Chamomile
More actions
| Summary | |
|---|---|
| Binomial | Matricaria chamomilla L. (= M. recutita); Chamaemelum nobile (L.) All. |
| Family | Asteraceae |
| Common names | German chamomile, Roman chamomile, babunaj (Arabic), babuna (Hindi), Kamillen (German), maythen (Old English) |
| Native range | Europe and western Asia; naturalized worldwide |
| Cultivars / varieties | the German Matricaria is the principal medicinal species; Roman Chamaemelum is the perennial of British and southern European tradition, with a solid (not hollow) flower-head disc |
| Parts used | flower heads, harvested at full bloom and dried in shade |
| Cultivation | annual (Matricaria) or low-growing perennial (Chamaemelum); both widely cultivated for tea, cosmetic, and pharmaceutical use |
| Pharmacy | |
| Preparations | infusion 2-4 g flowers per cup; tincture 1-4 mL; standardized apigenin-1.2% extract 220-1100 mg/day; topical cream 3-10%; sitz bath, steam inhalation, eyewash |
| Pregnancy | generally safe in moderate culinary and tea use |
| Legal status | unscheduled; Commission E approved |
| Pharmacology | |
| Active constituents | volatile oil (α-bisabolol, chamazulene from matricin); apigenin (GABA-A); luteolin; coumarins; mucilage |
| Mechanism (summary) | apigenin agonism at the GABA-A benzodiazepine binding site (anxiolytic, mild hypnotic); chamazulene and α-bisabolol inhibition of COX-2, lipoxygenase, and NF-κB (anti-inflammatory); spiroether smooth-muscle antispasmodic |
Chamomile is the dried flower head of Matricaria chamomilla L. (German chamomile, the annual) and of Chamaemelum nobile (L.) All. (Roman chamomile, the perennial), used medicinally for several thousand years for digestive complaints, mild anxiety and insomnia, and topical inflammation of skin and mucous membrane. The genus name Matricaria is from the Latin matrix (womb), reflecting the medieval use of the plant in gynecological complaints; the common name chamomile is from the Greek chamaimēlon (ground-apple), for the apple-like scent of the crushed flower. The Egyptian physicians of the Eighteenth Dynasty dedicated the plant to the sun-god Ra and prescribed it for fever and the "shaking fits" that were the recognized description of malaria, and the cosmetic use to lighten hair has continued in some traditions from the era of Cleopatra to the present.
History and traditional use
The clinical use of chamomile is documented in the Ebers papyrus of approximately 1550 BCE for fevers and feminine complaints.[1] Pedanius Dioscorides, in book three of his De Materia Medica of about 60 CE, described its use for headache, kidney and liver complaints, and fevers; the Greek root of the plant's name (chamai-mēlon, ground-apple) reflects the apple-fragrance noted in his description.[2]
In Anglo-Saxon medicine the herb appeared as maythen in the Lacnunga manuscript of approximately 1000 CE, where it was named as one of the Nine Sacred Herbs in a charm against poison and disease.[3] The name has survived in modern English in the common name mayweed for the related Matricaria discoidea (pineappleweed). The medieval European tradition continued through the herbals of Hildegard von Bingen (twelfth century, using it for fever and digestive complaints) and Nicholas Culpeper (The English Physitian, 1652, recommending it for "the colick of the lower belly" and as a fomentation for inflammation). The Islamic and Unani tradition documented the plant as babunaj in Avicenna's Canon of Medicine (early eleventh century) for similar indications.
The German clinical tradition has been the most influential on modern Western herbal practice. The Commission E monographs of the 1980s and 1990s, the German regulatory framework that pharmacognosist Heinz Schilcher and his colleagues used to evaluate the evidence for traditional botanical medicines, approved chamomile internally for gastrointestinal spasm and inflammation, externally for skin and mucous-membrane inflammation, in mouthwash form for oral and pharyngeal inflammation, and by inhalation for upper-respiratory inflammation.[4] The proprietary preparation Kamillosan, formulated by Robugen in the late twentieth century from a high-bisabolol cultivar selected for its volatile-oil profile, has been the standard German clinical chamomile preparation for several decades.
The principal contemporary clinical indication of chamomile is the family of digestive complaints with a nervous component: colicky abdominal pain, infant colic, gastritis, peptic ulcer, irritable bowel syndrome, and the "nervous stomach" of anxiety-associated dyspepsia. Mild insomnia, particularly in children, and the homeopathic Chamomilla 6X preparation for the irritable, demanding teething child are well-established traditional uses. Topical preparations are used for eczema and other inflammatory skin conditions, for conjunctivitis (the cooled and strained infusion as eyewash), for mouth ulcers and sore throat (gargle), and (in the sitz-bath form) for hemorrhoidal and genital inflammation. The use as a steam-inhalation for sinus inflammation is the original German practice from which the formal Commission E inhalation indication derives. Ayurvedic adoption is recent (babuna) and TCM use is modern; the plant is not native to either tradition.
The contemporary controlled-trial evidence has substantially supported the anxiolytic and digestive indications. The 2009 Amsterdam trial of 220 mg apigenin-standardized chamomile extract three times daily for generalized anxiety disorder showed significant benefit over placebo at eight weeks;[5] the 2016 Mao follow-up trial confirmed sustained efficacy and the favorable safety profile,[6] and subsequent meta-analyses have supported the anxiolytic use in mild-to-moderate generalized anxiety.[7] Pediatric trials of chamomile-pectin combinations have shown reduced duration of acute diarrhea in children.[8] The 1987 Glowania trial of topical chamomile cream demonstrated accelerated wound healing in the tattoo-removal model.[9] The Sharifi trial in premenstrual syndrome found chamomile equivalent to mefenamic acid for emotional symptoms (the comparator being more effective for physical pain).[10] The molecular basis of the anxiolytic effect was established when apigenin was shown to bind the benzodiazepine site of the GABA-A receptor:[11] the chamomile tea before bedtime is, mechanistically, real pharmacology.
Botany and identification
Both species are members of the daisy family (Asteraceae). German chamomile is an annual to two feet (60 cm) with finely divided feathery leaves and daisy-like flower heads with white reflexed ray florets and a hollow conical yellow disc; the hollow disc is the diagnostic feature distinguishing it from Roman chamomile (whose disc is solid) and from wild chamomile and from the related mayweed (Matricaria discoidea). The plant is sweetly apple-fragrant when crushed (the source of both the Greek and German common names). Roman chamomile is a low-growing perennial of similar appearance but with a solid disc and a more strongly bitter (less sweetly aromatic) flavor; the cultivated double-flowered ornamental cultivar is the form most commonly sold in U.K. herb gardens. Distinct from feverfew (Tanacetum parthenium), which is sometimes confused visually but has bipinnate yellow-green leaves and a strong camphor scent.
Active constituents
The volatile oil (0.3 to 1.5 percent in German chamomile flowers) is the principal carrier of the medicine's pharmacology. Steam distillation of the matricin proazulene yields chamazulene, an ink-blue sesquiterpene that is anti-inflammatory and anti-allergic; the deep blue color of pharmaceutical-grade chamomile essential oil is the diagnostic visual sign of this compound. The other principal volatile-oil constituent is α-bisabolol and its oxides A and B (anti-inflammatory through inhibition of cyclooxygenase-2 and 5-lipoxygenase; antispasmodic on intestinal smooth muscle). Farnesene contributes to the aromatic profile; spiroether is the most potent antispasmodic constituent identified to date.
The flavonoid fraction is dominated by apigenin (the principal anxiolytic component; it binds the benzodiazepine site of the GABA-A receptor as a partial agonist), with luteolin, quercetin, and rutin as the principal additional flavonoids. Bitter glycosides (anthemic acid), coumarins (umbelliferone, the basis of the theoretical warfarin interaction), and mucilage round out the chemistry. Roman chamomile shares the basic chemistry but has substantially less proazulene and so a less blue and less anti-inflammatory essential oil.
Preparations
Multiple traditional preparation forms are in current use: the infusion (covered to retain the volatile oil) is the principal domestic and clinical form, made at 2 to 4 grams of dried flower heads per cup and drunk three to four times daily; the tincture (1:5 in 45 percent alcohol) at 1 to 4 mL three times daily; the standardized extract (apigenin 1.2 percent) at 220 to 1100 mg daily for the anxiolytic indication; the cream or ointment at 3 to 10 percent chamomile content for topical use; the sitz bath (a strong infusion added to a shallow seated bath) for hemorrhoidal and genital inflammation; the steam inhalation (a handful of flowers in a basin of hot water under a towel) for sinus and respiratory inflammation; and the eyewash (cooled and carefully strained infusion) for conjunctivitis. The essential oil is concentrated and is rarely used internally without practitioner supervision.
Pharmacokinetics
Apigenin and other flavonoids are absorbed after oral administration with substantial first-pass glucuronidation and sulfation. The volatile-oil components (chamazulene, bisabolol) reach the systemic circulation after oral or topical absorption but are present at relatively low concentrations in the bloodstream after typical clinical doses. The therapeutic effect of the standardized extract is consistent with a low-dose pharmacology rather than a saturable receptor-occupancy model.
Pharmacodynamics
Apigenin is a partial agonist at the benzodiazepine binding site of the GABA-A receptor, producing the anxiolytic and mild hypnotic effects of chamomile; in vitro experiments show binding affinity in the micromolar range with intrinsic activity below that of the classical benzodiazepines. Chamazulene and α-bisabolol inhibit cyclooxygenase-2, 5-lipoxygenase, and NF-κB-mediated transcription, providing the anti-inflammatory effect. Spiroether and α-bisabolol relax intestinal smooth muscle through mechanisms that include calcium channel modulation. The antimicrobial effect against Candida albicans and several Gram-positive bacteria is attributed to the volatile-oil fraction.
Experience
Log in to add your own experience.
Problems
Digestive complaints with nervous component including colicky abdominal pain, infant colic, gastritis, peptic ulcer, and irritable bowel syndrome. Mild generalized anxiety disorder and insomnia, particularly in children and the elderly. Topical inflammatory skin conditions including eczema, contact dermatitis, and minor wounds (vulnerary effect). Inflammatory mucous-membrane conditions including conjunctivitis, mouth ulcers, sore throat, and hemorrhoidal inflammation. Premenstrual syndrome (emotional and somatic symptoms). Adjunctive use in pediatric acute diarrhea.
Titration and dosing
Infusion 2 to 4 g dried flowers per cup, three to four times daily (covered to retain volatile oil). Tincture 1:5 in 45% alcohol, 1 to 4 mL three times daily. Apigenin-standardized extract (1.2% apigenin) 220 mg three times daily for anxiety; titrated to 220 to 1100 mg total daily dose. Topical cream 3 to 10% applied three times daily. Sitz bath: 50 g flowers infused in two liters of hot water, added to a shallow bath, for 15 minutes once or twice daily.
Effects
No effects listed yet, be the first to suggest one.
Interactions
Theoretical additive sedation with benzodiazepines, alcohol, and other central-nervous-system depressants is described but not consistently reproduced in controlled studies. Modest theoretical increase in warfarin effect through the coumarin content (umbelliferone) has been reported in occasional case reports but is not a routine clinical problem at culinary doses. The essential oil and high-dose extracts may inhibit CYP1A2 and CYP3A4 in vitro; the clinical relevance of these interactions at typical tea doses is small.
Pregnancy and lactation
Generally considered safe in moderate culinary and tea use. The classical mild emmenagogue and uterotonic action is dose-dependent; large therapeutic doses of the standardized extract have not been studied in pregnancy and are conventionally avoided. Topical and sitz-bath use is considered safe throughout pregnancy. The plant is widely used in postpartum care in many traditions for digestive and sleep complaints in both mother and infant.
Patient counseling
Patients should be counseled that the Asteraceae family includes ragweed, marigold, and chrysanthemum, and that allergic cross-reactivity is rare but possible; patients with established ragweed allergy should approach chamomile cautiously. The infusion should be covered while steeping to retain the volatile-oil components on which much of the medicine's effect depends. The chamomile essential oil is concentrated and should not be taken internally without practitioner supervision; topical use of properly diluted essential-oil preparations is conventional. For the conjunctivitis eyewash, the infusion should be freshly prepared and carefully strained on each use to limit contamination risk.
Relevant anecdote
No anecdotes yet, share a relevant one.
Relevant Literature
No literature entries yet.
Log in to submit relevant literature.
See also
Lavender, Lemon balm, Peppermint, Valerian, Passionflower, Feverfew, Calendula
References
- ↑ Bryan CP (translator). The Papyrus Ebers. London: Geoffrey Bles; 1930.
- ↑ Beck LY (translator). Pedanius Dioscorides of Anazarbus: De Materia Medica. Hildesheim: Olms-Weidmann; 2005 (translation of c. 60 CE original).
- ↑ Pollington S. Leechcraft: Early English Charms, Plant Lore, and Healing. Hockwold-cum-Wilton: Anglo-Saxon Books; 2000.
- ↑ Blumenthal M, Busse WR, Goldberg A, Gruenwald J, Hall T, Riggins CW, Rister RS (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, TX: American Botanical Council; 1998.
- ↑ Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. Journal of Clinical Psychopharmacology. 2009 Aug;29(4):378-382. PMID 19593179.
- ↑ Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: a randomized clinical trial. Phytomedicine. 2016 Dec 15;23(14):1735-1742. PMID 27912875.
- ↑ Hieu TH, Dibas M, Surya Dila KA, Sherif NA, Hashmi MU, Mahmoud M, et al. Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials. Phytotherapy Research. 2019 Jun;33(6):1604-1615. PMID 31006899.
- ↑ Becker B, Kuhn U, Hardewig-Budny B. Double-blind, randomized evaluation of clinical efficacy and tolerability of an apple pectin-chamomile extract in children with unspecific diarrhea. Arzneimittel-Forschung. 2006;56(6):387-393. PMID 16889120.
- ↑ Glowania HJ, Raulin C, Swoboda M. Effect of chamomile on wound healing: a clinical double-blind study. Zeitschrift für Hautkrankheiten. 1987 Sep 1;62(17):1262-1271. PMID 3318208.
- ↑ Sharifi F, Simbar M, Mojab F, Alavi Majd H. Comparison of the effects of Matricaria chamomila (chamomile) extract and mefenamic acid on the intensity of premenstrual syndrome. Complementary Therapies in Clinical Practice. 2014 Feb;20(1):81-88. PMID 24439651.
- ↑ Viola H, Wasowski C, Levi de Stein M, Wolfman C, Silveira R, Dajas F, Medina JH, Paladini AC. Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Medica. 1995 Jun;61(3):213-216. PMID 7617761.