American Medical Publishing
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| Comfrey (Symphytum officinale) — In the opinion of some experts, comfrey taken orally, has too many risks to justify its use. It may cause severe liver damage with long term use. If you do take it, don't do so for more than four to six weeks per year. Do not use during pregnancy or while nursing except under the direct advice of an expert.
• Feverfew (Tanacetum parthenium) - Do not use during pregnancy unless by advice of expert. Mouth sores and stomach problems occur in a few users, usually in the first week of use. No long-term adverse effects are known. |
Stephen Cummings and Dana Ullman
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 Symphytum, or comfrey is the herb that has been known for centuries in Europe as "knitbone" because of its ability to aid the healing of fractures. Give Symphytum 6x twice a day for two to three weeks, or Symphytum 30x or 30c once a day for seven to ten days.
Bryonia often is helpful for the pain of fractured ribs. Give it as directed for Arnica above, but give a dose or two of Arnica before starting the Bryonia.
Silica is an excellent medicine if small chips have been broken from the bone. Give the 6x potency twice daily for two weeks. |
Josef A. Brinckmann and Michael P. Lindenmaier
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 In a recent randomized, placebo-controlled, multicenter (143 patients in 5 centers), double-blind study, the percutaneous efficacy of a comfrey root extract ointment was demonstrated in patients with unilateral sprained ankle joints ([20], wherein additional lit references for clinical efficacy can be found).
Moreover, the drug is used in folk medicine for rheumatism, bronchitis, pleuritis, and as an antidiarrheic.
Side effects: In long-term studies, the pyrrolizidine alkaloids of the drug have demonstrated hepatotoxic, carcinogenic, and mutagenic actions in rats [21—23; and further lit. |
David Hoffman, FNIMH, AHG
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 For example, does topical use of comfrey pose a different level of risk than internal use?)
• Does objective data for both toxicity and efficacy exist? Are the research results valid enough to form some basis for approximate risk assessment?
• How does the science compare with the perceived risk expressed by the FDA, practitioners of orthodox medicine, or herbalists? |
Dian Dincin Buchman, Ph.D.
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 Comfrey liquid can be added to clay poultices to relieve pressure and nerve damage pain. If only ointment of comfrey is available, alternate gentle topical applications of the ointment with clay poultices, or any of the clay plus herb poultices.
DIARRHEA
Clay pellets or clay diluted in a glass of water are helpful in treating most kinds of diarrhea. Do not take any but the purest clay internally. Add any quieting herbal infusion (tea) to the clay water. |
| The following herbal poultices are also useful: hot moistened flaxseed, cooked marshmallow root, cooked hot comfrey root, moistened comfrey leaves, and gingerroot tea. Place any of these in a handkerchief, light kitchen towel, or cloth, and apply to the area of pain.
SPRAIN AND SWELLING Water Therapy
Immediately apply an ice pack to the sprain for 20 minutes an hour during the first 24 hours. This reduces recovery time as well as potential inflammation. Practice RICE: Rest, Icing, Compression, and Elevation. Compression means either light bandaging or an elastic bandage such as sold by Ace. |
Dr. Michael Heinrich, Joanne Barnes, Simon Gibbons and Elizabeth M. Williamson
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 For example, when six commercial samples of comfrey leaf were tested, none of these alkaloids were undetectable; however, in fresh plant material, and also root samples, they may be present in significant amounts. The total recommended maximum dose of these alkaloids is less than 1 tig daily for less than six weeks per year. If herbal products, which may contain these, are to be employed (and some are very useful, e.g. butterbur and coltsfoot; see Chapter 15), the content must be estimated and if necessary the alkaloids should be removed before use.
H CH3
OH f. |
| This accounts for the withdrawal of comfrey (Symphytum officinale), which has a long history of use
Nicotine Coniine Arecoline as a medicinal plant but also contains these toxic alkaloids. Senecionine occurs in groundsel (Senecio vulgaris, Asteraceae), which is problematic in farms and paddocks where it can cause poisoning of livestock and horses.
Phenylalkylamine alkaloids
The natural products of this group do not have a cyclic nitrogen atom but have either a free amine or an alkyl-sub-stituted amine. |
| Medicinal herbs that may be affected include comfrey (Symphytum spp.), butterbur (Petasites hybridus), alkanet (Alkanna tinctoria, Boraginaceae), coltsfoot (Tussilago farfara) and hemp agrimony (Eupatorium cannabinum, Asteraceae). Not all pyrrolizidine alkaloids are toxic, only those that are unsaturated at the Imposition (e.g. senecionine; Fig. 10.2). These are liver toxins and can produce veno-occlusive disease of the hepatic vein as well as being hepatocarcinogenic, and their effects are cumulative. Several documented clinical examples can be found in the literature. |
| For example, high-yielding strains of Catharanthus and Dioscorea may be required, or the development and maintenance of pyrrolizidine-free strains of common comfrey (Symphytum officinale L.) and coltsfoot (Tussilago farfara L.), or virus-free Digitalis lanata Ehrh. cultures.
• For the semi-synthetic production of some natural products (e.g. production of digoxin from digitoxin).
• For the direct synthesis of a medicinal natural product, although this is only rarely achieved by this method. |
Gary Null
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| Use fenugreek tea and comfrey tea throughout the day. You may benefit from the medically supervised treatments of chelation therapy, intravenous vitamin therapy, and hyperbaric oxygen therapy. Take vitamin C at 5,000 to 15,000 mg; DMG at 300 mg, three times a day; TMG (use as directed); and MSM (as directed). The sulfur in MSM binds to allergens, thus preventing allergic reactions. It also coats the intestinal lining to prevent dust mites from causing asthmatic reactions. |
Andrew Pengelly
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 PAs from comfrey include symphytine, intermedidine and symlandine—these do not contain the macrocyclic diesters.
Few therapeutic effects have been postulated for PAs. The main interest has been in their toxicity; this is dealt with in numerous other publications (e.g. Bruneton 1995).
Indole alkaloids
This is a very large group of alkaloids whose basic structure contains a pyrrole ring fused to a benzene ring. |
Earl L. Mindell, RPh, PhD with Virginia Hopkins, MA
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| A glass of room temperature water, raw cabbage or potato juice, or herbal teas such as fenugreek, slippery elm, comfrey, licorice, and meadowsweet (lukewarm, no lemon) can bring quick relief. Fresh papaya or banana can help as well.
If you do need to lower your stomach acidity, you can use a form of organic sulfur called MSM (methylsulfonylmethane) in supplement form, 1,000 mg daily. Don't eat a lot of fat, either, as fat slows the emptying of the stomach. Use alcohol and chocolate in moderation. Eat several small meals a day so that you don't overeat at any one meal. |
Josef A. Brinckmann and Michael P. Lindenmaier
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| External products with PA-containing comfrey have the following warning: For external use only. Do not apply to broken or abraded skin. Do not use when nursing.
Authentication: Macroscopic (see: Description) and microscopic, following DAC 1979 (no longer official in DAC 1986). See also:
BHP 1996. Characteristic are the mucilaginous parenchymatic cells with reticulate and punctiform vessels. The swelling index is not less than 8, but this does not allow for the distinction from other cultivated Symphytum species.
TLC Identification: (according to DAC 1979). |
Michael F. Jacobson, Ph.D., Lisa Y. Lefferts and Anne Witte Garland
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| Some foods, including comfrey tea or false morels (a type of wild mushroom), contain naturally occurring substances that may cause cancer; other foods may develop toxins if they're stored improperly, such as the nerve poison solanine in green potatoes.
Safe Food solutions
þ Avoid the foods that are most likely to contain natural toxins. Never eat moldy nuts and grains. Avoid comfrey, coltsfoot, and false morels. Cut out and throw away green or damaged spots on potatoes. And don't eat noncommercially harvested shellfish. |
Elson M. Haas, M.D.
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 Herbal teas made from lemon grass, peppermint, ginger root, red clover, and comfrey are very nourishing, and do not have the depleting side effects. The algaes can also be energizing in place of caffeine.
If we do like a cup of coffee or caffeinated tea a day, it might be best to drink it in the mid- to late afternoon, which is different from what most people do, using caffeine as their wake-up call and for energy through the day. The afternoon cup best fits our body's natural cycle, avoiding the high-adrenal morning and late pre-sleep hours. |
Sheldon Saul Hendler
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 Recently, a "detox" tea made from comfrey, goldenseal, orange peel, mullein and spearmint has been used to help addicts kick their cocaine, heroin, and methadone habits. This certainly would be great if it worked. Without scientific testing we can't say one way or the other. Besides, one of the ingredients, comfrey, may be quite toxic.
High doses of goldenseal may cause nausea, vomiting, a decrease in the white blood count and feelings of pins and needles in the hands and feet. Goldenseal is interesting and needs more study. Some of goldenseal's derivatives may eventually prove quite useful. |
| Comfrey ointments may be useful in the treatment of wounds because of the high allantoin content. The topical (external) use of comfrey should be safe, since the alkaloids require the liver for conversion to toxic metabolites. However, because of the herb's toxicity, I would recommend not using it internally at all.
Cruciferous Vegetables
(Cancer Fighters)
Once again, your mother was right when she told you: "Eat your vegetables; they're good for you." Evidence is mounting that the cruciferous vegetables, in particular, are good for you, especially in terms of protecting against cancer. |
Ralph Golan, M.D.
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 However, because hepatotoxicity is so rare, and successful results so common, some physicians continue to prescribe comfrey for oral use (not during pregnancy or infancy, however), but only for short periods of time. Other practitioners (myself included) are more conservative. We avoid the oral use of comfrey altogether and substitute other allantoin- and mucilage-containing herbs (ALOE VERA, MARSHMALLOW ROOT, PLANTAIN, SLIPPERY ELM). |
James A. Duke, Ph.D.
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 Herbalist Jeanne Rose suggests combining vitamin E with a comfrey ointment and applying it to the labia before sex. Sounds good to me, though you may have to hunt around for a comfrey ointment.
Increase your vitamin C, too. In one study, 900 menopausal women were given 1,200 milligrams of vitamin C plus 1,200 milligrams of citrus flavonoids. Half of the women reported fewer hot flashes. I'd wager that they had less vaginal dryness as well. If you want to try vitamin C to relieve vaginal dryness, most naturopathic physicians recommend taking 300 milligrams a day. |
David Hoffman, FNIMH, AHG
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| However, it is important to note that in these cases, the connection with comfrey was not considered in the context of other contributing factors. For example, concomitant illness, the use of prescription or over-the-counter hepatotoxic drugs (like acetaminophen, for example), and impaired nutritional status clearly increase the likelihood that PA-containing herbs will cause hepatotoxicity.
With minimal epidemiological data, what insights can be garnered from the laboratory research into toxicity? |
Robert S. McCaleb, Evelyn Leigh, and Krista Morien
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 Some other herbs presenting potential safety concerns are listed here.
• comfrey (Symphytum officinale):
Contains liver toxins called pyrrolizidine alkaloids. The degree of risk is unclear, but we do not recommend using comfrey internally.
• Chaparral (Larrea tridentata): Reported by the FDA to have caused liver toxicity. However, a review by doctors funded by the American Herbal Products Association found insufficient evidence that chaparral caused the incidents. |
David Hoffman, FNIMH, AHG
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| Based on structure-toxicity studies, it can be concluded that the PAs in comfrey (such as symphytine, a retronecine monoester) are less toxic than those present in the plants Senecio, Crotolaria, and Heliotropium. These have actually caused human toxicity (for example, senecionine, a macrocyclic retronecine diester).12
Not all animals are susceptible to PA toxicity. As with most substances, responses to PAs among different animals vary greatly. Pigs, chickens, and rats are highly sensitive to poisoning by Senecio, whereas mice and sheep are resistant. |
Josef A. Brinckmann and Michael P. Lindenmaier
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| For the status of comfrey in Canada, the
Excerpt prom the German Commission E monograph
(BAnz no. 138, Published July 27, 1990) Uses
External: contusions, strains, sprains.
Contraindications
None known. Warning:
Apply only to intact skin. Consult a doctor before using during pregnancy.
Side effects
None known.
Interaction with other drugs
None known.
Dosage
Unless otherwise prescribed: ointments or other preparations for external use containing 5—20% of the dried root; corresponding preparations. |
Frantisek Stary
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 Common comfrey (1) is a tall herb, perceptibly roughly hairy to the touch, with a polycapitate, turnip-like root, sometimes called the 'blackroot', that is whitish inside and dark on the surface (2). It is gathered in spring before the flowering period or in the autumn after the flowers have faded. comfrey grows in damp grassy places from lowland to submontane elevations, reaching a height of one metre. The stem is hollow, winged, and much-branched. The rather large, relatively thin leaves are oval spears in outline, wrinkled, and roughly hairy. The flowering period is from May until September. |
Josef A. Brinckmann and Michael P. Lindenmaier
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| A normal cup of comfrey root tea may contain up to 8.5 mg alkaloids [30]. With external application, only a small amount is absorbed. Following application of an alcoholic extract on rats, corresponding to a dosage of 194 mg per kg body weight of an alkaloid/alkaloid N-oxide mixture, between 0.1-0.4% alkaloids were excreted in the urine, predomi-nandy as N-oxides. The oral application, within the same length of time, led to a 20-50 times higher excretion of N-oxides and free alkaloids in the urine [31]. |
Gary Null
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 Comfrey root contains mucilage—a slimy or gelatinous form of sugar which is soothing to digestive tract mucous membranes. comfrey also contains allantoin, a natural cell healer; it is one of the few plant sources of vitamin B12.
A tablespoon of dried leaves steeped in hot water for three to five minutes makes a gentle tea. Fresh leaves can be chopped and added to salad.
DANDELION is an unlikely healer to most of us who know it as a lawn pest, but in fact the entire dandelion plant is a valuable herbal source. |
Robyn Landis
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 According to FDA Consumer, the forty-seven-year-old woman who developed liver disease was consuming up to ten cups of comfrey tea a day and taking comfrey pills by the handful for more than a year in an attempt to cure her stomach pains, fatigue, and allergies.11 (No herbalist we know recommends taking any single herb in such exorbitant amounts, even short term, let alone for a year. You work up slowly, and ten cups of something plus handfuls is clearly excessive. Also, if a problem doesn't go away in due time, you don't keep taking it for a year and not address it. |
David Hoffman, FNIMH, AHG
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| A serious Digitalis poisoning due to accidental substitution of foxglove for comfrey was reported in Great Britain. The patient was an elderly man, and he needed intensive care treatment to recover.
Microorganisms and Microbial Toxins
Commercially produced herbs may be contaminated by pathogenic microorganisms, like Salmonella, or microbial toxins, such as bacterial endotoxins. Toxic substances may also be formed through microbial transformation of botanical constituents. |
Susun S. Weed
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 Nourishing herbal infusions that are renowned for helping prevent—perhaps even cure—cancer include comfrey leaf, stinging nettle leaf, violet leaf, burdock root, red clover blossoms/tops, and oatstraw. They also help prevent side effects from chemotherapy and radiation. Nourishing herbal infusions contain antioxidants, phytosterols, chlorophyll, carotenes, and acids. See Materia Medica for individual herbs. |
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