-IBIS-1.5.0-
rx
herb
Symphytum officinale (Comfrey)
botanicals
definition
botanical name(s): Symphytum officinale
synonyms: comfrey, blackwort, nipbone, knitbone, consolida, knitback, bruisewort, gum plant, healing herb, salsify, slippery root, wallwort, beinwell, consoude, wallwurz, beindweld, grand consoude, oreille d'ane, consuelda mayor, consolida maggiore, simfit, zinzinnici, sinfit
part(s) used: root and leaves
qualities: sweet, bland, cool, moist
affinities: bones, liver, lung, skin, stomach, intestine, bladder and genitals
actions: vulnerary, demulcent, astringent, expectorant, cell proliferative, tonic, styptic
dosage:
» externally: use as poultice, salve, oil or liniment
» internally: use tea or tincture (2 - 4 ml.) see toxicity
» powder: 1 - 2 g.
therapy: wounds, fracture as poultice, strains and sprains as poultice
AHPA Botanical Safety Rating: 2a, 2b, 2c
toxicity: 3; see pyrrolizidine alkaloid toxidrome
» contraindicated for internal use due to hepatotoxic effects and carcinogenic activity of pyrrolizidine alkaloids (Brinker, 1995; Wichtl)
» contraindicated during pregnancy and lactation (Brinker, 1996, pp. 91, 110) due to fetal/infant hepatotoxicity resulting from transferral of toxic pyrrolizidine alkaloids from mother (Winship)
» contraindicated for use on broken skin to avoid excessive percutaneous absorption of toxic pyrrolizidine alkaloids which is typically low on intact skin (Wichtl, De Smet, Brauchli et al)
» caution is advised regarding use in children due to their sensitivity to alkaloids (Brinker, 1996 , p. 91)
» pyrrolizidine alkaloids have caused hepatic occlusive disease in humans and cancer in rats; long-term use (over 10 days) is contraindicated as well as use during pregnancy and nursing and use in malnourished patients (e.g. Crohn's disease); for the most safety, external use only is recommended; young leaves are highest in the alkaloid
constituents: mucilage, gum, allantoin, tannin, alkaloids, resin, volatile oil and pyrrolizidine alkaloids
» The major chemical of significance in Comfrey is allantoin (0.6 - 2.5%).
» Comfrey also contains large amounts of mucilage along with tannins, starch and two alkaloids (0.3%, consolidine and symphytocynglossine, or symphytine and echimidine), lithospermic acid, 29% mucopolysaccharide, 2.4% pyrocatechol tannins, steroidal saponins, echinatine and others.
» The plant also provides large amounts of minerals and vitamins (per 100 gm): thiamine (0.5 mg); riboflavin (1.0 mg); niacin (5.0 mg); pantothenic acid (4.2 mg); Vitamin B12 (0.07 mg, very rare in vegetable matter); Vitamin A (28,000 IU); Vitamin C (100 mg); and Vitamin E (30 mg).
footnotes
Brauchli J, Luthy J, Zweifel U, Schlatter C. 1982. Pyrrolizidine alkaloids from Symphytum officinale L. and their percutaneous absorption in rats. Experientia, 38:1085-7.
Brinker F. 1995. Botanical Medicine Research Summaries. (from Eclectic Dispensatory of Botanical Therapeutics, vol.11), Sandy, Oregon: Eclectic Medical Publications.
Brinker F. 1996. The Toxicology of Botanical Medicines, rev. 2nd ed., Sandy, Oregon: Eclectic Medical Publications.
De Smet PAGM et al. (eds.). 1993. Adverse Effects of Herbal Drugs 2, Berlin: Springer-Verlag
Kumana CR, Ng M, Lin HJ, Ko W, Wu PC, Todd D. Herbal tea induced hepatic veno-occlusive disease: quantification of toxic alkaloid exposure in adults. Gut 1985 Jan;26(1):101-104.
Abstract: Four young Chinese women took daily doses of an unidentified 'Indian' herbal tea as treatment for psoriasis. Three (one of whom died), developed ascites, hepatomegaly and biochemical abnormalities within 19-45 days. The fourth patient discontinued herbal tea after 21 days when she developed a skin rash. Two patients had portal hypertension, while all had liver histology showing features of veno-occlusive disease. Pyrrolizidine alkaloids were identified spectrophotometrically in the brewed tea, and in the chopped leaves of the herbal mixture; the mean dose in the tea prepared for consumption being 12 mg/day of alkaloid base and 18 mg/day of N-oxide. The mean cumulative dose of alkaloids (base + N-oxide) before onset of symptoms (three patients), was estimated to be 18 mg/kg. In the asymptomatic patient with histological liver disease only, the corresponding dose was 15 mg/kg. These cases thus provide some measure of pyrrolizidine alkaloid toxicity in adults.
Pauwels A, Mostefa-Kara N. [Hepatotoxicity of medicinal plants and plant-based preparations]. Gastroenterol Clin Biol 1993;17(5 Pt 2):H79-H85. [Article in French]
Roulet M, Laurini R, Rivier L, Calame A. Hepatic veno-occlusive disease in newborn infant of a woman drinking herbal tea. J Pediatr 1988 Mar;112(3):433-436
Sperl W, Stuppner H, Gassner I, Judmaier W, Dietze O, Vogel W. Reversible hepatic veno-occlusive disease in an infant after consumption of pyrrolizidine-containing herbal tea. Eur J Pediatr 1995 Feb;154(2):112-116.
Abstract: Veno-occlusive disease was diagnosed in an 18-month-old boy who had regularly consumed a herbal tea mixture since the 3rd month of life. The boy developed portal hypertension with severe ascites. Histology of the liver showed centrilobular sinusoidal congestion with perivenular bleeding and parenchymal necrosis without cirrhosis. The tea contained peppermint and what the mother thought was coltsfoot (Tussilago farfara). The parents believed the tea aided the healthy development of their child. Pharmacological analysis of the tea compounds revealed high amounts of pyrrolizidine alkaloids. Seneciphylline and the corresponding N-oxide were identified as the major components by thin-layer chromatography, mass spectrometry and NMR spectroscopy. We calculated that the child had consumed at least 60 micrograms/kg body weight per day of the toxic pyrrolizidine alkaloid mixture over 15 months. Macroscopic and microscopic analysis of the leaf material indicated that Adenostyles alliariae (Alpendost) had been erroneously gathered by the parents in place of coltsfoot. The two plants can easily be confused especially after the flowering period. The child was given conservative treatment only and recovered completely within 2 months. CONCLUSION: In all cases of veno-occlusive disease pyrrolizidine alkaloids ingestion should be excluded. The identity of collected plant material should be verified by pharmaceutically trained experts and information of composition, dosage and mode of administration should be included in guidelines for herbal preparations.
Wichtl M (ed.). 1994. Herbal Drugs and Phytopharmaceuticals. Boca Raton, FL: CRC Press.
Winship KA. 1991. Toxicity of comfrey. Adverse Drug React. Toxicol. Tev., 10:47-59.
Yeong ML, Swinburn B, Kennedy M, Nicholson G. Hepatic veno-occlusive disease associated with comfrey ingestion. J Gastroenterol Hepatol 1990 Mar;5(2):211-214.
Abstract: A 23 year old man presented with hepatic veno-occlusive disease and severe portal hypertension and subsequently died from liver failure. Light microscopy and hepatic angiography showed occlusion of sublobular veins and small venous radicles of the liver, associated with widespread haemorrhagic necrosis of hepatocytes. The patient had been on a predominantly vegetarian diet and, prior to his illness, took comfrey leaves which are known to contain hepatotoxic pyrrolizidine alkaloids. Comfrey is widely used as a herbal remedy, but so far has only been implicated in two other documented cases of human hepatic veno-occlusive disease. A possible causal association of comfrey and this patient's veno-occlusive disease is suggested by the temporal relationship of the ingestion of comfrey to his presentation, the histological changes in the liver and the exclusion of other known causes of the disease.
Yeong ML, Clark SP, Waring JM, Wilson RD, Wakefield SJ. The effects of comfrey derived pyrrolizidine alkaloids on rat liver. Pathology 1991 Jan;23(1):35-38.
Abstract: Three groups of young adult rats were fed pyrrolizidine alkaloids derived from Russian comfrey to study the effects of the herb on the liver. Group I animals received a single dose of 200 mg/kg body wt, Group II 100 mg/kg three times a week for 3 weeks and Group III 50 mg/kg three times a week for 3 weeks. All rats showed light and electron-microscopic evidence of liver damage, the severity of which was dose dependent. There was swelling of hepatocytes and hemorrhagic necrosis of perivenular cells. There was a concomitant loss of sinusoidal lining cells with disruption of sinusoidal wall and the sinusoids were filled with cellular debris, hepatocyte organelles and red blood cells. Extravasation of red blood cells was evident. Terminal hepatic venules were narrowed by intimal proliferation, and in Group II and III, reiculin fibres radiated from these vessels. These appearances have been described in veno-occlusive disease due to pyrrolizidine alkaloids from other plant sources such as Senecio and Crotalaria. The safety of comfrey, a widely used herb, in relation to human consumption requires further investigation.