Herbal Medicine: Expanded Commission E
Witch Hazel leaf and bark
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Latin Name: Hamamelis virginiana
Pharmacopeial Name: Hamamelidis folium et cortex, Hamamelidis folium, witch hazel leaf; Hamamelidis cortex, witch hazel bark
Other Names: Hamamelis
Overview
Witch hazel is a deciduous shrub or small tree that flowers in the fall, native to damp woods in eastern North America from New Brunswick and Quebec to Minnesota, south to Florida, Georgia, Louisiana, and Texas (HPUS, 1992; Leung and Foster, 1996; Wichtl and Bisset, 1994). It is cultivated on a small scale in Europe (Wichtl and Bisset, 1994), though the material of commerce is obtained mainly from the eastern United States and Canada (BHP, 1996; Wichtl and Bisset, 1994). Witch hazel preparations have a long history of traditional use in North America (Der Marderosian, 1999; Duke, 1985). The aqueous infusion of the bark was used in aboriginal medicine to treat hemorrhages, inflammations, and hemorrhoids (Millspaugh, 1974). The decoction was used in poultices for painful swellings and tumors (Grieve, 1979). These traditional uses were later adopted by nineteenth century American Eclectic physicians and the aqueous decoction form became an official preparation in the Eclectic Materia Medica. The alcoholic fluidextract form became official in the United States Pharmacopoeia in 1882 (Millspaugh, 1974). Today, the external use of witch hazel is well known for the astringency associated with the tannin content of its leaves and bark. In Europe, tannin-rich witch hazel extracts made from the leaf and bark are used. In the United States, the FDA has approved as an over-the-counter drug a witch hazel water, made from the steam distillate of the twigs, this preparation having virtually no tannin content. However, the product contains about 14–15% alcohol in water with a small amount of the essential oil of witch hazel. Thus, whatever astringent properties may be attributed to this type of preparation are probably due to the alcohol content, not any tannins from the herb (Tyler, 1994). However, there are reports of the distillate containing 2.5–4.2 mg/liter hamamelitannins (Zeylstra, 1998). In a recent clinical study, a witch hazel preparation demonstrated anti-inflammatory activity on skin irritations caused by ultraviolet light. The preparation, an after-sun lotion (Eucerin®), contained a lotion base and 10% witch hazel distillate. The witch hazel lotion helped reduce inflammation by 20% after 7 hours and 27% after 48 hours compared to 11–15% for other lotions (Hughes-Formella et al., 1998). In another double-blind randomized clinical study comparing a witch hazel distillate (5.35% with 0.64 mg ketone) in a cream base to both the herb-free cream base and a 0.5% hydrocortisone cream in patients with severe ectopic eczema, the witch hazel cream was not as effective as the hydrocortisone preparation, despite what the authors confirm as the "mild, yet unmistakable anti-inflammatory effect of hamamelis cream in experimental models of inflammatory skin disease" (Korting et al., 1995). Some of these same authors had conducted an earlier randomized controlled trial comparing a witch hazel distillate (0.64 mg/2.56 mg hamamelis ketone in 100 g) with phosphatidylcholine; these were compared to a chamomile cream and a 1% hydrocortisone cream and four base preparations. The results showed an anti-inflammatory action of the hamamelis distillate on experimentally induced skin erythemas, but the hydrocortisone cream was deemed more potent, even when the herb distillate was increased by four times (Korting et al., 1993). In Germany, witch hazel is listed in the Drug Codex, approved in the Commission E monographs, and the tea infusion form is official in the Standard License monographs (BAnz, 1998; Braun et al., 1997; DAC, 1986; Wichtl and Bisset, 1994). Witch hazel leaf and bark are used in some hemorrhoid teas and antiphlebitis (vein inflammation) drugs. Several witch hazel mono-preparations and combination products (e.g., with horse chestnut) are available in various dosage forms, including ointments, suppositories, coated tablets, and tinctures (Wichtl and Bisset, 1994). The mother tincture (1:10) and liquid dilutions thereof, are also official in the German Homeopathic Pharmacopoeia (GHP), prepared from different plant parts including the fresh leaves, the fresh bark from roots and branches, as well as a mixture of bark from the branches with tips of the shoots. The GHP also includes a monograph for an ethanolic decoction of the dried bark from stems and branches, specifying bark which contains not less than 2.5% tannins, precipitable with hide powder, calculated as pyrogallol (GHP, 1993). In the United States, witch hazel distillate, from partially dried twigs, is official in the currently valid USP (USP 24–NF 19, 1999). An alcoholic tincture (1:10 w/v, in 55% alcohol v/v) of the bark, including the root bark, is also classified in the Homeopathic Pharmacopoeia of the United States as an OTC Class C drug (HPUS, 1992). Witch hazel is used in several over-the-counter astringent and hemostatic preparations such as Dickinson's® witch hazel astringent cleaner towelettes with Aloe, Parke-Davis Tucks® hemorrhoidal pads, Preparation H® hemorrhoidal cooling gel, and Thayers® witch hazel astringent with Aloe vera. European pharmacopeial grade witch hazel leaf consists of the dried leaves of Hamamelis virginiana L. containing not less than 7.0% tannins calculated with reference to the dried leaf. It may contain no more than 7% stem pieces and maximum 2% other foreign matter. Botanical identity must be confirmed by thin-layer chromatography (TLC) as well as macroscopic and microscopic examinations (Ph.Eur.3, 1997). Both the British Herbal Pharmacopoeia and ESCOP monographs require the leaf to conform with the requirements of the European Pharmacopoeia (BHP, 1996; ESCOP, 1997). The German Standard License requires that the leaf conform with the quality requirements of the German Drug Codex monograph (Braun et al., 1997). The German Drug Codex requires not less than 5.0% tannins, precipitable with hide powder (DAC, 1986, Wichtl and Bisset, 1994). Pharmacopeial grade witch hazel bark consists of the dried bark from stems and branches of H. virginiana L. collected in the spring. The bark must contain not less than 20% ethanol (45%)-soluble extractive. Botanical identity must be confirmed by TLC as well as by macroscopic and microscopic examinations (BHP, 1996). The German Drug Codex requires not less than 9.0% tannins, precipitable with hide powder (DAC, 1986; Wichtl and Bisset, 1994). Witch Hazel USP is the clear, colorless distillate prepared from freshly cut and partially dried dormant twigs of H. virginiana L. It is prepared by macerating the twigs in water for 24 hours, then distilling it down until 800–850 mL of distillate is yielded from each 1,000 g of twigs, then adding 150 mL of alcohol to each 850 mL of distillate. It has a tannins limit of 0.03 mg tannic acid per mL, a pH between 3.0 and 5.0, and alcohol content of 14.0–15.0% (USP 24–NF 19, 1999).
Description
Witch hazel leaf consists of the dried leaf of H. virginiana L. [Fam. Hamamelidaceae], as well as its preparations in effective dosage. The leaf contains 3–8% tannin, mainly gallotannins. Other ingredients are flavonoids and essential oil. Witch hazel bark consists of the dried bark of the trunk and branches of H. virginiana L., as well as its preparations in effective dosage. The bark contains at least 4% tannins. Characteristic ingredients of witch hazel bark are b-hamamelitannin and g-hamamelitannin, the depside ellagitannin, catechin derivatives, and free gallic acid. Fresh leaf and twigs of H. virginiana L. consist of leaves and twigs collected in spring and early summer for the production of water distillates.
Chemistry and Pharmacology
Witch hazel leaf contains 3–10% tannins (a mixture of catechins, gallotannins, plus cyanidin and delphinidin type proanthocyanidins), mainly hamamelitannin and hamamelose (Budavari, 1996; Meyer-Buchtela, 1999; Wichtl, 1989); catechins, mainly (+)-catechin, (+)-gallocatechin, (–)-epicatechin gallate, (–)-epigallocatechin gallate; phenolic acids (caffeic and gallic acids); flavonoids such as kaempferol, quercetin, quercitrin, and isoquercitrin (ESCOP, 1997; Hnsel et al., 1993); 0.01–0.5% volatile oil (Meyer-Buchtela, 1999; Wichtl, 1989), of which 40% are aliphatic alcohols, 25% are carbonyl compounds (n-hex-2-en-1-al, acetaldehyde, a- and b-ionone), 15% are aliphatic esters, and not more than 0.2% safrole (Wichtl and Bisset, 1994; Zeylstra, 1998). Witch hazel bark contains 8–12% tannins, composed mainly of hamamelitannins (1–7%), followed by monogalloylhamamelose, free gallic acid, condensed catechin tannins, and small amounts of oligomeric proanthocyanidins; a small amount of flavonols; approximately 0.1% volatile oil with a very complex composition (Hnsel et al., 1993; Meyer-Buchtela, 1999; Wichtl, 1996). The Commission E reported astringent, anti-inflammatory, and locally hemostatic activities. The British Herbal Pharmacopoeia reported astringent action for witch hazel bark (BHP, 1996). The Merck Index reported its therapeutic category as astringent (Budavari, 1996). Witch hazel leaf fluidextract is vasoconstrictive in the rabbit (Bruneton, 1995). In a pharmacological study in humans a topical application of witch hazel leaf hydroglycolic extract significantly reduced skin temperature, which was interpreted as vasoconstrictive action (Diemunsch and Mathis, 1987; ESCOP, 1997). Astringent, antiseptic, and hemostatic properties of witch hazel leaf and bark infusions, ointments, and suppositories have been demonstrated in animal experiments (Wichtl and Bisset, 1994).
Uses
The Commission E approved the use of witch hazel preparations for minor skin injuries, local inflammation of skin and mucous membranes, hemorrhoids, and for varicose veins. Witch hazel is used as an active compound in topical ointments and suppositories for the treatment of hemorrhoids (Anon., 1991; Reynolds, 1989). The German Standard License for witch hazel leaf and/or bark tea infusion, for oral ingestion or as a mouthwash, approves its use as supportive therapy for acute, non-specific diarrhea, and also to treat inflammation of the gums and mucous membranes of the mouth (Braun et al., 1997). ESCOP indicates the internal use of witch hazel leaf infusion and/or fluidextract for symptomatic treatment of conditions related to varicose veins (painful and heavy legs, and for hemorrhoids) and the external use of the decoction and/or semisolid extract for bruises, sprains, and minor injuries of the skin, local inflammations of the skin, and mucosa, hemorrhoids, and relief of neurodermatitis atopic symptoms (ESCOP, 1997). In France, witch hazel extracts and tinctures are approved for oral and topical application to treat subjective symptoms of venous insufficiency and hemorrhoids. Local application is also allowed for relief of eye irritation and for oral hygiene (Bruneton, 1995).
Contraindications
None known.
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: Cut leaves and/or bark or extracts for internal and external use, or steam distillate of fresh leaves and bark for internal and external use, as follows: Internal (mucous membranes): Suppositories (vaginal and rectal): The amount of a preparation corresponding to 0.1–1 g drug (decoction), one to three times daily (Commission E); or, a semi-solid cylinder or cone containing 200 mg witch hazel leaf dry alcoholic extract with cocoa butter or other comparable fatty oils, one to two times daily (BPC, 1973; ESCOP, 1997; Reynolds, 1989; Zeylstra, 1998); or prepared from the concentrated infusion in a base of powdered gelatin or cocoa butter and glycerin (Cowper, 1996). Internal (oral): Infusion: Steep 2–3 g leaf or bark in 150 ml boiled water for 10 to 15 minutes. Drink two to three times daily between meals (Braun et al., 1997; Hnsel et al., 1993; Meyer-Buchtela, 1999; Zeylstra, 1998). Fluidextract, 1:1 (g/ml), 45% ethanol: 2–4 ml, three times daily (BHP, 1983; BPC, 1973; ESCOP, 1997). Tincture, 1:5 (g/ml), 25% ethanol: 2–4 ml, three times daily (BPC, 1934; Karnick, 1994; Zeylstra, 1998). External: Aqueous steam distillate (witch hazel water with preservative): For local application as needed, undiluted or diluted 1:3 with water, several times daily (Commission E). Aromatic hydrosol (without preservative): For local application as needed, several times daily. Hydrosols may be more suitable than distillates for sensitive skin (Blackwell, 1998). Compress: Semi-solid or fluid preparations containing 5–10% decoction or distillate are spread or soaked on linen. Fold and apply firmly to affected area. [Note: Hemorrhoidal pads are commercially available which can be folded and used as a compress on inflamed tissue].
Decoction (bark): For use as a component of compresses, place 2–3 g fine-cut or coursely powdered bark in 150 ml cold water, bring to a boil and simmer for 10 to 15 minutes (Meyer-Buchtela, 1999; Wichtl and Bisset, 1994). Decoction (leaf): For use as a component of compresses and irrigations, boil 5–10 g in 250 ml water for 10 to 15 minutes (Commission E; ESCOP, 1997; Hnsel et al., 1993; Meyer-Buchtela, 1999). Fluidextract 1:1 (g/ml), 45% alcohol: For use as a component of ointment, gel, or salve (Reynolds, 1989). Gargle or mouth wash: Use the warm decoction or infusion several times daily (Braun et al., 1997). Ointment, gel, or salve: Semi-solid preparation containing 10% decoction or fluidextract, in a base of vaseline or wool fat (anhydrous lanolin) and yellow soft paraffin, applied locally (BPC, 1973; Cowper, 1996; ESCOP, 1997; Reynolds, 1989; Zeylstra, 1998). Poultice: Semi-solid paste containing 20–30% aqueous steam distillate or decoction, applied locally (Commission E). Tincture 1:5 (g/ml): For use as a component of ointment, gel, or salve.
References
Anon. 1991. Drug therapy for hemorrhoids. Proven results of therapy with a hamamelis containing hemorrhoid ointment. Results of a meeting of experts. Fortschr Med Suppl 116:111. BAnz. See Bundesanzeiger. Blackwell, R. 1998. A new look at aromatic hydrosols. Eur J Herbal Med 4(2):1316. 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. 110. . 1996. Exeter, U.K.: British Herbal Medicine Association. 9798. British Pharmaceutical Codex (BPC). 1934. London: The Pharmaceutical Press. . 1973. London: The Pharmaceutical Press. 218. Bruneton, J. 1995. Pharmacognosy, Phytochemistry, Medicinal Plants. Paris: Lavoisier Publishing. 327. Budavari, S. (ed.). 1996. The Merck Index: An Encyclopedia of Chemicals, Drugs, and Biologicals, 12th ed. Whitehouse Station, N.J.: Merck & Co, Inc. 786787. Bundesanzeiger (BAnz). 1998. Monographien der Kommission E(Zulassungs- und Aufbereitungskommission am BGA f r den humanmed. Bereich, phytotherapeutische Therapierichtung und Stoffgruppe). Kln: Bundesgesundheitsamt (BGA). Cowper, A.B. 1996. Manufacturing Handbook for Herbal Medicines. Morisset, Australia: Anne B Cowper. 3138. Der Marderosian, A. (ed.). 1999. The Review of Natural Products. St. Louis: Facts and Comparisons. Deutscher Arzneimittel-Codex (DAC). 1986. Stuttgart: Deutscher Apotheker Verlag. Diemunsch, A.M. and C. Mathis. 1987. Effet vasoconstricteur de l'hamamlis en application externe. STP Pharma 3:111114. Duke, J.A. 1985. Handbook of Medicinal Herbs. Boca Raton: CRC Press. ESCOP. 1997. 'Hamamelidis folium.' Monographs on the Medicinal Uses of Plant Drugs. Exeter, U.K.: European Scientific Cooperative on Phytotherapy. Europäisches Arzneibuch, 3rd ed. (Ph.Eur.3). 1997. Stuttgart: Deutscher Apotheker Verlag. 10201021. German Homeopathic Pharmacopoeia (GHP). 1993. Translation of the German Homopathisches Arzneibuch (HAB 1), 5th suppl. 1991 to the 1st ed. 1978. Stuttgart. Deutscher Apotheker Verlag. 489498. Grieve, M. 1979. A Modern Herbal. New York: Dover Publications, Inc. Hnsel, R., K. Keller, H. Rimpler, G. Schneider (eds.). 1993. Hagers Handbuch der pharmazeutischen Praxis, 5th ed. Vol. 5. Berlin-Heidelberg: Springer Verlag. 367384. The Homeopathic Pharmacopoeia of the United States (HPUS). 1992. Arlington, VA: Pharmacopoeia Convention of the American Institute of Homeopathy. Hughes-Formella, B.J. et al. 1998. Anti-inflammatory effect of hamamelis lotion in a UVB erythema test. Dermatology 196(3):316322. Karnick, C.R. 1994. Pharmacopoeial Standards of Herbal Plants, Vol 2. Indian Medical Science Series, No. 37. Delhi: Sri Satguru Publications. 173174. Korting, H.C., M. Schafer-Korting, H. Hart, P. Laux, M. Schmid. 1993. Anti-inflammatory activity of hamamelis distillate applied topically to the skin. Influence of vehicle and dose. Eur J Clin Pharmacol 44(4):315318. Korting H.C. et al. 1995. Comparative efficacy of hamamelis distillate and hydrocortisone cream in atopic eczema. Eur J Clin Pharmacol 48(6):461465. Leung, A.Y. and S. Foster. 1996. Encyclopedia of Common Natural Ingredients Used in Foods, Drugs, and Cosmetics. 2nd ed. New York: John Wiley & Sons, Inc. McGuffin M, C. Hobbs, R. Upton, A. Goldberg. 1997. American Herbal Product Association's Botanical Safety Handbook. Boca Raton: CRC Press. Meyer-Buchtela, E. 1999. Tee-RezepturenEin Handbuch f r Apotheker und rzte. Stuttgart: Deutscher Apotheker Verlag. Millspaugh, C.F. 1974. American Medicinal Plants. New York: Dover Publications, Inc [reprint of 1892 American Plants]. 227229. Ph.Eur.3. See Europäisches Arzneibuch. Reynolds, J.E.F. (ed.). 1989. Martindale: The Extra Pharmacopoeia, 29th ed. London: The Pharmaceutical Press. 778779. Tyler, V.E. 1994. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York: Pharmaceutical Products Press. United States Pharmacopeia, 24th rev. and National Formulary, 19th ed. (USP 24NF19). 1999. Rockville, MD: United States Pharmacopeial Convention, Inc. 1755. Wichtl, M. (ed.). 1989. Teedrogen, 2nd ed. Stuttgart: Wissenschaftliche Verlagsgesellschaft. Wichtl, M. and N.G. Bisset (eds.). 1994. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Medpharm Scientific Publishers. 243247. Wichtl, M. 1996. MonographienKommentar. In: Braun, R. et al. 1997. Standardzulassungen f r FertigarzneimittelText and Kommentar. Stuttgart: Deutscher Apotheker Verlag. Zeylstra, H. 1998. Hamamelis virginiana. British Journal of Phytotherapy 5(1):2328.
Additional Resources
Bernard, P., A. Bovis, G. Balansard. 1971. L'essai chromatographique des preparations galeniques a base de feuilles d'Hamamelis [Chromatographic assay of galenic preparations from Hamamelis leaves]. J Pharm Belg 26(6):661668. Bernard, P., P. Balansard, G. Balansard, A. Bovis. 1972. Valeur pharmacodynamique toniveineuse des preparations galeniques a base de feuilles d'hamamelis [Venitonic pharmacodynamic value of galenic preparations with a base of hamamelis leaves]. J Pharm Belg 27(4):505512. Bernard, P. 1977. Les feuilles d'hamamlis. Plantes Md Phytothr 11(Spcial):184188. Bown, D. 1995. Encyclopedia of Herbs and Their Uses. New York: DK Publishing, Inc. 291. Council of Europe. 1989. Plant Preparations Used as Ingredients of Cosmetic Products, 1st ed. Strasbourg: Council of Europe. Duke, J.A. 1997. The Green Pharmacy. Emmaus, PA: Rodale Press. Erdelmeier, C.A.J. et al. 1996. Antiviral and antiphlogistic activities of Hamamelis virginiana bark. Planta Med 62(3):241245. Hartisch, C., H. Kolodziej, F. von Bruchhausen. 1997. Dual inhibitory activities of tannins from Hamamelis virginiana and related polyphenols on 5-lipoxygenase and lyso-PAF: acetyl-CoA-acetyltransferase. Planta Med 63(2):106110. Hrmann, H.P. and H.C. Korting. 1994. Evidence for the efficacy and safety of topical herbal drugs in dermatology: Part 1: Anti-inflammatory agents. Phytomed 1:161171. Khory, R.N. and N.N. Katrak. 1985. Materia Medica of India and Their Therapeutics. Delhi: Neeraj Publishing House. Laux, P. and R. Oschmann. 1993. Die ZaubernussHamamelis virginiana L. Z Phytother 14:155166. Lloyd and Lloyd. 1935. History of Hamamelis extract and distillate. J Am Pharm Assoc 24:220. Madaus, G. 1979. Lehrbuch der biologischen Heilmittel, Vols. 13. Hildesheim: Georg Olms Verlag. Malhotra, S.C. 1990. Phytochemical Investigations of Certain Medicinal Plants Used in Ayurveda. New Delhi: CCRA & S, Government of India. Newall, C.A., L.A. Anderson, J.D. Phillipson. 1996. Herbal Medicines: A Guide for Health-Care Professionals. London: The Pharmaceutical Press. Pharmacope Franaise Xe dition (Ph.Fr.X.). 19831990. Moulins-les-Metz: Maisonneuve S.A. Pharmacopoeia Helvetica, 7th ed. (Ph.Helv.VII), Vol. 14. 1987. Bern: Office Central Fdral des Imprims et du Matriel. Reynolds, J.E.F. (ed.). 1993. Martindale: The Extra Pharmacopoeia, 30th ed. London: The Pharmaceutical Press. Sorkin, B. 1980. Hametum-Salbe, eine kortikoidfreie antiinflammatorische Salbe. Phys Med Rehab 21:5357. Steinegger, E. and R. Hnsel. 1992. Pharmakognosie, 5th ed. Berlin: Springer Verlag. Van Hellemont, J. 1988. Fytotherapeutisch Compendium, 2nd ed. Utrecht: Bohn, Scheltema & Holkema. 284286. 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
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