• Akao, T., Yoshino, T., Kobashi, K., and Hattori, M. Evaluation of salicin as an antipyretic prodrug that does not cause gastric injury. Planta Med 2002;68(8):714-718. View abstract.
  • Black A, Künzel O, Chrubasik S, and et al. Economics of using willow bark extract in outpatient treatment of low back pain . 8th Annual Symposium on Complementary Health Care, 6th-8th December 2001 2001.
  • Cameron, M., Gagnier, J. J., Little, C. V., Parsons, T. J., Blumle, A., and Chrubasik, S. Evidence of effectiveness of herbal medicinal products in the treatment of arthritis. Part I: Osteoarthritis. Phytother.Res 2009;23(11):1497-1515. View abstract.
  • Chrubasik, J. E., Roufogalis, B. D., and Chrubasik, S. Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res 2007;21(7):675-683. View abstract.
  • Chrubasik, S., Kunzel, O., Black, A., Conradt, C., and Kerschbaumer, F. Potential economic impact of using a proprietary willow bark extract in outpatient treatment of low back pain: an open non-randomized study. Phytomedicine 2001;8(4):241-251. View abstract.
  • Clauson, K. A., Santamarina, M. L., Buettner, C. M., and Cauffield, J. S. Evaluation of presence of aspirin-related warnings with willow bark. Ann Pharmacother. 2005;39(7-8):1234-1237. View abstract.
  • Dabrowska-Zamojcin EI, Glinko A, Samochowiec L, and et al. Willow bark extract and aspirin, their potential for gastric injury in mice and other toxicity aspects. 8th Annual Symposium on Complementary Health Care, 6th-8th December 2001 2001.
  • Ernst, E. and Chrubasik, S. Phyto-anti-inflammatories. A systematic review of randomized, placebo-controlled, double-blind trials. Rheum.Dis Clin North Am 2000;26(1):13-27, vii. View abstract.
  • Gagnier JJ, VanTulder MW, Berman B, and et al. Botanical medicine for low back pain: a systematic review . 9th Annual Symposium on Complementary Health Care, December 4th-6th, Exter, UK 2002.
  • Gagnier, J. J., van Tulder, M., Berman, B., and Bombardier, C. Herbal medicine for low back pain. Cochrane.Database.Syst.Rev. 2006;(2):CD004504. View abstract.
  • Hyson MI. Anticephalgic photoprotective premedicated mask. A report of a successful double-blind placebo-controlled study of a new treatment for headaches with associated frontalis pain and photophobia. Headache 1998;38:475-477.
  • Kammerer, B., Kahlich, R., Biegert, C., Gleiter, C. H., and Heide, L. HPLC-MS/MS analysis of willow bark extracts contained in pharmaceutical preparations. Phytochem Anal. 2005;16(6):470-478. View abstract.
  • Khayyal, M. T., El Ghazaly, M. A., Abdallah, D. M., Okpanyi, S. N., Kelber, O., and Weiser, D. Mechanisms involved in the anti-inflammatory effect of a standardized willow bark extract. Arzneimittelforschung 2005;55(11):677-687. View abstract.
  • Levesque, H. and Lafont, O. . Rev Med Interne 2000;21 Suppl 1:8s-17s. View abstract.
  • Little CV, Parsons T, and Logan S. Herbal therapy for treating osteoarthritis. The Cochrane Library 2002;1.
  • Loniewski I, Glinko A, and Samochowiec L. Standardised willow bark extract: a potent anti-inflammatory drug . 8th Annual Symposium on Complementary Health Care, 6th-8th December 2001 2001.
  • Marson, P. and Pasero, G. . Reumatismo. 2006;58(1):66-75. View abstract.
  • Meier B, Shao Y, Julkunen-Tiitto R, and et al. A chemotaxonomic survey of phenolic compounds in Swiss willow species. Planta Medica 1992;58(suppl 1):A698.
  • Schaffner W. Eidenrinde-ein antiarrheumatikum der modernen Phytotherapie? 1997;125-127.
  • Steinegger, E. and Hovel, H. . Pharm Acta Helv. 1972;47(3):222-234. View abstract.
  • Sweeney, K. R., Chapron, D. J., Brandt, J. L., Gomolin, I. H., Feig, P. U., and Kramer, P. A. Toxic interaction between acetazolamide and salicylate: case reports and a pharmacokinetic explanation. Clin Pharmacol Ther 1986;40(5):518-524. View abstract.
  • Vane, J. R. The fight against rheumatism: from willow bark to COX-1 sparing drugs. J Physiol Pharmacol 2000;51(4 Pt 1):573-586. View abstract.
  • Werner G, Marz RW, and Schremmer D. Assalix for chronic lower back pain and arthralgia: interim analysis of a post marketing surveillance study. 8th Annual Symposium on Complementary Health Care, 6th – 8th December 2001 2001.
  • <p>Kenstaviciene P, Nenortiene P, Kiliuviene G, Zevzikovas A, Lukosius A, Kazlauskiene D. Application of high-performance liquid chromatography for research of salicin in bark of different varieties of Salix. Medicina (Kaunas). 2009;45(8):644-51.</p> View abstract.
  • <p>Little CV, Parsons T. Herbal therapy for treating osteoarthritis. Cochrane Database Syst Rev. 2001;(1):CD002947.</p> View abstract.
  • <p>Moro PA, Flacco V, Cassetti F, Clementi V, Colombo ML, Chiesa GM, Menniti-Ippolito F, Raschetti R, Santuccio C. Hypovolemic shock due to severe gastrointestinal bleeding in a child taking an herbal syrup. Ann Ist Super Sanita. 2011;47(3):278-83.</p> View abstract.
  • <p>Nahrstedt A, Schmidt M, Jäggi R, Metz J, Khayyal MT. Willow bark extract: the contribution of polyphenols to the overall effect. Wien Med Wochenschr. 2007;157(13-14):348-51.</p> View abstract.
  • <p>Vlachojannis JE, Cameron M, Chrubasik S. A systematic review on the effectiveness of willow bark for musculoskeletal pain. Phytother Res. 2009 Jul;23(7):897-900.</p> View abstract.
  • Andreev E, Koopman M, Arisz L. A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible? J Intern Med 1999;246:247-52. View abstract.
  • Beer AM, Wegener T. Willow bark extract (Salicis cortex) for gonarthrosis and coxarthrosis–results of a cohort study with a control group. Phytomedicine. 2008 Nov;15(11):907-13. View abstract.
  • Biegert C, Wagner I, Ludtke R, et al. Efficacy and safety of willow bark extract in the treatment of osteoarthritis and rheumatoid arthritis: results of 2 randomized double-blind controlled trials. J Rheumatol 2004;31:2121-30. View abstract.
  • Boullata JI, McDonnell PJ, Oliva CD. Anaphylactic reaction to a dietary supplement containing willow bark. Ann Pharmacother 2003;37:832-5.. View abstract.
  • Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med 2000;109:9-14. View abstract.
  • Chrubasik S, Künzel O, Model A, and et al. Assalix&reg; vs. Vioxx&reg; for low back pain – a randomised open controlled study. 8th Annual Symposium on Complementary Health Care, 6th – 8th December 2001 2001.
  • Chrubasik S, Kunzel O, Model A, et al. Treatment of low back pain with a herbal or synthetic anti-rheumatic: a randomized controlled study. Willow bark extract for low back pain. Rheumatology (Oxford) 2001;40:1388-93. View abstract.
  • Clark JH, Wilson WG. A 16-day-old breast-fed infant with metabolic acidosis caused by salicylate. Clin Pediatr (Phila) 1981;20:53-4. View abstract.
  • Coffey CS, Steiner D, Baker BA, Allison DB. A randomized double-blind placebo-controlled clinical trial of a product containing ephedrine, caffeine, and other ingredients from herbal sources for treatment of overweight and obesity in the absence of lifestyle treatment. Int J Obes Relat Metab Disord 2004;28:1411-9. View abstract.
  • D’Agati V. Does aspirin cause acute or chronic renal failure in experimental animals and in humans? Am J Kidney Dis 1996;28:S24-9. View abstract.
  • Dulloo AG, Miller DS. Ephedrine, caffeine and aspirin: “over-the-counter” drugs that interact to stimulate thermogenesis in the obese. Nutrition 1989;5:7-9.
  • Dulloo AG, Miller DS. Aspirin as a promoter of ephedrine-induced thermogenesis: potential use in the treatment of obesity. Am J Clin Nutr 1987;45:564-9. View abstract.
  • Fiebich BL, Appel K. Anti-inflammatory effects of willow bark extract. Clin Pharmacol Ther 2003;74:96. View abstract.
  • Fiebich BL, Chrubasik S. Effects of an ethanolic salix extract on the release of selected inflammatory mediators in vitro. Phytomedicine 2004;11:135-8. View abstract.
  • Food and Drug Administration, HHS. Final rule declaring dietary supplements containing ephedrine alkaloids adulterated because they present an unreasonable risk; Final rule. Fed Regist 2004;69:6787-6854. View abstract.
  • Food and Drug Administration, HHS. Labeling for oral and rectal over-the-counter drug products containing aspirin and nonaspirin salicylates; Reye’s Syndrome warning. Final rule. Fed Regist 2003;68:18861-9. View abstract.
  • Gagnier JJ, van Tulder MW, Berman B, Bombardier C. Herbal medicine for low back pain. A Cochrane review. Spine 2007;32:82-92. View abstract.
  • Horton TJ, Geissler CA. Aspirin potentiates the effect of ephedrine on the thermogenic response to a meal in obese but not lean women. Int J Obes 1991;15:359-66. View abstract.
  • Krivoy N, Pavlotzky E, Chrubasik S, et al. Effect of salicis cortex extract on human platelet aggregation. Planta Med 2001;67:209-12. View abstract.
  • Mills SY, Jacoby RK, Chacksfield M, Willoughby M. Effect of a proprietary herbal medicine on the relief of chronic arthritic pain: a double-blind study. Br J Rheumatol 1996;35:874-8. View abstract.
  • Nieman DC, Shanely RA, Luo B, Dew D, Meaney MP, Sha W. A commercialized dietary supplement alleviates joint pain in community adults: a double-blind, placebo-controlled community trial. Nutr J 2013;12(1):154. View abstract.
  • Schmid B, Kotter I, Heide L. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Eur J Clin Pharmacol. 2001;57:387-91. View abstract.
  • Schmid B, Ludtke R, Selbmann HK, et al. Efficacy and tolerability of a standardized willow bark extract in patients with osteoarthritis: randomized placebo-controlled, double blind clinical trial. Phytother Res 2001;15:344-50. View abstract.
  • Schwarz A. Beethoven’s renal disease based on his autopsy: a case of papillary necrosis. Am J Kidney Dis 1993;21:643-52. View abstract.
  • Uehleke B, Müller J, Stange R, Kelber O, Melzer J. Willow bark extract STW 33-I in the long-term treatment of outpatients with rheumatic pain mainly osteoarthritis or back pain. Phytomedicine. 2013 Aug 15;20(11):980-4. View abstract.
  • Unsworth J, d’Assis-Fonseca A, Beswick DT, Blake DR. Serum salicylate levels in a breast fed infant. Ann Rheum Dis 1987;46:638-9. View abstract.
  • Wagner I, Greim C, Laufer S, et al. Influence of willow bark extract on cyclooxygenase activity and on tumor necrosis factor alpha or interleukin 1 beta release in vitro and ex vivo. Clin Pharmacol Ther 2003;73:272-4. View abstract.
  • Wuthold K, Germann I, Roos G, et al. Thin-layer chromatography and multivariate data analysis of willow bark extracts. J Chromatogr Sci. 2004;42(6):306-9. View abstract.

Willow bark

Willow bark is a herbal preparation that’s available over the counter in the form of tablets. Its active ingredient, salicin, reduces the production of pain-inducing chemicals in your nerves. Limited evidence suggests that willow bark may have a moderate effect in treating pain caused by osteoarthritis and rheumatoid arthritis. In the single study testing it against a non-steroidal anti-inflammatory drug (NSAID) for osteoarthritis, it wasn’t as effective for pain relief.

  • Family: Herbal medicine of the willow (Salicaceae) family
  • Scientific name: Willow
  • Other names: Salix spp., basket willow, bay willow, beta-salicin, black willow, brittle willow, crack willow, daphne willow, populin, purple willow, salicin, salicortin, salicoylsalicin, salicyl alcohol, salicylate, salicylic acid, salicyluric acid, salidroside, saligenin, salipurposide, Salix alba, Salix daphnoides, Salix fragilis L., Salix pentandra, Salix purpurea, white willow, white willow bark, willow tree, willowprin

The bark of some species of Salix trees has been used for treating inflammatory and arthritis-related conditions since ancient times. Extracts from the following species of Salix trees have been used as sources of willow:

  • Salix purpurea (purple willow)
  • Salix fragilis (crack willow)
  • Salix alba (white willow)
  • Salix daphnoides (violet willow)
  • Salix pentandra (bay willow).

These Salix species are also considered the natural source of acetylsalicylic acid, also known as aspirin. You can buy willow bark capsules from UK-based internet sites.

White Willow

Famous as the original source of salicylic acid (the precursor of aspirin), white willow and several closely related species have been used for thousands of years to relieve joint pain and manage fevers. White willow is the original Aspirin, and has the same indications as its synthetic counterpart. Where these two compounds differ though, is that white willow is milder on the stomach lining than is Aspirin and has a reduced anticoagulant action. It has a very bitter and astringent flavour, especially when fresh.

An infusion of the leaves has a calming effect and is helpful in the treatment of nervous insomnia. The leaves can be used internally in the treatment of minor feverish illnesses and colic and in the treatment of rheumatism, arthritis, gout, inflammatory stages of auto-immune diseases, neuralgia and headache. Try adding this herb to the bath water, the infusion is of real benefit in relieving rheumatism.
The active compounds in white willow, called salicylate glycosides, work as an effective anti-inflammatory by interfering with pain transmission in the nervous system and by treating the cause of inflammation.

The benefit of using white willow is that reduction in non-steroidal anti-inflammatory drugs (NSAID) is achievable, and that they can still be used to reduce pain as required.

Growing white willow:
The plant’s rapid growth and wind tolerance make it a very good pioneer species to use in establishing woodland conditions in difficult sites. Spacing cuttings about every 5 metres will soon provide shelter and a suitable environment for planting out woodland trees that are not so wind tolerant. The main disadvantage in using this species is that the roots are far-ranging and the plant is quite greedy, so it will not as much effect as species such as the alders (Alnus species) in enriching the soil and thus feeding the woodland plants.

Asking for trouble

Alchemilla mollis is particularly good at getting into cracks, and has successfully fringed the paving along my shady front border. That done, it needs curbing but, being bulky and conspicuous, it is easy to remember to shave it to the ground as soon as its froth of lime-green stars starts to fade, and so prevent a new deluge of youngsters. It then bounces back with new leaves for the second half of the summer.

Plants that colonise by underground runners are potentially even more of a headache, because they can have thoroughly infiltrated neighbouring plants before you have cottoned on. One of my most disastrous introductions here, years ago, was the creeping bamboo Sasaella ramosa (formerly Arundinaria vagans). I admired it in the parrot aviaries at Chester Zoo, and acquired a bit. I failed to realise I needed the parrots, too. Only their constant chewing can hope to keep it in check. In the end we had to lift yards of paving slabs to find its secret lairs.

I think I may have made another mistake introducing Clerodendrum bungei into the border. This is a fabulous late-summer performer with huge, domed flowers that are bright pink and sweetly scented. I knew it was a runner, but thought I could control it. But it is already 10ft down the border among the agapanthus. I should have isolated it somewhere between a path and a sunny wall. At Dunham Massey in Cheshire, it is well partnered with another thug, the white-flowered tree poppy Romneya coulteri. The two battle it out at the edge of a shrubbery, and the contrast of their leaves, one oval and purplish and the other grey and finely cut, is very good.

Orange Euphorbia griffithii ‘Fireglow’ certainly needs monitoring, but if you are looking for a neighbour that will put up with its questing roots, I can recommend Phlomis russeliana. This is a herbaceous version of Jerusalem sage, and has whorls of creamy yellow flowers above big heart-shaped leaves. I have ‘Fireglow’ blazing right through it, but it doesn’t seem to object in the slightest. As ‘Fireglow’ starts to fade in June, I chop down the stems and the phlomis flowers take over. The two have been co-existing happily for at least eight years.

Because a species has a bad reputation, it doesn’t mean all its variants are dangerous. For instance, no one in their right mind would introduce the wild pink rosebay willow-herb into the garden, but the white form, Epilobium angustifolium var album, is a great July beauty and not nearly as invasive – at least on my heavy soil. (Plants can behave differently in different conditions.)

Nor have I encountered any problem with the variegated ground elder. I wouldn’t plant it in a border, but under a hedge it is a very well behaved and handsome ground cover. Yet common ground elder, as you know, is the prince of terrorists. If you are confronted by it, you may be interested to know that experiments conducted in Germany have shown that over time the invasive (but easily extracted) yellow-flowered, variegated dead-nettle Lamium galeobdolon subsp montanum ‘Florentinum’ (‘Variegatum’) is capable of smothering and eradicating it for you.

Rogues’ gallery

Plants that need watching: (R) runner (S) seeder

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