Topical application appears to be safe but further rigorous assessment is needed. Individual clinical trials showed evidence of benefit for ankle distortion, back pain, abrasion wounds and osteoarthritis. The majority of included trials had an overall unclear risk of bias due to poor quality of reporting. Of 1348 identified records, 64 full texts were screened for inclusion and 26 were included in the review - 13 RCTs, 5 non-randomised controlled trials and 8 observational studies evaluating treatments for ankle distortion, back pain, abrasion wounds, venous leg ulcers and osteoarthritis. Studies were grouped and summarised according to the type of indication treated. Observational studies were included only in the assessment of adverse events. Randomised or non-randomised clinical trials assessing the external use of comfrey for any indication were included and methodological and reporting quality were assessed. Six bibliographic databases, 10 grey literature databases and nine trials registers were searched plus reference lists of included studies and a descriptive overview of comfrey. Traditional practice suggests comfrey can be used to treat musculoskeletal disorders, wounds and various other conditions however a full and critical coverage of the evidence base has not yet been undertaken.Ī critical scoping review was undertaken. Use on dirty skin or deep wounds (surface may heal too fast trapping dirt and pus).External preparations of the herb comfrey (most commonly Symphytum officinale L.) are widely available for over-the-counter, practitioner and healthcare professional usage. The plant has centuries of use with beneficial results.Ĭontraindications: Internal use in liver disease, pregnancy & lactation, or in infants. Toxicity reports are based on isolated compounds, not on the whole plant usage. Note: The current debate about whether to use Symphytum internally is due to concern over the pyrrolizidine alkaloids, specifically the echimidine alkaloid found primarily in the root. Toxicity: Alkaloids have been shown to cause veno-occlusive disease of the liver (one documented human case and in rats). If using for longer than 2 months test liver enzymes and question whether this is the best herb to use. Note: Short-term dosing (2-3 weeks on and 2-3 weeks off – repeat as needed). Pharmacy: Infusion (leaves) 5 g/cup, TID. Decoction: 5 g/cup, TID. Cold extraction (mucilage). Tincture: (1:5, 25%), 2-4 ml TID. Fluid extract: (1:1, 25%) 1-3 ml TID. Ointment, Cream, Lotion, Fomentation, Compresses, Poultices, Washes, Baths. Silicic acid helps preserve elasticity of connective tissue, controls Ca+ absorption and is needed for bone and cartilage formation.Pyrrolizidine alkaloids are hepato-toxic and carcinogenic.Allantoin promotes wound healing through cell proliferation and is anti-inflammatory.Phenolic acid rosmarinic is anti-inflammatory.Bronchial irritation and irritated coughs with hemoptysis respond well. External use of Symphytum is well indicated for a variety of conditions such as sore muscles, bone fractures, sprains, ligament tears and any damage to aching joints. The astringent action of Symphytum also reduces hemorrhage associated with uclers and colitis. These conditions respond to the demulcent, vulnerary, astringent, antihemorrhagic, and anti-inflammatory properties of the plant. Medicinal use: Internal use of Symphytum is indicated in the treatment of diarrhea and dysentery, and shallow G.I. Medicinal actions: Anti-hemorrhagic, anti-inflammatory, astringent, expectorant, anti-rheumatic, cell-proliferant, vulnerary, demulcent, hemostatic, cell proliferant (root), wound/tissue healer, bone healer Symphytum officinalis Common name: ComfreyĬonstituents: Alkaloid (pyrrolizidine) (root only), mucilage, gum, tannin, triterpenes (sitosterols, stigmasterol, steroidal saponins), silicic acid, phenolic acid (caffeic, rosmarinic, chlorogenic), allantoin, asparagine, choline, chlorophyll (higher in leaves, Ca, K+, P, trace minerals, vitamins A and C).
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