Scientific Name(s): Achillea millefolium L. Common Name(s): Green arrow, Milenrama, Milfoil, Millefolli herba, Nosebleed plant, Thousand-leaf, Wound wort, Yarrow
Clinical studies are limited.
Traditionally, yarrow herb 4.5 g/day has been used for various conditions. However, there are no quality clinical studies to validate this dosing.
Yarrow use is contraindicated in known allergies to any members of the Aster family. Data for reported contraindications in epilepsy are lacking.
Avoid use. Documented adverse effects.
None well documented.
Contact dermatitis is the most commonly reported adverse reaction, but high doses may be associated with anticholinergic effects.
Yarrow is not generally considered toxic; however, an antispermatogenic effect has been reported, and safety data are insufficient to support use of the herb in cosmetic products.
The name yarrow applies to approximately 80 species of daisy plants native to the north temperate zone. A. millefolium L. has finely divided leaves and white, pink, or red flowers. It can grow up to 1 m in height. This hardy perennial weed has invasive fibrous rhizomes and blooms from June to November. The whole aerial plant part is used medicinally. Golden yarrow belongs to a distinct genus in the Aster family, Eriophyllum confertiflorum.1, 2 Yarrow is a member of the daisy (Asteraceae) family that includes aster, chamomile, chrysanthemum, feverfew, ragweed, sunflower, and tansy.
The use of yarrow in food and medicine dates back at least to 1200 BC.3 The genus name Achillea is derived from the Greek myth of Achilles who was said to carry A. millefolium (also known in antiquity as herba militaris) into battle to treat wounds.3 Yarrow leaves have been used for tea, and young leaves and flowers have been used in salads. Infusions of yarrow have served as cosmetic cleansers and medicines. Sneezewort leaves (Achillea ptarmica) have been used in sneezing powder, while those of A. millefolium have been used for snuff.4 Yarrow has been used as a "strengthening bitter tonic" and astringent. The fresh leaves have been used to relieve toothaches and to heal wounds, and may have anti-inflammatory effects.3, 5 Fresh yarrow and dried herb are also used in China for dog and snake bites and to alleviate menstrual bleeding.1
The constituents of yarrow have been reviewed in detail, particularly the essential oil.6, 7, 8 The plant yields approximately 1% essential oil containing azulene, alpha and beta pinenes, borneol, cineole, and other compounds including chamazulene (also found in chamomile) and trace amounts of thujone, although the composition varies.1, 7 Other constituents identified include sesquiterpene lactones, flavonoids, tannins, sterols, alkanes, and fatty acids, among others.1, 7
Uses and Pharmacology
In vitro studies have shown that the essential oil of yarrow possesses limited antibacterial and antiviral (Newcastle disease virus) activity. Because of the association of Helicobacter pylori with gastritis, peptic ulcer, and gastric cancer, in vitro experimentation was conducted in H. pylori-infected gastric epithelial cells with 24 medicinal plants indigenous to Pakistan to evaluate their effect on secretion of interleukin (IL)-8 and generation of reactive oxygen species (ROS) in order to assess anti-inflammatory and cytoprotective effects. Although no significant direct cytotoxic effects on the gastric cells or bactericidal effects on H. pylori were found, yarrow was observed to have mild and moderate inhibitory activity on IL-8 at 50 and 100 mcg/mL, respectively, and significant suppression on ROS generation in H. pylori-infected gastric cells.43
Activity against trypanosomes, Leishmania, and malarial parasites has also been demonstrated,3, 9, 10, 11, 12, 13 and yarrow’s role in protection against gastric ulcers has been examined in rats.37 Insect repellent activity has also been demonstrated.3
Research reveals no clinical data regarding the use of yarrow extracts in infectious diseases.
The cytotoxicity of yarrow extracts has been examined.3 In vitro studies suggest that the activity of casticin, sesquiterpene compounds, and other extracts exerts apoptotic and antitumor activity against various human cancer cell lines.14, 15, 16, 17, 18, 19
Current research reveals only inconclusive clinical data regarding the use of yarrow extracts in cancer. A study evaluated the additive effect of A. millefolium (12 ppm distillate mixed with standard therapy mouthwash) in oral mucositis in 56 patients with cancer for 14 days, and found clinically significant healing rates.20
An effect on rat vascular smooth muscle cells has been demonstrated in vitro.21 The flavonoid artemetin extracted from A. millefolium was hypotensive in normotensive rats.22 Diuretic effects of certain yarrow extracts have also been demonstrated.23 Other studies have demonstrated hypotensive effects in rats, as well as negative inotropic and chronotropic effects of crude yarrow extracts in isolated guinea pig atrial tissue.24
Research reveals no clinical data regarding the use of A. millefolium in cardiovascular conditions; however, a related plant, Achillea wilhelmsii, produced antihypertensive and lipid-modifying effects in a clinical study.3
A study evaluating orally administered extracts of A. millefolium for diuretic effects in rats found that diuresis was effectively increased. The study found the effect to depend on both the activation of bradykinin B2 receptors and the activity of cyclooxygenases.23 Extracts of the plant have also been shown to protect against induced nephrolithiasis in rats.25 Additionally, antioxidant effects have been demonstrated in rat systems, including the kidney.26
Administration of the aerial plant parts of A. millefolium were studied in a clinical trial involving31 patients with chronic kidney disease. Reductions in plasma nitrite and nitrate content were observed and compared with placebo; however, statistical significance was not reached.27
Traditional uses as a hemostatic agent and for cerebral and coronary thrombosis are without clinical validation. In one study, A. millefolium tea consumed 3 times daily for 3 days reduced pain severity in primary dysmenorrhea.28
Anti-inflammatory activity has been described in animal and in vitro studies.19, 21, 29, 30, 31 Anxiolytic effects in mice have also been described.32, 33
Dermatological applications have been evaluated.34 Wound healing has been studied in rodents; however, clinical studies are lacking.3
Relaxant effects on smooth muscle tissue have been studied in animals.5, 35, 36
Traditionally, yarrow herb 4.5 g/day has been used for various conditions, including inflammatory disorders appetite loss, and dyspepsia.1, 38 However, there are no quality clinical studies to validate this dosing.
Pregnancy / Lactation
Avoid use. Although present in small amounts, thujone is an abortifacient.4, 6, 38 Toxic reproductive effects in rats have not been proven.39
None well documented. Interactions may occur with diuretic medicines.38
Contact dermatitis is the most commonly reported adverse reaction from yarrow, and its use is contraindicated in known allergies to any members of the Aster family.1, 40 Data for reported contraindications in epilepsy are lacking.38 One case report exists documenting anticholinergic adverse effects associated with the consumption of 5 cups of yarrow tea per day for a 1 week.41
Yarrow is not generally considered toxic; however, an antispermatogenic effect has been reported.1 Safety data are insufficient to support safe use of the herb in cosmetic products.1, 42 Weak genotoxicity has been reported,42 and toxic reproductive effects in rats have not been proven.39
Commercial preparations must be thujone-free because, although present in small amounts in yarrow, thujone is anabortifacient.1, 6
1. Khan I, Abourashed E. Leung’s Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. 3rd ed. Hoboken, NJ: Wiley; 2009.2. Achillea millefolium. USDA, NRCS. 2015. The PLANTS Database (http://plants.usda.gov, 2015). National Plant Data Center, Baton Rouge, LA 70874-4490 USA. 2015.3. Nemeth E, Bernath J. Biological activities of yarrow species (Achillea spp.). Curr Pharm Des. 2008;14(29):3151-3167.190756974. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, OR: Eclectic Medical Publications; 1998.5. Benedek B, Kopp B. Achillea millefolium L. s.l. revisited: recent findings confirm the traditional use. Wien Med Wochenschr. 2007;157(13-14):312-314.177049786. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: Pharmaceutical Press; 1996.7. Duke J. Handbook of Biologically Active Phytochemicals and Their Activities. Boca Raton, FL: CRC Press, Inc; 1992. http://www.ars-grin.gov/duke/. Accessed 2015.8. Bisset N. Herbal Drugs and Phytopharmaceuticals. Stuttgart, Germany: CRC Press; 1994.9. Akram M. Minireview on Achillea millefolium Linn. J Membr Biol. 2013;246(9):661-663.2395902610. Santos AO, Santin AC, Yamaguchi MU, et al. Antileishmanial activity of an essential oil from the leaves and flowers of Achillea millefolium. Ann Trop Med Parasitol. 2010;104(6):475-483.2086343611. Freires IA, Denny C, Benso B, de Alencar SM, Rosalen PL. Antibacterial activity of essential oils and their isolated constituents against cariogenic bacteria: a systematic review. Molecules. 2015;20(4):7329-7358.2591196412. Vitalini S, Beretta G, Iriti M, et al. Phenolic compounds from Achillea millefolium L. and their bioactivity. Acta Biochim Pol. 2011;58(2):203-209.2150327913. Rezatofighi SE, Seydabadi A, Seyyed Nejad SM. Evaluating the efficacy of Achillea millefolium and Thymus vulgaris extracts against newcastle disease virus in ovo. Jundishapur J Microbiol. 2014;7(2):e9016.2514767814. Belščak-Cvitanović A, Durgo K, Bušić A, Franekić J, Komes D. Phytochemical attributes of four conventionally extracted medicinal plants and cytotoxic evaluation of their extracts on human laryngeal carcinoma (HEp2) cells. J Med Food. 2014;17(2):206-217.2432545815. Dias MI, Barros L, Dueñas M, et al. Chemical composition of wild and commercial Achillea millefolium L. and bioactivity of the methanolic extract, infusion and decoction. Food Chem. 2013;141(4):4152-4160.2399359916. Düsman E, de Almeida IV, Coelho AC, Balbi TJ, Dusman Tonin LT, Vicentini VE. Antimutagenic effect of medicinal plants Achillea millefolium and Bauhinia forficata in vivo. Evid Based Complement Alternat Med. 2013;2013:893050.2445953217. Li Y, Zhang ML, Cong B, et al. Achillinin A, a cytotoxic guaianolide from the flower of Yarrow, Achillea millefolium. Biosci Biotechnol Biochem. 2011;75(8):1554-1556.2182194318. Peng HY, Lin CC, Wang HY, Shih Y, Chou ST. The melanogenesis alteration effects of Achillea millefolium L. essential oil and linalyl acetate: involvement of oxidative stress and the JNK and ERK signaling pathways in melanoma cells. PLoS One. 2014;9(4):e95186.2474374519. Zaidi SF, Muhammad JS, Shahryar S, et al. Anti-inflammatory and cytoprotective effects of selected Pakistani medicinal plants in Helicobacter pylori-infected gastric epithelial cells. J Ethnopharmacol. 2012;141(1):403-410.2243353520. Miranzadeh S, Adib-Hajbaghery M, Soleymanpoor L, Ehsani M. Effect of adding the herb Achillea millefolium on mouthwash on chemotherapy induced oral mucositis in cancer patients: A double-blind randomized controlled trial. Eur J Oncol Nurs. 2015;19(3):207-213.2566712321. Dall'Acqua S, Bolego C, Cignarella A, Gaion RM, Innocenti G. Vasoprotective activity of standardized Achillea millefolium extract. Phytomedicine. 2011;18(12):1031-1036.2168413022. de Souza P, Gasparotto A Jr, Crestani S, et al. Hypotensive mechanism of the extracts and artemetin isolated from Achillea millefolium L. (Asteraceae) in rats. Phytomedicine. 2011;18(10):819-825.2142028923. de Souza P, Crestani S, da Silva Rde C, et al. Involvement of bradykinin and prostaglandins in the diuretic effects of Achillea millefolium L. (Asteraceae). J Ethnopharmacol. 2013;149(1):157-161.2379180724. Khan AU, Gilani AH. Blood pressure lowering, cardiovascular inhibitory and bronchodilatory actions of Achillea millefolium. Phytother Res. 2011;25(4):577-583.2085743425. Bafrani HH, Parsa Y, Yadollah-Damavandi S, Jangholi E, Ashkani-Esfahani S, Gharehbeglou M. Biochemical and pathological study of hydroalcoholic extract of Achillea millefolium L. on ethylene glycol-induced nephrolithiasis in laboratory rats. N Am J Med Sci. 2014;6(12):638-642.2559905226. Baggio CH, de Martini Otofuji G, Freitas CS, Mayer B, Marques MC, Mesia-Vela S. Modulation of antioxidant systems by subchronic exposure to the aqueous extract of leaves from Achillea millefolium L. in rats. Nat Prod Res. 2015:1-3.2587000927. Vahid S, Dashti-Khavidaki S, Ahmadi F, Amini M, Salehi Surmaghi MH. Effect of herbal medicine Achillea millefolium on plasma nitrite and nitrate levels in patients with chronic kidney disease: a preliminary study. Iran J Kidney Dis. 2012;6(5):350-354.2297626028. Jenabi E, Fereidoony B. Effect of Achillea Millefolium on relief of primary dysmenorrhea: a double-blind randomized clinical trial. J Pediatr Adolesc Gynecol. 2015;28(5):402-404.2623856829. Jonsdottir G, Omarsdottir S, Vikingsson A, Hardardottir I, Freysdottir J. Aqueous extracts from Menyanthes trifoliate and Achillea millefolium affect maturation of human dendritic cells and their activation of allogeneic CD4+ T cells in vitro. J Ethnopharmacol. 2011;136(1):88-93.2151102130. Vazirinejad R, Ayoobi F, Arababadi MK, et al. Effect of aqueous extract of Achillea millefolium on the development of experimental autoimmune encephalomyelitis in C57BL/6 mice. Indian J Pharmacol. 2014;46(3):303-308.2498717831. Zolghadri Y, Fazeli M, Kooshki M, Shomali T, Karimaghayee N, Dehghani M. Achillea millefolium L. hydro- alcoholic extract protects pancreatic cells by down regulating IL- 1beta and iNOS gene expression in diabetic rats. Int J Mol Cell Med. 2014;3(4):255-262.2563525232. Baretta IP, Felizardo RA, Bimbato VF, et al. Anxiolytic-like effects of acute and chronic treatment with Achillea millefolium L. extract. J Ethnopharmacol. 2012;140(1):46-54.2215539133. Sarris J, McIntyre E, Camfield DA. Plant-based medicines for anxiety disorders, Part 1: a review of preclinical studies. CNS Drugs. 2013;27(3):207-219.2343625534. Pain S, Altobelli C, Boher A, et al. Surface rejuvenating effect of Achillea millefolium extract. Int J Cosmet Sci. 2011;33(6):535-542.2171146335. Koushyar H, Koushyar MM, Byrami G, Feizpour A, Golamnezhad Z, Boskabady MH. The effect of hydroethanol extract of Achillea millefolium on beta-adrenoceptors of guinea pig tracheal smooth muscle. Indian J Pharm Sci. 2013;75(4):400-405.2430279336. Feizpour A, Boskabady MH, Byrami G, Golamnezhad Z, Shafei MN. The effect of hydro-ethanolic extract of Achillea millefolium on muscarinic receptors of guinea pig tracheal smooth muscle. Indian J Pharmacol. 2013;45(1):13-17.2354362137. Cavalcanti AM, Baggio CH, Freitas CS, et al. Safety and antiulcer efficacy studies of Achillea millefolium L. after chronic treatment in Wistar rats. J Ethnopharmacol. 2006;107(2):277-284.1664723338. Duke J, Bogenschutz-Godwin M, duCellier J, Duke P. Handbook of Medicinal Herbs. 2nd ed.. Boca Raton, FL: CRC Press; 2002.39. Boswell-Ruys CL, Ritchie HE, Brown-Woodman PD. Preliminary screening study of reproductive outcomes after exposure to yarrow in the pregnant rat. Birth Defects Res B Dev Reprod Toxicol. 2003;68(5):416-420.1474599140. Doğan N.O., Çevik Y., Günaydin G.P. An unexpected anticholinergic effect due to yarrow (Achillea Millefolium). Akademik Acil Tip Olgu Sunumlari Dergisi. 2013;4(3):89-91.41. Calapai G, Miroddi M, Minciullo PL, Caputi AP, Gangemi S, Schmidt RJ. Contact dermatitis as an adverse reaction to some topically used European herbal medicinal products - part 1: Achillea millefolium-Curcuma longa. Contact Dermatitis. 2014;71(1):1-12.2462115242. Final report on the safety assessment of Yarrow (Achillea millefolium) Extract. Int J Toxicol. 2001;20(suppl 2):79-84.43. Zaidi SF, Muhammad JS, Shahryar S, et al. Anti-inflammatory and cytoprotective effects of selected Pakistani medicinal plants in Helicobacter pylori-infected gastric epithelial cells. J Ethnopharmacol. 2012;141(1):403-410.
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