Herbs for Health

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Bark of the white willow (Salix alba) has been used as a pain reliever for thousands of years, but it may not measure up to aspirin’s power to relieve some forms of pain.
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The fruiting bodies of the Humulus lupulus plant are known as hops and are used dried, in capsule, tincture, or tea form to decrease anxiety and insomnia and increase appetite.
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Bark of the white willow (Salix alba) has been used as a pain reliever for thousands of years, but it may not measure up to aspirin’s power to relieve some forms of pain.
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Bark of the white willow (Salix alba) has been used as a pain reliever for thousands of years, but it may not measure up to aspirin’s power to relieve some forms of pain.

The willow is a symbol of the changeable human
spirit and of immortality. In the Shaker tradition, numerous song
references are made to the willow. “I will not be like a stubborn
oak, but I will be like the willow tree. . .,” one song begins.
Another song starts, “Yielding and simple may I be like a pliant
willow tree.” These and many other references to the willow remind
us of a capacity for change.

So many willows

Botanically, the genus Salix, to which the willows belong, is
itself a symbol of change. The genus contains more than 400
species, primarily native to the Northern Hemisphere, with some
species growing south to the equator as well. In China alone, there
are more than 250 willow species. They hybridize readily, and for
the botanist, the genus represents a taxonomic nightmare. There are
more than fifty species of willows in the eastern United States,
and California has more than thirty species. The willow family
(Salicaceae) is represented by two genera, Salix and the poplars
(Populus). Salix is the classical name for the willow tree.

Of the eighty or more species of willows occurring in North
America, most are low-growing shrubs. About a third of the species
are trees. In addition to the native species, several European and
Asian species are cultivated in American horticulture. A number of
these, including European white willow (Salix alba), have been
naturalized in this country. The European white willow and the
American black willow (S. nigra) are both more or less typical of
the genus, in terms of botanical characteristics and medicinal use.
Most herb books mention the main source of willow bark as S. alba.
Black willow is one of the most common willow species in North
America, and was probably the most widely used species among Native
American groups.

Traditional use

The black willow is one of the loftiest representatives of the
genus in North America, growing to a height of thirty to forty
feet. Sometimes it may become a massive tree more than 100 feet
tall. It was commonly used as a material as well as a medicine.
Willow switches were often used as horse whips, and were used when
a combination of toughness and elasticity were required, such as in
the manufacture of rustic chairs and baskets. The tough, stringy
bark was used for making cords and mats, fishing nets, harnesses,
and more. Its high tannin content made it suitable for tanning and
dyeing. Willow switches were commonly used by Native Americans as a
building material for the frames of temporary shelters, sweat
lodges, and furniture. Women and children wove sunshades from the
leafy stems for long journeys.

Native Americans used numerous willow species. S. nigra root
bark was used by the Houma as a blood thinner. The Chippewa used
the root for diarrhea, and in combination with other herbs to treat
indigestion. The Creek used the root tea as an anti-inflammatory
for rheumatism and to reduce fevers. The Penobscot used willow bark
as a cold remedy, and smoked the leaves to relieve asthma. The
Ojibwa used one willow species to treat colds. Many tribes used the
leaves as a poultice for wounds and sores. The Kiowa rubbed the
leaves on their bodies to treat rheumatic pains, and chewed the
leaves to relieve toothaches. The Chickasaw used the roots of one
willow species to treat headaches. The Montagnais made a poultice
of the leaves that was applied to the forehead to relieve
headaches. In short, Native Americans from Florida to California to
Alaska used willow bark as modern Americans use aspirin. In
American folk traditions, the bark was used as a blood thinner
(like aspirin), and to treat fevers.

Toward modern medicine

Willow bark’s modern history began in the mid-eighteenth
century. Reverend Edward Stone wrote a short note published in the
Philosophical Transactions of the Royal Society in London, in which
he reported on the successful use of white willow bark to treat
intermittent fevers (malaria). From this one report, willow bark
became a popular substitute for Peruvian bark or cinchona (source
of quinine) among European and American physicians of the
late-eighteenth and early-nineteenth centuries. In his American
Dispensatory (1813), James Thatcher tells the story. “In 1763, Mr.
Stone, an English clergyman, presented a paper to the Royal
Society, on the beneficial effects of the Salix alba, or white
willow, in intermittent fevers; and Dr. Cullen, on this authority,
and from the sensible qualities it possesses, recommends it, in his
Materia medica, as a substitute for the cinchona. Mr. Stone
gathered the bark in the summer, when it was full of sap; dried it
by gentle heat, and gave a drachm of it powdered every four hours,
betwixt the fits. In a few obstinate cases he mixed it with
one-fifth part of the cinchona. Some judicious physicians here,
says Dr. Cutler, made trial of the bark of white willow, and
recommend it as a valuable substitute for the Peruvian bark. They
have used principally the bark of the root.”

White willow is the “classic” willow, used medicinally since the
time of the ancient Greeks. Many willow species are used
interchangeably. Writing in King’s American Dispensatory in the
early 1900s, H. W. Felter and J. U. Lloyd state: “There are
numerous species of Salix, many of which, undoubtedly, possess
analogous medicinal virtues. The best rule to follow is to select
those whose barks possess great bitterness, combined with
astringency.”

While white willow is listed in most of the herbal literature as
a primary source for willow bark, four other European species are
recognized as sources of medicinal willow. These include S.
fragilis, S. purpurea, S. daphnoides, and S. pentandra. All except
S. daphnoides are naturalized in North America. White willow
contains only small amounts of the active constituent salicin (0.5
to 1.0 percent), whereas the other recognized species contain much
higher amounts. S. purpurea contains 6.1 to 8.5 percent salicins;
S. daphnoides contains 4.9 to 6.4 percent; and S. fragilis contains
3.9 to 10.2 percent. The total content of salicin is highest in
spring or summer and lowest in winter.

Comparisons to aspirin

Salicin is a white or colorless, silky, shining crystalline
substance, found in most species of willows and in poplars. It is
the primary chemical component responsible for the therapeutic
qualities of willows, including fever-reducing, mild
anti-inflammatory, and mild pain-relieving and blood-thinning
effects.

Willow has emerged as the best-known herbal alternative to
nonsteroidal anti-inflammatory synthetic drugs. While aspirin is
chemically related to analgesic compounds in willow bark, aspirin,
contrary to popular belief, was never derived from willow. Aspirin
was discovered as a result of research on compounds found in willow
(as well as a number of other plant species).

In ancient times, willow was used for the treatment of the pain
of arthritis and rheumatism. People made special clay pots in which
willow was soaked in olive oil, then submerged their ailing joints
in the pots to help relieve pain. Seldom used in the ensuing
centuries, modern interest in willow was sparked in 1763 by a
French scientist, Leroux. He first isolated salicin from willow
bark and published his findings in 1830. In 1838, salicylic acid
was prepared from salicin. In 1839, salicylic acid (also called
spiric acid) was also obtained from the flowerbuds of Filipendula
ulmaria (also known as Spirea ulmaria). Salicylic acid was used to
reduce the discomfort of rheumatic fever, as well as for rheumatic
pains, lumbago, sciatica, and for its diuretic activity. However,
it caused numerous side effects such as roaring in the ears,
vertigo, and profuse sweating, and it was extremely irritating to
the stomach.

In the 1890s, a chemist under the employ of Heinrich Dreser,
director of a research group at Bayer in Germany, brought a sample
of acetyl salicylic acid to Dreser. The researchers were interested
in developing a safer, non-irritating derivative of salicylic acid.
To see if it produced local irritation like salicylic acid did,
Dreser tested acetyl salicylic acid on the gills of live goldfish.
It proved to be far less irritating. Clinical trials were
initiated, and in 1899 Bayer launched this new form of salicylic
acid. At first it was called acteyl-spiric-acid (from the form of
salicylic acid isolated from Spirea), then asperic acid, and
finally it came to be known as aspirin. Before long, it became the
most widely used drug in the world, second only to alcohol.

In modern herbal practice, willow bark teas and extracts are
still used. Willow bark contains compounds called phenolic
glycosides esters, including salicin and related compounds, such as
fragilin, temulacin, and others, collectively known as salicortin.
When the bark is exposed to high temperatures, these compounds are
transformed into salicin. Intestinal microorganisms transform these
compounds into saligenin, which becomes oxidized in the liver and
blood, to produce salicylic acid, which has pain-relieving
effects.

How much is enough?

The question then becomes whether you can take enough willow
bark to achieve pain-relieving effects. According to the late Varro
Tyler, Ph.D., the answer is probably not, at least not in doses
large enough to treat arthritis. A standard dose of willow is 1 to
2 g of the powdered bark (about 1/4 to 1/2 teaspoon), corresponding
to 20 to 40 mg of salicin. Taken three times a day, it could
deliver as much as 120 mg of salicin. Tyler calculated that, based
on the low salicin levels in most commercial willow bark samples,
it would take between 6 cups and 1.25 gallons of willow bark tea to
achieve a single dose of salicin equivalent to an average daily
dose of aspirin high enough to treat arthritic pain. Another
problem with drinking willow bark tea is its astringent taste. The
first time I tried to drink a strong tea of willow bark to treat a
fever was, in fact, the last time I tried it.

The solution comes in producing a willow bark product that
contains enough salicin to deliver an effective dose. Standardized
willow bark products that contain 41 mg of salicin per 270-mg
capsule of willow bark extract are available at health-food stores.
According to the German Commission E monograph on willow bark, the
bark should contain at least 1 percent salicin, with a daily dose
of 60 to 120 mg of total salicin.

Despite its long-term use for purposes similar to aspirin, there
have been few clinical studies on the effectiveness of willow bark
preparations. The most recent study was published in the American
Journal of Medicine in 2000. The study looked at the “treatment of
low back pain exacerbations with willow bark extract.” Two hundred
and ten patients with chronic low-back pain were recruited for the
study. The patients received willow bark extract with either 120 mg
of salicin (low dose), a higher dose with 240 mg of salicin, or a
placebo. The study lasted for four weeks. Data was available on 191
patients at the end of the study. Those receiving a high dose
showed response after only one week of treatment. Thirty-nine
percent of patients in the high-dose group and 21 percent in the
low-dose group (only 6 percent in the placebo group) were pain-free
in the last week of treatment. The authors concluded that willow
bark extract may be safe and useful for the treatment of low-back
pain. The positive outcome of this trial may help pave the way for
further studies.

For more than 2,000 years, people of the Northern Hemisphere
have utilized the bark of willow species. Today, aspirin, perhaps
the most popular twentieth-century drug, serves the same purpose.
Properly formulated willow bark products that deliver a predictable
level of active constituents can have similar effects. Hidden in
the history of the willow is the knowledge that plants hold many
unrevealed secrets for the future benefit of the human race.

References

Chrubasik, S., et al. “Treatment of low back pain exacerbations
with willow bark extract: a randomized double-blind study.”
American Journal of Medicine 2000, 109: 9-14.

Foster, S. Herbs for Your Health. Loveland, Colorado: Interweave
Press, 1996.

Foster S., and Tyler, V. E. Tyler’s Honest Herbal (4th ed.).
Binghamton, New York: Haworth Herbal Press, 1999.

Tyler, V. E. Herbs of Choice: The Therapeutic Use of
Phytomedicinals. Binghamton, New York: Pharmaceutical Products
Press, 1994.

C a p s u l e s

Valerian-hops combination improves sleep

If two herbs can be commonly associated with sleep, they are
valerian (Valeriana officinalis) and hops (Humulus lupulus).
Valerian’s reputation as an herbal antispasmodic and sleep aid did
not emerge until about 500 years ago. Hops has been recognized for
its sleep-inducing qualities since ancient times. Because of its
bitter flavor and ability to produce relaxation, hops emerged as
the perfect flavoring ingredient for beer many centuries ago.

At least eleven clinical studies have assessed the benefits of
valerian preparations on reducing the time it takes to fall asleep
and improving sleep quality and the length of a full night’s rest.
The results have been generally positive. Most of the studies from
the 1980s looked at the effect of valerian on sleep when given just
before bedtime, on an acute basis. A recent clinical study
suggested that it might require taking a valerian preparation for a
month or more before experiencing significant benefits in improving
sleep quality.

Far fewer studies have been conducted on hops. Traditionally,
hops was used as a sleep aid, and the two herbs have long been used
in combination. At least two studies have shown that a combination
of hops and valerian may interact with GABA-ergic receptor systems,
thus inducing brain hormones to heighten a good night’s sleep. Both
contain amino acids that may chemically activate this hormone
system, but a single active constituent from either plant that
improves chemical mechanisms related to sleep has yet to be
identified. Therefore, researchers suggest the “full extract” must
be regarded as the active substance.

Sleep disorders are one of the most common health complaints in
industrialized societies, experienced by between 20 and 30 percent
of the population. Therefore, finding a safe and effective herbal
sleep aid with few or no side effects is appealing. Recently,
researchers at German and Swiss institutions conducted a pilot
study on the effects of a fixed-extract valerian-hops combination
called Ze 91019 in thirty patients with mild to moderate
non-organic insomnia. The product, manufactured by Zeller AG in
Switzerland, is sold in several European countries under various
trade names. In the United States, the product is marketed under
the name Alluna® and advertised on national television as a
“natural sleep aid.”

In the open, uncontrolled pilot study, patients selected had
been sent to a sleep laboratory for diagnosis. Once they agreed to
participate, they received two tablets each evening for two weeks.
Each tablet contained 250 mg of a valerian extract and 60 mg of a
hops extract. After two weeks, the patients were reassessed by the
sleep laboratory using a battery of tests, measuring the amount of
time it took to go to sleep, length of sleep, and how refreshed the
patients felt upon awakening. Overall sleep efficiency increased,
and numbers on several parameters, including sleep latency (the
time between turning off the light and falling asleep) and total
waking time (while lying in bed), decreased significantly. The
ratio of true sleep time compared to time spent in bed also
improved. No adverse effects were recorded. The researchers stated
that the successful results of the pilot study set the stage for a
larger controlled clinical study. (1)

Garlic and cancer

Garlic is a food, medicine, and flavoring. Its complex chemistry
has lent itself to hundreds of documented uses, ranging from
Hippocrates prescribing it for lung ailments to the ancient Chinese
using it for sadness and depression. In recent years, many
epidemiological and pharmacological studies have shown that various
foods such as soybeans, broccoli, and Alliums (such as garlic and
onions) may affect the incidence of cancer rates among various
populations. Animal and laboratory studies have provided evidence
that garlic may produce cancer-protective or anticancer effects for
cancers of the stomach, head and neck, colon, lung, breast, and
prostate.

Researchers at the Department of Epidemiology at the University
of North Carolina at Chapel Hill recently published an assessment
of nineteen studies that reported relative estimates of how garlic
consumption may affect cancer incidence. Using a complex
statistical analysis of the studies and their quality, the
assessment revealed that a high intake of fresh or cooked garlic
may have a protective effect in stomach and colorectal cancers.
Four studies and one case-control report on garlic supplements
showed that the supplements did not appear to reduce the risk of
cancer in specific populations. The researchers found that some of
the studies were conducted on too few participants, some were
poorly designed, and some may have had biased results.

The authors concluded that the available studies suggest a
preventive effect of garlic consumption in stomach and colorectal
cancers.
However, they caution that limitations of existing studies point
to the need for more definitive research and improvement of
nutritional epidemiological data. Most readers of The Herb
Companion probably prefer their garlic in haute cuisine rather than
capsules, anyway.

(1) Fussel, A., et al. “Effect of a fixed valerian-hop extract
combination (Ze 91019) on sleep polygraphy in patients with
non-organic insomnia: a pilot study.” European Journal of Medical
Research 2000, 5:385-390.

(2) Fleischauer, A. T., and L. Arab. “Garlic and cancer: a
critical review of the epidemiologic literature.” Journal of
Nutrition (Supplement) 2001, 1032S-1040S.

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