Filipendula ulmaria (meadowsweet, Queen of the meadow).

Family: Rosaceae

Parts used: flowering tops and leaves

Description:  The sweetly fragranced, small, white flowers are arranged in foamy, branched clusters, or panicles. The stems are stiff and the leaves are large and toothed, silvery underneath. It grows up to 3-5 feet, throughout Europe in damp meadows, flowering in July and August.

Constituents, actions and indications:

Filipendula has traditionally been used to treat inflammatory and painful conditions as well as problems with the stomach and intestines.  For example, salicylaldehyde and salicylate in Filipendula relieve inflammation in gastritis (inflammation of the stomach).  Rutin, a flavonoid in Filipendula repairs damaged capillaries and damaged mucosa in gastritis and is therefore anti-ulcerogenic.  It is used to treat irritable bowel syndrome, flatulence, distension, colic, hyperacidity and prevents gastro-oesophageal reflux disease (GORD) and associated pain.  Its astringent properties due to tannins will improve lower oesophageal sphincter tone, so decreasing the risk of GORD and also treat diarrhoea.  Salicylaldehyde in Filipendula give it analgesic properties.  It is also used to treat headaches, arthritis, myalgia and rheumatic pain, fevers (salicylate and spiraein are anti-pyretic) and abdominal cramps.

Contraindications:  It should be avoided by those with an allergy to aspirin.  It may have an additive effect with anticoagulants, either herbal or orthodox, increasing bleeding time.

Galium aparine (cleavers, goose grass).

Family: Rubiaceae

Parts used: Aerial

As it is a diuretic, Galium is useful in cystitis and is also anti-lithic (helps prevent the formation of calculi or stones).  Galium is considered to be an alterative and blood cleanser and is detoxifying for skin conditions such as eczema and psoriasis.  It is also anti-inflammatory. As a support for the lymphatic system it is prescribed for lymphadenitis, lymphadenopathy, lymphoedema and any affection of the lymphatics.  There is uncertainty as to its physiological effects but it may be that its diuretic properties enable the kidneys to eliminate excess toxins. The major active constituents are believed to be iridoids, polyphenolic acids, alkanes, flavonoids and tannins.

Ginkgo biloba (Maidenhair tree).

Family: Ginkgoaceae

Parts used: Leaf

Description: Deciduous tree, either male or female, up to 125 feet tall and 3-4 feet in diameter.  Green to yellow fan shaped leaves.  Female trees produce small, yellow or orange fruits.  Gingko can live up to 1000 years.

Constituents and actions

Ginkgo has the ability to both vasodilate and to reduce blood viscosity.  It has a vasoregulatory (altering the tone of blood vessels) effect, promoting increased blood flow, including cerebral, possibly by inhibiting nitric oxide.  The gingkolides A, B and C, which are diterpene lactones, and flavonoids, are responsible for this action.  They are also neuroprotective, by increasing oxygen and glucose uptake by nerve cells and reducing neuronal damage following ischemia.  Bilobalide, consisting of sesquiterpene lactones, may stimulate regeneration of damaged nerve cells.  The flavonoids (bilobetin and about 40 others) have an antioxidant effect by neutralising free radicals and antagonising lipid peroxidation.

It is antithrombotic by antagonism of platelet-activating factor (PAF).  This effect is specific to the ginkgolides (predominantly B).  PAF causes platelet (a blood constituent involved in blood clot formation) aggregation, mast cell degranulation and oxygen radical production. 

Indications:

·         The effects of Ginkgo on improvement of cerebral blood flow and neuronal metabolism improves concentration, learning and memory and is of benefit in age-related senile dementias such as vascular dementia and Alzheimer’s disease.  It may also alleviate anxiety caused by cognitive decline (Woelk et al. 2007).

·         Ginkgo biloba is traditionally used for tinnitus of vascular origin and may improve hearing.

·         It improves the flow of blood to the peripheries such as the eyes, where it may slow macular degeneration and may increase penile blood flow for impotence caused by diabetes, atherosclerosis or SSRI (selective serotonin reuptake inhibitor) antidepressants.

·         It is known to be useful in cases of intermittent claudication caused by peripheral arterial disease, by increasing blood supply to the muscles in the legs, allowing a sufferer to walk further before experiencing pain (usually in the calf).

·         By its vasoregulatory action it is cardiotonic, increasing blood flow to the heart and lowering blood pressure.

·         Ginkgo’s antagonistic action on PAF results in inhibition of mast cell degranulation.  It is therefore beneficial in asthma.

·         Premenstrual symptoms including breast tenderness, anxiety and depression may improve with Ginkgo.

Side-effects:  Occasional nausea and digestive disturbance, headaches or dizziness.

Cautions and contraindications:

·         Ginkgo may diminish the efficacy of anticonvulsant medication (Kupiec and Raj 2005).

·         Should not be used with anti-clotting drugs such as warfarin, an anticoagulant, or aspirin, an anti-platelet drug.  A recent clinic trial, however, suggests there is no additive action with aspirin (Gardner et al. 2007) – although the sample size was too small for the results to be conclusive.  An additive anti-clotting effect may result in haemorrhage.  As elderly patients are susceptible to bleeds due to weak capillaries bleeding time should be monitored in those taking Ginkgo.  Any patient should stop using it if there is increased petichiae, purpura, bruising or bleeding.

·         May increase the activity and therefore toxicity of monamine oxidase inhibitors (Kupiec and Raj 2005).

No known contraindications in pregnancy.

Glycyrrhiza glabra (Liquorice).

Family: Fabiaceae

Part used: dried root

Glycyrrhiza contains triterpenoid saponin glycyrrhizin (GL) and its aglycone glycyrrhetinic acid (GA), which are the active constituents.  (GA is the active metabolite of GL in vivo). 

Stress:  Glycyrrhiza is one of a group of herbs termed ‘adaptogens’.  These herbs help the body adapt to stress and prevent adrenal cortex exhaustion.  The adrenal cortex glands secrete cortisol in response to stress and in cases of continuous stress the glands may become depleted, resulting in exhaustion. GA in Glycyrrhiza prevents cortisol breakdown in the liver by inhibition of the enzyme 5-beta-reductase.  Additionally, it inhibits the conversion of active cortisol to inactive cortisone by 11-beta-hydroxysteroid-dehydrogenase (11-beta-HSD).  Some of the free cortisol binds to mineralocorticoid receptors in the kidney, thus enabling an *aldosterone-like effect by cortisol.  Aldosterone output is decreased, consequently decreasing negative feedback inhibition of the anterior pituitary and allowing it to secrete more ACTH, and hence more cortisol is secreted from the adrenal cortex. The overall effect is more cortisol available to combat stress.

*Aldosterone is a hormone, produced by the adrenal cortex, which stimulates reabsorption of sodium, with a loss of potassium. With excessive use of Glycyrrhiza, therefore, there is a risk of hypokalaemia (potassium deficiency), which leads to muscular weakness and hypertension (high blood pressure). 

Gastro-intestinal tract: Glycyrrhiza is anti-spasmodic and helps to relieve nervous spasms associated with stress that cause irritable bowel syndrome and colic.  By its action on stimulating bile secretion it is a mild aperient, which will aid bowel motility and remove impacted faeces.  Due to the following properties it also has an anti-ulcer action:

·         It stimulates secretion of mucus and mucosa cell proliferation.

·         Demulcent – soothes and protects the irritated mucosa of the stomach and intestines due to polysaccharide content. 

·         It has anti-inflammatory and anti-stress properties, probably by potentiation of cortisol but also glycyrrhizin has direct anti-inflammatory properties. 

·         Its combined anti-stress, anti-inflammatory and demulcent properties, its ability to reduce stomach acid secretion and increase mucus production will help prevent ulcer formation. 

Polycystic ovary syndrome (PCOS):

In PCOS there is characteristically an elevation of male hormones (androgens) such as testosterone. Glycyrrhiza used in conjunction with Paeonia lactiflora, curbs production of male hormones in the following ways:

·         Inhibits 17-beta-hydroxysteroid dehydrogenase, therefore prevents conversion of androstenadione to testosterone in the ovaries.

·         Inhibits 11-beta-hydroxysteroid dehydrogenase – precursor to adrenal cortex androgen dihydroepiandrosterone (DHEA).

·         Inhibits 5-alpha-reductase that converts testosterone to dihydrotestosterone (DHT).

·         Meanwhile, Paeonia lactiflora, by action the monoterpene paeoniflorin, promotes aromatase conversion of testosterone to oestradiol.

PCOS cannot be treated by these two herbs alone and tests for hormonal status should be conducted initially.  See your herbal practitioner for advice. 

(Greenstein 1994; Mills and Bone 2000; Trickey 2003).

Hypericum perforatum (St John’s wort).

Family:  Hypericiaceae, Clusiaceae, Guttiferae

Parts used:  Flowering tops

Description:  A hardy, shrubby perennial with yellow, five-petalled flowers with multiple protruding stamens.  The flowers contain oil glands and when rubbed, a red pigment is released.  It takes its name in folklore from the belief that this stain was the blood of St John the Baptist

Indications and actions:

Nervous system:  Hypericum can help to alleviate mild to moderate depression as well as anxiety.  It is considered to be particularly useful in depression linked to nervous exhaustion.  .  It is useful in cases of insomnia and for relief of menopausal and premenstrual anxiety and depression.  It is analgesic and, taken internally or applied topically, it helps to alleviate the pain of joint damage or sciatica.

Although it is not definitive which are the active constituents they may act by inhibition of neurotransmitter breakdown or depletion.  Its hyperforin content is believed to inhibit serotonin and GABA (gamma amino butyric acid) reuptake, reducing depression and anxiety respectively, while its hypericin has a dopamine reuptake inhibitory action, further reducing anxiety.  Hypericin is believed to also be a monoamine oxidase (MAO) inhibitor. MAOs cause breakdown of dopamine, an insufficient amount of which may cause emotional disturbances.  As dopamine inhibits output of the hormone prolactin, which may be raised in premenstrual syndrome, it may be via this modulating effect on dopamine that premenstrual anxiety is helped by Hypericum.  Hypericin is mainly responsible for Hypericum’s antidepressant effects and hyperforin for its sedative effects

Circulation: Topically and internally Hypericum may increase capillary blood flow and improve peripheral circulation.

Wound healing: Hypericum inhibits pro-inflammatory cytokines so may reduce inflammation.  Additionally, it speeds the healing of trauma and nerve damage, while at the same time is analgesic.  Topically, used as an oil or tincture extract, it is useful for post-herpetic pain as in shingles, for haemorrhoids, bruises, cuts and burns.  It has an anti-inflammatory, wound-healing effect on the bowel and on peptic ulcers, probably due in part to the presence of astringent tannins (Grianger Bissett and Wichtl 1994: 274).

Infections:  Hypericum is both antiviral and antibacterial.

Side-effects:  It may cause photosensitivity in some individuals.

Hypericum perforatum-drug interactions (effects in brackets)

Evidence suggests that Hypericum acts as an inducer of the cytochrome p450 3A4 enzyme.  As certain prescribed medicines are substrates of the enzyme taking Hypericum concurrently with these drugs may lead to a loss or reduction in their therapeutic effect.  Such dugs include HIV protease inhibitors (increased viral load), oral contraceptives (unwanted pregnancies), ciclosporin (organ transplant rejection) and warfarin (altered clotting time), SSRIs (additive effect leading to ‘serotonin syndrome’ eg agitation, fever, sweating, confusion, diarrhoea and tremor), theophylline (reduced blood concentration of the drug) (Medicines Control Agency 2002).  Worsening of angina, hypertension or arrhythmia may result from interactions with certain cardiovascular drugs, such as amlodipine, diltiazem, lidocaine, losartan, lovastatin, nifedipine, simvastatin, and verapamil (Frishman et al. 2005).

Matricaria recutita (German chamomile).

Family:  Asteraceae

Parts used: Flowers

Matricaria is anxiolytic and sedative due to the action of apigenin as a ligand for central bezodiazepine receptors so will help to relieve stress and poor sleep patterns.  It is anti-inflammatory as it contains the sesquiterpene chamazulene, which blocks the peroxidation of arachidonic acid.  Alpha-bisabolol, a sesquiterpene, and apigenin, a flavonoid, inhibit formation of 5-lipoxygenase and cycoxygenase. Alpha-bisabolol and apigenin also have anti-spasmodic and spasmolytic actions, which will help to relieve stress-related dyspepsia and colic and IBS symptoms.  Alpha-bisabolol has anti-ulcer actions.

Mentha piperata (peppermint).

Family: Labiatae

Parts used: Leaves, picked just before the flowers open.

Mentha piperata is one of the oldest herbs in medicinal and culinary use.  It has been used for centuries for disorders of the digestive tract, such as flatulence, nausea, digestive pains and cramps as well as dysmenorrhoea (menstrual cramps).  It is drunk as a tea with yarrow and elderflower as a traditional treatment for the early stages of a cold or influenza.

Indications and actions:

·         The oil is antispasmodic, spasmolytic, analgesic and so in the digestive system Mentha piperata is particularly useful in relieving symptoms of bloating, pain and spasm in irritable bowel syndrome (IBS); pain, inflammation, spasm and mild antiseptic action in diverticulitis; intestinal colic; flatulent dyspepsia; and to allay nausea and vomiting.  It aids digestion by its bitter properties, stimulating the flow of bile and digestive juices. 

·         Its antispasmodic and analgesic properties help to relieve dysmenorrhoea.

·         It has antibacterial and antifungal actions.

·         It may help to reduce fevers by promoting sweating.

·         In the respiratory system, is antitussive and decongestant and can help to relieve the symptoms of asthma in combination with other herbs. 

·         Combined with other relaxing herbs it can help to alleviate minor stress.

·         Topically, it is a useful addition to creams to alleviate pain and itching in skin conditions and the oil may be applied to the forehead and temples to relieve tension headaches.

NB:  When infusing the herb as a tea it should be kept covered to prevent the volatile oils from evaporating.

Key constituents: volatile oils, notably menthol and menthone, flavonoids and tannins.

Contraindications: Mentha piperata may be initially soothing for heartburn but as a powerful muscle relaxant and stimulant of gastric secretion it often results in aggravation of symptoms, particularly in those with gastro-oesophageal reflux disease (GORD) and/or hiatal hernia  and, unless enteric coated, should therefore be avoided for treatment of other conditions in these patients.  As it contains salicylates it should not be given to those with an allergy to aspirin.  It is not suitable for lactating women as the oils may pass to infants in the milk.

Side-effects:  The oil may be an irritant in some individuals and, in particular, should not be applied to the face or chest in small children as it may cause irritation or bronchial or laryngeal spasms.

Rosa damascena/ Rosa centrifolia (Damask rose).

Family:  Rosaceae

Parts used:  Petals, leaves

Indications

R. damascena is useful component in a sleep/stress mix or a nasal spray, and is a pleasant addition to teas, due to its digestive and relaxing effects and wonderful colour and aroma - to lift the spirits; the fragrance is believed to have cephalic properties (clears the head).  Although there is a dearth of scientific evidence for the benefit of this species of rose for grief, it has been traditionally used for this purpose (Potterton 1983: 138) and may have a placebo effect due to its pleasant smell. The leaves are used as a cathartic and, according to Culpepper, the petals ‘may be taken for strengthening the stomach’ (Potterton 1983: 138).

·         The flowers are reputed to be astringent, bitter, anti-inflammatory and carminative and will therefore help to alleviate digestive problems. They are also mildly laxative.

·         They are also depurative (alterative) and with their anti-inflammatory action will therefore benefit skin conditions.

·         Rosa is traditionally used for stress-related palpitations.  The petals are purported to have cardiotonic, circulatory stimulant and hypotensive actions and to lower cholesterol. 

·         Its expectorant action is useful for a minimally productive cough.

Topically, R. damascena petals are antiseptic, anti-inflammatory, cooling and emollient for skin.  Rosewater is soothing when applied to inflamed eyes.

Key constituents: essential oil - citronel, nerol, geraniol and phenylethanol, flavonoids quercetin, kaempferol, cyaniding 3, 5- diglucoside, a bitter principle, tannins, fatty oil and organic acids and is a source of vitamin C.

Salvia officinalis (Garden sage).

Family: Labiatae

Parts used: Leaves

S. officinalis is an aromatic, evergreen shrub up to 75 cm in height with greyish-green oblong to lanceolate opposite leaves covered in a fine down.  It has bluish-violet, two-lipped flowers arranged in whorls (Wildwood 1998). 

Indications:

Nervous system:  Salvia officinalis and other members of the Sage family, such as Salvia lavandulaefolia, have a long history of use as memory-enhancing agents.  Sage was used in medieval Europe as a tisane for prolonging life and is a traditional spring tonic for strengthening weak constitutions (Lipp 1996).  According to Culpepper: ‘Sage is of excellent use to help the memory, warming and quickening the senses…’ This can be borne out by modern day clinical research, which has indicated that Salvia species have cholinergic properties (inhibit the enzyme acetylcholinesterase), which may have the potential to alleviate the cognitive deficits associated with Alzheimer's disease (Tildesley et al. 2005). 

There is evidence to suggest that S. officinalis modulates gamma-amino butyric acid (GABA) imbalances, possibly by the action of thujone which inhibits it and hispidulin, which increases output.  Excess GABA can impair memory and learning, contributing to dementia states, whereas insufficient GABA may cause depression and mood changes. Added to sedatives, Salvia stops early morning waking, common in depression (Birzniece et al. 2006; Chebib et al. 2004; Johnson and Beart 2004; Olsen 2000).  In addition, numerous workers have suggested a role in dementia for Salvia spp. with regard to its antioxidant, anti-inflammatory and sex hormone modulating properties.

Inflammation: An old country remedy indicates its efficacy and traditional use for inflammation was to wash a sunburnt face with sage tea (Page 1978).  As an antiphlogistic, it is now used for inflammation of the mucous membranes, such as those lining the mouth, throat and intestines.  As such it is beneficial as a gargle or rinse for the amelioration of stomatitis, tonsillitis, pharyngitis and gingivitis and as a tea for intestinal inflammation and diarrhoea (Grainger Bisset and Wichtl 1994).

Other uses: It has antimicrobial properties and can be used topically as a poultice (Hoffmann 2003: 580).  As a carminative it alleviates flatulence. It is useful for the alleviation of night sweats (antisudorific action) and excessive milk production (galactorrhoea) (Grainger Bisset and Wichtl 1994: 440).  It lowers prolactin. Thujone in the leaves is believed to be oestrogenic and helps to regulate menstrual periods (Chevallier 1996). Another traditional use is for headaches and migraine (Page 1978).

The major active constituents of the leaves are believed to be the volatile oils (1.0-2.8%), containing monoterpenes such as alpha-pinene, beta-pinene, 1-8-cineole, camphor, geraniol and thujone.  S. officinalis contains around 50% alpha - and beta - thujone whereas only traces have been found in S. lavandulaefolia.  Thujone, a terpenoid ketone, is potentially neurotoxic.  S. officinalis also contains polyphenolic compounds including rosmarinic acid, methyl carnosate, luteolin, luteolin-7-0-glucoside and caffeic acid, triterpenes eg oleanic acid and the flavonoids 5-Methoxysalvagenin and hispidulin. Thujone is believed to be responsible for its stomachic, oestrogenic and antiseptic effects.  Geraniol is also oestrogenic.  Other constituents include rosmarinic acid (tannin), which is anti-inflammatory and antioxidant to treat rheumatism and tumours.   Cineole is anti-catarrhal.  Bitters, saponins and fruit acids are digestive and liver cleansing (Barnes et al. 2002; Chevallier 1996; Grainger Bisset and Wichtl 1994; Johnston and Beart 2004; Kennedy and Scholey 2006).

Dosage

Tincture: 2-4 ml tds (1: 5 in 40& alcohol).

Infusion: 1-2 tsp dried leaf to a cup of boiling water.  Infuse for 10 minutes, covered. Drink tds.  For a gargle use 2 tsp in 500 ml and bring to boil.  Stand 15 min.  Gargle several times daily (Hoffmann 2003: 580).

Safety considerations

Overdose (more than 15 g per dose) or prolonged use can lead to tachycardia, vertigo, hot flushes and convulsions (Grainger Bisset and Wichtl 1994).  It should be avoided during pregnancy as it stimulates uterine muscle (Hoffmann 2003).

Sambucus nigra L (common elder).

Family:  Caprifoliaceae

Parts used:  Leaves, flowers, berries and bark.  The leaves are picked in dry weather from late April to June and used, unwashed, immediately.  The flowers do not appear until late in May, the fruits in August, the berries in early September and bark should be collected in the summer. 

Elders have been cultivated for thousands of years for medicinal purposes and have become surrounded by much folklore, possibly stemming from the legend that Judas Iscariot hanged himself from an elder tree.  It is still supposed to be bad luck to cut down an elder without asking its permission and was believed that witches used elder for black magic.  The latter myth probably stems from the fact that herbalists were considered to be witches, although a belief that is somewhat conflicting is that to grow an elder close to the house would keep witches away (Jordan 1997).

Sambucus nigra is widely distributed throughout Europe, North Africa and Western Asia.  It grows in nitrogen-rich soil and can be found in woodland edges and hedgerows (Stuart 1979).  Often these are small deciduous shrubs but can grow to approximately 10 metres high.  The trunk has a diameter of up to 30 cm with shoots erect from the base.  Some of the branches are arching, the deeply furrowed, corky bark is brownish-grey in colour and the twigs have prominent lenticels (Atkinson & Atkinson 2002; McClintock & Fitter 1956). 

This species of elder is the only shrub in the British Isles to have opposite leaves. They are attached to the stem by a grooved petiole.  The leaves are compound pinnate and at the time of picking the longest were around 12cm.  Each leaf has 3-5 serrate leaflets, ovate or elliptic, up to 10 cm in length.   The leaflets are sessile, excepting the lower pair, which has a short stalk.  Some of the leaves have tiny stipules at the base.  The slightly hairy dorsal side of the leaf is paler and shinier than the ventral side.  There are reddish coloured axillary buds of about 1 mm and horizontal scars on the stem (Atkinson & Atkinson 2002; McClintock & Fitter 1956).

The flowers grow in a flat-topped cyme, which is creamy-white, arranged in corymbs and is up to 20 cm in diameter.  Each flower has 5 pale yellow anthers.  The fruit that follows the flowering stage is a black drupe of 6-8 mm (Atkinson & Atkinson 2002; McClintock & Fitter 1956). 

Indications and actions

Leaves:  Topical elder leaf preparation is vulnerary.  Substances that promote wound healing do so by styptic and anti-inflammatory action.  It is also anti-tumourigenic and is useful for urticaria (Trattler 1985), bruises, sprains and chilblains and has emollient and analgesic properties (Bianchini & Corbetta 1975).  Internally the leaves have purgative, diaphoretic, diuretic and expectorant actions (Hoffmann 2003).

Constituents of the leaves which give them their healing properties are:  Cyanogenic glycosides (sambunigrin, zierin and holocalin), releasing hydrogen cyanide by enzyme action - animals are occasionally poisoned from eating the leaves (Atkinson & Atkinson 2002: 901).  An enzyme, emulsin, present in the leaves, converts sambunigrin to hydrocyanic acid, benzaldehyde and glucose.  Elder leaves also contain an alkaloid, sambucine, the sugar converting enzyme invertin and potassium nitrate (British Pharmaceutical Codex 1911), triterpenoid saponins a- and ß-amyrin, ursolic acid and oleanic acid and steroidal saponins campesterol and stigmasterol (Inoue & Sato 1975).

The tannins are styptic/astringent by haemostatic action and by complexing with exposed tissues they form a protective barrier.  They are also anti-viral and antimicrobial.  The flavonoids, volatile oils, resins and saponins are anti-inflammatory.  Flavonoids, particularly rutin, are believed to inhibit pro-inflammatory enzymes and histamine release and to reduce capillary fragility and bruising as well as inhibiting collagenases and elastinases, so promoting healing.  They also inhibit tumour growth, as do the cyanogenic glycosides.  Alkaloids have analgesic properties and the volatile oils and resins are antiseptic (Mills & Bone 2001;  Mills S 1990).

Flowers:  The flowers are indicated for any catarrhal condition affecting the upper respiratory tract, such as colds, hayfever, influenza and sinusitis.  The flowers inhibit production of mucus as well as being directly anti-inflammatory.  They have mild diuretic properties so can help in cases of hypertension or cystitis.  An added benefit is that they have a calming effect on the nervous system.  The main active constituents of Sambucus flowers are the flavonoids (including rutin, isoquercitrin and kaemferol), triterpenes (including ursolic acid and oleanolic acid), fixed oils and phenolic acids (Hoffmann 2003).

Berries:  In vitro studies have shown the berries to inhibit influenza viruses and to activate the immune system by increasing production of inflammatory cytokines, particularly tumour-necrosis-factor-alpha (Barak et al. 2001). The berries are also are purported to be effective in rheumatism.  They also have a mild laxative effect.  They are rich in vitamin C and antioxidant anthocyanins and flavonoids and contain numerous aromatic compounds.

Caution:  As the berries increase levels of cytokines caution should be exercised in certain conditions.  For example, in avian flu there is a cytokine storm and it is therefore possible that elderberry could produce unwanted effects by enhancing this excessive production of cytokines.  However, recent research has demonstrated its effectiveness in vitro against avian flu (Blackburn 2006).  The antiviral effects are believed to be by strengthening cell membranes and prevention of the virus from entering the cell (Hoffmann 2003).

Bark:  The bark, containing triterpenoid saponins, has a stronger laxative effect than the berries and may also be used as an emetic (Bartram 1995).