Herbal Medicine: Expanded Commission E
Plantain
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Latin Name: Plantago lanceolata and P. major
Pharmacopeial Name: Plantaginis lanceolatae herba
Other Names: P. lanceolata: English plantain, lanceleaf plantain, narrowleaf plantain, ribwort plantain; P. major: common plantain, greater plantain, broadleaf plantain
Overview
Plantain is a perennial herb widely distributed throughout Europe and Asia (Wichtl and Bisset, 1994). In India, it is found growing in the Western Himalayas from Kashmir to Simla (Nadkarni, 1976). Of the 250 known species of Plantago worldwide, P. lanceolata and P. major are among those with the widest geographic ranges (Der Marderosian, 1999). The material of commerce is obtained mainly from cultivation in Bulgaria, Germany, Hungary, the Netherlands, Poland, the former Yugoslavia, and the former U.S.S.R. (Wichtl and Bisset, 1994). In Germany, ribwort plantain is one of the most important medicinal plants obtained from cultivation. It is cultivated on 'set-aside areas' in accordance with EEC Regulation 1765/92 in the state of Bayern (Lange and Schippmann, 1997). Plantain herb has been used in European medicine since ancient Roman and Greek times (Grieve, 1979; Nadkarni, 1976) documented through the centuries by various herbalists including Roman naturalist Pliny the Elder (ca. 2379 C.E.), fourteenth century English poet Geoffrey Chaucer, and seventeenth century English physician Nicholas Culpepper (Grieve, 1979). In Germany, plantain is official in the German Pharmacopeia, approved in the Commission E monographs, and the tea form is official in the German Standard License monograph for oral ingestion, rinses, and gargles as well as external use as a cataplasm (BAnz, 1998; Braun et al., 1997; DAB 10, 19911996; Wichtl and Bisset, 1994). It is used to suppress coughs associated with bronchitis, colds, and upper respiratory inflammation, and to reduce skin inflammation (Tyler, 1994). Plantain is employed as a component in numerous antitussive and expectorant medicines, such as the instant antitussive tea Bronchostad (Wichtl and Bisset, 1994). A few studies have been found in the literature. Human trials have investigated its use as a treatment for chronic bronchitis (Koichev et al., 1983; Koichev, 1983; Matev et al., 1982) and also its diuretic effects (Doan et al., 1992). German pharmacopeial grade plantain herb consists of the whole or cut, dried aerial parts of P. lanceolata L. It may contain no more than 5% dark-brown to blackish-brown fragments and no more than 2% other foreign matter. The pulverized dried herb must have a swelling index of not less than 6. Botanical identity must be confirmed by thin-layer chromatography (TLC), macroscopic and microscopic examinations, and organoleptic evaluation (DAB 10, 19911996). The Swiss pharmacopeia requires that it contain not less than 30% water-soluble extractive and not more than 10% discolored and brown leaves (Ph.Helv.VII, 1987; Wichtl and Bisset, 1994). Rare adulteration with Digitalis lanata is reported in the Swiss pharmacopeia though this is easily detected microscopically. Raw material adulterated with digitalis entered the supply channels in the United States undetected in the late 1990s, which resulted in significant adverse reactions.
Description
Plantain herb consists of the fresh or dried aboveground parts of Plantago lanceolata L. or P. major L. [Fam. Plantaginaceae], harvested at flowering season, and their preparations in effective dosage. Plantain contains mucilage, iridoid glycosides such as aucubin and catalpol, and tannin.
Chemistry and Pharmacology
Plantain herb contains 26.5% mucilage composed of polysaccharides; 6.5% tannins; iridoid glycosides, including 0.32.5% aucubin and 0.31.1% catalpol; over 1% silicic acid; phenolic carboxylic acids (protocatechuic acid); flavonoids (apigenin, luteolin); and minerals, including significant zinc and potassium (Hnsel et al., 19921994; Meyer-Buchtela, 1999; Wichtl and Bisset, 1994). The Commission E reported astringent and antibacterial activity. In vitro bacteriostatic and bactericidal activity have been shown for the cold aqueous extract and attributed to the aglycone, aucubigenin (Wichtl and Bisset, 1994). The bacteriostatic and bactericidal actions are, however, destroyed by heat, so the cold macerate form is used as a rinse, gargle, and/or cataplasm for antibacterial action (Meyer-Buchtela, 1999; Wichtl and Bisset, 1994). Experimental research using isolates of P. lanceolata has shown an inhibitory effect on mouse ear edema (Murai et al., 1995). In laboratory tests, plantain reduced plasma lipid, cholesterol, b-lipoprotein, and triglyceride concentrations in rabbits with atherosclerosis; it also increased isolated guinea pig and rabbit uterine smooth muscle tone (Maksyutina et al., 1978). The iridoid glycoside aucubin has stimulated laxative actions in mice, and has also demonstrated protective effects on liver cells (Inouye et al., 1974). The effectiveness of plantain's actions is due to its mucilage and iridoid glycoside content. Plantain contains mucilage, which produces demulcent and emollient actions. The iridoid glycosides, aucubin and catalpol, show antibacterial activity when isolated from fresh plants (Tyler, 1994; Newall et al., 1996).
Uses
The Commission E approved the internal use of plantain for catarrhs of the respiratory tract and inflammatory alterations of the oral and pharyngeal mucosa. It's external application is approved for inflammatory reactions of the skin. The German Standard License indications for use are identical to those in the Commission E monograph (Braun et al., 1997). Plantain tea is indicated for phlegm congestion (Schulz et al., 1998). Human studies have found positive results in the treatment of chronic bronchitis of a spastic or non-spastic nature with plantain (Koichev, 1983; Matev et al., 1982).
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: 3-6 g per day of cut herb and other galenical preparations for internal and external use. [Note: According to the Pharmacopeia of Austria, the average single dose is 1.5 g dried herb per cup of tea infusion (Meyer-Buchtela, 1999; ÖAB, 1991).]
Internal: Infusion: Steep 1.4 g of herb in 150 ml boiled water for 10 to 15 minutes, three to four times daily (Braun et al., 1997; Meyer-Buchtela, 1999). Fluidextract 1:1 (g/ml): 1.4 ml, three to four times daily; 2-4 ml, three times daily (BHP, 1983). Tincture 1:5 (g/ml): 7 ml, three to four times daily. External: Cold macerate: For use as a rinse, gargle or cataplasm: Soak 1.4 g cut herb in 150 ml cold water for 1 to 2 hours, stirring often (Braun et al., 1997; Meyer-Buchtela, 1999). Cataplasm: Prepare using the cold macerate and apply to affected area (Braun et al. 1997). Rinse or gargle: Soak 1.4 g cut herb in 150 ml cold water for 1 to 2 hours, stirring often, three to four times daily (Braun et al., 1997; Meyer-Buchtela, 1999).
References
BAnz. See Bundesanzeiger. Braun, R. et al. 1997. Standardzulassungen f r FertigarzneimittelText and Kommentar. Stuttgart: Deutscher Apotheker Verlag. British Herbal Pharmacopoeia (BHP).1983. Keighley, U.K.: British Herbal Medicine Association. Bundesanzeiger (BAnz). 1998. Monographien der Kommission E (Zulassungs- und Aufbereitungskommission am BGA f r den humanmed. Bereich, phytotherapeutische Therapierichtung und Stoffgruppe). Kln: Bundesgesundheitsamt (BGA). Der Marderosian, A. (ed.). 1999. The Review of Natural Products. St. Louis: Facts and Comparisons. Deutsches Arzneibuch, 10th ed. (DAB 10). 1991. (With subsequent supplements through 1996.) Stuttgart: Deutscher Apotheker Verlag. Doan, D.D. et al. 1992. Studies on the individual and combined diuretic effects of four Vietnamese traditional herbal remedies (Zea mays, Imperata cylindrica, Plantago major and Orthosiphon stamineus). J Ethnopharmacol 36(3):225231. Grieve, M. 1979. A Modern Herbal. New York: Dover Publications, Inc. Hnsel, R., K. Keller, H. Rimpler, G. Schneider (eds.). 19921994. Hagers Handbuch der Pharmazeutischen Praxis, 5th ed. Vol. 46. Berlin-Heidelberg: Springer Verlag. Inouye, H. et al. 1974. Purgative activities of iridoid glycosides. Planta Med 25:285288. Koichev, A. 1982. Study on the therapeutic effect of different doses from the preparation Plantago major in cold. Probl Vatr Med 10:117124. Koichev, A. et al. 1983. Pharmacologic-clinical study of a preparation from Plantago major. Probl Pneumos Ftiziatr 11:6874. Koichev, A. 1983. Complex evaluation of the therapeutic effect of a preparation from Plantago major in chronic bronchitis. Probl Vatr Med 11:6169. Lange, D. and U. Schippmann. 1997. Trade Survey of Medicinal Plants in GermanyA Contribution to International Plant Species Conservation. Bonn: Bundesamt f r Naturschutz. 2935. Maksyutina, N.P. et al. 1978. Chemical composition and hypocholesterolemia action of some drugs from Plantago major leaves. Part I. Polyphenolic compounds. Farm Zh (Kiev) 4. Matev, M., I. Angelova, A. Koichev, M. Leseva, G. Stefanov. 1982. [Clinical trial of Plantago major preparation in the treatment of chronic bronchitis] [In Bulgarian]. Vutr Boles 21(2):133137. Meyer-Buchtela, E. 1999. Tee-RezepturenEin Handbuch f r Apotheker und rzte. Stuttgart: Deutscher Apotheker Verlag. Murai, M., Y. Tamayama, S. Nishibe. 1995. Phenylethanoids in the herb of Plantago lanceolata and inhibitory effect of arachidonic acid-induced mouse ear edema. Planta Med 61(5):479480. Nadkarni, K.M. 1976. Indian Materia Medica. Bombay: Popular Prakashan. 986987. Newall, C.A., L.A. Anderson, J.D. Phillipson. 1996. Herbal Medicines: A Guide for Health-Care Professionals. London: The Pharmaceutical Press. sterreichisches Arzneibuch, 1st and 2nd suppl. ( AB). 1991. Wien: Verlag der sterreichischen Staatsdruckerei. Pharmacopoeia Helvetica, 7th ed. Vol. 14.(Ph.Helv.VII). 1987. Bern: Office Central Fdral des Imprims et du Matriel. Schulz, V., R. Hnsel, V.E. Tyler. 1998. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine. New York: Springer. Tyler, V.E. 1994. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York: Pharmaceutical Products Press. Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers.
Additional Resources
Baldo, B.A., Q.J. Chensee, M.E. Howden, P.J. Sharp. 1982. Allergens from plantain (Plantago lanceolata). Studies with pollen and plant extracts. Int Arch Allergy Appl Immunol 68(4):295304. Bruneton, J. 1995. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier Publishing. Chakarski, I. et al. 1982. Clinical study of a herb combination consisting of Agrimonia eupatoria, Hypericum perforatum, Plantago major, Mentha piperita, Matricaria chamomilla for the treatment of patients with gastroduodenitis. Probl Vatr Med 10:7884. Deutsches Arzneibuch, 10th ed. Vol. 16. (DAB 10). 1991. Kommentar. Stuttgart: Wissenschaftliche Verlagsgesellschaft. Granel, C. et al. 1993. Plantain allergy (Plantago lanceolata): assessment of diagnostic tests. Allergol Immunopathol (Madr) 21(4):158160. Razina, T.G. and E.P. Zueva. 1992. [The effect of a plantain preparation on the efficacy of the irradiation of experimental animals with tumors] [In Russian]. Radiobiologiia 32(2):266270. Wren, R.C. 1988. Potter's New Cyclopaedia of Botanical Drugs and Preparations. Essex: The C.W. Daniel Company Ltd. This material was adapted from The Complete German Commission E MonographsTherapeutic 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.
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