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Comfrey (Symphytum spp.)

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Also listed as: Symphytum
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • 3-O-[beta-D-glucopyranosyl-(1-->4)-beta-D-glucopyranosyl-(1-->4)-alpha-L-arabinopyranosyl]-oleanolic acid, 7-Acetylintermedine, 7- uplandine, acetyllcopsamine, allantoin, allantoin-beta-cyclodextrin, anadoline, asperum polymer, ass ear, assear, asses-ears, Beinwell (German), black root, black wort, blackwort, blue comfrey, bocking 14, boneset, Boraginaceae (family), Borago-Symphytum, borraja, bourrache, bruisewort, bulbous comfrey, buyuk karakafesotu, Caucasian comfrey, comfrey extract, comfrey herb, comfrey root, common comfrey, comphrey, consolida, consolida aspra (Italian), consolidae radix, consolida majoris, consolide maggiore (Italian), consormol, consoude, consoude grande (French), consoude rude (French), consound, consuelda (Spanish), creeping comfrey, Crimean comfrey, echimidine, Extr. Rad. Symphyti, glucofructan, great comfrey, ground comfrey root, gum plant, healing blade, healing herb, heliotrine, hirehari-so, hydroxycinnamate-derived polymer, integerrimine, intermedine, knitback, knitbone, Kytta-Balsam® f, Kytta-Plasma® f, Kytta-Salbe® f, lasiocarpine, liane chique, lithospermic acid, lycopsamine, medicinal comfrey, mucopolysaccharides, navadni gabez (Slovenian), nipbone, okopnik sherohovaty (Russian), oreille d'ane (French), otonecine- pyrrolizidine alkaloids, poly[oxy-1-carboxy-2-(3,4-dihydroxyphenyl)ethylene], prickley comfrey, pyrrolizidine alkaloid, Quaker comfrey, radix symphyti, rauher Beinwell (German), rauhe Wallwurz (German), Reinweld (German), retronecine, retrorsine, retrorsine N-oxide, riddelliine, ridelliine N-oxide, rosmarinic acid, rough comfrey, ru kulsukker (Danish), Russian comfrey, ruwe smeerworted (Dutch), salsify, saponins, senecionine, senecionine N-oxide, seneciphylline, senkirkine, simfit (Italian), slippery root, S. x uplandicum, symlandine, symphyti herba, symphyti folium, symphyti radix, symphytine, symphytum alkaloids, Symphytum 5CH, Symphytum asperrimum Donn, Symphytum asperum, Symphytum asperum Lepechin, Symphytum asperum x officinale, Symphytum bulbosum, Symphytum caucasicum, Symphytumcaucasicvum, Symphytum cream, Symphytumgrandiflorum, Symphytumibericum, Symphytum officinale Linn, Symphytum orientale,Symphytum peregrinum Lebed, Symphytum radix, Symphytum spp., Symphytum tauricum, Symphytum tuberosum, Symphytum x, Symphytum x uplandicum, Symphytum x uplandicum Nyman, Syrupus de Symphyto (Spanish), tannins, tarharaunioyrtti (Finnish), the great comfrey, Traumaplant®, tuberous comfrey, uplandine, wallwort, wallwurz (German), white comfrey, yalluc (Saxon), zinzinnici (Italian).

Background
  • Comfrey (Symphytum spp.) is native to both Europe and Asia and has traditionally been used as both a food and forage crop. Three plant species in the genus Symphytum are medicinally relevant and include wild or common comfrey, prickly or rough comfrey, and Caucasian, Quaker, Russian, or blue comfrey.
  • Comfrey has traditionally been both applied to the skin for inflammation, pain and wound healing, and taken by mouth for stomach, intestine, breathing and female health concerns.
  • Research has shown that comfrey used on the skin has benefits for pain and inflammation associated with injuries.
  • Taking comfrey by mouth should be avoided due to evidence showing that it may cause cancer and liver toxicity. Many countries withdrew comfrey products that are taken by mouth from their markets and warned people to avoid using comfrey on open wounds.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Comfrey may have anti-inflammatory effects. Research has shown that comfrey applied to the skin decreases inflammation and pain associated with sprains and muscle injuries. Additional study is needed to confirm these results.

B


Research has shown comfrey applied to the skin to be safe and beneficial for reducing osteoarthritis knee pain and improving knee function and joint flexion. Further research is needed to draw conclusions.

B


Research has shown that applying comfrey creams to the skin reduces inflammation and pain from sprains, muscle injuries, and dental procedures. Additional study is needed to confirm these results.

B


Research has shown that using comfrey on the skin improves and speeds up wound healing. Further research is needed to fully evaluate the role of comfrey in wound healing.

B


A comfrey-containing cream has been applied on the skin to reduce myalgia, or muscle pain. Improvements in pain at rest and in motion were noted. Further studies are required before a firm recommendation can be made.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Acne, aging, anemia, chest pain, antifungal, antimicrobial, antioxidant, arthritis (general), breast inflammation, broken bones, bronchitis / cough, bruises, burns, cancer, conjunctivitis (pinkeye), cough, diarrhea, ear infection, expectorant (loosens phlegm), eye infections, fever reducer, food uses, gangrene (tissue death), gastritis (inflammation of the stomach lining), gout, gum disease, gynecological disorders (female health problems), hair tonic, hemorrhoids (swollen veins in the anus), hernia, high blood pressure, impetigo (skin infection), inflammatory bowel disease, lupus, lung inflammation, rash, sexual arousal, sinus infection, skin disorders, skin inflammation, sore throat, sports injuries, sprains, thyroid disorders, ulcers, urine blood, uterine tonic, varicose veins (swollen, painful veins), vasoprotective (protects blood vessels).

Dosing

Adults (18 years and older)

  • Due to safety concerns, taking comfrey by mouth is not recommended and comfrey that is taken by mouth cannot be sold in the United States. Traditionally, a cloth or gauze soaked in an infusion (100 grams fresh, peeled root simmered in 250 milliliters water for 10-15 minutes) and applied to the skin several times daily has been used. For a salve, olive oil and beeswax can be added and cooled.
  • For inflammation, 2-3 grams of Traumaplant® or Kytta-Salbe® f cream has been applied to the skin three to four times daily for up to 14 days.
  • For osteoarthritis of the knee, a 6 centimeter long thread of Kytta-Salbe® f ointment has been applied to both knees three times daily for three weeks.
  • For pain, 2-4 grams of Kytta-Salbe® f, cream Traumaplant® cream, or 10% comfrey ointment has been applied to the skin of the affected area three to four times daily for up to 14 days.
  • For wound healing, a 10% comfrey cream has been applied over the wound daily for 10 days.

Children (younger than 18 years)

  • Due to safety concerns, taking comfrey by mouth is not recommended and comfrey that is taken by mouth cannot be sold in the United States.
  • For wound healing, a 10% comfrey cream has been applied to the wound as a thick layer that covered approximately one centimeter of intact skin on all sides; the area was then covered with a non-occlusive dressing and the procedure was repeated daily for 7-9 days.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid with a known allergy or sensitivity to comfrey, its parts, or members of its botanical family.

Side Effects and Warnings

  • Comfrey is possibly safe when applied to the skin for short-term (up to two weeks) treatment of minor injuries which lack open wounds. Products made of comfrey root contain high levels of pyrrolizidine alkaloids.
  • Use comfrey on the skin cautiously for extended periods of time.
  • Use cautiously in people taking cytochrome P450 3A4-inducing agents, which may increase the amount of toxic compounds in comfrey.
  • Avoid taking comfrey by mouth due to liver damaging and cancer causing pyrrolizidine alkaloids; taking comfrey by mouth has caused death. The United States Food and Drug Administration (FDA) has recommended removal of comfrey products taken by mouth from the market.
  • Avoid comfrey used on the skin in individuals with or at risk for liver disorders, cancer, or immune disorders.
  • Avoid comfrey during pregnancy or breastfeeding.
  • Comfrey may cause blocked veins in the liver, blocks in the intestine, breathing problems, Budd-Chiari syndrome (a rare liver disease in which a blood clot occurs in the large vein leading from the liver), cancer, change in production of oxidation, death, death and damage of liver cells, death of cells around the veins, eczema, elevated liver enzymes, enlarged liver, filling of blood vessels to excess, fluid build-up in the stomach cavity, heart toxicity, high blood pressure in the liver vein, high blood pressure in the lungs, immune system suppression, jaundice, leaking of red blood cells, liver cancer, liver damage, liver failure, liver toxicity, lung inflammation, mass of debris collected in the stomach, nausea, nose inflammation, skin redness and irritation, stomach pain, swelling of liver cells hepatocytes, and vein inflammation.

Pregnancy and Breastfeeding

  • Avoid comfrey during pregnancy and breastfeeding.

Interactions

Interactions with Drugs

  • Agents that induce CYP3A4 enzymes may increase the amount of toxic compounds in comfrey.
  • Comfrey may also interact with agents that damage the liver, aminopyrine N-demethylase metabolized agents, analgesics, anti-cancer agents, antifungals, and anti-inflammatory agents.

Interactions with Herbs and Dietary Supplements

  • Agents that induce CYP3A4 enzymes may increase the amount of toxic compounds in comfrey.
  • Comfrey may also interact with aminopyrine N-demethylase metabolized herbs and supplements, analgesics, antifungals, anti-inflammatory herbs and supplements, anti-cancer herbs and supplements, antioxidants, licorice, ginkgo biloba, herbs and supplements damaging to the liver, pokeweed, pyrrolizidine alkaloid-containing herbs, rosemary, sassafras, and uterine tonic herbs and supplements.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Altamirano JC, Gratz SR, Wolnik KA. Investigation of pyrrolizidine alkaloids and their N-oxides in commercial comfrey-containing products and botanical materials by liquid chromatography electrospray ionization mass spectrometry. J AOAC Int 2005;88(2):406-412.
  2. Barna M, Kucera A, Hladikova M, et al. Randomized double-blind study: wound-healing effects of a Symphytum herb extract cream (Symphytumxuplandicum Nyman) in children. Arzneimittelforschung. 2012;62(6):285-289.
  3. Bleakley CM, McDonough SM, and MacAuley DC. Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. Aust.J Physiother. 2008;54(1):7-20.
  4. D'Anchise R, Bulitta M, and Giannetti B. Comfrey extract ointment in comparison to diclofenac gel in the treatment of acute unilateral ankle sprains (distortions). Arzneimittelforschung. 2007;57(11):712-716.
  5. Di Mambro VM, Fonseca MJ. Assays of physical stability and antioxidant activity of a topical formulation added with different plant extracts. J Pharm Biomed Anal. 2-23-2005;37(2):287-295.
  6. Giannetti BM, Staiger C, Bulitta M, et al. Efficacy and safety of comfrey root extract ointment in the treatment of acute upper or lower back pain: results of a double-blind, randomised, placebo controlled, multicentre trial. Br.J Sports Med. 2010;44(9):637-641.
  7. Grube B, Grunwald J, Krug L, et al. Efficacy of a comfrey root (Symphyti offic. radix) extract ointment in the treatment of patients with painful osteoarthritis of the knee: results of a double-blind, randomised, bicenter, placebo-controlled trial. Phytomedicine. 2007;14(1):2-10.
  8. Gyorik S and Stricker H. Severe pulmonary hypertension possibly due to pyrrolizidine alkaloids in polyphytotherapy. Swiss.Med.Wkly. 4-4-2009;139(13-14):210-211.
  9. Laslett LL, Quinn SJ, Darian-Smith E, et al. Treatment with 4Jointz reduces knee pain over 12 weeks of treatment in patients with clinical knee osteoarthritis: a randomised controlled trial. Osteoarthritis.Cartilage. 2012;20(11):1209-1216.
  10. Lin CC, Yang CC, Phua DH, et al. An outbreak of foxglove leaf poisoning. J Chin Med.Assoc. 2010;73(2):97-100.
  11. Mackinnon M. In general practice, 'always expect the unexpected'. Aust.Fam.Physician 2008;37(4):235-236.
  12. Mazzocchi A and Montanaro F. Observational study of the use of Symphytum 5CH in the management of pain and swelling after dental implant surgery. Homeopathy. 2012;101(4):211-216.
  13. Predel HG, Giannetti B, Koll R, et al. Efficacy of a comfrey root extract ointment in comparison to a diclofenac gel in the treatment of ankle distortions: results of an observer-blind, randomized, multicenter study. Phytomedicine 2005;12(10):707-714.
  14. Staiger C. Comfrey: a clinical overview. Phytother.Res 2012;26(10):1441-1448.
  15. Turley AJ and Muir DF. ECG for physicians: a potentially fatal case of mistaken identity. Resuscitation 2008;76(3):323-324.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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