Comfrey Uses, Benefits — Dosage — Herbal Database

Comfrey

Medically reviewed by Drugs.com. Last updated on Jan 17, 2019.

Scientific Name(s): S. asperum Lepechin, S. tuberosum L., Symphytum officinale L., Symphytum x uplandicum Nyman
Common Name(s): Blackwort, Bruisewort, Comfrey, Knitbone, Radix consolidate, Russian comfrey, Slippery root, Symphyti radix

Clinical Overview

Therapeutic use of comfrey is limited because of its toxicity. A limited number of clinical trials show short-term efficacy of topically applied, alkaloid-free comfrey preparations in skin abrasions and inflammatory conditions. Although not examined in clinical trials, comfrey may possess antifungal and anticancer activity.

Dosing

Oral use of comfrey is not supported because of potential hepatotoxicity. Additionally, because externally applied alkaloids are well absorbed and detected in the urine, topical use of comfrey should not exceed an alkaloid exposure of 100 mcg/day. Limited trials have evaluated the efficacy of alkaloid-free preparations for topical use; however, these studies do not report on hepatic laboratory indices of study participants.

Contraindications

Comfrey is not recommended for internal use because of the hepatotoxic pyrrolizidine alkaloid content. Patients with hypersensitivity or allergic reactions to the plant should avoid external use. Use is contraindicated during pregnancy and lactation, in infants, and in patients with liver or kidney disease.

Pregnancy/Lactation

Contraindicated because of documented adverse effects. Pyrrolizidine alkaloids have abortifacient effects and increase the risk of fatal hepatic veno-occlusive disease. Animal experiments have detected alkaloids in breast milk.

Interactions

None well documented.

Adverse Reactions

Neither internal nor extensive topical use of comfrey is recommended because of numerous reports of liver toxicity (see Toxicology). Case reports show hepatic veno-occlusive disease and pulmonary hypertension related to comfrey use. Infants are more susceptible to pyrrolizidine-related, veno-occlusive disease; therefore, the use of comfrey in this population is contraindicated.

Toxicology

The Food and Drug Administration (FDA) released an advisory in July 2001 recommending that comfrey products be removed from the market because of cases of hepatic veno-occlusive disease. Comfrey is generally considered unsafe, with numerous toxicological effects in animals and humans.

Scientific Family

Botany

Comfrey is a perennial plant found in moist grasslands in western Asia, as well as in North America. It grows to heights of 50 to 150 cm and has long, hairy lanceolate leaves and bell-shaped, red-violet or yellowish flowers. S. x uplandicum Nyman is a hybrid of S. officinale and S. asperum, and has been cultivated to contain insignificant amounts of alkaloids in the aerial parts of the plant.Kucera 2005, PLANTS 2017, Stickel 2000

History

Comfrey has been cultivated in Japan as a green vegetable and has been used as an herbal medicine for more than 2,000 years. Comfrey’s original name, knitbone, derives from the external use of poultices of its leaves and roots to heal burns, sprains, swelling, and bruises. In Western Europe, comfrey has been used topically for treating inflammatory disorders such as arthritis, gout, and thrombophlebitis, and internally for treating diarrhea. Comfrey has been claimed to heal gastric ulcers and hemorrhoids, and to suppress bronchial congestion and inflammation. Symphyti radix (comfrey root) is recommended in the German Commission E Monographs for external use in bruises and sprains.Staiger 2013, Stewart 2001, Stickel 2000

Chemistry

Numerous hepatotoxic pyrrolizidine alkaloids with differing toxicities have been identified in the plant, including symphytine, echimidine, intermedine, symviridine, and lasiocarpine (retronecine mono- and diester alkaloids). Roots contain a 100-fold higher alkaloid content than the aerial portions.Furuya 1971, Rode 2002, Stickel 2000

The healing action of poultices of comfrey roots and leaves may be related to the presence of allantoin. The underground roots contain allantoin 0.6% to 0.7% and tannin 4% to 6.5%; the leaves contain a higher proportion of tannin relative to allantoin. The roots also contain rosmarinic and lithspermic acid.Ahmad 1993, Mutterlein 1993, Tyler 1972, Wagner 1970

Large amounts of mucilage, fructanes, and starch are found in the leaves and rootsGiannetti 2010, Koll 2004 while a pentacyclic triterpene glycoside of oleanolic acid was identified in the root.Ahmad 1993, Wagner 1970

Uses and Pharmacology

The therapeutic use of comfrey is due in part to allantoin and rosmarinic acid content, but it is limited by the toxicity of pyrrolizidine alkaloids.Stewart 2001 Controlled cultivation of S. x uplandicum is said to produce a plant devoid of the toxic alkaloids in the aerial plats, enabling the production of relatively nontoxic comfrey preparations.Kucera 2005 Pyrrolizidine alkaloid-free preparations of comfrey have been used in clinical studies in Germany.

Antifungal activity

Aqueous extracts from comfrey leaves strongly inhibited plant pathogenic fungi, most likely because of the plant’s phenolic compounds.Karavaev 2001

Cancer

Various extracts and fractions of S. officinale have inhibited tumor cell proliferation and exerted antimitotic effects in animal and in vitro experiments.Yeong 2001, Awang 1987, Gomes 2010, Olinescu 1993

Hormonal

Lithospermic acid isolated from the root appears to have antigonadotropic activity.Wagner 1970

Inflammation

Clinical data

A limited number of clinical trials have been conducted to assess the efficacy of topically applied, alkaloid-free comfrey preparations in ankle sprains, osteoarthritic knee conditions, and back pain/myalgia. Critical reviews of clinical trials have been published.Cameron 2013, Frost 2013, Gagnier 2016 Outcome measures include patient assessment of pain and mobility, as well as measures of ankle swelling and clinician evaluations. Most studies show a statistically significant advantage of active preparation over placebo in the short term; however, because many of these trials have been conducted by product manufacturers, the possibility of publishing bias exists.Cameron 2013, Frost 2013, Gagnier 2016 Other open-label or single-blind trials with topical comfrey preparations have been conducted; however study design limits the validity of the results.Koll 2002, Kucera 2000, Predel 2005 Preparations generally contained a 35% liquid root extract from which toxic alkaloids were removed and standardized to allantoin 0.2% to 0.5%Giannetti 2010, Grube 2007, Koll 2004, Predel 2005 or to a preparation with 10% extract of S. x uplandicum aerial parts.Kucera 2005, Kucera 2004 Duration of use ranged from 5 days to 3 weeks in these studies. The studies report no adverse effects, although liver function test results were not reported.

Mechanisms of action include effects on platelet activating factor, as well as on the synthesis of the enzymes catalase and superoxide dimutase.Dolganiuc 1997, Tunón 1995

Lower back pain

Clinical data

A systematic review evaluated randomized trials of various herbal therapies in patients with acute, subacute, and chronic low back pain. The review found that compared with placebo, the evidence for effectiveness was the best for topical Capsicum frutescens (cayenne), with some evidence for oral Harpagophytum procumbens (Devil’s claw), oral Salix alba (white willow bark), topical Symphytum officinale (comfrey root extract), and topical lavender essential oil. However, there were methodologic limitations to the trials, outcomes assessed were short-term, and it is not clear how these treatments compare with over-the-counter analgesics.Oltean 2014

Wound healing

Clinical data

The use of a dermal preparation of comfrey derived from alkaloid-free cultivars of S. x uplandicum has been studied in limited clinical trials. Applied to fresh abrasions, a 10% preparation showed faster decreases in wound size and shorter times to healing, with no cutaneous reactions to the preparation reported.Barna 2007, Kucera 2005 The preparations were applied to the skin over short time periods (days) only. Efficacy in wound healing may be related to the presence of allantoin, rosmarinic acid, or another hydrocolloid polysaccharide.Andres 1989, Franz 1989

Dosing

The oral use of comfrey cannot be supported because of potential hepatotoxicity. Because externally applied alkaloids are well absorbed (detected in the urine), topical use of comfrey should not exceed an alkaloid exposure of 100 mcg/day.Staiger 2013, Stickel 2003

Limited trials have evaluated the efficacy of alkaloid-free preparations for topical use; however, these studies do not report on hepatic laboratory indices of the participants.

Pregnancy / Lactation

Avoid use because of documented adverse effects. Pyrrolizidine alkaloids have abortifacient effects and increase the risk of fatal hepatic veno-occlusive disease.Brinker 1998, Ernst 2002, Newall 1996 An extract of S. officinale has been reported to enhance uterine tone.Shipochliev 1981 Animal experiments have detected comfrey alkaloids in breast milk.Panter 1990, Schoental 1982

Interactions

Case reports are lacking. Experimental evidence exists of the potentiation of toxicity of comfrey’s alkaloids by phenobarbital via the cytochrome P450 pathway.Stickel 2000

Adverse Reactions

Neither internal nor extensive topical use of comfrey can be recommended because of numerous reports of liver toxicity (see Toxicology). Case reports show hepatic veno-occlusive disease and pulmonary hypertension related to comfrey use.Stickel 2000, Györik 2009 Infants are more susceptible to pyrrolizidine-related, veno-occlusive disease; therefore, the use of comfrey in this population is contraindicated.Stickel 2000

Toxicology

Carcinogenicity

S. officinale extract and components lasiocarpine and symphytine are carcinogenic in rats, possibly via genotoxic mechanismsSvoboda 1972, Hirono 1979, Hirono 1978, Mei 2005; however, an association of comfrey consumption with cancer in humans is lacking.Stickel 2000

A pyrrolizidine alkaloid-free liquid extract of comfrey root was not mutagenic when tested by the bacterial reverse mutation assay.Benedek 2010

Hepatotoxic effects

The FDA released an advisory in July 2001 recommending that comfrey products be removed from the market following several cases of hepatic veno-occlusive disease in which the destruction or obliteration of small hepatic veins led to cirrhosis and, eventually, liver failure. Also in 2001, the Federal Trade Commission brought enforcement action against a company marketing comfrey-containing products. The parties agreed to a preliminary injunction that prohibited the company from marketing any comfrey-containing products intended for internal use or use on open wounds, as well as requiring a warning on comfrey products intended for external use.FDA 2006, Mattocks 1990, Ridker 1985, Larrey 1994, Kumana 1983, Yeong 1990, Mattocks 1968

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Human poisonings with pyrrolizidine alkaloids are usually accidental and may be caused by ingestion of contaminated flour, milk, certain goat products that are resistant to the alkaloids, honey produced by bees fed on pyrrolizidine-containing weeds, and consumption of certain herbal or bush teas. It also may be caused by comfrey used in salads.Stewart 2001, Rode 2002, Schoental 1982, Panter 1990

References

dms/dspltr06.html. Accessed January 10, 2006

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Ginger

Medically reviewed by Drugs.com. Last updated on Dec 20, 2018.

Scientific Name(s): Zingiber capitatum Smith., Zingiber officinale Roscoe.
Common Name(s): Black ginger, Ginger, Ginger root, Zingiberis rhizoma

Clinical Overview

There are many traditional uses for ginger, but recent interest centers on the prevention and management of nausea. However, information to support ginger’s use for nausea, especially in pregnancy, is limited or lacking. Ginger may possess anti-inflammatory and analgesic effects, and has been effective in dysmenorrhea in limited studies.

Dosing

Ginger has been used in clinical trials in dosages of 170 mg to 1 g 3 to 4 times daily. Essential oils of ginger have been administered as aromatherapy for postoperative and chemotherapy-induced nausea and vomiting.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Avoid use. Despite trials conducted to determine its effectiveness in pregnancy-related nausea, data on fetal outcomes are lacking.

Interactions

Anticoagulants (eg, warfarin), agents with antiplatelet properties, nonsteroidal anti-inflammatory agents, salicylates or thrombolytic agents, antihypertensives, and hypoglycemic agents interact with ginger.

Adverse Reactions

The US Food and Drug Administration (FDA) lists ginger as generally recognized as safe (GRAS), but large doses carry the potential for adverse reactions. Mild GI effects (eg, heartburn, diarrhea, mouth irritation) have been reported, and case reports of arrhythmia and immunoglobulin E (IgE) allergic reaction are documented.

Toxicology

Toxicological information regarding the use of ginger in humans is limited, and mutagenicity is contested.

Scientific Family

Botany

Native to tropical Asia, ginger is a perennial plant cultivated in the tropical climates of Australia, Brazil, China, India, Jamaica, West Africa, and parts of the United States. The rhizome, which is used medicinally and as a culinary spice, is harvested at 6 to 20 months; taste and pungency increase with maturity. The plant carries a green-purple flower in terminal spikes, and the showy flowers are pollinated by insects.1, 2

History

Medicinal use of ginger dates back to ancient China and India; references to its use are found in Chinese pharmacopeias, the Sushruta scriptures of Ayurvedic medicine, and Sanskrit writings. When its culinary properties were discovered in the 13th century, use of this herb became widespread throughout Europe. In the Middle Ages, apothecaries recommended ginger for travel sickness, nausea, hangovers, and flatulence.

Ginger is found in the official pharmacopeias of Austria, China, Egypt, Great Britain, India, Japan, the Netherlands, and Switzerland. It is approved as a nonprescription drug in Germany and as a dietary supplement in the United States.2, 3, 4

Chemistry

Only unbleached ginger (scraped or unscraped) is accepted as a medicinal-grade drug, containing 1.5% or more volatile oil. Quality standards for ginger can be found in the United States Pharmacopeia.

More than 400 different compounds have been identified in ginger. The major constituents in ginger rhizomes are carbohydrates (50% to 70%), which are present as starch. The concentration of lipids is 3% to 8% and includes free fatty acids (eg, palmitic, oleic, linoleic, linolenic, capric, lauric, myristic), triglycerides, and lecithins. Oleoresin provides 4% to 7.5% of pungent substances as gingerol homologues, shogaol homologues, zingerone, and volatile oils. Volatile oils are present in 1% to 3% concentrations and consist mainly of the sesquiterpenes beta-bisabolene and zingiberene; other sesquiterpenes include zingiberol and zingiberenol. Numerous monoterpenes are also present. Amino acids, raw fiber, ash, protein, phytosterols, vitamins (eg, nicotinic acid, vitamin A), and minerals are among the other constituents.

Analyses of the oleoresins have resulted in the identification of a class of structurally related compounds called gingerols, which form shogaols and degrade further to zingerone when dehydrated. The main components are [6]-gingerol and [6]-shogaol; however, the pharmacologically active compounds [6]- and [10]-dehydrogingerdione and [6]- and [10]-gingerdione have also been identified.1, 5, 6, 7, 8, 9

Uses and Pharmacology

The ginger rhizome is a widely used culinary spice. The relative safety of ginger and the availability of randomized clinical trials in humans render data from animal trials largely irrelevant for some indications.

Analgesic/Anti-inflammatory effects

Animal data

Anti-inflammatory effects of ginger include effects on the inflammatory precursor arachidonic acid6, 10 and inhibition of prostaglandin and leukotriene synthesis.5, 11

Clinical data

Results from published studies are equivocal, and several trials are compromised by methodological flaws.6, 12, 13, 14 Ginger 2 g/day over 11 days was effective in reducing exercise-induced muscle pain; however, markers of prostaglandin synthesis were unaffected, and a single dose was ineffective.15, 16 A randomized, double-blind, placebo-controlled trial in 20 non–weight-trained adults found that ginger supplementation (4 g/day × 5 days) significantly improved muscle recovery in the early stages after exercising (24 to 48 hours) (P = 0.002) but not 72 or 96 hours after exercising, in contrast to placebo. Additionally, ginger appeared to increase indicators of muscle damage, as pairwise comparisons revealed significant increases in overall creatine kinase (P = 0.01) and impaired flexibility (P Consumer resources

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Bay Leaf

What other names is Bay Leaf known by?

Bay, Bay Laurel, Bay Tree, Daphne, Grecian Laurel, Laurel, Laurel Común, Laurier d’Apollon, Laurier Noble, Laurier-Sauce, Laurier Vrai, Laurus nobilis, Mediterranean Bay, Noble Laurel, Roman Laurel, True Bay.

What is Bay Leaf?

Sweet bay is an herb. The Greeks made it famous by crowning their heroes with wreathes made out of sweet bay leaves. In addition to decorative use, the leaves and oil are used to make medicine.

Sweet bay is used to treat cancer and gas; stimulate bile flow; and cause sweating.

Some people apply sweet bay to the scalp for dandruff. It is also put on the skin for pain, especially muscle and joint pain (rheumatism).

The fruit and fatty oils of sweet bay are used on the skin to treat boils (furuncles) caused by infected hair follicles.

Veterinarians use sweet bay as an udder ointment.

In food, sweet bay is used as a seasoning in cooking and in processed foods.

In manufacturing, the oil is used in cosmetics, soaps, and detergents.

Insufficient Evidence to Rate Effectiveness for.

  • Diabetes. Early research suggests that taking ground bay leaf twice daily along with medication for diabetes can lower pre-meal blood sugar levels, as well as levels of cholesterol, “bad” low-density lipoprotein (LDL) cholesterol, and blood fats called triglycerides in people with diabetes. Also, taking ground bay leaf seems to increase “good” high-density lipoprotein (HDL) cholesterol levels in these people.
  • Cancer.
  • Gas.
  • Stimulating bile flow.
  • Causing sweating.
  • Dandruff, when applied to the skin.
  • Joint and muscle pain (rheumatism), when applied to the skin.
  • Boils, when applied to the skin.
  • Other conditions.

More evidence is needed to rate the effectiveness of bay leaf for these uses.

How does Bay Leaf work?

Sweet bay contains ingredients that might cause sleepiness and might act against some bacteria and fungi.

Are there safety concerns?

Bay leaf and bay leaf oil is LIKELY SAFE for most people in food amounts. Ground bay leaf is POSSIBLY SAFE when taken by mouth in medicinal amounts, short-term. But, if you cook with whole bay leaf, be sure to remove it before eating the food. Taking the whole, intact leaf by mouth is LIKELY UNSAFE. The leaf can’t be digested, so it remains intact while passing through the digestive system. This means it can become lodged in the throat or pierce the lining of the intestines.

Special Precautions & Warnings:

Diabetes: Bay leaf might interfere with blood sugar control. Monitor blood sugar closely if you have diabetes and use bay leaf as a medicine.

Surgery: Bay leaf might slow down the central nervous system (CNS). There is a concern that it might slow down the CNS too much when combined with anesthesia and other medications used during and after surgery. Stop using bay leaf as a medicine at least 2 weeks before a scheduled surgery.

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Are there any interactions with medications?

Bay leaf can lower blood sugar in people with type 2 diabetes. Diabetes medications are also used to lower blood sugar. Taking bay leaf along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Medications for pain (Narcotic drugs)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

The body breaks down some medications for pain to get rid of them. Bay leaf might decrease how fast the body gets rid of some medications for pain. By decreasing how fast the body gets rid of some medications for pain, bay leaf might increase the effects and side effects of some medications for pain.

Some medications for pain include meperidine (Demerol), hydrocodone, morphine, OxyContin, and many others.

Sedative medications (CNS depressants)Interaction Rating: Moderate Be cautious with this combination.Talk with your health provider.

Bay leaf might cause sleepiness and drowsiness. Medications that cause sleepiness are called sedatives. Taking bay leaf along with sedative medications might cause too much sleepiness.

Dosing considerations for Bay Leaf.

The appropriate dose of sweet bay depends on several factors such as the user’s age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for sweet bay. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

QUESTION

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).

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