A Chinese Medicine Perspective
Peter Holmes, L.Ac., M.H.
© Peter Holmes 2004
The elder tree is a familiar sight in both
town and country, and a good seasonal marker. It is said that the
'English summer is not here until the elder is fully in flower, and that
it ends when the berries are ripe' (Grieve 1971). This common
pan-European tree with its 'flat-topped masses of creamy-white, fragrant
blossoms', has provided several traditional herbal remedies since
prehistoric days: Elder flower, berry, bark and leaf. The most versatile
and widely used of these, however, is the flower, which therefore
deserves a fresh look as a potential neo-Chinese medicinal herb.
Elderflower is the whole flower corymb of Sambucus nigra in the
honeysuckle (Caprifoliaceae) family. Its pharmaceutical name is Flos
sambuci (using the Chinese method of pharmaceutical nomenclature).
The traditional European usage of
Elderflower is centered around its ability to promote sweating
(diaphoresis) and its specific affinity for the respiratory tract. Its
primary indications are the onset of colds and flus, especially with
fever present, as well as bronchitis and asthma (Weiss 1985, Schauenberg
1977 et al.). With the rise of the toxicosis and elimination theories
in Western herbal medicine during the seventeenth centuries, its
diaphoretic action has also been put to service to promote general
detoxification, i.e. toxin elimination (Valnet 1983, Willfort 1986). In
North America Eclectic doctors also utilised Elderflower's diuretic,
anti-inflammatory and depurative actions for chronic edema and urinary
and skin infections in particular (King 1902, Fyfe 1909 et al.). More
recent physiomedical usage in America and England has also included
application for acute upper respiratory discharges (Lyle 1897, Mills
1978) because of its pronounced anticatarrhal or mucostatic effect.
Since time immemorial,
Elderflower has provided countless cherished culinary and domestic
medicine products, both in England and overseas, including elderflower
wine, cordial, vinegar (for sore throat), floral water (for eye and skin
lotions) and ointment (for skin conditions). The berries too have been
made into syrups, purees or robs, jams, jellies, chutneys and ketchups.
Many of the recipes for these originated in the Tudor still-rooms of
larger households. Maud Grieve devotes a full 11 pages to the many
traditional uses of the elder tree in construction, ritual, medicine and
cooking, setting out with the statement that 'a wealth of folk-lore,
romance and superstition center round this English tree'. I would refer
the reader to this excellent compilation for further information-and
recipes-in these various areas.
Properties and Functions
As regards its toxicity category, Elderflower is considered a mild
remedy that possesses minimal to no chronic cumulative toxicity. It may
therefore safely be used over long periods of time, all the more so as
it will be combined-more often than not-with other herbs in a formula.
The taste is pungent, sweet and
somewhat aromatic. Pungent and aromatic give it the potential for
dispersing pathogens and promoting sweating, as well as for activating
the Qi and transforming phlegm and damp. Meanwhile, its sweet taste
allows it to strengthen the Spleen and drain damp.
The warmth/thermal quality is
cool. As a light flower, its directional tendency is floating upwards
(fu) when drunk hot, allowing it to enter the Lung, diffuse Lung Qi and
then disperse the surperficies and expel pathogens. Its floating
movement also means that it can treat local problems in the skin, eyes
and upper regions in general, such as fire toxin symptoms and rashes.
When taken at room temperature or cold, however, its Qi tendency is
definitely more neutral and moderate, and includes a draining action on
water and damp-heat through the Spleen and Bladder.
The meridians entered are the
Lung, Spleen and Bladder. In terms of the three warmers (san jiao),
Elderflower actually affects all three warmers, although it is most
pronounced in the upper and lower warmers. In the upper warmer it
disperses wind and heat pathogens from the surface, and transforms
phlegm, damp and Qi stagnation in the Lung with its pungent-aromatic
quality. In the lower warmer the herb clears heat and drains damp
through its sweet property.
These qualities and essential
actions in concert now provide us with grounding for a modern
application of this herb in Chinese medicine.
Clinical Functions and
1. Releases the
exterior, dispels wind-heat and stops discharge
Elderflower eliminates external pathogens with its pungent and
aromatic properties that enter the Lung channel. The mechanism of this
is by causing sweating to release the exterior. This is its strongest
action. Cooling by nature, Elderflower treats external wind-heat,
particularly with fever, nasal discharge and congestion, and sore
throat. The nasal discharge and congestion could be described as
damp-heat invading the head, and it would not be wrong to say that
Elderflower actually dispels wind-damp-heat in the exterior.
Unfortunately there is no exact
equivalent in the Chinese materia medica to this first action. On one
hand Elderflower is an unequivocal external wind-heat herb like Ju Hua
(Fl. Chrysanthemi), Jin Yin Hua (Fl. Lonicerae), etc.-all of them
flowers too-that adresses typical wind-heat symptoms. On the other hand,
this herb has the additional specific function of stopping nasal
discharges that are due to damp and heat invading the sinus passages. In
that sense it acts like a cooling version of Cang Er Zi (Fr. Xanthii)
and Xin Yi Hua (Gemma Magnoliae), but with a far greater emphasis on
drying up the discharges (rather than opening the sinuses, as in the
case of these two herbs).
Western combining herbs for
external wind-heat with just fever and sore throat include Yarrow (Hb.
Achilleae) and Linden (Fl. Tiliae). For wind-heat with damp-heat nasal
discharge, Eyebright (Hb. Euphrasiae) and Plantain (Fm. Plantaginis) are
good choices. Note here that the old Western standby combination of
Peppermint, Yarrow and Elderflower for the onset of colds actually is
somewhat of a catch-all formula that adresses external wind-cold as well
as wind-heat (Peppermint being the main wind-cold agent here)-although
it works better, on the whole, for external wind-heat because of the two
relaxant diaphoretics Yarrow and Elderflower.
Because of its great tropism for
the Lung, and as it dispels wind-heat, Elderflower is also appropriate
for Lung wind-heat syndromes with fever, sore throat and cough, where it
could be combined with such similar herbs as Burdock seed Niu Bang Zi
(Fr. Arctii), Bo He (Hb. Menthae haplocalycis), Spearmint (Fm. Menthae
spicatae) and White horehound (Hb. Marrubii).
Elderflower is traditionally also
used for treating fevers in general. It works best in most fevers that
are still in the early stages, when the skin is dry. Elderflower can
break the fever by causing sweating, including Qi-level heat or 'warm
fevers' in the early-stages (see also below).
2. Dries damp,
transforms phlegm and diffuses Lung Qi
Pungent, aromatic and dispersing, and focusing on the Lung, Elderflower
also dries damp and transforms phlegm in the upper warmer, while at the
same time regulating Lung Qi to dispel the Qi accumulation resulting
from the stagnant damp-phlegm excess. It therefore treats sputum
production and cough from phlegm-damp in the Lung, while relieving the
wheezing from the Qi accumulation in the Lung.
In this sense Elderflower is both
like Ban Xia (Rz. Pinelliae praeparata) (for transforming phlegm-damp)
and like Xuan Fu Hua (Fl. Inulae) or Bai Qian (Rx. et rz. Cynanchi) (for
regulating Lung Qi and dispersing Qi accumulation). The only difference
here is that Elderflower is cooling, not warming. Again, unfortunately
here there is no exact TCM equivalent.
Similar Western herbs that offer
combining possibilities here include the equally aromatic herbs Thyme
(Hb. Thymi) and Hyssop (Hb. Hyssopi) (with pronounced phlegm-damp). With
wheezing and coughing present, Coltsfoot (Hb. Tussilaginis) and White
horehound (Hb. Marrubii) would be more appropriate.
Because it is both heat-clearing
and dispersing, Elderflower can also be also useful in Lung phlegm-heat
patterns with Qi accumulation present. Typical symptoms adressed here
would be fever, sputum, wheeze and cough, where it will benefit from
similar-acting herbs such as Gua Lou (Fr. Tricosanthis), Dong Gua Ren
(Sm. Benincasae), Zhu Ru (Cs. Phyllostachis), White horehound (Hb.
Marrubii) and Pleurisy root (Rx. Asclepiadis tuberosae). Note here that
although Elderflower is useful for Lung wind-heat and Lung phlegm-heat
patterns, which include the symptom of cough, it does not actually expel
phlegm or stop coughing (nor do these three Chinese herb examples). It
simply transforms phlegm-damp, moderately clears heat and diffuses the
stagnant Lung Qi.
Likewise, note also that
Elderflower could not be said to descend Lung Qi in the sense of Xing
Ren (Sm. Pruni armeniacae), Bai Qian (Rx. et rz. Cynanchi) or Sang Bai
Pi (Cx. radicis Mori). These herbs posess a much stronger action which
expresses itself as downward moving and therefore strongly wheeze and
cough relieving. Elderflower is just not in this league. We should think
of Elderflower simply as a gentle yet effective Qi mover in the Lung
when either wind, phlegm or heat pathogens obstruct Qi flow-as simple as
that. This is why Elderflower is excellent for treating mild cases, for
when two or more of these pathogens are present, as well as for
treating children in general.
3. Strengthens the
Spleen, promotes urination and drains damp
With its sweet taste quality, and when drunk cold, Elderflower can drain
accumulation of water-damp and relieve edema by strengthening the
Spleen. It mainly treats chronic edema, particularly around the waist or
generalised water retention in the tissues, arising from Spleen Qi
deficiency. Here the clear equivalents are the sweet-bland herbs Fu Ling
(Scm. Poriae) or Fu Ling Pi (Cx. Poriae), Yi Yi Ren (Sm. Coicis) and Ze
Xie (Rz. Alismatis). Western possibilities include Nettle (Hb.
Urticae), Goldenrod (Hb. Solidaginis), Juniper (Fr. Juniperi) and Lovage
(Rx. Levistici), although the last two are warming, not cooling.
4. Clears heat,
drains damp and harmonizes urination
Elderflower also has an excellent affinity for the urinary tract, the
Bladder. Being heat clearing and damp transforming, the herb is also
indicated for Bladder damp-heat syndromes, including those presenting
strangury or otherwise difficult urination, and including those seen in
damp and Stone lin syndromes.
Similar Chinese herbs for this
clinical function include Che Qian Zi (Sm. Plantaginis), Mu Tong (Cs.
Akebiae seu Aristlochiae) and Bian Xu (Hb. Polygoni avicularis), while
Western additions might include Horsetail (Hb. Equiseti), Cleavers (Hb.
Galii) and Goldenrod (Hb. Solidaginis).
Elderflower can also be chosen
for damp-heat syndromes that present urinary stones and irritation, and
in this sense is a good damp-heat drainer for the lower warmer in
general, like Che Qian Zi (Sm. Plantaginis). Other suitable herbs here
include Shi Wei (Fm. Pyrrosiae), Jin Qian Cao (Hb. Lysimachiae) and Dong
Kui Zi (Sm. Abutili seu Malvae); while Cleavers (Hb. Galii), Hydrangea
(Rz. Hydrangeae) and Gravel root (Rx. Eupatorii purpureii) provide some
5. Clears fire
toxin and benefits the skin
This last function divides into three main clinical applications.
First, fire toxin such as boils,
ulcers, abscesses, especially when found in the upper regions (remember
this is a dispersing and floating herb). Chinese equivalents here
include (once again) Jin Yin Hua (Fl. Lonicerae), Lian Qiao (Fr.
Forsythiae) and Ye Ju Hua (Fl. Chrysanthemi indici); while Western
possibilities include Marigold (Fl. Calendulae) and Echinacea (Rx.
Second, fire toxin with eye
inflammations. Good equivalents for this usage include Selfheal Xia Ku
Cao (Spica Prunellae) and Ye Ju Hua (Fl. Chrysanthemi indici); as well
as Camomile (Fl. Matricariae seu Anthemis) and Eyebright (Hb.
Third, fire toxin and/or
damp-heat in the skin causing chronic eczema (pustular, suppurative) and
ulcers. Similar herbs here include Bai Xian Pi (Cx. radicis Dictamni),
Di Fu Zi (Fr. Kochiae) and Ku Shen (Rx. Sophorae flavescentis); as well
as Red clover (Fl. Trifolii), Burdock (Rx. Arctii) and Walnut leaf and
hull (Fm. et pm. Juglandis) among Western options.
Elderflower and Jin Yin Hua (Fl.
Lonicerae) are both in the botanical honeysuckle family, so it is worth
pausing for a moment to see whether this natural link will translate to a
therapeutic connection that may be useful as a mnemonic aid, if nothing
else. Certainly, we have seen that Jin Yin Hua has equivalent functions
in many of Elderflowers'. But exactly how far do their similarities
extend, and where do their functions clearly diverge?
As flowers both herbs are clearly
similar in their sweet, light and floating qualities; however Jin Yin
Hua is cold, whereas I consider Elderflower cool. Both flowers release
the exterior to dispel wind-heat, and both clear fire toxin. However,
Elderflower releases the exterior mainly through causing sweating,
whereas Jin Yin Hua does so mainly through clearing heat and dispelling
toxin-or, in microbial terms, through a stronger anti-infective action.
In this sense, the two would form an excellent mutual assistance (xiang
shi) if not mutual enhancement (xiang xu) combination for treating
wind-heat onsets. For treating fire toxin conditions, Elderflower treats
more superficial, milder and upper-region heat toxin (such as eye
infections), whereas Jin Yin Hua treats more internal and more severe
fire toxin such as intestinal abscesses, severe sore throat from
laryngitis, and so on. Also, Elderflower treats damp-heat skin lesions
(in common with its theme of transforming damp), unlike Jin Yin Hua.
Here again, the two would form a nice duo.
Would Elderflower also treat
Qi-level heat in early-stage warm fevers, like Jin Yin Hua? Provided
this was a dry fever/heat without sweating, yes definitely. Being still
in the beginning stage with a rising temperature, Elderflower would
easily break the fever by causing sweating.
And here their functions part
ways. Elderflower with its dispersing energy goes on to transform
phlegm-damp and 'ventilate' the Lung, as well as drain water-damp and
Bladder damp-heat. Jin Yin Hua on the other hand, with its colder nature
moves to the nutritive and Blood level to clear the heat of epidemic
warm fevers. In summary, I would say that Elderflower is better at
releasing the exterior, while Jin Yin Hua is better at clearing fire
Elderflower is a mild remedy with no chronic toxicity and may
be used freely. However, because it promotes sweating when drunk warm or
hot, contraindicated in sweating from external deficiency or Yin
deficiency (like Ma Huang, in fact), and in Qi-level heat with sweating
The basic preparation for releasing exterior conditions is the hot water
infusion. Because this preparation is dispersing, it is excellent (with
or without other wind-heat dispelling herbs-see above) for releasing
the exterior at the onset of symptoms. The cool or cold infusion is
preferable for all other uses, which engages a more descending effect.
Elderflower can also be given in
the convenient tincture form and is available as such from various
suppliers. The tincture is an alternative to the cold infusion for its
other functions, as this is more activating on the interior.
When used in conjunction with a
decoction formula, such as Yin Qiao San or Cang Er Zi San, Elderflower
can be added 5 minutes before the end of decocting time or, better
still, stirred into the hot finished decoction and allowed to infuse for
another 15 minutes with the lid on before straining. Elderflower does
contain an essential oil that will evaporate in the decocting or
infusing process if the lid is not put on!
Local preparations with
Elderflower for fire toxin symptoms, such as eyewashes, skin compresses,
creams, ointments, and so on, are also good options in adition to
internal intake. Topical and internal administration will always
reinforce each other's action.
Elderberry (Fr. Sambuci) has similar qualities to the flower and can be
used in a short decoction, especially to dispel wind-damp obstruction
and open the bowels. Because modern research has shown Elderberry
specifically to possess antiviral properties, it is today an important
remedy for viral onset of flu. Elderberry can be used preventively in
case of a flu pandemic, and when taken during an infection has shown to
speed up recovery time. The flower and the berry can of course always be
used together in external conditions.
Elder bark (Cx. Sambuci) (using
the inner bark) strongly drains downward. In a decoction it strongly
drains water-damp (for edema) and purges accumulation (for severe
The dosage is average: 6-16 g for the hot infusion; 2-5 ml for the
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