Comfrey (Symphytum Officinale) - Medicinal Uses, Interactions, Side Effects, Dosage

Comfrey
Herb Description:
Comfrey, Symphytum officinale, is an herb that grows in temperate climates. It was long known in Europe under names such as boneset, blackwort, slippery root, and gum plant. It is in the same family as borage. Various species of comfrey are grown in different countries.
Uses and Benefits:
Comfrey is named from its ancient application in "bonemending": the Latin, confirma which means made firm; the Greek, Symphytum, which means to unite. Traditionally, its roots and leaves have been used to treat broken bones and wounds. The mucilaginous root content was formerly promoted as an expectorant and antitussive, and to treat gastrointestinal disorders. Comfrey is promoted in Ayurvedic and other herbal systems, with claims for benefit in disorders such as peptic ulcer. Comfrey also has been commonly used as a topical anti inflammatory healing agent. Although still a component in some cosmetics, comfrey is no longer readily available as an herbal remedy in the U.S. due to its toxic potential.
Pharmacology:
Although the leaves are also used, the main therapeutic components are thought to be found in the roots. These include mucilage (fructans), tannins, allantoin, rosmarinic acid, sarracine, platyphylline, triterpenes, and sterols. However, the most important constituents of the roots are the hepatotoxic pyrrolizidine alkaloids, such as intermedine and its acetylated derivatives­symphytine and the very toxic echimidine. These compounds include an unsaturated necine base, which causes the pyrrolizidine alkaloids to be hepatotoxic. The non-toxic allantoin, mucilage, astringent tannins, and anti-inflammatory rosmarinic acid, however, could have a soothing effect on inflammatory skin disorders.
Clinical Trials:
No significant clinical trials have been reported in humans. There is insufficient evidence of comfrey's value to justify clinical studies.
Adverse Effects:
The main toxic outcome of ingesting comfrey is liver disease, and several cases have been recorded of veno-occlusive disease of the liver, resulting in ascites and hepatic fibrosis. Other toxicity may be seen, including a curare-like defect, adverse effects in pregnant women, and possibly carcinoqenesis. Presumably, individual patient factors affect susceptibility, but the dangers of the herb are unpredictable. Because of this, systemic use of comfrey has been banned in many countries, and the FDA discourages its use. Russian comfrey is said to be more toxic than the common comfrey of North America.
Side Effects and Interactions:
There are no recognized drug interactions.
Cautions:
Comfrey should not be used orally or internally. Although it can be used topically, it should probably not be placed on broken skin. All forms of comfrey should be avoided in pregnant and nursing women.
Preparations & Doses:
Preparations of root and leaf parts are now less readily available. Tablets and other herbal extracts have been employed, but very dilute teas or decoctions are safer; however, internal use is not recommended. The herb is used in topical preparations including lotions, creams, salves, and poultices, and it is sometimes used as a gargle. Herbal authorities recommend that it can be employed externally for contusions, bruises, and sprains for up to 6 weeks during a year, but such use is rarely justified.
Summary Evaluation:
No evidence exists to support the clinical use of comfrey, and it has been found to have significant hepatotoxic effects. The topical use of comfrey products for skin diseases may be safe, provided the skin is not broken and the preparation is not used chronically. Oral administration of dilute teas may be safe, but in view of the potential serious toxicity and the lack of proven value, oral intake of comfrey should be avoided.

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