Herbal Medicine: Expanded Commission E
Stinging Nettle herb and leaf
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Latin Name: Urtica dioica
Pharmacopeial Name: Urticae herba, stinging nettle herb; Urticae folium, stinging nettle leaf
Other Names: common nettle or great stinging nettle (U. dioica);dwarf nettle or small stinging nettle (U. urens)
Overview
Stinging nettle is a perennial herb, found growing wild throughout the temperate zones of both hemispheres worldwide (Bombardelli and Morazzoni, 1997; Leung and Foster, 1996).The material of commerce comes mostly from wild plants collected in Albania, Bulgaria, Hungary, Germany, the former U.S.S.R., and the former Yugoslavia, though it is also cultivated somewhat (Bombardelli and Morazzoni, 1997; Wichtl and Bisset, 1994). The genus name Urtica comes from the Latin verb urere, meaning "to burn," because of its urticate (stinging) hairs. The species name dioica means "two houses" because the plant usually has either male or female flowers (Bombardelli and Morazzoni, 1997). Herb and Leaf: Stinging nettle herb has been used since ancient times. Greek physicians Dioscorides (first century C.E.) and Galen (ca. 130–200 C.E.) reported nettle leaf had diuretic and laxative action and was useful for asthma, pleurisy, and for the treatment of spleen-related illness. Roman naturalist Pliny the Elder (ca. 23–79 C.E.) reported hemostatic properties (Bombardelli and Morazzoni, 1997). In traditional African medicine the herb is used as a snuff powder for nosebleeds, excessive menstruation, and to treat internal bleeding. It is applied on burns (List and Hörhammer, 1979). In India, the Ayurvedic Pharmacopoeia lists stinging nettle herb for uterine hemorrhage, cutaneous eruptions, infantile and psychogenic eczema, and nosebleed, at dosage 2–4 g herb or 3–4 ml fluidextract, always in combination with other herbs (Karnick, 1994). It is also taken in syrup or tincture form to treat urticaria (nettle rash) (Nadkarni, 1976). Stinging nettle is also widely used in North American aboriginal medicines. People of the Hesquiat, Sanpoil, Shuswap, and Tainarna nations use it as an antirheumatic drug (Moerman, 1998; Palmer, 1975; Smith, 1973; Turner and Efrat, 1982; Ray, 1933). It is also used as a gynecological aid by women of the Cowlitz, Cree, Kwakiutl, Lummi, Quinault, and Squaxin nations. It is taken as an aqueous infusion during childbirth to relax the muscles. The plant juice is taken by pregnant women who are overdue and the tips of the plant are chewed by women during labor (Gunther, 1973; Leighton, 1985; Moerman, 1998; Turner and Bell, 1973; Turner and Efrat, 1982). In Germany, stinging nettle herb is licensed as a standard medicinal tea for diuretic action. It is also used as a component of prepared medicines intended for supportive treatment of rheumatic ailments and irrigation therapy in inflammatory conditions of the lower urinary tract (Wichtl and Bisset, 1994). Stinging nettle herb is used in German homeopathy in treatments for urticaria, herpes, eczema, hypersensitive reactions in the skin and joints, and burns (List and Hörhammer, 1979). In the United States, stinging nettle herb is used as a component in a wide range of dietary supplements. It is also used during and following birth and during lactation in traditional women's tonic formulas. It is prescribed by naturopathic physicians and licensed acupuncturists as a component in formulas used to treat hayfever and other allergies. Modern clinical studies have investigated the use of stinging nettle herb to treat allergic rhinitis (Mittman, 1990), rheumatic complaints (Ramm and Hansen, 1995), acute arthritis (Chrubasik et al., 1997), and as a diuretic (Kirchhoff, 1983). In a double-blind randomized study, 98 individuals with allergic rhinitis compared the effects of a freeze-dried stinging nettle herb powder (Eclectic Institute, U.S.A.) with placebo. Sixty-nine individuals completed the study. Assessment was based on daily symptom diaries and global response recorded at the follow-up visit after one week of therapy. The extract was rated higher than placebo in the global assessments. In the diary data, however, stinging nettle extract was rated only slightly better. The study reported that the extract produced positive, though limited results in the treatment of allergic rhinitis (Mittman, 1990). In a multicenter study, 152 patients with degenerative, rheumatic diseases were given 1.54 g nettle herb dry extract (6.4–8.0:1) daily. Subjective improvement of symptoms was observed in 70% of the patients after three weeks (Ramm and Hansen, 1995). In another open randomized study, 40 patients with acute arthritis compared the effects of stewed stinging nettle herb combined with a sub-therapeutic dose of the anti-inflammatory drug Diclofenac against a standard dose of Diclofenac. Half of the patients took 50 g nettle and 50 mg Diclofenac and the other half took 200 mg Diclofenac. Thirty-seven patients completed the study. Assessment was based on the decrease in the elevated acute phase protein CRP (a protein elevated by inflammatory events and other pathological processes) and the clinical signs of acute arthritis: physical impairment, subjective pain, and pressure pain (patient assessment) and stiffness (physician assessment). All assessments were done on a verbal rating scale from 0 to 4. In both groups median scores improved by about 70% relative to the initial value. Only minor adverse effects occurred during treatment. The authors concluded that stinging nettle herb may enhance the NSAID antirheumatic effectiveness and that further investigations are needed in order to determine whether acute attacks of arthritis may respond to stewed stinging nettle herb on its own (Chrubasik et al, 1997). In an open 14-day clinical study, 32 patients diagnosed with myocardial or chronic venous insufficiency were treated with 15 ml of nettle herb juice three times daily. A significant increase in the daily volume of urine was observed throughout the treatment, the volume in day two being 9.2% higher (p<0.0005) than the baseline amount in patients with myocardial insufficiency and 23.9% higher (p<0.05) in those with chronic venous insufficiency. Minor decreases in body weights (approximately 1%) and systolic blood pressure were also observed. Serum parameters were unaffected and the treatment was well tolerated apart from a tendency towards diarrhea. The treatment produced a distinct diuretic effect (Kirchhoff, 1983). Pharmacopeial grade stinging nettle herb (leaf, flower, and stem) must be collected during the flowering period and contain not less than 18% water-soluble extractives, not more than 2% stem above 3 mm in diameter, and other quantitative standards. Botanical identity must be confirmed by thin-layer chromatography (TLC) as well as macrocopic and microscopic authentication (BHP, 1996). The German Pharmacopoeia and German Pharmaceutical Codex require similar standards though they do not have a water-soluble extractive requirement and the Codex requires not more than 10% stem fragments (DAB 10, 1994; DAC, 1986; Wichtl and Bisset, 1994). The ESCOP monograph requires that the material comply with the standards of the German Pharmacopoeia or the Swiss Pharmacopoeia (ESCOP, 1997). Root: Stinging nettle root is used in Germany as a component of approved medicines for treatment of benign prostatic hyperplasia (BPH). In the United States, it is used similarly though as a dietary supplement its indications for use are limited to non-therapeutic "structure and function" claims. Naturopathic physicians prescribe it for BPH. Modern clinical studies have investigated the use of nettle root in the treatment of BPH (Belaiche and Lievoux, 1991; Bombardelli and Morazzoni, 1997; ESCOP, 1997; Krzeski et al., 1993; Leung and Foster, 1996; Schneider et al., 1995; Skeland and Albrecht, 1997; Vontobel et al., 1985). In a randomized, reference-controlled, multicenter, double-blind clinical trial 543 patients with Aiken's stage I to II BPH compared therapeutic equivalence between finasteride (Proscar®, Merck), and a combination nettle root-saw palmetto fruit extract (PRO® 160/120, Prostagutt® forte). For 48 weeks, patients were given 2 capsules of PRO® 160/120 or 1 capsule of finasteride per day. The primary variable was the change of the maximum urinary flow after 24 weeks of therapy. Urodynamic parameters such as average urinary flow, micturition volume, and micturition time were monitored as secondary variables. An increase in urinary flow rate was observed in both treatment groups (1.9 ml/s with PRO160/120; 2.4 ml/s with finasteride). The average urinary flow increased, whereas the micturition time decreased in both groups to a similar extent. The International Prostate Symptom Score (IPSS) decreased from 11.3 to 8.2 after 24 weeks and to 6.5 at week 48 for the PRO160/120 group, and from 11.8 to 8.0 and to 6.2 at week 48 for the finasteride group. Fewer adverse reactions were reported for the nettle-saw palmetto treatment group, such as diminished ejaculation volume, erectile dysfunction, and headache (Skeland and Albrecht, 1997). An open, prospective, multicenter observational study involving 419 specialist urological practices tested the efficacy and tolerability of a combination preparation made of stinging nettle root extract (WS 1031; Schwabe, Germany) and saw palmetto fruit (Serenoa repens) extract (WS 1473; Prostagutt®, Schwabe, Germany) with 2,080 patients suffering from BPH, stage I to II according to Aiken. A before-and-after comparison revealed an improvement in the pathological findings and in the obstructive and irritative symptoms. Efficacy and tolerability of the preparation were assessed by the physicians as generally "good" or "very good." Most patients in the study reported an improvement in their prostatic symptoms and general quality of life (Schneider et al., 1995). In a double-blind study, 134 patients between the ages of 53 and 84 with symptoms of BPH were drawn from two medical centers in Warsaw. The patients were randomly assigned to receive 2 capsules of the standard dose of a stinging nettle root-pygeum bark (Prunus africanum) preparation (300 mg nettle with 25 mg pygeum) or 2 capsules containing half the standard dose, twice daily for eight weeks. After 28 days of treatment, urine flow, residual urine, and nocturia were significantly reduced in both treatment groups. After 56 days, further significant decreases were found in residual urine in the half-dose group, and in nocturia in both groups. Five patients reported adverse effects from the treatment, though treatment was not discontinued due to side effects. The authors concluded that half-doses of the nettle-pygeum combination extract are as safe and effective as the recommended full dose (Krzeski et al., 1993). In a placebo controlled, double-blind study the effect on symptomatology and objective findings of stinging nettle root extract vs. placebo were investigated in 50 patients with prostatic hyperplasia. Twenty-five BPH I-II patients were given 300 mg stinging nettle root dry extract (5:1) twice daily for nine weeks, and 25 received placebo. Average age was 67 years. A significant (p<0.05) improvement of micturition volume (44% increase) and maximum urinary flow was observed, and a highly significant (p=0.0005) decrease in serum levels of sex hormone binding globulin (SHBH) (Vontobel et al., 1985). In another study, 67 men over 60 years of age with prostatic adenoma evaluated the effects of a stinging nettle root alcoholic tincture (1:5, 40% ethanol) with a daily dose of 5 ml. After six months of treatment, symptoms of nocturia were alleviated (nocturnal micturition frequency), especially in less severe cases (Belaiche and Lievoux, 1991). Pharmacopeial grade stinging nettle root must pass botanical identity tests as determined by TLC as well as macroscopic and microscopic authentication. Quantitative standards include not less than 15% water-soluble extractive (BHP, 1996; DAB, 1997; Wichtl and Bisset, 1994). The ESCOP monograph requires that the material comply with the standards of the German Pharmacopoeia (ESCOP, 1997). The approved modern therapeutic applications for stinging nettle herb, leaf and root are supportable based on their history of clinical use in well established systems of traditional medicine, on well documented phytochemical investigations,on pharmacological studies in animals,and on human clinical studies.
Description
Stinging nettle herb consists of fresh or dried aboveground parts of Urtica dioica L., U. urens L. [Fam. Urticaceae], and hybrids of these species, collected during flowering season, and their preparations in effective dosage. Stinging nettle leaf consists of fresh or dried leaves of U. dioica L., U. urens L. and/or hybrids of these species, gathered during flowering season, and their preparations in effective dosage. Stinging nettle leaf and herb contain mineral salts, mainly calcium and potassium salts, and silicic acid. The preparation must conform to the currently valid pharmacopeia.
Chemistry and Pharmacology
Stinging nettle herb and leaf contain up to 20% mineral salts, mainly calcium, potassium, silicon (0.9–1.8%), and nitrates; 1.0–2.7% chlorophylls a and b; the amines acetylcholine, betaine, choline, histamine, 5-hydroxytryptamine (serotonin) (0.02%), lecithin; choline acetyltransferase; caffeoylmalic acid (up to 1.6%), caffeic and chlorogenic acids; the flavonoids quercetin, isoquercitrin, rutin, kaempferol, and isorhamnetin; acetic, butyric, citric, formic, and fumaric organic acids; carotenoids (b-carotene, lycopene); leukotreines; sterols (b-sitosterol); tannins; volatile oil (38.5% ketones, 14.7% esters, 2% free alcohols); vitamins A, B2, C, K1, folic acid, and pantothenic acid (Bradley, 1992; Bruneton, 1995; ESCOP, 1997; Leung and Foster, 1996; List and Hörhammer, 1979; Newall et al., 1996; Wichtl and Bisset, 1994). The Commission E did not report pharmacological actions. The British Herbal Compendium reported mild diuretic and hemostatic activities. Its flavonoids and high potassium content may contribute to the diuretic action (Bradley, 1992). In a multicenter study, 70% of 152 patients suffering from various rheumatic, mainly degenerative, diseases experienced subjective improvement after ingesting a nettle herb dry extract for three weeks at 1.54 g daily (Ramm and Hansen, 1995). In a clinical study with patients suffering from myocardial or chronic venous insufficiency, diuretic action was reported after ingesting nettle juice (Kirchhoff, 1983).
Uses
The Commission E approved the internal use of nettle herb and leaf as irrigation therapy for inflammatory diseases of the lower urinary tract and prevention and treatment of kidney gravel. Internal and external application: as supportive therapy for rheumatic ailments. The German Standard License for nettle herb tea indicates its use to increase the amount of urine and to treat complaints associated with urination (Bradley, 1992; Wichtl and Bisset, 1994). In France, uses are permitted for oral and topical administration: traditionally used to treat moderate acne, and traditionally used for the symptomatic treatment of pain in the joints (Bruneton, 1995). Externally the juice of the fresh herb is used as a gargle and as a cataplasm on wounds, ulcers, and hemorrhoids (List and Hrhammer, 1979). ESCOP indicates its use as an adjuvant treatment of rheumatic conditions and as irrigation therapy in inflammatory conditions of the lower urinary tract (ESCOP, 1997).
Contraindications
None known. Note:No irrigation therapy if edema exists due to impaired heart or kidney function.
Side Effects
None known.
Use During Pregnancy and Lactation
No restrictions known (McGuffin et al., 1997).
Interactions with Other Drugs
None known.
Dosage and Administration
Unless otherwise prescribed: 8–12 g per day of cut herb for teas and other galenical preparations for internal use, as stinging nettle spirit for external application. Note: In irrigation therapy, intake of copious amounts of fluids must be taken.
Internal: Dried herb: 2–5 g, three times daily. Infusion: Steep 2–5 g in 150 ml boiled water for 10 to 15 minutes, three times daily. Decoction: 2–5 g in 150 ml cold water, then boil for 10 to 15 minutes, three times daily. Juice (Succus Urticae herba): 5–10 ml, three times daily. Fluidextract 1:1 (g/ml): 2–5 ml, three times daily. Native dry extract 6.4–8.1:1 (w/w): 0.3–0.7 g, three times daily. Normalized dry extract 3.5–4.5:1 (w/w): 0.5–1.25 g, three times daily. External: Spirit or essence (Spiritus Urticae herba, 50% alcohol by volume): Alcoholic solution of distilled nettle, applied locally with a cloth. Cataplasm: Semi-solid paste containing spirit of nettle herb for a moist-heat direct application to the skin used like a poultice.
References
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Additional Resources
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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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