Herbal Medicine: Expanded Commission E
Uva Ursi leaf
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Latin Name: Arctostaphylos uva ursi
Pharmacopeial Name: Uvae ursi folium
Other Names: Arctostaphylos, bearberry, and beargrape
Overview
Uva ursi is an evergreen perennial shrub, native to temperate regions of the northern hemisphere, growing wild in the northern latitudes of North America, Europe, and Asia (Leung and Foster,1996; USD XI, 1858; Wichtl and Bisset, 1994).In North America its range extends from the Arctic Circle as far southward as New Jersey, Wisconsin, and Northern California. Its northerly range includes Iceland, Greenland, and Ireland (Grieve, 1979; Millspaugh, 1974; USD XI, 1858). The material of commerce comes entirely from wild plants collectedthroughout Europe, mainly Spain, Italy, the Balkans, and the former USSR (BHP, 1996; Leung and Foster, 1996; Wichtl and Bisset, 1994).Uva ursi leaf has been put under protected status in Germany. This species is listed in Annex 1 of the German Federal Ordinance on the Conservation of Species (BArtSchV) and a permit is necessary for both import and export of any wild collected material, excluding populations in Spain and in Scandinavian countries (Lange and Schippmann, 1997). Uva ursi is an ancient astringent, though little used in European medicine until reported by Welsh physicians of Myddfai in the thirteenth century. In 1601, Clusius reported its earlier use by Galen (ca. 130200 C.E.) as a hemostatic (Grieve, 1979; Millspaugh, 1974). In modern western medical practice, its use seems to begin with Spanish and Italian physicians (ca. 17301740 C.E.) for calculus complaints. Its more general adoption dates from the writings of De Haen in 1756, Gerhard of Berlin in 1763, and Murray in 1764 as a remedy in nephritic disorders (Grieve, 1979; Stille, 1874; Millspaugh, 1974). It also became official in the London Pharmacopoeia in 1763 (Millspaugh, 1974). In American Eclectic medicine its use was specific for relaxation of the urinary tract, with pain and mucous or bloody secretions (Felter and Lloyd, 1985). Uva ursi leaf, dry extract, and fluidextract were official in the United States Pharmacopoeia and National Formulary from 1820 to 1950. Today, uva ursi is official in the pharmacopeias of Austria, the Czech Republic, Egypt, France, Germany, Hungary, Japan, Russia, and Switzerland. Its use in North American aboriginal medicine probably predates its acceptance into European medicine.Native Americans used uva ursi as a drug to treat inflammations of the urinary tract, especially cystitis. The dried leaf mixed with tobacco, known as sagack-homi in Canada and kinnikinnick among Western tribes, was also smoked ritually (Hutchens, 1991; Millspaugh, 1974). People of theCherokee Nation used uva ursi to treat uterine dropsy and urinary diseases(Hamel and Chiltoskey, 1975). The Cheyenne used it as a diuretic for congested kidneys (Grinnell, 1972). The Okanagan and Thompson tribes decocted the leaves and stems for use as a urinary aid and tonic for kidneys and bladder (Moerman, 1998; Perry, 1952; Steedman, 1928). In Germany,uva ursi leaf is licensed as a standard medicinal tea, used as a single herb and a component of many bladder and kidney teas. In dry and fluidextract form it is used for urinary tract infections (Bradley, 1992; Braun, 1997; Wichtl and Bisset, 1994). In the United States,uva ursi leaf is used as a urinary antiseptic and diuretic in a wide range of dietary supplement products. Clinical studies on its urinary disinfectant effects have been conducted in Germany (Frohne, 1970; Newall et al., 1996). The approved modern therapeutic applications for uva ursi leaf are supportable based on its history of use in well established systems of traditional and conventional medicines,on well documented phytochemical investigations of its hydroquinone derivatives, on pharmacodynamic and pharmacokinetic studies in human urine, on pharmacological studies in animals, and on limited clinical studies. German pharmacopeial gradeuva ursi leaf must contain not less than 6% hydroquinone derivatives, calculated as anhydrous arbutin, and not more than 5% stem fragments, among other quantitative standards. Identity must be verified by thin-layer chromatography (TLC) (DAB method V.6.20.2) and macroscopic and microscopic examinations (DAB 10, 1994; Wichtl and Bisset, 1994). French pharmacopeial gradeuva ursi leaf must contain not less than 7% glycosides, calculated as arbutin. Absence of known adulterants (Buxus sempervirens, Vaccinium uliginosum, V. vitis-idaea) must be verified by macroscopic and microscopic examination (Bruneton, 1995; Ph.Fr.X, 1990). The Austrian Pharmacopoeia requires not less than 5% glycoside derivatives, calculated as arbutin ( AB, 1981; Wichtl and Bisset, 1994), The Japanese Pharmacopoeia requires not less than 7.0% arbutin (JP XII, 1993),and the Swiss Pharmacopoeia requires not less than 8% (Ph.Helv.VII, 1987; Wichtl and Bisset, 1994).
Description
Uva ursi (bearberry) leaves, consisting of the dried leaves of Arctostaphylos uva ursi (L.) Sprengel [Fam. Ericaceae] and its pharmaceutical preparations.
Chemistry and Pharmacology
Uva ursi contains 618% (usually 79%) hydroquinone derivatives, mostly arbutin (hydroquinone mono-b-D-glucoside) with small amounts of the glycosides methylarbutin (up to 4%) and piceoside (P-hydroxyacetophenone glucoside), and the free aglycones hydroquinone and methylhydroquinone; 620% polyphenolic tannins, mainly gallotannins, ellagic tannins, catechin, and anthocyanidin derivatives; phenolic acids (approximately 0.25%) in free form, mainly gallic, P-coumaric, and syringic acids; flavonoids (approximately 1.3% hyperoside), mainly the flavonols quercetin, kaempferol, and myricetin and their glycosides, isoquercitrin, quercitrin, hyperin, and myricitrin; 0.40.8% triterpenes, mostly ursolic acid and uvaol; monotropein (an iridoid glucoside); resin (ursone); trace of volatile oil; and wax (Bradley, 1992; Bruneton, 1995; Budavari, 1996; ESCOP, 1997; Leung and Foster, 1996; Newall et al., 1996; Wichtl and Bisset, 1994). The Commission E reported that preparations made from uva ursi act antibacterially in vitro against Proteus vulgaris, E. coli, Ureaplasma urealyticum, Mycoplasma hominis, Staphylococcus aureus, Pseudomonas aeruginosa, Friedlnder's pneumonia, Enterococcus faecalis, Streptococcus strains, and Candida albicans. The antimicrobial effect is associated with the aglycone hydroquinone released from arbutin (transport form) or arbutin waste products in the alkaline urine. A methanol extract of the preparation (50%) is said to have an inhibiting effect on tyrosinase activity. The forming of melanin from DOPA using tyrosinase as well as from DOPA-CHROM through auto-oxidation is also said to be inhibited by the preparation. There are indications that after uva ursi tea (3 g/150 ml) has been taken, hydroquinone glucuronides occur predominately alongside low levels of hydroquinone. The British Herbal Compendium reported its actions as urinary antiseptic and astringent (Bradley, 1992). The Merck Index reported its therapeutic category as urinary antiseptic. It also reports the therapeutic category of isolated arbutin as urinary anti-infective (Budavari, 1996).
Uses
The Commission E approved the use of uva ursi for inflammatory disorders of the efferent urinary tract. The British Herbal Compendium lists its use for mild infections of the urinary tract (Bradley, 1992). The French marketing authorization for phytomedicines allows its use to promote the renal elimination of water and as an adjuvant to diuresis treatments in benign urinary tract infections (Bradley, 1992; DPM, 1992). The German Standard License for uva ursi medicinal tea indicates its use as support in the therapy of catarrhs of the bladder and kidney (Bradley, 1992; Braun, 1991; Wichtl and Bisset, 1994). ESCOP lists uva ursi for uncomplicated infections of the lower urinary tract, such as cystitis (ESCOP, 1997).
Contraindications
Pregnancy, lactation, children under 12.
Side Effects
Nausea and vomiting may occur in persons with sensitive stomachs.
Use During Pregnancy and Lactation
Should not be administered during pregnancy. The occurrence of arbutin/hydroquinone in breast milk has not been researched. The preparation, therefore, should not be administered during lactation.
Interactions with Other Drugs
Uva ursi preparations should not be administered with any substances that cause acidic urine, since this reduces the antibacterial effect. An alkaline pH should be maintained by consuming a diet rich in dairy products, vegetables (especially tomatoes), fruits and fruit juices, potatoes, etc. (Tyler, 1994).
Dosage and Administration
Unless otherwise prescribed: 10-12 g per day of crushed leaf or powder corresponding to 400-840 mg hydroquinone derivatives calculated as water-free arbutin, for infusions or cold macerations; extracts and solid forms for oral administration. Infusion: Steep 3 g in 150 ml boiling water for 15 minutes, up to four times daily, corresponding to 400-840 mg arbutin per day. Cold macerate: Steep 3 g in 150 ml cold water for several hours, up to four times daily, corresponding to 400-840 mg arbutin per day. Dry extract: Containing 100-210 mg hydroquinone derivatives calculated as water-free arbutin, up to four times daily. Fluidextract 1:1 (g/ml): 3 ml, up to four times daily, corresponding to 400-840 mg arbutin per day. (Bradley, 1992; Braun, 1991; ESCOP, 1997; Karnick, 1994; Newall et al., 1996; Wichtl and Bisset, 1994). Duration of treatment: Medication containing arbutin should not be taken for longer than a week or more than five times a year without consulting a physician.
References
Bradley, P.R. (ed.). 1992. British Herbal Compendium, Vol. 1. Bournemouth: British Herbal Medicine Association. Braun, R. et al. 1997. Standardzulassungen f r FertigarzneimittelText and Kommentar. Stuttgart: Deutscher Apotheker Verlag. British Herbal Pharmacopoeia (BHP). 1996. Exeter, U.K.: British Herbal Medicine Association. 34. Bruneton, J. 1995. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier Publishing. Budavari, S. (ed.). 1996. The Merck Index: An Encyclopedia of Chemicals, Drugs, and Biologicals, 12th ed. Whitehouse Station, N.J.: Merck & Co, Inc. Deutsches Arzneibuch, 10th ed., 3rd suppl. (DAB 10). 1994. Stuttgart: Deutscher Apotheker Verlag. Direction de la Pharmacie et du Mdicament (DPM). 1992. Bulletin Officiel No. 92/11 bis. [English edition]. Paris: Direction des Journaux Officiels. Dispensatory of the United States of America, 11th ed. (USD XI). 1858. Philadelphia, PA: Lippencott. 781782. ESCOP. 1997. 'Uvae ursi folium.' Monographs on the Medicinal Uses of Plant Drugs. Exeter, U.K.: European Scientific Cooperative on Phytotherapy. Felter, H.W. and J.U. Lloyd. 1985. King's American Dispensatory, Vols. 12. Portland, OR: Eclectic Medical Publications [reprint of 1898 original]. 840841, 20382040. Frohne, D. 1970. Untersuchungen zur frage der harndesinfizierenden wirkungen von Brentraubenblatt-extrakten [The urinary disinfectant effect of extract from leaves uva ursi]. Planta Med 18(1):2325. Grieve, M. 1979. A Modern Herbal. New York: Dover Publications, Inc. Grinnell, G.B. 1972. The Cheyenne IndiansTheir History and Ways of Life, Vol. 2. Lincoln: University of Nebraska Press. 183. Hamel, P.B. and M.U. Chiltoskey. 1975. Cherokee Plants. Sylva, N.C.: Herald Publishing Co. 25. Hutchens, A.R. 1991. Indian Herbology of North America. Boston: Shambhala. 2930. Japanese Pharmacopoeia, 12th ed. (JP XII). 1993. Tokyo: Government of Japan Ministry of Health and WelfareYakuji Nippo, Ltd. 4446. Karnick, C.R. 1994. Pharmacopoeial Standards of Herbal Plants. Delhi: Sri Satguru Publications. 2425. Lange, D. and U. Schippmann. 1997. Trade Survey of Medicinal Plants in GermanyA Contribution to International Plant Species Conservation. Bonn: Bundesamt f r Naturschutz. 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. Millspaugh, C.F. 1974. American Medicinal Plants. New York: Dover Publications, Inc. [reprint of 1892 American Plants]. 392396. Moerman, D.E. 1998. Native American Ethnobotany. Portland, OR: Timber Press, Inc. 8589. Newall, C.A., L.A. Anderson, J.D. Phillipson. 1996. Herbal Medicines: A Guide for Health-Care Professionals. London: The Pharmaceutical Press. sterreichisches Arzneibuch, Vols. 12, 1st suppl. ( AB). 19811983. Wien: Verlag der sterreichischen Staatsdruckerei. Perry, F. 1952. Ethno-Botany of the Indians in the Interior of British Columbia. Museum of Art Notes 2(2):3643. Pharmacope Franaise Xe dition (Ph.Fr.X.). 19831990. Moulins-les-Metz: Maisonneuve S.A. Pharmacopoeia Helvetica, 7th ed. Vol. 14.(Ph.Helv.VII). 1987. Bern: Office Central Fdral des Imprims et du Matriel. Stille, A. 1874. Therapeutics and Materia Medica: A Systematic Treatise on the Action and Uses of Medicinal Agents Including Their Description and History, 4th ed. Vol. 2. Philadelphia, PA: Lea and Blanchard. 638639. Steedman, E.V. 1928. The Ethnobotany of the Thompson Indians of British Columbia. Smithsonian InstitutionBureau of American Ethnology Annual Report 45:441522. USD XI. See Dispensatory of the United States of America. Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers.
Additional Resources
British Pharmaceutical Codex (BPC). 1934. London: The Pharmaceutical Press. Deutsches Arzneibuch, 10th ed. Vol. 16. (DAB 10). 1991. Kommentar. Stuttgart: Wissenschaftliche Verlagsgesellschaft. B5. Frohne, D. 1977. Arctostaphylos uva-ursi (L.) SPRENG. (Brentraube). Bonn: Kooperation Phytopharmaka. Unpublished report. . 1986. Arctostaphylos uva-ursi (L.) SPRENGDie Brentraube. Z Phytother 7:4547. Haslam, E., T.H. Lilley, Y. Cai, R. Martin, D. Magnolato. 1989. Traditional herbal medicinesthe role of polyphenols. Planta Med 55(1):18. Kedzia, B., T. Wrocinski, K. Mrugasiewicz, P. Gorecki, H. Grzewinska. 1975. [Antibacterial action of urine containing arbutine metabolic products] [In Polish, with English summary]. Med Dosw Mikrobiol 27(3):305314. Steinegger, E. and R. Hnsel. 1988. Lehrbuch der Pharmakognosie und Phytopharmazie, 4th ed. Heidelberg: Springer Verlag. Weiss, R.F. 1988. Herbal Medicine. Beaconsfield, England: Beaconsfield Publishers. . 1991. Lehrbuch der Phytotherapie, 7th ed. Stuttgart: Hippokrates Verlag. 315316. Wichtl, M. (ed.). 1997. Teedrogen, 4th ed. Stuttgart: Wissenschaftliche Verlagsgesellschaft. 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.
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.
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