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Family Boraginaceae
Komprey
Symphytum officinale L.

COMFREY

Scientific names  Common names 
Consolida major Garsault  [Invalid] Komprey (Tag.)
Consolida major Gilib.  [Invalid] Black root (Engl.) 
Symphytum officinale L. Blackwort (Engl.)
Symphytum peregrinum Ledeb. Common comfrey (Engl.)
  Knitbone (Engl.)
  Nipbone (Engl.)
  Slippery root (Engl.)  
  Symphytum radix (Engl.)
Symphytum officinale L. is an accepted name The Plant List

Other vernacular names
GERMANY: Schwarzwurz.
HINDI: Sankuutan.
SPANISH: Conswelda, Sinfito.

General info
- An ancient herb known since 400 B.C., used by the Greeks to treat bronchial problems, wound healing and mending of broken bones. The name "Comfrey" is a corruption of con firma, the uniting of bones.

Botany
Symphytum officinale is a hardy, leafy perennial. Rhizomes are thick, black on the outside and white inside, containing a mucilaginous juice. Leaves are entire, lanceolate to ovate-lanceolate, up to 10 inches long, deep green and hairy. Flowers are variable in color, blue, yellow or white, borne on short curved racemes, with five-lobed calyx and five stamens. Fruits are nutlets.

Distribution

- Introduced in the Philippines in the late 60s.
- Cultivated.
- Propagated by seed.

Toxicity Concerns and Safety Studies
Hepatotoxicity: Since the late 70's, subject of persisting concerns and debate on certain alkaloid contents that may cause liver damage, veno-occlusive liver disease, ascites and hepatic fibrosis.
• Advice is given against use of comfrey as salad green or tea.
• In July 2001, the US FDA took steps to stop the marketing of comfrey as a dietary supplement. (Source)

Possibly safe when used topically on unbroken skin in small amounts for less than 10 days.
• Use should be limited to 4 to 6 weeks per year at less than 100 mcg of unsaturated pyrrolizidine alkaloids. However, with toxicity concerns, it is advisable to seek alternatives.
Avoid oral use: Probably not safe when taken orally. Potential for liver toxicity.
• Contraindicated in pregnancy and lactation.

Interactions: Hepatotoxic drugs interacts with comfrey. Taking comfrey with drugs that might harm the liver can increase the risk of liver damage. Medications that increase breakdown of medications by the liver (cytochrome P450 3A4 (CYP3A4) inducers) interacts with comfrey. (10)

Constituents
• Considered antitussive, expectorant, haemostatic, vulnerary, homepathy.
• Contains allantoin, between 0.6 to 0.8 % to which is attributed its wound-healing properties.
• The healing constituent is allantoin. Ingredients may be steeped or dissolved in hot water; boiling should be avoided as this may cause the breakdown of allantoin.
• Phenolic acids: rosmarinic, chloogenic, caffeic and lithospermic acids.
• Contains potentially hepatotoxic compounds: pyrrolizidine alkaloids, including heliosupine, echimidine, heliosuipine, lycopsamine, symphytine and cynoglossine. The alkaloid concentration is highest in small, young leaves. Roots also contain high levels of these compounds.

• Study of hydroalcohlic extracts identified bioactive compounds viz., tannins, terpenoids, sterols/triterpenoids, flavonoids, amino acids, reducing agents, flavones, saponins, and alkaloids. (11)
• Study of ethanolic and aqueous extracts yielded total phenolic contents of 116.93 mg GAE/g and 99.49 mg GAE/g, respectively. (see study below) (12)
Study isolated three pyrrolizidine alkaloids from the roots viz., symlandine, symphytine, and echimidine. (20)

Properties
· Considered antitussive, expectorant, haemostatic, vulnerary.
- The healing constituent is allantoin. Ingredients may be steeped or dissolved in hot water; boiling should be avoided as this may cause the breakdown of allantoin.

Parts utilized
Leaves , flowers and roots.

Uses
Folkloric
· Decoction of leaves used for a variety of illnesses: Asthma, cough, ulcers, constipation, hypertension.
· Poultice of fresh leaves used for sprains and fractures, inflammatory swelling, external wounds, sores, athlete's foot, burns, insect bites, and abscesses.
· Used for excessive menstrual flow, cancer, angina, gums disease
· Juice of leaves used for a variety of skin ailments and wounds healing; apply three times daily.
· Decoction of tea as a sleep-aid.
· Oil and ointment used to treat acne, boils, and psoriasis.
· Roots and leaves used for broken bones and wounds.
· In Ayurveda, used for peptic ulcer.
· In Polish pharmacopoeia, as Radix symphyti, recommended as expectorant, especially for children.


Studies
Antiproliferative:
Study evaluated the effects of chronic oral treatment of wistar rats with 10% comfrey ethanolic extract in a RHM (resistant hepatocyte model). Results showed the oral treatment of rats with 10% alcoholic extract reduced cell proliferation in the RHM model. (4)
· Mutagenic Effects:
Mutagenic effects of aqueous extracts of Symphytum officinale L. and of its alkaloidal fractions – Aqueous solutions of three alkaloid fractions were studied for antimitotic and mutagenic activity. Results showed mutagenic activity to be induced by lasiocarpine, by alkaloidal fraction 1 and by diluted infusions from Radix symphyti. Fraction III had only antimitotic effect. (1)
Herbal Tea Concerns / Pyrrolizidine Alkaloids / Hepatotoxicity: Analysis of herbal teas made from the leaves of comfrey (Symphytum officinale): reduction of N-oxides results in order of magnitude increases in the measurable concentration of pyrrolizidine alkaloids: The concentration of symphytine and echimidine varied considerably in different tea leaves preparation. Since alklaloids are known to be hepatotoxic, and because the concentration of pyrrolizidine alkaloids may be underestimated, consumption of comfrey herbal teas, in native or packaged forms, is not advised. (8)
Proliferative / Antimitotic:
Results indicate crude extract and its proteic fraction stimulate invivo proliferation of studied neoplastic cells and and antimitotic effect on human T lymphocytes in vitro stimulated with PHA.
(6)
Non-mutagenic: Study of the comfrey root fluid extract contained in Kytta-Salbe (R) f and Kutta Plasma (R) f was not mutagenic in bacterial reverse mutation assay.
(7)
Safety Assessment: Study highlighted significant differences in the reported identification of pyrrolizidine alkaloids from the same plant species, and demonstrates the inadequacy of some procedures to include N-oxides in the assessment of pyrrolizidine alkaloid-related safety of food and herbal products.
(8)
Antioxidant / Proliferative Effect: Study in Swiss albino mice evaluated the antioxidant and proliferative effects of aqueous and ethanolic extracts of Symphytum officinale. An ethanolic extract showed stronger radical scavenging activity against DPPH radical (IC50 39.97 µg/ml) compared with an aqueous extract (IC50 96.21 µg/ml). On cell proliferation assay evaluated on 3T3 Swiss albino mouse fibroblast cells by MTT and NRU assay, both extracts showed proliferative activity.
(12)
Liver Effects / Leaves: Study investigated the effect of aqueous extract of Symphytum officinale leaf on the liver of adult wistar rats. Doses of 0.4 ml, 0.6 ml, and 0.8 ml of aqueous extract were given orally for 28 days. Results showed consumption of Symphytum officinale in low dose or small amount had no effect on the histological appearance of the liver. However, high or excessive doses induced mild distortion of histological liver appearance, including mild central vein hypertrophy, increased cellularity and periportal fibrosis of liver cells. (13)

Cytostatic Activity on HeLa Cells:
Study investigated the cytostatic activity of total plant extracts of HeLa cells culture. Results suggest in vitro treatment of HeLa neoplastic cells with the concentrated extracts showed a mitoinhibitory effect with statistical and cytostatical significant amplitude. (15)
Fracture Treatment:
Report presents four cases of patients with bone fractures, treated with the aid of Homeopathic Remedy Symphytum officinale after proper alignment of the bone fragments. Although one case showed severely comminuted fracture and two showed poor compliance to immobilization, result of treatment was excellent, clinically and radiologically. Results suggest Symphytum can accelerate solid healing of the fractured bones. (16)
Adverse Male Fertility Effects / Toxic Testicular Effects:
Study evaluated the effect of aqueous extract of leaves of Symphytum officinale on male fertility in Wistar rats. Findings show increased dose of aqueous extract of leaves led to damage in testicular epithelium and adverse effect on sperm quality. Results showed toxic effects in testicular morphology of the rats. (17)
Study on Carcinogenic Activity:
Study evaluated the carcinogenicity of S. officinale in inbred ACI rats fed comfrey leaves for 480-600 days and comfrey roots for varying lengths of time. Hepatocellular adenomas were induced in all experimental groups. Hemangioendothelial sarcoma of the liver was infrequently induced. (18)
Anti-Inflammatory / Roots:
Study evaluated the anti-inflammatory effect of methanolic extract of roots of Symphytum officinale in an acute model of inflammation using egg white-induced edema in Wistar albino rats. Results showed oral administration of the extract significantly (p<0.05, p<0.01) inhibited raw egg albumin-induced rat paw edema. Maximum inhibitory effect was observed at 750 mg/kg. (19)
Three Pyrrolizidine Alkaloids / Roots:
Study isolated three pyrrolizidine alkaloids from the roots: symlandine, symphytine, and echimidine. (20)
Ointment Treatment for Subacute Low Back Pain:
Study evaluated the effect of a phytotherapic ointment of Symphytum officinale (PSO) on moderate physical exertion on sedentary subjects with subacute low back pain. PSO ointment treatment provided antalgic and emotional protection in treated subjects. Results suggest a potential for the PSO ointment as a form of pain therapy and antalgic protection in patients with low back pain during rest and under moderate exercise conditions. (21)
Treatment of Pressure Ulcers: An open, prospective study evaluated 161 patients with 198 stage II or III decubitus ulcers with topical preparation of symphytum herb extract cream. Efficacy of symphytum herb extract treatment was surprisingly good. Over a treatment duration of 25-30 days, an 89.2% reduction of total decubitus area was observed, with 88% reduction of pressure ulcer depth. (22)
Ointment for Treatment of Ankle Injuries: In a placebo-controlled clinical study, a statistically and clinically significant superiority of a comfrey extract versus placebo was demonstrated for the treatment of ankle distortions
using tonometrically registered pain variables as target criteriia. (23)

Availability
- Wildcrafted
- Ointments
, root and leaf extracts in the cybermarket.

Last Update October 2016

IMAGE SOURCE: / Photograph / /Steve Hurst @ NUTRAWIKI / click on image to go to source page / NUTRAWIKI
OTHER IMAGE SOURCE: / Seeds /Steve Hurst @ USDA-NRCS PLANTS Database / USDA
OTHER IMAGE SOURCE: / Illustration / Britton, N.L., and A. Brown. 1913. An illustrated flora of the northern United States, Canada and the British Possessions. 3 vols. Charles Scribner's Sons, New York. Vol. 3: 92. Provided by Kentucky Native Plant Society. / USDA

Additional Sources and Suggested Readings
(1)
Mutagenic effects of aqueous extracts of Symphytum officinale L. and of its alkaloidal fractions / Mirosawa Fumanowa et al / Journal of Applied Toxicology • Volume 3 Issue 3, Pages 127 - 130 / DOI 10.1002/jat.2550030304
(2)
COMFREY
(3)
Analysis of herbal teas made from the leaves of comfrey (Symphytum officinale): reduction of N-oxides results in order of magnitude increases in the measurable concentration of pyrrolizidine alkaloids / Nicholas H Oberlies et al / Public Health Nutrition: 7(7), 919–924 / DOI: 10.1079/PHN2004624
(4)
Comfrey (Symphytum Officinale. L.) and Experimental Hepatic Carcinogenesis: A Short-term Carcinogenesis Model Study / Maria Fernanda Pereira Lavieri Gomes et al / Evid Based Complement Alternat Med. 2010 Jun; 7(2): 197–202 / doi:10.1093/ecam/nem172
(5)
Notes on poisoning: Symphytum officinale / Canadian Biodiversity Information Facility
(6)
Action of some proteic and carbohydrate components of Symphytum officinale upon normal and neoplastic cells
/ Olinescu A et al / Arch Microbiol Immunol. 1993 Apr-Jun;52(2):73-80.
(7)
Absence of mutagenic effects of a particular Symphytum officinale L. liquid extract in the bacterial reverse mutation assay./ Benedek B et al / Phytother Res. 2009 Oct 13
(8)
Safety assessment of food and herbal products containing hepatotoxic pyrrolizidine alkaloids: interlaboratory consistency and the importance of N-oxide determination / Cao Y et al / Phytochem Anal. 2008 Nov;19(6):526-33.

(9)
Symphytum officinale / Synonyms / The Plant List
(10)
Comfrey: Interactions / WebMD
(11)
PHYTOCHEMICAL STUDY OF SOME SYMPHYTUM OFFICINALIS EXTRACTS CONCENTRATED BY MEMBRANOUS PROCEDURES / Elena NEAGU, Gabriela PĂUN, Lucian Gabriel RADU / U.P.B. Sci. Bull., Series B, Vol. 73, Iss. 3, 2011
(12)
Antioxidant and proliferative effects of aqueous and ethanolic extracts of Symphytum officinale on 3T3 Swiss albino mouse fibroblast cell line / Fulya Ustun Alkan , Ceren Anlas, Oya Ustuner, Tulay Bakırel and Ataman Bilge Sari / Asian Journal of Plant Science and Research, 2014, 4(4):62-68
(13)
THE EFFECT OF AQUEOUS LEAF EXTRACT OF SYMPHYTUM OFFICINALE (COMMON COMFREY) ON THE LIVER OF ADULT WISTAR RATS / Ezejindu D.N., Udemezue O.O., Anyabolu A.E., Chukwujekwu I.E., Anike L.C., Obialor D.C., Akingboye A.J. and Ihim A.C. / International Journal of Innovative Research and Review, 2015 Vol. 3 (2) April-June, pp.76-82
(14)
SYMPHYTUM OFFICINALE AND ARTHRITIS / greenmedicineedu
(15)
Concentration of Symphytum officinale extracts with cytostatic activity by tangential flow ultrafiltration / GABRIELA PAUN ROMAN, ELENA NEAGU, VERONICA MOROEANU, GABRIEL LUCIAN RADU / Roumanian Biotechnological Letters Vol. 13, No. 6, 2008, pp. 4008-4013
(16)
Fracture treatment with the aid of the homeopathic remedy Symphytum officinale. A report of four cases /
Dionysis Tsintzas, George Vithoulkas / OAT
(17)
Testicular Cell Devastation in Wistar Rats on Administration of Aqueous Leaves Extract of Symphytum officinale / Ezejindu DN*,Akingboye AJ, Chukwujekwu IE, Ihim AC, Ndukwe GU / UKJPB / DOI: http://dx.doi.org/10.20510/ukjpb/4/i4/113988
(18)
Carcinogenic Activity of Symphytum officinale / Iwao Hirono, Hideki Mori and Masanobu Haga / JNCI: Jnl of National Cancer Institute Volume 61, Issue 3, Pp. 865-869.
(19)
Anti Inflammatory Activity of Symphytum Officinale Linn Root on Wistar Albino Rats / D. Yashwanth Kumar*, D.S.S.N. Neelima, Pradeep Kumar Choda, Namani Srilatha / Pharma Research Library
(20)
Isolation of Symlandine from the Roots of Common Comfrey (Symphytum officinale) Using Countercurrent Chromatography / Nam-Cheol Kim, Nicholas H. Oberlies, Dolores R. Brine, Robert W. Handy, Mansukh C. Wani,* and Monroe E. Wall / J. Nat. Prod., 2001, 64 (2), pp 251–253 / DOI: 10.1021/np0004653
(21)
Influence of moderate physical exertion on subacute low back pain, after Symphytum officinale ointment treatment / Jurcău, Ramona; Jurcău, Ioana / Palestrica of the Third Millennium Civilization & Sport . Jul-Sep 2013, Vol. 14 Issue 3, p175-180.
(22)
Efficacy and safety of topical Symphytum cream in the treatment of pressure ulcers. / Stepan J, Ehrlichova J, Hladikova M. / Zeitschrift fur Gerontologie und Geriatrie. 2014;47(3):228-235.
(23)
Comfrey Ointment Effective in Treating Ankle Injuries
/ Raymond Khoury / Journal of the Australian Traditional-Medicine Society, June 2005, Volume 11, Issue 2

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