]I:C%:C1 7 ]I:CR%H:QJ ]I:CJJQ0:QJ By Kristin Gilmour BHSc (Nat) TECHNICAL INFORMATION FEVERFEW (Tanacetum parthenium) OPTIMALRx P 1300 889 483 W 1 1 18 Q ] I: C `6 8 HQ I8 : % E1J`QQ]I:C`68HQI8:% FOR PRACTITIONER REFERENCE ONLY Botanical Name: Tanacetum parthenium Common Name: Feverfew Botanical Family: Asteraceae Part Used: Aerial Parts Dosage: 5ml to 15ml per week of a 1:5 liquid extract Synonyms: Chrysanthemum parthenium, Matricaria parthenium, Pyrethrum parthenium1,2,3 Common Names: Altamisa (Spanish), Bachelor’s Buttons, Camomille Grande (French), Chamomile Grande, Chrysanthemum Atricaire, European Feverfew, Federfoy, Feverfew, Featherfew, Feather Few, Feather-Fully, Featherfoil, Feddygen Fenyw (Welsh), Flirtroot, Flirtwort, Febrifuge Plant, Grande Chamomile, Matrem (Danish), Midsummer Daisy, Mother Herb, Mutterkraut (German), Nosebleed, Parthenolide, Pyrethrum, Santa Maria, Vetter-Voo, Wild Chamomile, Wild Quinine1,3,4 Taste: Bitter, sour5 Thermal Properties: Cooling5 Actions: t Analgesic t Antioxidant t Anthelmintic t Antiparasitic t Antiallergy t Antispasmodic t Antibacterial t Bitter tonic t Anticancer t Emmenagogue (in high doses) t Antifibrotic t Gastroprotective t Antifungal t Hepatoprotective t Anti-inflammatory t Renoprotective t Antinociceptive Indications: t Allergy (e.g. asthma, hayfever, urticaria) t Arthritis t Bacterial infections o Gram-positive bacteria: Bacillus cereus var. mycoides, Bacillus megaterium, Bacillus subtilis, Micrococcus lysodeikticus, Staphylococcus albus, Staphylococcus aureus, Staphylococcus epidermidis o Gram-negative bacteria: Escherichia coli, Klebsiella pneumoniae, Shigella flexneri, Vibrio fischeri o Mycobacteria: Mycobacterium spp. t Bone destructive disorders t Chemoprevention/adjunct to cancer therapy t Fever t Fungal infections o Aspergillus niger, Candida albicans, Candida krusei t Gastrointestinal disorders (e.g. atonic dyspepsia) t Headache t Inflammatory disorders (e.g. autoimmune disease, rheumatoid arthritis) t Migraine (prophylaxis and treatment) t Kidney injury 2 t Liver disease t Skin conditions involving inflammation and oxidative stress (e.g. acne, dermatitis, eczema, psoriasis, photoageing) t Parasitic infections o Leishmania amazonensis, Trypanosoma cruzi Traditional Use: The genus Tanacetum contains medicinal herbs belonging to the Asteraceae family, which is commonly referred to as the aster, daisy, or sunflower family6. From this genus, Feverfew (Tanacetum parthenium) is a medicinal plant that has been used for centuries as a febrifuge, hence its common name7. Interestingly, the origin of the Latin species name, parthenium, has been ascribed by the ancient Greek author Plutarch to an incident where Feverfew was administered to save the life of someone who had fallen from the Parthenon during its construction in the 5th century B.C.7. An alternative origin comes from the Greek word ‘parthena’, which means ‘virgin’, presumably because of the reputation of the herb as a medicinal antidote for women’s ailments. This therapeutic use is additionally reflected both in a Germanic name for the plant, ‘mutterkraut’ (meaning mother herb), and in the Welsh ‘feddygen fenyw’ (meaning woman’s plant)7. Feverfew has also been termed ‘Featherfew’, due to its feathery leaves4. Feverfew is a short, bushy, aromatic perennial with yellow-green leaves and flowers that resemble those of Chamomile (Matricaria recutita); comprising a single layer of white outer florets with a yellow centre4. Medicinally, Feverfew has a long tradition of use in folk medicine, especially among early European herbalists4. Since ancient times Feverfew has been prescribed for the treatment of a wide range of disorders including; rheumatism/arthritis, headache, toothache, earache, tinnitus, vertigo, dizziness, melancholy, nervous debility, the excessive use of opium, coughs and colds, fever, psoriasis, dermatitis, insect bites, worm infestation, asthma, allergies, stomach ache, atonic dyspepsia, wind, colic, constipation, nausea, spasms, swelling, menstrual disorders, threatened miscarriage, for aiding the ejection of afterbirth and stillbirths, for strengthening the womb, and for cleansing the kidneys and bladder4,7,8. Eclectic physicians recommended infusions of Feverfew in water and especially in alcohol. They regarded Feverfew as a tonic that influenced the entire gastrointestinal tract, increased appetite, improved digestion, promoted secretion, and acted upon the renal and cutaneous (skin) functions9. Moreover, infusions of Feverfew have been traditionally prescribed to purge choler (yellow bile), phlegm, and melancholy (black bile); three of the four humors of ancient and medieval physiology. When present in excess, choler was thought to cause anger and irritability, while excess phlegm was believed to cause lethargy and 3 passivity, and excess melancholy was thought to aggravate moodiness and sadness. Sixteenth century herbalist Nicholas Culpeper stated that, “the powder of the herb taken in wine, with some Oxymel, purges both choler and phlegm, and is available for those that are short-winded, and are troubled with melancholy and heaviness, or sadness of spirits”10. Elizabethan herbalist John Gerard echoed this sentiment, writing that “Feverfew dried and made into pouder, and two drams of it taken with hony or sweet wine, purgeth by siege melancholy and flegme; wherefore it is very good for them that are giddie in the head, or which have the turning called vertigo, that is, a swimming and turning in the head. Also it is good for such as be melancholike, sad, pensive, and without speech”11. Gerard also recommends Feverfew for the alleviation of St Anthony’s fire (a very painful burning sensation in the arms and legs caused by excessive exposure to ergotamines), and all inflammations and hot swellings7,11. Likewise, 1st century Greek physician, Dioscorides, prescribed Feverfew for “all hot inflammations” and to prevent or reduce fevers4. Consequently, Feverfew has been referred to as ‘medieval aspirin’4,7. Clinical Tip: For the management of fevers, a tincture combination of Feverfew, Echinacea (Echinacea angustifolia), and Cayenne (Capsicum annuum) has been recommended in North American herbal texts3. Traditional Applications of Feverfew in Europe and America4,5,7,8 Body System Traditional Use Cardiovascular System Cardiotonic activity Female Reproductive Emmenagogue activity, menstrual cramps, menstrual disorders, menstrual tonic System for strengthening the womb, morning sickness, threatened miscarriage Gastrointestinal System Atonic dyspepsia, bitter tonic activity, colic, constipation, intestinal parasites, nausea, poor appetite, stomach ache, wind Immune System Allergies, inflammations, insect bites, fever, worm infestation Integumentary System Dermatitis, psoriasis Musculoskeletal System Joint pain, rheumatism/arthritis, spasms, swelling Nervous System Dizziness, earache, headache, irritability, melancholy, nervous debility, the excessive use of opium, tinnitus, toothache, vertigo Renourinary System Cleansing the kidneys and bladder, kidney pain Respiratory System Asthma, coughs and colds The more recent surge of interest in Feverfew’s medicinal properties can be traced back to newspaper reports in the late 1970s, mainly emanating from Wales, that patients were successfully using the herb in the prophylaxis of both migraines and arthritis7. These observations were in line with previous historical texts. Eighteenth century herbalist John Hill reported of Feverfew that, “in the worst headache this herb exceeds whatever else is known”7. Furthermore, Culpeper advocated Feverfew’s topical benefit in head pain, stating that Feverfew “is very effectual for all pains in the head coming from a cold cause, the herb being bruised and applied to the crown of the head”10. Subsequently, Feverfew has become renowned for its ability to alleviate migraine headaches. Clinical Note: The first modern, public account of Feverfew’s use in migraine prevention appeared in 1978 in the British Health Magazine, Prevention. The story concerned a Welsh female patient who had suffered from severe migraines since 16 years of age. At 68 years of age, this woman took the advice of a friend, which was supposedly based on the recommendation of a traditional Welsh healer, and began ingesting three fresh leaves of Feverfew daily. After ten months her migraines ceased completely and did not return as long as she continued the Feverfew4. 4 Phytochemistry: The phytochemistry of Feverfew is well defined4. Feverfew contains many sesquiterpene lactones, with a high concentration of parthenolide (comprising up to 85% total sequiterpene content). There appears to be more parthenolide in the flower heads of Feverfew than in the leaves, and there is none present in the stems4,12. Parthenolide has displayed significant anti-inflammatory and anticancer activity in vitro and in vivo. Due to results from clinical trials, a minimum 0.2% parthenolide content is generally recommended for herbal medicines used in the prevention of migraine headaches. Although parthenolide is known as a key bioactive constituent of Feverfew, preclinical studies show that parthenolide is not solely responsible for Feverfew’s pharmacological activity and that other constituents play a significant role13,14,15,16,17. Both lipophilic compounds and hydrophilic compounds are thought to contribute to the bioactivity of Feverfew16,17. Further to these constituents, it has been ascertained that the flowering aerial parts of Feverfew contain approximately 0.02%-0.07%