The juice was also beneficial in reducing lipid levels of patients with Fredrickson types IIa and IIb primary hyperlipidaemia.204

Isolated cynarin however did not improve the biochemistry of patients with familial type II hyperlipoproteinaemia in short-term trials.205

Reviews of clinical trials using Cynara in hyperlipidaemias conclude that although it has demonstrated good reductions in blood cholesterol the trials generally lack rigor.206,207 However the herb has received some acceptance as a hypolipidaemic agent and as it is safe, it is suitable for long-term use, having fewer side-effects and added benefits compared to the corresponding pharmaceuticals.208

The herb is, in addition, a diuretic.

Gastro-intestinal

In vitro—Whilst the phenolic constituents are credited with the herb's capacity to act as a choleretic and hepatoprotective214 the whole extract likely contributes to these activities.209

In vivo—Investigations of Cynara have shown that it is a choleretic210 and has spasmolytic, carminative and anti-emetic activity.211

It was used to treat functional dyspepsia and dyspepsia due to irritable bowel syndrome with subjective improvement in gastro-intestinal function and quality of life.212–214

Other

In vitro—The herb has antifungal properties.215 A number of the phenolic constituents also have activity against bacteria including Staphylococcus aureus, Escherichia coli, Salmonella typhimurium and Pseudomonas aeruginosa and against some pathogenic fungi like Candida albicans and C. lusitaniae.193

Cynara has anti-inflammatory properties.216

In vivo—It was not effective as a prophylactic for hangovers.217 The herb was shown in early studies to have decreased blood levels of urea and nitrogenous waste218 and so may aid detoxification.

Medicinal uses

Cardiovascular system

Gastro-intestinal tract

Urinary tract

Musculoskeletal

By enhanced elimination via kidneys and liver could aid the treatment of:

Skin

For the same reasons as above, an aid to treatment of:

Pharmacy

The BHP has no entry for Cynara.

Three times daily (German Commission E recommended)

Infusion of dried leaf –   2 g
Tincture 1:5 –   6 ml
Fluid extract –   2 ml

Clinical trials used doses ranging from 320–1920 mg daily of encapsulated standardised herb or 10 ml of the juice of leaves/buds three times daily. In the latter case results were measurable after 6 weeks.

CONTRAINDICATIONS—It has been suggested that lactating and pregnant women should use Cynara with caution because of the milk curdling enzyme—there are no adverse reports and it seems unlikely to be a problem.

Pharmacokinetics

Studies indicate that the main phenolics in plasma after absorption of Cynara are caffeic, ferulic and isoferulic acid and their hydrogenated derivatives which in the main are conjugated. The nonhydrogenated metabolites have peak plasma levels 1 hour after oral administration and the hydrogenated metabolites peak after 6–7 hours.219

Precautions and/or safety

From clinical trials Cynara seems to be safe with only mild, transient, infrequent side-effects including flatulence, hunger and weakness.207 Also reported are contact dermatitis,220 rhinitis and asthma221 after handling the fresh plant and a case of anaphylaxis to inulin of Cynara origin.222 For allergic reactions see General Precaution p. 25.

Historical uses

For body odour in addition to the above uses. Snakebites.

Echinacea angustifolia

Narrow-leaved purple coneflower

Description

Tap-rooted perennial, 15–50 cm tall with erect single or branched stems which are covered with stiff bristly hairs. Leaves lance-shaped, entire, dark green with 3–5 nerves running the length of the blade. Basal leaves on long petioles, upper stem leaves sessile, alternate. Flower head solitary, with prominent, cone shaped red-brown disc florets surrounded by sterile pale to deep purple spreading rays which are about as long as the width of the disc. Involucral bracts are lance-shaped and overlapping in a series of two or more and transfer into pales as they move to the flowers themselves. (The pales are chaffy scales subtending the fruit, and extend slightly beyond the corolla of each disc flower.) They appear to be folded together lengthwise and end in sharp, blunt or slightly curved points. Once the flower head is dry the pales remain intact and this is what gave the plant its name after echinos, Greek for sea urchin or hedgehog. Achenes are four-sided and have slight teeth at each corner of the crown. Flowers mid-summer to mid-autumn.

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Family Asteraceae, Tribe Heliantheae

Odour—mildly aromatic; taste—sweet becoming bitter and causing a tingling sensation on the tongue.

Habitat and cultivation

Native to barren and dry prairies in North America from Minnesota to Texas, Western Okalahoma, Kansas, Nebraska and Iowa, the Dakotas, Eastern Colorado, Wyoming and Montana and extreme Southern Saskatchewan and Manitoba. Grown from seed which needs cold and light to germinate. Also grown from root division. Slow growing and often does not flower until second or third year. Likes an open, sunny situation and slightly alkaline soil, is drought tolerant.

Parts used

The fresh or dried root harvested after flowering is over and after the 2nd year of growth.

Echinacea pallida

Pale purple coneflower

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Family Asteraceae, Tribe Heliantheae

Description

A tap-rooted perennial growing up to a 1 m tall and dying back in winter. Leaves alternate, lower leaves lance-shaped, stiff, hairy with short petioles. Stem leaves smaller and sessile. Flowers solitary or few on long peduncles, ray florets, sparse, pale pinkish purple, about 10 cm long and drooping. Disc florets in cone whose scales are longer than the disc florets. Seeds whitish-grey and tooth-like. Blooms from late spring to late summer.

Odour—mildly aromatic; taste—sweet becoming bitter, does not cause a tingling sensation on the tongue.

Habitat and cultivation

Native to prairies and glades of North America from Michigan to Nebraska, south to Georgia and west to Texas. Can be grown commercially or in gardens from seed stratified in containers in the refrigerator for about 6 weeks or from root division in early spring. It prefers rich sandy soil and a cold winter.

Parts used

Roots of 2 year old plants harvested after the plants have gone to seed.

Echinacea purpurea

Purple coneflower

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Family Asteraceae, Tribe Heliantheae

Description

Fibrous rooted perennial growing from 60–150 cm tall often branching. Basal leaves oval to broadly lanceolate, coarsely pubescent and coarsely dentate with irregular teeth and long petioles. Stem leaves alternate and smaller. Capitula large with sterile rosy-purple ray florets and bright orange-tipped pales. Flowers mid-summer to late autumn.

Odour—mildly aromatic; taste—sweet becoming bitter and causing a tingling sensation on the tongue.

Habitat and cultivation

Native to open woods thickets and prairies from Louisiana, North East Texas and Eastern Okalahoma north through Ohio, Michigan and eastward. Cultivated as an ornamental for at least 200 years. Cultivars available. Grown like E. angustifolia but self-sows in frosty areas, and grows faster and taller, often flowering in first or second year.

Parts used

Whole plant in flower.

Active constituents

There are not only variations in the 3 medicinal species of Echinacea but within the same species genetic differences occur naturally223 though how this affects the constituents of the herb is unclear. E. angustifolia and E. pallida are more alike224 and at one time were considered varieties of the same species.225

1) Alkamides, more than 20, not all have been identified. Isobutylamides are predominant in E. angustifolia, the main one being dodeca-2,4,8,10 tetraenoic acid isobutylamide. Isobutylamides occur also in E. purpurea and to a much lesser extent in E. pallida226

2) Caffeic acid esters including caftaric, cholorogenic, caffeic and cichoric acids, echinacoside and cynarin.227 The latter is present only in E. angustifolia and is used as a marker for the species.225 E. purpurea contains the highest concentration of these phenolic constituents (the predominant one being cichoric acid which reaches a maximum of 2.27%228), followed by E. pallida and then E. angustifolia.229 Echinacoside (0.4–1.7%) is present in larger amounts in E. pallida (around 2%)230 than in E. angustifolia (1.04%)228 and not present in E. purpurea. It is however one of the main phenolic constituents in E. angustifolia.228 Verbascoside is the other predominant phenolic in E. purpurea.231 In E. pallida these constituents are caffeic glycosides or caffeic esters of quinic or tartaric acid232

3) Volatile oil (0.2–2.0%), including in all species acetaldehyde, dimethyl sulfide, camphene, hexanal, β-pinene and limonene.233 Also in E. angustifolia humulene and in E. purpurea borneol, bornyl acetate, a germacrene D derivative, caryophyllene and a sesqutierpene based on eudesmane.232,234 α-phellandrene is present in the roots of E. angustifolia and E. purpurea only. In all species butanals and propanals constitute about half of the volatile oil233

4) Polysaccharides, two types, an arabinogalactan-protein, rich in hydroxyproline, and a heteroxylan225,235,236

5) Polyacetylenes including ketoalkenes and ketoalkynes

Also resin, betaine (0.3%), trace amounts of pyrrolizidine alkaloids (tussilagin and isotussilagin), phytosterols including β-sitosterol and inulin.

In the past Echinacea was often substituted with Parthenium integrifolium as they both have the common name in the USA of “Missouri snakeroot”. P. intergrifolium is distinguished by its sesquiterpene esters.237

Nutritional constituents

Vitamins: A, C and E

Minerals: Iron, iodine, copper, potassium and sulphur. In E. purpurea:- root—iron, copper and manganese; aerial—calcium, magnesium and zinc238

Actions

1) Immunomodulator

2) Antimicrobial

3) Diaphoretic

4) Vasodilator (peripheral)

5) Anti-inflammatory

6) Vulnerary

7) Alterative

Scientific information

The historical use of Echinacea in the West dates back to the 19th Century when the herb was introduced to new settlers in North America by the indigenous peoples who used it predominantly to treat infections.239 E. angustifolia was an official herb in USA National Formulary until 1950.240 E. angustifolia and E. pallida were undoubtedly used interchangeably in commercial preparations in the past.225

Apart from the interest in the efficacy and mechanism of its action, Echinacea has also generated a good deal of scientific enquiry into its safety and potential for interaction due to its widespread public use.241–243 26% of primary health care patients questioned had used, or were, using Echinacea244 and it has been estimated that spending in 2005 on this one herb in the United States had reached more than US$300 million annually.245

The constituents responsible for its effects have not been determined although alkamides, phenolics and polysaccharides are all potentially active. (The bio-availability of the polysaccharides is questionable; they are not soluble in ethanol). The activity of this species is likely to be multi-factorial.

Anti-oxidant

In vitro—Anti-oxidant activities have been shown in all species of Echinacea.231,246 The phenolic constituents seem to be strongly correlated with this activity and within them,227 echinacoside has the highest anti-oxidant potential and caftaric acid the lowest.229 However studies have shown that a number of the caffeic acid esters have low cell permeability and therefore may not cross the intestinal mucosa.247

Ex vivo—Healthy people who took Echinacea had an improved plasma anti-oxidant capacity.263

Immunomodulatory

The reputation that Echinacea has for immune stimulation is based on over 50 years of scientific research. In vitro and in vivo, whole extracts, as well as isolated constituents have been shown to:-

In vitro—The alkamides from E. purpurea are not only immunomodulatory258 they also inhibit COX-1 and -2 activity.259

Interestingly a study using simulated-digestion extracts of various Echinacea preparations stimulated macrophages, in vitro, where the whole herb extract/juice did not260 and the effect of liver metabolism on constituents is likely to alter the in vivo effects of the herb.261

In vivo—Immune function and natural killer cell activity increased, after using E. purpurea extracts, not only in healthy volunteers but also in patients suffering with chronic fatigue syndrome or AIDS.262 A combined E. angusifolia and E. purpurea preparation increased both immune response (including raising white blood cell count) and anti-oxidant status in healthy people.263 However some small studies using a number of different Echinacea preparations orally and given over several days failed to corroborate enhanced phagocytosis in healthy subjects.264,265

Treatment of autoimmune based uveitis improved when Echinacea was used alongside standard therapy.266

Injections of Echinacea polysaccharides were found to help chemotherapy-induced leukopenia267 however this may be irrelevant for oral use of Echinacea and parenteral use is no longer recommended by German Commission E.

Antimicrobial

In vitro—E. purpurea extracts have good antifungal activities against Candida spp., including C. albicans, when combined with UV light exposure, although this activity still occurs to a lesser extent without it. The ketoalkenes and ketoalkynes are considered key to phototoxicity.268

In all species the whole extracts and alkamides inhibit HSV-1 in UV-A and visible light.269 Cichoric acid also inhibits the enzyme that allows the AIDS virus to integrate into host DNA but it is poorly absorbed into cells.270

In vivo—Most of the clinical research that has been carried out relates to Echinacea's most widespread application, that of treating respiratory infections including the common cold. This may involve a direct antimicrobial action but most likely is through an enhanced immune response. Results have been variable and are presented below.

Positive studies using either Echinacea preparations alone or in combination with other agents have shown:

A recent meta-analysis found the herb does appear to reduce the incidence and duration of the common cold.280 Negative studies using Echinacea alone concluded:

A number of reviews have suggested reasons for the above inconsistencies which include variability in the Echinacea species, type and quality of extract used, outcome measures sought and dosage regimes used (these tended to be low in negative studies).252,288–290

Overall the conclusion, though not unanimous,245,291 is that Echinacea treatment is effective in terms of reducing duration and severity of symptoms.248,253,292–294

Whole extracts of E. purpurea administered for 6 months did not benefit patients with recurrent genital herpes.295

Other

In vitro—Apart from the effect of the herb on the immune system, Echinacea extracts and echinacoside296 also inhibit hyaluronidase,225 an enzyme used by invading organisms to break down host connective tissue allowing microbial entry and spread. The herb can increase fibroblast activity which would aid healing of connective tissue.225

Extracts of all 3 roots are cytotoxic to a number of cancer cell lines with E. pallida demonstrating the most effective activity.297 However phenolic constituents of E. angustifolia have also increased the proliferation of some cancer cells cotreated with a chemotherapeutic drug.298

Alkylamides from E. angustifolia are inhibitors of COX-2299 and the whole herb has potential anti-inflammatory activity.260

In vivo—E. purpurea has been used traditionally for healing wounds, a clinical trial indicates it increased the healing of purulent wounds.300

Medicinal uses

Cardiovascular system

Respiratory tract

All infections of this tract, for treatment and prevention e.g.:

Gastro-intestinal tract

All infections in this tract e.g.:

Urinary tract

All infections of this tract e.g.:

Reproductive tract

Musculoskeletal

Skin

All infections, allergic reactions, an aid to skin conditions (including those of immune origin) e.g.

Pharmacy

Three times daily  
Decoction/infusion of dried herb –   0.5–1 g
Tincture 1:5 (45%) –   1–2 ml
Fluid Extract (45%) –   0.25–1 ml

Echinacea has been used externally in creams, ointments or lotions to treat skin infections.

The level of essential oil is increased markedly by drying. However the active constituents of Echinacea are complex and the gain of essential oil on drying may be balanced by the loss of other actives. There is no clear evidence yet whether the herb is more effective when used dry or fresh and both preparations achieve satisfactory results.

The quality of commercial products inevitably has come under scrutiny, it is very variable.301 This has no doubt contributed to the lack of consistency in clinical trials.

Pharmacokinetics

Echinacea has been used frequently by pregnant women302 with no increased risk to foetal development.303 Standard mutagenicity and carcinogenicity tests undertaken on the species have not raised safety concerns.225

Studies to date have shown that following ingestion of a combined E. angustifolia and E. purpurea tablet prepared from an ethanolic extract, the caffeic acid esters were not measurable at any time in the blood samples of healthy volunteers.

The alkamides were present in the blood stream 20 minutes after ingestion and were still detectable up to 12 hours later.304 Alkamides from E. angustifolia tincture were maximal in the blood stream after 30 minutes.305

Precautions and/or safety

Echinacea should cause a tingling sensation on the tongue and is a sialagogue. This effect is more marked in E. angustifolia. The fluid extract can cause excessive salivation and discomfort if taken in too large a quantity, undiluted.

Considering the very widespread use of Echinacea there have been very few reports of adverse reactions and these have, in the main, been mild involving gastro-intestinal upsets, rashes240 and infrequently allergic reactions.306,307 In 1997/8 of reported adverse events associated with herbal remedies and dietary supplements around 7% of these related to Echinacea, the majority of them being classed as minor.308 Echinacea was reported as being safe and well tolerated in the above studies.253,274,285,288

See General Precaution p. 25. The risk of allergic reaction is somewhat lower for Echinacea.79

Serious adverse event reports in which Echinacea is cited include anaphylaxis, acute asthma, eye irritation and conjunctivitis (topical use),309 a suspected link to recurrent erythema nodosum,310 acute cholestatic auto-immune hepatitis311 and possible aggravation of pemphigus vulgaris.312

A small proportion of liver transplant patients using “large amounts” of Echinacea had raised blood transaminase levels which returned to normal on cessation of the supplement involved.313 There has been some speculation about the potential harm of Echinacea based on its content of pyrrolizidine alkaloids, a class of alkaloids associated with hepatotoxicity in the Senecio spp. However those found in Echinacea have a 1,2 saturated necine ring which are not considered hepatotoxic.225

German Commision E suggests Echinacea should not be taken for longer than 8 weeks (due to tachyphylaxis), or where the immune system is dysfunctional, such as in auto-immune conditions. (The trial on patients with auto-immune uveitis does not corroborate this caution266).

The above restrictions for using the herb are theoretical.

Interactions

In vitro—Studies have shown Echinacea and/or its constituents can inhibit CYP3A4,314 CYP2C9315 and CYP2E1.316

In vivo—Echinacea appears to have some effect on cytochrome CYP450. One study indicated an interaction with CYP3A substrates and those of CYP1A2.317 In another the effects on cytochromes CYP1A2, CYP2D6, CYP2E1 and CYP3A4 (considered the most important ones) were not found to be significant.318,319 It does not interact with β-glycoprotein mediated drug metabolism e.g. digoxin.320

A review of studies in 2001 found no reported drug/herb interactions.321

Historical uses

Fevers; infections; snake and spider bites.

Eupatorium cannabinum

Hemp agrimony

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Family Asteraceae, Tribe Eupatorieae

Description

A perennial with short woody rhizomes forming clumps 1.5 × 1 m and dying down completely in winter. Stems round and hairy. Leaves opposite, divided into 3 lanceolate coarsely toothed segments, the middle segment largest 3–11 cm long, dull green. Flowers in dense corymbs. The involucre has 10 bracts arranged in 2 rows with purple tips, the outer row shorter than the inner. The florets are all tubular, hermaphrodite, 5–7 to each flower, white or pinkish-mauve. The fruit is a 5-angled achene, dotted with glands, with a whitish pappus. Flowers in late summer to early autumn.

Habitat and cultivation

Native to Europe and North Africa E. cannabinum grows in sun or semi-shade in rich, moist soil. It is frost resistant but drought tender and may be grown from seed or root division.

Parts used

The herb.

Active constituents

There are varieties of E. cannabinum which may differ in composition and proportions of constituents.323

1) Volatile oil (about 0.5%) including germacrene D (approx. 28.5%), α-phellandrene (approx 20%),322 α-terpinene, thymol (up to 12%)323 and p-cymene

2) Sesquiterpene lactones the main one being eupatoriopicrin324

3) Flavonoids including astragalin, kaempferol, hyperoside, isoquercitrin, rutin, hispidulin and eupafolin325

4) Alkaloids (pyrrolizidine) including supinine, echinatine,326 amabiline, viridiflorine, lycopsamine, cynaustraline and intermidine

Also contains polysaccharides, euparin, eupatopicrin and lactucerol.

Actions

1) Diuretic

2) Alterative

Scientific information

This herb was well known in former times but has fallen out of modern use in the west.

In vitro—Eupatoriopicrin has antitumour activity being both cytostatic and cytotoxic,323 the mode of action may be due to DNA damage.327 The polysaccharides are immunostimulant and have been found to encourage phagocytosis.328

The pyrrolizidine alkaloids found in this herb are considered to be potentially hepatotoxic and/or carcinogenic although 80% of them are saturated at the 1,2 necine ring position which chemically makes this very unlikely.329 There are no cases of toxicity reported in the literature.

Flowering tops have been used in Italy in an ointment as a cicatrizing agent.330

Precautions and/or safety

Possible allergic reaction (see General Precaution p. 25).

Historical uses

For fevers; bilious catarrh; influenza; hypocholesterolaemic, jaundice with swollen feet (portal hypertension); spring tonic to purify the blood and for scurvy. A strong infusion as a purgative and emetic; for psoriasis, eczema, fomenting ulcers and putrid sores.

Eupatorium perfoliatum

Boneset, thoroughwort

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Family Asteraceae, Tribe Eupatorieae

Description

Perennial growing 50 cm–1.5 m tall, with erect, stout, round, pubescent stems growing from rhizomes and branching at the top. Leaves opposite, lanceolate to 20 cm long, acuminate, mostly connate-perfoliate, (stem seems to be inserted through the middle of leaf pairs) crenate-serrate, rugose. Flowers 10–40, in flat-topped corymbs, all tubular, bisexual, white. Blooms late summer—mid autumn.

Habitat and cultivation

Native to North America from Nova Scotia to Florida, Louisiana, Texas and North Dakota, growing in moist woods or thickets. May be grown from seed or root division. Spring growth slow. Frost resistant and drought tender.

Parts used

The herb harvested during or just prior to flowering.

Active constituents

1) Sesquiterpene lactones including eupafolin, euperfolitin, eufoliatin, eufoliatorin, euperfolide,331 eucannabinolide and helenalin

2) Polysaccharides mainly 4-O-methylglucuroxylans

3) Flavonoids including kaempferol, quercitin, hyperoside, astragalin, rutin and eupatorin332

Also contains diterpenes, phytosterols, small amounts of volatile oil and some PABA.

Nutritional constituents

Vitamins: C

Minerals: Calcium, magnesium and potassium

Actions

1) Diaphoretic

2) Antipyretic

3) Aperient

4) Emetic (large doses)

5) Laxative (large doses)

Scientific information

There is very little new information available on the medicinal actions of this plant or its constituents although it was well known and well used by the North American Indians and appeared in the US Pharmacopoeia until 1916 as a stimulant as well as for above uses.333

In vitro—The leaves are strongly cytotoxic to normal and cancer cells and weakly antibacterial against Gram-positive bacteria like Staphylococcus aureus.332 Eupatorin is a bitter and also has cytotoxic activity.334

The sesquiterpene lactones and polysaccharides increase phagocytosis.335,336

Medicinal uses

Respiratory tract

BHP specific use—influenza with deep aching and congested respiratory mucosa.

Gastro-intestinal tract

The bitterness may contribute to the laxative action used in larger doses for:

Pharmacy

Three times daily  
Infusion of dried herb –   1–2 g
Tincture 1:5 (45%) –   1–4 ml
Fluid Extract (25%) –   1–2 ml (2–4 ml Potter's)

Diaphoresis best achieved with hot infusion.

Historical uses

Muscular rheumatism; intermittent fever/malaria also typhoid and yellow fevers. Dyspepsia and in old age to improve digestive function. Cutaneous diseases. Tape worm.

Eupatorium purpureum

Gravel root, Joe-pye weed

Description

Perennial up to 3 m tall with green stems hairy above, glabrous below, and tinged purple at leaf nodes. Leaves in whorls of 3–4; petiole glabrous to sparsely hairy, 15–35 mm long; lamina glabrous above but hairy beneath especially on veins; ovate-lanceolate, acute-acuminate, serrate, 80–120 × 20–60 mm, upper leaves smaller. Flowers numerous in slightly convex terminal corymbs.

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Family Asteraceae, Tribe Eupatorieae

Florets pink to purple. Flowers later summer to early autumn.

Habitat and cultivation

Native to North America, New Hampshire to Florida, Arkansas, Okalahoma, West Nebraska to Minnesota. Grown from seed or root division. Spring growth slow. Frost resistant, drought tender.

Parts used

The root and rhizomes collected in late summer or early autumn.

Active constituents

1) Volatile oil (about 0.07%)

2) Flavonoids including the benzofurans euparin, euparone and cistifolin337

3) Resin—eupurpurin

May also include tannins and saponins.

Actions

1) Diuretic

2) Antilithic

3) Antirheumatic

Scientific information

This species was also an official medicine but was dropped from the US Pharmacopoeia much earlier than E. perfoliatum333 where it was listed as a diuretic, stimulant, astringent, emetic and cathartic. There is very little scientific information available for either the herb or its constituents.

In vitro—Studies were conducted on some of the herb's benzofurans which are anti-inflammatory, particularly cistifolin.337,338 The herb and cistifolin inhibit cell-cell and cell-protein adhesion strongly and may offer a potential treatment for diseases mediated by integrin adhesion eg. thrombosis and cancer.339

Medicinal uses

Genitourinary tract

The herb has the reputation of being able to dissolve “solids” and soothe and tone tissues.

Musculoskeletal

Pharmacy

Three times daily  
Decoction of dried root –   2–4 g
Tincture 1:5 (40%) –   1–2 ml
Fluid extract (25%) –   2–4 ml

Historical uses

Dropsy and chronic renal and cystic problems. Similar uses to E. perfoliatum. Used also as a partus praeparator and considered to tone and normalise uterine function and treat leucorrhoea. Asthma and chronic catarrh.

Grindelia camporum [Syn. G. robusta var. rigida]

Gum plant, gum weed

Description

A glabrous, perennial herb growing to 1 m in flower. Basal leaves, petiolate, slender spoon-shaped with slightly toothed margins, pale matt green both sides. Stem leaves alternate, smaller, sessile and clasping. Flowers yellow, borne alternately on single peduncles on stout stems. Flower-heads oozing a sticky white gummy substance, noticeable in the bud and continuing in the flower, borne in a green, softly spiny cup-shaped receptacle. Blooms in summer.

Odour—balsamic, taste—aromatic and bitter.

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Family Asteraceae, Tribe Astereae

Habitat and cultivation

Native to California in coastal areas and in central and western desert regions, also in parts of Oregon. May be grown easily in gardens from seed sown in spring.

Parts used

Dried aerial parts of the plant harvested before or during flowering.

Active constituents

1) Saponins (2%) including grindeliasapogenin D, oleanolic acid and bayogenin340

2) Resin (up to 20%)341 comprising grindelane diterpenoids many based on grindelic acid,342 also camporic, chrysolic and strictanonic acids.343 Most are methyl esters.

3) Flavonoids including acacetin, kumatakenin and quercetin342

4) Volatile oil

Also contains a phytosterol, hentriacontane (a longchain hydrocarbon), tannins, possibly an alkaloid (termed “grindeline”).

Grindelia displays polyploidy and can be either diploid or tetraploid. It was at one time assumed that G. robusta was the main medicinal species but this is not commonly found growing and by the early 20th century it was recognised that G. camporum was the main medicinal although other species have also been used.344

Chemical constituents and their levels vary with species, variety and geographical location.

Actions

1) Antispasmodic

2) Expectorant

3) Anti-asthmatic

Scientific information

Grindelia species have been official medicines in various countries as expectorants with a spasmolytic effect.42 The herb was introduced into official American medicine in 1875, appearing in the U.S. Pharmacopoeia and National Formulary between 1882–1960. However, it was described as having “feeble physiologic powers”.344

G. camporum produces a great quantity of resin especially in the glands of the involucre bracts and this has attracted scientific interest for its potential use as a bio-fuel.345

There are no recent investigations into its pharmacology. It appears to have antibacterial and anti-inflammatory properties and is also considered a cardiac depressant as it can slow, and regulate, the action of the heart via the nervous system.344

Medicinal uses

Respiratory tract

The saponins are considered to have a stimulating expectorant action, helping to thin thick mucus. It is well suited to the treatment of:

The BHP specific use of the herb is for bronchial asthma asscociated with tachycardia.

Urinary tract

Externally

Pharmacy

Three times daily  
Infusion of dried herb –   2–3 g
Fluid Extract 1:1 (22.5%) –   0.6–1.2 ml
Tincture 1:10 (60%) –   0.5–1 ml

Lotion diluted F.E. 1:10 in 10% alcohol

Precautions and/or safety

Large doses are purported to cause renal irritation, some active constituents are excreted via the kidneys.42

Historical uses

To treat chronic catarrh of the bladder. Topically for burns and vaginitis. Smoked to treat asthma. Roots decocted to treat lice.

Inula helenium

Elecampane

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Family Asteraceae, Tribe Inuleae

Description

Erect rhizomatous perennial up to 2 m tall. Dormant in winter. Stems densely hairy, branched above to form the inflorescence. Leaves, lower cauline sparsely to moderately hairy on upper surface, tomentose on lower, ovate-elliptic, petiolate and cuneate, acute, finely denticulate, up to 60 × 20 cm. Upper leaves similar but alternate, smaller, apetiolate and usually amplexicaul. Capitula 6–9 cm diameter, few, in corymbs. Outer involucral bracts tomentose, herbaceous, ovate, 10–15 mm long, inner bracts glabrous or tomentose only on lamina, membranous, 15–25 mm long. Ray florets numerous; ligules yellow, c. 2–3 cm long. Disc yellow. Achenes glabrous 4–5 angled with faces finely ribbed, 3.5–5 mm long; pappus minutely barbellate, fused at the base. Flowers from late spring to autumn.

Habitat and cultivation

Native to Europe and Asia and cultivated elsewhere. Grown from seed or division of crowns during winter dormancy. Prefers damp, semi-shady places with deep soil. Drought tender, frost resistant.

Parts used

Roots and rhizomes gathered in early winter or early spring after 2nd year's growth.

Active constituents

1) Essential oil (1–4%) including

a) camphor, alantol,† alantoic acid and thymol derivatives346,347

b) sesquiterpene lactones including mainly eudesmanolides of which around 90% comprises alantolactone and isoalantolactone.348 Also germacranes and elemanes348,349

2) Triterpenes including dammaradienyl acetate,350 stigmasterol, sitosterol and friedelin

3) Polyacetylenes

4) Inulin up to 44% in autumn, 20% spring

Mucilage and resin have been reported.

“Helenin” which is sometimes quoted as a constituent of Inula actually refers to a combination of the sesquiterpene lactones, alantolactone and isoalantolactone, produced after processing.351

Nutritional constituents

Vitamins: A

Minerals: Calcium, potassium, sodium and magnesium

Actions

1) Expectorant

2) Antitussive

3) Diaphoretic

4) Antibacterial

5) Anthelmintic

6) Digestive tonic

Scientific information

There are a number of medicinal species of Inula. I. helenium was an official medicine in some European countries,347 there is however, a lack of recent research into this herb.

Many of the actions of the herb have been attributed to the sesquiterpene lactones, often to alantolactone.

In vitro—Inula and/or its constituents (helenin in particular) have shown:-

The lactones are anti-inflammatory.347

Medicinal uses

Respiratory tract

Gastro-intestinal tract

Inula is a bitter and can stimulate appetite and digestion:

Pharmacy

Three times daily  
Decoction of dried root –   1.5–4 g
Tincture 1:5 (25%) –   3–5 ml (suggested guidelines)
Fluid extract (25%) –   1–2 ml

Precautions and/or safety

Inula can cause allergic dermatitis (see General Precaution p. 25) and anecdotal evidence suggests it may do so with relative frequency.79,358

German Commission E states that large doses can cause vomiting, diarrhoea, spasms and paralysislike symptoms, however, no incidents have been reported in the literature.

Historical uses

A long history exists for the use of this herb. Described by Hippocrates as a herb to cure chronic skin eruptions and itch and used by the Prophet Job to treat chronic boils.359 Used in Salerno and by the Welsh Physicians, who called it Marchalan. As a diuretic for dropsy; an emmenagogue; a tonic; an immune stimulant and detoxifier e.g. for snake bites. Sciatica; neuralgia (rubefacient) and gout; some women's problems; dyspepsia; asthma; cramps and convulsions. For treating skin complaints in humans (USA) and animals. Employed as a paint for diphtheria.

Matricaria recutita [Formerly M. chumomilla]

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Family Asteraceae, Tribe Anthemideae

Annual chamomile, German chamomile

Description

An erect, aromatic, glabrous annual, 30 cm or more tall. Stems round, hollow, furrowed. Leaves sessile, alternate 2–3 pinnatisect, pale green. Flowers—capitula in terminal corymbs, pedunculate, involucral bracts in 2–3 rows, with membranous margins; receptacle conic without scales; ligules white, soon reflexed, c. 1 cm long, disc florets yellow, 5-toothed. Seeds—achenes 1–1.5 mm long, glandular, without a corona.

Odour—pleasant and aromatic, taste—slightly bitter and aromatic.

Habitat and cultivation

Originally from Europe and West Asia chamomile is cultivated and naturalized world-wide. Grown from seed, it may self-sow to give several crops a year in open sunny places and rich, friable soil. Does not self-sow in extremes of heat or wet. Drought and frost resistant.

Parts used

Flower heads collected at the start of flowering.

Active constituents

1) Volatile oil (0.4–2%). Four chemotypes have been identified based on the major constituent of the essential oil viz. bisabolol, bisabololoxide-A, bisabololoxide-B and bisabolonoxide. The first type is the one that is preferred for medicinal purposes.360 The volatile oil comprises:-

a) sesquiterpenes361 (-)-α-bisabolol (up to 50% of this fraction), bisaboloxides A and B, matricin (a proazulene and guaianolide lactone); trans-β-farnesene (up to 45%) and γ-cadinene;362 and the minor constituents spathulenol and chamaviolin (guaianolide)

b) spiroether which is comprised of cis- and trans-en-yn-dicycloethers and is highest in the centre of the flower head363

2) Flavonoids (up to 8%) including derivatives of apigenin, luteolin and quercetin364,365

3) Coumarins (0.06%) including herniarin and umbelliferone

4) Mucilage (up to 10%) consisting of polysaccharides

5) Also contains phenols, cyanogenic glycosides, salicylates, phytosterols and a spermine derived polyamine, concentrated in the pollen.366 Matricin is converted to chamazulene by steam distillation and gives Matricaria oil a blue colour the deepness of which varies with the amount of azulene present.

The various active constituents of Matricaria require different temperatures for their stability and the level of matricin in Matricaria's volatile oil decreases on drying. Therefore the flowers should be processed soon after harvesting367 or they may be preserved by freezing until ready for processing.

Matricaria displays polyploidy, diploid and tetraploid cultivars having been grown368 in an effort to increase what is considered the more important constituents of the volatile oil. The constituents also vary with origin, growth conditions and method of preparation.369

Nutritional constituents

Minerals: Iodine, calcium, potassium, magnesium, iron, zinc and manganese370

Actions

1) Relaxant

2) Carminative

3) Antispasmodic

4) Anti-inflammatory

5) Anti-allergic

6) Bitter

7) Vulnerary

8) Antimicrobial

9) Sedative (mild)

Scientific information

Scientific interest in Matricaria arises from two perspectives. One is its long history of use as a medicine—it has been an official medicine in a number of pharmacopoeias worldwide (internally as an aromatic bitter and externally as a poultice for inflammation42) and it has the approval of German Commision E for many of its traditional uses. The other, as in the case of Echinacea spp. relates to its widespread use by the public for self-medication and the effect such a practice may have on the efficacy and safety of prescribed pharmaceuticals.

Although there is a great deal of research on Matricaria, most of this relates to animal experiments or the action of isolated constituents in vitro.

There are a large number of active constituents though much of Matricaria's activity is attributed to the volatile oil and flavonoid fractions. In the latter case apigenin-7-glucoside is considered to be of great importance whilst in the former it is (-)-α-bisabolol. Because of the positive actions of(-)-α-bisabolol the cultivated variety of Matricaria recutita, called Manzana, which is rich in this constituent has been used in commercial products and in a number of clinical trials. Manzana also has a very low potential for allergic reactions.

Anti-inflammatory

In vitro—Matricaria is known to be anti-inflammatory, it inhibits the action of COX and LOX.364 A number of the constituents also inhibit leukotriene synthesis—the sesquiterpene fraction,364 (-)-α-bisabolol;360,364 chamazulene371 and the spiroether component.372 The flavonoids, particularly apigenin, not only inhibit arachidonic acid metabolism but also stabilise and inhibit calcium influx into mast cells.360,373 Although the polyamine too was found to have good potential both as an anti-inflammatory and anti-allergic agent, it may not be absorbed in vivo.366

In addition its anti-oxidant activity has been studied as inflammation often results from oxidative stress. The herb is anti-oxidant374 as is the volatile oil fraction375 with chamazulene having the strongest potential.371,376

In vivo—Oral mucositis, a side effect of chemo- and radio-therapy, was successfully treated using a mouthwash of the herb377,378—not corroborated.379 A spray applied to the cuff of endotracheal tubes prior to surgery did not however prevent subsequent inflammation of mucous membranes.380

Antispasmodic/spasmolytic

The relaxant effect of chamomile has been known and valued for hundreds of years. Several of its constituents display both antispasmodic activity (matricine, chamazulene, the bisabloloxides and (-)-α-bisabolol364) and spasmolytic activity (apigenin, apigenin-7-glucoside, (-)-α-bisabolol).364 Apigenin is also considered an anxiolytic.381

In vitro—These activities have been examined for binding to benzodiazepine receptor sites in which apigenin was shown to be active.382

In vivo—Allergic asthma treated with a combined herbal extract which included Matricaria reduced associated sleep discomfort, frequency and intensity of coughing as well as significantly improving respiratory function.383

Antimicrobial

In vitro—Matricaria has antimicrobial activity against:-

The polysaccharide fraction is immunostimulant.387

In vivo—Matricaria is also acaricidal against a mite pathogenic to domestic animals388 and there is anecdotal evidence of it successfully being used to treat an unusual but persistent human infestation by poultry mite.389

A study found daily intake of chamomile tea over 2 weeks may increase anti-oxidant activity possibly through altered bacterial gut flora as these changes persisted for a further 2 weeks after tea intake ceased.390

Other

In vitro—(-)-α-bisabolol and Matricaria itself have antipeptic activity i.e. they inhibit the action of pepsin.364

Matricaria stimulates osteoblast differentiation, is anti-oestrogenic to breast cancer cells and inhibits cervical adenocarcinoma cells, actions probably mediated through binding to oestrogen receptor sites. The herb may help prevent Osteoporosis.391

Most studies on Matricaria's flavonoids relate to apigenin which in addition to activities mentioned above, has also shown:

In vivo—One of the main traditional uses of Matricaria has been in treating gastro-intestinal problems. A combined extract, which included it, effectively treated functional dyspepsia,399 the anti-oxidant and anti-inflammatory action of chamomile being considered valuable to the overall effectiveness.400 A preparation containing pectin and Matricaria also effectively treated diarrhoea in children.401

A combination of Angelica sinensis and Matricaria was effective in controlling menopausal hot flushes, insomnia and fatigue.402

Consumption of flavonoids has been inversely related to death from coronary heart disease in epidemiological studies.403

Several studies have tested the value of topical applications, this being another area of traditional use for the herb. Applied externally the flavonoid fraction of Matricaria is able to penetrate into the deeper layers of skin.404 The whole herb has been shown to be:-

Medicinal uses

Respiratory tract

Gastro-intestinal tract

BHP specific for gastro-intestinal disturbance with associated nervous irritability in children.

Nervous system

As a significant nervous system relaxant used for:

Reproductive tract

The name Matricaria derives from “matrix” meaning mother or womb, it is used for:

Externally

N.B. The use of Matricaria externally to treat eczema is augmented by its internal use.

Pharmacy

Three times daily  
Infusion of dried herb –   2–8 g
Tincture 1:5 (45%) –   3–10 ml
Fluid Extract (45%) –   1–4 ml

Chamazulene can be developed by using the herb in steam inhalations or as hot infusions that are kept covered whilst steeping.

Precautions and/or safety

There are a number of studies that have looked into the quality of commercial chamomile flowers/teas and these found the quality and level of contamination could pose problems.409–411

The effect of drinking chamomile tea with a meal may inhibit iron absorption by 47%. Black tea by comparison inhibits iron absorption by between 79–94%, adding milk does not negate this effect.412

(-)-α-bisabolol was tested for its potential to cause mutations as it is used in many topical preparations and it was found, in fact, to offer some protection.413 Apigenin and luteolin have also been tested for potential genotoxicity and they have been declared safe.414

Matricaria is regarded as a safe herb generally. However there are a few recorded cases of allergic reactions to the external and internal use of the herb, including anaphylaxis.415,416 There is also a degree of cross-reactivity between sensitivity to Artemisia vulgaris and Matricaria in vivo (see General Precaution p. 25).417 Allergic conjunctivitis can result from using Matricaria as an eyewash—this occurred in a small number of patients (around 2%) who were suffering from hayfever although they had no reaction to the tea. The reaction is believed to be due to pollen in the flowers.418 Considering the widespread use of this herb, allergic reactions are extremely rare.364 There is also some speculation that at least some of the reported cases of allergic reactions to chamomile have been due to the adulteration/substitution of Matricaria with Anthemis cotula as anthecotulid, a sesquiterpene lactone found in the latter but not the former, has been specifically cited as the causative agent.360

Interactions

In vitro—Matricaria's isolated constituents, particularly the essential oil components, inhibit cytochrome P450 enzymes CYP1A2, CYP2C9, CYP2D6 and CYP3A4 which in turn could effect the metabolism of drugs using these for their elimination.419,420

In vivo—As flavonoids inhibit platelet aggregation in vitro, apigenin was tested for this effect through dietary use of parsley in healthy volunteers, the results showed there was no measurable effect on platelet activity.421 There has been speculation that Matricaria could potentiate the effect of warfarin,422 perhaps due to the flavonoids, to-date no interactions between them have been reported. No drug interactions in vivo have been reported for chamomile.

Historical uses

For aiding problems in the head—“purge the head and to emptie it of superfluous humour and other grosse matter”. For fevers; phlegm, melancholy; inflammation of the bowels; liver and spleen problems; as a bath to ease weariness and pain. It also has acquired a reputation of healing ailing plants if planted nearby.

Silybum marianum

Milk thistle, St Mary's thistle

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Family Asteraceae, Tribe Cynareae

Description

Annual or biennial. Stems erect, branched above, ridged, with sparse mealy hairs, 0.5–2 m tall, not winged. Leaves alternate, elliptic to lanceolate, lyrate-pinnatifid to pinnate, sinuate, coarsely dentate, green with conspicuous white markings along veins 20–60 × 10–30 cm, with sparse, short, mealy hairs on the lamina, and sparse, long, tangled multicellular hairs on midrib; base amplexicaul, auriculate, with very spinous margins; prickles marginal, yellowish, spreading, 5–12 mm long. Upper leaves alternate, clasping stems. Capitula ovoid, erect, 4–6 × 5–7 cm, solitary, terminal and pedunculate; and also sessile in axils of uppermost leaves; peduncles with appressed cobwebby tomentum. Involucral bracts sparsely covered with short mealy hairs; margins with sparse cobwebby hairs. Outer bracts leaf-like, obovate with spinous apex and margins. Middle bracts oblong with spinous margins. Inner bracts lanceolate. Corolla reddish purple, 20–28 mm long, florets male and female, all tubular. Anther filaments joined at margins into a tube. Style extended 1–2 mm beyond corolla lobes. Achenes brown or black-streaked, obovoid, weakly transversely flattened, smooth, about 6 × 3 mm. The width of the variegated bands and the leaf length and number of spines on the leaf margin seem to be highly correlated!423 Flowers in late spring to summer. Fruits mid-summer to autumn.

Leaves taste bitter, sharp and unpleasantly salty. Seeds taste oily and bitter.

Habitat and cultivation

Originally from the Mediterranean and South Western Europe, milk thistle is naturalised worldwide in waste and cultivated land. Grows from seed in any soil but prefers open sunny situations with adequate water. It is large, with spines, and classified as a noxious weed. Drought and frost resistant.

Parts used

Seeds collected when the white pappus is visible and not too long after the head has opened. The seeds are used in medicine, the leaves and stems in cooking.

Active constituents

1) Flavolignans (1.5–3.0%)424 including what is collectively called “silymarin”, which comprises silybin A and silybin B (diastereoisomers),425 silydianin, silychristin and diastereoisomers isosilybin A and isosilybin B (max. 5% of silymarin).425–427 An extract comprising an equal ratio of silybin A and B is called silibinin. The more mature seeds have been shown to contain the highest content of flavolignans.

2) Flavonoids including taxifolin a 2,3 dihydroflavonol and apigenin428

3) Amines including tyramine, histamine and trimethylglycine (betaine)

4) Polyacetylenes

Also fixed oil of around 25% (w/w),428 mostly linoleic and oleic acid, also myristic, palmitic and stearic acids.429

Actions

1) Hepatoprotective

2) Digestive tonic

3) Galactagogue

Scientific information

Milk thistle has been used in medicine for nearly 2000 years and preparations have been officially approved for use in Europe since 1969.430 German Commission E has approved its use for dyspepsia and to support liver damage due to toxins, inflammation or cirrhosis.

Anti-oxidant and anti-inflammatory

In vitro—The following has been found:

Hepatoprotective

Silybum's current prominence is based mostly on its effectiveness in the treatment of liver dysfunction, one of the main areas of traditional use and one where pharmaceuticals are not, as yet, very effective.

A good deal of the original clinical work arose from the herb's use in treating accidental poisoning with the very toxic Amanita phalloides—the Death Cap mushroom—which inhibits hepatocyte function, and has a fatality rate of 20%. Silymarin given up to 36 hours after toxin ingestion significantly reduced mortality and was more effective than standard orthodox therapy.424,437,443

Silybum and its various extracts are amongst the best studied of herbal medicines, they are commonly used by people with liver problems.438 Most of the current research has been carried out on the flavolignan fraction or some part of it, not the whole herb. The results have been impressive enough for an extract to be registered in Belgium as a prescription only medicine.439 Silybum and silymarin in particular have general recognition as a therapy for liver disease, and are recognised as hepatoprotective, anti-inflammatory and regenerative agents.440,441 The flavolignans are assumed to achieve cytoprotection through their anti-inflammatory and anti-oxidant actions and also because they stabilise cell membranes and enhance protein biosynthesis.435,436

In vitro—All the main flavolignans, tested separately, protect hepatocytes from toxicity due to alcohol and carbon tetrachloride—silydianin and silychristin particularly—and were themselves devoid of toxicity.442

In vivo—Reviews443–446 of over 30 trials conducted into the effects of Silybum on liver function have been undertaken over the last few years and although trial results have not been constistent, reviewers have concluded that silymarin may benefit the treatment of:-

The inconsistent clinical data may be due to factors commonly cited in these sorts of trials including poor design and reporting, problems with the actual aetiology and severity of the disease being treated, small sample sizes, variable duration and levels of dosing and also variations in quality of preparations used.

A recent study using silymarin to treat chronic hepatitis C patients gave only symptomatic improvement, and whilst the treatment was deemed safe, markers of the disease were unchanged after one year of treatment.447 However further related clinical trials are due to be carried out.448

Anticancer

In vitro—Silybum and/or the main flavolignans have a range of activities that alter the growth of different cancer cell lines. Actions found to-date are:-

These actions have prompted the initiation of clinical trials into their use in the treatment of prostate cancer.462 Their potential to aid cancer treatment is greatly supported by their lack of toxicity and compatibility in acting alongside conventional cancer therapy.

Antimicrobial

In vitro—Silybin, in particular, but also silymarin have strong antibacterial activity against Gram-positive bacteria.466 Silybin also increases the susceptibility of resistant Staphylococcus aureus to antibiotic therapy.467

Silymarin may block the replication of some viruses, including that of HIV, by blocking nuclear transcription factor NF-kB.436

Other

In vitro—Silybum and its flavolignans stimulate lymphocytes468 (increasing their proliferation469) and activate leucocytes (this has been shown to occur ex vivo too470).

In addition silymarin may be a useful agent in sunscreens in preventing photo-induced carcinogenesis471 and was shown to protect cells from UV-induced apoptosis.472

Anti-allergy properties have been demonstrated by silybin via inhibition of T-lymphocyte activity473 and through inhibition of histamine release from basophils.424

Ex vivo—Peritoneal macrophages from patients receiving dialysis (which tends to compromise the cells’ function) had their activity restored when exposed to silymarin and silibinin.474

Silybum has been advocated as supportive therapy for AIDS to not only protect liver function but also because of its possible antiviral activity.436,475

In vivo—Silybum was beneficial in the treatment of gastro-intestinal ulcers.476 Silymarin improved the lipid profile of patients with hyperlipoproteinaemias477 and also improved the status of type 2 diabetes by reducing levels of glycated haemoglobin and fasting glucose and improving their lipid profiles.478

Medicinal uses

Gastro-intestinal tract

The main use of this herb is to protect and tone the liver:

Reproductive tract

Pharmacy

Three times daily  
Decoction –   2–4 g
Tincture 1:5 (25%) –   2–4 ml

The flavolignans are commercially extracted by first defatting Silybum seeds to increase their yield, and then subjecting the resulting matter to high extraction temperatures not used in the preparation of herbal tinctures. They are soluble in both ethanol and hot water and are relatively stable at temperatures up to 100°C.479–481 However silymarin in commercial tablets may be quite variable in bioavailable flavolignans.482

Amanita poisoning was treated with water extracts of silybin at a dose of 20 mg/kg of body weight per day.

Pharmacokinetics

Studies have shown that about half of the total intake of silymarin is slowly absorbed intestinally, blood levels peak 2 hours after oral dosing and have a half-life of around 6 hours. 5–7% of what is absorbed is subsequently excreted from the kidneys, the majority staying within the liver and being incorporated into bile before being excreted via this route.483 Biliary levels of silybin peak within 2–9 hours and are still detectable after 24 hours.430 Silybin appears to be well absorbed into many tissues including plasma.462 Silybin and silychristin are not excreted in urine.424

Precautions and/or safety

Adverse effects reported are rare and minor including gastro-intestinal disturbances, headaches and allergic skin rashes. Allergic reactions are possible—see General Precaution p. 25.

More severe reactions reported include a single case of anaphylaxis after drinking a tea made from the herb424 and a case of a severe reaction attributed to an encapsulated Silybum product.484 However given that the herb is one of those most frequently used in a population where liver function is likely to be impaired the safety is generally accepted as very good even after long term use.485

Interactions

Warnings of possible drug/herb interactions have arisen from the observation of flavolignans affecting hepatocyte cytochrome enzymes CYP3A4, CYP2D6, CYP2E1, CYP2C9 and uridine diphophoglucronosyl transferase in vitro.486–489 It was later found that the concentration of these constituents would not reach the levels at which they could cause inhibition in vivo. More recently a study looking into possible interactions with metabolism of an HIV protease inhibitor found no interaction between silibinin and indinavir in vitro490 or in vivo.491–493 The herb did not alter the activity of CYP1A2, CYP2D6, CYP2E1 or CYP3A4494 in vivo either, nor did a standardized Silybum extract affect the metabolism of a chemotherapeutic drug that uses CYP3A4 and UGT1A enzymes.495

Historical uses

Eaten as a vegetable for a spring tonic. Snake bite; the plague; urinary calculus; “melancholy”, antimalarial; emmenagogue, disorders of the uterus and spleen. Thought to cure rabies; for pains in the sides; internal griping. Eclectic use for varicose veins and pelvic congestion. Externally applied for cancer.

Solidago virgaurea and S. canadensis

Golden rod

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Family Asteraceae, Tribe Astereae

Description

S. virgaurea (left) is a stoloniferous perennial plant with erect, simple or branched, round, often pubescent stems to 1 m high in flower. Leaves alternate, mostly sessile. Basal leaves obovate from a tapering base, 2–12 cm long. Stem leaves oblong-lanceolate to elliptical, entire or slightly toothed, acute. Inflorescence a raceme or panicle, each short-stemmed flower head 0.5–1 cm in diameter. Involucral bracts in many rows, linear, greenish. Ray florets in one row, female, yellow. Disc florets also yellow, hermaphrodite. Fruit a 2.7–3.1 mm brown, pubescent achene with a greyish-white pappus. Blooms from summer to autumn.

S. canadensis (right) is a stoloniferous perennial which forms dense clumps. Stems not branched, erect, green or reddish, smooth at base but slightly hairy higher up, 1–1.5 m tall in flower. New shoots reddish purple. Basal leaves dark green, elliptic-lanceolate and withering at flowering. Stem leaves alternate and arranged in whorls, apetiolate, usually entire, sometimes serrate, rough on the upper surface, 8–10 × 1–2 cm, upper leaves smaller. Inflorescence a lax, racemose panicle mostly with all flowers arranged along one side. Flower heads cylindrical 3.5–5 mm across. Ray florets 8–12 with yellow, linear-obovate ligules. Disc florets 3–5, yellow. Flowers in autumn.

Odour—slightly aromatic when dry; taste—astringent and bitter.

Habitat and cultivation

S. virgaurea is native to Europe, Asia and North Africa in dry grasslands and open woods. It prefers light well-drained soil and open sunny situations. Grown from seed and root division. Drought and frost resistant.

S. canadensis is native throughout North America and commonly grown in gardens in other countries from seed or root division. Adaptable to most soils and situations. Frost resistant and drought tender. Hybrids of the two species have been identified.

Parts used

The herb harvested during or just prior to flowering.

Active constituents

S. virgaurea

1) Triterpenoids

a) saponins (2–6%) including bisdesmosidic polygala acid derivatives comprising a minimum of 30% of this fraction, a number of them being oleanane-type saponins called solidagosaponins and also virgaureasaponins496–498

b) triterpenes based on germacrene, transphytol, β-amyrin499,500

2) Tannins (approx. 10%) of the catechin type

3) Flavonoids (1.5%) including rutin, quercetrin, isoquercetrin, astragalin, hyperoside, nicotiflorin and kaempferol499

4) Essential oil (0.4–0.5%) predominantly α-cadinene

Also phenol glycosides including leiocarposide (a heterodimer of salicin)501 and virgaureoside A, phenolic acids including caffeic and chlorogenic acids,499 diterpenoid lactones of cis-clerodane type (solidagolactones and elongatolides C and E), benzoates,502 α-tocopherol-quinone500 and polysaccharides.

S. canadensis

1) Triterpenoids

a) saponins (9–12%) mainly bayogenin glycosides which are bisdesmosidic saponins called canadensis-saponins 1–8503,504

b) triterpenes of lupane type and lupeol, ursolic acid, α-amyrin, stigmasterol and cycloartenol505

2) Tannins

3) Flavonoids (2.4%) including quercetrin, isoquercetrin and rutin506

4) Essential oil including sesquiterpenes (+) and (–)germacrene D,507 germacrene A, α-humulene and β-caryophllene508–510

Also phenolic acids including chlorogenic, hydroxycinnamic and caffeic acids, diterpenes and polysaccharides.

Actions

1) Diuretic

2) Diaphoretic

3) Anti-inflammatory

4) Antiseptic

5) Carminative

6) Anticatarrhal

Scientific information

S. virgaurea is highly valued in Europe where it is considered to have proved itself over the centuries. It has been approved by German Commission E for lower urinary tract diseases and for the treatment and prevention of urinary lithiasis. S. canadensis has been in use in Europe for around 700 years.506

Neither of the two medicinal Solidago spp. has received much scientific attention. Their chemistry though very similar is not identical.

S. virgaurea

In vitro—The whole extract has strong cytotoxicity for tumour cells from prostate, breast, melanoma and small cell lung carcinoma511—triterpenes and α-tocopherol-quinone are individually also cytotoxic.500

The herb inhibits muscarinic receptor-mediated contraction of bladder tissue.512

It has antibacterial activity against a range of organisms513 and some of the constituents are antifungal against Candida and Cryptococcus species514,515 and may also be potential immunostimulants.502,516

A combination of Solidago virgaurea, Fraxinus excelsior and Populus tremula has anti-oxidant, anti-inflammatory and analgesic activities.517–519

In vivo—Clinical trials using the above combination found it as effective as NSAIDs in the treatment of mild to moderate osteoarthritis and rheumatoid arthritis and with much fewer side-effects.520,521

S. canadensis

In vitro—The lupane triterpenoids inhibit DNA replication giving them a potential in cancer chemotherapy505 and some of these constituents also have moderate cytotoxicity for several tumour cell lines.502

The whole extract is anti-oxidant, the phenolics making a large contribution to this activity.506,522

Both Solidago species are described as “aquaretic”, rather than diuretic, as they increase urine output by increasing renal blood flow and therefore glomerular filtration rate. The increase in urinary output is not accompanied by electrolyte loss.

Solidago spp. are also considered anti-catarrhal with an action in the upper respiratory tract and they may have hypotensive activity.513 The genus name of Solidago is based on the Latin “solidare” to make whole, a reference to the ability of the herb to act as a styptic and to heal wounds. This action is not acknowledged in modern herbalism.

Medicinal uses

Respiratory tract

BHP specific for low grade inflammation of the nasopharynx with persistent catarrh.

Gastro-intestinal tract

As a carminative may be used for:

Urinary tract

Externally

Pharmacy

Three times daily  
Infusion of dried herb –   0.5–2 g
Tincture 1:5 (45%) –   0.5–1 ml
Fluid Extract (25%) –   0.5–2 ml

About a fifth of the available bound flavonoids and tannins are extracted into infusion after steeping the herb for up to 10 minutes.523 Phenolics (flavonoids and phenolic acids) are best extracted either in water infusions or in tincture using 70% alcohol.506

Pharmokinetics

The flavonoids are primarily excreted through the urinary tract.524

Precautions and/or safety

For allergic reactions see General Precaution p. 25. Solidago is considered to be very safe with no known side-effects.525

Historical uses

Internally for bruising and bleeding; ruptures; nausea due to weak digestion; dysmenorrhoea and amenorrhoea; diphtheria. Externally as a styptic and wound healer of great value; to secure loose teeth.

Tanacetum parthenium [Formerly Chrysanthemum parthenium]

Feverfew

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Family Asteraceae, Tribe Anthemideae

Description

Strongly aromatic perennial herb with roots not a rhizome. Stems round, erect, 20–60 cm tall, ribbed, sparsely to moderately clothed in short hairs, not much branched from the base. Basal leaves petiolate, ovate to ovate-oblong, sparsely to moderately clothed in short hairs and with scattered, pitted glandular hairs, 1-pinnate with leaflets again 1–2-pinnatisect, 3–15 × 2–6 cm; primary leaflets in 3–5 pairs, ovate, all on one plane, shortly petiolate at the base of leaf, ultimate segments ovate to oblong, crenate or serrate. Cauline leaves alternate, similar to basal, but above becoming shortly petiolate, smaller and less divided, usually with numerous glandular hairs on the lower surface. Corymb with 8–40 loosely packed capitula. Capitula 15–30 mm diameter; ray florets 12-numerous; ligules white, disc florets usually numerous, yellow, but few in double forms. Achenes c. 1.5 mm long, pale brown, glandular, ribbed; corona lobed, c. 0.2 mm long. Flowers most of the year depending on weather and climate.

Odour—camphorous; taste—bitter and camphorous.

Habitat and cultivation

Originally from Europe and temperate Asia feverfew is now a common garden plant. It is a short-lived perennial grown from seed or root division. Prefers light soils and an open sunny situation. Single and double flowered forms are found and one with yellow leaves. Drought and frost resistant.

Parts used

Flowering herb or leaves only.

Active constituents

1) Sesquiterpene lactones, many possessing an α-methylene-γ-lactone structure the predominant one being a germacranolide—parthenolide (0.2–0.9%); also guaianolides including canin and artecanin.526 Over 45 sesquiterpenes have been characterised so far.527 Parthenolide content is highest in leaves and flowering tops,528 is higher in plants harvested in the afternoon and is increased following watering after water-stressing the plant.529 Wild T. parthenium may naturally have higher parthenolide levels as do the lighter leaf phenotypes530

2) Volatile oil including pinene, camphor, limonene, camphene, γ-terpinene, linalool, (E)-β-ocimene and (E)-chrysanthenol531

3) Flavonoids including derivatives of kaempferol (tanetin), quercetin, apigenin and luteolin,532 also santin and centaureidin533

4) Polyacetylenes

There is also a small amount of melatonin.534

Nutritional constituents

Vitamins: A, B1, B2, niacin and C

Minerals: High amounts of iron, manganese, phosphorus, potassium, calcium, chromium and selenium

Actions

1) Anti-inflammatory

2) Stomachic

3) Migraine prophylactic

4) Antipyretic

5) Anthelmintic

6) Antirheumatic

Scientific information

The species name, parthenium, is thought to derive from the Greek word parthenos meaning a virgin, as the herb was traditionally valued for treating menstrual cramps. It was used in the past for many more applications than it is today, the main recognised use now being that of treating migraines.

Anti-inflammatory

In vitro—Detailed biochemical actions have been explored for the herb and/or its constituents. Both anti-inflammatory and migraine prophylaxis are likely to use at least some of the same biochemical mechanisms. Some of this detail has been elucidated and in summary involves inhibition of the following:-

Whilst parthenolide and the lactones containing the α-methylene-γ-lactone structure have been found to contribute largely to this action, the flavonols, and possibly other constituents are also strongly involved in eicosanoid synthesis inhibition.548

In vivo—Given the wide spectrum of anti-inflammatory actions above it is not difficult to understand why feverfew was indicated for rheumatic/arthritic conditions. However there does not appear to have been much clinical investigation into this aspect of the herb. One study has reported no benefit from using the herb in the treatment of rheumatoid arthritis.549

Migraine prophylaxis

In vivo—The first clinical studies into the prophylactic effect of T. parthenium in migraines were done in the 1980s. Since then a number of studies and/or reviews have appeared assessing benefits of feverfew in both the prevention and treatment of migraines with conflicting results. Some authors have concluded there is no proven benefit of feverfew preparations over placebo,550–553 others that there is qualified support for the herb reducing migraine frequency and/or some of the related symptoms.554–560 It has also been reported that the herb may only be effective in people with a migraine frequency in excess of 4 in a 28 day period.561 A combination of Salix and T. parthenium also has therapeutic benefits (see Salix) and T. parthenium combined with Zingiber officinale, used sub-lingually in the early phase, helped abort full blown attacks.560

More robust testing is still required to satisfy medical criteria of efficacy. However Canada has made a feverfew extract officially available for migraine prophylaxis.562

Anticancer

In vitro—Parthenolide has been studied in the context of its anticancer properties. It has:-

Parthenolide's action as a cytostatic and apoptotic agent probably involves more than one mechanism.573 The flavonols, particularly centaureidin, are antimitotic.533

Other

In vitro—The whole herb and/or its constituent lactones have antimicrobial activity including against Leishmania amazonenesis,574 Mycobacterium tuberculosis,575 Staphylococcus aureus, Streptococcus haemolytica, Candida albicans and Trichophyton mentagrophytes.576 Parthenolide also inhibits the replication of the hepatitis C virus and potentiates the antiviral activity of interferon-a.577

The effects of parthenolide on immune cells are numerous and are being explored. Parthenolide inhibits activation-induced cell death of T-cells, a process implicated in severe diseases including auto-immunity.578

Medicinal uses

Nervous system

Gastro-intestinal tract

As a bitter used for:

Musculoskeletal

Pharmacy

Dried herb in tablet or capsule –   50–200 mg
Tincture 1:5 (25%) –   5–20 drops

Ethanol is a slightly better extractive medium than water for the sesquiterpene lactones of T. parthenium.579 For the prophylaxis of migraines the above preparations or fresh leaves (one large or three small taken in a sandwich) once a day, for up to six months. Feverfew preparations may be taken at the start of an attack.

Parthenolide, considered the main active constituent, is often used to standardise the herb and clinical trials using such preparations were based on 0.5 mg parthenolide equivalent a day. However it is likely that there are a number of important active constituents.580

The commercial quality has been found to be very variable,581 preparations showing a 10-fold variation in concentration of herb and an even larger variation in parthenolide content.582

CONTRAINDICATIONS—Pregnancy.

Precautions and/or safety

Checks for chromosomal damage from T. parthenium used for periods of greater than 11 months continuously found it was safe.583

The occasional person develops mouth ulcers from taking the fresh leaf. Other potential side-effects reported include dizziness, indigestion, heartburn, loss of taste, inflammation of mouth and tongue, weight gain527 and a possible rebound headache may occur on ceasing to use the herb. Many of the above clinical studies checked for adverse reactions and reported a very good safety record for feverfew551,559,561 even in preparations containing quite high levels of parthenolide.584

For allergic reactions—see General Precaution p. 25. A low level of contact dermatitis, up to 4.5%,585 has been noted through occupational handling of the plant586 or from airborne exposure, resulting in a type of photosensitive reaction that occurs on sun-exposed skin.9,587 This may be generalised or may only affect the hands, and/or face. 65% of individuals may have associated blistering of the hands.9 The sesquiterpene lactones, particularly parthenolide,588 are considered instrumental in the development of the allergy (predominantly dermatitis),589 although other phytochemicals may also contribute.531,590,591

Interactions

It has been assumed that because the herb can inhibit platelet aggregation it may interact with anticoagulant drugs like warfarin592 and aspirin,593 but to date no interactions have been reported in vivo. An early study checked the platelet aggregation of long-term feverfew users and found no changes had occurred.594 Interestingly it is considered possible that NSAIDs may negate the benefit of feverfew in migraine prophylaxis.595

Historical uses

Strengthens the womb; helps expel the after-birth; as an emmenagogue, dysmenorrhoea. Pain of the head involving coldness. To lift the spirits; for hysteria and nervousness. For colic; coughs; wheezing; difficulty breathing. Externally to treat freckles; insect bites and as an insect repellent.

Tanacetum vulgare

Tansy

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Family Asteraceae, Tribe Anthemideae

Description

A rhizomatous, strongly aromatic perennial which dies back to basal leaves in winter. Stems erect, ribbed and slightly hairy, from 30–200 cm tall, branching above to form the inflorescence. Basal leaves petiolate, ovate, obovate or elliptic; pinnate, about 15–25 × 5–10 cm, primary leaflets in 10–15 pairs, lanceolate to narrow ovate, all on one plane, ultimate segments often triangular, serrate. Cauline leaves alternate, similar, but usually glabrous and glandular and becoming sessile and smaller with fewer leaflets higher up the stems. Flowers in a corymb with up to 15 or more densely packed capitula. Involucral bracts usually glabrous with a brown margin. Capitula from 6–12 mm across, outer florets female but not or shortly ligulate, disc florets numerous, all yellow. Achenes brown, glandular, ribbed, about 1.5 mm long. Flowers midsummer to late autumn.

Habitat and cultivation

Native to Europe and temperate Asia and now naturalised widely in waste and cultivated land. Forms large clumps in most soils and may be grown from root division. Drought and frost resistant.

Parts used

The herb harvested during or just prior to flowering.

Active constituents

T. vulgare exists as different genotypes and 26 different chemoforms having been found in Hungary.596,597 The constituents and morphology vary according to genotype and geographical location.597–599

1) Volatile oil (up to 0.3% in herb, up to 1. 9% in flowers) more than 100 mono- and sesquiterpenes have been identified.599 Composition depends on chemotype and consists of differing amounts of the main constituents α–thujone (up to 61%), β-thujone (up to 81%), (-)-camphor (most frequently found monoterpene), borneol, 1,8-cineole-bornyl acetate, α-terpineol and/or (E)-chrsysanthenyl acetate (up to 40% or more)596,598–602

2) Sesquiterpene lactones including predominantly parthenolide also germacrene D.603–606 Also some non-volatile sesquiterpenes including davanone,600,607 tanacetols A and B608–610

3) Flavonoids including those based on scutellarein, luteolin, apigenin, quercitin, eupatorin, chrysoeriol and diosmetin532,611

4) Terpenoids—artemisia ketone, transphytol,604 pyrethrins, α-amyrin, β-amyrin and taraxasterol612,613

5) Sterols including β-sitosterol, stigmasterol and campesterol612

Also contains tannins, resin and a pectin polysaccharide (tanacetan).614,615

Actions

1) Anthelmintic

2) Emmenagogue

3) Carminative

4) Spasmolytic

Scientific information

In ancient times tansy was used as an embalming agent and insect repellent. It is still known for its repellent properties but is also used in the food flavouring and cosmetics industries.

In spite of the amount of research that has been conducted into the chemical constituents and its variations in make-up, not a great deal has been done into its actions.

In vitro—The essential oil has acaricidal properties tested against the spider mite, Tetranychus urticae, β-thujone is considered the main active constituent.616 The whole herb has partial activity in inhibiting the virus responsible for tick-borne encephalitis.384

T. vulgare has anti-oxidant617 and anti-inflammatory activity.618 As cited for T. parthenium parthenolide also has anti-inflammatory activity but it is present at much lower concentrations in this herb and it is very likely other constituents are contributing to the action.611

The polysaccharide fraction has immunomodulatory activity.619

Medicinal uses

Gastro-intestinal tract

May be used to improve digestive function, however, it is mainly used as an anthelmintic:

Reproductive tract

As an emmenagogue the herb has been used for:

Externally

Pharmacy

Three times daily  
Infusion of dried herb –   1–2 g
Liquid Extract (25%) –   1–2 ml

As an anthelmintic T. vulgare may be combined with other anthelmintic agents and a laxative. The combined herbs are administered once a day, at night or on an empty stomach in the morning, for two weeks. The flowers are stronger than the whole herb.

A scabies lotion may be prepared stronger than that recommended for internal use.

T. vulgare oil is very strong and should be used with great caution. It may be incorporated into an ointment to apply to the anus to kill emerging adults and their eggs.

CONTRAINDICATIONS—Pregnancy.

Precautions and/or safety

Tansy is a strong herb and should not be used continuously for long periods of time. The recommended dosage should not be exceeded. For allergic reactions—see General Precaution p. 25. Photoallergic contact dermatitis has also been observed in patch testing.620

The essential oil of tansy may cause convulsions, an activity attributed to the monoterpene ketones.621

Historical uses

Hysteria; kidney weakness; fever and ague; gout; epilepsy (essential oil in small doses); joint pains; sciatica. Externally for sprains; swellings; rheumatism; mouth and gum sores and loose teeth (gargle); morphew; sunburn; pimples; freckles; eye inflammations. Was used as a strewing herb.

Taraxacum officinale

Dandelion

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Family Asteraceae, Tribe Lactuceae

Description

Perennial rosette herb with tap root(s). Leaves all basal, linear oblanceolate to obovate, runcinate-pinnatifid to not lobed, toothed, glabrous or with sparse short multicellular hairs especially on midrib above, 5–30 × 1–10 cm; terminal lobe triangular to deltoid, acute or obtuse, truncate or hastate at base; lateral lobes narrowly to broadly triangular, usually recurved, often toothed, petiole and proximal part of midrib hollow. Scape stout, hollow, glabrous or cobwebby, 3–35 cm tall. Capitula 3–5 cm diameter, solitary, terminal. Calyx dull green or reddish, strongly reflexed or recurved at flowering and fruiting. Corolla ligulate, florets golden yellow. Achene body cream to greenish brown, ribbed, clavate, 2.5–3.5 mm long. Pappus white, 5–7 mm long. Flowers most of the year with the main season in spring.

Habitat and cultivation

Temperate weed throughout the Northern Hemisphere and naturalised elsewhere in grasslands, lawns and gardens. Self-sows and needs no cultivation but provides better leaves and roots in deep, moist soil. Drought and frost resistant.

Parts used

Leaves gathered throughout the year but before flowering occurs; roots dug from plants two years old or more, in autumn.

Active constituents

Taraxacum is another herb in which polyploidy has been well documented. The herb not only reproduces sexually but can do so asexually, a process called apomixis, this could be a new phenomenon in this species.622 The normal sexually reproduced plants are diploid but the plant can exist in a polyploid form, mainly triploid and tetraploid,623 through interaction of the different genetic types. Rural plants can be genetically different from urban ones, the level of pollution apparently making plants less genetically diverse.624 The constituents of the herb may therefore have some variation depending on genotype.

1) Sesquiterpene lactones, of following types:-

a) germacranolide including derivatives of taraxinic acid (root and leaf)625

b) guaianolide including a dihydrolactucin, ixerin D and ainslioside (root)626

c) eudesmanolide including tetrahydroridentin B627 and taraxacolide glucoside (root)

2) Also an ester of γ-butyrolactone glucoside called taraxacoside (root).628 The sesquiterpene lactones give the herb its bitterness.

3) Flavonoids—glycosides of quercetin629 (root and leaf); luteolin glucosides630 (leaf)

4) Phenolic acids including caffeic and p-hydroxyphenylacetic acids and derivatives of caffeoylquinic acid and tartaric acid predominantly cichoric and monocaffeoyltartaric acid, hydroxycinnamic and chlorogenic acids (root and leaf); syringin (root)626,629,630

5) Carotenoids including lutein, violaxanthin and β-carotene631 (leaf)

6) Triterpenoids including pentacylic alcohols taraxasterol, Ψ-taraxasterol, taraxerol and β-amyrin (root); β-amyrin (leaf)632 and cycloartenol (leaf) and the phytosterols β-sitosterol, stigmasterol (leaf and root) and campesterol (leaf)

7) Coumarins scopoletin, esculetin, cichoriin and aesculin (leaf)630

The root has in addition tannins, mucilage, volatile oil and polysaccharides including inulin (up to 40% in autumn), glucans, fructosans and mannans.

The leaf has in addition furan fatty acids,633 choline and potassium salts (up to 4.25%).

Nutritional constituents

Vitamins: A, B, C, and D in leaf and root; carotenoids in the leaf

Minerals: Potassium, iron, copper in the leaf and root; calcium, sodium, some phosphorous and zinc in the root

Actions

1) Diuretic (leaves)

2) Choleretic

3) Laxative

4) Antirheumatic

Scientific information

Both root and leaf have been used in many traditions over hundreds of years. The root has been an official medicine used as a bitter for atonic dyspepsia and as a laxative.42 Both herb and root are approved for use by German Commission E the former as a diuretic and for prevention of renal gravel the latter as indicated in the pharmacopoeias.

There has been very little modern research into the medicinal use of this herb in humans, early studies using animals forming the basis of the current understanding of its mode of action.

In vitro—The herb is one commonly chosen by Italian herbalists in the treatment of diabetes,634 one possible explanation may be that it can inhibit α-glucosidase (this is an orthodox approach used to treat type 2 diabetes mellitus).635

The root can:-

In vivo—A clinical trial used Taraxacum in combination with four other herbs (Hypericum, Calendula, Melissa and Foeniculum) to treat chronic non-specific colitis. The preparation gave a very high level of pain-relief.640

Traditionally the action of Taraxacum is via stimulation of liver and kidney function. Both parts of the herb are considered to have activities in both areas though the leaves are used for kidney excretion and the root for liver based secretion.

The potassium content of the leaves compensates for loss of this electrolyte which normally occurs with diuretics.

Recent analysis of the flowers has identified flavonoids with good anti-oxidant641 and anti-inflammatory642 activity, but this part of the herb is not used in herbal medicine.

Medicinal uses

Cardiovascular system

As a diuretic Taraxacum folia (leaves) is indicated where there is oedema:

Gastro-intestinal tract

The bitter properties of Taraxacum radix (roots) through stimulating digestive secretions make it suitable for treating:

The herb may also be beneficial in hypoglycaemia.

Urinary tract

Taraxacum folia is considered one of the strongest herbal diuretics, comparable in effect to the orthodox drug frusemide. However quite large quantities of the leaves, the juice or fluid extract would be required.

Musculoskeletal

Pharmacy

Three times daily

Leaf

Infusion of dried herb 4–10 g
Fluid extract (25%) 4–10 ml

Root

Decoction of dried root 2–8 g
Tincture 1:5 (45%) 5–10 ml
Fluid Extract (30%) 2–8 ml
Juice of fresh root 4–8 ml

Dandelion root, roasted, has been used as a coffee substitute.

Precautions and/or safety

The white juice found in the stem has been known to make children, who have ingested it in quantity, nauseous, also causing vomiting, diarrhoea and palpitations. No other toxicity or problems are known for this herb although because of the ability of Taraxacum to absorb lead and cadmium from the soil care should be taken when wild-crafting the herb to make medicine.643

For allergic reactions—see General Precaution p. 25. There are documented cases of contact dermatitis644–646 but it is only likely to cause a reaction in those with known contact allergies.647 A few cases have been reported of children not usually senstive to the Asteraceae family developing a contact eczema for which Taraxacum patch-tested positive.648,649 The frequency of reaction to dandelion appears to be quite low.650 There is one recorded case of Taraxacum causing erythema multiforme after exposure to it whilst gardening.651

Historical uses

“Cleanseth imposthumes and inward ulcers in the urinary passages” and to help those with cachexy—meaning a bad habit of the body. Phthisis and skin diseases such as scurvy, scrofula, eczema and eruptive skin conditions generally. The white latex has been used to treat warts.

Tussilago farfara

Coltsfoot, coughwort

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Family Asteraceae, Tribe Anthemideae

Description

A perennial with creeping rhizomes, and erect flowering stems arising directly from the rhizomes, which lengthen in fruit to 15–35 cm. Flowers in early spring, followed by the appearance of the leaves as flowers fade. Leaves all basal, stalked, large 10–30 cm across, orbicular-heartshaped with wide, irregular, shallow lobes. The leaf surface is deep green but underneath it is covered in soft white hairs. Flower heads solitary, bright yellow, 1½–3½ cm consisting of numerous ray florets in many rows. Flower stems are thick with scale-like leaves. Flowers close at night. Fruits each have a long white pappus.

Odourless; taste mucilaginous—bitter and astringent.

Habitat and cultivation

Native to all Europe and Britain, Tussilago grows in waste places, banks, screes and gravelly places. It is naturalised in parts of USA and considered to be a noxious weed in other places because of its spreading habits. Propagated by division. Frost and drought resistant.

Parts used

Leaves; flowers to a lesser extent.

Active constituents

1) Flavonoids including rutin and hyperoside (flowers); quercetin (leaves)

2) Mucilage (about 8%)

3) Alkaloids of pyrrolizidine type (about 0.015%), including tussilagine,652 isotussilagine, senkirkine653 and senecionine654

4) Sesquiterpenes including a bisabolene epoxide,655 farfaratin656 and tussilagone657 (flowers)

5) Triterpenoids including arnidiol and faradiol (flowers), β-amyrin, taraxasterol and the phytosterols sitosterol and stigmasterol (leaves)

Also tannins and inulin.

Nutritional constituents

Vitamins: A, B12, B6, C, and P

Minerals: Calcium, potassium, zinc, traces of manganese, iron and copper

Actions

1) Expectorant

2) Antitussive

3) Demulcent

4) Anticatarrhal

Scientific information

Tussilago is a widespread herb that has been part of the traditional medicine of many different countries. The botanical name testifies to its well established value across all these countries as a remedy to treat coughs. Both flowers and leaves were at one time official medicines in European pharmacopoieas used to treat chronic and irritable coughs.42

There is not a great deal of information available for the herb in the medical literature, most of the scientific interest having centred round its pyrrolizidine alkaloid content (see Precautions).

In vitro—The herb's activity has only been assessed in animal models but includes anti-oxidant and anti-inflammatory activity, via inhibition of arachidonic acid metabolism, inhibition of nitric oxide production and antagonism of PAF.655

It had good antimicrobial activity against Bacillus cereus and Staphylococcus aureus.658

In vivo—A decoction of a number of Chinese herbs, including Tussilago was effective in clearing up residual airways obstruction in a group of convalescing asthmatics.659

Medicinal uses

Respiratory tract

The herb is considered antispasmodic and an aid to mucociliar activity.

Weiss considers one of Tussilago's uses is in the treatment of coughs due to emphysema or silicosis where it would not cure these irreversible conditions but could help to relieve their symptoms. In addition he suggests the bitterness would be an added “tonic” in these debilitating diseases.

Pharmacy

Three times daily

Infusion of dried herb –   0.6–2 g
Tincture 1:5 (45%) –   2–8 ml
Fluid extract (25%) –   0.6–2 ml
Syrup (25%) –   2–8 ml

Weiss suggests steeping the herb overnight in a thermos (vacuum) flask for use the next morning. It has been used in herbal tobaccos and was formerly used as a smoke inhalation to treat respiratory conditions like asthma.

Precautions and/or safety

The pyrrolizidine alkaloids present in Tussilago could theoretically cause hepatotoxicity but in practice the level of these alkaloids are very low. There are no reports to-date of its having done so apart from two cases of veno-occlusive disease initially attributed to Tussilago which appear to be cases of incorrect plant identification, the substituted plant being of similar appearance.660–662

The alkaloids are also potentially carcinogenic and teratogenic though again no link has yet been found.663 In fact senkirkine, which is present in very small concentrations in the herb, is not mutagenic to human lymphocytes even at high concentrations.664

Coltsfoot is not available in some countries because of the concern over the pyrrolizidine alkaloids, even though it has been used throughout the world over many centuries. Where it is available maximum daily doses, given above, should not be exceeded.

Historical uses

To aid treatment of fevers, scrofulous conditions, calculus. Externally for inflammations or hot swellings; wheals; piles.

_____________

†Active against bacteria, fungi, viruses and protozoa.

†Echinacea as part of combination.

†Including Streptococcal infections.

†Alantol is a breakdown product of the essential oil on distillation.

†Double blind studies show it increases survival time in this condition.

†Includes hookworms, threadworms and pinworms.