Overview

Valerian has been used to ease insomnia, anxiety, and nervous restlessness since the second century A.D. It became popular in Europe in the 17th century. It has also been suggested to treat stomach cramps. Some research -- though not all -- suggests that valerian may help people with insomnia. Germany's Commission E approved valerian as an effective mild sedative and the United States Food and Drug Administration listed valerian as "Generally Recognized As Safe" (GRAS).

Scientists aren't sure how valerian works, but they believe it increases the amount of a chemical called gamma aminobutyric acid (GABA) in the brain. GABA helps regulate nerve cells and has a calming effect on anxiety. Drugs such as alprazolam (Xanax) and diazepam (Valium) also work by increasing the amount of GABA in the brain. Researchers think valerian may have a similar, but weaker effect.

Insomnia

Valerian is a popular alternative to prescription medications for sleep problems because it is considered to be both safe and gentle. Some studies show that it helps people fall asleep faster and feel that they have a better quality of sleep.

One of the best designed studies found that valerian was no more effective than placebo for 14 days, but by 28 days valerian greatly improved sleep for those who were taking it. Some researchers now think you may need to take valerian for a few weeks before it begins to work. However, in another study, valerian was more effective than placebo almost immediately.

Other studies show that valerian reduces the time it takes to fall asleep and improves the quality of sleep. Unlike many prescription sleeping pills, valerian may have fewer side effects, such as morning drowsiness.

But not every study has found that valerian had a positive effect. One review of several studies found that valerian probably doesn't work to treat insomnia. So the evidence remains contradictory.

Valerian is often combined with other sedating herbs, such as hops (Humulus lupulus) and lemon balm (Melissa officianalis), to treat insomnia. In one study of postmenopausal women, a combination of valerian and lemon balm helped reduce symptoms of insomnia.

Plant Description

Valerian is a perennial plant that is native to Europe and grows up to 2 feet tall. It is grown to decorate gardens, but also grows wild in damp grasslands. Straight, hollow stems are topped by umbrella-like heads. Its dark green leaves are pointed at the tip and hairy underneath. Small, sweet-smelling white, light purple, or pink flowers bloom in June. The root is light grayish brown and has little odor when fresh.

What's It Made Of?

The root of the plant is used as medicine and is pressed into fresh juice or freeze-dried to form powder.

Available Forms

Valerian fluid extracts and tinctures are sold in alcohol or alcohol-free (glycerite) bases. Powdered valerian is available in capsule and tablet form, and as a tea.

Valerian root has a sharp odor. It is often combined with other calming herbs, including passionflower (Passiflora incarnata), hops (Humulus lupulus), lemon balm (Melissa officinalis), skullcap (Scutellaria lateriflora), and kava (Piper methysticum) to mask the scent. However, kava has been associated with liver damage, so avoid it.

How to Take It

Valerian is often standardized to contain 0.3% to 0.8% valerenic or valeric acid, although researchers aren't sure that these are the active ingredients.

Pediatric

Preliminary studies suggest that valerian may help improve concentration and impulsiveness among primary school children. DO NOT give valerian to a child without first talking to your doctor.

Adult

For insomnia, valerian may be taken 1 to 2 hours before bedtime, or up to 3 times in the course of the day, with the last dose near bedtime. It may take a few weeks before the effects are felt.

• Tea. Pour 1 cup boiling water over 1 teaspoonful (2 to 3 g) of dried root, steep 5 to 10 minutes.
• Tincture (1:5). 1 to 1 1/2 tsp (4 to 6 mL).
• Fluid extract (1:1). 1/2 to 1 tsp (1 to 2 mL).
• Dry powdered extract (4:1). 250 to 600 mg.

Once sleep improves, keep taking valerian for 2 to 6 weeks.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects, and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

Valerian is generally regarded as safe. Most studies show no harmful effects on fertility or fetal development, but more research is needed. Experts advise pregnant and nursing women to avoid taking valerian.

Some people may have a paradoxical reaction to valerian, feeling anxious and restless after taking it instead of calm and sleepy.

For most people, valerian does not appear to cause dependency. Nor does it cause withdrawal symptoms for most. But there are a few reports of withdrawal symptoms when valerian has been used over very long periods of time. If you want to stop taking valerian, lower your dose gradually rather than stopping all at once.

Don't use valerian while driving, operating heavy machinery, or doing other things that require you to be alert.

Don't use valerian for longer than 1 month without your health care provider's approval.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use valerian without talking to your health care provider.

Medications broken down by the liver

Valerian may slow down how quickly certain drugs are broken down by the liver. Many medications rely on the liver to break them down, so it's possible that in some cases, too much of these drugs could build up in the body. To be safe, ask your doctor before taking valerian if you are also taking any other medications.

Sedatives

Valerian can increase the effect of drugs, including:

• Anticonvulsants, such as phenytoin (Dilantin) and valproic acid (Depakote)
• Barbiturates
• Benzodiazepines, such as alprazolam (Xanax) and diazepam (Valium)
• Drugs to treat insomnia, such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), and ramelteon (Rozerem)
• Tricyclic antidepressants, such as amitriptyline (Elavil)
• Alcohol

The same is true of other herbs with a sedating effect, such as chamomile, lemon balm, and catnip.

Other drugs

Because valerian is broken down by certain liver enzymes, it may interact with other drugs that are broken down by the same enzymes. These may include many different medications, including but not limited to the following:

• Antihistamines
• Statins, taken for high cholesterol
• Some antifungal drugs

Anesthesia

Valerian may increase the effects of anesthesia. If you are having surgery, it is important to tell your doctors, especially your surgeon and anesthesiologist, that you are taking valerian. The doctors may recommend you slowly lower the dose of valerian before surgery. Or, they may allow you to use valerian up to the time of surgery, making any needed adjustments to the anesthesia.

Supporting Research

Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001;286(2):208-216.

Attele AS, Xie JT, Yuan CS. Treatment of insomnia: an alternative approach. Altern Med Rev. 2000;5(3):249-259.

Bagheri-Nesami M, Gorji MA, Rezaie S, Pouresmail Z, Cherati JY. Effect of acupressure with valerian oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome in a cardiac intensive care unit. J Tradit Complement Med. 2015;5(4):241-247.

Balderer G, Borbely AA. Effect of valerian on human sleep. Psychopharmacology (Berl). 1985;87(4):406-409.

Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for sleep: a systematic review and meta-analysis. Am J Med. 2006;119(12):1005-1012. Review.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:394-400.

Coxeter PD, Schluter PJ, Eastwood HL, Nikles CJ, Glasziou PP. Valerian does not appear to reduce symptoms for patients with chronic insomnia in general practice using a series of randomised n-of-1 trials. Complement Ther Med. 2003;11(4):215-222.

De Feo V, Faro C. Pharmacological effects of extracts from Valeriana adscendens Trel. II. Effects on GABA uptake and amino acids. Phytother Res. 2003;17(6):661-664.

Donath F, Quispe S, Diefenbach K, Maurer A, Fietze I, Roots FI. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Pharmacopsychiatry. 2000;33(2):47-53.

Ernst E, Pittler MH, Wider B, eds. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. 2nd ed. New York, NY: Elsevier Mosby;2006:160-162.

Ernst E. Herbal medications for common ailments in the elderly. Drugs Aging. 1999;15(6):423-428.

Ferri F. Ferri's Clinical Advisor 2009. 1st ed. Philadelphia, PA: Elsevier Mosby; 2009.

Gromball J, Beschorner F, Wantzen C, Paulsen U, Burkart M. Hyperactivity, concentration difficulties and impulsiveness improve during seven weeks' treatment with valerian root and lemon balm extracts in primary school children. Phytomedicine. 2014;21(8-9):1098-1103.

Gyllenhaal C, Merritt SL, Peterson SD, Block KI, Gochenour T. Efficacy and safety of herbal stimulants and sedatives in sleep disorders. Sleep Med Rev. 2000;4(3):229-251.

Heiligenstein E, Guenther G. Over-the-counter psychotropics: a review of melatonin, St John's wort, valerian, and kava-kava. J Am Coll Health. 1998;46(6):271-276.

Holst L, Nordeng H, Haavik S. Use of herbal drugs during early pregnancy in relation to maternal characteristics and pregnancy outcome. Pharmacoepidemiol Drug Saf. 2008;17(2):151-159.

Kakehashi A, Kato A, Ishii N, et al. Valerian inhibits rat hepatocarcinogenesis by activating GABA (A) receptor-mediated signaling. PLoS One. 2014;9(11):e113610.

Leatherwood PD, Chauffard F, Heck E, Munoz-Box R. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharm Biochem Behavior. 1982;17(1):65-71.

Miller LG. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200-2211.

Miyasaka LS, Atallah AN, Soares BG. Valerian for anxiety disorders. Cochrane Database Syst Rev. 2006;(4):CD004515.

Modabbernia A, Akhondzadeh S. Saffron, passionflower, valerian and sage for mental health. Psychiatr Clin North Am. 2013;36(1):85-91.

Rakel D, ed. Intergrative Medicine. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2012.

Stevinson C, Ernst E. Valerian for insomnia: a systematic review of randomized clinical trials. Sleep Med. 2000;1(2):91-99.

Taavoni S, Nazem Ekbatani N, Haghani H. Valerian/lemon balm use for sleep disorders during menopause. Complement Ther Clin Pract. 2013;19(4):193-196.

Taibi DM, Landis CA, Petry H, Vitiello MV. A systematic review of valerian as a sleep aid: Safe but not effective. Sleep Med Rev. 2007;11(3):209-230.

Taibi DM, Vitiello MV, Barsness S, Elmer GW, Anderson GD, Landis CA. A randomized clinical trial of valerian fails to improve self-reported, polysomnographic, and actigraphic sleep in older women with insomnia. Sleep Med. 2008;10(3):319-328.

Wagner J, Wagner ML, Hening WA. Beyond benzodiazepines: alternative pharmacologic agents for the treatment of insomnia. Ann Pharmacother. 1998;32(6):680-691.

Wong AH, Smith M, Boon HS. Herbal remedies in psychiatric practice. Arch Gen Psychiatr. 1998;55(11):1033-1044.

Yao M, Ritchie HE, Brown-Woodman PD. A developmental toxicity-screening test of valerian. J Ethnopharmacol. 2007;113(2):204-209.

Ziegler G, Ploch M, Miettinen-Baumann A, Collet W. Efficacy and tolerability of valerian extract LI 156 compared with oxazepam in the treatment of non-organic insomnia--a randomized, double-blind, comparative clinical study. Eur J Med Res. 2002;7(11):480-486.

Overview

In the 18th and 19th centuries, herbalists used wild yam (Dioscorea villosa) to treat menstrual cramps and problems related to childbirth, as well as for upset stomach and coughs. In the 1950s, scientists discovered that the roots of wild yam -- not to be confused with the sweet potato yam -- contain diosgenin. Diosgenin is a phytoestrogen, or plant-based estrogen, that can be chemically converted into a hormone called progesterone. Diosgenin was used to make the first birth control pills in the 1960s.

Although herbalists continue to use wild yam to treat menstrual cramps, nausea and morning sickness, inflammation, osteoporosis, menopausal symptoms, and other health conditions, there's no evidence to show it works for these uses. Several studies have found that it has no effect at all. That is because the body cannot change diosgenin into progesterone; it has to be done in a lab. Wild yam, by itself, does not contain progesterone.

General

Early Americans used wild yam to treat colic, a reason for another name for the plant, colic root. Traditionally, it has been used to treat inflammation, muscle spasms, and a range of disorders, including asthma. However, there is no scientific evidence that it works. Several studies show wild yam has powerful antifungal properties and may help fight yeast and other fungal infections.

Menopause and Osteoporosis

Although wild yam is often advertised as a natural source of estrogen, there is no scientific evidence that wild yam works to treat menopausal symptoms or osteoporosis. In fact, several studies have found that wild yam does not reduce the symptoms of menopause, such as hot flashes, or raise levels of estrogen or progesterone in the body. Some preparations of wild yam may contain progesterone, but only because a synthetic version of progesterone (medroxyprogesterone acetate or MPA) has been added to them.

Breast Cancer

Preliminary studies suggest wild yam may act as an anti-invasive agent in breast cancer.

High Cholesterol

Researchers have speculated that taking wild yam may help lower cholesterol levels, although studies have shown mixed results. Diosgenin seems to block the body from absorbing cholesterol, at least in animal studies. But in studies of people, cholesterol levels have not gone down -- although fats in the blood (triglycerides) have decreased. More research is needed to determine whether wild yam would help people with high cholesterol.

Plant Description

Also known as colic root, wild yam is a twining, tuberous vine. One species is native to North America; another is native to China. Both contain diosgenin and have similar medicinal properties. There are an estimated 600 species of yam in the genus Dioscorea. Many of them are wild species that flourish in damp woodlands and thickets, and not all of them contain diosgenin. Wild yam is a perennial vine with pale brown, knotty, woody cylindrical rootstocks, or tubers. Unlike sweet potato yams, the roots are not fleshy. Instead they are dry, narrow, and crooked, and bear horizontal branches of long creeping runners. The thin, reddish-brown stems grow to a length of over 30 feet. The roots initially taste starchy, but soon after taste bitter and acrid.

The wild yam plant has clusters of small, greenish-white and greenish-yellow flowers. The heart-shaped leaves are long and broad and long-stemmed. The upper surface of the leaves is smooth while the underside is downy.

What's it Made of?

The dried root, or rhizome, is used in commercial preparations. It contains diosgenin, a phytoestrogen that can be chemically converted to the hormone progesterone. However, diosgenin on its own does not seem to act like estrogen in the body.

Available Forms

Wild yam is available as liquid extract and as a powder. The powdered form may be purchased in capsules or compressed tablets. The fluid extract can be made into tea. Creams containing wild yam are also available.

How to Take It

Pediatric

Wild yam hasn't been studied in children, so it is not recommended for pediatric use.

Adult

Wild yam frequently comes in capsule form as a dried herb. Often it is dosed in a tincture, which is an alcohol extract. It is also available as a 12% cream for topical use.

Ask your doctor to help you find the right dose.

Note: Wild yam is often combined with other herbs said to have estrogen-like effects, such as black cohosh. Wild yam creams, as well as tablets and powders, may contain synthetic hormones. Check the ingredients carefully.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

Anyone with a personal or family history of hormone-related cancer (such as breast cancer, ovarian cancer, and uterine cancer) should check with their doctor before using any form of natural hormone replacement, including wild yam. Although it does not seem to act like a hormone in the body, there is a slight risk that wild yam could produce similar effects to estrogen.

Pregnant women and nursing mothers should avoid wild yam.

People who have protein S deficiency should not take wild yam without talking to their doctor. Some doctors think wild yam may possibly increase the risk of forming clots, because of its estrogen-like effects.

Possible Interactions

Hormone Replacement Therapy or Birth Control Pills

An animal study indicated that the active component of wild yam, diosgenin, may interact with estradiol. Estradiol is a hormone that occurs naturally in the body and also is used in some birth control medications and certain hormone replacement therapies.

If you are currently being treated with either of these medications, you should not use wild yam without first talking to your provider.

Supporting Research

Accatino L, Pizarro M, Solis N, Koenig C. Effects of diosgenin, a plant derived steroid, on bile secretion and hepatocellular cholestasis induced by estrogens in the rat. Hepatology. 1998;28(1):129-140.

Ali Z, Smillie TJ, Khan IA. Cholestane steroid glycosides from the rhizomes of Dioscorea villosa (wild yam). Carbohydr Res. 2013;370:86-91.

Aumsuwan P, Khan SI, Khan IA, et al. The anticancer potential of steroidal saponin, dioscin, isolated from wild yam (Dioscorea villosa) root extract in invasive human breast cancer cell line MDA-MB-231 in vitro. Arch Biochem Biophys. 2016;591:98-110.

Aumsuwan P, Khan SI, Khan IA, et al. Evaluation of wild yam (Dioscorea villosa) root extract as a potential epigenetic agent in breast cancer cells. In Vitro Cell Dev Biol Anim. 2015;51(1):59-71.

Bhandari MR, Kawabata J. Bitterness and toxicity in wild yam (Dioscorea spp.) tubers of Nepal. Plant Foods Hum Nutr. 2005;60(3):129-35.

Boban PT, Nambisan B, Sudhakaran PR. Hypolipidaemic effect of chemically different mucilages in rats: a comparative study. Br J Nutr. 2006;96(6):1021-1029.

Bone K, Mill S, eds. Principles and Practices of Phytotherapy, Modern Herbal Medicine. London: Churchill Livingstone; 2000.

Carroll DG. Nonhormonal therapies for hot flashes in menopause. Am Fam Physician. 2006;73(3):457-464. Review.

Chang WC, Yu YM, Wu CH, Tseng YH, Wu KY. Reduction of oxidative stress and atherosclerosis in hyperlipidemic rabbits by Dioscorea rhizome. Can J Physiol Pharmacol. 2005;83(5):423-430.

Cho J, Choi H, Lee J, Kim MS, Sohn HY, Lee DG. The antifungal activity and membrane-disruptive action of dioscin extracted from Dioscorea nipponica. Biochim Biophys Acta. 2013;1828(3):1153-1158.

Foster S, Tyler VE. Tyler's Honest Herbal. Binghamton, NY: The Haworth Herbal Press; 2000:381-382.

Haimov-Kochman R, Hochner-Celnikier D. Hot flashes revisited: pharmacological and herbal options for hot flashes management. What does the evidence tell us? Acta Obstet Gynecol Scand. 2005;84(10):972-9. Review.

Kelley KW, Carroll DG. Evaluating the evidence for over-the-counter alternatives for relief of hot flashes in menopausal women. J Am Pharm Assoc (2003). 2010;50(5):e106-115. Review.

Komesaroff PA, Black CV, Cable V, Sudhir K. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric. 2001;4(2):144-150.

Manda VK, Avula B, Ali Z, et al. Characterization of in vitro ADME properties of diosgenin and dioscin from Dioscorea villosa. Planta Med. 2013;79:1421-1428.

Park MK, Kwon HY, Ahn WS, Bae S, Rhyu MR, Lee Y. Estrogen activities and the cellular effects of natural progesterone from wild yam extract in mcf-7 human breast cancer cells. Am J Chin Med. 2009;37(1):159-167.

Taylor M. Alternatives to conventional hormone replacement therapy. Compr Ther. 1997;23(8):514-532.

Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs, and spices. Proc Soc Exp Biol Med. 1998;217(3):369-378.

Overview

The use of willow bark dates to the time of Hippocrates (400 BC) when people were advised to chew on the bark to reduce fever and inflammation. Willow bark has been used throughout the centuries in China and Europe, and continues to be used today for the treatment of pain (particularly low back pain and osteoarthritis), headache, and inflammatory conditions, such as bursitis and tendinitis. The bark of white willow contains salicin, which is a chemical similar to aspirin (acetylsalicylic acid). In combination with the herb's powerful anti-inflammatory plant compounds (called flavonoids), salicin is thought to be responsible for the pain-relieving and anti-inflammatory effects of the herb. In fact, in the 1800s, salicin was used to develop aspirin. White willow appears to bring pain relief more slowly than aspirin, but its effects may last longer.

Plant Description

The willow family includes a number of different species of trees and shrubs native to Europe, Asia, and some parts of North America. Some of the more commonly known species are white willow/European willow (Salix alba), black willow/pussy willow (Salix nigra), crack willow (Salix fragilis), purple willow (Salix purpurea), and weeping willow (Salix babylonica). Not all willow species accumulate a therapeutically sufficient amount of salicin. In one study, the amount of salicin after 1 and 2 year growth in autumn and spring ranged from 0.08 to 12.6%. The willow bark sold in Europe and the United States usually includes a combination of the bark from white, purple, and crack willows.

Medicinal Uses and Indications

Willow bark is used to ease pain and reduce inflammation. Researchers believe that the chemical salicin, found in willow bark, is responsible for these effects. However, studies show several other components of willow bark, including plant chemicals called polyphenols and flavonoids, have antioxidant, fever-reducing, antiseptic, and immune-boosting properties. Some studies show willow is as effective as aspirin for reducing pain and inflammation(but not fever), and at a much lower dose. Scientists think that may be due to other compounds in the herb. More research is needed.

Treatment

Studies suggest that willow bark may be useful for the following conditions:

Headache

Willow bark has been shown to relieve headaches. There is some evidence that it is less likely to cause gastrointestinal side effects than other pain relievers, such as ibuprofen (Advil) and other nonsteroidal anti-inflammatory drugs, do. However, studies have not shown this beyond all doubt, and people who are prone to stomach upset may want to avoid willow bark. Large-scale studies are needed to fully determine how safe and effective willow bark is for chronic or recurring headaches.

Low back pain

Willow bark appears to be effective for back pain. In a well-designed study of nearly 200 people with low back pain, those who received willow bark experienced a significant improvement in pain compared to those who received placebo. People who received higher doses of willow bark (240 mg salicin) had more significant pain relief than those who received low doses (120 mg salicin).

Osteoarthritis

Several studies show that willow is more effective at reducing pain from osteoarthritis than placebo. In a small study of people with osteoarthritis of the neck or lower back, those who received willow bark experienced significant improvement in symptoms compared to those who received placebo. A similar study of 78 people hospitalized with osteoarthritis of the knee or hip joint found that people who received willow bark had significant pain relief compared to those who received placebo.

Other uses

Professional herbalists may recommend willow bark for the following conditions, however, more research is needed.

• Menstrual cramps
• Fever
• Flu
• Tendonitis
• Bursitis
• Cancer

Dosage and Administration

Pediatric

Because of the danger of developing Reye syndrome (a rare but serious illness associated with the use of aspirin in children), children under the age of 18 should not take willow bark.

Adult

Speak to your doctor to determine the appropriate dose for you.

Precautions

Because willow bark contains salicin, people who are allergic or sensitive to salicylates (such as aspirin) should not use willow bark. Some researchers suggest that people with asthma, diabetes, gout, gastritis, hemophilia, stomach ulcers, or with kidney or liver issues should also avoid willow bark. If you have any of these conditions, or if you take nonsteroidal anti-inflammatory drugs (NSAIDs) or blood-thinning medication, ask your health care provider before taking willow bark. Children under the age of 16 should not take willow bark.

Side Effects

Side effects tend to be mild. However, stomach upset, ulcers, nausea, vomiting, and stomach bleeding are potential side effects of all compounds containing salicylates. Overdoses of willow bark may cause skin rash, stomach inflammation/irritation, nausea, vomiting, kidney inflammation, and tinnitus (ringing in the ears).

Pregnancy and Breastfeeding

Salicylates are not recommended during pregnancy, so pregnant and breastfeeding women should not take willow bark.

Interactions and Depletions

Because willow bark contains salicylates, it might interact with a number of drugs and herbs. Talk to your doctor before taking willow bark if you take any other medications, herbs, or supplements.

Willow bark may interact with any of the following:

Anticoagulants (blood-thinning medications): Willow bark may strengthen the effects of drugs and herbs with blood-thinning properties, and increase the risk of bleeding.

Beta blockers: including Atenolol (Tenormin), Metoprolol (Lopressor, Toprol-XL), Propranolol (Inderal, Inderal LA). Willow bark may make these drugs less effective.

Diuretics (water pills): Willow bark may make these drugs less effective.

Nonsteroidal anti-inflammatory drugs: including ibuprofen (Advil, Motrin) and naproxen (Aleve). Taking willow bark with these drugs may increase risk of stomach bleeding.

Methotrexate and phenytoin (Dilantin): Willow bark may increase levels of these drugs in the body, resulting in toxic levels.

Supporting Research

Bisset NG. Herbal Drugs and Phytopharmaceuticals. Stuttgart, Germany: Medpharm Scientific Publishers; 2004:534-536.

Blumenthal M. The Complete German Commission E Monographs. Austin, TX: American Botanical Council. Boston: Integrative Medicine Communications; 1998.

Chrubasik JE, Roufogalis BD, Chrubasik S. Evidence of effectiveness of herbal anti-inflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res. 2007 Jul;21(7):675-83. Review.

Chrubasik S. Pain therapy using herbal medicines [abstract]. Gynakologe. 2000;33(1):59-64.

Chrubasik S, Eisenburg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double blind study. Am J Med. 2000;109:9-14.

Enayat S, Banerjee S. The ethanolic extract of bark from Salix aegyptiaca L. inhibits the metastatic potential and epithelial to mesenchymal transition of colon cancer cell lines. Nutr Cancer. 2014;66(6):999-1008.

Ernst E, Chrubasik S. Phyto-anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials. Rheum Dis Clin North Am. 2000;26(1):13-27.

Foster S, Duke JA. A Field Guide to Medicinal Plants and Herbs of the Eastern and Central US. Boston, MA: Houghton Mifflin; 2000:321-323.

Freischmidt A, Jurgenliemk G, Kraus B, et al. Contribution of flavonoids and catechol to the reduction of ICAM-1 expression in endothelial cells by a standardised Willow bark extract. Phytomedicine. 2012;19(3-4):245-52.

Gagnier JJ, van Tulder M, Berman B, Bombardier C. Herbal medicine for low back pain. Cochrane Database Syst Rev. 2006;(2):CD004504.

Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm. 2000;57(13):1221-1227.

Hoffmann D. Therapeutic Herbalism. Santa Cruz, CA: Therapeutic Herbalism Press; 2000.

Kenstaviciene P, Nenortiene P, Kiliuviene G, Zevzikovas A, Lukosius A, Kazlauskiene D. Application of high-performance liquid chromatography for research of salicin in bark of different varieties of Salix. Medicina. 2009;45(8):644-51.

Kuhn MA, Winston D. Herbal Therapy and Supplements. Philadelphia, PA: Lippincott; 2001.

Little CV, Parsons T, Logan S. Herbal therapy for treating osteoarthritis. The Cochrane Library. 2002:1.

McGuffin M, Hobbs C, Upton R, et al, eds. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press; 1997:101.

Rakel: Integrative Medicine. 3rd. ed. Philadelphia, PA: Elsevier Saunders; 2012.

Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo-controlled, double blind clinical trial.Phytother Res. 2001 Jun;15(4):344-50.

Setty AR, Sigal LH. Herbal medications commonly used in the practice of rheumatology: mechanisms of action, efficacy, and side effects. Semin Arthritis Rheum. 2005 Jun;34(6):773-84.

Uehleke B, Muller J, Stange R, Kelber O, Melzer J. Willow bark extract STW 33-I in the long-term treatment of outpatients with rheumatic pain mainly osteoarthritis or back pain. Phytomedicine. 2013;20(11):980-4.

Vlachojannis J, Magora F, Chrubasik S. Willow species and aspirin: different mechanism of actions. Phytother Res. 2011;25(7):1102-4.

Overview

Legend has it that yarrow (Achillea millefolium) was named after Achilles, the Greek mythical hero who used it to stop the bleeding in his soldiers' wounds. Popular in European folk medicine, yarrow contains flavonoids, plant-based chemicals that increase saliva and stomach acid to help improve digestion. Yarrow may also relax smooth muscle in the intestine and uterus, which can relieve stomach and menstrual cramps.

Few scientific studies have looked at yarrow as an herbal medicine. Traditionally, it was used in 3 ways:

• Applied to the skin for wounds and minor bleeding
• Taken by mouth to reduce inflammation, especially in the digestive tract
• Taken as a sedative to relieve anxiety or insomnia

Today, yarrow is sometimes suggested for the following uses, although there is a lack of scientific evidence:

• Loss of appetite
• Indigestion or heartburn
• As a diuretic, to increase urine flow
• Amenorrhea (irregular menstrual cycle)
• Menstrual cramps and pain
• Muscle spasms
• Inflammation
• To fight infection
• Fever (brings temperature down through sweating)
• To reduce bleeding
• Wound healing

Plant Description

Yarrow, a member of the aster family, is closely related to chrysanthemums and chamomile. It flourishes in a sunny and warm habitat, and is frequently found in meadows and along roadsides, as well as on dry, sunny slopes. It grows as a simple, upright, and hairy stem, usually under 3 feet. Yarrow blooms between June and September. The flowers are typically white, but either pink or pale purple flowers are common in mountain areas. The petals are densely arranged in flattened clusters, and the leaves look like feathers. The plant spreads rapidly. There is substantial genetic variation in the plant's beneficial properties.

Parts Used

The flowers, leaves, and stems of the yarrow plant are used as medicine. Yarrow is collected while in bloom.

Available Forms

Yarrow is available in the following forms:

• Dried or fresh herb
• Capsules or tablets
• Tinctures
• Liquid extracts

How to Take It

Pediatric

There have been no studies to determine whether yarrow is safe for children, so it is not recommended for pediatric use. Talk to your child's health care provider before giving yarrow to a child.

Adult

Ask your provider to help you determine a dose.

Precautions

The use of herbs is a time-honored approach to strengthening the body and treating disease. However, herbs can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

If you are allergic to plants in the aster family (chrysanthemums, daisies, and ragweed), you may be allergic to yarrow, either taken by mouth or applied to the skin.

Yarrow may make your skin more sensitive to sunlight.

Pregnant women should not take yarrow. Its ability to relax the smooth muscle of the uterus could cause miscarriage. At least one study found that yarrow was associated with reduced fetal weight in rats. Other studies have shown an increase in the percentage of abnormal sperm among male rats treated with yarrow extract.

No studies have been done to know whether yarrow is safe in breastfeeding women. If you are nursing, talk to your health care provider before taking yarrow.

Possible Interactions

Because of the potential for side effects and interactions with medications, you should only take dietary supplements under the supervision of a knowledgeable provider.

Yarrow may interact with the following medications:

Blood-thinning medications

High doses of yarrow may slow down blood clotting. If taken with medications that thin the blood, such as aspirin, clopidogrel (Plavix), and warfarin (Coumadin), it may raise the risk of bleeding.

Lithium

Yarrow may increase the amount of lithium in the body, leading to dangerous levels.

Medications to reduce stomach acid

Because yarrow may increase the production of stomach acid, it can interfere with both over-the-counter and prescription drugs, including:

• Cimetidine (Tagamet)
• Famotidine (Pepcid)
• Ranitidine (Zantac)
• Esomeprazole (Nexium)
• Omeprazole (Prilosec)
• Lansoprazole (Prevacid)

Medications for high blood pressure

Yarrow may lower blood pressure slightly, and could strengthen the effects of prescription drugs taken to lower blood pressure.

Drugs that cause sleepiness

Because yarrow is a mild sedative, it can increase the effects of other drugs you take for anxiety or sleepiness. These include:

• Anticonvulsants, such as phenytoin (Dilantin)
• Barbiturates
• Benzodiazepines, such as alprazolam (Xanax) and diazepam (Valium)
• Drugs for insomnia, such as zolpidem (Ambien), zaleplon (Sonata), eszopiclone (Lunesta), ramelteon (Rozerem)

Supporting Research

Akkol EK, Koca U, Pesin I, Yilmazer D. Evaluation of the Wound Healing Potential of Achillea biebersteinii Afan. (Asteraceae) by in vivo Excision and Incision Models. Evid Based Complement Alternat Med. 2011;2011:474026.

Boswell-Ruys CL, Ritchie HE, Brown-Woodman PD. Preliminary screening study of reproductive outcomes after exposure to yarrow in the pregnant rat. Birth Defects Res B Dev Reprod Toxicol. 2003;68(5):416-420.

Cavalcanti AM, Baggio CH, Freitas CS, et al. Safety and antiulcer efficacy studies of Achillea millefolium L. after chronic treatment in Wistar rats. J Ethnopharmacol. 2006;107(2):277-284.

Dalsenter PR, Cavalcanti AM, Andrade AJ, Araujo SL, Marques MC. Reproductive evaluation of aqueous crude extract of Achillea millefolium L. (Asteraceae) in Wistar rats. Reprod Toxicol. 2004;18(6):819-823.

Ebrahimi M. Inter- and intra-specific genetic diversity of Iranian yarrow species Achillea santolina and Achillea tenuifolia based on ISSR and RAPD markers. Genet Mol Res. 2012;11(3):2855-2861.

Final report on the safety assessment of Yarrow (Achillea millefolium) Extract. Int J Toxicol. 2001;20 Suppl 2:79-84. Review.

Hausen BM. A 6-year experience with compositae mix. Am J Contact Dermat. 1996;7(2):94-99.

Karamenderes C, Apaydin S. Antispasmodic effect of Achillea nobilis L. subsp. sipylea (O. Schwarz) Bassler on the rat isolated duodenum. J Ethnopharmacol. 2003;84(2-3):175-179.

Kazemi M, Rostami H. Chemical composition and biological activities of Iranian Achillea wilhelmsii L. essential oil: a high effectiveness against Candida spp. and Escherichia strains. Nat Prod Res. 2015;29(3):286-288.

Khan AU, Gilani AH. Blood pressure lowering, cardiovascular inhibitory and bronchodilatory actions of Achillea millefolium. Phytother Res. 2011;25(4):577-583.

Nemeth E, Bernath J. Biological activities of yarrow species (Achillea spp.). Curr Pharm Des. 2008;14(29):3151-3167.

Rakel D, ed. Integrative Medicine. 3rd ed. Philadelphia, PA; Elsevier Saunders; 2012.

Rohloff J, Skagen EB, Steen AH, Iversen TH. Production of yarrow (Achillea millefolium L.) in Norway: essential oil content and quality. Agric Food Chem. 2000;48(12):6205-6209.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc.; 2002:369-371.

Stojanovic G, Radulovic N, Hashimoto T, Palic R. In vitro antimicrobial activity of extracts of four Achillea species: the composition of Achillea clavennae L. (Asteraceae) extract. J Ethnopharmacol. 2005;101(1-3):185-190.

Van der Weijden GA, Timmer CJ, Timmerman MF, Reijerse E, Mantel MS, Van der Velden U. The effect of herbal extracts in an experimental mouthrinse on established plaque and gingivitis. J Clin Periodontol. 1998;25(5):3099-3410.

White L, Mavor S. Kids, Herbs, Health. Loveland, CO: Interweave Press;1998:22, 43.

Yaeesh S, Jamal Q, Khan AU, Gilani AH. Studies on hepatoprotective, antispasmodic and calcium antagonist activities of the aqueous-methanol extract of Achillea millefolium. Phytother Res. 2006;20:(7)546-551.