German chamomile is a low-growing, annual herbaceous plant native to southern and eastern Europe and northern and western Asia, now common in wastelands and neglected fields as well as cultivated ground throughout Europe, extending to northern Asia and India. It is particularly abundant in Hungary and Croatia and northern and eastern Africa; it is also naturalized in Australia and the United States (Bruneton, 1995;Felter and Lloyd, 1983; Foster, 1990; HPUS, 1992; Iwu, 1990; Leung and Foster, 1996;Wichtl and Bisset, 1994). The material of commerce, however, comes from cultivated plants from Argentina, Egypt, Bulgaria, and Hungary, and to a lesser extent from Spain, the Czech Republic, and Germany (BHP, 1996;Wichtl and Bisset, 1994). In Germany, chamomile is one of the most important medicinal plants obtained from cultivation. It is cultivated on 'set-aside areas' in accordance with EEC regulations (Lange and Schippmann, 1997). The material used in Indian Ayurvedic medicine grows in the Punjab and Upper Gangetic plains (Karnick, 1994; Nadkarni, 1976). The material used in African medicine grows in north Africa and cooler regions of south and eastern Africa (Iwu, 1990).
Chamomile has been described in medical writings since ancient times and was an important drug in ancient Egyptian, Greek, and Roman medicines. Its name is derived from the Greek chamos (ground) and melos (apple), referring to its low-growing habit and the apple scent of its fresh blooms. Descriptions of the plant are found in the writings of Hippocrates, Dioscorides, and Galen. Over the past 30 years, extensive scientific investigations have confirmed its traditional uses (Foster, 1990; Salaman, 1992). In the United States,chamomile was first cultivated by German settlers and was formerly official in the United States Pharmacopoeia and the National Formulary. During the nineteenth century it became an important drug prescribed by American Eclectic physicians, particularly in diseases of young children (Felter and Lloyd, 1983; Leung and Foster, 1996). Today, it is official in many national pharmacopeias, including those of Austria, Egypt, France, Germany, Hungary, Italy, the Netherlands, Switzerland, and Russia (Bradley, 1992; Newall et al., 1996).
In Germany, chamomile flower-is licensed as a standard medicinal tea (infusion) for oral ingestion, for topical application as a rinse or gargle, cream, or ointment, as a vapor inhalant, and as an additive for sitz baths or vapor baths. It is official in the German Pharmacopoeia and is an approved herb in the Commission E monographs. Aqueous infusions, hydroalcoholic dry extracts, fluidextracts, and tinctures, and the volatile oil are all used as monopreparations and as active components of more than 90 licensed prepared medicines (ABDA, 1982; BAnz, 1998; Bradley, 1992; Braun et al., 1997; DAB 10, 1991; Meyer-Buchtela, 1999; Schilcher, 1997; Wichtl and Bisset, 1994). In German pediatric medicine, chamomile preparations are the first choice in caring for the sensitive skin of infants and young children, especially for inflammatory skin conditions such as nappy rash and milk crust (Schilcher, 1997). In the United States, it is now one of the most widely used herbal tea ingredients. It is used singly or as a primary component in a wide range of dietary supplement and health food products for oral ingestion, and in skin care for topical application (Foster, 1990; Leung and Foster, 1996). German chamomile is also classified in the Homeopathic Pharmacopoeia of the United States as an OTC Class C drug prepared as a 1:10 (w/v) alcoholic tincture of the whole flowering plant, in 45% v/v alcohol (HPUS, 1992).
Modern human studies have investigated its anti-inflammatory, antipeptic, antiphlogistic, antispasmodic, antibacterial, and sedative actions (Bradley, 1992; Leung and Foster, 1996; Mann and Staba, 1986; Szabo-Szalontai and Verzar-Petri, 1977; Newall et al., 1996). One in vivo skin penetration study of chamomile flavones was carried out with nine healthy female volunteers. The study concluded that the flavonoids are not only absorbed at the skin surface, but penetrate into deeper skin layers, which is important for their topical use as antiphlogistic agents (Merfort et al., 1994).
In another controlled bilateral comparative study, the efficacy of a chamomile ointment (Kamillosan) vs. 0.25% hydrocortisone, 0.75% fluocortin butyl ester, and 5% bufexamac was studied as dermatologic agents in maintenance therapy of eczematous diseases. Over a period of three to four weeks, maintenance therapy was carried out on 161 patients suffering from inflammatory dermatoses on hands, forearms, and lower legs who had been initially treated with 0.2% difluorcortolone valerate. The chamomile preparation showed more or less equally effective therapeutic results as the hydrocortisone. It proved superior, however, to the non-steroidal anti-inflammatory agent 5% bufexamac as well as to the 0.75% fluocortin butyl ester. The authors concluded that for treatment of neurodermitis, chamomile ointment is therapeutically comparable to hydrocortisone and superior to the other tested products (Aertgeerts et al., 1985).
In a prospective, double-blind, randomized, multicenter, parallel group study, 79 children (6 months to 5.5 years of age) with acute, non-complicated diarrhea received either an apple pectin-chamomile extract preparation or placebo in addition to the usual rehydration and alimentation diet. After three days of treatment, the diarrhea had ended significantly more in the experimental group than in the placebo group. The pectin-chamomile preparation reduced the duration of diarrhea significantly (p <0.05) by at least 5.2 hours. The parents documented the well-being in a diary twice daily and, in contrast to placebo, a trend of continuous improvement was observed in the pectin-chamomile group (de la Motte et al., 1997).
In a clinical double-blind study the therapeutic efficacy of a chamomile extract on wound healing was investigated on 14 patients after receiving tattoos. Objective parameters were used to evaluate the epithelial and drying effect of the chamomile preparation topically applied to the weeping wound area after dermabrasion from tattoos. The authors reported the decrease of weeping wound area as well as the drying tendency to be statistically significant (Glowania et al., 1987).
Despite popular use of chamomile teas as mild sedatives and sleep aids in Germany and elsewhere, Commission E did not grant approval for such use due to the lack of published research in this area. However, a study indicated that apigenin, a water-soluble component of chamomile, binds at benzodiazepine receptor sites, thus providing a molecular basis for a possible weak central nervous system-depressing activity (Viola et al., 1995).
Pharmacopeial grade German chamomile must be composed of the dried flowerheads (capitulums) containing not less than 0.4% (v/w) blue volatile oil (Ph.Eur.3 method 2.8.12). Additionally, not more than 25% flower fragments, able to pass through a 710 sieve, are allowed. Botanical identity must be confirmed by thin-layer chromatography (TLC) as well as macroscopic and microscopic examinations(Bruneton, 1995; Ph.Eur.3, 1997; Ph.Fr.X, 1990; Wichtl and Bisset, 1994).Both the British Herbal Pharmacopoeia and ESCOP monographs require that the material comply with the European Pharmacopoeia (BHP, 1996; ESCOP, 1997; Schilcher, 1997).
Description
Chamomile, consisting of fresh or dried flowerheads of Matricaria recutita L. (syn. Chamomilla recutita (L.) Rauschert) [Fam. Asteraceae] and its preparations in effective dosage. The flowers contain at least 0.4% (v/w) essential oil. Main ingredients of the essential oil are x-bisabolol or bisabolol oxide A and B. The flowers also contain matricin and flavone derivatives such as apigenin and apigenin-7-glucoside.
Chemistry and Pharmacology
Chamomile contains flavonoids (up to 8%), including apigenin and luteolin, volatile oils (0.4-2.0%) composed of x-bisabolol (up to 50%) and chamazulene (1-15%), sesquiterpene lactones (matricin and matricarin), mucilage (10%) composed of polysaccharides, amino acids, fatty acids, phenolic acids, choline (up to 0.3%), and coumarins (0.1%) (Bradley, 1992; Bruneton, 1995; Leung and Foster, 1996; Newall et al., 1996; Wichtl and Bisset, 1994).
The Commission E reported antiphlogistic, musculotropic, antispasmodic, wound-healing promotional, deodorant, antibacterial, bacteriostatic, and skin metabolism stimulant activities.
Chamomile exhibited anti-inflammatory, antipeptic, and antispasmodic activities on the human stomach and duodenum. Oral administration of chamomile extract induced a deep sleep in 10 of 12 patients undergoing cardiac catheterization (Mann and Staba, 1986). Chamomile tea has a marked hypnotic effect (Reynolds, 1989). A hydroalcoholic extract of chamomile flower heads had spasmolytic action on guinea pig ileum (Bruneton, 1995; Newall et al., 1996). The flavones, especially apigenin, as well as a-bisabolol and other volatile oil constituents, are responsible for its spasmolytic actions (Bradley, 1992). In vitro, chamomile has demonstrated antistaphylococcal properties (Molochko et al., 1990).
Uses
The Commission E approved the internal use of chamomile for gastrointestinal spasms and inflammatory diseases of the gastrointestinal tract and approved its external use for skin and mucous membrane inflammations, as well as bacterial skin diseases, including those of the oral cavity and gums. It is also approved for inflammations and irritations of the respiratory tract (inhalations) and ano-genital inflammation (baths and irrigation). The British Herbal Compendium lists chamomile internally for spasms or inflammatory conditions of the gastrointestinal tract, peptic ulcer, and mild sleep disorders, and its external use for inflammations and irritations of skin and mucosa in any part of the body and for eczema (Bradley, 1992). The German Standard License for chamomile tea indicates its use for gastrointestinal complaints and irritation of the mucous membranes of the mouth and throat and of the upper respiratory tract (Wichtl and Bisset, 1994).
Contraindications
None known.
Side Effects
None known.
Use During Pregnancy and Lactation
No restrictions known.
Interactions with Other Drugs
None known.
Dosage and Administration
Unless otherwise prescribed: 3 g of whole flower head three to four times daily between meals.
Internal:
Infusion: 3 g in 150 ml water, three or four times daily for gastrointestinal complaints. Use the tea infusion as a wash or gargle for inflammation of the mucous membranes of the mouth and throat.
Fluidextract 1:1 (g/ml): 3 ml, three or four times daily.
Tincture 1:5 (g/ml): 15 ml, three or four times daily.
External:
Bath additive: 50 g per 10 liters (approximately 2 1/2 gallons) of hot water.
Inhalation: Inhale steam vapor of hot aqueous infusion for inflammation of the upper respiratory tract.
Poultice: Semi-solid paste or plaster containing 3-10% m/m of flower head.
Rinse: Hot aqueous rinse containing 3-10% infusion.
References
ABDA (ed.). 1982. Pharmazeutische Stoffliste, 4th ed., with supplements. Frankfurt am Main: Arzneibüro der ABDA.
Aertgeerts, P. et al. 1985. [Comparative testing of Kamillosan cream and steroidal (0.25% hydrocortisone, 0.75% fluocortin butyl ester) and non-steroidal (5% bufexamac) dermatologic agents in maintenance therapy of eczematous diseases] [In German]. Z Hautkr 60(3):270-277.
BAnz. See Bundesanzeiger.
Bradley, P.R. (ed.). 1992. British Herbal Compendium, Vol. 1. Bournemouth: British Herbal Medicine Association.
Braun, R. et al. 1997. Standardzulassungen für Fertigarzneimittel—Text and Kommentar. Stuttgart: Deutscher Apotheker Verlag.
British Herbal Pharmacopoeia (BHP). 1996. Exeter, U.K.: British Herbal Medicine Association. 131.
Bruneton, J. 1995. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier Publishing.
Bundesanzeiger (BAnz). 1998. Monographien der Kommission E (Zulassungs- und Aufbereitungskommission am BGA für den humanmed. Bereich, phytotherapeutische Therapierichtung und Stoffgruppe). Köln: Bundesgesundheitsamt (BGA).
de la Motte, S., S. Bose-O'Reilly, M. Heinisch, F. Harrison. 1997. Doppelblind-vergleich zwischen einem apfelpektin/kamillenextrakt-präparat und plazebo bei kindern mit diarrhoe [Double-blind comparison of an apple pectin-chamomile extract preparation with placebo in children with diarrhea]. Arzneimforsch 47(11):1247-1249.
Deutsches Arzneibuch, 10th ed. (DAB 10). 1991. (With subsequent supplements through 1996.) Stuttgart: Deutscher Apotheker Verlag.
ESCOP. 1997. 'Matricariae flos.' Monographs on the Medicinal Uses of Plant Drugs. Exeter, U.K.: European Scientific Cooperative on Phytotherapy.
Felter, H.W. and J.U. Lloyd. 1983. King's American Dispensatory, 18th ed., 3rd rev. Portland, OR: Eclectic Medical Publications [reprint of 1898 original]. 1246-1247.
Foster, S. 1990. Chamomile. Botanical Booklet Series, No. 307. Austin: American Botanical Council.
Glowania, H.J., C. Raulin, M. Swoboda. 1987. [Effect of chamomile on wound healinga clinical double-blind study] [In German]. Z Hautkr 62(17):1262, 1267-1271.
The Homeopathic Pharmacopoeia of the United States (HPUS). 1992. Arlington, VA: Pharmacopoeia Convention of the American Institute of Homeopathy.
Karnick, C.R. 1994. Pharmacopoeial Standards of Herbal Plants. Delhi: Sri Satguru Publications. 251-252.
Lange, D. and U. Schippmann. 1997. Trade Survey of Medicinal Plants in Germany—A Contribution to International Plant Species Conservation. Bonn: Bundesamt f r Naturschutz. 2935.
Leung, A.Y. and S. Foster. 1996. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2nd ed. New York: John Wiley & Sons, Inc.
Mann, C. and E.J. Staba. 1986. In: Craker, L.E. and J.E. Simon (eds.). Herbs, Spices, and Medicinal PlantsRecent Advances in Botany, Horticulture, and Pharmacology. Phoenix: Oryx Press. 235280.
Merfort, I., J. Heilmann, U. Hagedorn-Leweke, B.C. Lippold. 1994. In vivo skin penetration studies of camomile flavones. Pharmazie 49(7):509511.
Meyer-Buchtela, E. 1999. Tee-Rezepturen—Ein Handbuch für Apotheker und Ärzte. Stuttgart: Deutscher Apotheker Verlag.
Molochko, V.A., T.M. Lastochkina, I.A. Krylov, K.A. Brangulis. 1990. [The antistaphylococcal properties of plant extracts in relation to their prospective use as therapeutic and prophylactic formulations for the skin] [In Russian]. Vestn Dermatol Venerol (8):54-56.
Nadkarni, K.M. 1976. Indian Materia Medica. Bombay: Popular Prakashan. 772-773.
Newall, C.A., L.A. Anderson, J.D. Phillipson. 1996. Herbal Medicines: A Guide for Health-Care Professionals. London: The Pharmaceutical Press.
Reynolds, J.E.F. (ed.). 1989. Martindale: The Extra Pharmacopoeia, 29th ed. London: The Pharmaceutical Press.
Salaman, I. 1992. Chamomile: A Medicinal Plant. Herb Spice Med Plant Digest 10(1):14.
Schilcher, H. 1997. Phytotherapy in Paediatrics: Handbook for Physicians and Pharmacists. Stuttgart: Medpharm Scientific Publishers. 19-26, 123-124, 157-158.
Szabo-Szalontai, M. and G. Verzar-Petri. 1977. The antibacterial effect of chamomile oil and its isolated compounds. May Parfumerie und Kosmetik.
Viola, H. et al. 1995. Apigenin, a component of Matricaria recutita flowers, is a central benzodiazepine receptors-ligand with anxiolytic effects. Planta Med 61(3):213-216.
Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers.
Additional Resources
Achterrath-Tuckermann, U., R. Kunde, E. Flaskamp, O. Isaac, K. Thiemer. 1980. [Pharmacological investigations with compounds of chamomile. V. Investigations on the spasmolytic effect of compounds of chamomile and Kamillosan on the isolated guinea pig ileum] [In German]. Planta Med 39(1):38-50.
Carle, R. and O. Isaac. 1987. Die Kamille—Wirkung und Wirksamkeit. Ein Kommentar zur Monographie Matricariae flos (Kamillenblüten). Z Phytotherapie 8:67-77.
Della Loggia, R. 1985. Lokale antiphlogistische Wirkung der Kamillen-Flavone. Dtsch Apoth Ztg 125:911(43, suppl. 1).
Grieve, M. 1967. A Modern Herbal, Vol. 2. New York; London: Hafner Publishing Co.
Isaac, O. 1980. Therapy with chamomile experiences and verifications. Dtsh Apoth Ztg 120:567-570.
List, P.H. and L. Hörhammer (eds.). 1973-1979. Hagers Handbuch der Pharmazeutischen Praxis, Vols. 17. New York: Springer Verlag.
McGuffin, M., C. Hobbs, R. Upton, A. Goldberg. 1997. American Herbal Product Association's Botanical Safety Handbook. Boca Raton: CRC Press.
Stuppner, H., M. Huber, R. Bauer. 1993. Zur Analytik des ätherischen Öles in Kamillenpräparaten - Headspace-Gaschromatographie. Pharm Ztg Wiss 138(26):46-49.
This material was adapted from The Complete German Commission E Monographs—Therapeutic Guide to Herbal Medicines. M. Blumenthal, W.R. Busse, A. Goldberg, J. Gruenwald, T. Hall, C.W. Riggins, R.S. Rister (eds.) S. Klein and R.S. Rister (trans.). 1998. Austin: American Botanical Council; Boston: Integrative Medicine Communications.
1) The Overview section is new information.
2) Description, Chemistry and Pharmacology, Uses, Contraindications, Side Effects, Interactions with Other Drugs, and Dosage sections have been drawn from the original work. Additional information has been added in some or all of these sections, as noted with references.
3) The dosage for equivalent preparations (tea infusion, fluidextract, and tincture) have been provided based on the following example:
Unless otherwise prescribed: 2 g per day of [powdered, crushed, cut or whole] [plant part]
Infusion: 2 g in 150 ml of water
Fluidextract 1:1 (g/ml): 2 ml
Tincture 1:5 (g/ml): 10 ml
4) The References and Additional Resources sections are new sections. Additional Resources are not cited in the monograph but are included for research purposes.
This monograph, published by the Commission E in 1994, was modified based on new scientific research. It contains more extensive pharmacological and therapeutic information taken directly from the Commission E.
Excerpt from Herbal Medicine: Expanded Commission E Monographs Copyright 2000 American Botanical Council Published by Integrative Medicine Communications Available from the American Botanical Council.