ST. JOHN’S WORT

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Herbal Monograph

Herb:   ST. JOHN’S WORT   (Hypericum perforatum; Hypericaceae)

Other Names: hardhay, amber, goatweed, klamath weed, tipton weed    (2)

Character/Energetics: bitter, cool    (6)

bitter-sweet, cool, drying   (15)  

Meridians/Organs/Body Parts affected: liver, kidney, spleen, stomach    (6)

stomach, bladder, blood, liver and nerves    (14)

Part(s) used: aerial parts collected during flowering season and dried; whole fresh flowering plant.   (2)

Aerial portions    (6)

Identification & Harvesting: Golden yellow flowers in sparsely-blossomed terminal cymes; 5 petals and numerous stamens fused into 3 bundles; dark brown or black cylindrical seeds 1-3 mm long, covered in small warts.  Perennial with a long-lived fusiform branched root and rhizome.  Erect stem, reddish tinged, 3 feet high; leaves oblong, margined, opposite, translucent, sessile and often covered with black glands.  When squeezed, the flowers release a red-violet juice.  Cultivated all over the world in temperate zones.  Cut and gather at the start of flowering season and dry quickly, to preserve volatile constituents. (2)

Harvest in high summer.   (15)

Stem is angular, 1 to 1-1/2 foot high.  Leaves opposite, sessile, oval, oblong, with small black dots on the edges, and numerous transparent, round oil glands immersed in the surface.  The name perforatum is due to the number of small hole-like dots in the leaf.  Flowers are yellow.  Tastes aromatic, bitter and astringent.    (57)

Native to Europe and naturalized almost everywhere.    (61)

Active Constituents: Anthracene derivatives .1-.15% — naphthadihydrodianthrones, partic’ly hypericin, pseudohypericin; flavonoids 2-4% — chiefly hyperoside, quercitrin, rutin, isoquercitrin, also bioflavonoids incl. amentoflavone; xanthones incl. 1,3,6,7-tetrahydroxy-xanthone; acylphloroglucinols incl. hyperforin and to a lesser extent adhyperforin; volatile oils — chiefly aliphatic hydrocarbons incl. 2-methyloctane, undecane, dodecanol, mono- and sesquiterpenes incl. alpha-pinene, caryophyllene, 2-methyl-3-but-3-en-2-ol;  oligomeric procyanidins;  catechin tannins;  caffeic acid derivatives incl. chlorogenic acid.    (2)

Essential oil, hypericine (a glycoside that is a red pigment), a polyphenolic flavonoid derivative (hyperaside)   (6); glycosides, flavonoids, (inc. rutin), volatile oils, tannins, resins.  (15) 

                                                                                                                                                                                                                                                                                         

Actions:   Mild antidepressant, sedative and anxiolytic (reduces anxiety) actions observed; Antidepressant effect may originate with a mono-amine oxidase-inhibiting function, or perhaps inhibition of serotonin re-uptake.  Oily preparations demonstrate an anti-inflammatory action due to high flavonoid content.    (2)

Alterative, antispasmodic, anti-inflammatory, astringent, vulnerary  (6);

Primarily astringent; also alterative, aromatic, diuretic, nervine, sedative.    (14)

astringent, analgesic, anti-inflammatory, sedative, restorative tonic for the nervous system  (15)    

Slightly astringent, expectorant, diuretic.    (57)

Conditions & Uses: Use internally for depressive moods, skin inflammation, anxiety; use externally for mild burns or contusions.    (2)

Taken internally, St. John’s Wort is a pain relieving sedative used in the treatment of neuralgia, anxiety and nervous tension. Externally, it is a specific treatment for diseases directly affecting the spine. It is applied as a liniment or poultice for sciatica, neuralgia and rheumatic pains; and as a lotion to relieve the pain and inflammation of bruises, varicose veins and mild burns. St. John’s Wort oil is made by soaking the herb in olive oil and allowing it to stand in a warm place for a few days.     (6)

Internal uses — afterbirth pains, bedwetting, blood purifier, hysteria, muscular bruises and pains, spinal pains and tenderness:  tincture, fluid extract.  Coughs:  infusion*.  Irregular menstruation, uterine disorders:  infusion*, tincture, fluid extract, powder*.  Lung problems (expectorant):  infusion.

External uses — breast tumors, bruises, enlarged glands, swellings:  oil, salve, fomentation.

*Usually used in combination with other herbs when treating the indicated problem.

The tea is a good blood purifier and is used for boils, uterine pain, suppressed urine, diarrhea, dysentery and jaundice.  A small amount of aloe powder added to the tea will strongly influence the liver.  The tea can be taken for uterine cramping, insomnia, bedwetting and other nervous conditions.  The extracted oil makes a good external application for burns, wounds, bruises and other sensitive skin problems.  Steep the flowers in olive oil for two weeks, strain and apply topically for swollen breasts, hard tumors, wounds, ulcers and burns.    (14)

Aerial parts:  Taken internally, the aerial parts can lighten the mood and lift the spirits. They make a restorative nerve tonic, ideal for anxiety and irritability, especially during the menopause. They are also good for chronic, long-standing conditions where nervous exhaustion is a factor. They can relieve a variety of nerve pains, such as sciatica and neuralgia. Harvest in summer.

Flowering Tops:  Used to prepare St. John’s Wort oil, a blood-red infused oil made by steeping the flowers in cold-pressed safflower, walnut or sunflower oil in the sun for a few weeks. This can be used topically

for burns, inflammations (of the skin, muscles, and connective tissues), and neuralgia. Harvest in high summer.

For treating neuralgia:  repairs and restores the nervous system; anti-inflammatory. Take an infusion; apply the infused oil externally to the affected area. Add lavender and scullcap to the infusion as calming nervines.    

During Pregnancy & Childbirth: Perineal Tears  (Key symptoms: tears in the perineum during birth, which may require stitches). Tears in the perineum can be painful and slow to heal. These (St. John’s Wort, Pilewort, Comfrey) herbs also help bruising and soreness: St. John’s Wort: anti-inflammatory, healing, astringent. Apply the infused oil or add a strong infusion to a hipbath. Add lavender and marigold oils to infused oil, or add the dried leaves to infusions for baths.   (15)

Useful in coughs, colds, consumption, and all lung diseases generally.  Highly esteemed in affections of the urinary passages.  The fresh flowers infused in olive oil make a healing application to wounds, sores, ulcers, and swellings.    (57)

Used as a vulnerary in US in 19th century, esp. for lacerations involving damaged nerves; also as a diuretic, astringent and mild sedative.  Currently used to treat mild to moderate depression.  Externally, the oil is used to treat wounds, abrasions and first-degree burns.    (61)

Combinations: For treating neuralgia:  repairs and restores the nervous system; anti-inflammatory. Take an infusion of the flowering tops; apply the infused oil externally to the affected area. Add lavender and scullcap to the infusion as calming nervines.    (15)

Re: Perineal Tears (see text above)–Add lavender and marigold oils to infused oil, or add the dried leaves to infusions for baths.   (15)

During a transition from SSRI antidepressants to SJ’s W, it is possible to give kava kava to patients instead of prescription tranquilizers, but while it may help anxiety, it may also worsen depression.  Should only be done under a physician’s care.    (1b)

Precautions:   “We simply don’t know whether it’s safe to combine St. John’s Wort with any prescription antidepressant, including Tofranil and Prozac…. We think it may work like Prozac and other similar drugs by preventing the brain from reabsorbing the mood regulating chemical serotonin or by decreasing the sensitivity of serotonin receptors. It might act in some way on other neurohormonal mechanisms, which deal with the production and actions of various biochemicals affecting the nervous system.” (1)

No known hazards with designated dosages; however the tannin content can lead to digestive complaints such as fullness or constipation.  Photosensitization has been observed in animals following very large doses.    (2)

St. John’s Wort can cause dermatitis after taking it internally, then exposing the skin to the sun. Contact dermatitis can typically be caused if pruning or gathering the plant in moist but sunny conditions…. Toxicity possible in large amounts.    (15)

Three hypotheses concerning St.John’s Wort have been disproven:  1) it doesn’t behave like a monoamine oxidase inhibitor (MAOI) in the body; 2) it doesn’t behave like a selective serotonin reuptake inhibitor (SSRI);  3) hypericin is not the active constituent in mood-alteration activity.  But it does have weak MAOI activity in vitro, and thus has the potential to dangerously amplify the effects of MAOI antidepressants.  SJ’s W should not be taken concurrently with MAOI’s, but many patients have successfully switched to SJ’s W from Prozac or other SSRI’s, with no significant side effects; however it is a complex process and should be done gradually and under a physician’s care.    (1b)

Can cause hypertension, esp. if used with the common post-op pain reliever meperidine.    (1c)

Far fewer side effects than standard prescription meds.  May cause fair-complected people to have photodermatitis.    (61)

Interactions with Pharmaceutical Drugs: There are reports of increased serotonin levels in patients using selective serotonin reuptake inhibitors (e.g., sertraline) with St. John’s Wort. (88:44)

Evidence suggests that St. John’s Wort affects the hepatic cytochrome P450 system, increasing activity of its most abundant isozyme, CYP3A4, thereby possibly lowering the activity of simultaneously administered drugs that are known substrates for this isozyme, including nonsedating antihistamines, oral contraceptives, certain anti-retrovirals, antiepileptics, calcium channel blockers, cyclosporine, some chemotherapetics, macrolide antibiotics, and selected antifungals. (88:45,50)

Tincturing Process:

Applications:    Infusion:  steep 5-15 min.; 1 oz. as needed, up to 1 cup during the day.  Tincture:  10-20 drops as needed.  Fluid extract:  1/2-1 tsp as needed.  Powder:  5-10 #0 capsules (30-60 grains) as needed.    (14)

Aerial Parts:

            Infusion: Use for anxiety, nervous tension, irritability or emotional upsets, especially if associated with the menopause or premenstrual syndrome.    

            Tincture:  Take for at least two months for long-standing nervous tension leading to exhaustion and depression. For childhood bedwetting, give 5-10 drops at night.

Wash:  Use the infusion to bathe wounds, skin sores, and bruises.

 

            Flowering Tops:

            For treating neuralgia:  repairs and restores the nervous system; anti-inflammatory. Take an infusion; apply the infused oil externally to the affected area. Add lavender and scullcap to the infusion as calming nervines

Cream: Use for localized nerve pains, such as sciatica, sprains, and cramps, or to help relieve breast engorgement during lactation. Can also be used as an antiseptic and styptic on scrapes, sores, and ulcers.

            Infused Oil:  Use on burns (and sunburn) and muscle or joint inflammations including tennis elbow, neuralgia, and sciatica. Add a few drops of lavender oil for burns, or yarrow oil for joint inflammations. …and 

Re: Perineal Tears (see text above)–Add lavender and marigold oils to infused oil, or add the dried leaves to infusions for baths.   (15)

The fresh flowers infused in olive oil make a healing application to wounds, sores, ulcers, and swellings.    (57)

Divination:

Dosage:    Avg daily dose for internal use is 2-4 g herb, or standardized to .2-1 mg total hypericin.  For depressive moods, take for 4-6 weeks; if no improvement is noted, use another therapy.  Success rate is 60-80%    (2)

One to two teaspoons per cup of boiling water, taken two to three times daily. 

  Standard decoction or 3-9 gms.    (6)

  Tincture:   1-4 ml 3x daily  (8)   

                  10-20 drops as needed  (14)

      Take for at least two months for long-standing nervous tension leading to exhaustion and depression.  (15)

The infusion of an ounce to a pint of boiling water is taken in half-cup doses.  Liquid extract dose 1/2-1 drachm.    (57)

For products standardized to .3% hypericin, take 300 mg. 3 x daily.  Steep 1/2-1 tsp dried herb in a cup of hot water for 10-15 min.  Tincture 15-40 drops up to 3 x daily.    (61)

General Notes:  “For chilblains: boil the roots of tutsan and pour upon curds. Pound with old lard and apply as a plaster.” Remedy of the Physicians of Myddfai, Wales, 13th century.

It is said that St. John’s Wort takes its name from the Knights of St. John of Jerusalem, who used it to treat wounds on Crusade battlefields. It was also believed to dispel evil spirits–which is why the insane were often compelled to drink its infusions. Being yellow, the herb was associated with “choleric” humors and used for jaundice and hysteria. Old herbals often refer to tutsan (H. androsaemum), from the French toutsain or heal-all, which was also used to treat injuries and inflammations.  (15)

SJ’s W is popular for three reasons:  it’s just as effective as drugs for mild depression; it’s far less expensive than most antidepressants; and it has very few side effects.    (1b)

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References:

(1) Joniris Herbals Research Data, “St. John’s Wort” file “Herb/Drug Interactions” by Varro Tyler, pg. 93-94 Prevention  9/98

(1b) Joniris Herbals Research Data, “Herbs and antidepressant drugs can cross paths, with careful use” by Robert Rountree, MD, Herbs for Health, Sept/Oct ’99, p. 32, et al.

(1c) Joniris Herbals Research Data, “Body News” by Dianne Partie Lange, Allure, Feb. ’99, p. 70

(2)  PDR for Herbal Medicines (Medical Economics Co., 1998), pgs. 905-06

(6) Planetary Herbology by Michael Tierra, C.A., N.D., pgs. 199-200

(8) The New Holistic Herbal by David Hoffman., pg. 235

(14) Natural Healing With Herbs by Humbart Santillo BS, MH, pgs. 180-81

(15) The Complete Medicinal Herbal by Penelope Ody, pgs. 68, 127, 132-33, 170-71

(57) Potter’s Cyclopaedia by R.C. Wren, F.L.S., p. 331

(61) 101 Medicinal Herbs by Steven Foster, pgs. 192-93

(88) HerbalGram 49 (2000)— Possible Interactions With Pharmaceutical Drugs, pg. 62::::::

—(44) Lantz MS, Buchalter E, Giambanco V. St. John’s Wort and antidepressant drug interactions in the elderly.  J Geriatr Psychiatry Neurol. 1999; 12:7-10.—(45) Roby CA, Kantor , Anderson GD, et all. St. John’s wort impact on CYP3A4 activity [poster presentation]. Boca Raton FL: 39th annual meeting of the New Clinical Drug Evaluation Unit Program; 1999 June 1-4. (50) Roby CA< Anderson GD Kantor Ga, et all, St. John’s Wort: Effect on CYP3A4 activity. Clin Pharmacol Ther. 2000;67:451-457.