Filipendula ulmaria

Botany

Description
Meadowsweet is a small perennial, grassy plant commonly referred to as a shrub that is 1-4 feet tall with green and cylindrical stems up to 5mm in diameter (4, 7). Its leaves are a deep dark green seen predominantly on the superior surface while the inferior surface is decorated with greyish-white (4). Alternate, simple, ovate with an acute apex portray the best description of the plants leaves while its flowers consisting of five petals of creamy white or, less commonly, pink, are arranged in a 'terminal corymb' with numerous protruding stamens, form the inflorescence (4, 5, 6, 7).

Geographical Distribution
Meadowsweet is native to Europe with related species found in North America (7).

Habitat
Meadowsweet flourishes in particularly damp locations, favouring the banks of streams and rivers as well as ditches over places with dry and harsh qualities (6).

Major Active Constituents

Salicylates
Spiraein, methyl salicylate, salicylic acid, salicin and salicylaldehyde (1, 14).

Tannins
Mainly hydrolysable polyphenols, the major one is rugosin-D (5).

Volatile Oil
Mainly phenolic components (1, 5, 13), including salicylaldehyde, phenylethyl alcohol, benzyl alcohol, and methy salicylate (5).

Actions

Anti-inflammatory and analgesic (8, 10, 15)
Astringent (7, 11)
Antacid and anti-ulcerogenic (9, 12, 13)
Mild urinary antiseptic (2, 3, 5)
Stomachic (1, 6, 7)

Pharmacology

In vitro Studies
In a study examining the immunomodulatory activity of meadowsweet, extracts from the flowers in the form of ethyl acetate were shown to inhibit both T cell proliferation and compliment cascade activation as well as reactive oxygen species production and function (16). These specific effects were also observed in parts of the cellular immune system whereby modulatory control was exhibited. All are proven to play a role in the inflammatory process and as the authors suggest may explain the effectiveness of meadowsweet preparations in particular pathologies that are associated with inflammation (5, 16). Methanol extracts of meadowsweet were also studied and showed similar inhibitory activity to that of the ethyl acetate, but on further investigation it was the ethyl acetate only that retained this action. The differences in these results suggested that the 'tannin content was less likely to contribute to this immunomodulatory activity and that other compounds within the plant may be more significant in relation to these actions' (16). It remained inconclusive as to what compounds in particular were involved which warrants further study.

Extracts from the seeds and flowers of meadowsweet have shown anticoagulant activity in both in vitro and in vivo studies which is believed to be associated with the heparin-like and salicylate compounds (13).

Antimicrobial properties against five specific strains of bacteria have been shown mostly in extracts form the rhizomes, stems and flowers of the meadowsweet plant (17).

In vivo Studies
A study on the anti-ulcerogenic activity in rats with the flowers of meadowsweet, showed protective benefits of the aqueous extract through the plants ability to generate healing in acetylsalicylic acid and ethanol induced lesions of the stomach (18). However, these results were not replicated in highly acidic environments or on stimulation by histamine, and even showed increased ulcerogenic properties in guinea pigs (18, 19).

Depression of the central nervous system was exhibited in vivo through inducing cardiac relaxation, decreasing motor activity and rectal temperature, as well as decreasing vascular/capillary permeability, the last of which may be associated with its anti-inflammatory action (20).

Clinical Outcome Studies

In a clinical study, meadowsweet was utilised as an ointment and applied topically in 48 patients with known cervical dysplasia (5). Complete remission was seen in 25 cases, and in 32 patients beneficial results were conclusive. In addition to this no reappearance of the cervical dysplasia occurred over a 12 month period in 10 of the patients in complete remission (5, 9).

Indications

Meadowsweet is indicated in many conditions as it is perceived as 'one of the best digestive remedies available' (8). The indications that are comparable across the literature include:

Gastrointestinal conditions associated with hyperacidity (3, 7)

• Gastritis
• Peptic ulceration
• Dyspepsia
• Heartburn

Conditions associated with mild-moderate pain/inflammation (9, 10, 12)

• Arthritic and rheumatic problems including gout
• Fever
• Genitourinary tract disorders such as cystitis

Other uses

• Diarrhoea in children (11)
• Cervical dysplasia (supported by clinical trials) (5, 9)

Contra-indications and Cautions

Documented potential interactions with Pharmaceutical drugs
Controlled studies for the most part are not readily available which suggests that most are limited by theoretical opinion (13). Despite this there are still some significant correlations between some studies and pharmaceutical drugs.

Caution is advised in individuals taking warfarin, an anticoagulant drug, as its effects may be further perpetuated due to the heparin-like and salicylate compounds in meadowsweet which also demonstrate an anticoagulant action (13). It is recommended that patients on both of these should be very closely monitored (21).

Aspirin should not be taken simultaneously with meadowsweet as its actions may be further enhanced through the plants own anti-inflammatory action (12). It has been hypothesised that this may actually be beneficial although no evidence has been shown to support this.

Toxicity
There is no known or documented toxicity of meadowsweet, however excessive astringency may occur due to the plants high quantity of tannins which may cause irritation in some (2).

Other Cautions and Side effects
Salicylate constituents have been documented in meadowsweet, therefore it is recommended that the use of this plant be avoided, or used with caution, in those with salicylate sensitivity as it has been shown to produce idiosyncratic reactions in susceptible people (22).

Due to the high tannin content, meadowsweet should not be used long term (2). It has also been deemed as inappropriate in conditions of constipation, iron deficiency anaemia and malnutrition (2).

Studies have demonstrated anticoagulant activity; caution should be taken in those with bleeding disorders (12).

Meadowsweet has been shown to cause bronchospasm on ingestion; caution is advised in individuals with asthma (12).

Posology

Dosages have been expressed as a range, assembled from various resources.

Liquid Extract
2-6 ml/day of a 1:1 or 1:2 liquid extract (1, 2, 5)
20-40 ml/week of a 1:1 or 1:2 liquid extract (9)

Dried Herb
2-6 g/day dried herb (7)
4-5 g/day fresh herb (3, 5, 13)
2.5-3.5 g/day flowers (5, 13)

Tincture
1-4 ml/three times daily of a 1:5 tincture (40-45% alcohol) (5, 11)

References

1. British Herbal Medicine Association. 1992. British Herbal Compendium Volume 1: a handbook of scientific information on widely used plant drugs. Bournemouth, UK: British Herbal Medicine Association.

2. Mills S, Bone K. 2005. The Essential Guide to Herbal Safety. St Louis, Mo: Elsevier Churchill Livingstone.

3. Newall CA, Anderson LA, Phillipson JD. 1996. Herbal Medicines - a guide for healthcare professionals. London: Pharmaceutical Press.

4. Anonymous. 1996. British Herbal Pharmacopoeia. London: British Herbal Medicine Association.

5. Mills S, Bone K. 2000. Principles and Practice of Phytotherapy. Edinburgh: Churchill Livingstone.

6. Chevalier A. 2001. The Encyclopaedia of Medicinal Plants. St Leonards, NSW: Dorling Kindersley.

7. Willard T. 1951. Textbook of Modern Herbology. 2nd edition. Calgary: Wild Rose College of Natural Healing.

8. Hoffman D. 2003. Medical Herbalism. Rochester, Vt: Healing Arts Press.

9. Bone K. 2003. A Clinical Guide to Blending Liquid Herbs: herbal formulations for the individual patient. St Louis, Missouri: Churchill Livingstone.

10. Lewis WH. 2003. Medical Botany: Plants affecting Human Health. 2nd edition. New Jersey: John Wiley and Sons.

11. Barnes J, Anderson LA, Phillipson JD. 2007. Herbal Medicines. 3rd edition. London: Pharmaceutical Press.

12. Meadowsweet. Drug Digest. 2007. Express Scripts. Accessed 15th August 2008. <www.drugdigest.org/DD/DVH/HerbsWho/0,3923,4106%7CFilipendula%2Bulmaria,00.html>.

13. Braun L, Cohen M. 2005. Herbs and natural supplements: an evidence-based guide. 2nd edition. Marrickville NSW: Elsevier.

14. American Herbal Products Association. 1997. Botanical Safety Handbook. CRC Press.

15. Bone, K. 2007. The Ultimate Herbal Compendium: a desktop guide for herbal prescribers. Warwick, Qld: Phytotherapy Press.

16. Beukelman CJ, Halkes SBA, Kroes BH, Labadie RP, Van den Berg AJJ, Van Dijk H. In Vitro Immunomodulatory Activity of Filipendula ulmaria. Phytotherapy Research 1997; 11: 518-520.

17. Rauha JP et al. Antimicrobial effects of Finnish plant extracts containing flavanoids and other phenolic compounds. International Journal of Food and Microbiology 2000; 56: 3-12.

18. Barnaulov OD, Denisenko PP. Antiulcerogenic action of the decoction from flowers of Filipendula ulmaria. Pharmacological Toxicology 1980; 43: 700-705.

19. Yanutsh AY et al. Astudy of the ulcerogenic action of the extracts from the supernatant part and roots of Filipendula ulmaria. Farm Zh 1982; 37: 53-56.

20. Barnaulov OD et al. Chemical composition and primary evaluation of the properties from Filipendula ulmaria and Maxim flowers. Rastit Resur 1977; 13: 661-669.

21. Kuhn MA. Herbal Remedies: Drug-Herb Interactions. Critical Care Nurse 2002; 22: 22-35.

22. Brinker F. 1997. Herb Contraindications and Drug Interactions. Sandy: Eclectic Institute.

This monograph was authored in 2008 by Sereena Turner, a student in Southern Cross University's Bachelor of Naturopathy programme, and edited by Nena Aleschewski BNat. While the author and editor have strived to cite published information accurately, Southern Cross University will not be responsible for any inaccuracies that may have occurred.

This information is provided for educational purposes only and does not constitute medical advice. If you wish to use herbal medicine as part of your health care, seek the advice of an appropriately qualified practitioner.